bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy related inappropriate sinus tachycardia: a distinct arrhythmia?
Authors: Sharp A , Patient C , Pickett J , Belham M 
Published: November 2020

Abstract

Background
The syndrome of inappropriate sinus tachycardia (IST) is well recognized and affects ∼1% of the population. We believe IST in pregnancy is a relatively frequent yet under-recognized phenomenon that may represent a distinct arrhythmia. To date, there are only three case reports in the literature.

Purpose
To further understand the natural history of IST in pregnancy, and to explore maternal outcomes.

Methods
A retrospective, observational cohort analysis.

Results
19 pregnant women presented to our institute with a definitive diagnosis of IST (as defined by task force criteria) between January 2016 and January 2017. Symptom onset was 4–36 weeks gestation (mean 20 weeks). Of those in their second or subsequent pregnancy (n=8), 50% described symptoms compatible with IST in previous pregnancies. 42% attended the emergency department on ≥1 occasion with symptoms of IST. 32% required hospital admission. 26% required pharmacological therapy (beta-blockers in all). There were no maternal deaths, instances of heart failure or acute coronary syndrome, no thromboembolic or haemorrhagic complications during pregnancy. Rates of Caesarean section were similar to the background rate of our unit; however, rates of induction were notably elevated (58% vs 25%), with 55% of these women being induced purely for symptoms of IST. Following delivery, symptoms resolved within one week for 17 of the women in the cohort, 1 had symptoms resolve after 4 month and 1 had persistent symptoms as she became pregnant again.

Conclusion
IST in pregnancy likely represents a distinct arrhythmia; the majority of individuals here had symptoms only during pregnancy, which resolved rapidly postpartum. Additionally, half of the women in a second or subsequent pregnancy had suffered IST symptoms during previous pregnancies, with no symptoms in between pregnancies. It is biologically plausible and may represent an exaggerated cardio-autonomic response to the physiological changes of pregnancy such as increased sympathetic tone and change in baroreceptor reflex sensitivity. Recognition of the condition is important given it is associated with significant morbidity, the distressing nature of symptoms leading to high rates of hospitalization and induction of labour.

Funding Acknowledgement
Type of funding source: None
Effects of evolocumab on plasma levels of proprotein convertase subtilisin/kexin type 9 and lipoprotein(a) in acute myocardial infarction
Authors: Nakamura A , Kanazawa M , Kagaya Y , Kondo M , Sato K , Endo H , Nozaki E 
Published: November 2020

Abstract

Background
There are two types of circulating proprotein convertase subtilisin/kexin type 9 (PCSK9), mature and furin-cleaved. Most types of lipoprotein(a) [Lp(a)], an independent risk factor of cardiovascular events, bound to mature PCSK9.

Purpose
This study examined the effects of monoclonal anti-PCSK9 antibody on plasma PCSK9 and Lp(a) levels in acute myocardial infarction (MI).

Methods
Acute MI patients (n=36) were randomly divided into evolocumab (140 mg; n=17) and non-evolocumab (n=19) groups. Changes in plasma PCSK9 and Lp(a) levels were monitored before and 1, 3, 5, 10, and 20 days after evolocumab administration.

Results
In the non-evolocumab group, plasma levels of mature PCSK9, furin-cleaved PCSK9, and Lp(a) (236.4±57.3 ng/mL, 22.4±5.8 ng/mL, and 19.2. ± 16.5 mg/dL, respectively) significantly increased by day 3 (408.8±77.1 ng/mL, P&lt;0.001; 47.2±15.7 ng/mL, P&lt;0.001; and 39.7±21.3 mg/dL, P&lt;0.005, respectively) and returned to the baseline by day 10 or 20. In the evolocumab group, mature PCSK9 significantly increased by &gt;1000 ng/mL with a simultaneous decline of furin-cleaved PCSK9 below the measurement sensitivity level after day 3. The incremental area under the curve for plasma Lp(a) levels was significantly smaller in the evolocumab group compared with the non-evolocumab group (P=0.038).

Conclusion
Mature and furin-cleaved PCSK9 are transiently upregulated after MI onset. Evolocumab significantly increases mature PCSK9 and decreases furin-cleaved PCSK9 and might inhibit transient increase of plasma Lp(a) in acute MI.
Figure 1

Funding Acknowledgement
Type of funding source: None
The effect of in-hospital high-dose vs. low-dose intensive statin in patients with non-ST segment elevation acute coronary syndrome
Authors: Chen P , Liu Y , Duan C , Fan H , Zeng L , Guo W , Jiang L , Xue W , He W , Tao S , Guo Z , Chen J , Tan N , He P 
Published: November 2020

Abstract

Background
Statins remain a standard treatment for acute coronary syndrome (ACS) patients. We aimed to determine the association between different dosages of in-hospital statins and the prognoses among patients receiving percutaneous coronary intervention (PCI).

