bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2444Comparison of 3D and 2D echocardiography-derived indices of left ventricular function and structure to predict long-term mortality in the general population: Southall And Brent Revisited (SABRE) study
Authors: Al Saikhan L , Park C , Tillin T , Williams S , Mayet J , Chaturvedi N , Hughes A 
Published: October 2019

Abstract

Background
Three-dimensional echocardiography (3DE) may have advantages over two-dimensional echocardiography (2DE) for the assessment of left ventricular (LV) function and structure. However, studies comparing 3DE and 2DE-derived indices in relation to mortality are limited, particularly in the general population.

Purpose
We examined associations between 2DE and 3DE-derived LV ejection fractions (LVEF) and volumes for all-cause mortality in a population-based sample.

Methods
A total of 899 individuals (age, 69.6±6.1 years; 77.5%male) from the SABRE study, a UK-based tri-ethnic community cohort, underwent a comprehensive transthoracic echocardiography examination. 2D LVEF and volumes were calculated, and full-volume 3D LV datasets acquired over 4 sub-volumes were obtained using a matrix-array transducer and were analysed offline using Qlab advanced, v7.0. The associations between both 2D- and 3D-derived LVEF (≥55% vs. <55%), body surface area indexed end-diastolic volume (iEDV) and end-systolic volume (iESV), and all-cause mortality were determined using Cox proportional hazards models. Survival curves were constructed using the Kaplan-Meier method.

Results
Of the 899 individuals, 118 (13.1%) died over a median follow-up period of 8 years to 2018. Kaplan Meier survival estimates (Figure 1 illustrates LVEF) and Cox regression revealed that 2D and 3D LVEF, iEDV and iESV were associated with increased risk of all-cause mortality (LVEF (≥55% vs. <55%), 3DE: HR=0.53 (0.35, 0.80); 2DE: HR=0.51 (0.34, 0.75), iEDV (per 1SD increment), 3DE: HR=1.20 (1.0, 1.41); 2DE: HR=1.19 (1.0–1.41), iESV (per 1SD increment), 3DE: HR=1.27 (1.1, 1.52), 2DE: HR=1.32 (1.15, 0.1.51)). However, 3DE associations tended to be stronger in models adjusted for classical risk factors including age, sex, ethnicity, systolic blood pressure, cholesterol:HDL ratio, body mass index, antihypertensive medications, diabetes, and smoking (LVEF (≥55% vs. <55%), 3DE: HR=0.59 (0.39, 0.90); 2DE: HR=0.69 (0.46, 1.0), iEDV (per 1SD increment), 3DE: HR=1.20 (1.0, 1.41); 2DE: HR=1.10 (0.93, 1.31), iESV (per 1SD increment), 3DE: HR=1.27 (1.1, 1.52), 2DE: HR=1.20 (1.04, 0.1.39)).
Figure 1. Kaplan-Meier curves.

Conclusions
In this population-based study, both 2DE and 3DE-derived indices of LV structure and function were associated with all-cause mortality independently of classical risk factors, with some indication that strengths of association were greater for 3DE-derived indices.

Acknowledgement/Funding
SABRE is funded by BHF, Diabetes UK, the MRC and the Wellcome Trust. LA holds a scholarship grant from Imam Abdulrahman Bin Faisal University, SA
P2452Application of left atrial strain for differentiation between pre- and post-capillary pulmonary hypertension
Authors: Inoue K , Remme E W , Khan F H , Andersen O S , Gude E , Skulstad H , Smiseth O A 
Published: October 2019

Abstract

Background
Pulmonary hypertension (PH) is classified as pre- or post-capillary PH, and pulmonary capillary wedge pressure (PCWP) >15 mmHg is used as criterion for post-capillary PH. Elevated left atrial (LA) pressure is associated with reduced LA reservoir strain. Thus, LA strain may potentially serve to differentiate between these diagnoses.

Objectives
This study tested the hypothesis that LA strain can be used as a noninvasive parameter to differentiate between pre- and post-capillary PH.

