bluuebunny/crossref_metadata_2025_split huggingface dataset:
P37 Long-term outcomes of patients at risks for Fontan operation: role of temporary fenestration
Authors: Ozawa H , Hoashi T , Nakata T , Shimada M , Ichikawa H 
Published: January 2020

Abstract

Purpose
Whereas fenestration at Fontan operation was reported to be effective for smooth initiation to Fontan circulation, subsequently developed aortopulmonary collateral arteries under the presence of remaining hypoxia were a matter of concern.So as our institutional policy, it is closed as much and early as possible (temporary fenestration). This study aimed to reveal long-term outcomes for patients at riskswho underwent Fontan operation with temporary fenestration.

Methods
Of 107 patients undergoing Fontan operation from 1995 to 2004, 79 patients (73.8%) were free from any risks (NR group) and 28 patients (26.2%) had risks for Fontan operation (R group). Hypoplastic left heart syndrome, heterotaxy syndrome with obstructive total anomalous of pulmonary venous connection, and individual cases with high preoperative pulmonary artery pressure (PAP), systemic ventricular end diastolic pressure (SVEDP) or low ejection fraction (SVEF) were defined as a risk for Fontan completion.Age at Fontan operation was older in R group (6.6 vs 2.3years-old, p = 0.0004). Preoperative PAP (12.8 vs 11.3mmHg, p = 0.03) and SVEDP (8.8 vs 7.1mmHg, p = 0.02) were higher and SVEF (53.7 vs 60.0%, p = 0.002) was lower in R group. Pulmonary vascular resistance (PVR) was not different. Fenestration was created in all patients in R group, then it was closed at the mean duration of 2.9 years after Fontan operation.

Results
Freedom from death or protein-losing enteropathy rate at 5, 10, and 15 years after Fontan operation were 97, 96, and 93% in NR group and 96, 93, and 86% in R group (log-rank: p = 0.20). Fifty-one patients (64.6%) in NR group and 17 patients (60.7%) in R group underwent serial catheter examinations at 5, 10, and 15 years after Fontan operation and exercise capacity testing at 15 years after Fontan operation (Figure). In R group, arterial oxygen saturation was lower and PVR was higher even after close of fenestration (Figure). In addition, 12 patients (71%) in R group developed significant veno-venous collaterals, which were defined by more than 3mm in diameter of collateral veins or a condition where pulmonary veins were contrasted in venography. On the contrary, cardiac index (CI), SVEDP, and PAP were not different and no significant difference on peak oxygen uptake and anaerobic threshold were observed between in 2 groups.

Conclusions
Although the mild cyanosis remained due to the development of veno-venous collaterals after the closure of temporary fenestration, CI, SVEDP and PAP well maintained in patients at risk for Fontan operation. These results might to lead acceptable life prognosis and freedom fromprotein-losing enteropathy rate for patients at risk for Fontan operation.
Abstract P37 Figure
P38 Developing a model for predicting in-hospital death in patients with the use of extracorporeal membrane oxygenation
Authors: Lin J W , Yu H Y , Chen Y S 
Published: January 2020

Abstract

Funding Acknowledgements
Minister of Science and Technology

Background
The objective of this study was to develop a predicting model for estimating the odds of in-hospital death in the patients who receive extracorporeal membrane oxygenation (ECMO).

Methods
Adult patients who received ECMO for a variety of etiologies in our National University Hospital from 2005 and 2016 were included. The demographic, anthropometric, hemodynamic, and laboratory data when ECMO was instituted were recorded for each individual. A logistic regression model was applied to find the risk variables that were independently associated with in-hospital mortality. The predicted probability derived from the model was used to plot a receiver-operating-characteristic (ROC) curve, and area under curve (AUC) was found to represent the differentiating capacity of this approach.

Results
A total of 919 patients (659 men and 260 women) were included in the analysis. The mean age was 53.7[SD 15.9] years. The analysis showed that age (odds ratio [OR]: 1.018, 95% confidence interval [CI]: 1.008-1.028 per year), blood urea nitrogen (1.008 [1.001-1.014] per mg/dL), use of inotropic agent in terms of inotropic equivalent (1.007 [1.002-1.013]), the presence of cardiogenic shock (1.910 [1.097-3.327]), and the need of hemodialysis (2.262 [1.304-3.926]) were positively associated with mortality. In addition, body surface area (OR: 0.414 [0.204-0.840] per square meter), systolic blood pressure (0.995 [0.990-0.999] per mmHg), Glasgow Coma Scale (0.928 [0.899-0.957] per unit), pH value (0.395 [0.158-0.988] for each unit), and urine output (OR: 0.974 [0.964-0.985] per dL) were negatively associated with the probability of in-hospital death. The AUC in ROC analysis was 0.754 (95% CI: 0.722-0.787).