Methods
NSTE-ACS patients were retrospectively enrolled from January 2010 to December 2014 from five centres in China. Patients receiving either atorvastatin or rosuvastatin during their hospitalizations were included. All the patients were categorized into high-dose statin group (40mg atorvastatin or 20mg rosuvastatin) or low-dose statin group (20mg atorvastatin or 10mg rosuvastatin). In-hospital events and long-term all-cause death was recorded.

Results
Of the 7,008 patients included in the study, 5,248 received low-dose intensive statin (mean age: 64.28±10.39; female: 25.2%), and 1,760 received high-dose intensive statin (mean age: 63.68±10.59; female: 23.1%). There was no significant difference in in-hospital all-cause death between the two groups (adjusted OR, 1.27; P=0.665). All-cause death was similar between the two groups during the long-term follow-up period (30-day: adjusted HR, 1.28; P=0.571; 3-year: adjusted HR, 0.83; P=0.082). However, there was a robust association between the high-dose statin and the reduction in in-hospital dialysis (adjusted OR, 0.11; P=0.030).

Conclusions
The in-hospital high-dose intensive statin is not associated with lower risks of in-hospital or follow-up all-cause death in NSTE-ACS patients undergoing PCI. Considering the robust beneficial effect of in-hospital dialysis, an individualized high-dose intensive statin can be rational in specified populations.
Univariate and multivariate analyses

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Science and Technology Planning Project of Guangzhou City athe China Youth Research Funding
Efficacy and safety of PCSK9-Inhibitors in the real-world: data from a clinical registry
Authors: Saba P.S , Murgia A , Gazale E , Terrosu P , Sanna G.D , Parodi G 
Published: November 2020

Abstract

Background
To date, little information is available on the real impact of PCSK9 inhibitors in terms of reducing cholesterolemia, events and the actual tolerability in the so-called “real world”. This lack of information is substantially related to the fact that these drugs have only been marketed recently. In Italy, few centres are licensed to prescribe these drugs. This, on the one hand, limited the number of patients to whom the new therapy was offered but, on the other hand, “concentrated” the observations in a few centres, making it possible to more easily collect the few data currently available. The Cardiology Unit of our university hospital is the only prescribing centre in the North Sardinia and therefore represents the natural collector of all the prescriptions of this drug in this wide geographical area.

Purpose
The aim of the study was to evaluate the efficacy and tolerability of PCSK9 inhibitors in the current clinical practice.

Methods
Data were collected reviewing all Alirocumab and Evolocumab prescriptions provided by the Cardiology Unit of our university hospital included in the Italian National Drug Agency (AIFA) registry from February 2017 to October 2019. In order to collect complete clinical information, all patients were interviewed regarding their health status, the on-treatment cholesterol levels and the possible appearance of side effects or cardiovascular events.

Results
In the reference period, 111 patients (58.9% males, age 63±10 years) received PCSK9-Inhibitors prescription (52.7% Evolocumab, 47.3% Alirocumab), 86.5% as secondary prevention. Statin intolerance was the indication for PCSK9-Inhibitors in the majority (73.3%) of patients. LDL cholesterol at eligibility evaluation was 175±50 mg/dl and reduced to 87±44 mg/dl (p&lt;0.0001) at last follow-up assessment (median 12.3 IQR 6.8–21.4 years). Maximal per cent variation of LDL-cholesterol was achieved already after 6 months of therapy (−45±3% vs basal). No attenuation in LDL-cholesterol lowering was observed; conversely, LDL levels continued to reduce during treatment (p for linear trend = 0.01; Figure 1). During follow-up, 8 patients (7.2%) stopped PCSK9 inhibitors: 2 subjects (1.8%) for side effects certainly related to the drug (flu-like syndrome, allergic reaction), 4 for possible side effects (myalgia, abdominal pain), the remaining for other reasons.

