bluuebunny/crossref_metadata_2025 huggingface dataset:
P2496Results cardiopulmonary exercise testing in patients with obesity and chronic heart failure
Authors: Zaletova T , Bogdanov A , Panova Y , Derbeneva S , Gioeva Z
Published: October 2019

Purpose

Determination of exercise tolerance in patients with obesity and chronic heart failure.

Methods

An exercise cardiorespiratory testing (CPET) was performed using a spiroergometer in combination with treadmill using the modified BRUCE protocol in 222 patients divided into the following groups: Group 1: obesity I-II grade – 60 patients; Group 2: obesity I-II grade + chronic heart failure (CHF) – 49 patients; Group 3: grade III obesity – 60 patients; Group 4: grade III obesity + CHF – 53 patients.

Results

The results of CPET showed that the reason for the decrease in tolerance to physical activity in patients with obesity without CHF is detraining. Patients with obesity and CHF were characterized by a more pronounced decrease in exercise tolerance, which was reflected in a decrease in peak oxygen consumption (VO2peak), which in patients with obesity I-II + CHF was equal to 72.7±3.4% (moderate decrease), and in patients with obesity III + CHF – 50±2.1% (marked decrease); differences when compared with the groups without CHF were 44.3% and 24.4% (p<0.001).The maximum aerobic performance of patients with obesity I-II + CHF was equal to 5.5±0.9 MET (moderate decrease), and in patients with obesity III + CHF – 3.8±0.4 MET (marked reduction); differences when compared with patients without CHF were significant at p<0.001. A small reduction in the global pumping function of the heart was found only in patients with obesity III + CHF – the oxygen pulse was 9.4±2.2 ml/beats and was significantly different from the group of patients without CHF. In addition, a decrease in alveolar gas exchange (VE/VCO2) was observed in the groups of patients with obesity and CHF, which was equal to 32.1±1.5 units in the group of patients with obesity I-II degree and 33.6±2.5 units in the group of patients with obesity Grade III (the norm is less than 32), which is probably due to the presence of pulmonary hypertension and a decrease in the ventilation-perfusion ratio.

Conclusion

The development of CHF in patients with obesity leads to impaired alveolar ventilation, a decrease in aerobic muscle power and tolerance to physical exertion. In addition, it was found that when performing a stress test in patients with obesity and CHF (unlike patients without CHF), the anaerobic threshold is reached before the stage corresponding to their average daily exercise. This means that the usual physical activity of patients does not allow them to carry out effective fat oxidation, which may be the metabolic cause of the progression of obesity in patients with CHF.

Acknowledgement/Funding

Research No. 0529-2019-0061 Diagnostics, prevention and dietaterapy of patients with alimentary-dependent diseases
P2506Prognostic importance of ventilatory efficiency in healthy subjects
Authors: Brown O I , Witte K , Shahi S , Clark A L
Published: October 2019

Background

Low cardiorespiratory fitness, defined by reduced maximal oxygen consumption (VO2), is a predictor of mortality in patients without chronic disease. However, the relation between ventilatory efficiency (as measured by the slope of the relation between ventilation (VE) and carbon dioxide production (VCO2)) and all-cause mortality is unknown.

Purpose

To assess the relation between variables derived from cardiopulmonary exercise testing and long-term survival in normal subjects

Method

We recruited 145 healthy subjects, with no history of chronic disease (57% male, mean age 63±12) from primary care at random. All participants underwent cardiopulmonary exercise testing at baseline. Participants were followed for 15.5±3.5 years. The primary end-point was all-cause mortality. Cox-proportional hazard models were used to assess the relationship between measures of exercise performance and outcome. Hazard ratios (HR) are reported with 95% confidence intervals (CI).

Results

During follow up, 34 participants (23.4%) died. On univariable analysis, VE/VCO2 slope, peak VO2, respiratory exchange ratio at peak exercise, peak heart rate and 6-minute walk test distance were significant predictors of all-cause mortality (table 1). However, only VE/VCO2 slope (HR per unit increase: 1.13, 95% CI: 1.00–1.28, P=0.043) and peak heart rate (HR per 10 unit increase: 0.73, 95% CI: 0.57–0.93, P=0.010) were independent predictors of all-cause mortality on multivariable analysis.

Table 1. Cox regression analysis (univariable and multivariable) for cardiopulmonary exercise testing measures and all-cause mortality HR Presentation Univariable analysis Multivariable analysis HR 95% CI p value HR 95% CI p value Peak VO2 (ml/kg/min) Per unit increase 0.90 0.86–0.95 <0.001 0.94 0.86–1.03 0.214 VE/VCO2 slope Per unit increase 1.08 1.01–1.17 0.049 1.13 1.00–1.28 0.043 Exercise RER Per 0.1 unit increase 0.46 0.31–0.67 <0.001 0.72 0.45–1.17 0.185 Peak heart rate (bpm) Per 10 unit increase 0.73 0.65–0.81 <0.001 0.73 0.57–0.93 0.010 6MWT (metre) Per 25 unit increase 0.92 0.86–0.98 0.009 1.02 0.86–1.17 0.789 Peak systolic BP (mmHg) Per 10 unit increase 1.13 0.98–1.31 0.101 – – – Multivariable analysis is adjusted for age, body mass index, sex, smoking, resting systolic blood pressure and forced vital capacity. Abbreviations: 6MWT, 6-minute walk test; CI, confidence interval; HR, hazard ratio; RER, respiratory exchange ratio.