Methods
We analyzed 103 patients (mean age: 58 years, 51 female) referred to right heart catheterization due to unexplained dyspnea or suspected heart failure. Echocardiography was performed within 24 hours of the invasive procedure. Mean pulmonary artery pressure (PAP) was noninvasively estimated from tricuspid regurgitation (TR) velocity and inferior vena cava (IVC) diameter and collapsibility. LA reservoir strain was calculated from apical four-chamber view by speckle tracking echocardiography, and was feasible in 101 patients.

Results
Twenty-eight patients were invasively confirmed with pre-capillary PH and 43 patients with post-capillary PH. The remaining 32 patients had no PH. LA reservoir strain was significantly lower in patients with post-capillary PH than patients with pre-capillary PH (9.9±5.5% vs. 24.6±8.2%, p<0.01). At a cut-off value of 15.4%, LA reservoir strain could predict elevated PCWP >15 mmHg with AUC=0.88, sensitivity=84.8% and specificity=81.8%. As shown in the figure, echocardiography with LA reservoir strain correctly differentiated 82% of patients into pre- and post-capillary PH.

Conclusions
These results suggest that LA reservoir strain can be used to predict elevated PCWP, thus allowing discrimination between pre- and post-capillary PH.
P2455Global peak left atrial longitudinal strain - a good predictor of left atrial appendage thrombus in patients in sinus rhythm with heart failure and very low left ventricular ejection fraction
Authors: Zandecki L , Kurzawski J , Janion-Sadowska A , Sadowski M 
Published: October 2019

Abstract

The aim of this study was to determine if various clinical and transthoracic echocardiography data including left atrial strain analysis could predict the presence of left atrial appendage thrombus (LAAT) in heart failure (HF) patients with very low left ventricular ejection fraction (LVEF), sinus rhythm at presentation and no history of atrial fibrillation or any other established indication for anticoagulation.

Material and methods
Sixty-seven patients with HF, LVEF <25%, sinus rhythm and not anticoagulated were included. Transesophageal echocardiography was performed in all patients to allow detection of LAAT.

Results
LAAT was found in 21 (31.3%) patients. Global peak left atrial longitudinal strain (PALS) was the best predictor of LAAT presence in univariate logistic regression analysis (Gini index 0.65, AUC 0.83) – data for other variables are presented in the Table 1. In the multivariate model after the inclusion of global PALS no other available variable could significantly improve it. The global PALS value of 8% was a good discriminator of LAAT presence with OR 26.2 (95% CI 6.8–103) if global PALS was <8% at p<0.001.
Table 1. Univariable models for potential risk factors for LAAT incidence in the study population OR (95% CI) p-value Gini index Age 1.01 (0.96–1.06) 0.71 0.02 Heart rate 0.99 (0.94–1.03) 0.57 0 Body surface area 0.66 (0.03–12.45) 0.78 0.03 Ischaemic HF etiology 2.11 (0.73–6.07) 0.17 0.18 Hypertension 1.10 (0.39–3.09) 0.86 0.02 Diabetes 0.59 (0.18–1.89) 0.37 0.11 Chronic kidney disease 1.29 (0.46–3.65) 0.63 0.06 Prior stroke or TIA (transient ischemic attack) 1.75 (0.35–8.63) 0.49 0.06 LA diameter 0.96 (0.3–3.03) 0.94 0.02 LAVI (LA volume index) 1.06 (1.01–1.11) 0.01 0.46 LVEF 0.99 (0.87–1.12) 0.88 0.07 E/A 1.28 (0.79–2.09) 0.31 0.1 E/e' 0.98 (0.91–1.04) 0.44 0.15 Global PALS 0.43 (0.29–0.64) <0.001 0.65 Global PACS (peak atrial contraction strain) 1.42 (0.91–2.21) 0.13 0.27

Conclusions
LAAT has been a relatively common finding in this group of HF patients and PALS has shown prognostic potential in LAAT identification.
P2465Assessment of left atrial electro-mechanical delay to predict atrial fibrillation in hypertrophic cardiomyopathy
Authors: Tjahjadi C , Hiemstra Y L , Van Der Bijl P , Pio S M , Marsan N A , Delgado V , Bax J J 
Published: October 2019

Abstract

Background
Left atrial remodelling in hypertrophic cardiomyopathy (HCM) is recognized as the main contributor to the development of atrial fibrillation (AF). It is well reported that the occurrence of AF in HCM increases both morbidity and mortality. Therefore, early recognition of AF is essential. Due to its often silent and paroxysmal nature, the diagnosis can be missed.

