bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3401Comparison of APACHE II, SAPS II and GRACE 2.0 risk scores to estimate early and late mortality in patients with ST-segment elevation acute myocardial infarction
Authors: Silva-Obregon A , Arroyo Espliguero R , Viana-Llamas M C , Estrella-Alonso A , Saboya-Sanchez S , Uribe-Heredia G , Arriero-Fernandez N , Eguileor-Marin Z , Toran-Martinez C , Garcia-Magallon B , Castillo-Sandoval A , Marian-Crespo C 
Published: October 2019

Abstract

Background
Many specific prognostic risk scores have been validated for myocardial infarction (MI), such as the Global Registry of Acute Coronary Events (GRACE) 2.0. Other general risk scores are used in intensive care units (ICUs), such as the Acute Physiologic and Chronic Health Evaluation (APACHE) II and the Simplified Acute Physiology Score (SAPS) II.

Purpose
Compare the ability of GRACE 2.0, APACHE II and SAPS II risk scores to estimate in-hospital, 3- and 12-month mortality after primary angioplasty (PA) for ST-segment elevation MI (STEMI).

Methods
Retrospective cohort of 427 consecutive STEMI patients (64 years [55–75]; 78% men) admitted to a general ICU between November-2013 and February-2017. We used Area under the Receiver Operating Characteristic (ROC) curve (AUC) analysis to asses performance of risk scores, and the Hosmer-Lemeshow (HL) goodness of fit test and the Standardized Mortality Ratio (SMR) to assess calibration.

Results
All risk scores were associated with in-hospital, 3- and 12-month mortality (P<0.001). SAPS II had the highest sensitivity for short-term mortality and the highest AUC for in-hospital, 3- and 12-month mortality (Figure). SAPS II had the highest calibration and the less underestimation of mortality in all follow-up periods analysed (Table).
Performance of prognostic risk scores Youden index (J) Sensitivity (%) Specificity (%) AUC (95% CI) H-L (P value) SMR In-Hospital mortality (5.4%)   SAPS II 32 87.0 89.4 0.938 (0.887–0.988) 1.826 (0.969) 1.64   GRACE 2.0 150 86.9 83.7 0.922 (0.865–0.979) 8.111 (0.423) 1.77   APACHE II 17 82.6 93.8 0.896 (0.841–0.986) 11.941 (0.154) 1.92 3-month mortality (5.6%)   SAPS II 32 79.2 89.1 0.913 (0.854–0.973) 3.635 (0.821) 1.85   GRACE 2.0 150 79.1 85.4 0.902 (0.842–0.962) 5.149 (0.742) 2.0   APACHE II 17 79.1 93.8 0.882 (0.792–0.971) 9.244 (0.322) 2.0 12-month mortality (7.0%)   SAPS II 32 73.3 89.7 0.880 (0.809–0.951) 1.994 (0.960) 1.58   GRACE 2.0 150 76.7 84.1 0.878 (0.816–0.941) 4.073 (0.850) 2.31   APACHE II 17 70.0 92.4 0.824 (0.722–0.927) 7.464 (0.487) 2.14 AUC: Area under the curve; H-L: Hosmer-Lemeshow; SMR: Standardized Mortality Ratio.
Area under the ROC curves (AUC)

Conclusions
SAPS II represents the best model to estimate mortality in this cohort of STEMI patients, with an appropriate calibration and less underestimation of mortality. Underestimation of mortality showed by all risk scores suggests the need of creating new risk prediction models that improve identification of high risk STEMI patients.
P3403Clinical utility of the integration of Life Simple 7 designed by the American Heart Association and the model for cardiovascular risk prediction IberScore
Authors: Ruilope L M , Calvo-Bonacho E , Quevedo-Aguado L , Catalina-Romero C , Valdivielso P , Sanchez-Chaparro M A , Fernandez-Labandera C 
Published: October 2019

Abstract

Background/Introduction
Practice guidelines are agreed on the importance of lifestyle advice for cardiovascular risk reduction as well as cardiovascular risk prediction in planning preventive strategies.

