bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1916A novel echo-guided approach of cryoballoon ablation without using contrast medium
Authors: Kanda T , Masuda M , Asai M , Iida O , Okamoto S , Ishihara T , Nanto K , Tsujimura T , Matsuda Y , Okuno S , Mano T 
Published: October 2019

Abstract

Background
Pulmonary vein isolation (PVI) using cryoballoon requires contrast medium injection for the confirmation of appropriate venous occlusion. However, some patients have contra-indications against contrast use such as allergy for contrast medium, bronchial asthma or renal dysfunction. We hypothesized that intra-cardiac echocardiographic observation of microbubble leakage after saline injection from the cryoballoon lumen can be used as a maker of incomplete venous occlusion.

Purpose
The aim of this study was to assess the effect of echo-guided approach using saline injection on the acute clinical outcomes as well as the amount of contrast medium.

Methods
Twenty consecutive patients with paroxysmal atrial fibrillation (AF) were studied. They had any reason to avoid using contrast medium. Plain CT scan was performed in all cases to understand the anatomical features. Intra-cardiac echocardiography was used in all cases to guide transseptal puncture and to confirm pulmonary-vein occlusion. Procedural results and clinical outcomes were compared with patients who were performed by the conventional method (n=279).

Results
In all study patients, we could perform PVI without using contrast medium. A total of 2 patients required touch-up ablation using radiofrequency ablation catheter. The procedure time (85±23 vs 86±27 min, P=0.84), the dose of radiation exposure (108±78 vs. 140±133 mmGy/m2, P=0.29), and ratio of requiring touch-up ablation (5% vs 4%, P=0.81) were similar between the study group and the reference group. There was no significant difference in the AF-free survival rate (73% vs. 76%, P=0.79) during a follow-up period of 14±6 months.
Images of ICE

Conclusion
Echo-guided approach using saline infusion was effective and less invasive in terms of reduction of contrast use.
P1927A European randomised controlled trial for m-health guided cardiac rehabilitation in the elderly; results of the EU-CaRE RCT study
Authors: De Kluiver E P , Van Der Velde A E , Meindersma E P , Prins L F , Wilhelm M , Iliou M C , Pena Gil C , Gonzalez-Juanatey J R , Snoek J A , Kolkman E , Van't Hof A W J , Prescott E 
Published: October 2019

Abstract

Introduction
Knowledge about effectiveness of cardiac rehabilitation (CR) in the elderly is limited. Participation rates in supervised CR are consistently lower in the elderly and innovative interventions are needed. The EU has granted a CR study project; a randomised controlled trial conducted in 5 European countries, investigating the effectiveness of mobile telemonitoring guided CR (mCR) in elderly cardiac patients who declined regular CR.

Methods
Patients ≥65 years with indication for CR who declined regular CR were eligible for inclusion. Patients were randomised between regular care (without CR) and a 6-month mCR programme: dedicated programmed smartphone, heartrate monitoring (target HR zones) and coaching. The primary endpoint is the difference in VO2peak between 6-months follow-up and baseline.

Results
Between 2015 and 2018 179 patients were included. Baseline characteristics between groups (table 1) did not differ significantly, except for hypertension. The difference in VO2peak was significantly better in the mCR group (table 1). After correction (mixed linear model) for baseline VO2 peak (fixed factor) and centre (random factor) this difference remained significant. Mean number of registered activity sessions was 4.79 (95% CI; 4.07–5.50) per patient per week.
Table 1. Baseline and primary outcome parameters Baseline Control Programme (n=90) mCR Programme (n=89) P-value Gender (m/f) 76/14 69/20 0.238 Age (mean±SD) 73.57±5.46 72.38±5.37 0.121 Diabetes 15 (16.7%) 23 (25.8%) 0.133 Hypertension 60 (66.7%) 73 (82.0%) 0.019* Hypercholesteremia 71 (78.3%) 74 (83.1%) 0.468 Normal LV-function 48/89 (53.9%) 53/89 (59.6%) 0.497 Index event (CABG/Valve/PCI/none) 0.735   Cardiac history prior to index event 48/89 (53.9%) 53/89 (59.6%) 0.702   Non cardiac comorbidity 40 (44.4%) 44 (49.4%) 0.503 Results   Baseline VO2peak (ml/kg/min) (95% CI) 19.83 (18.65–21.01) 18.78 (18.67–19.89) 0.191   Delta VO2peak at 6 months (ml/kg/min) (95% CI) 0.20 4 (−0.34–0.83) 1.62 (0.86–2.39) 0.005*   Corrected delta VO2peak at 6 months (ml/kg/min) 0.50 (−1.04–2.04) 1.65 (0.11–3.2) 0.015* *Significant.

