bluuebunny/crossref_metadata_2025 huggingface dataset:
P4148Contemporary prognosis of patients hospitalised with a primary diagnosis of heart failure: a report from the national heart failure audit of England & Wales
Authors: Cleland J G F , Shote A , Hardman S , McDonagh T
Published: October 2019

Background

Since 2009, National Health Service hospitals in England & Wales have been required to participate in a national audit of people with a hospital death or discharge attributed primarily to heart failure. The data collection tool is web-based with >250 fields. Mandatory data include age, sex, deprivation-index, admission symptoms, aetiology and co-morbidity, electro- and echo-cardiographic data, standard laboratory tests and discharge medications. Patients are followed up for re-admissions and deaths through linkage to national records. Altogether >500,000 patients have been enrolled.

Purpose

To describe the contemporary in-patient and post-discharge mortality of patients with a primary death or discharge diagnosis of heart failure reported by hospitals in England & Wales, stratified by age, sex and left ventricular phenotype.

Methods

Descriptive. Patient characteristics are described as medians with inter-quartile ranges. Time to event analyses using Kaplan-Meier.

Results

Altogether, 253,981 unique patients (>75% of all relevant admissions) were entered into the registry between April 2014-March 2018, of whom 45% were women (median age of 82 (75–88) years; 45% with LVEF <40%) and 55% were men (median age of 78 (69–85); 65% with LVEF <40%. Amongst 45,772 patients surviving to discharge in 2017–18 with an LVEF <40%, 92% were discharged on a loop diuretic, 22% on digoxin, 72% on an ACE inhibitor, 23% on an ARB, 83% on an ACE inhibitor and/or ARB, 89% on a beta-blocker and 56% on an MRA. Patients who received disease-modifying agents were younger and had a better prognosis.

Age, but neither sex nor LVEF, was a strong determinant of both in-patient and post-discharge mortality. In-patient mortality ranged from 3.2% in those aged <45 years to 16.5% in those aged >85 years. One year mortality for patients who survived to discharge ranged from 10.4% in those aged <45 years to 45.6% in those aged >85 years (figure shows age-stratified, post-discharge, one-year mortality for people enrolled 2014–17).

Age-Stratified Post-Discharge Mortality

Conclusions

More than 60% of people hospitalised for heart failure in England & Wales are aged >75 years. In-patient and post-discharge mortality remain high for patients hospitalised with a primary diagnosis of heart failure. Treatment and outcome are strongly influenced by age.

Acknowledgement/Funding

The Healthcare Quality Improvement Partnership and National Institute for Cardiovascular Outcomes Research funded by UK Government
P4149Real world evidence (RWE) versus cardiology registries and clinical trials: a largely different epidemiological profile of a community setting of 13,168,444 subjects
Authors: Maggioni A P , Dondi L , Orso F , Pedrini A , Calabria S , Ronconi G , Piccinni C , Martini N
Published: October 2019

Aims

Patients with heart failure (HF) included in controlled trials (RCTs) or included in cardiology registries (CRs) do not fully represent the “real world”. This study describes the characteristics of HF by analyzing administrative data of more than 13,000,000 subjects.

Methods and results

Analyses were carried out from the ReS database, a population-based database linking demographic data, prescription records, hospital discharge records, outpatient examinations/procedures. Patients were selected when discharged with a diagnosis of HF (in year 2014). Clinical characteristics, pharmacological treatments, re-hospitalizations, and direct costs for the NHS were described during 1-year follow-up (FU).

Of the 13,168,444 subjects included in the database, 54,268 (0.4%) were hospitalized for HF. Table shows the patient characteristics compared to those of HF patients included in RCT or CR. During 1-year FU, 47.7% of patients had at least one re-hospitalization. Of total hospitalizations, 22% was due to HF, 51.7% was due to non-CV causes. Mean cost per patient per year was 10399€, of which 80.5% was related to hospitalizations.

Variable RCT: ASCEND-HF CR: HFA HF Long Term Big data: ReS database (2010) (2011–2014) (2014) No. of patients 7,141 6,629 54,268 Mean age 67 75 77 Females, % 34 37 47 Diabetes, % 41 39 34.7 Hypertension, % 72 66 65.2 COPD, % 15 19 55.7 Coronary disease, % 60 54 31# Renal dysfunction, % 30 25 23.6# Depression, % NR 7 23.2 Neoplasia, % NR 5 9 ACE-I/ARBs, % 60 79 65.8 Betablockers, % 58 89 65.2 MRAs, % 28 56 40.9 Ivabradine, % NR 3 6.4 #Defined as hospital admissions for the specific cause. NR = not reported.

Conclusions

RWE provides an epidemiological profile of HF that is largely different from that reported by RCTs or CRs. The high costs for the NHS are mainly driven by hospitalizations, which are more frequently due to non-CV reasons. These figures should be considered when the total burden of the HF is evaluated.
P4157Coronary flow reserve but not ischemia is a strong predictor of mortality in 551 outpatients referred for stress myocardial perfusion by Rubidium-82 PET imaging
Authors: Tavares Poppi N , Soares Junior J , Meneghetti J C , Mahler Mioto B , Giorgi M C P , Izaki M , Machado Cesar L A
Published: October 2019

Background

The assessment of myocardial ischemia in patients with suspected coronary artery disease (CAD) is encouraged by current guidelines. The ischemic burden is associated with impaired prognosis. Coronary flow reserve (CFR) is also an independent predictor of cardiovascular mortality but it is unclear which one of these two variables would be stronger to predict mortality.

Purpose

To evaluate the predictors of death in symptomatic stable patients with suspected CAD referred for stress myocardial perfusion (MP) Rubidium-82 PET imaging.

