bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3784Impact of progressively impaired renal function on major adverse outcomes in European patients with atrial fibrillation: a report from the ESC EORP-AF long-term general registry
Authors: Boriani G , Proietti M , Laroche C , Diemberger I , Kalarus Z , Potpara T , Fauchier L , Crijns H J G M , Maggioni A , Lip G Y H 
Published: October 2019

Abstract

Background
Renal function is an important predictor of major adverse outcomes in the general population. In the setting of atrial fibrillation (AF), renal dysfunction may act both as a risk factor and a proxy of vascular risk factors and comorbidities.

Methods
We analyzed the association of renal function, as estimated glomerular filtration rate (eGFR) using the CKD-EPI formula, with 1-year outcomes in a “real-world” cohort of European AF patients from the EORP-AF Long-Term General Registry.

Results
7725 were available for this analysis. Of these, 1294 (16.7%) had normal renal function (≥90 mL/min/1.73 m2), 3848 (49.8%) mildly reduced renal function (60–89 mL/min/1.73 m2), 2311 (29.9%) moderately reduced renal function (30–59 mL/min/1.73 m2) and 272 (3.5%) severely reduced renal function (<30 mL/min/1.73 m2). CHA2DS2-VASc and HAS-BLED scores values increased across eGFR strata (p<0.0001). Among patients qualifying for oral anticoagulant (OAC) therapy, those with severely impaired renal function were less often prescribed with any OAC (79.8%, p<0.0001), more likely with vitamin K antagonist (62.9%) than non-vitamin K antagonist oral anticoagulants (16.9%) (p<0.0001). At 1-year follow-up the rates of any thromboembolic event (TE)/acute coronary syndrome (ACS)/cardiovascular (CV) death progressively increased with worsening renal function, up to 20.7% in patients with severe dysfunction (p<0.0001). Rates of CV death and all-cause death were higher in severe renal dysfunction (16.9% and 21.3%; p<0.0001). Cox regression analysis (adjusted for known predictors) showed that eGFR <30 mL/min/1.73 m2, compared to normal renal function was associated with an increased risk of all the adverse outcomes (Table). eGFR decrease by 10 mL/min/1.73 m2 was associated with increased risks (Table).
Any TE/ACS/CV Death CV Death All-Cause Death mL/min/1.73 m2 HR (95% CI) HR (95% CI) HR (95% CI) eGFR ≥90 (ref.) – – – eGFR 60–89 0.99 (0.67–1.46) 0.81 (0.44–1.51) 0.74 (0.47–1.19) eGFR 30–50 1.12 (0.74–1.69) 1.00 (0.53–1.89) 0.95 (0.59–1.54) eGFR <30 2.47 (1.52–3.99) 2.73 (1.36–5.49) 2.16 (1.25–3.72) eGFR (by 10 mL/min/1.73 m2 decrease) 1.11 (1.05–1.17) 1.18 (1.10–1.27) 1.11 (1.03–1.18) ACS = Acute coronary syndrome; CI = Confidence interval; CV = Cardiovascular; eGFR = estimated Glomerular Filtration Rate; HR = Hazard ratio; TE = Thromboembolic event.

Conclusions
In AF patients, impaired renal function at baseline is associated with a progressive increase in the risk of major adverse outcomes during follow up. Severe renal dysfunction is an independent predictor of all the adverse outcomes.
P3797Increased risk of cardiovascular events and stroke among patients with atrial fibrillation and obstructive sleep apnea
Authors: Dalgaard F , North R , Pieper K , Steinberg B A , Mahaffey K W , Fonarow G , Kowey P R , Gersh B J , Pokorney S , Peterson E D , Piccini J 
Published: October 2019

Abstract

Background
Obstructive sleep apnea (OSA) is common in patients with atrial fibrillation (AF). It is not well understood if OSA impacts cardiovascular outcomes in patients with AF.

Purpose
To investigate patient characteristics and major adverse cardiovascular and neurological events (MACNE) in patients with AF and OSA.