Purpose
To assess the clinical usefulness of the application of the predictive model of cardiovascular risk (CVR) IberScore combined with the recommendations of “Life's Simple 7” (LS7) of the American Heart Association (AHA) in a working population.

Methods
IberScore model is a predictive function for fatal and non-fatal cardiovascular (CV) events derived from a cohort of 774,404 workers (70.4% of the target population) between 16–65 years (average of 35.7 (SD = 10.7)) without CV disease at admission, which was followed for a period of 10 years. Age, sex, total cholesterol, HDL, SBP, glycemia, obesity and a history of dyslipidemia, hypertension and diabetes were used as factors of CVR. Using this model, patients were classified into 4 risk levels. It was also assessed the ideal health status according to the recommendations of “Life's Simple 7” (which includes healthy diet, physical activity, smoking cessation, BMI <25 kg/m2, total cholesterol without treatment <200mg/dl, blood pressure without treatment <120/80 mmHg and basal glycemia <100 mg/dl). Finally, these classifications were compared with the appearance of CV events in a 10-year follow-up.

Results
The results showed a high sensitivity (given that the predictive capacity reached 82% of the cardiovascular events) by using the IberScore, a logistic flexible parametric model to predict 10-year cardiovascular risk. Likewise, the clinical usefulness of the “Life's Simple 7” recommendations could be verified in order to reduce the incidence of total CV events (fatal and non-fatal).

Conclusions
The integration of the predictive model IberScore with the preventive recommendations “Life's simple 7” of the AHA applied to the working population would allow a more efficient cardiovascular prevention.

Acknowledgement/Funding
This project received a research grant from the Carlos III Health Institute (Ministry of Science, Innovation and Universities, Spain). Ref. PI18/01809
P3414Differences in total life expectancy and life expectancy with and without non-communicable diseases within the reference range of thyroid function
Authors: Bano A , Chaker L , Mattace-Raso F U S , Peeters R P , Franco O H 
Published: October 2019

Abstract

Background
Variations in thyroid function within the reference ranges are associated with an increased risk of diseases and death. However, the impact of thyroid function on life expectancy (LE) and the number of years lived with and without non-communicable diseases (NCD) remains unknown.

Purpose
We aimed to investigate the association of thyroid function with total LE and LE with and without NCD among euthyroid subjects.

Methods
Participants of the Rotterdam Study without known thyroid disease and with thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels within the reference ranges were eligible. NCD were defined as the presence of cardiovascular disease, diabetes mellitus type 2, or cancer. We used multistate life tables to calculate the total LE and LE with and without NCD among TSH and FT4 tertiles, in men and women. LE estimates were obtained using prevalence, incidence rates and hazard ratios for three transitions (healthy to NCD, healthy to death and NCD to death). Analyses were adjusted for sociodemographic and cardiovascular risk factors.

Results
The mean (standard deviation) age of 7644 participants was 64.5 (9.7) years and 52.2% were women. Over a median follow-up of 8 years, we observed 1396 incident NCD events and 1422 deaths. Compared with those in the lowest tertile, men and women in the highest TSH tertile lived 1.5 (95% confidence interval [CI], 0.8; 2.3) and 1.5 (95% CI, 0.8; 2.2) years longer, respectively; of which 1.4 (95% CI, 0.5; 2.3) and 1.3 (95% CI, 0.3; 2.1) years with NCD. Compared with those in the lowest tertile, the difference in LE for men and women in the highest FT4 tertile was −3.7 (95% CI, −5.1 to −2.2) and −3.3 (95% CI, −4.7; −1.9), respectively; of which −1.8 (95% CI, −3.1 to −0.7) and −2.0 (95% CI, −3.4 to −0.7) years without NCD.
Life expectancy in TSH and FT4 tertiles

Conclusions
There are meaningful differences in total LE, LE with and without NCD within the reference ranges of thyroid function. People with low-normal thyroid function live more years with and without NCD than those with high-normal thyroid function. These findings support a reevaluation of the current reference ranges of thyroid function.
P3434Galectin-3 identifies healthy subjects at risk of developing (pre-)diastolic dysfunction
Authors: Gehlken C , Hummel Y M , De Boer R A , Meijers W C 
Published: October 2019

Abstract

Background/Introduction
Biomarkers might be useful to identify healthy subjects who are at risk of developing diastolic dysfunction. Cardiac remodeling, in particular fibrosis, is a hallmark of diastolic dysfunction. Previous (pre)clinical studies have linked galectin-3 to fibrogenesis. Therefore, we aimed to evaluate whether galectin-3 would be able to identify apparently healthy individuals who are at risk of developing pre-clinical diastolic dysfunction.