Methods

551 consecutive patients (52% men, mean age 63 years) were enrolled in this study from February to October 2013. The primary endpoint was all-cause death. The event-free survival curves for the primary endpoint were obtained using the Kaplan-Meier method in four groups of patients based on whether ischemia was present and whether CRF was impaired (<2) (Figure). Univariate analysis was performed using Cox regression to identify the variables that were associated with mortality, and the Cox proportional-hazards regression model for the multivariate analysis adjustment.

Results

During a median follow-up period of 32 months there were 43 deaths giving an estimated cumulative event rate of 7.8%. Univariate predictors of death were: age, higher prevalence of DM and CKD, lower LVEF and BMI. Following a multivariate analysis, only CFR was independently associated with mortality (Table).

Predictors of death Variable Univariate model Multivariate model HR (95% CI) P value HR (95% CI) P value Age 1.03 (1.00–1.06) 0.036 1.01 (0.99–1.04) 0.324 Male sex 1.41 (0.76–2.56) 0.277 0.96 (0.70–1.32) 0.809 History of DM 2.12 (1,13–3,97) 0.019 – – History of CKD 4.95 (2,66–9,20) <0.001 – – BMI <30 1.14 (1.05–1.22) <0.001 2.22 (0.93–5.26) 0.071 Rest LVEF, % 0.98 (0.96–0.99) 0.029 0.99 (0.98–1.01) 0.477 Ischemia, % 1.02 (0.97–1.06) 0.436 0.99 (0.91–1.10) 0.990 Ischemia ≥10% 1.33 (0.59–2.99) 0.488 0.90 (0.40–2.05) 0.806 CFR 0.26 (0.15–0.43) <0.001 0.27 (0.16–0.46) <0.001 LVEF = left ventricular ejection fraction.

Survival curves for all-cause death.

Conclusions

In symptomatic outpatients with suspected CAD referred for stress MP Rubidium-82 PET imaging, CFR is the strongest predictor of mortality. Notably, neither the presence of ischemia nor the ischemic burden was associated with the outcome in question.
P4168Ischemic sudden cardiac deaths among victims under 50 years - Characteristics and autopsy findings
Authors: Vahatalo J H , Huikuri H V , Pakanen L , Kaikkonen K S , Tikkanen J , Perkiomaki J S , Junttila M J
Published: October 2019

Background

Sudden cardiac death (SCD) is one of the most prevalent cause of death in Western countries representing nearly 20% of total mortality. About 70–80% of SCDs are due to coronary artery disease (CAD). Especially among young victims, whose first cardiac event is often SCD, decent risk prediction and prevention strategies are sadly lacking.

Purpose

The aim of this study was to determine the characteristics and autopsy findings of ischemic sudden cardiac deaths among young victims under the age of 50 years.

Methods

The study population is derived from Fingesture study, consisting of prospectively collected consecutive victims of SCD in Northern Finland among whom post-mortem examinations were performed between years 1998–2017 (n=5,869). According to Finnish law, all unexpected deaths undergo medico-legal autopsy. All post-mortem examinations included histological examinations, as well as a toxicology investigation was carried out if needed. Information about the victims was collected from autopsy data, death certificates, medical records, standardized questionnaire to the closest family members of the victims and police reports about the conditions of the death. 10% off all SCDs occurred among victims aged under 50 years (607 victims).

Results

CAD was the most common underlying cause of SCD among young victims (265 victims, 44%), followed by obesity related (102 victims, 17%) and alcoholic cardiomyopathy (67 victims, 11%). The mean age of ischemic SCD victims was 44±4 years and they were mostly men (89%). 90% of victims had no history of CAD prior to death and 34% of these had a myocardial scar at autopsy indicating previously unrecognized MI. 26% of SCDs occurred during physical activity. Hypertrophied hearts (59%) and myocardial fibrosis (83%) were common findings among young ischemic SCD victims. 27% of victims had a history of heavy drinking and alcohol was found in toxicology investigations in 35% of victims. At least one cardiovascular risk factor (diabetes mellitus, hypertension, dyslipidemia, obesity) was present in 51% of cases.

Conclusions

CAD was the most common cause of SCD among victims under 50 years. Most ischemic SCDs among young occurred without previously diagnosed CAD, and yet severe findings were seen at autopsy.

Acknowledgement/Funding

Sigrid Juselius Foundation, Finnish Foundation for Cardiovascular Research, Aarne Koskelo Foundation
P4169The crucial role of the bystander in out-of-hospital cardiac arrest resuscitation
Authors: Campos T , Baert V , Hubert H , Wiel E , Benameur N
Published: October 2019

Background

Out-of-hospital cardiac arrest (OHCA) is a major public health concern in France, given that there are 61.5 cases per 100,000 inhabitants a year. The impact of bystander action, performed before the arrival of emergency medical services (EMS), on survival has never been studied in France.

Purpose

Determine whether bystander cardiopulmonary resuscitation (CPR), performed before the arrival of EMS, was correlated with an increased 30-day survival rate after an OHCA.

Methods

24,885 out-of-hospital cardiac arrests witnessed in France from 1 January 2012 to 1 May 2018 were analysed to determine whether CPR, performed before the arrival of EMS, was correlated with survival. Data from the Electronic Registry of Cardiac Arrests was used. The association between the effect of CPR performed before the arrival of EMS and 30-day survival rate was studied, using propensity analysis (which included variables such as age and sex of the patient, location, cause, and year of cardiac arrest, initial cardiac rhythm, EMS response time and no-flow time).