Methods
Using the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF I) and ORBIT-AF II we compared the adjusted risk of the composite of cardiovascular death, myocardial infarction, stroke/transient ischemic attack/non-CNS embolism (stroke/SE), and new-onset heart failure (MACNE) according to the presence or absence of OSA, using multivariable adjusted Cox proportional hazard models. Secondary outcomes were the individual components of MACNE.

Results
Among 22,760 patients with AF, there were 4,045 (17.8%) with OSA at baseline. Median follow-up time was 1.5 (IQR: 1–2.2) years. OSA patients were younger (median [IQR] 68 [61–75] years vs. 74 [66–81] years, were more likely to be male (70.7% vs. 55.3%), and had markedly increased body mass index (BMI) (median 34.6 kg/m2 [29.8–40.2] vs. 28.7 kg/m2 [25.2–33.0]). Those with OSA had a higher prevalence of diabetes (39.2% vs. 25.2%), chronic obstructive pulmonary disease (COPD) (20% vs. 12%), heart failure (32.2% vs. 25.1%), and hyperlipidemia (73.2% vs. 66.7%). After adjustment, the presence of OSA was significantly associated with MACNE (HR: 1.16 [95% CI: 1.03–1.31], p=0.011) [Figure]. Stroke/SE was higher in patients with OSA (HR: 1.38 [95% CI 1.12–1.70], p=0.003). Addition of OSA to a model containing the CHA2DS2-VASc risk factors slightly improved discrimination for stroke/SE: CHA2DS2-VASc risk factors alone C-index (Standard Error) was 0.6867 (0.0125) vs. CHA2DS2-VASc risk factors plus OSA 0.6876 (0.0124), p=0.022.
Figure 1. Hazard ratios with 95% confidence intervals and event rates for the association between obstructive sleep apnea and major adverse cardiovascular and neurological events combined and separately. Abbreviations: OSA; obstructive sleep apnea MACNE; major adverse cardiovascular and neurological events, CV; cardiovascular, TIA; transient ischemic attack.

Conclusion
One in five patients with AF in community practice had OSA. The presence of OSA was associated with higher risk of MACNE and stroke/SE. Addition of OSA to CHA2DS2-VASc risk factors only slightly improved discrimination for the occurrence of stroke.

Acknowledgement/Funding
The Danish Heart Foundation, T32 NIH Grant HL079896. The ORBIT-AF registry is sponsored by Janssen.
P3813The economic cost heterogeneity of patients with heart failure - a retrospective nationwide study
Authors: Bundgaard J S , Mogensen U M , Christensen S , Ploug U , Roerth R , Ibsen R , Kjellberg J , Koeber L 
Published: October 2019

Abstract

Background
Heart failure (HF) imposes a major economic burden, however the individual management for patients vary potentially leading to large cost heterogeneity. The aim of this study was to investigate the total direct health cost stratified across the spectrum of cost groups.

Methods
Using Danish nationwide registries from 2012 to 2015 we identified all patients >18 years with a first-time diagnosis of HF. Total health costs were investigated using two perspectives; at index and after 3 years (including index). We investigated the cost of patients in the highest cost group (highest 10%) vs. the lowest cost group (lowest 10%). A multivariable logistic regression was used to identify variables associated with being in the highest cost decile compared to the rest (90%).

Results
A total of 11,170 patients with HF were included and those in the highest cost decile (n=1,117, 10%) were younger (69 vs. 75 years), more males (43 vs. 34%), and more inpatients (83 vs. 70%) compared to the rest of the patients (n=10,053, 90%). Patients in the highest cost decile (10%) incurred a 30 times higher cost with a mean total health cost in index year of €86,607 compared to €2,893 for patients in lowest cost decile (10%) (Figure 1A). Results were similar for 3 years aggregated (€139,473 vs. €4,086), corresponding to a 34 times higher cost. At index year, variables associated with being in the highest cost decile included young age, male sex, inpatient admittance, renal disease, and several other comorbidities (Figure 1B).

