bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4535Discharge treatment with ACE inhibitor/ARB after a heart failure hospitalization is associated with a better prognosis irrespectively of left ventricular ejection fraction
Authors: Vicent Alaminos L , Cinca J , Vazquez-Garcia R , Gonzalez-Juanatey J R , Rivera M , Segovia J R , Pascual-Figal D , Bover R , Worner F , Delgado-Jimenez J , Fernandez-Aviles F , Martinez-Selles M 
Published: October 2019

Abstract

Background
Medical therapy could improve the prognosis of real-life patients discharged after a heart failure (HF) hospitalization.

Purpose
We aimed to determine the impact of discharge HF treatment on mortality and readmissions in different left ventricular ejection fraction (LVEF) groups.

Methods
Multicentre prospective registry in 20 Spanish hospitals. Patients were enrolled after a HF hospitalization.

Results
A total of 1831 patients were included (583 [31.8%] HF with reduced ejection fraction [HFrEF]; 227 [12.4%] HF with midrange ejection fraction [HFmrEF]; 610 [33.3%] HF with preserved ejection fraction [HFpEF], and 411 [22.4%] with unknown LVEF. Angiotensin-converting enzyme (ACE) inhibitors/Angiotensin II receptor blockers (ARB) at discharge were independently associated with a reduction in: i) all-cause mortality: hazard ratio (HR) 0.55, 95% confidence interval (CI) 0.41–0.74, P<0.001, with a similar effect in the four groups; ii) mortality due to refractory HF HR 0.45, 95% CI 0.29–0.64, P<0.001, with a similar effect in the three groups with known LVEF; iii) mortality/HF admissions (HR 0.61; 95% CI: 0.50–0.74), more evident in HFrEF (HR 0.54; 95% CI: 0.38–0.78) compared to HRmEF (HR 0.64; 95% CI 0.40–1.02), orHFpEF (HR 0.70; 95% CI 0.53–0.92).Inpatients with HFrEFtriple therapy (ACE inhibitor/ARB+ betablocker+ mineralocorticoid receptor antagonist) was associated with the lowest mortality risk (HR 0.21; 95% CI: 0.08–0.57, P=0.002) compared to patients that received none of these drugs.
Events according to the number of drugs – HFrEF (n=583) 0 (n=14) 1 (n=98) 2 (n=160) 3 (n=294) P Death or heart failure readmissions 10 (71.4) 58 (59.2) 66 (41.3) 106 (36.1) <0.001 All-cause mortality 9 (64.3) 28 (28.6) 31 (19.4) 36 (12.2) <0.001 Mortality due to refractory heart failure 7 (50.0) 14 (14.3) 17 (10.6) 17 (5.8) <0.001 – HFmrEF (n=227) 0 (n=18) 1 (n=57) 2 (n=81) 3 (n=65) P Death or heart failure readmissions 9 (50.0) 35 (61.4) 34 (42.0) 25 (38.5) 0.057 All-cause mortality 5 (27.8) 18 (31.6) 15 (18.5) 11 (16.9) 0.191 Mortality due to refractory heart failure 3 (16.7) 7 (12.3) 7 (8.6) 4 (6.2) 0.475 – HFpEF (n=610) 0 (n=61) 1 (n=242) 2 (n=219) 3 (n=69) P Death or heart failure readmissions 32 (52.5) 97 (40.1) 89 (40.6) 20 (29.0) 0.057 All-cause mortality 20 (32.8) 41 (16.9) 32 (14.6) 10 (14.5) 0.017 Mortality due to refractory heart failure 11 (18.0) 18 (7.4) 13 (5.9) 4 (5.8) 0.041 Outcomes according to the number of medications at discharge.
Kaplan-Meier Curves for study outcomes

Conclusions
Discharge treatment with ACE inhibitor/ARB after a HF hospitalization is associated with a reduction in all-cause and refractory HF mortality, irrespectively of LVEF.
P4540Obesity in patients with heart failure and without diabetes mellitus is associated with longer event-free survival only among those with high dietary sodium intake
Authors: Saleh Z , Lennie T , Moser D 
Published: October 2019

Abstract

Background
Obesity is paradoxically associated with better short- and long-term outcomes in patients with heart failure (HF) and without diabetes mellitus (DM). While excessive dietary sodium intake is common among obese persons, its impact on the association between obesity and outcomes has not been considered.

