bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6005Incidence and clinical characteristics of coronary artery spasm in patients with out-of-hospital cardiac arrest
Authors: Kawamura G , Okayama H , Kido S , Aono T , Matsuda K , Tanaka Y , Iseki Y , Hosokawa S , Kosaki T , Shigematsu T , Kawada Y , Hiasa G , Yamada T , Kazatani Y 
Published: October 2019

Abstract

Background
Substantial cases of out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome have been recognized thus far, but there have been few reports about the aetiology of patients with OHCA without the organic heart disease. Especially, coronary artery spasm would be one of the causes of OHCA.

Purpose
This study aimed to investigate causes of OHCA without the organic heart disease and to investigate the characteristics and angiographic findings of OHCA patients with vasospastic angina (VSA).

Methods
Between January 2010 and April 2018, 920 patients with OHCA caused by probable or definite cardiovascular disease were transferred to our hospital. Return of spontaneous contraction was successfully achieved in 151 patients, among whom diagnosis was made in 130 patients. First, we analysed the causes of OHCA in these patients. Second, we compared clinical and angiographic characteristics between the VSA group with OHCA (OHCA-VSA) and the VSA group without OHCA (stable VSA; n=72) from our database.

Results
Among the 130 patients, 95 (73%) had the organic heart disease; 72, acute coronary syndrome; 19, myocardial disease; 2, valvular heart disease; and 1, congenital heart disease. There were 35 patients (27%) without the organic heart disease. Nineteen patients had primary (i.e., Brugada syndrome, QT prolongation) or secondary arrhythmia (i.e. drug adverse effect). Electrocardiogram, coronary angiogram, and LV structure and function were normal in 35 patients. However, there were 16 patients (11%) with VSA defined by Japanese guideline. The OHCA-VSA group was significantly younger (50±14) than the stable VSA group (64±11, P=0.003). The incidence of diffuse-type spasm in the OHCA-VSA group (100%) was significantly higher than that in the stable VSA group (100% vs. 69%, P<0.05). In addition, the incidence of triple-vessel coronary spasm in the OHCA-VSA group was significantly higher than that in the stable VSA group (86% vs. 25%, P=0.003).

Conclusion
OHCA patients without the organic heart disease had considerable cases of VSA, in addition to primary or secondary arrhythmia. Furthermore, the severity of spasm in the OHCA-VSA group was more serious and extensive than in comparison with the stable VSA group.
P6017Permanent left bundle branch area pacing for atrioventricular block: feasibility, safety and acute effect
Authors: Li X F , Li H , Fan X H , Ma W T , Ning X H , Liang E P , Pang K J , Yao Y , Hua W , Zhang S 
Published: October 2019

Abstract

Background
Left bundle branch area pacing (LBBAP), lacks adequate evaluation for AVB.

Purpose
We aimed to assess the feasibility, safety, and acute clinical outcomes of permanent LBBAP in patients with AVB.

Methods
We retrospectively recruited AVB patients with indication for ventricular pacing who had underwent LBBAP from May to Sep. 2018. ECG characteristics, pacing parameters, echocardiographic parameters and adverse events were evaluated during follow-up. Successful LBBAP was defined as the paced QRS morphology of RBBB pattern and QRSd less than 130ms.

