bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5355Evaluation of maternal heart rate during the first week postpartum with wearable device
Authors: Gherbesi E , Squillace M , Gobbi C , Schiavone M , Malanchini G , Castelli B , Famiani R , Zippo D , Ossola M W , Bonanomi C , Lombardi F 
Published: October 2019

Abstract

Background
Throughout pregnancy and puerperium significant cardiovascular changes occur. Maternal heart rate (HR) increases from the first to the third trimester of pregnancy, with a further increase during labor. Changes in the postpartum period are less well defined, in particular, the phenomenon of postpartum maternal bradycardia (PMB).

Purpose
To describe the distribution of HR in the first week postpartum, the incidence of PMB and to investigate the relationship between PMB and other maternal factors such as age, BMI and type of delivery.

Methods
Women who gave their informed consent during a clinical evaluation in the third trimester of pregnancy, and delivered at our tertiary centre between 01/01/2018 and 30/09/2018, were included. Within 12 hours from delivery, a wrist-worn tracker with a light-emitting diode (FitBit Alta HR) was applied and then removed one week postpartum. Data were extracted as 5 minutes recordings, each showing a mean HR. Only day-time recordings were considered. PMB was defined as ratio between bradycardia recordings (mean HR<60 bpm) and all recordings >0.6. SPSS was used for statistical analysis.

Results
252 women were included (mean age 35.3±5 years, BMI 23.3±5 kg/m2). 63% of women underwent caesarean section. Mean HR of the total population on day 1 after delivery was 80.7±11 bpm and then progressively decreased, with a mean HR on day 7 of 76.5±12 bpm (figure 1). 24 women developed PMB, with an incidence of 9.5%. The trend of HR in bradycardic women was opposite to that of non-bradycardic women, with an increase from day 1 (55±7 bpm) to day 7 (60.5±9 bpm) (figure 2). Device recordings during the first two days were in agreement with periodic bedside HR measurements. No bradycardic woman experienced syncope or pre-syncope or required treatment. PMB showed a positive correlation with caesarean section vs. vaginal delivery (p<0.01) and maternal age (p<0.05). No correlation was found with BMI and postpartum haemoglobin.
Trend of HR in the first week postpartum

Conclusion
In our population the incidence of PMB identified with wearable device was 9.5% and was associated with caesarean section and maternal age. Considering that HR returned within normal limits 7 days after delivery and no woman was symptomatic, our study suggests that PMB might be considered a benign entity.
P5361Pregnancy in patients with cardiac arrhythmias
Authors: Kirgizova M , Dedkova A , Kisteneva I , Borisova E 
Published: October 2019

Abstract

Introduction
Negative trends in the state of somatic and reproductive health of the female population are observed in the last decades all over the world. On the background of declining birth rates, the problems of managing pregnancy in women with extragenital pathology become relevant.

Aim
To study the effects of cardiac arrhythmias and antiarrhythmic treatment on the course and outcomes of pregnancy.

Material and methods
A total of 55 case histories of pregnant women hospitalized in the Department of Interventional Arrhythmology. All patients signed informed consent to be enrolled in the study. The age of patients ranged from 17 to 41 years (mean age of 30.2±4.0 years). Patients were hospitalized on average at 28.0±6.4 weeks of gestation (from 12 to 37 weeks) and had some form of cardiac arrhythmia.

Results
Cardiac arrhythmias were idiopathic in 65% of cases; the rest of patients had verified cardiovascular diseases. Cardiac arrhythmias were registered in 41 (74%) of women prior to pregnancy and their arrhythmological history lasted for 7.9±1.1 years. Extrasystolic arrhythmia was the most common type of cardiac arrhythmias: ventricular premature beats occurred in 23 pregnant women (42%) including supraventricular premature beats in 8 patients (14%), supraventricular tachycardia in 12 patients (22%), and ventricular tachycardia (VT) in 5 women (9%). In three cases, VTs were hemodynamically significant. Radiofrequency ablation (RFA) of VT was performed in pregnant women at 26, 27, and 32 weeks of gestation. Five patients with gestational ages of 27–34 weeks received RFA for atrial tachycardia and atrioventricular (AV) reciprocal tachycardia to treat symptomatic intracardiac tachycardia (n=4) and continuous recurrent AV nodal tachycardia (n=1), paroxysms of which were accompanied by destabilization of hemodynamics.
AV block was registered in 4 pregnant women (9%); sick sinus syndrome was diagnosed in 1 patient (2%). Implantation of pacemaker was required in 1 case for a second-degree AV block type II (Mobitz type II) at 24 weeks of pregnancy. RFA and pacemaker implantation were carried out with minimal or zero fluoroscopy and only after the 22nd week of pregnancy, that is, without or with reduced radiation risk to the fetus.
16 patients (29%) had cesarean section; the rest of patients had spontaneous vaginal delivery. The average Apgar scores were 8.64 immediately after birth and 9.35 five minutes after birth. Preterm births (n=2) were due to obstetric pathology and were not associated with cardiac arrhythmias. Cardiac arrhythmias were not observed in any patient in childbirth.