Aim
To determine whether dietary sodium intake levels would affect the association between obesity and better outcomes in patients with HF and without DM.

Method
A sample of 129 patients (age 60±12.4 years; 30% female) provided a single 24-hour urine collection sample to estimate dietary sodium intake. Patients were divided into 4 groups based on body mass index (BMI) and the sodium intake recommendation for HF of 3g/day (obese with high sodium intake [n=41; 32%], obese with low sodium intake [n=16; 12%], non-obese with high sodium intake [n=35; 27%], and non-obese with low sodium intake [n=37; 29%]). Patients were followed-up during an average period of 395 days to determine time to first event of all-cause hospitalization or death. Cox regression was used to determine the association between obesity and outcomes in the context of sodium intake after controlling for age, gender, NYHA class (I II vs. III IV) and LVEF.

Results
There were 41 patients (31.8%) who had an event of all-cause hospitalization or death. Obese patients with high sodium intake had 61% lower risk for events than those non-obese with low dietary sodium intake (figure). There were no differences in the event-free survival among other groups.

Conclusion
These data suggest that dietary sodium intake may be particularly important for obese patients with HF and without DM.
P4550Growth differentiation factor 15 as an integrative biomarker of heart failure in patients with acute myocardial infarction
Authors: Meloux A , Rochette L , Maza M , Bichat F , Chague F , Cottin Y , Zeller M , Vergely C 
Published: October 2019

Abstract

Background
Growth differentiation factor 15 (GDF15), a stress-responsive cytokine member of the transforming growth factor-β family, is an emerging biomarker in cardiovascular (CV) diseases. GDF15 is weakly expressed in normal condition but increased in pathological situations such as inflammation, oxidative stress, and left ventricular remodeling. Recent data suggest GDF15 as a marker in heart failure (HF).

Purpose
We aimed to identify the determinants of GDF15 circulating levels in patients admitted for an acute myocardial infarction (AMI).

Methods
In our prospective study, all consecutive patients admitted from June 2016 to February 2018 for type 1 AMI in the Coronary Care unit from our University Hospital were included. Chronic HF patients were excluded. In-hospital severe HF was defined as killip class>2. Blood samples were taken on admission and serum levels of GDF15 were measured using a commercially available ELISA kit.

Results
Among the 284 AMI patients, median age was at 67 (57–78) y, 27% were women, 23% had diabetes and 59% were hypertensive. GDF15 levels (median = 1,144 (775–1,891) ng/L were strongly correlated with age (r=0.493, p<0.001), and elevated with most CV risk factors (i.e. hypertension, diabetes), prior CAD, chronic kidney disease (p<0.001 for all) and in patients with CRP >3 mg/L (p<0.001). When compared with patients who didn't develop severe HF (274/284), patients experiencing HF (10/284), GDF15 was more than twice higher (figure). By Receiving Operating Curve analysis, GDF15 was associated with HF (AUC (95% CI) = 0.716 (0.52–0.91), p=0.021). Moreover, GDF15 levels were negatively correlated with Left Ventricular Ejection Fraction (LVEF) (r=−0.193, p=0.001). Multivariate logistic regression analysis showed that GDF15 >5,000 ng/L [OR: 8.43; 95% CI (1.57–45.32)] is as independent estimate of HF, beyond age and other confounding (i.e. admission systolic blood pressure, LVEF and Log N-terminal pro-Brain Natriuretic Peptide).
GDF15 levels according to HF development

Conclusions
These preliminary results suggest that GDF15 could be an integrative biomarker of severe HF in patient with AMI. Further studies are needed to elucidate the underlying mechanisms linking the cytokine with the development of HF.
P4561Patients adherence with fixed dose combinations of renin-angiotensin-aldosterone system inhibitors in hypertension
Authors: Simonyi G A , Ferenci T , Finta E , Balogh S , Medvegy M 
Published: October 2019

Abstract

Introduction
The latest ESC/ESH guidelines recommended fixed dose combinations (FDC) for first therapy in hypertension. Preferred two-drug combinations are a RAS (renin–angiotensin system) blocker with a CCBs (calcium channel blockers) or a diuretic. There are no available data about these FDCs adherence in hypertension.