Results
A total of 33 patients were involved in this study (mean age: 55.1±18.5 years; 66.7% male, 48.4% with bundle branch block,BBB). LBBAP was successfully performed in 90.9% (30/33) of all patients. The mean capture threshold of LBBAP was 0.76±0.26 V/0.4 ms during the procedure and 0.64±0.20 V/0.4ms at 3-month follow-up. The paced QRSd was 112.8±10.9 ms during the procedure and 116.8±10.4ms at 3-month follow-up. Baseline left or right BBB was corrected by LBBAP (153.3±27.8 ms vs. 122.2±9.9 ms) with a success rate of 68.7% (11/16). One ventricular septal lead perforation occurred soon after the procedure and LBBAP was successfully repeated by lead revision. Cardiac function and left ventricular synchronization at three-month follow-up presented slightly improvement as compared with baseline.
Table 1. Complications and changes in pacing parameters within 3 months after LBBAP Pacing parameters LBBAP (N=30) During the procedure Before discharge 3-month follow up Sensing amplitude, mV 14.4±5.1 15.8±11.7 14.6±4.6 Pacing threshold@0.4ms, V 0.76±0.26 0.59±0.16 0.64±0.20 Pacing impedance, Ω 691.7±133.8 588.0±79.3 554.7±93.7 Paced QRSd at 3.0V@0.4 ms output, ms 112.8±10.9 114.4±14.2 116.8±10.4 VP, % NA NA 79.4±24.6 Complications, n (%) 1 (3.3) 0 (0.0) 0 (0.0) Infection, n (%) 0 (0.0) 0 (0.0) 0 (0.0) Septal perforation, n (%) 1 (3.3) 0 (0.0) 0 (0.0) Dislodgement, n (%) 0 (0.0) 0 (0.0) 0 (0.0) QRSd, QRS duration; VP, ventricular pacing percentage.
Figure 1. Characteristics of LBBAP

Conclusion
Permanent LBBAP yielded stable threshold, narrow QRSd and preserved left ventricle synchrony with few complications. Our preliminary results indicate that LBBAP holds promise as an attractive physiological pacing strategy for AVB.
P6136Intense daily cigarette smoking accelerates vascular damage of smokers with a moderate cumulative tobacco smoke exposure
Authors: Ioakeimidis N , Vlachopoulos C , Georgakopoulos C , Terentes-Printzios D , Koutagiar I , Dima I , Rokkas K , Skoumas I , Tousoulis D 
Published: October 2019

Abstract

Purpose
Coronary artery disease death has been associated with increased cigarette smoking intensity. Aim of the study is to investigate the impact of cigarette smoking intensity on vascular function and structure changes among male smokers with similar age at starting smoking and moderate cumulative tobacco smoke exposure.

Methods
Indices of vascular function and structure including carotid-femoral pulse wave velocity (PWV), brachial flow-mediated dilation (bFMD), carotid intima media thickness (cIMT) and microvascular damage (penile vasculature) were measured in 118 smokers consuming up to 1 pack (20 cigarettes)/day and 58 patients smoking >1 pack (20 cigarettes)/day. The two groups had a similar mean cigarette smoking exposure (32 pack/years). Microvascular damage was examined by measuring penile peak systolic velocity (PSV) with a dynamic penile color Doppler ultrasonography after intracavernous injection of prostanglandin E1. Lower PSV values indicate severe penile vascular disease.

Results
The individuals smoking more than 1 pack/day were 10 years younger than smokers consuming up to 1 pack/day, however systolic, diastolic blood pressure, body-mass index, fasting blood glucose levels, lipid profile, C-reactive protein and total testosterone concentration were similar between the two groups. Figure shows mean bFMD, penile PSV, PWV and cIMT of the two groups. Interestingly, despite the similar cumulative smoking exposure between the two groups, the younger in age individuals with the intense cigarette smoking history had significantly lower mean bFMD and penile PSV (all P<0.05) and similar PWV and cIMT compared to the mean values of older subjects smoking up to 1 pack/day.
Smoking intensity and vascular changes

Conclusions
Intense daily smoking accelerates damage of large arteries and significantly impairs microvascular and systemic endothelial function. Considering the predictive value of vascular biomarkers, the findings of this study imply the possibility that baseline daily smoking intensity could be a better summary measure of smoking-related cardiovascular risk among young heavy smokers, relative to total pack-years of smoking.
P6137Trends in mortality of sudden cardiac death in Brazil
Authors: Moreira H , Silva G L S , Sahium G M B , Faria M M , Pereira J P S , Faria R B C C 
Published: October 2019

Abstract

Background
Sudden cardiac death (SCD) is the most feared manifestation of heart disease. In the past few decades, substantial progress has been made in our understanding of SCD and in its prevention. However, there is no data concerning population incidence of SCD in Brazil.