Conclusions
Clinical use of PCSK9 inhibitors confirms its efficacy and safety also in the “real world” setting. LDL reduction occurs early during the treatment and shows a significant trend in further reduction during the observation period. More than 90% of subjects tolerate and persist in PCSK9 inhibitors treatment in the long-term follow-up.
Figure 1

Funding Acknowledgement
Type of funding source: None
REDUCE-IT: outcomes by baseline statin type
Authors: Bhatt D , Miller M , Steg P.G , Brinton E.A , Jacobson T.A , Ketchum S.B , Doyle R.T , Juliano R.A , Jiao L , Granowitz C , Tardif J.-C , Ballantyne C.M 
Published: November 2020

Abstract

Background
REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) randomized 8,179 statin-treated patients with elevated triglycerides and increased cardiovascular (CV) risk to either icosapent ethyl (IPE), a pure, stable prescription form of eicosapentaenoic acid, 4g/day or placebo. IPE significantly reduced time to first occurrence of the primary composite endpoint of major adverse CV events (CV death, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or hospitalization for unstable angina) (HR 0.75, CI 0.68–0.83) and key secondary endpoint events (composite of CV death, nonfatal MI, or nonfatal stroke) (HR 0.74, CI 0.65–0.83) versus placebo (all p&lt;0.0001). A modest reduction in placebo-corrected LDL-C was observed (−6.6%; p&lt;0.0001). The mechanisms for the CV benefit of icosapent ethyl are not fully understood.

Purpose
Explore the impact of statin type and lipophilic/lipophobic category on outcomes, and on LDL-C, to further consider the possible relevance of LDL-C pathways to the observed CV benefit of icosapent ethyl.

Methods
Primary and key secondary endpoint analyses and LDL-C changes from baseline were explored by individual statin type (atorvastatin, simvastatin, rosuvastatin, or pravastatin) at baseline, and then by categorizing these statins into lipophilic (i.e., hydrophobic: atorvastatin, simvastatin) and lipophobic (i.e., hydrophilic: rosuvastatin, pravastatin) statin groups; 96.1% of patients fell within these individual statin groups.

Results
CV outcomes were similar across statin types (interaction p=0.61) and lipophilic/lipophobic categories (interaction p=0.51) (Figure). Statin type and category had a similar lack of meaningful impact on the modest placebo-corrected median LDL-C changes from baseline to one year, which ranged from −5.8 to −8.4% (all p≤0.0003).

Conclusion
No meaningful treatment differences in the primary or key secondary endpoints across statin type or lipophilic/lipophobic category were observed. A similar lack of treatment difference was observed in LDL-C changes from baseline to one year. Therefore, the LDL-C changes and CV risk reduction in REDUCE-IT appear independent of the type of concomitant statin therapy. These data provide clinicians with additional insight regarding concomitant statin therapy considerations when prescribing icosapent ethyl and suggest there are important mechanisms of action for the substantial CV risk reduction observed with icosapent ethyl that are distinct from the LDL receptor pathway.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): The study was funded by Amarin Pharma, Inc.
Natriuretic effect of 2 weeks of dapagliflozin treatment in patients with type 2 diabetes and preserved kidney function: results of the DAPASALT trial
Authors: Scholtes R , Muskiet M.H.A , Van Baar M.J.B , Greasley P.J , Karlsson C , Hammarsterdt A , Arya N , Van Raalte D.H , Heerspink H.J.L 
Published: November 2020

Abstract

Background
Sodium glucose co-transporter 2 (SGLT2) inhibitors reduce the risk for heart failure hospitalization, potentially by inducing sodium excretion, osmotic diuresis and plasma volume contraction, leading to more favorable systemic hemodynamic function. However, this hypothesis has never been formally investigated as no studies have assessed cumulative sodium excretion with SGLT2 inhibition during standardized sodium intake.

Methods
We conducted a mechanistic open label study in patients with type 2 diabetes mellitus (T2D) with preserved kidney function, who were receiving a standardized sodium intake (150 mmol/day) to evaluate the acute effects (average day 2–4), effects at steady state (average day 12–14) and effects during three days wash-out of dapagliflozin on sodium balance and blood pressure. Primary outcome measure was 24-hr sodium excretion during the acute phase. Secondary outcomes included 24-hr glucose excretion and 24-hr blood pressure at each time period and sodium excretion at steady state and during follow-up.

Results
Seventeen patients with T2D were enrolled (64.7% male, mean ± SD age 64.24±7.33 years, weight 99.54±17.36 kg, eGFR 94.53±10.10 mL/min/1.73m2, HbA1c 7.20±0.63%). Average sodium excretion at baseline was 147±32 mmol/24 hr, which did not significantly change during treatment (Change at day 2–4 [95% CI]: −5.21 [19.54, 9.12] mmol/24 hr; Change at Day 12–14 [95% CI]: 3.69 [−24.82, 32.20] mmol/24 hr). However, sodium excretion was reduced following washout compared to end of treatment (Change at Day 15–17 [95% CI]: −16.72 [−34.11, 0.66] mmol/24 hr). Glucose excretion was significantly increased throughout the study. Systolic blood pressure was 127.0±10.3 mmHg at baseline and significantly reduced at Day 3 [95% CI]: −5.27 [−8.55, −1.99] mmHg and Day 14 [95% CI]: −7.10 [−10.04, −4.16] mmHg compared to baseline and remained lower following washout.

