bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4372Left atrial strain: a potential marker of early diastolic dysfunction in patients with Marfan syndrome
Authors: Garcia-Izquierdo Jaen E , Mingo Santos S , Torres Sanabria M , Monivas Palomero V , Moreno Casado S , Navarro Rico S , Martin Lopez C E , Martinez Lopez D , Mitroi C , Gonzalez Mirelis J , Cavero Gibanel M A , Forteza Gil A 
Published: October 2019

Abstract

Background/Introduction
Previous studies using conventional echocardiographic measurements have reported subclinical left diastolic dysfunction in patients with Marfan syndrome (MFS). Left atrial strain (LAS) has been shown to be an accurate predictor of left ventricular diastolic dysfunction. However, there is no evidence regarding the use of LAS in MFS.

Purpose
To assess feasibility of LAS and compare LAS derived measurements along with traditional diastolic parameters in MFS patients vs healthy controls.

Methods
46 MFS patients (normal LV ejection fraction, no previous cardiovascular surgery, no significant valvular regurgitation) vs. 20 healthy controls (age and sex-matched). We performed LAS analysis using 2D speckle-tracking (QLAB 10, Philips). LA strain was determined as the average value of the longitudinal deformation (7 segments) in the apical 4-chamber view (RR gating).

Results
LAS analysis was feasible in 40 MFS patients (87%). All participants had normal diastolic function according to current guidelines (ASE/EACVI 2016). MFS patients showed lower TDI e' velocities and higher average E/e' ratio, but still within normal range. Similarly, LVEF was normal but slightly reduced in MFS patients. LA strain and strain rate parameters during reservoir and conduit phase were significantly impaired in MFS patients compared to controls.
MFS vs controls MFS patients (n=40) Controls (n=20) p MFS patients (n=40) Controls (n=20) p Age 33.8±12.4 34.4±8.3 0.846 Septal e' (cm/s) 9.7±2.5 11.7±2.3 0.006 Male (%) 24 (60%) 12 (60%) 1.000 Average E/e' ratio 6.8±1.5 5.5±1.1 0.002 SBP (mmHg) 120.3±12.4 120.1±9.4 0.969 TR velocity (cm/s) 208.6±21.4 201.6±22.9 0.390 DBP (mmHg) 72.0±10.1 67.1±6.2 0.069 LAVi (ml/m2) 23.5±7.1 25.5±4.8 0.260 Aortic root (mm) 40.3±4.6 31.7±3.7 <0.001 LASr (%) 32.6±8.8 43.0±8.3 <0.001 LVEF (%) 60.9±5.6 64.2±4.2 0.022 LAScd (%) −20.1±8.0 −29.4±5.5 <0.001 E-wave (cm/s) 74.6±16.5 76.7±16.5 0.651 LASct (%) −12.8±6.1 −13.6±5.2 0.622 A-wave (cm/s) 55.2±10.9 52.0±12.8 0.327 LASRr 2.02±0.49 2.31±0.43 0.030 E/A ratio 1.4±0.4 1.5±0.4 0.287 LASRcd −2.22±0.61 −3.07±0.68 <0.001 Lateral e' (cm/s) 13.0±3.6 16.3±3.3 0.002 LASRct −2.24±0.90 −2.35±0.75 0.600 SBP: Systolic blood pressure. DBP: Diastolic blood pressure. LVEF: Left ventricular ejection fraction. LAVi: Left atrial volume index. LAS: Left atrial strain. LASR: Left atrial strain rate. (r): Reservoir. (cd): Conduit. (ct): Contraction.
Example of LA strain and strain rate

Conclusion
MFS patients showed a subtle impairment in diastolic function compared to controls. Although further evidence is needed, LAS derived parameters could be early markers of diastolic dysfunction in this group of patients.