Purpose
PA-TDI, representing total atrial conduction time, reflects the left atrial structural and electrical remodelling. We sought to evaluate the association between this novel non-invasive echocardiographic parameter and AF in patients with HCM.

Methods
The electronic charts of patients with HCM and no previous history of AF from 1993 to 2018 were retrospectively analysed. PA-TDI was measured offline using pulsed wave tissue Doppler imaging with the sample volume placed on the lateral wall of the left atrium just above the mitral annulus in an apical 4-chamber view. The time interval was determined from the onset of P wave on surface ECG to the peak of the a' wave of the left atrial tissue Doppler tracing.

Results
There were 208 patients (64% male) with a mean age of 53±14 years in this study. The incidence of AF was 20% over a median follow-up of 56.3 (IQR 18.4–84.5) months. Patients who developed AF, had higher baseline PA-TDI intervals when in sinus rhythm (134±23 ms vs 111±30 ms, P<0.001) than those who remained free from AF. The cut-off value of PA-TDI duration was the median at 115 ms. A PA-TDI ≥115 ms was independently associated with new onset AF (HR: 2.5, 95% CI: 1.1–5.5, P=0.02) after correcting for age, left atrial diameter and E/e'.

Conclusion
A prolonged PA-TDI was strongly associated with the development of AF in patients with HCM. This parameter may be useful to risk-stratify patients with HCM who are at risk of having AF.
P2471Adaptation of ventricular function the first year after heart transplantation assessed with echocardiography
Authors: Ingvarsson A , Werther Evaldsson A , Radegran G , Waktare J , Smith J G , Roijer A , Meurling C 
Published: October 2019

Abstract

Background/Introduction
Echocardiography is commonly used in evaluation patients after heart transplantation (HTx). Detecting discrete changes in ventricular function is important but challenging using standard echocardiographic parameters. Furthermore, interpretation of findings are complicated by the fact that data on early possible adaptation is sparse.

Purpose
We sought to detect alterations in biventricular function primarily using speckle tracking derived strain at four time-points during the first year post HTx.

Methods
Fifty HTx patients (40 males, mean age 50±12 years) were prospectively included. Patients were examined 1, 3, 6 and 12 months after HTx using an iE33 platform with a S5–1 transducer and strain analysis was performed offline with a dedicated software: CMQ, Q-lab 10.3 (Philips Healthcare, Eindhoven, NL). Values were compared using paired t-test and expressed as mean±SD, 95% CI.

Results
Regarding left ventricular (LV) parameters no difference were detected between 1 and 12 months. LV ejection fraction (EF) was 58±5% vs. 58±7%, global longitudinal strain (GLS) was −15±5% vs. −16±4% and global circumferential strain (GCS) was −22±7% vs. −21±6% respectively. Conventional parameters of right ventricular (RV) function: Tricuspid annular plane systolic excursion (TAPSE) improved from 12±2 mm at 1 month to 15±5 mm (p<0.01) at 12 months and tricuspid annular systolic velocity (S') improved from 8.1±1.9 cm/s to 9.5±2.7 cm/s (p<0.01) at 12 months. Fractional area change (FAC) remained unaltered. Strain measurements of RV function improved gradually between 1 and 12 months. RV GLS was −15±3% vs. −17±3% (p<0.01) and strain for the RV lateral wall (RVfree) was −15±3% vs. −18±3% (p<0.001) respectively. Progressive improvement in RV strain is illustrated in Fig 1.
Right ventricular strain post HTx

