bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4549Comparison of characteristics and prognosis of heart failure patients with preserved ejection fraction with diastolic dysfunction and normal diastolic function
Authors: Oeun B , Hikoso S , Yamada T , Yasumura Y , Uematsu M , Abe H , Nakagawa Y , Higuchi Y , Fuji H , Mano T , Nakatani D , Kitamura T , Kojima T , Kida H , Sakata Y 
Published: October 2019

Abstract

Background
Previous studies showed that some patients with heart failure with preserved ejection fraction (HFpEF) have no visible diastolic dysfunction assessed by echocardiography. There remains limited data on the prognosis of patients with diastolic dysfunction (DD) HFpEF and normal diastolic function (ND) HFpEF.

Purpose
This study aims to examine the prognostic significance of echocardiographic DD and ND in patients admitted with HFpEF.

Methods
We assessed consecutive 127 patients who were registered in the PURSUIT-HFpEF, a prospective multicenter observational study of patients with HFpEF enrolling patients with LVEF ≥50%, and NT-proBNP ≥400 pg/ml on admission. Median age was 82 [interquartile range (IQR): 76–87] years old, and 71.4% were female. The DD group included the patients with at least three of the following four criteria: (1) E/e' >14, (2) septal e' velocity <7 cm/s, (3) tricuspid regurgitation peak velocity >2.8 m/s, (4) left atrial volume index >34 ml/m2. The patients with only one or absent the above criteria were included in the ND group. The primary endpoint was a composite of all-cause death, HF readmission, and cerebrovascular events during one-year follow-up.

Results
63 patients (49.6%) were included in the DD group and 64 patients (50.4%) in the ND group. Patients with DD were significantly older, more likely female, had lower estimated glomerular filtration rate (e-GFR), and had higher NT-proBNP than those with ND. However, the prevalence of hypertension, diabetes mellitus, and previous myocardial infarction were not different between the two groups. During a median follow-up of 363 (IQR: 319–394) days, 33 patients (26%) met the primary endpoint. The primary endpoint occurred more frequently in the DD group than in the ND group (36.5% vs. 15.6%, P=0.007). Kaplan-Meier survival analysis showed that patients with DD had significantly higher cumulative events of the primary endpoint than those with ND, (log rank test P=0.011). After adjusting for covariates, multivariate Cox regression revealed that DD was associated with the primary endpoint (hazard ratio: 2.39, 95% confidence interval: 1.08–5.29, P=0.031).
Kaplan Meier

Conclusions
Patients with HFpEF and DD showed poorer one-year clinical outcomes than those with HFpEF and ND. The presence of DD may be an independent prognostic factor in patients with HFpEF.

Acknowledgement/Funding
Roche diagnostics and FUJIFILM Toyama Chemical
P4573In patients with acute myocardial infarction, PCSK9 levels do not predict severity and recurrence of cardiovascular events
Authors: Zeller M , Lambert G , Farnier M , Maza M , Mouhat B , Rochette L , Vergely C , Cottin Y 
Published: October 2019

Abstract

Background
In patients with coronary artery disease (CAD), it remains unclear whether serum PCSK9 levels can predict the severity of the disease and the risk of future cardiovascular events.

Methods
Among the patients admitted for an acute myocardial infarction (MI) from September 2015 to December 2016 in an intensive care unit from a university hospital, serum PCSK9 levels were measured on admission in patients not previously receiving statin therapy. We aimed to evaluate the association between PCSK9 levels, metabolic parameters, severity of CAD on coronary angiography, and the risk of in-hospital events and at one-year follow-up.

Results
In a total of 648 patients (mean age: 66 years, 67% male), the median PCSK9 was 263 ng/ml, higher for females compared with males (270 vs 256 ng/ml, p=0.009). Serum PCSK9 was associated with LDL cholesterol (r=0.083, p=0.036), total cholesterol (r=0.136, p=0.001) and triglycerides (r=0.137, p=0.001). A positive association was also observed in the subgroup of patients with CRP >10 mg/L (p<0.001), but not with NT-proBNP, troponin and creatine kinase. PCSK9 levels were similar whatever the SYNTAX score or the number of significant coronary lesions. Moreover, PCSK9 levels were not predictive of in-hospital events (death, recurrent MI and stroke) and events (cardiovascular death, cardiovascular events, recurrent MI) at one-year follow-up.