Results

CPR was performed before the arrival of EMS in 14,904 cases (59.9%) and was not performed in 9,981 cases (40.1%). The 30-day survival rate was 10.2% when CRP was performed by bystanders versus 3.9% when CRP was not performed before the EMS arrival (p<0.001). CPR performed by bystanders was associated with an increased 30-day survival rate (odds ratio 1.269; 1.207 to 1.334).

The effect of bystander CPR on survival

Conclusion

Bystander CPR performed before the arrival of EMS was associated with an increased 30-day survival rate after an out-of-hospital cardiac arrest in France.
P4172Prevalence and potential genetic determinants of young sudden unexplained death victims with suspected arrhythmogenic mitral valve prolapse
Authors: Giudicessi J , Tester D , Ackerman M
Published: October 2019

Background

Mitral valve prolapse (MVP) is largely considered a benign condition. Recently, arrhythmogenic MVP, a sudden cardiac death (SCD)-predisposing condition characterized clinically by frequent/complex ventricular arrhythmias likely secondary to prolapsing leaflet-induced fibrosis of the left ventricle (LV), has emerged as an underappreciated cause of sudden unexplained death in the young (SUDY).

Objective

To determine the prevalence and potential genetic underpinnings of suspected arrhythmogenic MVP in a referral cohort of SUDY cases.

Methods

In this retrospective necropsy study, the medical records, autopsy reports, and whole exome molecular autopsy (WEMA) results for 77 SUDY victims (27 females; average age at death 20.6±8.9 years) were reviewed. Evidence of myxomatous MVP and concomitant LV pathology were noted. Variants detected in the pre-specified 164 WEMA gene panel with a frequency <0.001 in public exomes were classified using the 2015 American College of Medical Genetics (ACMG) guidelines.

Results

Overall, 6/77 (7.8%; 2 females; average age at death 20.7±6.9 years) SUDY cases had MVP as the lone abnormal post-mortem finding. The majority had bileaflet involvement (5/6; 83%) and microscopic LV fibrosis (5/6; 83%). Two SUDY cases (33%) were diagnosed with MVP by echocardiography prior to death. No gross hypertrophy, myocyte disarray, or fibrofatty replacement was noted. Unexpectedly, an ACMG pathogenic/likely pathogenic (P/LP) was more likely to be detected in SUDY cases with MVP than those without [3/6 (50%) vs 9/71 (13%); p<0.05]. Interestingly, the three variants identified in MVP-positive SUDY cases localized to genes associated previously with a cardiomyopathy/channelopathy predisposition (p.E1518fsX25-DMD, p.S285N-RYR2, and p.R109X-TTN).

Conclusion

This WEMA series provides additional evidence that the combination of bileaflet MVP and microscopic LV fibrosis underlies an unexpected number of SUDY cases. Whether P/LP variants in cardiomyopathy/channelopathy-susceptibility genes function as contributing factors or if unrelated, but poorly understood, molecular mechanisms account for the distinct cardiomyopathy-like phenotype observed in arrhythmogenic MVP requires further investigation.
P4337Construction and validation of the instrument “nutritional knowledge and feeding practice scale – QCPA” – for children, 7 to 11 years
Authors: Bozzetto-Silva A B S , Piccoli A , Dal Ri C S D R , Pellanda L C P
Published: October 2019

Introduction

The increase in the prevalence of obesity is one of the major public health problems. There is a weak relationship between nutritional knowledge and feeding practices. Studies have evaluated that the associations between obesity and the level of nutritional knowledge and feeding practices in children are scarce. The evaluation of nutritional knowledge and feeding practices should be carried out using validated instruments. Study showed the need to improve the instruments of habit research and feeding practices in children for better evaluation. Objectives: To develop and validate an instrument about nutritional knowledge and feeding practices for use in children from 7 to 11 years, based on the Food Guide for the Brazilian Population.

Methods

The study filled all the steps expected to validate an instrument: review on the subject, instrument elaboration, Content's Validity (Content Validity Index – CVI) with two groups of judges: 1° – nutritionists and, after adjustments, 2° – multidisciplinary group), FACE Validity, reliability analysis [Intraclass Correlation Coefficient (ICC) and Kappa (K), Internal Consistency Analysis - Cronbach's Alpha] and Validity of Construct (Exploratory Factorial Analysis - EFA) The sample was calculated, considering, at least, 10 subjects for each question of the questionnaire.

Results

Validation occurred in a final sample of 453 children, 46.4% boys and 53.6% girls, mean age 9.45 (SD = 1.44). The validity of the content presented CVI ≥0.80 for relevance in 62.3% of items for nutritionist group and 100% of items for multidisciplinary group), clarity (49.4%, 91.8%), Pertinence (58.8%, 98.4%), respectively. The test-retest had a level of agreement of 84.3% and K=0.740 for the Knowledge Dimension; and the ICC=0.754 for the Practices Dimension. Cronbach's Alpha, for internal consistency analysis, was α=0.589 for the Knowledge Dimension and α=0.618 for the Practices Dimension. The EFA with variance of 47.01% (7.81% at 10.85%), with varimax rotation, it defined five factors for the Practices Dimension: Involvement; Healthy Eating and drinking; Unhealthy eating and drinking; Basic food consumption; Attitudes during the meal.

Conclusion

The instrument QCPA demonstrated validity and reliability to evaluate nutritional knowledge and practices in children aged 7 to 11 years.
P4344An example that big data analysis is ready for the prime time
Authors: Cortina C , Sarrion M , Mora L , Suberviola V , Beltran C , Gomez E , Sanchez A , Dominguez M , Vaqueriza D , Giganto M , Munoz R
Published: October 2019

Introduction

Data about the epidemiology of valvular heart disease (VHD) is scarce. The increasing aging of the population may cause an augmented prevalence of VHD, with a great number of comorbidities that conveys a higher surgical risk. The aim of this study was to describe the prevalence of VHD in the patients attended at our institution from 2007 until 2017 and to describe the main characteristics of this population.