Conclusions

Raised VE/VCO2 slope is an independent predictor of all-cause mortality in healthy patients with no history of chronic disease.
P2530Frailty assessment in atrial fibrillation patients with acute coronary syndromes: a subanalysis from LONGEVO-SCA registry
Authors: Esteve Pastor M A , Martin E , Alegre O , Castillo Dominguez J C , Formiga F , Martinez-Selles M , Diez-Villanueva P , Sanchis J , Ariza-Sole A , Marin F
Published: October 2019

Background

Different studies have observed a significant correlation between frailty, morbidity and mortality in elderly patients with cardiovascular diseases.Several scores have been developed to assess frailty in elderly patients. The FRAIL scale is a bed-side and easy tool that evaluates 5 items: fatigue, resistance, ambulation, concomitant diseases and weight loss. However, the evaluation of frailty status in AF patients with ACS is scarce.

Purpose

The aim of this study was to analyze the management of elderly patients with AF and ACS and the predictive value of frailty for adverse events.

Methods

The prospective multicentre LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. In this substudy, we divided patients according to rhythm status (AF or sinus rhythm [SR]) and to frail status. We validated the predictive performance of FRAIL scores for adverse events at 6 months follow-up.

Results

We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis and 145 (27.3%) patients were frail. Frail AF patients had higher risk of global mortality [HR 2.61, (95% CI 1.28–5.31; p=0.008)], readmissions [HR 2.28, (95% CI 1.37–3.80); p=0.002)] and the composite endpoint [HR 2.28, (95% CI 1.44–3.60); p<0.001)] compared with non-frail SR patients. After multivariate adjustment, Frail score [HR 1.41; 95% CI (1.02–1.97); p=0.040] was independently associated with mortality. Kaplan Meier analysis showed that frail AF patients had significantly worse prognosis during the follow-up with high risk of global mortality (log rank p=0.024) and readmission (log rank p<0.001) followed closely by those frail SR patients.

Event Free Survival according Frailty

Conclusions

In the LONGEVO-SCA registry, frail AF patients have 2-fold risk of adverse events compared to non-frail SR patients. Frailty status was an independent condition associated with high risk of adverse events at 6 months of follow-up.
P2543QTc interval during head-up tilt testing in patients with neurocardiogenic syncope versus patients with orthostatic hypotensio
Authors: Vanerio G
Published: October 2019

Background

The QT interval reflects shifting from parasympathetic to sympathetic activity. During head-up tilt testing (HUTT) normal subjects show a QTc shortening, but during an abnormal response: 1) neurocardiogenic syncope or 2) orthostatic hypotension an altered balance between the parasympathetic to sympathetic is present and probably detected through changes in the QTc interval.

Objective

Compare dynamic changes of the QT, QTc intervals during head-up tilt test (HUTT) in patients with neurocardiogenic syncope (NCS) and with orthostatic hypotension due to autonomic failure (OH)

Methods

We studied 78 patients. 45 (51%) were female. All were symptomatic and had an abnormal HUTT according to each definition. We divided the population into two groups depending on the response, 1) NCS n=61 2) OH n=17. In all patients; heart rate, QT and QTc, were measured on a continuous 12-lead electrocardiogram

Results

NCS patients were significantly younger with female prevalence. The max HR and the SD of the HR were significantly higher. The QTc interval during positive HUTT was very different. In the NCS the QTc shortened from 407±25 to 367±49 (p=0.001) and in OH group the QTc prolonged from baseline 427±37 ms to HUTT 442±52 ms; p=0.001).

Conclusion

HUTT revealed significant QTc differences in patients with OH and NCS. Patients with a NCS the QTc interval shortened; but in those with OH the QTc significantly prolonged. This finding is in accordance with the autonomic imbalance and could explain the increase in sudden death observed in the OH population.
P2558PDE4 regulates cardiac pacemaker function
Authors: Mika D , Gomez A M , Fischmeister R , Vandecasteele G
Published: October 2019

Background

Numerous epidemiological and clinical studies have revealed a positive correlation between heart rate (HR) and cardiovascular morbimortality. The autonomic nervous system is the major extracardiac determinant of HR. During sympathetic stimulation, the activation of β-adrenergic receptors (βAR) induces an increase in cAMP levels, leading to positive chronotropic effect. Among the 5 cardiac cAMP-PDE families, PDE4 is critical for controlling excitation-contraction coupling (ECC) during βAR stimulation in atrial and ventricular cells. PDE4 may also be important for automaticity. 3 genes encode for PDE4s: pde4a, pde4b, pde4d. Their respective contribution to the regulation of pacemaker activity remains ill-defined.

Purpose

Define the role of PDE4 isoforms in the regulation of cardiac pacemaker activity

Methods

Total PDE activity was determined in mouse sinoatrial node (SAN) tissue as the cAMP-hydrolytic activity measured in the absence of PDE inhibitor and the fraction corresponding to PDE4 activity was assessed by including the PDE4 inhibitor Ro-20-1724. The in vitro pacemaker activity was assessed by measuring spontaneous Ca2+ transients in Fluo4-loaded-SAN tissue. Images were obtained using confocal microscopy.

Results

Ro-20-1724 increased beating rate of intact SAN and increased PKA-phosphorylation of key ECC actors (ryanodine receptor, phospholamban and contractile proteins). PDE4 activity was found to account for 60% of the total cAMP-PDE activity in SAN (n=3 independent experiments). PDE4A, PDE4B and PDE4D isoforms were found to be expressed in mouse SAN (n=5 independent experiments). In PDE4D-, but not in PDE4B-deficient mice, Ca2+ homeostasis was altered in control conditions (ctrl) and after βAR stimulation with isoprenaline (iso). Indeed, ablation of PDE4D induced decreased beating rate (ctrl: 1.00±0.08 s–1 vs 1.57±0.05 s–1; iso: 1.71±0.17 s–1 vs 2.39±0.08 s–1, p<0.0001) and increased Ca2+ spark frequency (ctrl: 15.9±5.2 sparks/s/100 μm vs 1.9±0.4 sparks/s/100 μm; iso: 22.9±7.1 sparks/s/100 μm vs 0.6±0.2 sparks/s/100 μm, p<0.0001) (Figure).