Conclusion
Our data indicate that clinically stable HTx recipients have reached steady state regarding LV function already 1 month after transplantation. This suggests that alterations in LV function parameters after this time-point can be used to detect adverse events.
On the contrary, right ventricular longitudinal function show significant gradual improvement during the first year following HTx indicating that the RV adaptation-process is extended in comparison to the LV.
We found that measurements of LV function at 1 month and RV function at 12 months post HTx are comparable to previously published normal values in clinically stable HTx patients. Nevertheless, further studies addressing possible continuous improvement in RV function beyond 1 year post HTx would be of interest.
P2480Sub-optimal anti-diabetic treatment in patients with pre-existing and newly diagnosed diabetes admitted for acute myocardial infarction. A study from the FAST-MI 2015 registry
Authors: Schiele F , Puymirat E , Ferrieres J , Simon T , Danchin N 
Published: October 2019

Abstract

Background
In patients (pts) with Acute Myocardial Infarction (AMI), we evaluate how diabetes is detected and treated at discharge.

Methods
Using the French FAST-MI 2015 registry, pts were classed as non-diabetic (NonDiab), pre-existing (PreEx) or newly diagnosed (NewDiab) diabetes. PreEx was defined by history or pretreatment; NewDiab as no history, no anti-diabetic treatment plus HbA1C>6.5% or admission glucose ≥200mg/dL. Characteristics and adjusted 1-year mortality were compared.

Results
In 5291 FAST MI pts, 3857 (73%) were NonDiab, 1145 (21.5%) PreEx and 289 (5.5%) NewDiab (176 had glucose ≥200mg/dL; 143 had HbA1C >6.5%). PreEx pts were older, had more comorbidities, and higher GRACE score vs NonDiab. NewDiab pts had higher HbA1C (8.9%±9.2 vs 5.65%±0.38 in NonDiab; 7.5%±2.2 in PreEx). At 1 yr, diabetic pts (PreEx and/or NewDiab) had a 2.5-times higher adjusted risk of death. At discharge, DAPT, statins, ACEi and betablockers were less often prescribed in PreEx vs NonDiab or NewDiab pts. In diabetic pts, vs admission, the number of anti-diabetic treatments decreased at discharge in 11%, no change in 69% and increased in 20%. Despite higher HbA1C in NewDiab vs PreEx pts, anti-diabetics were less often prescribed in NewDiab (23%) vs PreEx pts (75%) (table). In pts with HbA1C>8%, treatment intensification was observed in 30%.
Admission treatment Discharge treatment NonDiab PreEx NewDiab NonDiab PreEx NewDiab 3759 (71%) 1283 (24%) 249 (5%) 3759 (71%) 1283 (24%) 249 (5%) Any Anti Diabetic Tx 0 975 (76%) 0 51 (1%) 931 (75%) 53 (23%) Insulin 0 339 (26%) 0 2 404 (33%) 13 (6%) Biguanide 0 456 (36%) 0 2 412 (34%) 30 (13%) Sulfonylureas 0 258 (20%) 0 2 244 (20%) 4 DPP4i 0 175 (14%) 0 2 176 (14%) 6 (3%) GLP1 RAs 0 108 (8%) 0 1 117 (10%) 10 (1%) DAPT 3212 (88%) 1009 (90%) 201 (87%) Aspirin 778 (21%) 550 (45%) 66 (27%) 3533 (96%) 1170 (95%) 218 (94%) Statins 964 (25%) 721 (56%) 69 (28%) 2394 (92%) 1109 (82%) 216 (93%) ACEi/ARB 1028 (27%) 672 (53%) 69 (28%) 2744 (74%) 925 (75%) 174 (87%) Coronary Angiography 3684 (98%) 1202 (94%) 240 (96%) PCI 3010 (80%) 907 (71%) 201 (81%)

Conclusions
In AMI pts, 5.5% have previously unknown diabetes and have a higher risk of death, similar to that of pts with PreEx diabetes. Treatment initiation and intensification are sub-optimal.
P2481The effect of DPP-4i, GLP-1RA, SGLT-2i and long-acting insulin on platelet function in patients with type 2 diabetes mellitus
Authors: Stampouloglou P K , Antonopoulos A , Siasos G , Bletsa E , Batzias K , Paschou S A , Oikonomou E , Gouliopoulos N , Tsigkou V , Kassi E , Thanopoulou A , Vryonidou A , Tentolouris N , Pallantza Z , Tousoulis D 
Published: October 2019

Abstract

Background
Patients with type 2 diabetes mellitus (T2DM) are at higher risk for thrombotic events. Platelet function may be used to assess prothrombotic state in patients with cardiovascular disease.