Methods

We used a new tool based on EHRead Technology to extract clinical relevant information from Electronic Health Records, designed for descriptive and predictive big data analysis. All medical reports generated at the outpatient clinic, ER or hospitalization ward were examined. Patients with a diagnosis of moderate or severe VHD were selected. The prevalence of VHD was also estimated in 2 quintiles, from 2008 until Feb 2013 and from March 2013 until Dec 2017.

Results

The total prevalence of VHD in our population was 1.04% (n=3431). Mitral regurgitation was the most frequent valvular lesion (0.4%, n=1318), followed by aortic stenosis (0.3%, n=967) and aortic regurgitation (0.28%, n=938). There was a clear female predominance (63%), and the median age was 76.4. In the 1st quintile the prevalence of VHD was 0.25%, and increased to 0.79% in the 2nd. This trend was consistent in all type of valvular lesions. The prevalence of comorbidities was higher than in other epidemiological studies (Table).

Prevalence of comorbidities Severe MR Severe AS Severe AR Euro Heart Valve Survey Hypertension 54,5% 69,1% 47,9% 49% Dyslipidemia 32,2% 40,6% 27,4% 35% Diabetes Mellitus 28,0% 31,5% 16,4% 15% Smoking (current) 5,6% 5,4% 13,7% 39% Coronary heart disease 12,0% 17,0% 12,3% 13% Stroke 7,0% 8,9% 5,5% 7% Chronic kidney disease 18,9% 16,9% 20,5% 15% Chronic obstructive pulmonary disease 11,2% 9,9% 11,0% 15% MR: Mitral regurgitation, AS: aortic stenosis, AR: aortic regurgitation, MS: mitral stenosis.

Sex Distribution

Conclusions

The older age and greater number of comorbidities seen in our series over the past ten years, compared to the Euroheart Valve Survey reinforce the idea that the percutaneous valvular therapies should play a major role in the treatment of patients with VHD. Although, the prevalence of VHD may be underestimated in our population, due to the methodology, it reflects an ever-growing pathology in an older and sicker population.
P4355Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up
Authors: Annone U , Omede' P , D'Ascenzo F , Montefusco A , Milan A , Moretti C , Grosso Marra W , Veglio F , Gaita F
Published: October 2019

Introduction

Prognosis in pulmonary hypertension (PH) is strictly linked to right ventricle (RV) failure, which results from uncoupling between RV and the superimposed pressure load; in first phases, coupling between these two actors still be preserved, at the price of augmented right ventricle wall tension (RVWT).

Purpose

We sought to describe how to estimate RVWT with echocardiography, how it correlates with RV hemodynamics and if it may predict prognosis.

Methods

A total of 190 patients without overt RV failure, with suspected pulmonary hypertension (PH) to a previous echocardiography, underwent to right heart catheterization (RHC) and nearly-simultaneous echocardiography. We estimated RVWT according to Laplace law (RV length × tricuspid regurgitation peak gradient [TRPG]), in order to predict initial RV stress, and was correlated with RV hemodynamic profile; its potential prognostic impact was tested along with canonical RV function parameters.

Results

In patients enrolled in our study, RVWT correlated significantly with invasive estimation of right ventricle end diastolic pressure (R 0.343, p<0.001); a significant relationship between RVWT and several hemodynamic variables was observed (mean pulmonary artery pressure, pulmonary artery compliance, transpulmonary gradient, pulmonary vascular resistance, RV telediastolic pressure, right atrial pressure, RV stroke work index; all p<0.001). At a mean follow up of five years and three months, only RVWT predicted all-cause mortality (p 0.036), while TAPSE, TAPSE/TRPG, RV fractional area change and RV S' wave did not.

Correlation: RWVT and RV hemodynamic Hemodynamic variable R R2 p value Mean pulmonary artery pressure 0.742 0.550 <0.001 RV differential pressure 0.794 0.630 <0.001 Pulmonary artery pulsatory pressure 0.740 0.547 <0.001 Mean right atrium pressure 0.326 0.106 <0.001 Cardiac index/right atrial pressure 0.209 0.044 0.012 RV stroke work index 0.588 0.346 <0.001 Pulmonary artery compliance 0.449 0.202 <0.001 Pulmonary vascular resistance 0.531 0.282 <0.001

Prognosis: different RV variables

Discussion

We identified a novel bedside echocardiographic predictor of altered RV hemodynamic, which results precociously altered in patients without overt RV failure, and able to predict all cause mortality at a long term follow up. Further studies are needed to confirm its role in PH patients.
P43673D analysis of mitral annular reshape with third generation MitraClip XTr in functional and degenerative mitral regurgitation
Authors: Toscano E , Altizio S , Cianfanelli L , Denti P , Stella S , Capogrosso C , De Bonis M , Buzzatti N , Godino C , Latib A , Montorfano M , Camici P G , Castiglioni A , Alfieri O , Agricola E
Published: October 2019

The 3rd generation Mitraclip XTr was recently introduced to improve device performance, through longer clip arms that should allow better grasping of the mitral leaflets, thus improving coaptation and results eventually. Several studies have demonstrated additional effects such as the reshape of the mitral annulus immediately after clip implantation.

The aim of our study was to evaluate the mitral valve (MV) annular remodelling with MitraClip XTr.

Between March 2018 and November 2018, 75 consecutive patients were enrolled. The population was divided in two groups: functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR).