Calcium Homeostasis in SAN cells

Conclusion

PDE4 controls pacemaker function in mice and PDE4D ablation strongly perturbs normal SAN activity.

Acknowledgement/Funding

ANR, Fondation Lefoulon Delalande, CORDDIM
P2591Circulating pro fibrotic protein promotes fibrosis in liver and heart
Authors: Tsukano Y , Shimizu I , Yoshida Y , Ikegami R , Hayashi Y , Suda M , Katsuumi G , Wakasugi T , Nakao M , Minamino T
Published: October 2019

Analyzing two sets of DNA micro array data with bioinformatics, we identified a secreted form pro-fibrotic protein (sPFP) expressed in dysfunctional brown adipose tissue (BAT) in mice. Testing our biobank samples, we found this protein increased in plasma of non-alcoholic steatohepatitis (NASH) patients or aged individuals. We generated a murine obese NASH model by imposing a high fat diet in C57BL/6NCr mice for 9–10 months since 4 weeks of age, and found that sPFP is produced predominantly by BAT. In this model, we also found that sPFP increased in plasma. We generated a murine systemic sPFP knockout (KO) model and found that liver fibrosis ameliorated in sPFP-KO model. We also suppressed circulating sPFP with a peptide vaccine targeting this molecule, and found that sPFP vaccination therapy inhibited liver fibrosis. Next, we generated sPFP gain of function (GOF) model by the administration of plasmid encoding sPFP into skeletal muscle. Liver fibrosis augmented in sPFP-GOF model, and these results suggested that sPFP has causal role for the progression of fibrotic response in liver. In the obese NASH model, we found that cardiac fibrosis also developed and it ameliorated in sPFP-KO model, indicating that sPFP may have pathological roles for heart failure with preserved ejection fraction (HFpEF) related with age-related disorders. In addition to an increase in circulating sPFP in aged individuals, we found that sPFP increased in BAT of chronological aged mice model. In vitro studies with differentiated brown adipocytes showed that c-Fos upregulated sPFP in transcript level. Our results suggest that sPFP contributes for the progression of fibrotic responses in obese or aged models. Inhibition of sPFP may become a therapy for NASH or HFpEF.
P2595The role of epicardial fat thickness and other parameters of visceral adiposity in right ventricular diastolic function in patients with metabolic syndrome
Authors: Sedaia E , Revenco V
Published: October 2019

Background

Abdominal obesity is associated with an increased risk of cardiovascular disease and all-cause mortality especially in patients with metabolic syndrome (MetS). Despite the undeniable importance of right ventricle (RV) function, little is known about RV diastolic function implication in obesity and MetS.

Purpose

The objective of our study was to evaluate the role of epicardial fat thickness (EFT) and other parameters of visceral obesity in diastolic function of RV in patients with MetS.

Methods

The study included 70 subjects with MetS (mean age 52.6±9.4 years) and 70 controls without MetS (mean age 53.8±7.5 years). MetS was defined by ≥3 criteria of International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute. We assessed RV diastolic function by pulsed wave and tissue Doppler echocardiography and determined the ratio of early (TV E) and late (TV A) trans-tricuspid valve inflow velocities (TV E/A), early tricuspid valve (TV) annular tissue Doppler velocity (TV e'), the TV E/e' ratio and TV deceleration time (DT). Anthropometric and sonographic parameters of visceral adiposity included: waist circumference (WC), waist-to-hip ratio (WHR), visceral adiposity index (VAI), intraabdominal fat thickness (IFT), abdominal wall fat index (AWFI) and epicardial fat thickness (EFT).

Results

Mean values of WC (p=0.030), WHR (p=0.008), VAI (p=0.001), IFT (p=0.035), AWFI (p=0.013) and EFT (p=0.012) were significantly higher in the group with MetS vs. controls. RV diastolic function parameters were also significantly changed in the group with MetS vs controls (tab.1). TV E/e' was positively correlated with WC (r=0.297, p<0.01), WHR (r=0.238, p<0.05), VAI (r=0.271, p<0.05), IFT (r=0.556, p<0.01), AWFI (r=0.604, p<0.01) and EFT (r=0.795, p<0.01). Using multivariate regression analysis EFT, WC and plasma glucose level were the most important predictors for RV diastolic dysfunction in subjects with MetS (p<0.05 for all parameters).

Table 1. RV diastolic function Variables MetS (n=70) Controls (n=70) p TV E, cm/s 48±11.1 52.1±14 0.025 TV A, cm/s 56.54±11 52.3±11.7 0.034 TV E/A 0.92±0.4 1.07±0.44 0.029 TV e', cm/s 10.6±2.7 10.7±3.5 0.001 TV E/e' 5.84±1.04 4.59±0.82 0.001 DT, ms 227.9±12.4 217±17.8 0.009

Conclusion

Our findings support that EFT and WC play an important role in RV diastolic dysfunction in patients with MetS.
P2601Trans-catheter or surgical mitral valve procedure versus conservative treatment in heart failure patients with preserved ejection fraction
Authors: Sun X , Nkomo V T , Pislaru S V , Lin G
Published: October 2019

Background

Secondary mitral regurgitation (SMR) impacts outcomes in heart failure with reduced ejection fraction (HFrEF) but whether it is a specific therapeutic target in heart failure patients with preserved ejection fraction (HFpEF) is less clear.

Purpose

The aims of this study were to investigate whether surgical or trans-catheter intervention reduces SMR and improves outcomes compared to optimal medical therapy in HFpEF patients.