Conclusion
The predicting model that used a simple set of physiological parameters could substantially discriminate whether the patients receiving ECMO could survive the in-hospital course. Further studies are needed to examine why false positive and false negative predictions took place.
Abstract P38 Figure.
P89 Role of inflammation as a risk factor for atrial fibrillation in rheumatic mitral stenosis and its correlation with atrial late gadolinium enhancement (LGE) on cardiac MRI
Authors: Malik M A , Sharma G , Ganga K P , Sharma S 
Published: January 2020

Abstract

Funding Acknowledgements
ICMR

Aims
Association of atrial fibrillation (AF) is a common cause of morbidity and mortality in patients with rheumatic heart disease (RHD). Association of Atrial Fibrillation with inflammation is well delineated in nonvalvular AF as compared to Rheumatic AF. This study evaluated the presence of atrial inflammation, in patients with AF and rheumatic mitral stenosis (MS), using cardiac MRI and its correlation with inflammatory markers.

Methods and Results
Twenty RHD patients with predominant mitral stenosis were recruited for the study. Ten patients had persistent AF, three had paroxysmal AF and seven were in sinus rhythm. Patients with AF had lower mitral valve areas. Cardiac MRI showed evidence of late gadolinium enhancement (LGE) in the atrial wall in 61.54% (8/13) of patients with AF as compared with only 20% (1/5; p &lt; 0.05) of patients in sinus rhythm. Mean levels of IL-6 were also significantly higher in patients with AF (10.62 ± 5.92 pg/mL versus 4.37 ± 2.68 pg/mL; P= 0.017). IL6 with a cutoff of ≥ 6.5 pg/mL was associated with a sensitivity of 76.92 % and specificity of 71.43 % for prediction of AF. There was also significant association between high IL-6 levels and LGE on MRI (13.13 ± 5.75 pg/mL vs 5.29 ± 3.23pg/mL; P &lt; 0.05)

Conclusion
Patients with MS who developed AF show evidence of atrial inflammatory sequelae in the form of fibrosis as suggested by LGE on cardiac MRI. Systemic inflammation in the form of elevated IL-6 levels correlated significantly with atrial fibrosis and AF.
Table 1: MS patients with or without AF Clinical Features Rhythm P-Value NSR (n = 7) AF (n = 13) Mean Valve Area (cm2) 1.28 ± 0.35 0.83 ± 0.26 &lt; 0.01 Mean Diastolic Gradient (mmHg) 6.29 ± 2.2 11.92 ± 5.65 &lt;0.01 Wilkin Score 7 ± 0.816 8.46 ± 1.66 0.04 LVEF % (non indexed) 59.57 ± 1.13 58.77 ± 2.89 0.49 LA Volume with MRI (ml) 127.50 ± 51.32 284.33 ± 133.12 &lt;0.01 Inflammatory Markers hs-CRP (mg/L) 5.59 ± 3.89 3.94 ± 3.47 0.34 IL6 (pg/mL) 4.37 ± 2.68 10.62 ± 5.92 0.017 sCD-40L (ng/mL) 3.72 ± 3.73 4.77 ± 2.80 0.48 Atrial LGE 0 (0%) 8 (61.5%) 0.04
Abstract P89 Figure. Image 1: Cardiac MRI showing LGE
P103 Heart failure with preserved ejection fruction defines the progression of abnormal brain aging: a prospective study of young-old hypertensive patients
Authors: Nomoto K , Kawashima K , Hirashiki A , Kokubo M , Shimizu A , Arai H , Toba K , Murohara T 
Published: January 2020

Abstract

Funding Acknowledgements
Ministry of Health, Labor and Welfare (MHLW) Geriatrics and Gelontorogy sponsored research funds
Background & purpose: Recently, many longitudinal studies have shown that heart failure with reduced ejection fraction (HFrEF) is associated with various types of brain abnormalities: cerebral micro-bleeding, atrophy, or pathologic degeneration (white matter hyperintensity; WMH). These brain abnormalities are known to increase with aging and to be closely associated with cognitive impairment. Heart failure with preserved ejection fraction (HFpEF) also increases with aging, but there have been few longitudinal studies to address the relationship between HFpEF and brain abnormalities. Thus, this longitudinal study aimed to clarify this relationship by focusing on WMH volume.