Purpose
We aimed to investigate whether the administration of novel antidiabetic agents influence platelet function in TDM2 patients.

Patients and methods
We 60 enrolled consecutive patients with T2DM, on stable antidiabetic therapy, who did not achieve therapeutic targets. Subjects were assessed to receive an additional anti-diabetic agent; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=24), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=22). Platelet reactivity was measured with PFA-200 collagen/epinephrine (c-EPI) and PFA-200 collagen/ADP (c-ADP) closure time. Glycosylated hemoglobin (HbA1c), c-EPI and c-ADP were assessed at baseline and 3 months after treatment intensification.

Results
There was no difference between the study groups regarding gender, age, hypertension, dyslipidemia, smoking, Hba1c and CADP or CEPI (p=NS for all) at baseline. All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up (for DPP4i: 7.4±0.2% vs 6.7±0.2%, for GLP1RA: 8.3±0.2% vs 6.9±0.1%, for SGLT2i: 7.5±0.1% vs 6.7±0.1% and for insulin 9.8±0.5% vs 7.7±0.4%, p<0.001 for all). After a 3 month-period, treatment intensification with these novel agents did not influence c-EPI and c-ADP values [155.4±6.64 sec vs 152.9±8.28 sec (p=0.678) and 106.6±4.30 sec vs 106.8±3.93 sec (p=0.955) respectively] in whole population. In subgroup analysis, for patients off antiplatelet treatment (n=31), c-EPI was significantly decreased from 148.4±8.5 to 129.8±13.9 sec (p=0.036), but not c-ADP (from 105.4±5.3 to 99.3±4.9 sec, p=0.094). In patients who did receive antiplatelets (n=37), c-EPI and c-ADP were not significantly changed (c-EPI 163.1±10.9 to 179.6±13.9 sec p=0.201 and c-ADP from 106.6±8.2 sec to 114.6±7.3 sec, p=0.318) respectively.

Conclusion
Antiplatelet treatment prevents thrombotic risk in T2DM patients receiving novel antidiabetics. The effects of novel antidiabetics on platelet reactivity -as well as any distinct class properties- merits further investigation.

Acknowledgement/Funding
None
P2487Echocardiography and NT-ProBNP both provide independent and improved prediction of prognosis in a type 1 diabetes population without heart disease and with preserved ejection fraction
Authors: Roerth R , Jorgensen P G , Andersen H U , Goetze J P , Rossing P , Jensen M T 
Published: October 2019

Abstract

Background
Cardiovascular disease is the most common comorbidity in type 1 diabetes (T1D). Current guidelines, however, do not include routine echocardiography or cardiac biomarkers in T1D.

Objectives
To investigate if echocardiography and NT-proBNP provide incremental prognostic information in individuals with T1D without heart disease and with preserved left ventricular ejection fraction (LVEF).

Methods
A prospective cohort of individuals with T1D without heart disease and with preserved LVEF (≥45%) from the outpatient clinic were included. Follow-up was performed through Danish national registers. The association between E/e', a marker of diastolic function, from echocardiography and NT-proBNP with major adverse cardiovascular events (MACE) was tested. MACE was defined as death from all-causes, acute coronary syndromes, cardiac revascularization, incident heart failure, or stroke. Additionally, the incremental prognostic value when adding E/e' and NT-proBNP to the clinical Steno T1D Risk Engine score (including age, sex, duration of diabetes, systolic blood pressure, LDL, HbA1c, presence of albuminuria (micro-or macroalbuminuria), eGFR, smoking status, and physical activity [low, medium, high]), was examined. Follow-up was 100% complete.