Purpose
To study whether galectin-3 is able to identify healthy subjects who are at risk of developing pre-clinical diastolic dysfunction over time.

Methods
We measured both galectin-3 and B-type natriuretic peptide (BNP) in 1.500 participants of the population study LifeLines. Based upon the biomarker profile, we selected 88 subjects with elevated galectin-3 (>14.3 ng/mL; n=42) and with low galectin-3 (<9.8 ng/mL; n=46) values, while all participants demonstrated low BNP. We matched these groups so other confounding variables like age, sex, kidney function (creatinine), body weight (BMI) and blood pressure were comparable between both groups. After approximately five years follow up, we invited those 88 participants to determine the level of diastolic dysfunction using echocardiography. Statistical analyses were performed in IBM SPSS Statistics 25 and StataMP 13.

Results
We included 88 participants at a median age of 50 years (standard deviation ± 11 years) in this case-control study. Besides the galectin-3 levels, all other variables were adequately matched and fully comparable between both groups. Obviously, galectin-3 levels (median, IQR) were markedly different between the groups (galectin-3 levels 7.35 ng/L (6.9 - 8.6) vs 16.4 ng/L (15.1- 17.8), P<0.001).
Subjects with elevated galectin-3 demonstrated signs of structural cardiac remodeling: enlarged left atrial diameter (35.3 mm vs. 37.3 mm P=0.034), and larger diastolic interventricular septum thickness (IVS) (9.4 mm vs. 10.1 mm P=0.038), and a smaller left ventricular end-diastolic internal dimension index (LVIDd Index) (2.3 cm/m2 vs. 2.2 cm/m2 P=0.026), a smaller left ventricular end diastolic volume (LVEDV) (98.9 mL vs. 89.9 mL P=0.025). In addition, they exhibited several indicators of worse diastolic function, such as a higher E/e' ratio (5.2 vs. 5.9, P=0.046), while there was no significant difference in the left ventricular ejection fraction (60.8% vs. 59.9%, P=0.110).

Conclusion
Elevated galectin-3, when fully matched for confounding factors, is associated with the development of preclinical-diastolic dysfunction before onset of clinical symptoms. Our data suggest that substantial elevations of galectin-3 in apparently healthy subjects hint towards preclinical cardiac dysfunction.

Acknowledgement/Funding
Dutch Heart Foundation 2015T034; NWO VIDI, grant 917.13.350; ERC CoG 818715, SECRETE-HF
P3443Myotonic dystrophy type 1 in childhood: benign from a cardiac perspective?
Authors: Hajra A , Wacher J , Field E , Walsh H , Norrish G , Kaski J P , Sarkozy A H , Cervi E 
Published: October 2019

Abstract

Introduction/Purpose
Patients with myotonic dystrophy (DM1) have an increased risk of cardiac conduction disease and ventricular tachycardia associated with sudden cardiac death. Whilst this is well-established in adults, there is little published data on cardiac abnormalities in paediatric patients. To our knowledge this is the largest described cohort of children with DM1. The aim of this study is to better understand the prevalence and type of cardiac abnormalities in paediatric patients with DM1.

Methods
We retrospectively studied consecutive patients referred to our paediatric quaternary institution between 31 December 2000 and 31 January 2019. The electronic patient record was reviewed for the presence of cardiac manifestations, including clinical assessment in clinic, echocardiogram, 12 lead ECG and 24-hour ECG.