Conclusions
Cardiac arrhythmias, observed in patients, did not require termination of pregnancy. Catheter ablation for symptomatic, hemodynamically significant, and life-threatening cardiac arrhythmias made it possible to effectively guide pregnant women to delivery with a close follow-up.
P5363Adherence to statin therapy drives survival of patients with symptomatic peripheral artery disease
Authors: Dopheide J F , Ramadani H , Veit J , Adam L , Papac L , Schindewolf M , Vonbank A , Baumgartner I , Drexel H 
Published: October 2019

Abstract

Background
Statins reduce cardiovascular morbidity and mortality, but adherence is suboptimal. We hypothesized that adherence to statin therapy determines survival in a population at very high cardiovascular risk.

Methods
Single center observational study with 691 symptomatic PAD patients admitted to a tertiary university center between 2010 and 2017. Outcome was evaluated over a mean follow-up of 50±26 months. We related statin adherence and LDL-C target attainment to total mortality.

Results
At the first contact, 73% of our PAD patients were on statins with a significant increase in statin use to 81% (p<0.0001) at follow-up: Statin dosage, normalized to simvastatin 40 mg, increased from 50 to 58 mg/ day (p<0.0001), and was paralleled by a mean decrease of LDL-C from 97 to 82 mg/ dL (p<0.0001). The proportion of patients receiving a high intensity statin increased over time from 38 to 62% (p<0.0001). Percent LDL-C decrease over time was highest in patients with high intensity statin treatment, followed by moderate, low intensity or non-statin treatment, respectively (p=0.01).
Patients never receiving statins had a higher mortality rate (34%) as compared to patients being on statins (20%) or having newly received a statin (15%; p<0.01). Moreover, patients on intensified statin medication had the lowest mortality (10%), whereas patients who terminated statin medication or reduced the statin dosage had a higher mortality rate (33% and 43%, respectively; p<0.05).
Figure 1

Conclusion
Our data prove that statin treatment, particularly high-intensity therapy, reduces mortality in symptomatic PAD. In terms of mortality, patients benefit even from de novo statin therapy (“it is never too late”), whereas dose reduction or statin discontinuation have deleterious effects. A strategy of intensive and sustained statin therapy is worthwhile.

Acknowledgement/Funding
None
P5367Indirect comparison of the safety and efficacy of alirocumab and evolocumab: from a comprehensive meta-analysis of 30 randomized controlled trials
Authors: Guedeney P , Sorrentino S , Giustino G , Chapelle C , Claessen B , Ollier E , Laporte S , Camaj A , Kalkman D N , Vogel B , De Rosa S , Indolfi C , Collet J P , Mehran R , Montalescot G 
Published: October 2019

Abstract

Background
Alirocumab and evolocumab, two proprotein convertase subtilisin–kexin type 9 inhibitors, have both been associated with improved outcomes in patients with atherosclerotic cardiovascular disease in addition to standard lipid-lowering therapies. However, their comparative safety and efficacy profiles are unknown.

Purpose
To compare the safety and efficacy of alirocumab versus evolocumab.

Methods
We conducted a systematic review and network meta-analysis of placebo-controlled randomized trials available up to November 2018 evaluating the safety and efficacy of alirocumab and evolocumab. We estimated risk ratio and 95% confidence intervals using fixed effect model in a frequentist pairwise and network metanalytic approach. The primary safety endpoints were any adverse events leading to treatment-discontinuation, injection site reaction, systemic allergic reaction, neurocognitive events, ophthalmologic events and new-onset of diabetes mellitus (DM) or worsening of pre-existing DM. The primary efficacy endpoints were all-cause and cardiovascular (CV) death, myocardial infarction (MI) and stroke. This study was registered in PROSPERO (CRD42018090768).

