bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3708Prognostic significance of electrocardiographic changes after subarachnoid hemorrhage
Authors: Yuba T , Kimura Y , Mukaida T , Aoyama T , Hirano H , Gen S , Ohashi K , Hattori A , Takayama A , Yui Y , Kuroki N , Abe D , Suzuki K 
Published: October 2019

Abstract

Background and purpose
Many reports have examined electrocardiographic (ECG) changes after subarachnoid hemorrhage from long ago; however, there are few reports on the prognosis of patients who have an ECG abnormality. Therefore, in this study, the prognoses of patients with subarachnoid hemorrhage showing abnormal ECG findings were retrospectively analyzed.

Methods
Over 30 months from January 2014 to June 2016, 199 patients (mean age, 61.1±17.0 years; 46.7% male) admitted with a subarachnoid hemorrhage (SAH) were enrolled. To assess the mechanism underlying abnormal ECG in the SAH, predictor variables, such as demographics (age, sex, and body surface area), hemodynamics (heart rate and systolic blood pressure), blood biochemical results, neurological assessments (Glasgow Coma Scale), and computed tomography (CT) severity classification (World Federation of Neurosurgical Societies classification) were recorded. The subarachnoid hemorrhage was classified into either the cerebral aneurysm rupture group (N=132) or traumatic subarachnoid hemorrhage group (N=67) and analyzed.

Results
In the cerebral aneurysm rupture group, the QT prolongation was significantly increased compared with the traumatic subarachnoid hemorrhage group (424.8±87.7 ms vs. 400.5±95.8 ms, P<0.05). There was a correlation between consciousness level (Glasgow Coma Scale) on admission and QT prolongation, and significant QT prolongation was observed in critical patients (Pearson's correlation coefficient test P=0.04). ST changes correlated with CT classification severity (WFNS classification), and the most severe group (WFNS Grade 5) showed significant ST changes. On admission, the cerebral aneurysm rupture group and 97.0% in the traumatic subarachnoid hemorrhage group.

Conclusions
Significantly prolonged QT and ST changes are noted in patients with severe aneurysmal subarachnoid hemorrhage. The cause of the ECG abnormality in subarachnoid hemorrhage patients is not yet understood. A small number of experimental animal models have shown that electrocardiogram abnormalities associated with subarachnoid hemorrhage develop in the brain stem, and an autonomic nerve abnormality may also be involved.
A D-dimer is positively correlated with both aneurysm trauma and traumatic subarachnoid hemorrhage and may be used for auxiliary diagnosis of a subarachnoid hemorrhage.
P3713Positive troponin levels and electrocardiographic findings in acute ischemic stroke
Authors: Zareba N D C , Urdapilleta M , Sandoval C E , Garcia Zamora S S , Ameriso S F , Herrera Paz J J 
Published: October 2019

Abstract

Background
Troponin elevation and ECG changes are frequent findings in patients with acute ischemic stroke (AIS). The pathophysiology of these findings is still debated.

Purpose
To assesss the prevalence of electrocardiographic (ECG) changes and troponin elevation in AIS and to determine if these findings correlate with stroke severity.

Methods
Observational, retrospective study among AIS patients admitted to our stroke unit between October 2016 and December 2018. ECG was performed at admission and 24 hours later. Troponin levels were obtained after 6 hours of stroke symptoms onset. The NIH Stroke Scale (NIHSS) was performed by stroke neurologists.

Results
We included 744 consecutive patients (58% male), aged 66.8 years ±16.6 SD. Main vascular risk factors were hypertension (62%), dyslipidemia (49%), type 2 diabetes (18%), smoking (16%) and coronary artery disease (CAD) (17%). Twelve patients (1.6%) died during the hospitalization. Almost a half of patients (48.7%) had abnormal ECG. The most frequent ECG findings were: long QTc (26%), pathologic Q wave (18%), atrial fibrillation (AF) (9.4%), T wave inversion (5%), left-bundle bunch block (LBBB) (4%) and ST segment depression (2%). Patients who had a history of CAD had abnormal ECG findings more frequently than those who had not. (71% vs 44%, p<0.001).
Thirteen percent of patients had positive troponin levels and 6% presented severe strokes (defined as a NIHSS >15). In the univariate analysis, positive troponin was associated with ST segment depression (p=0.01), T wave inversion (p<0.01), LBBB (p<0.01) and AF (p<0.01). Patients with severe strokes had more frequent ECG abnormalities (p=0.002) and positive troponin levels (p<0.001). LBBB and AF were also associated with severe stroke (p=0.002 and p<0.0001 respectively).