Methods

We retrospectively identified 120 HFpEF patients with moderate-to-severe or greater SMR from January 1, 2007, until December 31, 2017. Moderate-to-severe SMR was defined as an effective regurgitant orifice area of >0.3cm2, and/or a regurgitation volume of >45ml per beat. Those with primary mitral regurgitation, endocarditis, HFrEF, hypertrophic cardiomyopathy, congenital heart disease, and history of valve intervention were excluded. All-cause mortality was analyzed and correlated to clinical and echocardiographic characteristics. Amongst the 120 patients, 36 received surgical or trans-catheter procedure in addition to medical therapy (procedure group) and 84 patients received optimal medical therapy only (conservative treatment group). The median follow-up period was 864 (15–3553) days.

Results

Patients in the procedure group were younger (75±8 vs 81±10, P=0.0002) and with fewer comorbidities (Charlson Comorbidity Index 7.0±2.4 vs 8.0±2.0, P=0.022) compared to the conservative treatment group. In addition, the procedure group had larger left ventricular end-diastolic diameters and higher SMR volume at baseline. During follow-up, SMR decreased by ≥2 grades in 75% of patients (27/36) in the procedure group compared to 20% of patients (12/60) in the conservative treatment group. After adjusting for age and comorbidities, the procedure group showed better overall survival compared to the conservative treatment group (HR 0.37; 95% CI 0.17–0.80; P=0.011). On multivariate analysis for the different groups (procedure group vs. conservative treatment group) (HR 0.40; 95% CI 0.17–0.91; P=0.019), increasing Charlson Comorbidity Index (HR 1.16; 95% CI 1.02–1.32; P=0.028) and average mitral E/e' ratio (HR 1.06; 95% CI 1.01–1.11; P=0.031) were independent predictors of increased all-cause mortality.

Kaplan-Meier Survival Curve

Conclusion

Among heart failure patients with preserved ejection fraction and moderate-to-severe or severe SMR, surgical or trans-catheter mitral-valve repair or replacement resulted in lower all-cause mortality compared to conservative treatment after 9 years of follow-up.
P2625Pathophysiology of diaphragm involvement in systolic heart failure: insights from diaphragm ultrasound and phrenic nerve stimulation studies
Authors: Spiesshoefer J , Tuleta I T , Giannoni A G , Boentert M B
Published: October 2019

Background

Diaphragm ultrasound allows for assessment of both diaphragm excursion and thickness. Cervical and cortical magnetic stimulation (CEMS and COMS) with recording of the diaphragmatic compound motor action potential (CMAP) is diagnostically useful to evaluate the conductive properties of the inspiratory pathway. Systolic heart failure (HF) is characterized by a loss of systolic pump function. Diaphragm weakness in HF has been reported to potentially contribute to exercise intolerance

Methods

14 patients with systolic HF (11 men, 3 women; 64±12 years, NYHA 2±0.9, LVEF 36.1±5.6%) and 12 healthy controls matched for age and gender (4 men, 8 women; 56±8 years) underwent spirometric lung function testing and assessment of diaphragm excursion (during tidal breathing, TB, voluntary sniff, VS and deep breathing, DB) and thickness of the right hemidiaphragm by ultrasound. COMS and CEMS of the phrenic nerves with simultaneous bilateral recording of the diaphragm CMAP using surface electrodes was performed in 9 patients.

Results

Compared to controls, HF patients showed reduced forced vital capacity (75.46±18.05% vs. 107.62±17.13%, p<0.05). Diaphragm excursion amplitude was significantly reduced in HF patients (4.29±1.35 cm vs. 7.34±2.10 cm, p<0.05). Diaphragm contractility was impaired too, as reflected by the diaphragm thickening ratio (DTR; 2.01±0.46 vs. 2.53±0.74, p<0.05). Diaphragm CMAP following COMS and CEMS of the phrenic nerves revealed normal latencies in HF patients compared to controls (COMS Latency; 19.05±2.37 msec vs. 18.97±3.59 msec, p= n. s.).

Conclusions

Diaphragm involvement in systolic HF is reflected by reduced FVC and impaired ultrasound parameters of diaphragm function. Diaphragmatic pathology is likely to be myopathic because magnetic phrenic nerve conduction studies show no abnormalities. Diaphragm ultrasound may be useful as a diagnostic tool for assessment of diaphragm function in systolic HF.

Acknowledgement/Funding

This study was supported by Sanofi-Genzyme, Neu-Isenburg, Germany. The funders had no role in study design, data collection and analysis, preparation.
P2637Hypertension as a risk factor for all-cause and cardiovascular mortality in women compared with men: a systematic review and meta-analysis of prospective cohort studies
Authors: Wang Y , Nie J , Yu H
Published: October 2019

Background

What is more, some recent meta-analysis have demonstrated the sex difference between smoking, diabetes, and atrial fibrillation, and the risk of CVD mortality. Whether and to what extent the excess risk of cause-specific mortality from CVD death conferred by hypertension differs among women and men remain unclear.

Objective

A systematic review with meta-analysis was performed to explore whether and to what extent the excess risk of cause-specific mortality from CVD death conferred by hypertension differs among women and men.

Methods

PubMed and EMBASE was systematically searched for prospective cohort studies published from inception to 7 October 2017. Eligible studies reported sex-specific relative risk (RR) estimates for mortality of all-cause, CVD, coronary heart disease (CHD) and stroke associated with hypertension. The data were pooled using random effects models with inverse variance weighting, and estimates of the women-to-men ratio of RRs (RRR) for each outcomes were derived.

Results

Twenty-four studies with 2,939,659 participants were included in this meta-analysis. The RR for CHD mortality associated with hypertension compared with no hypertension was 2.24 (95% CI 2.03–2.46) in women and 1. 72 (1.61–1.84) in men. The multiple-adjusted RRR for CHD mortality was 22% greater in women with hypertension than in men with hypertension (RRR 1.22, 95% CI 1.03–1.44) with no significant heterogencity between studies (I2=45%, P=0.11, Figure 1). No evidence was observed sex difference in the relationship between hypertension and the mortality from all-cause, CVD and stroke. Furthermore, the subgroup analyses showed that the pooled RRR for all-cause mortality, CVD and stroke mortality were not significantly associated with cohort region, the duration of follow-up, mean age of participants and the publication year of studies.