Results
A total of 30 trials, enrolling 59,026 patients were included in this analysis, of whom 13,607 received alirocumab and 17,931 received evolocumab. Mean weighted follow-up time was 2.5 years, with an exposure time of 144,907 patients-years. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. There were no significant differences between alirocumab and evolocumab in terms of safety endpoints, except for injection site reaction with a 27% increased risk of injection site reaction with alirocumab compared to evolocumab (Figure). Compared with evolocumab, alirocumab was associated with a reduction of all-cause death but not CV death. There were no significant differences in MI or stroke between alirocumab and evolocumab.

Conclusion
Alirocumab and evolocumab share a similar safety profile. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to heterogeneity of the studied populations between the two drugs.
P5391Systemic administration of high-mobility group box 1 can suppress adverse post-infarction ventricular remodeling in a rat infarction model by enhancing self-regeneration
Authors: Goto T , Miyagawa S , Tamai K , Matsuura R , Harada A , Ueno T , Toda K , Kuratani T , Sawa Y 
Published: October 2019

Abstract

Background
High-mobility group box 1 protein (HMGB1) reportedly enhances CXCR4-positive bone marrow-derived mesenchymal stem cell (BM-MSC) recruitment to damaged tissue to promote tissue regeneration.

Purpose
Our aim of this study is to evaluate whether systemic administration of HMGB1 might promote tissue repair in a rat myocardial infarction (MI) model.

Methods
We prepared 26 MI model rats with high ligation of the left coronary artery. Two weeks later, HMGB1 (3 mg/kg/day) or phosphate-buffered saline (control: 3 mL/kg/day) was administered for 4 days via femoral vein. Cardiac performance was evaluated by ultrasonography, left ventricular (LV) remodeling via immunostaining. We then used immunostaining to examine MSC recruitment to damaged tissue in green fluorescent protein bone marrow transplantation (GFP-BMT) model rats, and also performed intravital imaging using two-photon microscopy to visualize BM-cells recruitment in real time.

Results
Compared with control rats, there was a significant improvement in the left ventricular ejection fraction of the HMGB1 group (HMGB1 vs. control: 48.6% ± 5.5% vs. 33.6% ± 5.4%; p<0.01) at 4 weeks after each administration. LV remodeling, characterized by interstitial fibrosis, cardiomyocyte hypertrophy, and a decrease of capillary density, was significantly attenuated in the HMGB1 group compared with control rats. On QT-PCR analysis, VEGF mRNA expression was significantly higher in the HMGB1 group than in the control (border zone; 1.6±0.6 vs. 1.1±0.2; p=0.02, septal zone; 1.1±0.1 vs. 0.9±0.1; p<0.01). In GFP-BMT rats, GFP+/PDGFR+ cells were significantly mobilized to the border zone in the HMGB1 group compared with the control (1331±197 vs. 615±45 /mm2; p<0.01), leading to formation of newly developed vasculature (Figure 1). In intravital imaging, more GFP+ cells were mobilized to the infarction area in the HMGB1 group than in the control, which was further enhanced at 12h later. Additionally, SDF-1 expression in the peri-infarction area increased significantly in MI rats compared with normal rats (MI vs. normal; 2.1±0.4 vs. 0.9±0.1; p<0.01), in where some cell-adhesions of vascular endothelial cells were destroyed.

Conclusions
Systemic administration of HMGB1 mobilized BM-MSCs to the damaged myocardium via the SDF-1/CXCR4 signaling complex. Those BM-MSCs might migrate to extracellular matrix in the border zone via the gap of each endothelial cell, leading to induction of angiogenesis and reduced fibrosis.

Acknowledgement/Funding
None
P5398CircRNAs deregulation in heart failure patients
Authors: Greco S , Made' A , Longo M , Tikhomirov R , Castelvecchio S , Menicanti L , Martelli F 
Published: October 2019

Abstract

Background
Circular RNAs (circRNAs) are an emerging class of noncoding RNAs stemming from the splicing and circularization of pre-mRNAs exons. CircRNAs can regulate transcription and splicing, sequester microRNAs acting as “sponge” and inducing the respective targets, and bind to RNA binding proteins. Recently, they have been found deregulated in dilated cardiomyopathies (DCM), one of the cardiovascular diseases with the worst rate of morbidity and mortality, and whose molecular mechanisms are only partially known.