Acknowledgement/Funding
Programa de Actividades de I+D de la Comunidad de Madrid
P4375Value of echocardiography to diagnose coronary arteries patterns in transposition of great arteries
Authors: Galoin Bertail C , Perouse De Montclos T , Bakloul M , Metton O , Mitchell J , Ninet J , Di Filippo S 
Published: October 2019

Abstract

The objective of this study was to evaluate the accuracy of echocardiographic to assess coronary arteries (CA) anatomy in transposition of the great arteries (TGA) and determine impact on outcomes.

Material and methods
Retrospective analysis of data in neonates diagnosed with TGA (isolated or associated with VSD). Preoperative echocardiographic (TTE) coronary artery pattern and surgical intraoperative reports (SURG) were compared. Mismatch between TTE and SURG, and its impact on perioperative outcome were assessed. Coronary patterns were classified in 4 groups: I= normal CA, II= CA with intramural course, III= CA loop, IV= CA loop and intramural segment.

Results
108 neonates who underwent arterial switch operation (ASO) for isolated TGA (67 cases) or TGA+VSD (41) were included in the study: 68 ranged in group I, 7 in group II, 32 in group III and 1 in group IV. Five patients died (4.6%), from coronary cause in 3. Survival rates were 96% at 1-month and 95.2% beyond. Intraoperative complications occurred in 10 cases. TTE and SURG CA diagnosis differed in 19 cases = 17.6% (mismatch). Diagnosis of CA anatomy differed in 4.4%, 42.8%, 37.5% and 100% of respectively groups I, II, III and IV. Mortality was 28.6% in group II (intramural CA) compared to 2.9% in group I, 3.1% in group III and 0% in group IV (p=0.002). Death rates was 15.8% if TTE/SURG mismatch and 2.2% if TTE and SURG were concordant (p=0.0108). Mortality in group II (intramural CA) increased up to 50% in case of mismach TTE/SURG versus 0% if concordance, and was similar in the other groups. Survival rates were 84.2% in TTE misdiagnosed CA anomalies compared to 97.6% if TTE assessment correlated with surgical reports. By multivariate analysis, groups II and III coronary anatomy were risk factors for mismatch between TTE and SURG (respectively p=0.008 and p=0.0005), and mismatch TTE/SURG was the only risk factor for perioperative mortality (p=0.045).

Conclusion
Echocardiography can accurately assess coronary artery anatomy in neonates with TGA. Intramural coronary course is often misdiagnosed. Missed diagnosis of coronary artery anomaly preoperatively may impact on perioperative mortality.
P4384Noninvasive and novel method to evaluate left ventricular contractility using pressure-volume loop area obtained by 3-dimensional speckle tracking echocardiography
Authors: Yoshizane T , Tanaka R , Kawasaki M , Otsuka M , Shoji T , Nagaya M , Hattori K , Yagasaki H , Minatoguchi S , Ono K , Murata I , Deguchi T , Arai M , Noda T , Okura H 
Published: October 2019

Abstract

Introduction
Left ventricular (LV) pressure-volume (P-V) loop area reflects stroke work (SW), but clinical use of this index is limited by the need of invasive pressure measurement. A noninvasive method to obtain LV pressure-strain loop was recently introduced to assess myocardial work (MW). The minimum LV diastolic pressure (mLVP) was reported to have a strong correlation with Tau and we reported that Tau was noninvasively evaluated by speckle tracking echocardiography (STE).

Purpose
We sought to evaluate the impact of preload change by leg lifts on LV SW noninvasively obtained by the novel method and to examine the utility to assess LV contractility by SW and end-diastolic (ED) volume relation (SW-VED).

Methods
Thirty six controls (age 71±10) and 30 patients with heart failure with reduced ejection fraction (EF) <50% (HF) (age 73±6) were enrolled. LV pressure in a cardiac cycle was estimated using systolic blood pressure (SBP), minimum diastolic pressure (mDP) and ED pressure (EDP) by utilizing the profile of an empiric, normalized reference curve. The mDP and EDP were estimated as (Tau − 33.7)/2.06 and as 12.3 − 10.1 x Log (left atrial active emptying function/minimum volume) as we reported. LVSW was obtained by P-V loop by the combination of these pressures and LV volume using 3-D STE.

