bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3542Natriuretic peptides added to clinical parameters predict two-year prognosis of patients with chronic heart with mid-range and reduced ejection fraction
Authors: Spinar J , Spinarova L , Spinarova M , Labr K , Jarkovsky J , Ludka O , Krejci J , Malek F , Ostadal P , Parenica J 
Published: October 2019

Abstract

Background
The guidelines recommend to determine natriuretic peptides, clinical status (NYHA classification) and comorbidities in order to predict the prognosis in patients with heart failure. The aim ofthis registry was to develop a prognostic score in chronic heart failure patients, using clinical status, comorbidities and natriuretic peptides.

Methods
Consecutive 1088 patients with stable chronic heart failure with reduced ejection fraction (HFrEF) (LVEF<40%) and mid-range EF (HFmrEF) (LVEF 40–49%) were enrolled. Two-year all-cause mortality, heart transplantation and/or LVAD implantation were defined as the primary endpoint (MACE).

Results
The occurrence of MACE was 14.9% and increased with higher NYHA, 4.9% (NYHA I), 11.4% (NYHA II) and 27.8% (NYHA III-IV) (p<0.001). The occurrence of MACE was 3%, 10% and 15–37% in patients with NT-proBNP levels ≤125pg/ml, 126–1000pg/ml and >1000pg/ml respectively. Discrimination abilities of NYHA and NT-proBNP were (AUC 0.670; p<0.001 and AUC 0.722; p<0.001). The predictive value of the developed clinical model, which took account of older age, advanced heart failure (NYHA III+IV), anaemia, hyponatraemia, hyperuricaemia and taking a higher dose of loop diuretics (>40 mg furosemide daily) (AUC 0.773; p<0.001) was increased by adding the NT-proBNP level (AUC 0.790).

Conclusion
Natriuretic peptides, clinical status and comorbiditis predict two year prognosis and they can help to a better identification of a high-risk groups of patients with heart failure with reduced and mid range ejection fraction in which more intense treatment should be considered, mainly LVAD implantation or listing to heart transplantation waiting list.

Acknowledgement/Funding
None
P3559Renal sympathetic nerve activity, assessed by renal 123-iodine metaiodobenzylguanidine scintigraphy, reflects disease severity in heart failure with reduced ejection fraction
Authors: Yoshitaka Y , Murai H , Tokuhisa H , Takamura M 
Published: October 2019

Abstract

Background
Sympathetic nerve activity is related to cardio-renal syndrome, which plays a crucial role in deterioration in heart failure with reduced ejection fraction (HFrEF). Previous studies reported that renal denervation was effective in HFrEF patients. Recently, we have demonstrated that renal 123-iodine metaiodobenzylguanidine (MIBG) scintigraphy is useful for assessment of renal sympathetic function in hypertension. However, it is unclear whether renal MIBG would reflect disease severity in HFrEF patients.

Methods
Twenty-four HFrEF patients and eleven control without heart failure were included in this study. HFrEF patients were performed MIBG and MSNA and hemodynamics inspection using Swan-Ganz's catheter (SGC). HFrEF was defined as echocardiography with EF of 50% or less. MSNA was recorded from the right peroneal nerve to evaluate direct sympathetic nerve activity to the peripheral vascular bed. MSNA was expressed as the number per minute (burst frequency = BF) and the number per 100 heartbeats (burst incidence = BI). Renal MIBG scintigraphy was simultaneously performed with cardiac MIBG scintigraphy. The 20 minutes (early) and 180 minutes (delayed) kidney-to-mediastinum ratio (K/M), early and delayed heart-to-mediastinum ratio (H/M), and washout rate (WR) were measured.