Results
60 children were identified with a diagnosis of DM1, 56 (93%) with the congenital form of the disease. The median age at diagnosis was 2.4 (IQR 1.2–24, n=52) months. 51 (85%) were under regular formal cardiac follow up. Cardiac symptoms (syncope, palpitations or chest pain) were present in 6 (10%). 12 lead ECGs were available in 50 (83%) and there was at least one echocardiogram performed in 57 (95%). There were 3 deaths (5%), 2 sudden and unexplained (aged 11 and 6.5 years old). 1 child (2%) underwent pacemaker implantation due to the presence of syncope and evidence of progressive conduction disease (Mobitz II AV block).
During the period of follow-up, 37 (62%) patients had evidence of conduction disease on 12 lead ECG or Holter: 1st degree or higher AV block (35%, n=21), trifascicular block (6.7%, n=4), intraventricular conduction delay (32%, n=19), prolonged QTc (15%, n=9) and junctional rhythm (5% n=3). In addition to abnormalities of conduction, 27 (45%) patients had axis deviation and 12 (20%) abnormal repolarisation.
Abnormalities were present in 8 (14%) of those with an echocardiogram. 2 (3.5%) had hypertrophic cardiomyopathy. Other abnormalities included bicuspid aortic valve, aortic root dilatation, dyskinetic septal motion, pericardial effusion, mitral valve thickening and perimembranous VSD.
24 (40%) patients had a signal averaged ECG of which 14 (58%) were positive in 1 or more vector. 3 (5%) patients had an exercise test with no arrhythmia or progression of conduction abnormalities. 1 patient had an invasive EP study showing a prolonged HV interval but no inducible ventricular tachycardia.

Conclusions
There appears to be a high incidence of cardiac involvement in children with DM1. Adverse events (death and pacemaker implantation) are represented in our cohort. More studies are required in order to establish how we might better identify those at risk of progression of conduction disease and ventricular arrhythmia. Regular and lifelong cardiac follow up is advisable but risk stratification and device implantation remains challenging.
P3458Sex, myocardial infarction, critical state and long-term outcome
Authors: Kanic V , Suran D , Krajnc I , Balevski I , Naji F H , Kompara G 
Published: October 2019

Abstract

Background
Myocardial infarction (MI) remains the most common cause of heart failure (HF). Data on sex-related critical state in patients with MI who underwent PCI and their long-term outcome, are missing.

Purpose
We evaluated whether there is a sex difference in critical state and if sex is associated with long-term survival in these patients.

Methods
We defined critical state as cardiogenic shock and/or mechanical ventilation and/or intra-aortic balloon pump and/or ejection fraction≤30%. We analyzed data on 5669 patients with MI treated with percutaneous interventions (PCI). The criteria for critical state were fulfilled by 539 (9.5%) patients, of whom 172 (31.9%) were women. Long-term mortality was observed. The median follow-up time was 5.0 (25th, 75th percentile: 3,8) years. Data were analyzed using descriptive statistics.

Results
The incidence of critical state was similar in both sexes [172 (9.8%) women compared to 367 (9.4%) men]. The women were older, suffered more diabetes and renal dysfunction, presented more often in cardiogenic shock, and had a higher maximal troponin/body surface area level. After adjustment, female sex was associated with critical state (adjusted OR 1.38; 95% CI 1.07 to 1.77; p=0.013). However, similar unadjusted long-term mortality was observed [111 (64.5%) of women died compared to 244 (66.5%) men, p=0.70]. Furthermore, after adjustment for potential confounders, female sex was associated with a 24% lower risk of dying in the long term (adjusted HR 0.76; 95% CI 0.58 to 0.98; p=0.037) compared to men (Figure 1). Other predictors of long-term mortality in patients with critical state were age, hyperlipidemia, renal dysfunction, and dual antiplatelet therapy.
Figure 1

Conclusion
Female sex was associated with critical state. However, the unadjusted long-term mortality was similar in both sexes. In addition, female sex was associated with better long-term survival in patients with critical state. Further investigation is required to answer these associations.
P3468Tentative criteria of a combined RV3+SV3 voltage for early diagnosis of pediatric patients with hypertrophic cardiomyopathy
Authors: Yoshinaga M , Iwamoto M , Horigome H , Sumitomo N , Ushinohama H , Izumida N , Tauchi N , Yoneyama T , Abe M , Kato T , Hokosaki T , Kato Y , Nagashima M 
Published: October 2019

Abstract

Background
A high voltage in midprecordial leads, termed the Katz-Wachtel sign, is a surrogate marker of left- or bi-ventricular hypertrophy. Asymmetrical interventricular hypertrophy is a characteristic feature of hypertrophic cardiomyopathy (HCM). In Japan, a school-based electrocardiographic (ECG) screening program was developed for all 1st, 7th, and 10th graders. Our hypothesis is that a combined voltage of RV3+SV3 {V3(R+S)} is a marker to screen pediatric HCM.