Aim
To assess one year persistence of recommended FDCs (RAS-inhibitors/CCBs or diuretics) in hypertensive patients.

Method
Prescriptions database of National Health Insurance Found in Hungary on pharmacy-claims were analysed between October 1, 2012 and September 30, 2013. We identified patients who filled prescriptions for FDCs of RAS-inhibitors/CCBs or diuretics prescribed for the first time in hypertensive patients who have not received similar drugs during one year before. To model the persistence, the apparatus of survival analysis was used, where “survival” was the time to abandon the medication.

Results
443,149 patients met the inclusion criteria. One-year persistence rate and hazard ratio (HR) of discontinuation (reference was ACEi/indapamide FDC) in patients with ACEi/CCB FDCs (n=124,154) was 44,95% (HR=0.69, [CI: 0.68–0.69], p<0.0001), ARB/HCT FDCs (n=109,707) was 42,52% (HR=0.80, [CI: 0.81–0.83], p<0.0001), ACEi/indapamide FDC (n=127,757) was 37,27% (HR=1.00, reference), ARB/CCB FDCs (n=13,542) was 29.04% (HR=1.19, [CI: 1.17–1.22], p<0.0001) and ACEi/HCT FDCs (n=67,989) was 27.47% (HR=1.17, [CI: 1.15–1.18], p<0.0001).
One year peristence of FDCs

Conclusions
We have found significant difference between FDC s of RAS-inhibitors in hypertensive in relation of patients adherence. Our result demonstrated that ACEi/CCBs FDC therapy has the best one year persistence rate.
P4575UA and NSTEMI in the era of high-sensitivity Troponin: impact on patient risk profile and management
Authors: Carvalheira Dos Santos R , Raposo L , Madeira S , Brito J , Goncalves M , Brizido C , Vale N , Leal S , Sousa P , Araujo Goncalves P , Mesquita Gabriel H , Campante Teles R , Almeida M , Mendes M 
Published: October 2019

Abstract

Aim
High-sensitivity troponin assays (HST) entered the clinical arena to facilitate exclusion of ACS in the emergency department (ER) in patients presenting with chest pain. Due to its higher sensitivity there is the potential for an overestimation of the diagnosis of NSTEMI, and possibly ACS overall. We assessed the impact of HST in the classification of ACS (NSTEMI vs UA) and its ability to predict obstructive coronary disease (CAD), in a population of pts referred to coronary angiography (ICA).

Methods
Retrospective analysis of 1844 pts with suspected NSTEMI or UA referred for ICA from a single ER between Feb 2013 and Nov 2018. Standard Troponin-I was used until Feb 2016 and HST thereafter. The characteristics of UA and NSTEMI pts before and after the introduction of HST were compared. Multivariate binary logistic regression models were used to access the association of different troponin assays with CAD (>50% for LM and >70% for the remaining). Sensitivity, specificity, NPV and PPV for angiographic CAD were also determined.

Results
The relative proportion of patients with UA and NSTEMI was similar between study periods: 31% vs 29% and 69% vs 71%, respectively (p=0.3). Clinical and angiographic characteristics did not differ in UA pts before and after the use of HST. NSTEMI patients in the HST era were less frequently women (39% vs 32%, p=0.026), had higher creatinine (0.93 IQR 0.75–1.3 vs 1.0 IQR 0.82–1.38), higher number of lesions (2 IQR 1–4 vs 3 IQR 1–4) and a lower rate of normal coronary arteries (10.5% vs 3.9%, p<0.001). The prevalence of significant CAD in this population, before and after HST, was 65% and 73%, respectively (p=0.001). However, when clinically relevant characteristics and judgement were accounted for, both standard troponin (OR 0.99, 95% CI 0.99–1.01) and HST (1.0, 95% CI 1.0–1.0) were poor predictors of significant CAD. Sensitivity was 69% vs 72%, specificity 30% vs 30%, PPV 65% vs 73% and NNP 34% vs 28%, respectively. Finally, rates of percutaneous intervention did not differ between the two periods (30% vs 33.5%, p=0.157), nor between ACS types within each period.
CAD/PCI in ACS within each period