The 3D MV datasets at baseline and immediately after the procedure were acquired and then analysed with semiautomatic MVQ software (QLAB Cardiac 3DQ v.10.0; Philips Medical Systems).

The software provides the following parameters: annular diameters (antero-posterior, AP, and inter-commissural, IC), circumference, area, height and ellipsicity (IC/AP ratio as percentage); saddle-index, defined as annular height to IC diameter ratio was derived.

The 3D post-processing was feasible in 54 patients (108 3D datasets): 28 had FMR (52%) and 26 had DMR (48%).

An average of 1.8 clips per patient were implanted: 2 clips in 38 (70%), 1 clip in 14 (26%) and 3 clips in 2 (4%) patients. The position was central in 93% of the procedures.

Results are reported in table 1. In the FMR group, a reduction in the AP diameter (p=0.001), an increase in both IC diameter (p=0.001) and annular ellipsicity (p<0.001) were observed.

In the DMR group, an increase in annular ellipsicity (p=0,008) and in saddle-index (p<0.05) were observed.

Table 1 Functional mitral regurgitation (N=28) Degenerative mitral regurgitation (N=26) Pre-clip Post-clip P-value Pre-clip Post-clip P-value IC diameter (mm) 39.3±4.2 41.9±4.1 0.001 40.9±6.5 41.8±5.8 0.257 AP diameter (mm) 32.8±4.6 30.4±3.2 0.001 32.6±4.8 31.7±4.5 0.199 Annular Height (mm) 5.1±1.8 5.4±1.8 0.336 4.8±1.9 5.7±2.2 0.026 3D circumference (mm) 122.7±15.1 123.5±11 0.718 123.5±19.0 124.0±17.1 0.812 3D area (mmq) 1128.0±280 1113.7±206 0.752 1160±346.7 1156.8±318.0 0.926 Annular ellipsicity (%) 121.5±12.2 138.5±11.8 0.0005 125.9±9.6 132.4±10.7 0.008 Saddle index 13.0±4 13.0±4 0.957 11.8±4.2 13.6±4.2 0.048

Our study demonstrates that the XTr implantation produces a MV annular remodelling both in FMR and DMR probably with different mechanisms. In FMR the MV annulus resulted more elliptical, wheras in DMR the geometrical modifications involve both the ellipsicity and the saddle-shape morphology.
P4369Direct comparison of prognostic value of echocardiographic parameters of right ventricular dysfunction in normotensive patients with acute pulmonary embolism
Authors: Kurnicka K , Ciurzynski M , Hobohm L , Thielmann A , Sobkowicz B , Sawicka E , Kostrubiec M , Ptaszynska K , Lankeit M , Pruszczyk P
Published: October 2019

Background

Although various echocardiographic parameters of right ventricular dysfunction (RVD) were reported to be of prognostic value in normotensive patients with acute pulmonary embolism (APE), an optimal definition of RVD on echocardiography is missing.

Purpose

We performed a direct comparison of prognostic value of RV/LV ratio, TAPSE, and TRPG/TAPSE for complicated clinical course that included: in-hospital APE related mortality, hemodynamic collapse or rescue thrombolysis.

Methods

Prospective cohorts of APE patients normotensive at admission, managed according to the ESC Guidelines 2014 were merged in a collaborative database. Transthoracic echocardiography was performed at admission, as soon as possible. All studied parameters were available in each patient. AUC in ROC analysis were assessed for each parameter and were compared between them. Multivariable Cox regression analysis was performed to assess the combination of echo-parameters.

Results

Overall, 490 pts were included in the study (229F), aged 64±18 years. Clinical endpoint occurred in 31 pts including 8 APE related deaths. AUC for SAE of RV/LV, TAPSE and TRPG/TAPSE were similar (Figure 1). TAPSE <16mm compared to other echo-parameters showed the highest PPV and NPV (Table 1). Cox regression analysis including SBP, HR, age, elevated troponin and echo-parameters showed that only blood pressure, RV/LV >1 and TAPSE <16mm were identified as independent predictors of outcome (HR 0.98 (95% CI: 0.96–0.99), p=0.03; 2,53 (95% CI: 1.2–5.7), p<0.03 and 3,76 (95% CI: 1.74–8.11), p<0.001).

Table 1. Predictive values of proposed cut offs of echocardiographic parameters Parameter Sensitivity Specificity PPV NPV TAPSE <16mm 52% 85% 18% 96% RV/LV >1.0 74% 63% 12% 95% TAPSE<20 & TRPG/TAPSE >4.5 10% 94% 10% 94%

Figure 1

Conclusions

Although all TAPSE, RV/LV ratio and TRPG/TAPSE showed similar performance for prognosticating of in-hospital outcome in normotensive PE patients, TAPSE<16mm showed the highest predictive value for identification of patients at risk of complicated clinical course.
P4376Circumferential ascending aortic strain in healthy adults aged 24 to 75 years
Authors: Shi J , Wang Y S , Zhao W P , Pan C Z , Shu X H
Published: October 2019

Background

Two-dimensional speckle-tracking echocardiography (2D-STE) for the measurement of circumferential ascending thoracic aortic strain (CAAS) in healthy adults is not elucidated. We aimed to establish normal adult STE-derived CAAS and to evaluate associations with age, gender and other physiologic parameters.

Methods

One hundred eighty-one healthy subjects aged 24–75 were prospectively gathered and examined with two-dimensional echocardiography. The global peak CAAS was the parameter used, and an average of six segments of arterial wall deformation was calculated. The corrected CAAS was calculated as the global CAAS/pulse pressure (PP). Aortic stiffness (β2) index was assessed according to ln(Ps/Pd)/CAAS.