Purpose
Therein, we will evaluate in ischemic DCM patients the modulation of 17 circRNAs, 14 out of them obtained from literature data on DCM ischemic or not, while the other 3 were circRNAs not characterized in the heart previously. The study aims to identify circRNAs candidates for further functional characterization in DCM. In addition, as differential expression (DE) analysis is not easily performed for circRNAs in RNA-seq datasets, the validated circRNAs will be used to set up the most specific and sensitive bioinformatics pipeline for circRNA-DE analysis.

Methods
We designed divergent and convergent specific primers for 17 circRNAs and their host gene, respectively, and their amplification efficiency was measured by RT-qPCR. Transcripts expression was measured in left ventricle biopsies of 12 patients affected by non end-stage ischemic HF and of 12 matched controls.

Results
We identified cPVT1, cANKRD17, cBPTF as DE, and validated the modulation of 5 out of the 14 DCM-related circRNAs (cHIPK3, cALPK2, cPCMTD1, cNEBL, cSLC8A1), while cPDRM5, cTTN1 showed opposite modulation, which may be due to the specific disease condition. All of them were modulated differently from the respective host gene. CircRNA/miRNA interactions were predicted using Starbase 3.0. Next, mRNAs-targets of the identified miRNAs were predicted by mirDIP 4.1 and intersected with gene expression datasets of the same patients, previously obtained by microarray analysis.
We found that cBPTF and cANKRD17 might sponge 12 and 2 miRNAs, respectively. Enrichment analysis of the relevant targets identified several important pathways implicated in DCM, such as MAPK, FoxO, EGFR, VEGF and Insulin/IGF pathways. In addition, deep RNA-Seq analysis that is currently ongoing and the validated circRNAs will be used to optimize the bioinformatics pipeline for circRNA DE analysis.

Conclusions
We identified a subset of circRNAs deregulated in ischemic HF potentially implicated in HF pathogenesis.
P5408Initiating angiotensin receptor blockade and neprilysin inhibitor (ARNI) in acute heart failure with mechanical support
Authors: Hsin H T , Chiu K M 
Published: October 2019

Abstract

Introduction
Heart failure still poses great threat to the afflicted patients and enormous burden to our health-care community. Thanks to the ushering of “Angiotensin Receptor Blockade and Neprilysin Inhibitor (ARNI), Entresto®”, we have made further progress by saving one out of 5 of our patients with chronic heart failure in this decade. Current treatment guidelines have suggested the commencement of ARNI in patients with chronic stable heart failure. There is no mention of starting ARNI in the very beginning of the acute phase of heart failure, especially in the patients needing mechanical support. We try to illustrate the clinical picture and implication of ARNI in acute heart failure.

Method
The study was conducted in a 20-bed based cardiovascular intensive care unit of a tertiary-referring center of Taiwan. We enrolled patients of cardiogenic shock, who were put on left ventricular assist device (LVAD) (CentriMag). Those who were dependent on any vasopressors (eg. nor-adrenaline or vasopressin) were excluded. Concurrent usage of inotropes, such as adrenalin, dopamine or dobutamine, would not preclude our application of ARNI and enrollment. The endpoint of this study were: successful weaning of LVAD, cardiovascular death, and the percentage of achieving guideline-suggested target dose of ARNI.

Results
From Jan. 2017 to Jan. 2019., there were 30 patients put on LVAD with CentriMag. Thirteen patients were excluded as their hemodynamics depended on nor-adrenaline. Seventeen patients of 53.1±9.6-year-old were enrolled and 13 of them were successfully rid of LVAD. Four patients succumbed during the support of LVAD, and 3 of them were due to cardiovascular death. Upon enrollment the LVEF was 18±10.1% and NT pro-BNP was 10327±12629 pg/ml. Fifty-three percent of the enrollee could be prescribed with the target dose of 200mg bid Entresto® within 5.1±3.6 days of initiating ARNI, but only 23.5% could tolerate 200mg bid as maintenance. On initiating ARNI, on-going acute kidney injury were taking place in 76.5% of our enrollee, but only 23.5% suffered persistent renal failure, depending on long-term renal replacement therapy. After 27.8±23.0 days of LVAD, the LVEF improved (43.3±23.0%) sufficing the weaning off.