Conclusions
The application of mCR in elderly patients who declined regular CR results in a better physical condition after 6 months. Compliance to mCR was excellent.

Acknowledgement/Funding
European Union's Horizon 2020 research and innovation programme under grant agreement number 634439, and funding from the Swiss Government.
P1941The nuclear receptor corepressor 1 blocks CD36-mediated foam cell formation in atherogenesis
Authors: Oppi S , Stein S , Marzolla V , Osto E , Rancic Z , Luscher T F , Oosterveer M , Stein S 
Published: October 2019

Abstract

Background
Nuclear receptors and their cofactors regulate the expression of various target genes in different tissue and organs to orchestrate downstream (patho)physiological processes. Although the function of several nuclear receptors in atherosclerosis has been studied, very little is known about the role of nuclear receptor cofactors in atherosclerosis. Given its important role to suppress inflammatory processes, we speculated that macrophage nuclear receptor corepressor 1 (NCOR1) plays a protective function in atherosclerosis development.

Purpose
To evaluate the contribution of macrophage NCOR1 in atherosclerosis we used myeloid cell-specific Ncor1 knockout mice on an atherosclerosis-prone background.

Methods and results
8-week-old male and female mice were exposed to a high high-cholesterol diet for 12 weeks. Our findings demonstrate that the lack of macrophage Ncor1 leads to a severe atherosclerotic phenotype in both sexes. These mice show a higher content of plaques along the thoraco-abdominal aortae as well as at the aortic sinus, which were characterized by larger necrotic cores and thinner fibrous caps, a typical signature of unstable plaques. Moreover, we found that the pro-atherogenic effects of the Ncor1 deletion are mediated via derepression of peroxisome proliferator-activated receptor gamma (PPARγ) target genes in mouse and human macrophages, especially the enhanced expression of the CD36 scavenger receptor and the subsequent rise in oxLDL uptake. Interestingly, while the expression of NCOR1 is reduced, the PPARγ signature is increased in human atherosclerotic plaques, and this signature is further pronounced in ruptured compared to stable carotid plaques.

Conclusion
Our findings suggest that macrophage NCOR1 blocks the pro-atherogenic functions of PPARγ in atherosclerosis and prevents the disease development.

Acknowledgement/Funding
The Swiss National Science Foundation, the Novartis Foundation, Olga-Mayenfisch Foundation, the OPO foundation
P1945High levels of unawareness and suboptimal management of hypertension in India: data from a large community based study
Authors: Mohan S , Jarhyan P , Ganesh S , Nikhil S V , Khatkar R , Rao B M , Reddy K S , Tandon N , Prabhakaran D 
Published: October 2019

Abstract

Background
Hypertension is the most common cause of the rising cardiovascular disease (CVD) epidemic in India. However, despite availability of proven therapies management remains sub-optimal.

Purpose
To determine the hypertension control rates and associated factors among adults with known hypertension in urban and rural India.

Methods
We conducted a representative population based cross-sectional survey among 12243 participants aged ≥30 years residing in rural and urban North and South India. Participants were selected using a multistage cluster random sampling technique. Trained personnel collected the data using an interviewer administered questionnaire, measured blood pressure, conducted anthropometry and collected bio-samples. Hypertension was defined as known hypertension (self-report of physician diagnosis) or systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure (DBP) ≥90 mmHg. Control was defined as SBP <140 mmHg and DBP <90 mmHg among those with known hypertension. The associations were measured using logistic regression.