Results
LVEF and longitudinal strain in HF before leg up by 3D-STE were lower compared to normal (LVEF; normal: 58±5 vs HF: 39±10*% and strain; −12±3 vs −8±3%*, *p<0.05 vs normal). LVEF was increased after leg up by 7±6% in normal and by 8±8% in HF associated with increased LVED volume (normal: 84±24 to 90±24 and HF: 124±36* to 136±42*ml). LV MW and SW in HF before leg up were lower compared to normal (MW: 1790±412 vs 1002±432*mmHg% and SW: 3946±1682 vs 3352±1026mmHgml). LV SW increased after leg up by 26±19% in normal and by 25±20% in HF. LV SW-VED in normal was greater than HF (241±151 vs 90±54*).

Conclusion
LV SW noninvasively obtained by P-V loop area was increased after leg up in both normal and HF but SW-VED in HF was smaller than normal, indicating reduced contractility in HF. This noninvasive method may be a new echocardiographic approach for quantification of LV SW and contractility.
P4386Prognostic value of pressure-strain curve analysis by echocardiography for cardiac death in patients with congestive heart failure
Authors: Manno T , Shimizu M , Ohomri M , Taomoto Y , Kaneda T , Yamakami Y , Iiya M , Shimada H , Isshiki A , Kimura S , Fujii H , Suzuki M , Hirao K 
Published: October 2019

Abstract

Background
Pressure-strain curve analysis (PS-curve) is novel method of echocardiographic evaluation for left ventricular (LV) systolic myocardial work including the effect of blood pressure. However, the prognostic value of PS-curve for prospective cardiac death in patients with congestive heart failure (CHF).

Purpose
To elucidate the prognostic value of PS-curve analysis for cardiac death in patients with CHF.

Methods
We enrolled 63 consecutive sinus-rhythm patients with CHF admission who were evaluated by PS-curve analysis before discharge (76.0±13.3 years, 39 males). Endpoint was set as all cardiac death.

Results
Observation period was median 327 days [25%: 91, 75%: 656 days], and the longest period was 1004 days. Five patients died for cardiac causes. Multivariate Cox regression analysis (stepwise regression) revealed diastolic blood pressure (BP) and global constructive work (GCW) were independent predictors (Hazard ratio: 0.854, 0.996, P value: 0.016, 0.019, respectively). ROC curve analysis demonstrated GCW ≤601 had high diagnostic performance for cardiac death (specificity 0.891, sensitivity 0.800, area under ROC 0.824). Kaplan-Meyer curve analysis indicated the group with GCW ≤601 was worse cardiac prognosis (Logrank P<0.001).
Cox Hazard Regression Analysis Univariate Multivariate (stepwise regression) Hazard Ratio 95% CI P Hazard Ratio 95% CI P BP systole (mmHg) 0.915 0.85–0.99 0.026 BP diastole (mmHg) 0.915 0.84–0.99 0.043 0.854 0.75–0.97 0.016 LVDd (mm) 1.064 1.01–1.12 0.025 NA LVDs (mm) 1.066 1.01–1.12 0.016 LVEF (%) 0.963 0.91–1.02 0.221 LAD (mm) 1.197 1.06–1.36 0.005 GWE 0.937 0.88–0.99 0.041 GWI 0.998 0.99–0.99 0.041 NA GCW 0.998 0.99–0.99 0.037 0.996 0.99–0.99 0.019 GWW 0.996 0.98–1.01 0.502 Considering multicollinearity, we excluded GWI and LVDd (correlation coefficient: GWI and GCW = 0.979, LVDd and LVDs = 0.942).