Conclusions

Hypertension is a major risk factor for all-cause, CVD, CHD and stroke among women and men. Moreover, women with hypertension have more than a 22% higher risk of CHD mortality compared with men with hypertension. Further studies need to identify the biological and/or lifestyle mechanisms involved in sex differences driving these associations.
P2638Preeclampsia is preceded by changes in the cardiovascular function
Authors: Paez O , Majul C R , Puleio P , Visser M , Cragnolino R
Published: October 2019

The changes in the cardiovascular function (CVF) during preeclampsia are known. Whether they begin prior clinical manifestation or persist after delivery remains unclear.

Objective

We hypothesized that preeclampsia is preceded by early CVF changes. We evaluated the eventual difference between patients who develop preeclampsia and those who stayed normotensives. Secondly we searched for a link between CVF changes and development of preeclampsia.

Methods

This prospective study, included 260 normotensive primiparous women, referred for routinely control to the Cardiology section. At week 22 of gestation and 1 year after delivery were performed: Office blood pressure (OBP), blood and urine lab test. Cardiac index (CI) and systemic vascular resistance index (SVRI) through impedance cardiography. Wave pulse velocity (PWV) through pressure signals. According to the evolution during pregnancy patients were assigned to one of 3 groups: G1 preeclampsia:. G2 Gestational hypertension G3 Normotensive. Statistic tests: one-way analysis of variance and the Bonferroni post-hoc test.

Results

12 patients evolved to preeclamsia, 18 to gestational hypertension and 230 remained normotensive. G1 had significantly lower value of CI in both measurements and higher values of OBP, SVRPI and WPV comparing to G3. G2 always showed intermediate values between G1 and G2. The median age of the population was 25 ≠ 4 years old. By logistic regression analysis WPV and SVRI at 22 week of gestation were predictors of preeclampsia. (p<0.05)

Patient Characteristics Characteristics G1 G2 G3 p<0.05 Systolic, mmHg OBP* 128±10 120±9 107±10 0.001 Diastolic, mmHg OBP* 84±6 75±7 66±6 0.001 Systolic mmHg OBP** 128±11 117±10 114±8 0.01 Diastolic, mmHg OBP** 77±7 71±6 70±6 0.09 WPV, m/sec* 10±4 7±0.8 5.6±1 0.02 WPV, m/sec** 9±1.3 6.4±1 4.7±1.5 0.01 CI, l/m2* 2.7±0.4 3.1±0.4 3.4±0.6 0.01 IC, l/m2** 2.4±0.6 2.6±0.3 3.2±0.6 0.01 SVRPI, dyn sec·cm* 1894±151 1783±454 1431±252 0.01 SVRPI, dyn sec·sec** 1900±436 1657±436 1385±248 0.01 Data are given as median and SD. *Measurements at week 22 of gestation. **Measurements at 1 year after delivery.

Conclusion

Preeclampsia showed different CVF compare with normotensive, before diagnosis and after delivery. The early endothelial dysfunction could be responsible of these changes.
P2643Antiproteinuric efficacy of ACE inhibitors, selective MRAs and ACE inhibitor/selective MRA combination therapy in diabetic hypertensives with microalbuminuria
Authors: El Mokadem M , Abd El Hady Y , Aziz A
Published: October 2019

Background

There is increasing evidence suggesting use of Mineralocorticoid Receptor Antagonists (MRA) in combination with Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARB) to have a protective effect on chronic kidney disease patients.

Purpose

The aim of our study was to compare the antiproteinuric efficacy of ACEI monotherapy, Selective MRA monotherapy and their combination in mildly hypertensive patients with type 2 diabetes mellitus (DM) and microalbuminuria.

Methods

Seventy five patients with established diagnosis of type 2 DM, mild hypertension (systolic BP 140–159 mmHg and/or diastolic BP 90–99 mmHg) and microalbuminuria (30–299mg/g) were randomly assigned to one of three groups of therapy; ramipril 10 mg monotherapy (25 patients), eplerenone 50 mg monotherapy (25 patients) and eplerenone/ramipril 50/10 mg combination therapy (25 patients).The duration of the study was 24 weeks. All patients had measurement of blood pressure, urinary albumin/creatinine ratio, renal function tests and serum K level at baseline and at the end of the study after 24 weeks. All patients were followed up monthly till the end of the study for detection of side effects and/or treatment failure.

Results

Both ramipril and eplerenone monotherapy significantly reduced microalbuminuria after 24 weeks nearly to the same extent (37% and 38% respectively) without significant difference between both groups (P=0.95). There was more significant reduction of microalbuminuria in the eplerenone/ramipril combination group (60%) compared with ramipril and eplerenone monotherapy groups (P=0.0001).All groups showed significant reduction of both systolic and diastolic BP with more significant reduction of systolic BP in combination group compared with monotherapy groups (P<0.0001).There was insignificant elevation of serum potassium level among the three groups with slightly higher non significant incidence of sustained hyperkalemia in combination group (P=0.5). All groups showed insignificant changes in serum creatinine and estimated glomerular filtration rate.

Conclusion

Addition of eplerenone (selective MRA) to an ACE inhibitor may confer further antiproteinuric benefit with low risk of hyperkalemia compared with MRA or ACEI monotherapy.

Acknowledgement/Funding

None
P2652Seasonal influences on clinical features, comorbidities, and outcome in patients with ST-elevation myocardial infarction managed invasively
Authors: Vintila V , Cotoban A , Udroiu C , Stuparu C , Lungeanu Juravle L , Vinereanu D
Published: October 2019

Background

Outcome of STEMI patients has improved in the last years, with better survival due to an improved onset of symptoms to balloon time, and better pharmacological and nonpharmacological treatment. However, influences of seasonal differences are not studied yet.