Results
In the HFrEF group, the EF was significantly lower than control group (EF 34.8±9.51% vs. 63.0±7.43, p<0.01), and MSNA parameters were significantly increased (burst incidence (BI), 57.7±18.7 vs. 37.0±11.3, p<0.01; BF 42.7±14.4 vs. 24.1±8.50, p<0.01). WR of cardiac MIBG was not related to MSNA parameters but negatively related to cardiac output (r=−0.46, p<0.05) and stroke volume (r=−0.61, p<0.01) and delayed H/M negatively correlated with mean pulmonary capillary wedge pressure (r=−0.57, P<0.05). WR of both left and right renal MIBG showed a strong correlation with MSNA (BI; left, r=0.69, p<0.01, right 0.60, p<0.01, BF; left, r=0.64, p<0.01, right, r=0.58, p<0.01) and no significant correlation between renal MIBG and hemodynamics parameters. HFrEF patients were divided into stage B and stage C based on American College of Cardiology/American Heart Association (ACC/AHA) classification (stage B, n=13; stage C, n=11). There was no significant difference between the two groups in cardiac MIBG parameters. Renal WRs in stage C was increased than stage B (Lt renal WR,51.6±10.6 vs. 40.6±6.53, p<0.05; Rt renal WR, 43.9±9.97 vs. 35.1±11.3, p<0.05).

Conclusions
Cardiac WR negatively correlated with cardiac output and renal WR correlated with MSNA. Renal WRs had a significant difference in the heart failure stage of ACC/AHA classification, but cardiac MIBG parameters did not. These results indicate that renal MIBG might be useful to assess renal sympathetic nerve activity in patients with HFrEF and suggesting that renal SNA might be promising therapeutic target in HFrEF.
P3562Efficient selection of patients with aldosterone-producing adenoma using the ACTH stimulation test
Authors: Kita T , Furukoji E , Sakae T , Kitamura K 
Published: October 2019

Abstract
Adrenal venous sampling (AVS) is the gold standard test for distinguishing between unilateral and bilateral primary aldosteronism (PA), however, AVS requires advanced and time consuming technique. The needs for AVS has been increasing due to increased utilization of screening for PA. Efficient selection of unilateral PA, such as aldosterone-producing adenoma (APA), before AVS is useful to avoid undesirable AVS in bilateral PA, such as idiopathic hyperaldosteronism. In this study, 40 patients who underwent all three confirmatory tests including the captopril-challenge test, furosemide upright test and adrenocorticotropin (ACTH) stimulation test (AST), and who were diagnosed as having PA by AVS were recruited. Subjects were diagnosed as having unilateral aldosterone excess (n=22) or bilateral aldosterone excess (n=18) by AVS. All patients with unilateral PA underwent operation and were finally diagnosed with APA. Major differences were detected in serum potassium level, basal plasma aldosterone concentration (PAC), presence of adrenal tumor, and AST results between the two groups. The PAC/cortisol ratio at 120 min in the AST showed the highest diagnostic capability for distinguishing the subtype of PA according to a receiver operating characteristic (ROC) curve analysis (area under the ROC curve was 0.956). At a cut-off value of 1.20 for the PAC/cortisol ratio at 120 min on AST, the sensitivity was 95.5% and the specificity was 88.9%. Sufficiently high sensitivity demonstrated indicates that the PAC/cortisol ratio at 120 min in the AST is useful for selecting patients with PA who are suitable for AVS.
P3578Determinants of visual-functional mismatches as assessed by coronary angiography and 3-D angiography-based quantitative flow ratio
Authors: Sugiyama T , Kanno Y , Hamaya R , Hoshino M , Usui E , Kanaji Y , Yamaguchi M , Hada M , Ohya H , Sumino Y , Hirano H , Yuki H , Horie T , Yonetsu T , Kakuta T 
Published: October 2019

Abstract

Background
Quantitative flow ratio (QFR) is a novel three-dimensional quantitative coronary angiography (QCA)-based computational index that can estimate fractional flow reserve (FFR) without pharmacologically induced hyperemia or the use of a pressure wire.

Purpose
We aimed to evaluate the determinants of visual-functional mismatches between conventional two-dimensional QCA and QFR.

Methods
A total of 504 de novo intermediate-to-severe lesions from 504 patients with stable angina who underwent angiographical and physiological assessments were analyzed. All lesions were divided into four groups based on the significance of visual (QCA-diameter stenosis [DS] >50% and ≤50%) and functional (QFR <0.80 and ≥0.80) stenosis severity. Patient characteristics, angiographic findings, QFR computations, and physiological indices were compared among the four groups.