Conclusion
Pressure-strain curve analysis had powerful predictive value for cardiac death in patients with CHF.
P4390Sex-specific association between secondhand smoke exposure and metabolic syndrome in 118,609 Korean never-smokers verified by both self-reported questionnaire and cotinine
Authors: Kim B J , Kim J H , Kim B S , Kang J H 
Published: October 2019

Abstract

Background
No study has reported the relationship between secondhand smoke (SHS) exposure and metabolic syndrome (MetS) in self-reported never-smokers verified by nicotine metabolite.

Purpose
The aim of this study is to determine the relationship between SHS exposure and MetS in self-reported and cotinine-verified never-smokers.

Methods
A total of 118,609 self-reported and cotinine-verified never-smokers (38,385 men; age 34.8±7.1 years) who participated in Kangbuk Samsung Health Study (KSHS) and Kangbuk Samsung Cohort study (KSCS) between 2011 and 2016 were included. Cotinine-verified never-smoker was defined as individuals having urinary cotinine <50 ng/mL. SHS exposure was defined as having experienced passive smoking indoors at home or the workplace.

Results
The prevalence of SHS exposure in the overall population was 22.6%, with rates of 27.4% for males and 20.3% for females (p<0.001). The overall prevalence of MetS was 6.8%; the prevalence in males was higher than that in females (10.7% versus 4.9%, p<0.001). In both males and females, the prevalence of MetS in group with SHS exposure was higher than that in group without SHS exposure (11.3% versus 10.4%, p=0.010 for males; 5.8% versus 4.6%, p<0.001 for females). However, there was significant gender interaction for the relationships between SHS exposure and MetS (p for interaction=0.010). A multivariate regression model was adjusted for the baseline variables including age, body mass index, frequency of alcohol drinking and vigorous exercise, blood urea nitrogen, creatinine, uric acid, total cholesterol, LDL cholesterol, and hsCRP. The results showed that SHS exposure only in females was associated with MetS (odds ratio [95% confidence interval], 1.17 [1.06, 1.29] for females; 1.02 [0.94, 1.11] for males). In particular, females with SHS exposure of ≥1 hours/day, ≥3 times/week, and ≥10 years increased the prevalence of MetS compared to those without SHS exposure (1.21 [1.02, 1.45], 1.30 [1.14, 1.49], and 1.12 [0.99, 1.28], respectively.

Conclusions
This study showed that the SHS exposure in females was significantly associated with MetS in self-reported never-smokers with low urinary cotinine levels (<50 ng/mL), suggesting that more active anti-smoking programs in the home and public are needed to reduce the risk of MetS.
P4392A systematic review and meta-analysis of the cardiovascular effects of e-cigarette
Authors: Antonopoulos A S , Skotsimara G , Oikonomou E , Ioakeimidis N , Mistakidi C V , Georgakopoulos C , Galiatsatos N , Charalampous G , Vlachopoulos C , Tousoulis D 
Published: October 2019

Abstract

Background
Electronic cigarette (EC) is marketed as a safe alternative to tobacco smoking, but EC cardiovascular effects remains largely unknown.

Purpose
To systematically review and meta-analyse published literature to investigate the cardiovascular effects and associated risk from EC use.

Methods
We searched PubMed from January 2000 until November 2017 for published studies assessing the cardiovascular effects of EC. For each eligible study we used the mean difference (MD) with 95% confidence intervals (CIs) for SBP, DBP and HR. The pooled MDs for each outcome of interest were calculated by using a fixed effects model. The presence of heterogeneity among studies was evaluated by the I2 statistic.