Results
The mean (±SD) age of participants was 47.7 (±12.5) years, women comprised 54%. The age-standardized prevalence of hypertension was 29.0% (95% CI: 28.2- 29.8) and known hypertension was 14.0% (13.4- 14.6). Among all hypertensives 38.6% (37.0–40.2) were on treatment and 26.2% (24.6–28.0) had their blood pressure controlled, while among known hypertensives 79.8% (77.8–81.7) were on treatment and 55.7% (53.3–58.1) had their blood pressure controlled. In multivariate analysis, participants from North Indian site [OR: 1.9 (1.6–2.3)], urban residents [1.3 (1.1–1.6)], younger participants [1.5 (1.2–1.8)], men [2.0 (1.5–2.6)], those with low socio-economic status [1.6 (1.1–2.3)], without comorbidities and those without a family history hypertension were more likely to be unaware about their hypertensive status and less likely to take treatment. Hypertension control was significantly higher in participants from South Indian site [1.5 (1.2–1.0)], the highly educated [1.6 (1.1–2.4)], those without heart diseases [1.8 (1.1–3.1)], those without central obesity [1.4 (1.1–1.9)], physically active individuals [1.5 (1.1–2.0)] and current non-alcohol users [1.9 (1.3–2.6)].

Conclusions
Many individuals with hypertension remain unaware and sub-optimally managed. This warrants the implementation of tailored public education to raise awareness, complemented by active screening for the early detection and effective management of hypertension, in order to stem the rising tide of preventable CVD in India.

Acknowledgement/Funding
Unrestricted educational grant from Eli Lilly under the Lilly NCD Partnership
P1948Socioeconomic inequalities in the prevalence and management of hypertension: analyses of the Chilean National Health Surveys 2003, 2010 and 2017
Authors: Passi A , Margozzini P , Mindell J , Ruiz M , Scholes S 
Published: October 2019

Abstract

Hypertension is the highest attributable risk of death worldwide, causing 7.1million deaths annually, and it is the primary cause of cardiovascular morbidity and mortality. In Chile, around one-in-three adults are living with this chronic health condition. Chilean evidence has shown inequalities in hypertension prevalence by various measures of socioeconomic position (SEP). However, information on SEP inequalities in the three key aspects of hypertension management (awareness, treatment, and control of high blood pressure), is only partially known.

Purpose
To assess SEP inequalities in hypertension prevalence and management in Chilean adults.

Methods
Data came from the Chilean National Health Surveys (ENS) 2003, 2010 and 2017. Years of formal education was used as the SEP measure. Age-and gender-specific Slope and Relative Indices of Inequalities (SII and RII) were calculated for the prevalence of hypertension (mean SBP ≥140mmHg, DBP ≥90mmHg, or current medication use to lower blood pressure) and for each management outcome.

Results
Analytical sample comprised 3,426; 4,838 and 5,373 participants aged ≥17y with blood pressure measurements for years 2003, 2010 and 2017, respectively. Prevalence of hypertension was 32.4%, 32.2% and 30.8% for the years 2003, 2010 and 2017, respectively. According to the SII and RII, males and females aged <65y showed higher hypertension prevalence among those with fewer years of education in 2003, 2010 and 2017. Among those classed as hypertensive, levels of awareness increased from 59.4% in 2003 to 65.9% in 2017. Over the same time period, levels of treatment increased from 39.0% to 65.2%, and levels of control increased from 14.1% to 23.9%. SEP inequalities in hypertension management – with better outcomes for the most educated – were highest among females aged ≥65y.

Conclusion
Introduction of universal access to care for hypertension in Chile in 2005 accounted partly for the rise of hypertension management levels since 2003. According to local and international strategies for the prevention and control of noncommunicable diseases, there is room for improvement. However, improvements should have a specific focus on SEP inequalities.

Acknowledgement/Funding
Chilean Ministry of Health
P1950How to improve early prediction of heart failure development after STEMI in clinical arena-is there a place for myocardial deformation imaging?
Authors: Trifunovic D , Krljanac G , Asanin M , Savic-Spasic L , Aleksandric S , Dudic J , Cucic L , Sulovic V , Mrdovic I 
Published: October 2019

Abstract

Heart failure (HF) development after myocardial infarction with ST segment elevation (STEMI) in the modern era varies greatly (between 4% and 28%), with the highest incidence in the first year. Since, HF still carries substantial morbidity and mortality, accurate and early identification of high-risk patients for HF development after pPCI allows for targeted use of intensive therapy.