Conclusions
This study shows that, during a standardized sodium intake, the SGLT-2 inhibitor dapagliflozin acutely reduces blood pressure without altering sodium excretion, indicating possible direct vascular effects independent of sodium balance.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Astra Zeneca
Periprocedural anticoagulation in AF cryoballoon ablation in a nationwide registry: no difference in complication rates between strategies
Authors: Zubkova P , Lubimceva T , Topchian A , Davtyan K , Artiykhina E , Tarasiyk E , Kosonogov A , Kryzhanovsky D , Sagitov I , Chetverikov S , Nechepurenko A , Poleshchenko Y , Vavilova T , Lebedev D , Mikhaylov E 
Published: November 2020

Abstract

Background
Standard treatment for patients with atrial fibrillation is pulmonary vein isolation (PVI). There are two widely adopted methods for PVI - cryoballon ablation (CBA) and radiofrequency (RF) ablation. There are several randomized studies evaluating different periprocedural anticoagulation strategies in patients undergoing PVI, and those mainly related to RF ablation procedures. However, there is a lack of data on safety of different anticoagulation strategies in CBA.

Purpose
To analyze the current anticoagulation approaches in patients undergoing cryoballoon ablation, the incidence and types of hemorrhagic and thromboembolic periprocedural events. The analysis was performed on data from the National cryoballoon AF ablation registry (NCT03040037).

Methods
Nineteen centers prospectively entered data into a web-based platform. The full data on AC therapy was available in 719 subjects. The specialists evaluated ischemic events clinically, and those included stroke, transient ischemic attack, pulmonary embolism or extracranial systemic embolism. Major bleedings were registered and classified according to the ISTH criteria.

Results
The mean CHA2DS2-VASc score was 2.0±1.4; mean BMI 29.5±4.8; mean GFR 92±28.9 ml/min. Periprocedurally, 574 (79.8%) subjects received direct oral anticoagulants (DOACs), 113 (15.7%) anti-vitamin K drugs (mainly warfarin); 16 (2%) patients received antiplathelet therapy. Uninterrupted DOAC therapy was used in 251 (34.9%) cases. Uninterrupted warfarin therapy was used in 36 (2%) patients. Bridging therapy was used in 325 (45.2%) patients. The total number of major adverse events was 25 (3.5%): 24 of them hemorrhagic and 1 transient ischemic attack (1 female patient on rivaroxaban with bridging). Five (0.7%) patients had hemopericardium: 3 - on uninterrupted rivaroxaban, 1 – rivaroxaban with bridging, 1 – interrupted apixaban. Seventeen (2.5%) patients had groin vascular complications and 1 -hemoptysis. Three patients died within 30 days following CBA from non-cardiovascular causes. There were no statistically significant differences in complications between patients receiving different periprocedural anticoagulation.

Conclusions
About 45% of patients referred for CBA receive bridging anticoagulation therapy in the periprocedural period. Although this is not in line with the current guidelines, we found no meaningful difference in complication rates between different anticoagulation approaches. CBA might be associated with different from RF ablation safety profile and requires randomized trials on periprocedural anticoagulation.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): RF President's council grant
Comparing clinical outcomes following 1 year of dual antiplatelet therapy in patients risk stratified by the PRECISE-DAPT and DAPT scores
Authors: Boudreau R , Fu A , Barry Q , Tran U , Perry-Nuygen D , Simard T , Le May M , Labinaz L , Dick A , Glover C , Froeschl M , Hibbert B , Chong A , So D 
Published: November 2020

Abstract

Background
Dual antiplatelet therapy (DAPT) is the standard of care following PCI. DAPT reduces ischemic events but increases bleeding risk. Duration of DAPT following PCI remains controversial. Current guidelines recommend duration be individualized based on risk of ischemia and bleeding. Although multiple strategies exist to risk stratify patients, including application of the PRECISE-DAPT and DAPT scores, there is currently no standardized risk assessment protocol.

Purpose
To determine if the PRECISE-DAPT and DAPT scores can identify patients at increased risk of ischemia or bleeding in a cohort prescribed 12 months of DAPT following PCI.