Conclusions
ECG changes are prevalent in acute stroke. T wave inversion, ST segment depression, AF and LBBB are associated with high troponin levels, potentially suggesting underlying CAD. High troponin levels, LBBB and AF are associated with severe stroke. Patients with acute stroke may have underlying cardiovascular disease and may benefit from cardiologic evaluation.
P3717More fresh thrombi in cardio embolic than vascular related acute vessel syndromes
Authors: Meuwissen M , Remmers M J M , Pertiwi K R , Scholzel B E , Versteylen R J , De Boer O , Sturm M F A M , Van Den Hoef T P , Ijsselmuiden A J J , Van Norden A G W , De Jong T E A M , Haans H A W , Aarts R A H M , Vos L D , Van Der Wal A C 
Published: October 2019

Abstract

Background
Acute thrombotic occlusion may lead to major life threatening syndromes such as ST elevation myocardial infarction (STEMI) or stroke. In the majority, the underlying pathophysiology may be related to local vascular factors or thrombotic emboli. Thrombus composition might be indicative of underlying etiology and affect therapeutic considerations. Comparison of thrombi of patients suffering from both these acute syndromes has not been made yet. In this study, we compared the “age” of thrombi of patients with STEMI and acute large vessel occlusion related stroke (LVOS).

Methods and results
A total of 126 consecutive patients underwent thrombectomy for either STEMI (n=51) or LVO (n=75). All STEMI patients had vascular related occlusions. Causes of LVOS were classified according to the TOAST criteria; i.e. large artery atherosclerosis (LAA), cardio embolic (CE), other determined and embolic stroke of unknown source. Aspirated material was histopathological ordered as fresh (<1 day old), lytic (1–5 days old) or organized (>5 days old). In general, thrombi of patients with LVOS were fresher compared to thrombi of STEMI patients (p=0,04). This difference is can be attributed mainly to CE patients, which had significantly younger thrombi (p=0.001). Thrombi of LAA had comparable age with thrombi of STEMI (Figure).

Conclusion
Thrombi of cardio embolic stroke are fresher compared to that of thrombi of atherosclerotic related stroke. The latter have thrombi with comparable age of that with thrombi of ST elevation myocardial infarction. These findings may have therapeutic implications in anti-thrombotic therapies.
P3724Impact of chronic kidney disease on efficacy and safety of interventional left atrial appendage closure – results from the prospective multicenter LAARGE registry
Authors: Fastner C , Brachmann J , Lewalter T , Zeymer U , Sievert H , Nienaber C A , Weiss C , Ince H , Maier J , Achenbach S , Sigusch H H , Hochadel M , Schneider S , Senges J , Akin I 
Published: October 2019

Abstract

Background
The interventional left atrial appendage closure (LAAC) is an effective and safe alternative to standard oral anticoagulation (OAC) for stroke prevention in atrial fibrillation (AF) patients with contraindications for long-term OAC. Chronic kidney disease (CKD) has a high prevalence among AF patients, and was shown to increase the number of peri-procedural complications in cardiac interventions.

Purpose
This subanalysis of the LAARGE registry aimed to investigate CKD's impact on outcomes after LAAC.

Methods
This prospective, real-world LAAC registry included 625 patients with documented renal function from 37 German centers between April 2014 and January 2016. CKD was defined by an eGFR <60 mL/min/1.73 m2. Procedure was conducted with different LAAC devices considering the relevant recommendations. Baseline characteristics, procedural data, intra-hospital and one-year follow-up outcome were registered for CKD and non-CKD patients stratified by the different CKD stages.