METHODS
The participants were 111 well-controlled hypertensive patients aged between 65 and 75 years with normal LV contraction and no history of symptomatic heart failure, ischemic heart disease, atrial fibrillation, stroke, or cognitive dysfunction. The participants were classified into 3 groups: Low E/e", E/e" &lt; 8; Middle E/e", 8≤ E/e" ≤ 15; and High E/e", E/e" &gt; 15. WMH volume was quantified on brain magnetic resonance imaging using analytical software.

RESULTS
During the mean 2.6 ± 1.0-year follow-up period, the rate of increase of WMH volume was significantly higher in the high E/e" group (1.1 ± 1.2 mL/year) than in the low E/e" group (0.30 ± 0.78 mL/year; P = 0.0238). Linear regression analysis including other confounders showed that the only positive association was between the rate of increase of WMH volume and the E/e" ratio (beta- coefficient = 0.225, P = 0.018).

CONCLUSION
The severity of LV diastolic dysfunction is positively correlated with increasing WMH volume.
Abstract P103 Figure. The rates of increase of WMH volumes
P193 The value of 12-lead electrocardiogram in secundum atrial defect with pulmonary hypertension
Authors: Santoso J O S , Prakoso R P , Simamora R S , Muliawan H S M , Siswanto B B S 
Published: January 2020

Abstract

Background
Pulmonary hypertension is a serious complication that can develop in patients with secundum Atrial Septal Defect (ASD) and based on Euro Heart Survey, 24,77% of ASD patients develop PH. The gold-standard for the diagnosis of pulmonary hypertension in ASD is right heart catheterization. However, in low-middle income country like Indonesia, right heart catheterization only available in a few centers while Indonesia is often referred as the world’s largest archipelago. Thus, there is a huge number of undiagnosed and untreated patients with ASD-PH in Indonesia, especially in patients who lives in rural and isolated area. This research was initiated to investigate the diagnostic value of simple 12-lead ECG in the diagnosis of pulmonary hypertension in ASD with the intention to help doctors in isolated area.

Method
We performed a cross-sectional study analyzing the 12-lead ECG and mean arterial pressure collected from right heart catheterization from 120 patients with secundum ASD aged &gt; 18 years old. The 12-lead ECG collected within 24 hours before RHC procedure.

Results
We analyzed the ECG and RHC from 60 subjects diagnosed with pulmonary hypertension and 60 subjects without pulmonary hypertension. We found that R in lead V1 + S in lead V6&gt; 12,5 mV, right axis deviation (RAD), and RV strain were independent predictors of pulmonary hypertension in secundum ASD. Based on Receiver Operator Characteristics (ROC), we obtained that R in V1 + S in V6&gt; 12,5 mm, right axis deviation (RAD), and RV strain has an Area Under of Curve (AUC) of 80,8%, 70,5%, and 85,6% respectively. We developed a scoring system and a score of &gt;5 have a sensitivity of 90%, specificity of 84,4%, positive predictive value of 84,4%, negative predictive value of 90%, and accuracy of 87,1%. We also developed a predictor for pulmonary vascular disease (low flow and high resistance PH) to predict wether the defect can be closed. We obtained that R in V6 + S in V6 &gt; 27,5 mm can predict a low flow high resistance pulmonary hypertension in secundum ASD with an AUC of 77,1% (CI 95% 58-96,1%)

Conclusion
ECG score of 12-lead ECG derived from this study can be used to predict PH in secundum ASD. It may help cardiologists or general practitioners in rural and isolated area to diagnose pulmonary hypertension in ASD and plan the best management for the patients.
P204 Automated detection of atrial fibrillation based on stationary wavelet transform and artificial neural network targeted for embedded system-on-chip technology
Authors: Hau Y W , Lim H W , Lim C W , Kasim S 
Published: January 2020

Abstract

Stroke is one of the most severe cardiovascular disease which can potentially cause permanent disability. Atrial Fibrillation (AF) is one of the major risk factors of stroke that can be detected from electrocardiogram (ECG) monitoring.
Objective
This study proposed an AF detection algorithm based on stationary wavelet transform (SWT) and artificial neural network (ANN) for screening purpose. The algorithm is aimed for embedded System-on-Chip (SoC) technology deployment as a standalone AF classifier for community in rural area where the internet infrastructure may not well established.
Methods
After standard ECG signal pre-processing, SWT is applied to filtered ECG and produces 12 sets of primary features in time-frequency domain. The power spectral density (PSD) and log energy entropy (LogEn) were calculated from these 12 sets of primary features, to measure atrial activity fall in frequency range of 4 to 9 Hz, and the randomness of an ECG signal caused by AF, respectively. Finally, the ANN classifier recognizes the pattern of AF based on high atrial activity and randomness of ECG signal. Algorithm exploration is carried out to determine the optimum parameter value which can yield the best classification and suitable to be implemented in embedded SoC technology for real-time computation performance. ECG training and testing datasets of the proposed AF detection algorithm were extracted from MIT-BIH Atrial Fibrillation Database which consists of 23 ECG record with each record contains a 10 hours ECG data.
Results
AF detection accuracy is 95.3% which was able to classify an ECG signal into categories of AF, sinus rhythm, and other arrhythmia.