Conclusion
The introduction of HST did not result in an increase of the diagnosis of NSTEM vs UA, suggesting that clinical judgment remains an important determinant of the diagnosis of ACS. Also there was no evidence of an increase in PCI rates, despite worse CAD severity in NSTEMI patients.
P4593Effectiveness of using the Syntax Score II calculator for the patients with multi-vessel coronary arteries lesion
Authors: Alekyan B , Karapetyan N , Kishmiryan D 
Published: October 2019

Abstract

Introduction
The most significant disadvantage of the SYNTAX score is the lack of an individualized approach due to the absence of the clinical parameters. The Syntax Score II calculator which includes 6 clinical indicators is more accurate decision-making tool that should help the “heart team” to choose a strategy for myocardial revascularization.
The purpose of the study was to examine the effectiveness of using Syntax Score II for patients with multi-vessel coronary artery lesions who was dedicated to PCI.

Material and methods
From 01/2018 to 12/2018, 760 patients were included in the research, who was dedicated to PCI by the decision of the local “heart team”. In present analysis were included 116 (15%) of these patients with the multi-vessel coronary lesion and with a left main coronary artery lesion of different complexity. Patients who had previously undergone myocardial revascularization were excluded from analysis. The age of patients ranged from 41 to 86 years (mean age 67 + 9 years). There were males - 67.2%. Diabetes mellitus was present in 34.5% of the patients. 42.2% of the patients had angina pectoris (NYHA 3–4), and 60.3% had II class chronic heart failure.

Results
The average Syntax Score of the 116 patients was 23.1 + 7.8 (from 11 to 59). Syntax Score of the 52 (44.8%) patients was more than 23, and less than 23 in 64 (55.2%) of the cases.
The Syntax Score II for the same patients recommended only CABG in 13 (11.2%), only PCI - in 6 (5.2%) and equality between methods - in 97 (83.6%) cases. Only in 6 (5.2%) patients, there was complete agreement between the risk scales, and for 53 (45.7%) of them, the methods were equal. For 44 (37.9%) patients, the Syntax score recommended CABG (Syntax score more than 23), and Syntax Score II indicated equality of methods. In 2 (1.7%) patients with a SYNTAX score of more than 23 the Syntax Score II nevertheless recommended PCI. The “heart team” decision and the Syntax Score II recommendation were in agreement in 103 (88.8%) of the cases, while the “heart team” decision and the SYNTAX recommendation were in agreement only in 64 (55.2%) of the cases.
At the hospital stage, there were 2 (1.7%) cases of stent thrombosis with a fatal outcome, both in patients with SYNTAX score 42 and 28.
To determine the degree of consistency between the risk scales, the Kappa Cohen coefficient was calculated, which was 0.06 (p=0.93), which indicates lack of consistency between SYNTAX and Syntax Score II in recommendations.

Conclusion
The Syntax Score II risk scale is an effective tool for making “heart team” decisions about myocardial revascularization method and expands indications for performing PCI, and in 88.8% of cases with multi-vessel coronary arteries lesion, it is possible to get equal predictions between the methods of revascularization. In 40% of cases in patients with a SYNTAX of more than 23 Syntax Score II determines an equiprobable prognosis for performing PCI and CABG.
P4596Long-term outcomes of culprit lesion only versus multi-vessel one-stage intervention in non-ST elevation acute coronary syndrome patients undergoing percutaneous coronary interventioo
Authors: Jia S , Liu Y , Yao Y , Yang Y J , Gao R L , Xu B , Yuan J Q 
Published: October 2019

Abstract

Background
It is recommended to base revascularization strategy on the clinical status, comorbidities and lesion characteristics in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). However, the risk and benefit of Culprit Lesion Only (CVO) versus Multi-vessel One-stage Intervention (MVOI) is unclear. We aim to compare the long-term prognosis of NSTE-ACS undergoing CVO and MVOI PCI strategy.