Aim
The current study is a sub-study of PREDICT-VT study (NCT03263949). Its aim is to define multi-parametric model for early HF prediction in STEMI patients treated by pPCI, based on three data sets: clinical data, conventional echocardiographic data and data from myocardial deformation analysis obtained by early speckle tracking echocardiography.

Methods
In 264 consecutive pts enrolled in PREDICT-VT study early echocardiography (5±2 days after pPCI) was done and included LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec). LV index of post systolic shortening for longitudinal strain (PSS LS) and for circumferential strain (PSS CS) were calculated for the purpose of this study as average of PSS over 18 LV segments.

Results
From 195 patients who completed 1-year follow-up, 17 (8.7%) develop HF NYHA class 3 or 4, 60 (30.8%) NYHA class 2 and remaining 118 patients (60.5%) were in NYHA class I. Significant univariate predictors of NYHA were: from clinical parameters – female gender (β=0.169, p=0018), Killip class on admission (β=0.253, p<0.001) and previous atrial fibrillation (β=0.205, p=0.004); from conventional echocardiographic parameters – LV WMSI (β=0.223, p=0.0072), LVEF (β=−0.256, p<0.001), LAVI (β=0.174, p=0.020) and TAPSE (β=−0.263, p=0.001); from parameters of longitudinal LV deformation – LS at the epicardial level (β=0.242, p=0.001) and PSS LS (β=0.360, p<0.001); from parameters of LV circumferential deformation – CS at epicardial level (β=0.225, p=0.001) and PSS CS at epicardial level (β=0.124, p=0.004); from left atrial mechanics – LA strain (β=−0.199, p=0.007). In multivariable stepwise regression model 5 variables were further identified as independent predictors that significantly increased model power to predict HF development (R square from 0.134 to 0.270, p<0.001). They are: PSS LS (β=0.255, p=0.002), previous atrial fibrilation (β=0.205, p=0.008), TAPSE (β=−0.176, p=0.031), female gender (β=0.165, p=0.032) and PSS CS (β=0.155, p=0.047).

Conclusion
Independently from and above classical clinical and echocardiographic parameters, amount of left ventricular post-systolic deformation in longitudinal and circumferential direction, expressed as LV indexes of post-systolic shortening, significantly improved early prediction of HF development after pPCI.
P1961Clopidogrel compared to aspirin in symptomatic peripheral arterial disease, a nationwide cohort study
Authors: Eldrup N , Toegersen F A T , Soegaard M S , Nielsen P B N , Larsen T B L 
Published: October 2019

Abstract

Background
Aspirin and clopidogrel is currently recommended as equivalent choices for antithrombotic therapy for peripheral arterial disease (PAD) in both European and US guidelines. A recent meta-analysis quested the efficacy of aspirin in prevention of myocardial infarction and cardiovascular mortality and found it protective only against non-fatal stroke. Clopidogrel, however, was effective against non-fatal myocardial infarction and the composite endpoint of death, non-fatal stroke, and myocardial infarction.

Purpose
To investigate if clopidogrel provide clinical benefits over aspirin in a national cohort of revascularized patients with PAD.

Methods
Comparative cohort study including all Danish patients recorded in the Danish Vascular Registry undergoing surgical or endovascular revascularization due to symptomatic PAD in Danish hospital settings from 2000 through 2016. We used multiple national population-based registries to collect individual-level data on comorbidity, medical treatment, and life status. We emulated the principles of a pragmatic randomized controlled trial, i.e. eligibility criteria, exclusion criteria, treatment assignment, and follow-up period, and used inverse probability of treatment weighting to account for treatment confounding.