Purpose
To estimate trends of mortality for SCD in Brazil between 1996 and 2015.

Methods
Data from death certificates in Brazil from 1996 to 2015 were obtained by consulting the Mortality Information System (SIM) national database. SCD was defined as deaths occurring out of the hospital (residence or public way) with an underlying cause of death reported as a cardiac disease (ICD-9 code 390–398, 402, or 404–429; ICD-10 code I00-I09, I11, I20-I51). Annual death rates (deaths/100,000 inhabitants) were calculated for the population aged ≥20 years and standardized by the direct method to the 2010 Brazilian Census population. Trend analyses in the period were performed using Poisson regression.

Results
In 2015, there were 200,372 cardiac disease deaths among Brazilian adult population, of which 63,390 (31.6%) were defined as SCD. Over this 20-years period, 1,002,648 deaths were attributed to SCD, and coronary heart disease was the underlying cause on 59% of death certificates. The adjusted mortality rate ranged from 52.9 in 1996 to 39.7 deaths/100,000 inhabitants in 2015 (R2=0.685, P<0.001). This reduction in SCD mortality was more pronounced among women (50.4 to 34.0 deaths/100,000 inhabitants; R2=0.785, P<0.001) than men (59.7 to 49.9 deaths/100,000 inhabitants; R2=0.477, P=0.03). With the exception of individuals aged 20 to 39 years, in the all other age groups this reduction in mortality was also significant.

Conclusions
This data gives an insight into the pattern of SCD deaths in a big developing country. Despite the inherent limitations in collecting information based on death certificates, in addition to the absence of a clear national standardized definition of SCD, it is possible to affirm that there was a reduction in mortality due to SCD in the last 20 years in Brazil. Prospective surveillance programs would enable more accurate determination of SCD burden in the community.
P6138Quality of clinical trial evidence on devices and drugs approved to treat coronary artery disease
Authors: Stefanini G G , Naci H , Cao D , Malanchini G , Sturla M , Byrne R , Baber U , Reimers B , Condorelli G , Mossialos E , Windecker S , Mehran R 
Published: October 2019

Abstract

Background
Regulatory approval of drugs and devices follow two different pathways. Whether different approval pathways underlie meaningful differences in quality of clinical trial evidence is unknown. We aimed to compare the quality of evidence of clinical trials that served as a basis for approval by the U.S. Food and Drug Administration (FDA) of drugs and devices used for the treatment of coronary artery disease.

Methods
FDA databases were searched for devices (i.e., coronary artery drug-eluting stents) and drugs (i.e., agents targeting atherothrombosis) approved between January 1st, 2001 and December 31st, 2017. FDA medical reviews were screened to identify trials that served for approval purposes. The pre-specified primary outcome was the prevalence of randomized trials used for approval (i.e. number of randomized trials/overall number of trials).

Results
A total of 97 trials were identified, 39 serving for approval of 13 devices and 58 serving for approval of 8 drugs. Devices were evaluated by fewer trials per item as compared with drugs (3.0±1.4 vs. 7.3±5.3, P=0.012) with similar study size (501 [100–1314] vs. 379 [183–904] patients per trial, P=0.55). Trials evaluating devices were less frequently randomized (56.4% vs. 94.8%, P<0.001) and more frequently designed powered for clinical endpoints (53.8% vs. 17.2%, P<0.001) as compared to those evaluating drugs. Use of randomization declined over time among trials supporting FDA approval of devices. In addition, significant differences were present between trials evaluating devices and those evaluating drugs in terms of study design, comparator used, blinding to treatment allocation, primary hypothesis, primary endpoint, and type of patients included.
Use of randomized trials for approval