Method
A total of 4768 consecutive patients with NSTE-ACS who underwent PCI in our hospital in 2013 were enrolled in this study. Patients were divided into CVO group and MVOI group according to whether the culprit vessel was the only target vessel. Prognosis impact on 2-year major adverse cardiovascular and cerebrovascular events (MACCE) is analyzed across 2 groups, including death, cardiac death, myocardial infarction, unplanned revascularization, in-stent thrombosis, stroke and bleeding.

Results
Compared with CVO group, MVOI patients had generally worse clinical baseline characteristics and angiographic findings, including higher BMI, SYNTAX score, higher proportion of diabetes, hypertension, NSTEMI, tri-vessel disease, total occlusion, etc. Two-year follow-up revealed that MVOI patients have significantly higher rate of unplanned revascularization (10.1% vs. 7.9%, p=0.018), stroke (2.2% vs. 1.3%, p=0.042) and MACCE (14.0% vs. 11.3%, p=0.012). Kaplan-Meier survival analysis yielded similar results. After adjusting for confounding factors by Cox regression analysis, MVOI was shown to be independently associated with higher rate of 2-year in-stent thrombosis (HR = 3.718, 95% CI: 1.125 - 12.293).
Two-year Clinical Outcomes CVO (n=3634) MVOI (n=1134) P value All-cause Death 39 (1.1) 13 (1.1) 0.836 Cardiac Death 18 (0.5) 8 (0.7) 0.402 Myocardial Infarction 64 (1.8) 22 (1.9) 0.693 Unplanned Revascularization 287 (7.9) 115 (10.1) 0.018 In-stent Thrombosis 26 (0.7) 12 (1.1) 0.257 Stroke 49 (1.3) 25 (2.2) 0.042 Bleeding 253 (7.0) 67 (5.9) 0.216 MACCE 409 (11.3) 159 (14.0) 0.012 CVO = Culprit Vessel Only; MVOI = Multivessel One-stage Intervention; MACCE = Major Adverse Cardiac and Cerebrovascular Events.
Cox Regression Analysis on CVO/MVOI

Conclusion
In our large cohort of Chinese patients, MVOI strategy for NSTE-ACS patient undergoing PCI was associated with worse 2-year prognosis compared with CVO strategy. MVOI is an independent risk factor for 2-year in-stent thrombosis.

Acknowledgement/Funding
Ministry of Science and Technology of the People's Republic of China (2016YFC1301301) and National Natural Science Foundation of China (81470486)
P4597Impact of operator experience with radial approach for clinical outcome on percutaneous coronary intervention in acute coronary syndrome performed with femoral artery access site
Authors: Tokarek T , Dziewierz A , Plens K , Rakowski T , Zabojszcz M , Dudek D , Siudak Z 
Published: October 2019

Abstract

Introduction
Radial approach (RA) for percutaneous coronary intervention (PCI) is associated with reduced mortality and access site complications. The routine use of the RA in patients should be strongly considered, keeping in mind the learning curve associated with the technique. However, promotion of RA may interfere with the equally important goal of maintaining proficiency in the femoral approach (FA), which is essential in a variety of procedures as well as when RA fails. There is possible risk of higher rate of complications in PCI with FA performed by operators mainly using radial artery as access site.

Purpose
The aim of this study was to evaluate impact of experience and proficiency with RA for clinical outcomes on PCI via FA in “real-world” patients with acute coronary syndrome (ACS).

Methods
A total of 539 invasive cardiologists performing PCI in 151 invasive cardiology centers on the Polish territory between 2014 and 2017 were included in study analysis. Proficiency threshold has been set at >400 procedures during four consecutive years per individual operator. They were categorized to quartiles according to total volume of radial artery utilization during all PCIs. Procedures performed on patients with Killip-Kimball class IV on admission to catheterisation laboratory were excluded from analysis.