Purpose

To identify differences in clinical features, associated comorbidities, and outcome of ST-elevation myocardial infarction (STEMI) patients, related to seasonal differences, in a temperate continental climate.

Methods

We examined data from the electronic STEMI registry from a high-volume PPCI center. We analyzed retrospectively data from 518 STEMI patients, managed invasively, admitted in the last year. We compared clinical features, comorbidities, and outcome, between winter months (December, January, and February) and summer months (June, July, and August).

Results

269 (52%) patients (74% men, median age 61 years) were admitted during winter months, while 249 (48%) patients (80% men, median age 59 years) were admitted during summer months. Killip class at admission was higher during winter (χ2=10.2; p=0.017), with significant differences for all Killip classes (Killip I: 83% winter vs. 92% summer; Killip II: 8.6% winter vs. 4.4% summer; Killip III: 3.7% winter vs. 1.2% summer; Killip IV: 4.5% winter vs. 2.0% summer, p=0.04). Meanwhile, maximal Killip class anytime during hospitalization was higher during winter (χ2=9.7; p=0.021). In terms of comorbidities, a trend toward more frequent atrial fibrillation (AF) was recorded during winter (5.2% vs. 2,0%; χ2=3.7; p=0.053). Severe left ventricular dysfunction (LVEF<30%) was more frequent among patients admitted in winter (9.7% vs. 4.4%; χ2=5.4, p=0.020). In-hospital mortality was higher during winter (9.7% vs. 4.4%; χ2=5.4; p=0,020). We computed a predictive model for in-hospital death for STEMI patients, using stepwise logistic regression analysis. Independent significant predictors were seasonal months, blood glycemia, and creatinine (χ2=53.3, p<0.005). Patients with STEMI admitted during winter months had a 2.8-fold increase in probability of death during index hospitalization compared with summer months.

Conclusions

Winter months are associated with worse clinical features, more frequent AF, worse LV function, and higher risk of death of STEMI patients managed invasively than summer months. We consider temperature differences, changes in air pressure, decrease in physical activity, and increase in food intake as possible explanations for worse evolution of winter patients. A prospective dedicated research is necessary to provide detailed explanations.
P2666Association of out-of-hospital cardiac arrest occurrence time and the survival in all-Japan utstein registry: difference between international resuscitation guidelines 2005 and 2010
Authors: Kato K , Otsuka T , Seino Y , Tahara Y , Yonemoto N , Nonogi H , Nagao K , Ikeda T , Sato N , Tsutsui H
Published: October 2019

Background/Introduction

Previous studies have shown that out-of-hospital cardiac arrest (OHCA) occurring at night have poor outcomes compared with OHCA occurring during daytime. On the other hand, nationwide OHCA outcomes have gradually improved in Japan.

Purpose

We sought to examine whether one-month survival of OHCA differed between daytime and nighttime occurrences, and they differed between the periods of International Resuscitation Guidelines 2005 and 2010.

Methods

Using the All-Japan Utstein Registry between 2005 and 2015, adult OHCA patients whose collapse was witnessed by a bystander and the call-to-hospital admission interval was shorter than 120 min were included in this study. OHCA patients were divided by period of the International Resuscitation Guideline 2005 and 2010. Guideline 2005 included years from 2006 to 2010, while Guideline 2010 included years from 2011 to 2015. The primary outcome was one-month survival with favorable neurological outcome, defined as Cerebral Performance Category scale of 1 or 2. Daytime, evening, and night were defined as 0700 to 1459 h, 1500 to 2259 h, and 2300 to 0659 h, respectively.

Results

Among 479,046 cases, 20.3% revealed OHCA occurring at night. OHCA patients occurring at night had lower rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use than those occurring at both daytime and evening. In addition, of those who received bystander CPR, higher rate of patients received CPR by family members. OHCA patients occurring at night in both guideline periods had significantly worse one-month survival than those occurring during daytime (reference) (adjusted odds ratio, 0.69, 0.64; 95% confidence interval 0.65–0.72, 0.61–0.67; P<0.001, P<0.001, Guideline 2005 and 2010 respectively). OHCA patients occurring during daytime in Guideline 2010 had better one-month survival than those in Guideline 2005 (adjusted odds ratio, 1.29; 95% confidence interval 1.24–1.34; P<0.001).

Conclusions

One-month survival with favorable neurological outcome in OHCA patients occurring at night remains to be significantly worse than those occurring during daytime, even improved by the periods during daytime. CPR training for the family members should be more expanded and strengthened against the night time imperfection.
P2671The addition of admission lactate to the CREST risk score to determine prognosis in out of hospital cardiac arrest: the C-AREST score
Authors: Kelham M , Jones T N , Rathod K S , Guttmann O , Proudfoot A , Wragg A , Baumbach A , Jain A , Weerackody R , Mathur A , Jones D A
Published: October 2019

Introduction

There has been an increasing focus on the development of scoring systems for patients admitted following resuscitation from out-of-hospital cardiac arrest (OHCA) to determine both prognosis and short-term management. One such system, the CREST score, has been shown to predict circulatory aetiology death in patients without ST-elevation myocardial infarction, however with an increasing number of OHCAs seen, general scoring systems to predict outcome in OHCA would be helpful.

Aims

We sought to determine whether the addition of an admission lactate ≥8 mmol/l to the existing CREST score was able to better predict in-hospital mortality in patients admitted with OHCA.