Conclusions
There are substantial differences in clinical trial evidence serving for FDA approval of devices and drugs used for treatment of coronary artery disease. The lower degree of randomized evidence used for approval of devices as compared to drugs raises some concerns, particularly in view of its decline over time.
P6142LATIN telemedicine - expanded umbrella of cost-effective ami coverage for 100 million people
Authors: Torres M A , Mehta S , Botelho R , Fernandez F , Cade J , Prudente M , Cavalcanti R , Dusilek C , Bojanini F , De Los Rios O , Alcocer Gamba M , Frauenfelder A , Matheus C , Vieira D , Mazzini J 
Published: October 2019

Abstract

Background
AMI is a unique entity where the immediate diagnosis can be made by a single test, the EKG. Despite this matchless attribute of easy diagnosis, developing (and some developed) countries lack resources and efficient pathways for urgent and reliable diagnosis of AMI. With Latin Telemedicine Infarct Network (LATIN), we have previously presented Telemedicine as a pragmatic solution for urgent and accurate diagnosis of AMI. In this work, we reveal pathways of scalable population-based AMI management models.

Purpose
To utilize telemedicine as a foundation pillar for creating cost-effective and global models of AMI management.

Methods
LATIN pilot tested the hypothesis of remote guidance of AMI management and expanded access by creating a hub and spoke, STEMI systems of care that exploited regional resources. A highly efficient, web-based, cloud-computing prototype was developed and scrupulously monitored with a new metric of time to telemedicine diagnosis (TTD). STEMI systems of care were created to efficiently triage the diagnosed patients for being treated with thrombolysis, pharmaco-invasive management or Primary PCI. This stratagem had enormous provincial variability and was constrained mainly by ambulance structure. Telemedicine and IT costs were forced lower and enabled a cost-effective process to hugely provide access to 100 million patients located in poorer regions of Colombia, Brazil, Mexico, and Argentina. Education and training have formed the mantra for LATIN and stakeholder development, and ambulance systems development has remained immutable goals.

Results
Almost 800,000 patients were successfully screening through LATIN with a cost for accurate STEMI diagnosis of < $3, a tele accuracy that exceeded 95% and with TTD <4 minutes. A total of 8,440 (1.1%) of patients were diagnosed with AMI in this manner and 3,924 (46.5%) urgently reperfused, mainly with Primary PCI (3,048, 77.8%). D2B times have been lowered now to 51 minutes but this is fortuitous, as several PCI-capable facilities are small, and direct transfer to the catheterization laboratory is easy. Door in and Door out times and transport times remain high as a large number of patients are denied by insurance and other payers for treatment. Overall, mortality is 5.2%.

Conclusions
Global financial and philanthropic institutions should contemplate models analogous to LATIN for saving the lives of millions of poor patients in developing countries from AMI.
P6150Clinical outcomes and downstream investigations following computed tomographic coronary angiography (CTCA) performed for evaluation of ambulatory patients with chest pain of recent onset
Authors: Lehru D , Mortimer N , Doshi S N , Zaphiriou A , George S , Khan S Q , Ludman P F , Townend J N , Nadir M A 
Published: October 2019

Abstract

Background
National Institute of Clinical Excellence guideline (NICE, CG95) recommends CTCA as a 1st line diagnostic test for evaluation of ambulatory patients with suspected stable angina based on its high sensitivity and low cost. This has led to increasing demand for CTCA across the National Health Service (NHS) in order to comply with the NICE recommendation.

Purpose
We studied the utility and effectiveness of CTCA in the evaluation of ambulatory patients with suspected stable angina attending rapid access chest pain clinic (RACPC) in a large tertiary hospital in the UK.