Conclusion
In this large cohort of patients hospitalized for acute MI and not previously receiving statin therapy, PCSK9 levels was not associated with the severity or the recurrence of cardiovascular events. The clinical utility of measuring PCSK9 levels remains to be demonstrated for this category of patients.
P4574Marked changes in the incidence of subendocardial and ST elevation myocardial infarctions: a twenty-one year study
Authors: Kostis W J , Zinonos S , Kostis J B , Cabrera J , Moreyra A E 
Published: October 2019

Abstract

Background/Introduction
The use of new biomarkers, pharmacologic and interventional therapies have resulted in marked changes of the type of myocardial infarction.

Purpose
The purpose of this study is to report on the changes in the incidence of subendocardial and ST elevation myocardial infarctions (STEMI) in the state of New Jersey from 1994 to 2015 and describe possible explanations for this secular change.

Methods
The rate of occurrence of ST elevation myocardial infarction (ICD9 410.00) and of subendocardial (NSTEMI, ICD9 410.70 to 410.72) myocardial infarction was studied using the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all admissions for acute myocardial infarction in New Jersey with more than 30 years longitudinal follow up. Admissions for myocardial infarction and unstable angina as well as for conditions associated with troponemia (heart failure ICD9 418.XX, chronic kidney disease ICD9 584.XX, 585.XX, 403.XX, diabetes ICD9 250.XX) were also identified. Associations among variables were examined using logistic regression and linear error in variables (LEIV) models.

Results
During the time period under consideration, there was a decrease in the total number of MIs in New Jersey by 17.5%, the number of STEMIs decreased by 67.4%, while the rate of NSTEMIs increased by 85.8% (top panel). There was a complementary relationship between the annual number of admissions for unstable angina to the annual number of admissions for NSTEMIs (bottom panel). The effect was more pronounced between 1994 and 2002 and plateaued thereafter corresponding to widespread use of troponins in the diagnosis of acute coronary syndromes.

Conclusions
The marked change in the type of myocardial infarction was due in part to the use of troponins that resulted in the classification of patients with unstable angina as patients with subendocardial infarction. These data support regionalization of facilities specializing in immediate intervention in STEMI patients.
P4581Outcome of surgical revascularization for coronary artery disease after 30 years
Authors: Delmo-Walter E M , Hetzer R 
Published: October 2019

Abstract

Objective
We report the long-term outcome of surgical revascularization in patients with coronary artery disease.

Methods
The institutional trial on Coronary Artery Disease and Surgical Therapy: Long-term Follow-up, is a 30-year follow-up study of 2728 patients with coronary artery disease who underwent surgical revascularization from April 1986 to December 1988. One-vessel coronary artery disease was found in 234 patients while 2 and 3-vessel diseases were found in 1021 and 1463 patients, respectively. Survival was analyzed according to age, gender, ejection fraction, and number of arterial and vein grafts (2165 males, mean age at coronary revascularization 59.4±8.8 years).

Results
Mean duration of follow-up was 30.6±1.2 years. Overall survival at this time point was 24.1%. Age–stratified survival was observed higher (40%) in those patients <50 years of age at that time of surgery compared to the other age groups, i.e. 50–59: 20%, 60–69: 10% and >70: 5% (p<0.001). Women had increased early mortality, hence have poorer survival (12%) than men (18%). However, when age (women=median 64.7, men=58.4, years) was considered between gender, no significant difference (p=0.13) in survival was observed. Interestingly, survival rate of patients with ejection fraction of <30% (n=826) was 6% which obviously fared well compared with 18% of those with ejection fraction of >30% (n=1902) at the time of coronary surgery. There was no significant difference between the use of a single internal mammary artery (IMA) [left or right] graft and use of 2 arterial grafts (combined left and right IMA or IMA and radial artery) on long-term survival (p=0.014). However, the use of an arterial graft combined with vein grafts are favorable (p<0.001).