Results
CKD patients (n=300; 48.0%) had a more pronounced cardiovascular risk profile, a higher stroke (CHA2DS2-VASc score 4.9±1.5 vs. 4.2±1.5; p<0.001) and bleeding risk (HAS-BLED score 4.3±1.0 vs. 3.5±1.0; p<0.001), and had experienced more prior bleedings (83.7 vs. 76.3%; p=0.022). Implantation success was similarly high between both groups (97.9%; p=n.s.). In CKD patients, MACCE during one-year follow-up was more frequent (18.1 vs. 6.8%; p<0.001) mainly being triggered by all-cause deaths, but in-hospital MACCE was not (0.3 vs. 0.3%; p=n.s.). Kaplan-Meier estimation showed a lower one-year survival among CKD patients (82.4 vs. 94.4%; p<0.001) without significant accentuation in patients with advanced CKD (i.e., <30 mL/min/1.73 m2; p=n.s. to other CKD patients). While annual rate of device associated complications (2.6 vs. 2.8%; p=n.s.) and strokes (0 vs. 1.0%; p=n.s.) was comparable during follow-up, annual severe bleeding rate was higher in CKD patients (2.6 vs. 0.3%; p=0.027) which was 71.4 and 94.4% less than expected from the HAS-BLED score (p<0.01 for the comparison to the estimated risks, but no significant interaction between groups).

Conclusions
Despite an increased cardiovascular risk profile of CKD patients, device implantation was safe, and annual stroke rate was statistically indifferent to non-CKD patients across all CKD stages after LAAC. Moreover, a substantial reduction of annual stroke and major bleeding risk was observed, as compared to the estimated annual risk.

Acknowledgement/Funding
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
P3728Impact of residual leaks and device-associated thrombus after left atrial appendage occlusion: long-term transesophageal follow-up and clinical outcome
Authors: Staubach S , Moertl M , Strohm H , Krollmann C , Mudra H 
Published: October 2019

Abstract

Background
Standardized transesophageal echocardiography (TEE) data regarding peri-device leaks and thrombus formation after left atrial appendage occlusion (LAAO) are sparse. Criteria to quantify residual leaks seem to appear highly arbitrarily. We therefore examined patients by long-term TEE follow-up after LAAO in a standardized Echo protocol.

Methods
Our patients were prospectively examined by questionnaires and TEE 6 weeks post-procedurally and ≥12 months after LAAO. TEE was performed according to the Munich consensus document, including multiple TEE views (2D and 3D) and an adequate, lower Nyquist limit (20–30cm/s) to detect low velocity flow. The severity of the leaks were graded as follows: >5mm severe, 3–5mm moderate and 1–2mm mild. Antithrombotic regime was administered according to the PROTECT-AF protocol for the Watchman device in the first 60 patients, and dual antiplatelet therapy for 1–3 months thereafter as well as for the Amplatzer device.

Results
In total, 107 LAAO were performed in our institution in patients with a mean age of 77 years. Mean CHA2DS2-VASc score was 4.3±1.3, mean HAS-BLED score 2.7±0.9. Mean clinical follow-up duration was 52.8 months, mean TEE follow-up 43.1 months. The overall annual stroke rate was 1.49%. None of the patients with a post-procedural stroke showed an intracardial thrombus by TEE after six weeks, during the event and in long-term FU. In long-term TEE follow-up 46% (n=18/39) had a mild to moderate residual leak and 2.6% (n=1/39) a severe leak >5mm.Two of the patients with a permanently existing leak sustained an ischemic stroke: in the first patient with a peri-device leak of 3mm the stroke occurred 80 months post-procedurally, in the second one with a growing leak from 3 to 6,5mm 25 months post-procedurally, both classified most likely as a cardioembolic stroke. One patient without a leak in long-term TEE FU suffered a stroke 5 years after LAAO (p=0.61). In all three patients antithrombotic regime during the event consisted of ASS alone.Device-associated thrombus was observed in 1.9% (n=2/107) six weeks after the procedure and increased to 15.4% (n=6 out of 39 TEE studies) in long-term FU, all appeared immobile. None of those patients suffered a thromboembolic event.

Conclusions
In long-term follow up, residual, mostly mild to moderate leaks and device-associated thrombi after LAAO seem to occur occasionally. However, patients with a residual leak or immobile thrombus do not appear to have a higher risk for thromboembolism so far.
P3735Incidence of bicuspid aortic valve in 16,185 neonates by echocardiographic screening in a single institution: is it really congenial?
Authors: Waki K , Ueda K , Satoh K , Ogino K , Hayashi T , Arakaki Y 
Published: October 2019

Abstract

Background
Bicuspid aortic valve (BAV) has been reported to be the most common congenital heart disease with an incidence of 1 to 2% in the general population; however, its incidence in neonates is still unclear because most of the reported incidence data are based on surgical or autopsy cases in adults.