Methods
The study included consecutive patients attending RACPC over a pre-specified period of 6-months who were suspected of having stable angina and hence, referred for CTCA. The data were collected on demographics, CTCA results including incidental finding and downstream investigations. All patients had a minimum of 12-months follow up for clinical outcomes.

Results
A total of 170 patients were referred for CTCA (mean age = 56.8 years, male = 53.5%) out of the 388 consecutive patients who were reviewed in the RACPC during the 6-month period. CTCA was non-diagnostic in 48/170 (28.2%) cases (Breathing artefact 35%, Severe Coronary Calcification 31%, Elevated heart rate/Ectopy 30%) while 63/170 (37.1%) of patients had incidental extra-cardiac findings. Amongst patients with incidental findings, 17/63 (27.0%) underwent further investigations. A total of 54/170 (31.7%) of patients were recommended to have downstream cardiac investigations such as a stress test (DSE/MRI/MPS) (23/170, 15.8%) while 31/170 (18.2%) were referred for invasive coronary angiography. Revascularisation procedures (PCI n=7.6%, CABG n=4.7%) were required in 21/170 (12.4%) patients. Based on 2017 NHS tariffs, overall average cost-per-patient with the initial CTCA approach was £122.11 excluding downstream investigations and £548.43 including the cost of downstream cardiac investigations.
Incidental Findings after CTCA

Conclusions
Our study suggests that a CTCA based approach is associated with non-diagnostic information in at least 1:4 patients and incidental extracardiac findings in 1:3 patients. Further downstream cardiac investigations are required in around 1:3 patients after a CTCA carried out for evaluation suspected stable angina. The NICE recommendation is based on the low initial cost of CTCA and high sensitivity, however, taking in to account the additional cost of downstream investigations, the average cost per patient of this approach is significantly (4.5 times) higher.

Acknowledgement/Funding
None
P6155Early computed tomographic evaluation for out-of-hospital cardiac arrest survivors: the CT-FIRST trial
Authors: Branch K R , Gatewood M O , Kudenchuk P , Lee J C , Strote J , Petek B J , De Boer I , Carlbom D , Shuman W P , Counts C R , Sayre M R , Gunn M 
Published: October 2019

Abstract

Background
Patients surviving an out-of-hospital cardiac arrest (OHCA) commonly present without an obvious etiology, but computed tomography (CT) can provide rapid, comprehensive anatomic evaluation of potential OHCA causes.

Purpose
To assess the diagnostic capabilities of whole body CT imaging in OHCA survivors.

Methods
From 11/2015 to 2/2018, the CT-FIRST (CT Feasibility In Resuscitated patient for Sudden death Triage) protocol enrolled 104 OHCA survivors without obvious OHCA cause to an early (<6 hours from hospital arrival) dual source Sudden Death CT (SDCT) scan protocol that included a non-contrast head, ECG-gated cardiac/thoracic angiography, and non-gated venous phase abdominal CT's. Cardiac CT analysis was blinded, but other SDCT findings were clinically available. Patients needing urgent cardiac catheterization or hemodynamically unable to tolerate CT were excluded. Primary endpoints were SDCT diagnosis compared to OHCA causes from adjudicated record review, and any significantly altered therapy based on SDCT. Acute coronary syndrome by SDCT was conservatively assumed if >50% stenosis was identified in major coronary artery(ies).

Results
SDCT scans identified 39% (41/104) of all OHCA causes and 95% (41/43) of causes potentially identifiable with SDCT (Table). No inappropriate treatments resulted from SDCT findings. SDCT changed or expedited treatments in 21/23 (95%) patients, including antibiotics, anticoagulants, and invasive evaluations or treatments. SDCT found or confirmed resuscitation complications including liver/spleen laceration (n=5), pneumothorax (n=7), and hemopericardium (n=1).
N=104 OHCA Cause SDCT Diagnosis of OHCA Cause N (%) N (%) Acute coronary syndrome 13 (13%) 13 (100%) Cardiomyopathy 8 (8%) 7 (88%) Pneumonia 11 (11%) 11 (100%) Hemorrhagic stroke 3 (3%) 3 (100%) Pulmonary embolism 4 (3%) 4 (100%) Perforated viscus 2 (2%) 2 (100%) Gut necrosis 1 (1%) 1 (100%) Pulmonary hemorrhage 1 (1%) 1 (100%) Substance use 22 (21%) 0 (0%) Unknown 7 (7%) 0 (0%) Other 32 (31%) 0 (0%)

