bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1426 Non-cardiac sourses of thromboembolic complications in atrial fibrillation
Authors: Germanova O , Germanov A 
Published: January 2020

Abstract

Background
Thromboischemic stroke is a significant medical problem. The most dangerous arrhythmia that causes the thromboembolism is atrial fibrillation. The source of thrombus mostly located in left atrium appendage or apex of left ventricle. But there’re a lot of cases of thromboischemic stroke in patients with atrial fibrillation without any intra-heart thrombus.

Purpose
To study the possibility of thromboembolic complications in patients with permanent form of atrial fibrillation without intra-heart thrombus.

Materials and methods
We included 48 patients with permanent form of atrial fibrillation. Mediana age - 68 ± 4,6 y.o. 32 (66,7%) were men and 16 (33,3%) women. All patients were performed 24-hours ECG monitoring to verify the atrial fibrillation. 34 (70,8%) were regularly took warfarin or NOACs to prevent the thromboembolic complications. We used CHADS-2 scale to make the prognosis of 1-year thromboembolic complications. 0 points - 0 (0%) patients, 1 point - 1 (2,1%), 2 points - 2 (4,2%), 3 points - 8 (16,6%), 4 points - 7 (14,5%), 5 points - 18 (37,5%), 6 points - 12 (25,1%). All patients were made transesophageal echocardiography. Only 3 (6,2%) of them had intra-heart thrombus. Intra-arterial blood flow we measured with Doppler-ultrasound. Most of patients – 39 (81,3%) had atherosclerotic plaques of internal carotid artery on one or both sides. In 22 (45,8%) patients were the signs of non-stability of plaques (heterogenic structure, rough surface). We valued the arterial wall kinetic parameters with sphygmography: speed, acceleration, power, work. We analyzed these parameters in different cardiocycles.

Results
We observed the following patterns:
1. If longer was the pause between cardiocycles in atrial fibrillation then more increase of biomechanical and kinetic parameters was observed.
2. The secondary hemodynamic arterial hypertension at the moments after long pause between cardiocycles. The longest duration of it was observed in bradysystolic atrial fibrillation (up to 38% of time).
3. In patients with hemodynamically important stenosis (about 70%) of internal carotid artery the speed after the long pause in atrial fibrillation is rising up to 4-4,5 meters per second. In comparison with sinus rhythm it is about 2,3 meters per second. Such rising of speed can cause the plaque integrity damage of parietal thrombus fragmentation.
4. Increased arterial wall deformation. The increased biomechanical parameters cause the appearance of additional waves, stand waves that may cause non-stability of plaques with further thromboembolism.
5. During the 1-year observation thromboembolic comlications appeared in 11 (22,9%) patients.

Conclusion
The source of thromboembolic complications can be non-cardiac in patients with multi-focus atherosclerosis and non-stable plaques.
P1428 Mortality in non-ischemic cardiomyopathy is low and close to the general population
Authors: Melichova D , Nguyen T M , Salte I M , Klaebo L G , Sjoli B , Karlsen S , Dahlslett T , Leren I S , Edvardsen T , Brunvand H , Haugaa K H 
Published: January 2020

Abstract

Funding Acknowledgements
South Eastern Norway regional health authority

Background
Patients with non-ischemic dilated cardiomyopathy (NDCM) have lower mortality compared to patients with ischemic cardiomyopathy (ICM). Recent reports suggest less benefit of a primary prophylactic implantable cardioverter defibrillator (ICD) in NDCM.

Purpose
We aimed to investigate mortality rate and appropriate ICD therapy in a consecutive cohort of patients with NDCM and ICM.

Methods
In this prospective multi-center study, we consecutively included NDCM and ICM patients with left ventricular ejection fraction (LVEF) &lt; 40% from July 2014 to January 2018. ICM or NDCM classification was based on coronary angiography. Echocardiography was performed at inclusion and LVEF and global longitudinal strain (GLS) were assessed. All-cause mortality and primary prevention ICD therapies were recorded during follow-up.