Methods and results

We retrospectively analysed the data of 500 patients admitted with an OHCA of presumed cardiac origin to our tertiary cardiac centre between June 2014 and Oct 2018. Mean age was 62.6y (±14.7), 379 (76%) were male and 250 (50%) were Caucasian. 313 (62.6%) were admitted with ST elevation myocardial infarction or equivalent. 48.6% (243/500) of patients died in hospital and of those that survived, 20.2% (52/257) were left with hypoxic brain injury (CPC score 3–4).

When analysed independently, all individual factors other than history of Coronary artery disease (OR 1.47, p=0.084) significantly predicted in-hospital mortality: Admission lactate ≥8 mmol/l (OR 6.78, p<0.0001), non-shockable Rhythm (OR 10.9, p<0.0001), Ejection fraction <30% (OR 5.84, p<0.0001), Shock at presentation (OR 5.49, p<0.0001) and ischaemic Time >25 minutes (OR 12.8, p<0.0001).

When each factor was assigned one point and totalled, both increasing CREST and C-AREST scores were associated with increasing in-hospital mortality: CREST (0–5 points): 4.3%, 30.5%, 41.5%, 85.6%, 95.2%, 100% vs C-AREST (0–6 points): 9.1%, 28.3%, 41.9%, 62.8%, 97.6%, 96.4%, 100%. When analysed with stepwise logistic regression, the addition of admission lactate ≥8 mmol/l to the model improved the prediction of in-hospital mortality: CREST (40.8% of variance explained) vs C-AREST (43.3%), with admission lactate remaining an independently significant predictor (OR 3.67, p=0.002).

Conclusion

We describe a novel modification to the previously described CREST scoring system for OHCA: the C-AREST score. The addition of admission lactate ≥8 mmol/l may have a role in differentiating those in intermediate risk categories (score between 2 and 3) where the predicted in hospital mortality would otherwise vary greatly. Given the relative ease of obtaining admission lactate, this scoring system may further improve stratification of patients who may or may not benefit from invasive management.
P2672Coronary artery calcification on the whole body computed tomography predicts coronary artery disease and mortality in patients with out-of-hospital cardiac arrest
Authors: Kato S , Matsuda J
Published: October 2019

Introduction

Coronary artery disease (CAD) is the most frequent cause of out-of-hospital cardiac arrest (OHCA). Although the prompt evaluation of coronary artery in OHCA patients is recommended, it is not easy to identify the CAD by coronary artery angiography (CAG) because OHCA patients often exhibit unstable systemic condition after the return of spontaneous circulation (ROSC). The Agatston score, which is a popular calcium scoring of coronary artery calcification by computed tomography (CT), is useful for the risk stratification in patients suspected CAD. The impact of coronary artery calcification to predict the existence of CAD in OHCA patients has not been sufficiently elucidated. The usefulness of coronary artery calcification to predict mortality has also been unclear.

Purpose

We sought to assess the impact of evaluating the Agatston score to predict the existence of coronary artery stenosis and patients' mortality at 30 days in OHCA.

Method

A total of 748 OHCA patients were transferred to our critical care center, of which 126 cardiovascular arrest patients achieving the ROSC were extracted from the institutional database from January 2017 to December 2018. Among those patients, we performed the whole-body CT scanning in Emergency Department (ED) for 101 patients and evaluated coronary artery by CAG for 82 patients. We assessed their coronary artery calcifications on CT findings, calculating the Agatston score. We investigated the usefulness of the Agatston score to predict the existence of coronary artery stenosis on CAG findings, and patients' mortality at 30 days.

Result

Both the whole-body CT scanning and CAG were performed in 70 patients. Among those patients, 31 (44.3%) patients had any coronary artery stenosis on CAG findings. The Agatston score was significantly higher in those who had any coronary artery stenosis (p<0.01). The optimal cut off value of the Agatston score to predict the existence of coronary artery stenosis was 9.9 ((Area under the curve (AUC) 0.75; 95% Confidence interval (CI) 0.63 - 0.87). The positive predictive value to predict coronary artery stenosis was 72.5%. In the present study, 101 patients were eligible to be calculated the Agatston score. The Agatston score was significantly higher in those who was dead at 30 days (p=0.04). The optimal cut off value of the Agatston score to predict the 30-days mortality was 15.1 ((Area under the curve (AUC) 0.62; 95% Confidence interval (CI) 0.51 - 0.73). Among the patients who had lower Agatston score (<15.1), 22 (50%) patients survived at 30 days.

Conclusion

The Agatston score calculated by the whole-body CT scanning in ED is helpful to predict the existence of coronary artery stenosis in OHCA patients. And evaluating the Agatston score is useful to predict mortality in OHCA patients.
P2673Challenging time limits: Using a single high-sensitive troponin I to rule-out acute myocardial infarction in early presenters
Authors: Hansen C , Bang C , Lauridsen K G , Frederiksen C A , Schmidt M , Jensen T , Hornung N , Loefgren B
Published: October 2019

Introduction

According to ESC guidelines, an acute myocardial infarction (MI) can be excluded without serial troponin measurements in patients presenting with a single high-sensitive troponin below the 99th percentile and chest pain starting >6 hours prior to admission. However, it is unclear if single-testing of high-sensitive troponin can rule-out MI in early presenters.

Purpose

To investigate the diagnostic performance of a single value of high-sensitive cardiac troponin I (hs-cTnI) at presentation for ruling-out MI in patients presenting with chest pain to the Emergency Department irrespective of chest pain onset.

Methods

We conducted a substudy of preliminary data from the RACING-MI trial. We included patients presenting with chest pain suggestive of MI to the Emergency Department of a Regional Hospital. We used the Siemens hs-cTnI (Siemens Healthcare, TNIH, Limit of detection: 2.21 ng/L) and a diagnostic cut-off value <3 ng/L to rule-out MI at presentation. Two physicians independently adjudicated the final diagnosis based on all clinical information. Patients were stratified based on time from chest pain onset to hospital admission as very early (0–3 hours), early (3–6 hours) and late presenters (>6 hours).