Results

We included 171 healthy subjects (age 44.3±10.9 years, 50% female, CAAS16.0±6.9%). The CAAS was independently predicted by age (β=−0.387, P<0.001), and gender (β=−2.701, P=0.001). The corrected CAAS was independently predicted by age (β=−0.009, P<0.001), SAC (β=−0.206, P<0.001) and gender (β=−0.068, P=0.001). The β2 index was independently predicted by age (β=0.136, P<0.001), and PP (β=0.059, P=0.007).

Conclusion

CAAS using 2D-STE can be performed on a clinical basis and may become an important method for the assessment of aortic mechanical parameter. Age, gender and LV afterload-related variables were the most import determinants of 2D-STE global CAAS. Therefore, these factors should be taken into account for strain interpretation in clinical practice.
P4380Echocardiographically determined myocardial work An emerging bioassay for clinical studies Results from the STAAB cohort study
Authors: Morbach C , Sahiti F , Tiffe T , Cejka V , Breunig M , Eichner F , Gelbrich G , Heuschmann P U , Stoerk S
Published: October 2019

Introduction

A novel echocardiographic method to non-invasively determine myocardial work based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated and offers new opportunities to study the mechanistic associations. Heart failure patients with prolonged electrical conduction (ie, left bundle branch block) exhibit reduced myocardial global work efficiency (GWE) due to an increase in global wasted work (GWW), which could be improved by biventricular pacing. We here investigated the association of ETI and myocardial work in a non-diseased population.

Methods

The Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study carefully characterized a representative sample of the population of a medium-sized town in Germany, aged 30–79 years and free from heart failure. Off-line analysis of the standardized, quality-controlled transthoracic echocardiograms regarding myocardial work yields the following parameters: global constructive work (GCW): work performed during shortening in systole and adding negative work during lengthening in isovolumic relaxation; global wasted work (GWW): negative work performed during lengthening in systole adding work performed during shortening in isovolumic relaxation; and global work efficiency (GWE): GCW/(GCW+GWW).

Results

We performed myocardial work analysis in 935 individuals from the sample of the first planned STAAB interim analysis who were in sinus rhythm, had preserved left ventricular ejection fraction and were free from significant valvular disease (51% female, 53±12 years). In linear regression including age, sex, heart rate, and ETI, we found increasing heart rate (64±10 bpm), QRS width (95±12 ms), QT interval (414±28 ms), and PQ interval (164±28 ms) associated with lower GWE (−0.11, −0.02, −0.03, and −0.001, respectively; all p<0.05) and higher GWW (+2.64, +0.29, +0.79, +0.16 mmHg%, respectively; all p<0.05).

Conclusion

In subjects free of overt cardiac disease, GWE strongly associated with ETI. Prolonged atrio-ventricular and intra-ventricular coupling and repolarization was associated with an increase in wasted work, while constructive work was not affected. These findings not only suggest a positive effect on myocardial energetics by reducing the heart rate, but also advocate the concept of myocardial work as a bioassay that is responsive to subtle changes. Myocardial work holds promise to be further studied in diseased patient groups.

Acknowledgement/Funding

German Ministry of Research and Education within the Comprehensive Heart Failure Centre Würzburg (BMBF 01EO1004 and 01EO1504)
P4416Influence of rosuvastatin on the secretion of leptin and its receptor by adipocytes isolated from different adipose depots in patients with ischemic heart disease
Authors: Dyleva Y A , Gruzdeva O , Uchasova E , Borodkina D , Belik E , Sinitsky M , Kozyrin K , Karetnikova V , Barbarash O
Published: October 2019

Obesity is still a major health, social and economic problem throughout the world. Recently, it is important to study the role of adipokines of adipose tissue of various localization in the development of cardiovascular diseases, as well as methods for their pharmacological correction.

Purpose

The study was to evaluate the effect of rosuvastatin on the secretion of leptin and its receptor by adipocytes of different localization, as well as on the expression of their genes in patients with ischemic heart disease.

Methods

29 patients with coronary heart disease which will be held coronary bypass surgery. Adipocytes were isolated from the samples of SAT, EAT and PVAT obtained during coronary artery bypass grafting, which were cultured for 24 hours with rosuvastatin 1 μmol/l and 5 μmol/l. A day later, the concentration of leptin and the leptin receptor in cell culture was determined. All study was carried out in compliance with the Helsinki Declaration, and its protocol was approved by the Ethical Committee of Research Institute. Statistical analysis was performed using Statistica 10.0. All patients gave written informed consent to participate in the study.

Results

1 μmol/l of rosuvastatin increased the level of leptin 1.6 and 2.9 times higher in adipocytes SAT compared with EAT and PVAT, respectively, and 1.8 times higher in EAT than in PVAT, which is consistent with the results of expression leptin gene. The concentration of rosuvastatin 5 μmol/l had an effect only on adipocytes SAT, increasing the level of leptin 1.6 and 2.2 times in comparison with adipocytes EAT and PVAT. Rosuvastatin had no significant effect on leptin receptor soluble levels. The free leptin index was higher in adipocytes SAT in the presence of 1 μmol/l of rosuvastatin 1.6 and 2.8 times in comparison with adipocytes of EAT and PVAT.