Conclusion
The findings in this study showed that after a relatively long-term follow-up, age-based survival was similar compared to the general population. Female gender demonstrated poorer survival than men. However, when this is adjusted for age, no significant difference was shown. Interestingly, several patients with severely reduced ejection fraction, considered inoperable by many cardiac surgeons and cardiologists at the time of revascularization have survived for >30 years. Use of one internal mammary artery graft demonstrated better survival than use of only vein grafts. Noteworthy is that the sole use of vein grafts may also lead to an acceptable long-term survival.
P4607A specific complex I-induced ROS modulator, OP2113, is a new cardioproctective agent against acute myocardial infarction injuries during reperfusion
Authors: Boucard A , Marin F , Monternier P A , Brand M , Le Grand B 
Published: October 2019

Abstract

Introduction
Hospital death rates due to myocardial infarction are still a concern and heart failure occurs in nearly a quarter of older patients who present with ST elevation myocardial infarction. Novel therapies are thus desperately needed to reduce infarct size to preserve left ventricular function and to prevent the onset of heart failure.

Purpose
OP2113, trithio-p-methoxyphenylpropene (anethole trithione, 5-(4-methoxyphenyl)-3H-1,2-dithiole-3-thione, anethole dithionethiol), a potential suppressor of complex I superoxide/hydrogen peroxide (ROS) production was evaluated in a sheep model of regional ischemia in order to demonstrate cardioprotective properties against infarct size and left ventricular function remodeling.

Methods
A series of experiments was performed in vitro on isolated mitochondria and on C2C12 cells to clarify the mechanism of action and to test whether OP2113 impacts biological variables of mitochondria. In vivo, anesthetized sheep underwent 60 min ischemia and 120 min reperfusion and either received OP2113 (1–5 μg/kg, i.v at start of and for the duration of the reperfusion) or the vehicle. The animals underwent then a 3-day follow-up period until euthanasia. Ischemic biomarkers, troponin I, CPK, and ventricular function through echocardiography were quantified during reperfusion and infarct size through histological analysis.

Results
OP2113 reduced ROS production from site IQ in mitochondria isolated from rat skeletal muscle, with IC50 of 26±1.4 μM (n=3). It is specific; IC50 values for other sites are at least 15-fold higher (site IIIQo – 414 μM; site IIF – 582 μM; sites IF/DH, PF, GQ >5 mM). Furthermore, OP2113 did not affect oxidative phosphorylation, respiration or growth of C2C12 cells. In the sheep model, OP2113 (1–10 μg/kg) dose-dependently prevented reperfusion-induced ST segment increase during the first minutes. When OP2113 plasmatic concentration was superior to 1 ng/mL (generally associated with a threshold dose of 5 μg/kg), troponin Ic levels measured over the experiment was strongly decreased and the cardiac function significantly improved (+86%), when compared to the vehicle group (left panel). Finally, the infarct size was diminished by 57% comparing to the vehicle group (10.3% vs 23.8%, respectively, right panel).

Conclusion
In a large animal model of ischemia-reperfusion, OP2113 with very low infused dose, reduced ST segment elevation, reduced troponin release, improved left ejection fraction and reduced infarct size. Collectively, these results demonstrate that OP2113, through a new mechanism of action, is a potent cardioprotective compound.
P4611Colchicine before percutaneous coronary intervention in acute myocardial infarction
Authors: Talasaz A H , Jenab Y , Hosseini S H 
Published: October 2019

Abstract

Aims
Myocardial perfusion could determine the outcome of patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the impact of colchicine on myocardial perfusion in this population.

Methods
In a double-blind, randomized trial, we assigned 196 patients with STEMI undergoing PCI to two groups: the colchicine group (N=95) and the control group (N=101). The primary endpoints were the thrombolysis in myocardial infarction (TIMI) score; TIMI myocardial perfusion grade (TMPG), and TIMI frame count (TFC). The major adverse cardiovascular events (MACEs) were recorded after one month of PPCI.

Results
The Final TIMI flow grade, TMPG and TFC were not significantly different between the 2 groups (p=0.75, p=0.533, p=0.161; respectively). MACE include Mortality, Non-fatal myocardial infarction, target lesion/vessel revascularization were similar between the 2 groups (p=0.058).
Study outcomes Characteristics Colchicine Group (n=95) Control Group (n=101) P value Discharge status   Deceased 2 (2.1%) 2 (2%) 1   Alive 93 (97.9%) 99 (98%) TIMI flow grade after PCI   0 2 (2.1%) 1 (1%) 0.747   1 2 (2.1%) 4 (4%)   2 17 (17.9%) 21 (20.8%)   3 74 (77.9%) 75 (74.3%) TIMI myocardial perfusion grade 2.39±0.89 2.31±0.95 0.533 ST segment resolution   Below 50 Percentage 23 (27.1%) 27 (32.1%) 0.71   Between 50 to 70 Percentage 8 (9.4%) 6 (7.1%)   Above 70 Percentage 54 (63.5%) 51 (60.7%)   MACE.1.Month 10 (9.9%) 3 (3.2%) 0.058   MACE.1.Month(Mortality) 4 (4.0%) 2 (2.1%) 0.451   MACE.1.Month(Non.Fatal.MI) 2 (2.0%) 0 (0%) 0.168   MACE.1.Month(TLR) 2 (2.0%) 1 (1.1%) 0.597   MACE.1.Month(TVR) 5 (5.0%) 1 (1.1%) 0.113