Conclusion
The proposed AF detection algorithm based on combination of SWT and ANN can achieve high accuracy and is suitable to be implemented as a standalone AF classifier based on embedded SoC technology targeted for early detection of AF in the community.
P253 Withdrawal of beta- blockers and ACE inhibitors after left ventricular systolic function recovery in patient with dilated cardiomyopathy randomized control trial
Authors: Bakhsh A , Thanassoulis G , Engert J C , Elstein E , Huynh T , Giannetti N 
Published: January 2020

Abstract

Funding Acknowledgements
The Rosenfeld Heart Fund

Introduction
recovery of left ventricle (LV) systolic function with normalization of ejection fraction (LVEF) occurs in 10 - 27% of patients with 80% maintaining recovery. However, the need for medical therapy after recovery is often questioned. Previous randomized studies of treatment withdrawal were small, not selected for non-ischemic dilated cardiomyopathy (DCM) and had a reference of improved or recovered EF to &gt; 40% or &gt; 10% change from LVEF at time of diagnosis. Hypothesis: In patients with DCM with recovery of the LV systolic function to an EF (&gt;50%), medical therapy withdrawal is possible without rebound LV systolic dysfunction. Method: This was a pilot randomized control open-label trial with 2:1 randomization for withdrawal of b-blockers and ACE inhibitors in patients with recovered LV systolic function. Patients’ medication discontinuation occurred in 2 phases with a six-month interval and patients were followed for one year. The primary endpoint was LVEF reduction (&lt; 40%). Results: There were 22 patients (10 females) enrolled. The mean age was 60 ± 12y. The mean LVEF at enrollment was 58 ± 5% with no significant difference in the mean LVEF in both groups. Sixteen patients were assigned to the withdrawal group and 6 assigned to the control group. The primary endpoint occurred in 31% of the withdrawal group compared to none of the control. The rate of 1ry outcome after withdrawal of medical therapy was 19%, p-value 0.15. The mean LVEF at 1 year for the treatment withdrawal group was 46.8 ± 12% and control 55 ± 6%, p-value 0.15. In the medication withdrawal group, the mean LVEF reduction was 10.6 ± 11% and the difference between the mean LVEF at enrollment and at 1 year was 10.6 ± 11% with 95% CI (4.6,16.49), p-value 0.0017. Conclusion: In DCM patients with recovery of LV systolic function, we observed worsening of LVEF after withdrawal of b-blockers and ACE inhibitors.
Abstract P253 Figure.
P278 Pharmacokinetics, pharmacodynamics and efficacy of OPC-61815, prodrug of tolvaptan for intravenous administration, in patients with congestive heart failure
Authors: Sato N , Uno S , Yamasaki Y , Watanabe S , Hirano T 
Published: January 2020

Abstract

Funding Acknowledgements
Otsuka Pharmaceutical Co. Ltd.

On Behalf
OPC-61815 phase II investigators
Background/Introduction: Tolvaptan, a vasopression V2-receptor antagonist, is effective for congestion in patients with congestive heart failure (CHF), and hyponatremia in patients with CHF and SIADH. But, this drug is not readily soluble in water and not suited for development as an injection. OPC-61815, a prodrug of tolvaptan having improved water solubility, is suitable for intravenous administration.

Purpose
The phase-II clinical study (ClinicalTrials.gov Identifier: NCT03254108) was conducted to investigate the dose for intravenous administration of OPC-61815 achieving tolvaptan exposure equivalent to that for oral administration of tolvaptan 15-mg tablet in CHF patients.

Methods
This study was a multicenter, a double-blind, randomized, active-controlled, parallel-group comparison clinical pharmacology trial. Sixty patients aged between 20 and 85 years with CHF with volume overload despite the use of conventional diuretics were randomly assigned to four treatment cohorts to receive OPC-61815 at doses of 2, 4, 8, 16 mg (i.v.) or tolvaptan at 15 mg (p.o.). Both drugs were administered once a day for 5 days. The primary endpoint was to assess the dose of OPC-61815 equivalent to tolvaptan at 15 mg using Cmax and AUC24h values after the first administration. Pharmacodynamics (urine volume, urine osmolality, serum electrolyte concentration, biomarkers), efficacy (body weight change, congestive symptoms) and safety were also evaluated.