Conclusion

The concentration of rosuvastatin 1 μmol/l had a more pronounced effect on adipocytes compared to a concentration of 5 μmol/l and increased the level of leptin and its expression in cell culture. At the same time, a high content of leptin under conditions of low expression of a soluble receptor to leptin in the presence of rosuvastatin 1 μmol/l can lead to leptin resistance, more pronounced in SAT adipocytes.
P4418Temporal analysis of leukocyte extravasation and morphological activation after standard cardiopulmonary exercise testing in patients with heart failure with reduced ejection fraction
Authors: Bahls M , Kia S , Kaczmarek S , Lehnert K , Urbaneck I , Landmesser U , Felix S E , Doerr M , Kraenkel N
Published: October 2019

Introduction

Long-term exercise training reduces the systemic inflammatory load in patients with cardiovascular diseases. Acutely, however, an exercise challenge can trigger pro-inflammatory responses. The underlying cardiac syndrome might also influence the response of the adaptive and innate immune system to an acute exercise challenge.

Purpose

We compared the acute response to a standardized cardiopulmonary exercise test (CPET) in patients with heart failure with reduced ejection fraction (HFrEF) and age matched controls.

Methods

Patients with HFrEF (n=8; left ventricular ejection fraction [LVEF] ≤40%) and controls (n=9, LVEF ≥50%) participated in a CPET. Blood samples were taken before, immediately after and 2 hours after the test. Quantitative and morphological changes in leukocyte subpopulations, and formation of leukocyte-platelet aggregates were assessed in fresh blood samples by flow cytometry. Results are given as median and inter-quartile range (IQR).

Results

HFrEF (mean LVEF: 34%) and controls (mean LVEF: 57%) were 59 (range: 41 to 80) and 57 (range: 50 to 65) years old, respectively. In both groups acute exercise increased total leukocytes per mL of blood (control: 1.37-fold [IQR: 1.16 to 1.49]; HFrEF: 1.24-fold [IQR: 1.20 to 1.32]), relative abundance of circulating NK cells (controls: 2.11-fold [IQR: 1.30 to 3.13]; HFrEF: 1.67-fold [IQR: 1.56 to 1.71] and NK-T cells (control: 1.69-fold [IQR: 1.52 to 3.60]; HFrEF: 1.62-fold [IQR: 1.60 to 2.53]). Contrarily, only in HFrEF patients CD4+ (control: 1.15-fold [IQR: 0.84 to 1.54]; HFrEF: 1.45-fold [IQR: 1.10 to 1.98]) and CD8+ T cells (control: 1.33-fold [IQR: 1.01 to 1.68]; HFrEF: 1.70-fold [IQR: 1.25 to 2.15]) were augmented. Circulating monocyte and neutrophil numbers did not change in response to CPET. Aggregation of thrombocytes with monocytes (control: 0.86-fold [IQR: 0.78 to 1.49]; HFrEF: 1.59-fold [IQR: 1.05 to 7.30-fold]), T-lymphocytes (control: 1.27-fold [IQR: 1.05 to 1.68]; HFrEF: 1.49-fold [IQR: 1.03 to 2.64]) and neutrophils (control: 1.08-fold [IQR: 0.87 to 1.25]; HFrEF: 2.13-fold [IQR: 1.62 to 2.19]) increased 2 hour post-exercise in HFrEF patients, but not in controls.

Conclusion

Patients with HFrEF show a differential leukocyte response to an acute exercise challenge, with an increase in T-lymphocyte abundance, a degranulation response in the intermediate monocyte subpopulation and an increased formation of neutrophil-platelet-aggregates compared to control subjects. Our data suggest differences in release and organ-homing of innate versus adaptive immune cells, thus underlining the importance of inter-organ communication in the acute adaption to physical exertion in HFrEF.
P4423Extreme bradycardia in athletes is due to intrinsic changes within the heart
Authors: Flannery M D , Sully F , Janssens K , Morris G , Kalman J , La Gerche A
Published: October 2019

Background

It is well known that athletes and in particular endurance athletes have lower resting heart rates than non-athletes. This has generally been considered a healthy adaptation. Traditionally this was thought be due to increased vagal tone. Several studies have shown that endurance athletes continue to have lower heart rates in the absence of autonomic influence suggesting bradycardia is due to intrinsic changes within the heart. A subset of endurance athletes have very low heart rates with Tour de France cyclists having described heart rates in the 30s. It is unclear whether in these elite athletes with very low heart rates the profound bradycardia is due to autonomic influence or intrinsic changes within the heart.

Aim

The aim of this study was to determine if extreme bradycardia in athletes is due to excess vagal tone or more profound intrinsic changes within the heart.

Methods

We recruited three cohorts for this study: non-athlete controls (NA), endurance athletes with a documented resting heart rate >40 (EA) and endurance athletes with a resting heart rate <40 (BA). All participants underwent baseline testing including ECG, echocardiography and VO2 max testing. All participants came back on a second occasion for treatment with dual autonomic blockade (DAB) to determine intrinsic heart rate in the following manner. After resting supine for five minutes resting heart rate was measured. Participants were then administered 0.04mg/kg of intravenous atropine. After five minutes participants were then administered 0.05mg/kg of intravenous metoprolol. This was repeated every five minutes until there was no further drop in heart rate or 0.2mg/kg had been administered. The resting heart rate at this stage was recorded as the intrinsic heart rate. Parasympathetic blockade was confirmed by lack of response to Valsalva manoeuvre and sympathetic blockade was confirmed by lack of response to metoprolol. VO2 max testing was then performed to determine maximum heart rate.

Results

9 NA (7 male), 10 EA (8 male) and 5 BA (4 male) participated in this study. The average age was similar in all groups (NA 32.9y, EA 32.4y, BA 31.4y). The average resting heart rate was 71.7 in the NA group, 48.3 in the EA group and 41.6 in the BA group (p<0.05 for comparisons between all three groups). Following dual autonomic blockade resting heart rate was 86.0 in the NA group, 76.9 in the EA group and 64.4 in the BA group (p<0.05 for comparisons between all three groups). Maximum heart rate under DAB was 140.1 in the NA group, 138.0 in the EA group and 140.4 in the BA group. These differences were not significant.