Conclusion
Among patients with HF a large total direct health cost heterogeneity exists with younger age, inpatient admittance, male sex, and comorbidities being associated with a higher likelihood of belonging to the highest cost group.

Acknowledgement/Funding
Novartis
P3834PULSE-COR REGISTRY: non invasive LV stiffness assessment in subjects with essential hypertension
Authors: Torbas O , Sirenko Y U , Rekovets O , Kushnir S 
Published: October 2019

Abstract

Background
Left ventricle (LV) diastolic dysfunction for a long time had been associated with its hypertrophy. But recent studies have demonstrated that it is more associated with LV fibrosis which is also the cause of poor prognosis. Unfortunately, there is no proven tool for its clinicall assessment. The aim of the study was to demonstrate which of LV stiffness parameters are associated with arterial stiffness which we can measure using validated techniques.

Methods
PULSE-COR is one center registry started in 2011 and still running. We included 779 subjects with AH. Final analysis included 320 patients that underwent all necessary diagnostic procedures from whom we have identified a separate cohort of patients (n=283) with essential AH without any significant comorbidities. We used SphygmoCor device (AtCor, Australia) for the determination carotid-femoral pulse wave velocity (cfPWV). Also we measured CAVI and ankle-brachial index (ABI) with the mean of VaSera 1500 (Fukuda Denshi, Japan). Ultrasound diagnostics included vascular ultrasound with intima-media thickness (IMT) measurement. Echocardiography was done according ASE standardized protocol, LV diastolic function was evaluated according to ASE 2016 guidelines. Ventricle-arterial coupling (VAC) was evaluated using standardized formula. In order to find associations we used Spearman correlation analysis.

Results
Mean age was 53,6±2,0 years, 17 men and 30 women. Mean body mass index 29,8±1,0 m/kg2, mean systolic blood pressure (SBP) was 159,8±4,5 mmHg, diastolic BP (DBP) was 97,9±2,6 mmHg, pulse BP (PBP) was 62,0±3,5 mmHg and heart rate (HR) was 76,6±2,2 bits per min. VAC was significantly associated with both (left and right) CAVI (R=0,698; P=0,012 and R=0,683; P=0,014, respectively). ABI was significantly associated with both E/A and E/e' (R=0,716; P=0,006 and R=0,764; P=0,002, respectively). Ea was significantly associated with IMT (R=0,491; P=0,24), total cholesterol (R=0,499; P=0,07), low-density lipoproteins (R=0,687; P=0,001), cfPWV was associated with almost the same factors (R=0,248; P=0,001 for correlation with IMT, R=0,382; P=0,01 for correlation with low-density lipoproteins). Ees was significantly associated with E/A (R=0,159; P=0,007); E/e' (R=-0,130; P=0,029), end diastolic volume (R=0,644; P<0,001) and with blood lymphocytes (R=-0,678; P=0,001).

Conclusions
We have found that VAC was significantly associated with arterial elasticity (CAVI), but we have not any correlation with CAVI for none of its component (Ea or Ees). Arterial elastance (Ea) was associated with similar factors as large arteries stiffness (cfPWV). Ventricle elastance instead was associated with diastolic dysfunction. All these components play role in clinical LV stiffness assessment.
P3835Improvement of myocardial energetic efficiency during treatment in hypertensive patients: the life study
Authors: Losi M A , Mancusi C , Gerdts E , Wachtell K , Kjeldsen S E , Greve A M , Devereux R B , De Simone G 
Published: October 2019

Abstract

Background
Myocardial energetic efficiency (MEE) per unit of left ventricular (LV) mass significantly predicts composite of cardiovascular (CV) events in treated hypertensive patients and specifically heart failure in an event-free population-based cohort with normal ejection fraction, independently of LV hypertrophy (LVH).

Purpose
To investigate whether MEEi changes over time in treated hypertensive patients, and whether different treatments have different effects.