Purpose
[1] To develop V3(R+S) voltage criteria in 1st, 7th, and 10th graders at the screening program and [2] to determine whether the criteria are useful for the early diagnosis of HCM.

Methods
[1] Overall, 48,401 digitally stored ECGs from 16,773 1st graders (6-year-olds), 18,126 7th graders (12-year-olds), and 13,502 10th graders (15-year-olds) were obtained after excluding ECGs of subjects with underlying diseases, arrhythmias, and ST/T changes. The prevalence of HCM in children is estimated at 2.9 per 100,000 (1/34,000). The screening points were assumed to be between 1/2,000 and 1/5,000 to exclude the possibility of false negatives. [2] In 12 HCM patients (males/females=10/2) who were diagnosed after 12 years of age (one case was diagnosed at 9 years of age), the ECGs at the screening program of their first grade (at 6 years of age) were retrospectively examined.

Results
[1] The V3(R+S) criteria were 6.0 mV, 6.0 mV, and 5.5 mV for 1st, 7th, and 10th grader males, and 5.0 mV, 4.5 mV, and 4.0 mV for 1st, 7th, and 10th grade females, respectively. The number of subjects (and prevalence in parentheses) selected by the criteria were 2 (1/4175), 3 (1/2981), and 1 (1/6477) for 1st, 7th, and 10th grade males, and 2 (1/4212), 3 (1/3061), and 1 (1/3513) for 1st, 7th, and 10th grade females, respectively. [2] Four of 12 cases fulfilled the criteria. Of these, one suddenly died at 18 years of age, one experienced out-of-hospital cardiac arrest at 16 years of age, and one already had an interventricular thickness of 19 mm at 12 years of age.

Conclusions
These tentative V3(R+S) voltage criteria may be useful for the early diagnosis of pediatric HCM patients, particularly severe patients. The children and adolescents who were screened can be followed at 2–3-year intervals with ECGs and echocardiography. Early diagnosis and intervention including lifestyle modification and medication may prevent them expiring from out-of-hospital cardiac arrest or sudden death. Finally, the criteria should be validated in clinical settings.

Acknowledgement/Funding
A Health and Labour Sciences Grant from the Ministry of Health, Labour and Welfare of Japan (H27-019)
P3501Oral administration of donepezil markedly prevents the progression of chronic heart failure in renal artery stenosis-induced hypertensive rats
Authors: Li M , Zheng C , Kawada T , Inagaki M , Uemura K , Sugimachi M 
Published: October 2019

Abstract

Introduction
Parasympathetic activation by donepezil has been shown to improve prognosis in chronic heart failure (CHF) rats following myocardial infarction. We examined whether donepezil is effective in the treatment of another CHF model complicated with renal artery stenosis (RAS)-induced hypertension.

Methods
RAS was created by ligating the left renal artery up to 50% in SD rats, at the same time, we implanted a blood pressure (BP) transmitter for confirming RAS-induced hypertension (7-week post-RAS: systolic BP = 154±7 mmHg; diastolic BP = 115±8 mmHg). At the 11th week after induction of RAS, surviving animals were randomly assigned to untreated (UT, n=10) or donepezil treated [DT, n=10, dissolved in drinking water (3mg/kg/day)] group. After a 6-week treatment, the effects of donepezil were evaluated by hemodynamics, blood levels of neurohumoral markers, and morphology.