Conclusion
In STEMI patients treated by PPCI, the effect of colchicine before PPCI was not revealed on myocardial perfusion markers.
P4618Lack of CD31 results in microvascular plugging and increased infarction size in an experimental model of myocardial ischemia-reperfusion injury
Authors: Syvannarath V , Di Carlo S , Even G , Gachet B , Nicoletti A , Caligiuri G 
Published: October 2019

Abstract

Background
The success of coronary recanalization therapy for the treatment of myocardial infarction can be hampered by microvascular plugging which prevents effective reperfusion of the ischemic tissue. Due to its constitutive expression in platelets, leukocytes, and endothelial cells and its peculiar tyrosine phosphatase cell detaching signaling properties, the trans-homophilic CD31 receptor may be important to modulate platelet and leukocyte aggregation in the microvasculature.

Objective
To investigate the impact of CD31 genetic deficiency on the infarct size, peri-infarction microvascular plugging and macrophage phenotype in a mouse model of heart ischemia/reperfusion.

Methods
Cardiac ischemia was induced in WT and CD31 KO mice (n=30, 15 females and 15 males in each group) by surgical ligation of the left anterior descending coronary artery (LAD) for 45 minutes followed by reperfusion for 72 hours. The area at risk (AAR) and necrotic zone (NZ) were assessed using ImageJ software on three consecutive 1 mm thick slices of the left ventricle (LV) by a combination of a blue dye and 2,3,5-triphenyltetrazolium chloride staining. Parallel sets of experiments served to evaluate by both fluorescence microscopy and cytometry the presence of microvascular plugs and leukocyte phenotype in the infarction area as compared to the peri-necrotic myocardium.

Results
The AAR was similar in WT and CD31 KO mice (41,7±3,5 vs 37±2,9% of LV, NS) whereas the size of myocardial infarction was significantly greater in CD31 KO as compared to WT mice (23,4±2 vs 17,8±1,7% of LV, p<0,05). Immunofluorescent microscopy showed a dramatic increase in microvascular platelets-rich plugs around the infarction in CD31 KO mice (Figure), confirmed by cytometry analysis (9749±573 vs 5976±376 platelet-leukocyte aggregates/mg of tissue, p<0.001). Furthermore, we found that the ratio between M1 and M2 type macrophages in the peri-infarction myocardium was significantly increased in CD31 KO mice (0,7±0.07) as compared to WT mice (0,4±0.06, p<0,01).

Conclusions
Our data suggest that CD31 is important for reducing the size of necrosis following coronary recanalization procedures by preventing the no-reflow phenomenon due to microvascular plugging and by promoting a reparative phenotype of peri-infarction macrophages.

Acknowledgement/Funding
Institut Servier - ANRT (CIFRE doctoral grant)
P4620Circulating concentration of presepsin improves early prediction of short-term mortality in patients treated at medical cardiac intensive care units
Authors: Ishii J , Takahashi H , Nishimura T , Kawai H , Muramatsu T , Harada M , Yamada A , Naruse H , Hayashi M , Motoyama S , Sarai M , Watanabe E , Izawa H , Ozaki Y 
Published: October 2019

Abstract

Background
Presepsin, a subtype of soluble CD14, is an inflammatory marker, which largely reflects monocytic activation. Presepsin appears to be an accurate diagnostic marker of sepsis, but its clinical significance remains unclear in cardiovascular disease.

Purpose
This prospective study aimed to investigate the predictive value of plasma presepsin levels on admission to medical (non-surgical) cardiac intensive care units (MCICUs) for short-term mortality.

Methods
We examined 1560 patients hospitalized in MCICUs and measured the baseline plasma presepsin levels at admission.