Results
We report conflicting evidence on the effects of EC on heart rate and blood pressure, which is mainly based on non-randomized clinical studies of moderate quality. In a meta-analysis of 14 studies (n=441 participants), that despite the negative effects of EC on heart rate (pooled MD=2.27, 95% CI: 1.64 to 2.89, p<0.001), diastolic (DBP, pooled MD=2.01mmHg, 95% CI: 0.62 to 3.39, p=0.004) and systolic blood pressure (SBP, pooled MD=2.02mmHg, 95% CI: 0.07 to 3.97, p=0.042), benefits may be observed in terms of blood pressure regulation when switching from tobacco smoking to EC (SBP pooled MD=−7.00, 95% CI: −9.63 to −4.37, p<0.001; DBP pooled MD=−3.65, 95% CI: −5.71 to −1.59, p=0.001). Evidence suggests that EC negatively affects endothelial function, arterial stiffness and the long-term risk for coronary events, but these findings are derived from single study reports and have not been confirmed in additional studies.

Conclusions
We report adverse effects of EC use on heart rate and blood pressure. Unless supported by stronger evidence, EC should not be labelled as cardiovascular safe products. Future studies should delineate whether EC use is less hazardous to cardiovascular health than conventional cigarette smoking.
P4395Arterial hypertension and anxiety level in Bukovinian region of Ukraine: obvious problem, which we ignore
Authors: Shorikova D , Shorikov E , Shorikov P 
Published: October 2019

Abstract

The hypothesis that symptoms of anxiety and depression contribute to the development of arterial hypertension (AH) has been controversial. Mermerelis A. (2016) in pilot study found the association of anxiety disoders with resistant hypertension. Since 2013 social-and-psychological situation, which had developed in Ukraine after beginning of military conflict on the East of the country, has led to the destruction of public consciousness and vital orientation of millions people. Psychoemotional overstrain and psychic disadaptation induced the increasing of level cardiovascular diseases (CVD). But till now, the psychological factor we don't include in the management of hypertensive patient.

Materials and methods
The prospective study included 596 patients (375 women and 220 men), treated with arterial hypertension in University Clinic, Military Hospital and Cardiological Ambulance of Bukovinian Region. The exclusion criterias were concominant CVD and other somatical diseases in decompensation. Also we didn't include patients with psychiatry disoders. For psychometric screening hospital anxiety and depression scale HADS-A and HADS-D was used. Considering that the data obtained are characterized by asymptomatic normal distribution the Mantel-Henzel factor of disagreement or odds ratio were used.

Results
The study under the scheme “case-control” showed that in women OR index stresses significant interrelation of anxiety and level of blood pressure (BP).
Thus, the subclinical anxiety at AH 1 degree was according to OR = 1.6 [CI95% - 0.96–2.54). This shows possible association of anxiety and AH at the lower border of the confidential interval. At resistance AH - OR was 3.26 [CI95% - 1.78–5.92], p<0.001. Clinical anxiety is associated with AH due to the index OR in the form of linear dependence, “p” is of high degree of reliability.
In men subclinical anxiety is also associated with AH, however “p” value shows reliability only in an estimation of resistance AH at OR 3.45 [CI95% - 1.33–9.57].
The most significant association, both subclinical and clinical anxiety, was noticed at resistance AH both in women 3.1 [CI95% - 1.17–5.2] and men 4.8 [CI95% - 1.93–12.3].
Estimating the value of the relation of chances by association of anxiety and degree of AH in women, it is possible to notice complete comorbidity of anxiety level and arterial hypertension irrespective of their forms and degree. In men association of anxiety level and various clinical degrees of arterial hypertension has its own features, reaching maximum in patients with AH 3 degree and resistance AH.

Conclusions
In both women and men clinical form of anxiety often associated with AH 3 degree and resistance AH, so it is necessary to introduce the parameter of the presence of anxiety-depressive syndrome in patients with AH in subclinical and clinical forms.
P4398Potentially modifiable clinical and psychosocial factors associated with recurrent cardiovascular events in an outpatient coronary population
Authors: Sverre E , Peersen K , Weedon-Fekjar H , Perk J , Gjertsen E , Husebye E , Otterstad J E , Gullestad L , Dammen T , Munkhaugen J 
Published: October 2019

Abstract

Background
Regular assessment and management of lifestyle, biological and psychosocial factors are recommended in coronary patients. The relative importance of these factors on risk of recurrent cardiovascular (CV) events in the outpatient coronary population is not well known.