Results
Among 504 lesions, 153 lesions (30.4%) showed concordantly negative (DS ≤50% and QFR >0.80) and 170 lesions (33.7%) showed concordantly positive (DS >50% and QFR ≤0.80) visual and functional assessments. Among 181 lesions (35.9%) with discordant results, 75 lesions (14.9%) showed a mismatch (DS >50% and QFR >0.80) and 106 lesions (21.0%) showed a reverse mismatch (DS ≤50% and QFR ≤0.80), respectively. Reverse mismatch was associated with smaller reference diameter (odds ratio [OR] 0.561; P=0.036), greater DS (OR 1.039, P=0.013), lower coronary flow reserve (CFR) (OR 0.571, P<0.001, non-diabetes mellitus (OR 2.141, P=0.013) and lower ejection fraction (OR 0.961, P=0.011). Mismatch was associated with smaller DS (OR 0.914, P<0.001), shorter lesion length (OR 0.894, P=0.001), higher CFR (OR 1,633, P<0.001), and lower estimated glomerular filtration rate (OR, 0.968, P=0.001). Lesion location and the index of microcirculatory resistance was not associated with the prevalence of reverse mismatch or mismatch.

Conclusions
There was a high prevalence of visual-functional mismatches between QCA-DS and QFR, and CFR was an important functional factor of mismatches. Our results suggested the difference between predictors of reported visual-functional mismatches of QCA/FFR and those of QCA/QFR.
P3638Triglyceride deposite cardiomyovasculopathy latency in population with coronary artery disease
Authors: Nakano Y , Onishi T , Niwa T , Takashima H , Shimoda M , Ohashi H , Ando H , Waseda K , Amano T 
Published: October 2019

Abstract

Background
Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel clinical concept found among Japanese cardiac transplant recipients in 2008 that the abnormal intracellular triglyceride (TG) metabolism results in the ectopic accumulation of TG in vascular smooth muscle cells and cardiomyocytes, leading to diffuse narrowing coronary artery disease (CAD) and heart failure. TGCV is estimated to affect almost forty to fifty-thousand people in Japan, but there is no real-world date about the prevalence or latency.

Purpose
To evaluate TGCV latency in population with CAD, especially requiring urgent coronary angiography as Study 1, and chronic hemodialysis as Study 2.

Methods
This is multicenter retrospective estimation consisting of two studies.
Study 1) From 2012 to 2017, consecutive 400 patients of unstable angina or acute myocardial infarction who underwent urgent coronary angiography (CAG) and following iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy, a tracer for the diagnosis of TGCV, were enrolled.
Study 2) From 2011 to 2017, 88 chronic hemodialysis patients who underwent planed CAG and BMIPP scintigraphy for detection of ischemic heart disease were enrolled.
TGCV was diagnosed based on the latest diagnostic criteria for TGCV. The criteria include two major items (2 points each: BMIPP scintigraphy Wash-Out Rare <10%, Diffuse narrowing coronary arteries) and two minor items (1 point each: Jordans' anomaly in peripheral blood smear, Diabetes). Four points or more and three points indicated definite and probable TGCV, respectively. Only Items other than Jordans' anomaly were available for the diagnosis of TGCV because of retrospective nature. We evaluated the latent rate of definite and probable TGCV.

Results
Study 1) Figure (left) demonstrates the result of Study 1. Definitive TGCV patients were 14 patients, accounting for 3.5% of total 400 patients, and probable TGCV patients were 39 patients, accounting for 9.8% of all. Total 53 definitive and probable TGCV patients accounted for 13.3% of all. Annual average latency were 3.6±1.7% as definitive, 10.0±5.5% as probable and 13.6±6.6% as definitive and probable TGCV, respectively.
Study 2) Figure (right) demonstrates the result of Study 2. Definitive TGCV patients were 17 patients, accounting for 19.3% of total 88 hemodialysis patients, and probable TGCV patients were 22 patients, accounting for 25.0% of all. Total 39 definitive and probable TGCV patients accounted for 44.3% of all. Annual average latency of definitive TGCV was 19.3±13.4%. Of the 17 definitive TGCV patients, 9 patients were hemodialysis patients with diabetes.
Figure 1