Methods
We calculated the PRECISE-DAPT and DAPT scores for 469 consecutive patients at baseline after PCI. Patients were grouped based on score treatment recommendation; PRECISE-DAPT prolonged or shortened (PRECISE DAPT &lt;25 vs. ≥25) and DAPT prolonged or shortened (DAPT ≥2 vs &lt;2). End points included 1-year rates of major adverse cardiovascular events (MACE) and TIMI major or minor bleeding.

Results
Among 469 patients, mean age was 64.4 (SD 12.2); 102 (21.7%) were women. Index presentation consisted of a STEMI in 207 (44.1%), NSTEMI in 99 (21.1%), and UA in 60 (12.8%). At presentation, 174 (37.1%) were current smokers, 115 (24.5%) had a prior MI, 118 (25.2%) had diabetes, 249 (53.1%) had dyslipidemia and 281 (60.0%) were previously diagnosed as hypertensive. Overall, there was an increase in bleeding and no difference in MACE for patients with a PRECISE-DAPT score ≥25 (13.3% vs. 4.1% P&lt;0.001). No difference in bleeding or MACE was present in patients stratified by the DAPT score.

Conclusion
A PRECISE-DAPT score ≥25 was associated with an increased rate of bleeding and no difference in MACE in patients prescribed 12 months of DAPT. This supports the use of the PRECISE-DAPT as a prospective tool in clinical practice.

Funding Acknowledgement
Type of funding source: None
Modifiable risk factors, limiting symptoms, anxiety and high expectations regarding therapy are common in patients with paroxysmal/persistent atrial fibrillation
Authors: Lachonius M , Widell C , Bergfeldt L , Odell A 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) is the most common heart rhythm disorder, increases the risk for stroke and heart failure, and commonly impairs health related quality of life. Increasing evidence shows the causative role of several risk-factors and that aggressive lifestyle interventions might reduce AF and its impact. The size of the problem and how to provide optimal multi-disciplinary management is less well known.

Purpose
To screen for potentially amenable risk factors and describe how patients rate their symptom burden, well-being and expectations of future treatment.

Methods
The risk profile, symptom burden, well-being and expectations of future treatment were identified in 352 consecutive patients referred for possible cardioversion and visiting a specialist nurse at an AF outpatient clinic. Various questionnaires and instruments were used in addition to medical history, ECG recording, and height, weight, BMI calculation and blood pressure (BP) measurement.

Results
Altogether 69% had 1–5 possibly modifiable risk factors, 50% were overweight or obese, 39% had a BP &gt;140/90 mmHg, 28% symptoms suggesting obstructive sleep apnoea and 25% reporterd no physical exercise. Respiratory distress during exertion was the most common symptom. Most patients had high expectations for their upcoming AF treatment, but men expected a full recovery more often than women (p=0.01). About 28% worried about their future health and reduced survival due to their AF.

Conclusion
Most of the patients with paroxysmal/persistent AF have risk factors suitable for life styles interventions. Many patients experience limitations in daily life, anxiety about their AF and worry about their future health and survival. Women and men also have different expectations of future care and treatment for recurrent AF.

Funding Acknowledgement
Type of funding source: None
Sex difference in the impact of smoking on Clinical outcomes following LVAD implantation
Authors: Imamura T , Combs P , Siddiqi U , Mirzai S , Stonebraker C , Bullard H , Simone P , Jeevanandam V 
Published: November 2020

Abstract

Background
Smoking would have a negative impact on clinical outcomes following left ventricular assist device (LVAD) implantation. However, its impact on male and female cohorts separately remains uninvestigated.

Purpose
We aimed to investigate the association between smoking and post-LVAD outcomes among male and female cohorts separately.

Methods
Data of consecutive patients who received LVAD implantation at our institute between Jan 2013 and Sep 2018 were retrospectively reviewed. Clinical outcomes were compared between the never smokers and the current smokers among male and female cohorts separately. Those with former smoking were excluded.

Results
Of all, 85 male patients (median 56 years old) and 45 female patients (median 56 years old) were included. Among the male cohort, total readmission rate was higher in the current smokers than never smokers (incidence rate ratio 1.51, p=0.09). Rates of gastrointestinal bleeding, stroke, and hemolysis trended to be higher in current smokers (Figure 1A). Among the female cohort, these rates were not different irrespective of the smoking status (Figure 1B). Survival was not different irrespective of smoking status among both male and female cohorts.

Conclusion
The impact of smoking on post-LVAD outcomes seems to be different between males and females. Different therapeutic strategy might be required for the LVAD candidates with active smoking between male and female cohort.
Figure 1

Funding Acknowledgement
Type of funding source: None