Results
Of 964 individuals (mean (SD)) age 49.7 (14.5) years, 51% men, HbA1c 66 (14) mmol/mol, BMI 25.6 (4.0) kg/m2, and diabetes duration 26.1 (14.5) years), 121 (12.6%) experienced MACE during 7.5 years of follow-up. In the full multivariable model, E/e' significantly and independently predicted MACE: (HR (95%)) E/'e <8 (n=639) vs. 8–12 (n=248): 2.00 (1.23; 3.25), p=0.005, E/'e <8 vs E/e'≥12 (n=77): 3.36 (1.8; 6.1), p<0.001. Also, NT-proBNP significantly predicted outcome: NT-proBNP <150 pg/ml (n=435) vs. 150–450 pg/ml (n=386): 1.52 (0.9; 2.5), p=0.11, NT-proBNP <150 pg/ml vs NT-proBNP >450 pg/ml (n=143): 2.78 (1.6; 4.9), p<0.001. Adding both (log)E/e' and (log)NT-proBNP to the Steno T1D Risk Engine score significantly and incrementally improved risk prediction: Harrell's C-index: Steno T1D Risk Engine (AUC 0.783 (0.747; 0.818)) vs. Steno T1D Risk Engine + (log)E/e' (AUC 0.805 (0.773; 0.837)): p<0.001 and Steno T1D Risk Engine + (log)E/e' + (log) NT-proBNP (AUC 0.816 (0.783; 0.848)): p=0.002. The risk of MACE by groups of E/e' and NT-proBNP is shown in the figure.
Figure 1

Conclusion
In individuals with T1D without heart disease and with preserved LVEF, E/e' and NT-proBNP significantly improved risk prediction of cardiovascular events beyond clinical risk factors alone. Echocardiography and NT-proBNP could have a role in clinical care.
P2489What are the main determinants of an increase in bnp level in asymptomatic diabetic patients without known cardiac disease?
Authors: Patin C , Vidal Trecan T , Dillinger J G , Paven E , Cohen Solal A , Logeart D , Riveline J P , Gautier J F , Henry P 
Published: October 2019

Abstract

Background
Diabetes mellitus is associated with a high risk of heart failure. The predictors of futures heart failure events in diabetic patients are not clearly understood. BNP measurement can be used as a surrogate endpoint for the diagnosis of heart failure. We investigated the determinants of an increase in BNP level in a large cohort of asymptomatic diabetic patients without known cardiac disease

Methods
This prospective study included consecutive stable diabetic (type 1 or 2) patients coming for yearly check-up between March 2015 and July 2018 in the university center for the study of diabetes and its complications. Patients with an history of cardiac disease (coronary artery disease, atrial fibrillation, cardiomyopathy, previous heart failure ...) were excluded. All patients had a complete clinical exam, blood pressure measurement (3 consecutive times – mean of 2 lasts measurements), ECG, and blood sample including HbA1C, risk factors assessment, renal function (CKD-EPI) and BNP measurement. Data are presented as mean±SD or median - Spearman's rank and multivariate regression were used for analysis.

Results
3743 patients (mean age 57±14 y.o. – 57% male – 78% / 18% / 4% of type 2, type 1 or other type of diabetes respectively – Mean duration of diabetes 17 [1–63] y. – 44% treated with insulin) were studied. Mean±SD / median [min-max] BNP level was 25±39 / 12 [4–737] ng/L. BNP was <20 / 21–35 / 36–50 / 51–100 / 101–400 / >400 ng/L in 69 / 15 / 6 / 7 / 3 / 0.1% of the population respectively. The parameters most correlated with BNP level in type 1 and type 2 diabetes were age, duration of diabetes, renal function, HbA1C, and pulsed pressure. For multivariate analysis, renal function was removed of the model as it was highly correlated with age (r=−0.68). Multivariate analysis demonstrated that in type 1 diabetes, high BNP level was linked to age (p<0.001), pulsed pressure (p<0.001), duration of diabetes (p=0.003) and HbA1C (p=0.02). In type 2 diabetes, high BNP level was linked to age (p<0.0001), pulsed pressure (p<0.0001), duration of diabetes (p=0.005) but not HbA1C (p=0.09). Interestingly the type of treatment (mainly insulin treatment) was not independently related to an increase in BNP level.

Conclusion
Age, pulsed pressure and duration of diabetes are the main determinants of an increased level of BNP in asymptomatic diabetic patients without any history of cardiac disease. This result could help to select a population who could benefit to a more extensive follow up concerning heart failure.