Methods
From the Losartan Intervention For Endpoint study (LIFE Echo Sub-study) we selected 744 hypertensive patients (age 66±7 years; 45% women) with LVH at ECG, without atrial fibrillation, previous or incident myocardial infarction and with normal echocardiographic ejection fraction (>50%). MEE was estimated as the ratio of stroke work to the “double” product of heart rate times systolic blood pressure (BP), simplified as the ratio of stroke volume to heart rate, as previously reported. MEE was normalized for LVM (MEEi) and analyzed in quartiles at baseline and at the end treatment, according to an “intention-to-treat” protocol.

Results
Age and proportion of women were not significantly different from the highest to the lowest quartiles (from 65±7 to 66±7 years, p for trend=0.352; from 45% to 42%, p=0.946, respectively), whereas diastolic blood pressure (from 97±8 to 100±9 mmHg, p=0.006), prevalence of obesity (from 14 to 31%, p=0.001) and diabetes (from 4 to 14%, 0.004) progressively increased. Prevalence of concentric LV geometry and echocardiographic LVH also progressively increased from the highest to the lowest quartile (from 14 to 70%, and 61 to 90%, both p<0.0001). MEEi increased over time (p<0.007), independently of initial diastolic BP, diabetes and obesity, significantly more in patients treated with atenolol than with losartan (p<0.0001) (Figure), due to both increased stroke volume and decreased heart rate (both p<0.0001).
Figure 1

Conclusions
In a randomized clinical study, MEEi improves with anti-hypertensive therapy. Improvement is more evident in patients with atenolol than with losartan-based treatment, possibly providing pathophysiologic explanation of the comparable performance in prevention of ischemic heart disease previously reported in the LIFE study.
P3838Evaluation of echocardiographic determinants of interatrial block in patients with essential hypertension
Authors: Kalcik M , Bekar L , Celik O , Yetim M , Dogan T , Karaarslan O , Ekinozu I , Yilmaz M M , Gokdeniz T , Karavelioglu Y 
Published: October 2019

Abstract

Introduction
Interatrial block (IAB), defined as a conduction delay between the right and left atrium, is manifested on the electrocardiogram as a prolonged P-wave duration. Large number of studies recently have been published regarding the prevalence of IAB and its associations with cardiovascular events. It has been previously reported that myocardial fibrosis may cause conduction delays in hypertensive patients. In this study, we aimed to investigate the echocardiographic determinants of IAB in patients with hypertension.

Methods
This study enrolled a total of 220 patients [male: 93 (42.3%), mean age: 61.8±7.8 years] with hypertension. Patients with atrial fibrillation were excluded. IAB was defined as P wave duration of ≥120 ms with or without presence of notching. Routinely obtained 12-lead electrocardiography recordings were examined, and patients were divided into two groups as those with and without IAB. All patients were evaluated by transthoracic echocardiography.

Results
Electrocardiography revealed IAB in 70 patients. The baseline demographic characteristics of the patients with and without IAB were similar in both groups. Left atrial diameter (LAD), interventricular septal thickness, posterior wall thickness, left ventricular mass, left ventricular mass index, and the prevalence of left ventricular hypertrophy (LVH) were found to be significantly increased in hypertensive patients with IAB. Increased LAD (OR=1.082; 95% CI: 1.006–1.164; p=0.034) and LVH (OR=3.051; 95% CI: 1.164–7.994; p=0.023) were found to be independent predictors of IAB. In the receiver operating characteristic curve analyses, LAD values above 38 mm predicted IAB with a sensitivity of 68%, and a specificity of 58% (AUC= 0.678; 95% CI: 0.601–0.754; p<0.001).

Conclusion
A significant association exists between the presence of IAB and echocardiographic parameters related to left ventricular hypertrophy and left atrial dilatation in patients with essential hypertension. The presence of IAB may be used as an electrocardiographic marker of cardiac remodelling and myocardial fibrosis in hypertensive patients.
P3850Impact of sex and risk factors for venous thromboembolism on the clinical course of first acute venous thromboembolism. Insights from the PREFER in VTE
Authors: Giustozzi M , Barco S , Valerio L , Klok F A , Vedovati M C , Becattini C , Konstantinides S V , Agnelli G 
Published: October 2019

Abstract

Introduction
The interaction between sex and specific provoking risk factors for venous thromboembolism (VTE) may influence initial presentation and prognosis.