Conclusion

In athletes with very low heart rates, bradycardia is due to more profound intrinsic changes within the heart.

Acknowledgement/Funding

NHMRC Project Grant
P4443Elevated levels of D-dimer are associated with inflammation and disease activity rather than risk of venous thromboembolism in patients with granulomatosis with polyangiitis
Authors: Borowiec A , Kowalik I , Hadzik-Blaszczyk M , Rusinowicz T , Krupa R , Zycinska K
Published: October 2019

Background

Granulomatosis with polyangiitis (GPA) is one of antineutrophil cytoplasmic autoantibody (ANCA) – associated vasculitis. The disease is characterized by necrotising inflammation of small vessels causing tissue ischemia in a variety of organs with a wide range of clinical presentations. It has been established that active GPA is associated with a very high risk of venous thromboembolic events (VTEs).

Purpose

The aim of the present study was an evaluation of inflammation, coagulation and fibrinolysis markers, and their association with various clinical and laboratory parameters in GPA patients.

Methods

The group of 100 consecutive patients with GPA was prospectively followed in the study. In all patients echocardiography and laboratory tests were performed.

Results

The patients were followed up for an average of 4.0±1.9 years. In this group, D-dimer was elevated in majority (56%) of patients. The circulating levels of D-dimer were significantly higher in GPA patients in active stage of disease compared with those in remission (652 vs. 405 ng/ml, p=0.0002). In 23 patients venous thromboembolism was diagnosed during observation. However, there was no difference in D-dimer concentration between patients with and without VTE either in active stage or in remission. Among the 100 GPA patients higher D-dimer levels were observed in patients with coronary artery disease (p=0.04), atherosclerosis (p=0.01), hypertension (p=0.0049), diabetes (p=0.0065) and hypercholesterolemia (p=0.03). Moreover, correlation analysis showed that the levels of D-dimer correlated with hs-CRP (r=0.42; p<0.0001) and creatinine (r=0.58; p<0.0001). In patients with VTE, D-dimer levels correlated positively with age (r=0.5, p=0.02), right ventricle diameter (r=0.63, p=0.0017), right ventricle systolic pressure (r=0.44, p=0.04), and negatively with pulmonary artery acceleration time (r=−0.43, p=0.05).

D-dimer – normal D-dimer – elevated p Inclusion – active stage n=44 (44%) n=56 (56%) Elevated creatinine 1 (2.27%) 25 (44.6%) <0.0001 Elevated CRP 5 (11.3%) 22 (39.2%) 0.0015 Venous thromboembolism 7 (15.9%) 16 (28.6%) 0.0712 CRP: C-reactive proteine.

Conclusion

In patients with Granulomatosis with polyangiitis elevated levels of D-dimer are associated with disease activity and inflammation, rather than with risk of venous thromboembolism. D-dimer is not a useful marker of venous thromboembolism episodes in patients with small vessel vasculitis.
P4444Hypertension, autoimmune inflammation and salt sensitivity in women with rheumatoid arthritis
Authors: Osipova I V , Starodubova J
Published: October 2019

Introduction

Hypertension (HTN) takes the first place among cardiovascular diseases in patients with rheumatoid arthritis (RA). Currently, the main risk factors for hypertension are known, but eating habits are often not considered in patients with RA. The salt taste sensitivity threshold (STST) in women with autoimmune inflammation and the effect of salt sensitivity to hypertension in RA have not been practically studied which was the novelty of our study.

Purpose

Purpose is to determine the salt taste sensitivity threshold in women with RA and assess the correlation between salt sensitivity, autoimmune inflammation and the development of hypertension in women with RA.

Methods

STST was studied in all patients with RA (n=202). Then, to assess the risk factors for hypertension in RA, the patients were divided into 2 groups: group 1 – patients with hypertension (n=141), group 2 – patients without hypertension (n=61). The patients' examination was carried out using the standards of the Association of Rheumatologists of Russia and the Russian Society of Cardiology. Salt taste sensitivity threshold was determined with R.J. Henkin's method. The patients with middle and high STST were considered salt-sensitive. Statistical data were obtained with Statistica 10.0. Regression analysis was used to identify the correlation between risk factors and the development of hypertension.

Results

The following results based on STST testing were obtained in patients with RA (n=202): high STST was in 129 patients (64.3%), middle - in 20 patients (10.7%), low - in 53 patients (25.0%). The activity of the inflammatory process was significantly higher in salt-sensitive patients (p=0.01). According to regression analysis, the predictors for hypertension in women with RA, in order of importance were age >55 years (p=0.001), early menopause (p=0.001), increased total cholesterol (p=0.001), taking prednisolone >10 mg/day (p=0.001), early family history of cardiovascular diseases (p=0.01), reduced glomerular filtration rate <60 ml/min 1.73 m2 (p=0.01), high STST (p=0.01), pregnancy pathology (p=0.01), high activity of the inflammatory process (p=0.01), psychosocial factors (stress, anxiety, depression) (p=0.01), obesity (p=0.01), RA duration >10 years (p=0.01). There were twice as many salt-sensitive patients with RA and HTN as with RA and without HTN (87% and 48%, respectively). Excessive fluid in the body was observed with decreased natriuresis that assumes the presence of volume-dependent hypertension.

Conclusion

The results of the study showed the importance to determine STST associated with a set of factors and autoimmune inflammation was significant among them. The widespread application of the method determining the salt sensitivity will make it possible to increase the effectiveness of hypertension treatment based on individual recommendations for women with RA.