Results
We included 290 patients (67 ± 13 years old, 74% males), 207 with ICM and 83 with NDCM. At inclusion LVEF was 31 ± 6% and GLS -10.5 ± -3.3%. Patients with ICM were older (68 ± 12 years vs. 63 ± 15 years, p &lt; 0.01), had better LVEF (32 ± 6% vs. 28 ± 7%, p &lt; 0.01), and shorter QRS duration (106 ± 23 ms vs. 122 ± 28 ms, p &lt; 0.01). A primary prevention ICD was implanted in 18 (9%) ICM patients and in 21 (25%) NDCM patients (p &lt; 0.001).
During 22 ±12 months follow up, all-cause mortality was 27 (9%) in the entire population. In patients with ICM 1/18 (6%) received appropriate shock from their primary prevention ICD compared to 3/21 (14%) NDCM patients. Mortality was more frequent in ICM; 26/207 (13%) compared to 1/83 (1.2%) in NDCM (Log rank p &lt; 0.01). All-cause mortality or appropriate ICD shock was more frequent in ICM compared to NDCM (27 (13%) vs. 4 (5%) log rank p = 0.02) (Figure). Assuming the arrhythmias treated by the ICD shocks would have been lethal, annual mortality of 2.5% in the NDCM population was only slightly higher compared to the age matched general population (1% annual mortality) (blue line).

Conclusion
Patients with NDCM had better survival, and in general a lower event rate, compared to patients with ICM. However, subgroups of NDCM patients may benefit from their primary prophylactic ICD and further studies should investigate the need of primary prevention ICD in patients with NDCM.
Abstract P1428 Figure.
P1432 Heart failure subgroups according to left ventricular ejection fraction A latent class analysis
Authors: Morbach C , Henneges C , Sahiti F , Breunig M , Cejka V , Ertl G , Frantz S , Angermann C E , Stoerk S 
Published: January 2020

Abstract

Funding Acknowledgements
German Research Foundation (BMBF 01EO1004 and 01EO1504)

OnBehalf
AHF
Background & Aims Heart failure (HF) is classified according to left ventricular (LV) ejection fraction (EF) into heart failure with reduced (HFrEF) and heart failure with preserved EF (HFpEF). In 2016, a third subgroup, heart failure with mid-range EF (HFmrEF), has been introduced by the ESC. We aimed to identify the number of naturally occurring heart failure subgroups according to LVEF using latent class analysis.
Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for acute heart failure (AHF). Echocardiography was performed within 72 hours prior to discharge. We first estimated the distribution of LVEF using histogram and kernel density estimation methods (bandwidth was selected by biased cross-validation). We then fitted Gaussian Mixture Models with increasing number of components to the data. To select the optimal number of components we calculated the Akaike Information Criterion (AIC) and the Bayesian Information Criterion (BIC). The minimum of each criterion suggests the optimal number of components for the final model. The BIC requires more data to select more components than the AIC and hence is more conservative. Finally, for each criterion the optimal model was determined.
Results Out of 629 patients, 585 (93%) patients received echocardiography and in 498 (79.2%) the LVEF could be calculated using Simpson´s biplane or monoplane method.
The BIC suggested two (panel B), the AIC three components (panel A). In the two-component model, mean ± SD LVEF values were 60.2 ± 8.7% and 30.8 ± 9.6%, thus covering 56% and 44% of patients, respectively (panel D). In the three-component model, respective LVEF values were 64.9 ± 6.2%, 50.2 ± 6.9%, and 28.4 ± 8.1%, thus covering 35%, 27%, and 38% of patients (panel C).
Conclusions Our analysis suggests that LVEF in patients with AHF is not a continuum, but clusters in two or three subgroups. In line with the HFrEF and HFpEF classification, the more conservative model suggested two subgroups of LVEF. The less restrictive model allowed for a third subgroup, compatible with HFmrEF. Future analyses will better characterize the identified subgroups.
Abstract P1432 Figure
P1434 Evolution of coronary wall shear stress following implantation of bioabsorbable vascular scaffolds - first results of a 1-year follow-up pilot study
Authors: Benedek T , Ferent I , Benedek A , Cernica D , Nita C , Puiu A , Itu L , Rapaka S , Puneet S , Benedek I S 
Published: January 2020

Abstract

Funding Acknowledgements
This research has been funded by the research grant PlaqueImage, contract number 26/01.09.2016, SMIS code 103544, Project funded by the European Union

Aims
Coronary shear stress (CSS) has been recently recognized to play a significant role in coronary plaque progression and vulnerabilisation. However, the evolution of CSS after implantation of different types of coronary stents is still under investigation. The aim of this study was to assess the evolution of the CSS along the coronary lesions following implantation of bioabsorbable vascular scaffolds (BVS), to determine the impact of BVS on coronary flow haemodynamics.