Purpose
We investigated the impact of sex on the risk of recurrence across subgroups of patients with first VTE classified according to baseline risk factors.

Methods
PREFER in VTE was an international, non-interventional registry (2013–2015) including patients with a first episode of acute symptomatic objectively diagnosed VTE. We studied the risk of recurrence in patients classified according to baseline provoking risk factors for VTE consisted of i) major transient (major surgery/trauma, >5 days in bed), ii) minor transient (pregnancy or puerperium, estroprogestinic therapy, prolonged immobilization, current infection or bone fracture/soft tissue trauma); iii) unprovoked events, iv) active cancer-associated VTE.

Results
A total of 3,455 patients diagnosed with first acute VTE were identified, of whom 1,623 (47%) were women. The percentage of patients with a major transient risk factor was 22.2% among women and 19.7% among men. Minor transient risk factors were present in 21.3% and 12.4%, unprovoked VTE in 51.6% and 61.6%, cancer-associated VTE in 4.9% of women and 6.3% of men, respectively. The proportions of cases treated with Vitamin-K antagonists (VKAs) and direct oral anticoagulants (DOACs) were similar between sexes. Median length of treatment of VKAs was 181.5 and 182.0 days and of DOACs was 113.0 and 155.0 days in women and men, respectively. At 12-months of follow-up, VTE recurrence was reported in 74 (4.8%) women and 80 (4.5%) men. Table 1 shows the sex-specific proportion of recurrences by VTE risk factor categories.
Table 1 Major Transient (n=722) Minor transient (n=573) Cancer-associated (n=195) Unprovoked (1965) Women (361) Men (361) OR (95% CI) Women (346) Men (227) OR (95% CI) Women (79) Men (116) OR (95% CI) Women (837) Men (1128) OR (95% CI) One-year follow-up, n (N%)   Recurrent VTE, 21 (6.2) 10 (2.9) 0.46 (0.2; 0.9) 9 (2.7) 12 (5.4) 2.09 (0.9; 5.0) 6 (8.0) 5 (4.5) 0.54 (0.2; 1.9) 38 (4.7) 53 (4.7) 1.03 (0.7; 1.6)   Major bleeding, 6 (1.8) 5 (1.5) 0.83 (0.3; 2.7) 5 (1.5) 1 (0.5) 0.30 (0.1; 2.6) 1 (1.3) 3 (2.7) 2.07 (0.2; 20) 10 (1.2) 15 (1.4) 1.11 (0.6; 2.4)   All-cause death, 37 (10.2) 31 (8.5) 0.82 (0.5; 1.4) 10 (2.9) 14 (6.2) 2.21 (0.9; 5.1) 26 (32.9) 49 (42.2) 1.49 (0.8; 2.7) 33 (3.9) 30 (2.7) 0.66 (0.4; 1.1)

Conclusions
The proportion of patients with recurrent VTE events after first acute symptomatic VTE provoked by transient risk factors was not negligible during the first year of follow-up during in both women and men. These results may have implications on the decision whether to consider extended anticoagulant therapy in selected patients with provoked events.

Acknowledgement/Funding
This study was funded by Daiichi Sankyo.
P4127CMR normal reference values of biventricular size and function in male athletes
Authors: D'Ascenzi F , Anselmi F , Piu P , Fiorentini C , Focardi M , Bonifazi M , Mondillo S 
Published: October 2019

Abstract

Background
Exercise-induced enlargement of cardiac chambers is commonly observed in competitive athletes. However, ventricular dilatation is also a common phenotypic expression of life-threatening cardiomyopathies. The use of cardiac magnetic resonance (CMR) for the exclusion of pathology is growing. However, normal reference values have not been established for athletes. The aim of this meta-analysis was to derive normal reference values of biventricular size and function estimated by CMR in competitive athletes.