Conclusion
The very beginning of acute heart failure may have the highest surge of neurohormonal bombardment by renin-agiotensin-aldosterone system. Initiating ARNI in this stage, particularly in patients needing mechanical support, may offer some clinical benefit, regardless of initial renal function.

Acknowledgement/Funding
None
P5419Cardiac reverse remodeling and recovery in dilated cardiomyopathy medication-naive patients requiring durable left ventricular assist device support
Authors: Taleb I , Yin M Y , Koliopoulou A G , Taleb M , Dranow E , Kemeyou L , McKellar S H , Caine W , Wever-Pinzon O , Alharethi R , Kfoury A G , Fang J C , Stehlik J , Selzman C H , Drakos S G 
Published: October 2019

Abstract

Background
Occasionally new onset cardiomyopathy patients (pts) present late and with such advanced disease stage that they cannot tolerate heart failure (HF) drug therapy. We sought to investigate the cardiac recovery (CR) potential following a combination of left ventricular assist device (LVAD) and guideline-directed HF drug therapy in this medication-naive population.

Methods
Chronic advanced HF requiring durable continuous-flow LVAD were prospectively evaluated. Patients with acute HF (myocarditis etc.) or post LVAD follow up <3 months were excluded. The “meds-treated” group (n=203) comprised patients treated adequately with at least one neurohormonal blocking agent during their HF history (b-blocker, ACEI/ARB, Aldosterone antagonist) and “meds-naive” group (n=8) comprised patients who were never before treated adequately with any HF medication. Baseline and follow up clinical, hemodynamic, imaging and laboratory data were analyzed. LVAD patients were phenotyped as CR responders or non responders, based on published predefined criteria.

Results
Univariate analysis showed that “med-naive” patients were younger, more likely to be on intravenous vasoactive agents, temporary mechanical support and with lower INTERMACS profile before LVAD implantation. Interestingly, no differences were seen in HF symptoms duration or other comorbidities. Baseline and follow up hemodynamics were similar in both groups, besides higher right atrial pressure pre-LVAD in the “meds-naive” group (16 vs 11 mmHg; p=0.04). Baseline echocardiographic (including LV dilation) and biochemical parameters revealed no differences between the groups, besides lower LVEF and higher BNP in the “meds-naive” group (14 vs 19%; p=0.03 and 2352 vs 1270; p=0.03, respectively). CR rates were significantly higher on “meds-naive” versus “meds-failed” group (50.0 vs 13.8%; p=0.005). Despite higher cardiac recovery rates in the “meds-naive” group the time course and magnitude of the favorable functional and structural response was similar among the CR responders of each of the 2 groups.

Conclusion
Young patients with new onset dilated cardiomyopathy sometimes present late, with advanced disease stage, unable to tolerate HF medications and requiring durable LVAD support. This patient population appears to have a potential for CR up to 50% and this could be factored in decisions surrounding their long-term therapeutic options.
P5426His-bundle pacing in CHF-patients with narrow QRS and chronic AF using dual-chamber ICD - an upgrade from single-chamber to dual-chamber ICD
Authors: Ciesielski A , Slawuta A , Boczar K , Zabek A , Malecka B , Gajek J 
Published: October 2019

Abstract

A single-chamber ICD is a standard method for primary SCD prophylaxis. In patients with chronic atrial fibrillation it dose not contribute to the regularization of heart rate, which is crucial for proper treatment.
The aim of our study was to assess the efficacy of direct His-bundle pacing in patients with congestive heart failure and chronic atrial fibrillation using upgrade from single chamber to dual-chamber ICD.

Methods
The study population included 21 patients with CHF and chronic AF implanted primarily with single chamber ICD with etablished pharmacotherapy and stable clinical status.

Results
The echocardiography measurements at baseline and during ollow-up were presented in the table:
Table 1 Baseline Follow-up p-value LVEDD (ms) 67.7±10.7 64.5±8.6 <0.05 EF (%) 27.0±4.8 33.2±6.9 <0.05 NYHA class 2.8±0.6 1.9±0,5 <0.05
During short 4-months of follow-up the mean values of EF and LV dimensions significantly improved. This was also accompanied by functional status improvement.

Conclusions
His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process.