Purpose
To elucidate the true incidence of congenital isolated BAV in neonates by echocardiographic screening in a population-based study.

Methods
We examined a total of 16,185 full-term neonates (male, 48.9%) born in our institution during either of the following two periods: September 1986 to February 2008 and October 2014 to September 2017. Mean gestational age (range) was 39.4 (36 to 42) weeks, and mean birth weight (range) was 3075 (2268 to 4622) g. On the second day after birth, we performed echocardiography and colour-Doppler flow mapping in all subjects. BAV was classified into two types on the basis of morphologicfindings in the parasternal short axis view of the aortic valve: BAV with raphe harbouring two cusps and commissures, showing a congenital fusion of two underdeveloped cusps, and BAV without raphe, showing a fish mouth appearance in systolic images. BAV associated with other congenital heart diseases such as coarctation of the aorta was excluded from this study.

Results
BAV was identified in 14 neonates (0.09%), an incidence of 0.9 in 1,000 live births. Of the 14 BAV neonates, five had BAV with raphe, whereas nine had BAV without raphe. Of the five BAV neonates with raphe, four had fusion of the right and noncoronary cusps, whereas one had that of the right and left coronary cusps. No aortic regurgitation was detected except trivial one in only one neonate, and no significant valvar stenosis was detected.

Conclusion
The incidence of BAV in neonates was much lower than previously reported incidence data. An acquired fusion of the cusps may develop in later life, and eventually may result in increased incidence of functional BAV.
P3747Does pulmonary vein isolation have similar results for treating AF in Chagas disease?
Authors: Macedo P , Rueda P , Serafim L , Oliveira E , Santos S , Henz B , Leite L 
Published: October 2019

Abstract

Background
AF is reported in up to 20% of patients with Chagas, a prevalent disease in Latin-America. PV isolation (PVI) in the cornerstone of AF ablation. However, in Chagas cardiopathy (ChC), microvascular and autonomic abnormalities, atrial fibrosis and sinoatrial dysfunction are possible mechanisms of AF. Therefore, the results of PVI may be different in this subgroup.

Objectives
To describe long-term results of AF ablation in pts with Chagas versus non-Chagas disease (ChC x NonCh) and evaluate risk factors for post-ablation recurrence.

Methods
This is a prospective, single-center study that included pts with nonvalvular AF who underwent PVI between 2013 and 2016. All procedures were guided by eletroanatomic mapping and intracardiac echocardiogram. Categorical variables were analyzed using chi-square test and numerical variables with t-student test. Binary logistic regression was performed to identify independent predictors of recurrence of any sustained atrial tachyarrhythmias.

Results
Ablation was performed in 160 pts (54±15 yo, 59% male): 42 pts with ChC (26%, 62±8 yo) and 118 NonChC (74%, 53±15 yo; p<0,001)). There was no difference in AF type (38x34% paroxysmal, 42x43% persistent, and 19x23% long-term persistent, p=NS) and left atrium diameter (38±5 vs 40±8mm, p=NS). In ChC the mean CHADSVASC score was higher (2.4 vs 1.4, p<0,001) and LVEF was lower (52±18% vs 64±8%, p=0.02). After a follow-up of 31±14 mo and 1.1 ablation per group, recurrence of AF/AT was higher in ChC (33% vs 14%, p=0.03) although more pts with Chagas were on AAD (71 vs 31%, p<0,001). During follow-up, occurrence of embolic events and cardiac or all-cause mortality were not different between groups (0% vs 1.7%, p=NS and 2.4 vs 1.7% p=NS; for ChC vs and NonChC, respectively).
At multivariate analysis, long-term persistent AF, hypertension and Chagas disease (HR= 2.21, 3.36 and 3.16, respectively) were independent predictors of recurrence.

Conclusions
Chagas disease is an independent predictor of recurrence after PVI. Further studies should address which strategy is more appropriate to this group of patients.
P3761Correlation between CHA2DS2-VASc score and left atrial size in patients with atrial fibrillation: an upto 15-year prospective follow-up study
Authors: Lin T T L , Lin L Y , Tsai C T T 
Published: October 2019

Abstract

Background
Left atrial (LA) size represents atrial fibrillation (AF) burden and a predictor of AF-related stroke. CHA2DS2-VASc score is also a well-established predictor of AF-related stroke. It is unknown whether these two factors are correlated and complimentary to each other, or one of them is a major determinant of stroke risk for AF patients.