Purpose
To estimate the relative effect of potentially modifiable risk factors on recurrent CV events in coronary patients from routine clinical practice.

Methods
A prospective cohort multicenter study from Norway included 1127 (21% women, 83% participation rate) consecutive patients aged 18–80 years 2–36 (mean 16) months after myocardial infarction and/or a coronary revascularization procedure. Thirty percent had at least one coronary event prior to the index event. The primary composite endpoint of recurrent major adverse CV events (MACE): myocardial infarction, revascularization, stroke, heart failure or cardiovascular death was obtained from the hospital records. Cox proportional hazard models stratified for 1 vs. 2+ previous coronary events were performed with model 1 adjusting for age and model 2 with add-on for coronary risk factors and CV comorbidity.

Results
At baseline 99% used platelet inhibition, 93% were taking antihypertensive agents and statins, and 45% had participated in cardiac rehabilitation (CR). During follow-up of mean 4.2 (SD 0.3) years, a total of 355 MACE occurred in 240 patients corresponding to a MACE risk of 31.5%. In model 1, smoking, insufficient physical activity, diabetes, not taking statin therapy, no participation in CR, peripheral artery disease (PAD), previous stroke, kidney failure and higher anxiety and depression scores were significantly associated with recurrent MACE (Table). In model 2, smoking, no physical activity, not taking statin, PAD, kidney failure, anxiety and depression remained significant.

Conclusions
Coronary patients in routine clinical practice were at significant risk of recurrent MACE, particularly in the presence of CV comorbidity. Not taking statin therapy, insufficient physical activity, smoking, anxiety and depression were the major potentially modifiable factors contributing to CV risk. Preventive efforts that target these factors are required to further reduce CV risk in the coronary population.

Acknowledgement/Funding
Grants from the Norwegian ExtraFoundation for Health and Rehabilitation and Vestre Viken Trust
P4399Low social support and risk of myocardial infarction in general population in Russia/Siberia: gender disparities. WHO epidemiological program MONICA-psychosocial study
Authors: Gafarov V , Gromova E , Panov D , Gagulin I , Gafarova A , Krymov E 
Published: October 2019

Abstract

Aim
To determine the gender differences in the effect of social support on risk of myocardial infarction (MI) in an open population 25–64 years in Russia/Siberia.

Methods
Under the third screening of WHO program MONICA-Psychosocial a random representative sample of both gender aged 25- 64 years in Novosibirsk was examined in 1994 (n=1346, males 48.8%, mean age 44,9±0,4 years). Indices of close contacts (ICC) and social relations (SNI) were evaluated at the baseline by Berkman-Syme test. New-onset MI incidences were identified over 16-years (1994–2010yy) of follow-up in the cohort.

Results
The prevalence of low ICC levels was higher in men compared to women (63.9% and 57.1%, respectively); the prevalence of low SNI levels was higher in women compared to men (77.7% and 43%, respectively). The risk of MI over 16 years of follow-up was 5.2-fold higher in men (95% CI 1.947–19.383; p<0.05) and4.9-fold higher in women (1.108–21.762; p<0.05) with low ICC. Low SNI increases risk of MI in 3.1 times in men (1.138–9.247; p<0.05) and in 2.9 times in women (95% CI 1.040–8.208; p<0.05). After adjustment for social variables multivariate model showed significant results in higher risk of MI in those males who are living alone with manual occupational status and in women with low educational degree.

Conclusions
Social support is a protective factor for MI incidence both in men and women. Better social gradient improves this influence. Family status and occupation are stronger to be attributable to risk in males while level of degree in females with low social support.