Results
The mean Cmax and AUC of the metabolite tolvaptan increased dose-dependently following single intravenous administration of OPC-61815 at 2, 4, 8, and 16 mg. Tolvaptan exposure (Cmax and AUC24h) on Day 1 following single intravenous administration of OPC-61815 at 16 mg was the closest and similar to that following single administration of tolvaptan 15-mg tablet. OPC-61815 increased urine volume from baseline, leading to decrease in body weight and improvement of lower limb edema. The incidence of treatment-emergent adverse events was 54.2% (26/48 subjects) in the OPC-61815 2 to 16-mg, and 83.3% (10/12 subjects) in the tolvaptan 15-mg groups. No clinically relevant changes from baseline were found in laboratory parameters, vital signs, or ECG findings.

Conclusions
Tolvaptan exposure on Day 1 following single intravenous administration of OPC-61815 at 16 mg was the most similar to that following single administration of tolvaptan 15-mg tablet. There was no marked difference in tolerability between OPC-61815 at 16 mg and tolvaptan 15-mg tablet, and no clinically significant problems were observed.
A case report of an acute coronary syndrome in a 10-year-old boy with homozygous familial hypercholesterolaemia
Authors: Leclercq Thibault , Falcon-Eicher Sylvie , Farnier Michel , Le Bret Emmanuel , Maudinas Raphaëlle , Litzler-Renault Stéphanie , Mousson Christiane , Lorgis Luc , Cottin Yves 
Published: January 2020

Abstract

Background
Familial hypercholesterolaemia is a well-known disorder, but clinical diagnoses tend to be delayed. Acute coronary syndrome may occur in childhood.

Case summary
Our patient, a young boy with homozygous familial hypercholesterolaemia, complained of persistent chest pain at rest and suffered a non-ST-elevation myocardial infarction (NSTEMI). The diagnosis of NSTEMI was made on the basis of his clinical features, dynamic electrocardiogram changes, troponin elevation, and cardiac computed tomography findings. The patient was managed surgically by intrathoracic artery (ITA) bypass graft. During post-operative follow-up, the young patient suffered from angina pectoris from unexpected and exceptional atheroma stenosis on the ITA.

Discussion
Familial hypercholesterolaemia needs to be identified quickly in young patients and lipid lowering therapies should be started without delay.
Comparison of P2Y12 receptor inhibitors in patients with ST-elevation myocardial infarction in clinical practice: a propensity score analysis of five contemporary European registries
Authors: De Luca Leonardo , Zeymer Uwe , Claeys Marc J , Dörler Jakob , Erne Paul , Matter Christian M , Radovanovic Dragana , Weidinger Franz , Lüscher Thomas F , Jukema Johan Wouter ,   the PIRAEUS group
Published: January 2020

Abstract

Aims
Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. Recent randomized clinical trials have demonstrated that novel antithrombotic therapies improve in-hospital outcomes in STEMI patients. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in clinical practice in patients with STEMI based on data from contemporary European ACS registries.

Methods and results
Five registries from the PIRAEUS initiative (AAPCI/ADPAT, ALKK-PIC, AMIS Plus, Belgium STEMI, and EYESHOT) provided data for the assessment of P2Y12 receptor inhibitor-based dual antiplatelet therapy. Registries were heterogeneous in terms of setting, patient characteristics, and treatment selection. Matched pair analysis and propensity score matching were used to assess all-cause in-hospital death rates based on data from 25 250 patients (8577 patients on prasugrel, 5995 on ticagrelor, and 10 678 on clopidogrel). The odds ratio (OR) for the death of any cause when compared with clopidogrel was 0.72 [95% confidence interval (CI) 0.62–0.84, P &lt; 0.001] in favour of the new P2Y12 receptor inhibitors (prasugrel and ticagrelor combined). In the comparison between prasugrel and ticagrelor, there were no relevant differences (OR 0.97, 95% CI 0.77–1.23; P = 0.81). Event rates of cardiovascular death and stroke were also substantially lower for the new P2Y12 receptor inhibitors. The differences between clopidogrel and prasugrel or ticagrelor on major bleeding were numerically in the same order as for death of any cause but were not statistically significant. No differences in ischaemic and bleeding outcomes were observed between prasugrel and ticagrelor.

Conclusion
This analysis suggests that the prasugrel or ticagrelor compared with clopidogrel have favourable outcomes in clinical practice while not being inferior in terms of safety.