Conclusions
TGCV might be latent with a probability of 3.6±1.7% per year in patients with unstable angina or acute myocardial infarction, and with a probability of 19.3±13.4% per year in chronic hemodialysis patients suspected of ischemic heart disease.
P3650Prognostic impact of post procedural aortic valve insufficiency on long-term risk for surgical aortic valve repair in patients undergoing balloon valvuloplasty for congenital aortic valve stenosis
Authors: Pavlovic A S , Djordjevic S A , Mehmedbegovic Z , Stefanovic I , Kalanj J , Topalovic M , Ostric Pavlovic I , Zivkovic V , Ilic S , Milovanovic V , Vulicevic I , Bisenic D , Vukomanovic G , Parezanovic V , Djukic M 
Published: October 2019

Abstract

Background
Limited evidence is available regarding the prognostic impact of post procedural aortic valve insufficiency (AVI) on long-term outcome in patients with congenital aortic valve stenosis treated with balloon aortic valvuloplasty (BAV).

Purpose
To assess the prognostic impact of immediate post procedural AVI on long-term outcome in patients undergoing BAV for congenital aortic valve stenosis.

Methods
We analyzed 89 patients (median age 4 years, range 6 days to 25 years), undergoing BAV during 2004–2017, from a prospective registry of a tertiary university center, with a median follow-up period of 4 years. Patients were classified into two groups based on presence of immediate post procedural AVI grade more than “+1/4” as assessed by echocardiography. Kaplan Meier cumulative mortality curves for groups above vs. bellow post procedural AVI grade “+1/4” were compared with log-rank test. Cox regression model was used to assess the risk for surgical aortic valve repair (SAVR) in long-term follow up with patients without worsening of AVI after BAV serving as the reference group.

Results
During follow up, SAVR was performed in 20% (n=18) of patients. Patients with immediate post procedural AVI grade more than “+1/4” after BAV had significantly higher long-term risk for SAVR compared to those without AVI worsening (72% vs. 18%, log-rank p<0.001). When adjusted for other significant aortic valve repair predictors, such as bicuspid aortic valve, neonatal age, residual aortic valve peak gradient >35 mm Hg, the presence of AVI grade more than “+1/4” immediately after BAV was independently associated with 6-fold (HR=5.60, 95% CI 2.03–15.42, p=0.001) increased risk for SAVR.
Kaplan-Meier freedom from SAVR curves

Conclusion
The presence of post procedural AVI grade more than “+1/4” in patients undergoing BAV for congenital aortic valve stenosis is independently associated with the increased risk for SAVR in long-term follow up.
P3669Impact of the endocarditis team on management strategies and mortality: the Dutch experience
Authors: Van Der Spoel T , Van Heusden H , Liesdek O , Boel E , Arends J , Suyker W , Chamuleau S 
Published: October 2019

Abstract

Background
Infective endocarditis (IE) was associated with poor survival. In 2015, the European Society of Cardiology (ESC) introduced the multidisciplinary IE team to improve diagnostics, treatment and outcome in patients with IE.

Purpose
This study evaluated the clinical implementation of the IE team in the Netherlands.

Methods
Retrospective cohort of all IE patients diagnosed between 2012–2016 in a tertiary single center. Clinical characteristics, data on imaging techniques, surgical procedures, IE-related complications and all-cause mortality were collected. Differences before and after installation of the IE team in 2015 were analyzed.

Results
Overall, 257 IE patients were included with a minimal follow-up of 1 year. No significant differences in baseline characteristics or imaging method were observed. The annual incidence of IE gradually increased over time from 36 cases in 2012 to 50 cases in 2016. This was caused by an increase in native IE cases. No difference in mortality was observed before and after 2015 (22% vs. 26%, P=0.43).
After 2015, a reduction in hospitalization duration was observed (37 vs. 32 days; P=0.09) and median time to surgery had significantly decreased (18 vs. 8 days; P=0.01). Although an increase in congestive heart failure and valvulair abscess were observed a downtrend in acute renal failure (25% vs. 16%, P=0.08) was observed. Multivariate analysis demonstrated that age, COPD, diminished LV function and surgery were important predictors for mortality but not the IE team.