Methods and results
This was a single center prospective pilot study which enrolled 15 patients (aged 58.35 +/- 7.79 years, 13 males) with coronary artery disease undergoing BVS implantation in a major epicardial vessel. In all patients, angio CT scanning (Siemens Somatom Sensation scanner, Erlangen, Germany) was performed prior to the BVS implantation and repeated after 12 months. Lumen information was extracted from the vessels of interest and coronary rest hemodynamics, including CSS, were calculated using a computational fluid dynamics solver. All shear stress calculations were performed at baseline and repeated after 1 year. Average CSS was determined proximally, distally, and at the level of the minimal lumen area (MLA). Average CSS along the stented segment significantly decreased after BVS implantation, from 2.87 +/- 1.64 Pa at baseline to 1.9 +/- 0.49 at 1 year (p = 0.0001). Maximum CSS along the segment also exhibited a significant decrease, from 11.78 +/- 10.06 Pa to 6.35 +/- 3.08 Pa (p = 0.0009). Proximally to the MLA, CSS significantly decreased after BVS implantation, from 3.39 +/- 1.93 Pa at baseline to 1.91 +/- 0.68 Pa at 1 year (p &lt;0.0001). However, this decrease in CSS was not significant distally to the MLA (1.3 +/- 0.72 Pa vs 1.59 +/- 0.65 Pa, p = 0.9).

Conclusions
Implantation of BVS leads to a significant decrease of CSS after 1 year, especially within coronary segments located proximally to the stenosis. This underlines the role of BVS in re-establishing a physiological pattern of coronary flow in diseased coronary vessels. The feature (mentioned herein) is not commercially available. Due to regulatory reasons its future availability cannot be guaranteed.
P1437 Integrated ST segment elevation score as a new predictor of the myocardial scar extent determined with LGE-CMR at 1-month follow-up after STEMI
Authors: Mester A , Benedek T , Opincariu D , Benedek A , Ratiu M , Hodas R , Cernica D , Kovacs I , Rat N , Chitu M , Benedek I 
Published: January 2020

Abstract

Funding Acknowledgements
Funded by the research grant PlaqueImage, contract number 26/01.09.2016, SMIS code 103544, by the European Union and the Government of Romania

Background
The inflammatory response in the acute phase of a myocardial infarction, as well as in later phases contributes to the healing process of the infarcted myocardium and the left ventricular remodeling. Restoration and improvement of LV function highly depends on the magnitude of scar formation. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging has been validated for an accurate determination of the myocardial scar size and transmurality. The recovery of ST segment elevation is a liable marker of vessel patency following PCI.

Purpose
The aim of the study was to validate a new integrated score of ST segment elevation score (ISSTE) as a new predictor of the myocardial scar tissue size, in relation with increased inflammatory biomarkers, with the extent of myocardial fibrosis at one month, assessed with LGE-CMR, after STEMI.

Methods
We included 65 patients with STEMI who underwent urgent revascularization with PCI in the first 12 hours from the onset of symptoms. The ISSTE was determined by summing the ST segment elevation in all registered ECG leads at presentation (ISSTE-1) and at 2 hours (ISSTE-2) after primary PCI. Blood samples were also collected at baseline and day-5 for determination of serum hs-CRP levels. At 1-month follow-up all patients under LGE-CMR (1.5T scanner) for evaluation of the myocardial scar extent (volume, percentage, transmurality).

Results
ISSTE-2 was significantly correlated with day-5 hs-CRP serum levels (r = 0.546, 95%CI: 0.030-0.832, p = 0.037), although no significant correlations were noted with baseline hs-CRP levels (r= 0.238, p = 0.407). There were no significant correlations between ISSTE-1 score and the myocardial scar percentage (r = 0.241, p = 0.11) or high transmurality volume (r = 0.194, p = 0.21), while ISSTE-2 significantly correlated with myocardial scar mass (r = 0.406, 95%CI: 0.107-0.637 p = 0.007) and high transmurality volume (r = 0.344, 95%CI: 0.0320-0.596, p = 0.0273). The restoration of the ST segment, reflected by the difference between ISSTE-1 and ISSTE -2 is correlated with the infarct size mass (r = 0.336, 95%CI: 0.0307 -0.584, p = 0.027).