Results
The most of the operators performed >75% of all procedures via radial artery (326 (60.5%)), 112 (20.8%) used RA in 50–75% of cases, 67 (12.4%) in 25–50% of all PCIs and only 34 (6.3%) invasive cardiologist were using RA in less than 25% of all procedures. Mortality during PCI via FA was higher in group of invasive cardiologist with >75% of all procedures performed with radial access (>75% vs. 50–75% vs. 25–50% vs. <25%: 1.63% (±2.52%) vs. 0.93% (±1.05%) vs. 0.68% (±0.73%) vs. 0.31% (±0.40%); p=0.01). A trend towards higher rate of bleeding at the puncture site during PCI procedures with femoral artery were reported in groups of operators with higher expertise in RA (>75% vs. 50–75% vs. 25–50% vs. <25%: 0.43% (±1.09%) vs. 0.14% (±0.36%) vs. 0.21% (±0.45%) vs. 0.14% (±0.37%); p=0.09).

Conclusions
Higher experience in radial access might be linked to worse outcome in PCI via FA in ACS settings. Femoral artery is important vascular approach and should not be abandoned while learning procedures with radial artery utilization.

Acknowledgement/Funding
None
P4610Gut microbiome and atherosclerotic plaque instability: does choline consumption in red meat influence plaque stability?
Authors: Chen Y.-C , Doma V , Reimark R , Ying Y.-L , Peter K 
Published: October 2019

Abstract

Background
Myocardial infarction is the major cause of deaths worldwide. Gut bacteria can process choline as abundant in red meat and subsequently converted by flavin containing monooxygenase in the liver to trimethylamin-N-oxide (TMAO) metabolite, which is strongly associated with cardiovascular events.

Aim
To investigate the gut microbiome and its association with atherosclerotic plaque instability.

Methods
Forty-eight Apolipoprotein E deficient mice were randomly divided into two groups and two time points, fed with a high fat diet (containing either 0.4% choline or 3% choline) at 12 weeks of age, for 7 weeks or for 14 weeks. All mice underwent Tandem Stenosis (TS) surgery to induce the development of unstable plaques. Stool samples were collected directly from the colon. Measurements of gut microbes were performed by AGRF diversity profiling. After bacterial genomic DNA isolation, 16S rRNA were sequenced by targeting 27F-519R (V1-V3) and 341F-806R (V3-V4) on the Illumina MiSeq platform. Vessel segments of TS were histologically processed and plaque composition of lipid, collagen, and intraplaque hemorrhage (marker of unstable plaques) were performed by a series of chemical staining and immunohistochemistry.

Results
Monocytes and granulocytes in mouse blood were significantly increased in the high choline group (p<0.05, unpaired t-test) after 7 weeks of high fat diet (21% fat, 0.15% Cholesterol, 3% Choline). Profiling of gut microbiota showed that Fimicutes were down regulated in the high choline group (p<0.05, unpaired t-test). Within Phylum Fimicutes, only Clostridia (class) Clostridiales (order) were significantly downregulated. Interestingly, histological analysis of TS segments showed that TER-119 (intraplaque haemorrhage marker) and CD42c (platelet marker) were significantly increased in the high choline group, indicating atherosclerotic plaques are more unstable and prone to rupture (p<0.05, unpaired t-test). Nevertheless, CD68 (Foam cells) in plaques, and total atherosclerotic plaque burden in the aortic sinus and aortic arch were not affected by the elevated levels of choline consumption.

Conclusion
Choline intake increases circulating monocytes and granulocyte numbers in the blood but not in the atherosclerotic plaque itself. Whereas the total plaque burden is not changed by an increased choline intake, the reduction of Fimicutes, Clostridia and Clostridiales seems to contribute to atherosclerotic plaque instability.

Acknowledgement/Funding
Heart Foundation 2018 Future Leader Fellowship (2018 FLF) ID: 102068 Chen