Methods
A total of 708 patients from the National Taiwan University AF Registry were followed upto 15 years. LA size was measured by M-mode of echocardiography and the CHA2DS2-VASc score was calculated as measures of stroke risk. Primary endpoints during follow-up were defined as ischemic strokes or transient ischemic accidents.

Results
Both LA size and CHA2DS2-VASc score were associated with the risk of stroke in univariate analyses (c statistic 0.662 [0.601 to 0.723] for CHA2DS2-VASc score and 0.595 [0.516 to 0.674] for LA size). There was a positive correlation between LA size and CHA2DS2-VASc score (r=0.17, P<0.0001). Patients with higher CHA2DS2-VASc scores had a higher mean LA size (P<0.01 for trend). When combining LA size and CHA2DS2-VASc score in the multivariate Cox model, only CHA2DS2-VASc score remained statistically significant to predict the thromboembolic endpoint (hazard ratio 1.39 [1.20–1.63]; P<0.001).
Mode of anlysis Harzard ratio (95% confidence interval) P value Univariate analysis*   CHADS2-VASc score 1.42 (1.22–1.66) <0.001   Left Atrial Size 1.30 (1.04–1.62) 0.019 Multivariate analysis*   CHADS2-VASc score 1.39 (1.20–1.63) <0.001   Left atrial size 1.20 (0.96–1.48) 0.106

Conclusion
There is a positive correlation between echocardiographic LA size and CHA2DS2-VASc score. LA size is not an independent predictor of AF-related stroke, but provides a diagnostic value to predict stroke risk through its association with CHA2DS2-VASc score. Calculation of CHA2DS2-VASc score may replace measurement of echocardiographic LA size when evaluating the risk of AF-related stroke.
P3767Progressive left atrial remodeling associates with cholesterol efflux capacity of HDL in atrial fibrillation patients
Authors: Takano A , Iwata H , Miyosawa K , Funamizu T , Hayashi H , Tabuchi H , Sekita G , Daida H 
Published: October 2019

Abstract

Background
The clinical significance of high-density lipoprotein (HDL) function, represented by cholesterol efflux capacity (CEC), in addition to serum HDL cholesterol (HDL-C) levels, has been recognized in the pathogenesis and prognosis in patients with atherosclerotic cardiovascular diseases. However, the roles of HDL in the development and the progression of atrial fibrillation (AF), has been rarely evaluated. In this study, we thus hypothesized that the compromised HDL function may be associated with the progression of pathological structural remodeling in left atrium (LA).

Objective
We explored the association between CEC of HDL and the left atrial dimension (LAD), a maker of structural remodeling in the LA, in patients with AF and control.

Methods
This is a single center case-control study including consecutive 260 AF patients (AF group) and 34 paroxysmal supraventricular tachycardia (PSVT) patients (PSVT group, served as a control group), who underwent catheter ablation from July 2017 to December 2018. Blood samples were collected before catheter ablation procedure. CEC of HDL was measured by using ex vivo radiotracer system that involved incubation of [3H] cholesterol-loaded J774.1 murine macrophage-like cells with apoB-depleted serum.

Results
Serum HDL-C level was lower in AF group compared to those of PSVT group (55.3±15.3mg/dl vs 61.7±13.3mg/dl: p=0.024). As a marker of HDL function, CEC of HDL was significantly lower in patients with AF group compared to those in PSVT patients (4.74±0.84% vs 5.20±0.99%: p=0.005, Fig 1). In all patients including both groups, CEC of HDL was inversely correlated with LAD (r=−0.25; p<0.001, Fig 2), indicating the inverse association between HDL function and the progression of structural remodeling in AF. Moreover, multivariate logistic regression analysis adjusted by age, gender, body mass index, ejection fraction, and HDL-C demonstrated that increase in CEC of HDL was associated with the lower risk to be highest quartiles of LAD (>42mm), even adjusted by serum HDL-C levels (odds ratio of 1-SD elevation in CEC of HDL for LAD>42mm: 0.63; 95% confidence interval: 0.40–0.97, p=0.037), which implicated the link between HDL function and progression of left atrial structural remodeling.

Conclusion
Findings in this study may suggest that compromised HDL functionality is associated with the pathogenesis of left atrial structural remodeling in AF patients.