Conclusion
The magnitude of ST segment elevation determined at 2 hours after PCI was associated with the inflammatory response at day 5 after STEMI and it may serve as a predictor for the extent of the myocardial scar tissue determined with LGE-CMR at 1 month following STEMI. The ISSTE-1 score calculated at presentation does not reflect extent of the affected myocardial tissue following PCI.
P1438 the impact of on-admission hyperglycemia in patients with STEMI on the left ventricular function and 60 days mortality
Authors: Aldujeli A , Stoskute N , Plisiene J , Unikas R 
Published: January 2020

Abstract

Background
Impaired on-admission glucose (AG) levels in patient with acute myocardial infarction is an often finding, even in the absence of diabetes mellitus (DM) within the patient past medical records. However, data regarding the relationship between hyperglycemia and LV function in STEMI are scarce. Furthermore it is unclear whether on-admission hyperglycemia tends to have any short to mid term-prognostic significance.

Purpose
The aim of this study was to determine the relationship of on-admission hyperglycemia on myocardial damage and evaluate the Short to mid term-prognostic significance of hyperglycemia in a high-risk STEMI population.

Methods
234 Consecutive patients with STEMI who underwent primary percutaneous coronary intervention were prospectively selected. Plasma glucose level was measured on admission in all selected patients. Hyperglycemia was defined as admission plasma glucose level equal or more than 11.1 mmol/l. LV function was assessed by the measurement of EF using Simpson"s biplane method and by measurement of global longitudinal strain (GLS) using 2D speckle-tracking echocardiography (STE). The primary clinical end point was the occurrence of major adverse cardiovascular events at 60 days follow-up. Statistical analyses were performed using the SPSS 20.0 software. The value of p &lt; 0,05 was considered as statistically significant.

Results
Patients were categorized on the basis of glucose level. 71 patients with high plasma glucose on admission were classified as a hyperglycemia group. Other 163 patients were assigned to a normoglycemia group. LV ejection fraction was significantly impaired within hyperglycemic group (44.9 ± 10,6% vs 50,4 ± 7,5%, p &lt; 0.02), as well as, GLS was similarly impaired in hyperglycemia group (-12.9 ± 4.2% vs. -15.5 ± 3.4, p &lt; 0.001). Occurrence of 60-days mortality was significantly higher in patients with hyperglycemia compared with normoglycemia group (10,3 % vs. 2%, p &lt; 0.05). Multivariable linear regression analysis revealed admission glucose level is independently associated with LV GLS (B = 0.08, 96 % CI 0.04 - 0.17, p &lt; 0.01). In multivariable logistic regression analysis was showed that admission glucose level is independently associated with 60-days mortality after adjustment of clinical variables (OR 1.10, 95% CI 1.01 - 1.25, p &lt; 0.05).

Conclusion
Our Study reveals that on-admission hyperglycemia is strong and independent predictor of left ventricular function and 60 days mortality in patients with ST-elevation myocardial infarction .
Abstract P1438 Figure.
P1443 Sex differences of coronary physiology can be justified by fractional myocardial mass
Authors: Kim H Y , Kim K H , Choi J H 
Published: January 2020

Abstract

Background Women has lower prevalence of coronary artery disease but has higher mortality from acute myocardial infarction. The gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease.

Purpose
We hypothesized that the gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease.
Background Women has lower prevalence of coronary artery disease but has higher mortality from acute myocardial infarction. The gender difference in the anatomical-physiological relationship may elucidate the gender difference in the clinical presentation of coronary artery disease.
Methods In this multicenter registry, 482 patients who underwent coronary CT angiography and fractional flow reserve (FFR) measurement were enrolled. Fractional myocardial mass (FMM, a vessel-specific amount of myocardium) and %FMM (fraction of FMM to whole myocardial mass) was measured in major coronary arteries and branches. FFR and quantitative coronary angiography (QCA) were interrogated in the subset of 772 vessels. The severity of physiological or anatomical stenosis was assessed by FFR and diameter stenosis (DS), respectively.
Results In the analysis of all major epicardial arteries (N = 3,833), FMM was lower in women compared to men (p &lt; 0.01, all), but %FMM was similar between women and men (p = NS, all). Among physiologically assessed 772 vessels, compared to men (N = 587), vessels of women (N = 185) showed smaller dimension (reference diameter (RD) = 2.90 ± 0.65 vs 3.14 ± 0.69 mm, minimal luminal diameter (MLD) = 1.30±.0.57 vs 1.40 ± 0.57 mm (p &lt; 0.05, all), similar severity of stenosis (DS = 55% vs 55% p = NS), and higher FFR (0.81 ± 0.13 vs 0.78 ± 0.15, p &lt; 0.001). In subgroup analysis according to the tertiary categories of DS, RD, and MLD, vessels of women showed higher FFR and lower FMM. Generalized estimating equations modeling demonstrated that gender, DS, RD, MLD, and location in left anterior descending artery were not (p = NS, all) but FMM/MLD were significant predictors for FFR ≤ 0.80 (p = 0.021).