Results
33,381 patients were considered for inclusion, and 15,737 was excluded according to prespecified criteria, leaving 13,653 taking aspirin and 1,312 clopidogrel. There were baseline differences between the two groups, which mitigated after applying treatment weights. Over a mean follow-up of 5.7 years, there were no treatment differences between aspirin (reference) and clopidogrel for outcomes of myocardial infarction, weighted hazard ratio (HR) 0.84 (95% CI; 0.64–1.10); stroke HR 1.09 (0.83–1.41); amputation HR 0.86 (0.66–1.13); and limb revascularisation HR 0.95 (0.73–1.124). For combined cardiovascular endpoints myocardial infarction, stroke or death we found HR 0.89 (0.75–1.05) and combined limb outcome, amputation and revascularisation HR 0.92 (0.75–1.13), Figure 1. Hazard ratios for risk of all bleedings were similar, also when divided on intracranial, gastrointestinal and others.
Figure 1

Conclusion
In this nationwide cohort of revascularized patients with PAD, clopidogrel in comparison with aspirin showed no difference for cardiovascular outcomes or limb protection.

Acknowledgement/Funding
None
P1964Impact of successful coronary intervention for chronic total occlusion on long-term clinical outcome of patients with impaired and preserved left ventricular ejection fraction
Authors: Tanaka H , Tada T , Fuku Y , Goto T , Kadota K 
Published: October 2019

Abstract

Background
Successful recanalisation of percutaneous coronary intervention for chronic total occlusion lesions has been associated with improved survival.

Purpose
This study aimed to assess the impact of successful percutaneous coronary intervention for chronic total occlusion lesions on the long-term outcome of patients with impaired and preserved left ventricular ejection fraction (LVEF).

Methods
The study sample consisted of 842 consecutive patients (928 chronic total occlusion lesions) undergoing percutaneous coronary intervention at our institution between October 2005 and December 2009. We divided them into 3 groups by the degree of LVEF: less than 40% (severely reduced LVEF, n=140), 40% to 59% (moderately reduced LVEF, n=470), and 60% and above (normal LVEF, n=232). We evaluated mortality during the 10-year follow-up period the basis of procedural success and failure.

Results
The overall procedural success rate was 89.1%. Median follow-up duration was 7.9 years. The 10-year cumulative incidences of cardiac death in each degree of LVEF are shown in the Figure.

Conclusions
Successful recanalisation for chronic total occlusion lesions in patients with impaired LVEF may be associated with reduced cardiac mortality.
P1966Impact of coronary artery calcification on long-term outcomes after implantation of first and second-generation drug-eluting stents: a patient-level analysis of 18 randomized trials
Authors: Guedeney P , Claessen B , Mehran R , Mintz G , Liu M , Sorrentino S , Farhan S , Leon M B , Serruys P , Smits P C , Von Birgelen C , Redfors B , Madhavan M V , Ben-Yehuda O , Stone G W 
Published: October 2019

Abstract

Background
Available data on the long-term impact of coronary artery calcification (CAC) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) are limited.

Purpose
We evaluated the long-term impact of CAC on outcomes after PCI and the respective performance of first- and second-generation DES.

Methods
We pooled patient-level data from 18 randomized trials evaluating DES categorized according to the presence of angiographic core lab-confirmed moderate or severe CAC in any target lesion. Outcome measures of interest were the patient-oriented composite endpoint (POCE; death, myocardial infarction [MI], or any revascularization), the device-oriented composite endpoint of target lesion failure (TLF; cardiac death, target vessel MI or ischemia-driven target lesion revascularization), and definite or probable stent thrombosis (ST). Multivariable Cox proportional regression with study as a random effect was used to assess 5-year outcomes.

Results
A total of 19,833 patients were included. Moderate or severe CAC was present in 6211 (31.3%) patients and associated with increased 5-year risk of the POCE (adjHR 1.12, 95% CI 1.05–1.20, p<0.001), TLF (adjHR 1.21, 95% CI 1.09–1.35, p<0.001), and a trend for greater ST (adjHR 1.24, 95% CI 0.99–1.54, p=0.06). In patients with CAC, second-generation DES were associated with a reduction in the 5-year risk of TLF and ST, and a trend for reduced POCE compared with first-generation DES (Table).

Conclusion
In this large-scale study, target lesion moderate or severe CAC was associated with adverse patient- and device-related outcomes at 5 years, risks that were reduced but not eliminated with second-generation DES.

Acknowledgement/Funding
This investigator-sponsored study was funded by Abbott Vascular.