Conclusion
This pilot study suggests the SDCT protocol has considerable promise to diagnose OHCA causes and complications of resuscitation, as well as change clinical treatment.

Acknowledgement/Funding
Medic One Foundation
P6160Long term prognosis of intramural course of coronary arteries in patients with hypertrophic cardiomyopathy assessed by coronary CT angiography
Authors: Nassar M , Arow Z , Monakier D , Zusman O , Shafir G , Kornowski R , Hamdan A 
Published: October 2019

Abstract

Background
The prognostic value of an intramural course of the coronary arteries detected by coronary CTA in patients with hypertrophic cardiomyopathy (HCM) is not well-known.

Purpose
To evaluate in patients with HCM, who were referred for coronary computed tomography angiography (CTA), whether an intramural course of a coronary artery is associated with a worse outcome compared to HCM patients without an intramural course of the coronary arteries.

Methods
The study population consisted of 92 patients with HCM who were referred for coronary CTA and who did not have obstructive CAD. During follow-up, the occurrence of unstable angina pectoris that required hospitalization, myocardial infarction, and all-cause mortality was evaluated (i.e. adverse cardiac events).

Results
Using coronary CTA, 57 patients (62%) had an intramural course of coronary arteries. Patients with HCM were followed over 5.5±3.5 years. The composite of adverse cardiac events occurred in 17/57 (29.8%) patients with, and 11 out of 35 (31.4%) patients without intramural course (P=0.87). The event rate of unstable angina pectoris requiring hospitalization (28.1% vs. 22.9%), myocardial infarction (1.8% vs. 8.6%), and all case mortality (0.0% vs. 0.0%) was similar in patients with and without an intramural course.

Conclusion
Intramural course of coronary arteries in patients with HCM was frequently observed by coronary CTA, but it was not associated with worse cardiovascular clinical outcome.
P6177Impact of relative flow reserve derived from dynamic computed tomography perfusion imaging for detection of functionally significant stenosis
Authors: Uetani T , Akazawa Y , Kinoshita M , Seike F , Sasaki Y , Higashi H , Fujii A , Aono J , Nagai T , Nishimura K , Inoue K , Ikeda S , Yamaguchi O 
Published: October 2019

Abstract

Background
Quantitative myocardial perfusion imaging with CT is increasingly used for the diagnosis of coronary artery disease. Relative flow reserve (RFRCT) derived from dynamic stress CT perfusion (CTP) is defined as the ratio between myocardial blood flow (MBF) in the stenosis-related territory and MBF in the non-stenosis-related territory.

Purpose
We sought to evaluate whether RFRCTcan be used as a non-invasive method for detection of functionally significant coronary artery stenosis compared with stress MBF.

Methods
This study was retrospectively included 31 consecutive patients (40 vessels) with coronary artery disease and examined with CT angiography, CTP, coronary angiography, and FFR. RFRCT and stress MBF results were compared with invasive FFR using a threshold of 0.80.

Results
The RFRCT values were significantly correlated to FFR values (R2=0.788, P<0.0001, Fig 1). The area under the receiver operator curve was larger for RFRCT (0.961) compared with stress MBF (0.837, Fig 2). The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of RFRCT were 92.5%, 84.2%, 100%, 100%, and 87.5%, respectively.
Figures 1 & 2

Conclusions
RFRCT was superior to stress MBF for detecting abnormal FFR in patients with stable coronary artery disease.