Results

We included 989 patients with available hs-cTnI results at admission. MI was confirmed in 82 (8.3%) patients. Using hs-cTnI <3 ng/L as diagnostic cut-off value at presentation, 302 (30.5%) patients without MI were classified as rule-out. Overall, the negative predictive value (NPV) for MI was 100% (95% CI 98.7–100).

Based on chest pain onset, 33.8% of patients were classified as very early, 12.8% as early, and 42.7% as late presenters, with 10.7% patients with unreported/unknown onset. NPV was 100% (95% CI 96.5–100) for very early, 100% (95% CI 88.3–100) for early and 100% (95% CI 97.3–100) for late presenters.

Conclusions

Using a single hs-cTnI value <3ng/L as diagnostic cut-off to rule-out MI seems to be safe and to allow rapid rule-out of MI in patients presenting with chest pain to the emergency department, even in very early presenters.

ClinicalTrials.gov Identifier: NCT03634384.

Acknowledgement/Funding

Randers Regional Hospital, A.P Møller Foundation, Boserup Foundation, Korning Foundation, Højmosegård Grant, Siemens Healthcare (TNIH assays), etc.
P2676Prospective validation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T in Asian countries
Authors: Shiozaki M , Inoue K , Suwa S , Lee C C , Chiang S J , Shimizu M , Fukuda K , Hiki M , Kubota N , Tamura H , Fujiwara Y , Sumiyoshi M , Daida H
Published: October 2019

Background/Introduction

Implementation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity troponin (hs-cTn) T in Asian countries presents a challenge for clinical practice.

Purpose

We aimed to prospectively validate the 0-hour/1-hour algorithm in Asian countries.

Methods

We conducted a prospective, multi-center, international cohort already utilizing 0-hour/1-hour algorithm using hs-cTnT for evaluation of patients with suspected of non-ST elevation acute coronary syndrome (NSTE-ACS). All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, continuous ECG monitoring, pulse oximetry, standard blood test, chest radiography, cardiac and abdominal ultrasonography. Patients presenting with congestive heart failure, terminal kidney disease on hemodialysis state, arrhythmia, or infection disease (which cause to increase troponin level) were excluded. Patients were divided into three groups according to the algorithm: hs-cTnT below 12 ng/L and delta 1 hour below 3 ng/L were the “rule out” group; hs-cTnT at least 52 ng/L or delta 1 hour at least 5 ng/L were in the “rule in” group; the remaining patients were classified as the “observational” group. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction.

Results

Of the 1,332 patients enrolled in 2014 to 2018, 933 patients were analyzed after exclusion. AMI was the final diagnosis for 122 (13.1%) patients. The algorithm ruled out AMI in 401 patients with a negative predictive value and sensitivity of 100% (95% confidential interval [CI], 98.6%-100%) and 100% (95% CI, 94.0%-100%), respectively, in the rule-out group. None of the patients were diagnosed with AMI. Among the 211 patients classified into the rule-in group, 90 were diagnosed as having AMI. The positive predictive value and specificity were 43.1% (95% CI, 36.2%-50.2%) and 78.3% (95% CI, 74.5%-81.7%), respectively. The median length of hospital stay was 159 min (142–180) in rule out group.

Conclusion(s)

Our findings suggest that the 0-hour/1-hour algorithm using hs-cTnT provides very high safety and efficacy for the triage toward rapid rule-out to rule-in of AMI.

Acknowledgement/Funding

JSPS KAKENHI Grant Number JP18K09554
P2678Performance of the European society cardiology 0/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T: meta-analysis
Authors: Burgos L M , Battioni L , Costabel J P , Trivi M
Published: October 2019

Introduction

A rapid rule-out or rule-in protocol based on the 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) is recommended by the European Society of Cardiology (ESC), and recently multiple studies have validated it in their settings. We conducted a systematic review and meta-analysis with the aim of assess the diagnostic accuracy of the 2015 ESC guidelines for management of acute coronary syndrome (ACS) in patients without ST-segment elevation's 0-/1-hour algorithm using hs-cTnT for the early rule-out and rule-in of acute myocardial infarction (AMI) on presentation. For the secondary analysis we evaluate cumulative mortality at 30 days.

Methods

We carried out a systematic review and meta-analysis of prospective studies involving adults presenting to the emergency department with possible ACS in which hs-cTnT measurements were obtained according to the ESC algorithm and AMI outcomes were adjudicated during the initial hospitalization. We searched MEDLINE, EMBASE, Cochrane database and LILACS, and unpublished abstracts presented in international congresses from 2015 to November 2018.To obtain estimates of sensitivity and specificity, with corresponding 95% confidence intervals (CI), we used a bivariable random-effects model. Summary receiver operating characteristic curves were drawn, plotting individual studies as well as the summary estimate.

Results

Seven studies involving 9251 patients were identified. The summary sensitivity of these tests in diagnosing acute MI at presentation to the emergency department was estimated to be 99.1% (95% CI 97.2–99.7%) and the summary specificity was 92.5% (95% CI 86.6–95.9%). With a false positive rate of 0.075 (95% CI 0.041–0.134), diagnostic odds ratio (DOR) of 1293.1 (95% CI −52.48 to 2638.5), and Likelihood Ratio (LR) +13.193 (95% CI 5.3–21, and LR −0.010 (95% CI −0.001 to 0.021). Cumulative mortality at 30 days in the rule-out group was 0,08% (4 studies; n=3715).

Conclusion

The European Society Cardiology 0-Hour/1-Hour Algorithm using High-Sensitivity Cardiac Troponin T has high diagnostic accuracy, it allows safe rule-out as well as accurate rule-in of acute myocardial infarction. With low cumulative 30-day mortality in patients assigned the rule-out zone.