Conclusions
Compared to men, coronary arteries of women are smaller and supply smaller amount of myocardium even after adjusting for vessel size, which may explain overall higher FFR value of women. This gender difference in anatomical-physiological relationship may explain the gender difference in the clinical coronary artery disease.
Abstract P1443 Figure.
P1444 Occurrence and predictors of right ventricular dysfunction after pericardiocentesis
Authors: Matsutani H , Amano M , Izumi C , Baba M , Abe R , Hashiwada S , Kuwano K , Shimada M , Sakamoto J , Miyake M , Tamura T , Matsuo S 
Published: January 2020

Abstract
Background—The changes in cardiac function that occur after pericardiocentesis are unclear.Purpose—This study was performed to assess right ventricular (RV) and left ventricular (LV) function with echocardiography before and after pericardiocentesis.
Method and Results—In total, 19 consecutive patients who underwent pericardiocentesis for more than moderate pericardial effusion were prospectively enrolled from August 2015 to October 2017. Comprehensive transthoracic echocardiography was performed before, immediately after (within 3 hours), and 1 day after pericardiocentesis to investigate the changes in RV and LV function. RV dysfunction is defined as meeting three of the four criteria: a TAPSE of &lt;17 mm, an S’ of &lt;9.5 cm, an FAC of &lt;35%, and an RV free wall longitudinal strain &gt;−20%. The mean age of all patients was 72.6 ± 12.2 years. The changes of echocardiographic parameters related to RV function are shown in Table. After pericardiocentesis, RV inflow and outflow diameters increased and the parameters of RV function significantly decreased. These abnormal values or RV dysfunction remained at 1 day after pericardiocentesis. Conversely, no parameters of LV function parameters changed after pericardiocentesis. Of 19 patients, 13 patients showed RV dysfunction immediately after pericardiocentesis and 6 patients did not. RV free wall longitudinal strain before pericardiocentesis was higher in patients with post-procedural RV dysfunction (−18.9 ± 3.6%) than in those without (−28.4 ± 6.3%). ROC analysis revealed that a RV free wall longitudinal strain cut-off value of −23.0% had a sensitivity of 100% and a specificity of 83.3% for predicting the occurrence of RV dysfunction after pericardiocentesis (AUC = 0.910).
Conclusions—The occurrence of RV dysfunction after pericardiocentesis should be given more attention. Pre-existing RV dysfunction maybe related to the occurrence of RV dysfunction after pericardiocentesis.
Changes in RV function before and after Before Immediately after One day after P−value Basal right ventricular linear dimension (mm) 32.8 ± 5.0 37.1 ± 4.4† 33.6 ± 5.4 0.028 Mid-cavity right ventricular linear dimension (mm) 34.5 ± 4.6 38.8 ± 5.3† 37.0 ± 5.6 0.0504 Proximal right ventricular outflow diameter (mm) 30.2 ± 4.0 33.9 ± 3.5† 31.4 ± 3.9 0.014 TAPSE (mm) 20.0 ± 4.2 13.6 ± 4.3* 14.7 ± 3.9 &lt;0.001 S" (cm/s) 12.6 ± 3.3 8.7 ± 2.4* 9.1 ± 2.4 &lt;0.001 Fractional area change (%) 48.3 ± 5.9 37.8 ± 8.0* 40.0 ± 9.0 &lt;0.001 Right ventricular free wall strain (%) −21.3 ± 6.3 −15.8 ± 6.7* −16.9 ± 5.2 0.036 Tricuspid regurgitation velocity peak (m/s) 2.41 ± 0.29 2.43 ± 0.25 2.34 ± 0.32 0.37