Results
Acute coronary syndrome was present in 46% of the patients, and acute decompensated heart failure in 36%. Before MCICUs admission, emergent coronary angiography or percutaneous coronary intervention was performed in 36%, mechanical ventilation was required for respiratory insufficiency in 2.1%, and intraaortic balloon pumps were needed for hemodynamic instability in 8.9%. During 6 months after admission, there were 113 (7.2%) deaths. Patients who died were older (median: 77 vs. 71 years, P<0.0001); had higher levels of presepsin (263 vs. 119 pg/mL, P<0.0001), B-type natriuretic peptide (BNP: 696 vs. 186 pg/mL, P<0.0001), high-sensitivity troponin T (hsTnT: 81 vs. 47 pg/mL, P=0.004), and high-sensitivity C-reactive protein (13.8 vs. 2.2 mg/L, P<0.0001); and had lower levels of estimated glomerular filtration rate (50 vs. 65 mL/min/1.73m2, P<0.0001) and left ventricular ejection fraction (43% vs. 51%, P<0.0001) than those of the survivors. In the multivariate Cox regression analysis, higher levels of presepsin (P=0.0002), BNP (P=0.04), and hsTnT (P=0.009) were all independent predictors of 6-month deaths. Quartiles of presepsin levels were associated with higher mortality rates within 6 months after admission (Table). Adding presepsin levels to a baseline model that included established risk factors, BNP, and hsTnT further enhanced reclassification (P=0.004) and discrimination (P=0.003) beyond that of the baseline model.
Mortality rates according to presepsin Presepsin quartile 1st 2nd 3rd 4th P value ≤80 pg/mL 81–124 pg/mL 125–232 pg/mL >232 pg/mL 1-month mortality 0.8% 2.0% 3.3% 8.0% <0.0001 6-month mortality 0.8% 3.8% 8.2% 16.3% <0.0001

Conclusions
Presepsin levels at admission could improve the prediction of short-term mortality in patients hospitalized at MCICUs.
P4623Impact of left ventricular ejection fraction in ischemic and bleeding risk after an acute coronary syndrome
Authors: Cespon Fernandez M , Raposeiras Roubin S , Abu-Assi E , Manzano Fernandez S , Dascenzo F , Simao Henriques J P , Saucedo J , Flores Blanco P , Cambronero Sanchez F , Ariza Sole A , Munoz Pousa I , Caneiro Queija B , Cobas Paz R , Lopez Rodriguez E , Iniguez Romo A 
Published: October 2019

Abstract

Introduction
Even though left ventricular ejection fraction (LVEF) is a well-documented strong predictor of mortality after an acute coronary syndrome (ACS), its differential impact on the ischemic and bleeding risk of hemorrhage and ischemia is not well established. The aim of this study was to assess the impact of LVEF, measured by echocardiography, on the risk of acute myocardial infarction (AMI) and major bleeding (MB) after hospital discharge for ACS, during treatment with dual antiplatelet therapy (DAPT).

Methods
The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. From the initial merged data set, that contained 26,076 patients, we have excluded those without data about LVEF. So the final cohort was composed by 20,518 patients. The impact of LVEF in the ischemic and bleeding risk was assessed by a multivariable competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. All those variables with statistical (p<0.05) or clinical significance for the association with AMI and MB were included in the analysis. Follow-up time was censored by DAPT suspension/withdrawal.

Results
During a mean follow-up of 12.2±5.2 months, 789 patients died (3.8%), 431 had an AMI (2.1%) and 537 had a MB (2.6%). The mean of LVEF was 53.2% ± 10.7%. Only 15.5% of patients had LVEF <40% (n=3,179). As the LVEF decreased, the risk of AMI increased, whereas the behavior of the risk of MB was more heterogeneous (Figure). After a multivariable adjustment, LVEF (as continuous variable) was significantly associated with AMI (sHR 0.98, 95% CI 0.98–0.99; p=0.010), but not with MB (sHR 1.00, 95% CI 0.99–1.01; p=0.270). After stratifying by LVEF groups (≥ vs <40%), we found an association between LVEF and AMI (sHR 1.40, 95% CI 1.10–1.76; p=0.005), but not between LVEF and bleeding (HR 0.85, 95% CI 0.67–1.08; p=0.185).

Conclusions
After an ACS, as the LVEF decreases, there is an increase in ischemic risk, but not in bleeding risk. A LVEF <40% was independently associated with higher risk of AMI, but not with higher risk of MB.