Methods
We conducted a systematic review of English-language studies in the MEDLINE, Scopus, and Cochrane databases investigating biventricular size and function by CMR in athletes. Athletes were divided into endurance, combined, and mixed groups according to the sport practiced. The potential impact of training volume was also evaluated.

Results
Twenty-seven studies and 983 competitive athletes were included for CMR quantification of biventricular size and function. In this review, normal reference values are presented for biventricular size and function to be applied to male competitive athletes according to the disciplines practiced. A significant impact of training volume was demonstrated for the right ventricle: athletes practicing the largest number of training hours per week were those exhibiting the greatest degree of right ventricular remodeling (Figure 1). Notably, biventricular function was not significantly affected by training volume.
Figure 1

Conclusions
The present meta-analysis defines the normal limits of biventricular size and function estimated by CMR in competitive athletes. The authors suggest using these normal reference values as an alternative to standard upper limits derived from the general population when interpreting CMR images in athletes.
P4133Atrial fibrillation in elderly patients with syncope and dementia: clinical insights from a large multicenter Italian registry
Authors: Ceccofiglio A , Fumagalli S , Mossello E , Mussi C , Bo M , Martone A M , Bellelli G , Nicosia F , Riccio D , Langellotto A , Tava G , Boccardi V , Tonon E , Abete P , Ungar A 
Published: October 2019

Abstract

Background
Syncope and dementia have a high prevalence in elderly individuals. Atrial fibrillation (AF) frequently occurs at advanced age. The coexistence of these conditions can be indicative of a clinically relevant frail status.

Purpose
The aim of this study was to evaluate the characteristics and the long-term outcome of AF patients with dementia and a history of syncope.

Methods
We evaluated the Syncope and Dementia (SYD) Registry. Data were collected by 11 Geriatric Departments between 2012 and 2016. Follow-up was closed at the 12-month evaluation.

Results
During the study period, 522 patients (women – 324, 62.1%; MMSE: 17±6) were enrolled. Of these 138 (26.4%) have or presented a history of AF. Patients with AF were older (85±6 vs. 83±6 years, p=0.012), with a higher heart rate (78±17 vs. 73±14 bpm, p<0.001), had a more complex clinical picture with an increased number (3.9±2.0 vs. 3.0±1.8, p<0.001) and severity (1.8±0.3 vs. 1.6±0.4, p<0.001) of comorbidities, as assessed with the Cumulative Illness Rating Scale. In particular, the prevalence of diabetes (28.3 vs. 20.1%, p=0.047), heart failure (13.8 vs. 7.3%, p=0.023) and stroke/TIA (26.1 vs. 17.7%, p=0.035) was higher in patients with the arrhythmia. Cardiac syncope was more frequently diagnosed at the final evaluation (18.8 vs. 4.9%, p<0.001). Even if the use of antipsychotics (13.0 vs. 27.6%, p=0.001) and cholinesterase inhibitors (6.5 vs. 16.4%, p=0.004) were less used in AF subjects, the total number of prescribed drugs was higher (6.9±2.9 vs. 5.9±2.7, p<0.001). At multivariate analysis (overall predictivity: 75%), AF patients were characterized by advanced age (p=0.041), a higher severity of comorbidities (p<0.001), a greater number of drugs (p=0.020), an increased heart rate (p=0.004) and a more frequent presence of cardiac symptoms (p=0.049).
At one-year follow-up (8 patients lost), the mortality rate in AF patients was 27.7% (N=36/130). Deceased patients presented a greater degree of disability (number of lost activities of daily living: 3.7±2.3 vs. 2.8±1.9, p=0.020) and a higher heart rate at baseline (85±17 vs. 76±15 bpm, p=0.006). Multivariate analysis (overall predictivity: 74%) confirmed the association of disability (p=0.039) and heart rate (p=0.045) with prognosis.

Conclusions
AF is frequently present in patients with dementia and a history of syncope. It is usually associated with a more complex clinical picture and high long-term mortality. Heart rate and a higher degree disability seem to be related to prognosis.

Acknowledgement/Funding
None