Results
Compared with UT, DT significantly prevented the progression of the left kidney atrophy (2.38±0.13 vs. 1.51±0.34 g/kg, P<0.05). DT also significantly improved cardiac remodeling, through suppressing the progression of cardiac hypertrophy (2.30±0.06 vs. 2.57±0.08 g/kg, P<0.01), cardiac dysfunction [cardiac index: 102±3 vs. 86±3ml/min/kg, P<0.05; left ventricular (LV) end-diastolic pressure: 12±2 vs. 20±2 mmHg, P<0.05; LV dp/dtmin: 5856±259 vs. 4924±227 mmHg/sec, P<0.05]. DT not only decreased serum levels of creatinine (0.54±0.02 vs. 0.63±0.03 mg/dl, P<0.05) and uric acid (1.4±0.2 vs. 1.9±0.2 mg/dl, P<0.05); but also decreased plasma levels of norepinephrine (273±38 vs. 846±242, P<0.01), angiotensin II (17±2 vs. 23±2 pg/ml, P<0.05), AVP (2729±347 vs. 4783±695 pg/ml, P<0.05) and BNP (360±13 vs. 460±39 pg/ml, P<0.05), and suppressed the systemic inflammation (CRP: 190±12 vs. 382±58 mg/ml, P<0.01).

Conclusions
Donepezil treatment markedly prevented the progression of cardiac remodeling and renal dysfunction, and improved the neurohumoral markers in the CHF rat model complicated with RAS-induced hypertension, suggesting that donepezil may be used as a new pharmacotherapy for CHF patients complicated with RAS-induced hypertension.
P3520Admission hyperglycemia is a predictor of mortality of acute heart failure: comparison between patients with and without diabetes mellitus
Authors: Cho J Y , Kim K H , Lee S E , Lee H Y , Choi J O , Jeon E S , Kim M S , Kim J J , Hwang K K , Chae S C , Kang S M , Choi D J , Yoo B S , Cho M C , Oh B H 
Published: October 2019

Abstract

Background
Regardless of diabetes mellitus (DM), admission hyperglycemia is not uncommon in patients with acute heart failure (AHF). Although DM is a well-known predictor of mortality in AHF, the impacts of admission hyperglycemia on clinical outcomes in non-DM patients with AHF have been poorly studied. The aim of this study, therefore, was to compare the impact of admission hyperglycemia on long-term clinical outcomes in AHF patients with or without DM.

Methods
Among 5,625 AHF patients enrolled in a nationwide registry, a total of 5,541 patients were enrolled and divided into 2 groups; DM group (n=2,125, 70.4±11.4 years) vs. non-DM group (n=3,416, 67.3±16.0 years). Each group were further divided into 2 groups according to the presence of admission hyperglycemia (admission serum glucose level >200mg/dl); admission hyperglycemia (n=248) and no hyperglycemia (n=3,168) in non-DM; admission hyperglycemia (n=799) and no hyperglycemia (n=1,326) in DM. All-cause death and hospitalization due to HF (HHF) during 1-year follow-up were compared.

Results
Death was developed in 1,220 patients (22.2%) including 269 inhospital deaths (4.9%) during 1-year of follow-up. Death rate were significantly higher in DM than in non-DM group (24.8% vs 20.5%, p<0.001), however there was no difference in inhospital death (5.1% vs 4.7%, p=0.534). Both inhospital death (7.6% vs. 4.2%, p<0.001) and 1-year death (26.2% vs. 21.3%, p=0.001) were more frequent in AHF patients with hyperglycemia. On Kaplan-Meier survival curve analysis, however, admission hyperglycemia was associated with significantly higher death (p<0.001 by log-rank test) and rehospitalization (p=0.006 by log-rank test) in non-DM group, but not in DM group. In non-DM group, admission hyperglycemia was an independent predictor of 1-year mortality (HR 1.46, 95% CI 1.10–1.93, p=0.009).

Conclusion
DM was a significant predictor of long-term mortality in patients with AHF. Admission hyperglycemia was associated with both higher inhospital and 1-year mortality. The present study also demonstrated that admission hyperglycemia is an independent predictor of mortality in non-DM patients with AHF, but not in DM patients. In addition to the presence of DM, admission hyperglycemia would be a useful marker in the risk stratification of AHF, especially in non-DM patients.