Conclusion(s)
The introduction of a multidisciplinary IE team led to earlier surgical intervention and was associated with a reduction in hospital duration but not an important predictor for mortality. These results are important in view of designing novel clinical trials.
P3677Heritable veno-oclusive pulmonary disease in iberian romani patients: the difficulty of genetic counseling and its impact in the perpetuation of the disease
Authors: Perez Olivares Delgado C , Tenorio J , Aurtenetxe A , Cristo M J , Navas P , Hernandez I , Moreno A , Bedate P , Martinez A , Palomino J , Arribas F , Escribano P 
Published: October 2019

Abstract

Pulmonary veno-oclussive disease (PVOD) is a rare form of pulmonary hypertension of poor prognosis and difficult diagnosis. A founder mutation in EIF2KA4 gene has been described in Iberian Romani patients with familial PVOD.

Aims
genetically and clinically characterize a cohort of Iberian Romani patients with familial PVOD. To perform the family screening, analyze the phenotype and socio-cultural determinants which may influence on disease's course and spreading.

Methods
Patients with familial PVOD were included from November 2011 until February 2019. Clinical and survival data were obtained from the Spanish National Registry of PAH. Genetic analysis of EIF2KA4 was performed in patients and relatives.

Results
13 index cases were included, all of them Iberian Romani, carrying the founder mutation (p.Pro1115Leu) in EIF2KA4. Genetic screening revealed 74 of healthy heterozygotes and 13 homozygotes: among them 10 affected and 3 unaffected at baseline assessment (7, 28 and 37 years old). More than half of their family members, including one complete family, refused genetic screening. The survival free of transplant or death was 77.3% and 52.4%, at 1 and 3 years, respectively.
Baseline characteristics Total n=23 Age, years (SD) 23.6 (11.8) Male sex, % 52.2 Functional class NYHA III-IV, % 85 Pulmonary vascular resistance, UW (SD) 10 (5.4) DLCO, % 31.1 6MWT, meters (SD) 352.4 (160) Lung transplant, % 47.8 Survival free of transplant 3 years, % 52.4 DLCO, diffusing capacity for carbon monoxide; 6MWT, 6-minute walk test.

Conclusions
Patients were seriously ill from a young age. They have early pregnancy and high number of children. The high frequency of endogamy in the Romani population is likely to have an important impact on the transmission of PVOD, as it would favor the appearance of new homozygous carriers. Currently, our major concern is the low range of family members that accepted to be studied, more than 50% of family members rejected genetic studies and counseling.
P3705Impact of subclinical atrial fibrillation detected by cardiac implantable electronic devices on the risk of future embolic stroke events from Far East
Authors: Nakano M , Kondo Y , Nakano M , Kajiyama T , Hayashi T , Ito R , Takahira H , Kobayashi Y 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is the most common type of arrhythmia. AF-related stroke tends to be more severe, and the mortality rate is higher compared with stroke without AF. The definition of AF in patients with cardiac implantable electronic devices (CIEDs) is not clear and the appropriate treatment guideline for patients with AF episode has not established yet. Recent CIEDs have led to an improvement in the early detection of AF episodes, especially in patients who are asymptomatic. Previous studies showed that atrial high-rate episodes (AHREs) detected by CIEDs are associated with embolic stroke events. However, little is known about the incidence of AF and stroke events in Japanese patients with CIEDs who have no prior AF and take no anticoagulant.

Objective
The purpose of this study was to identify the incidence of embolic stroke events in patients with and without AF events detected by CIEDs and examine the risk factors of embolic stroke events.

Methods
We retrospectively analyzed the database of our hospital. Every 6 months, AF events were checked by CIEDs. AF30 was defined as AF episodes lasting for ≥30 seconds detected by CIEDs. We examined the characteristics and incidence of embolic stroke events and investigated the relationship between AF30 and the incidence of embolic stroke events.

Results
We enrolled 348 consecutive patients who had no prior AF and took no anticoagulant in this study (follow-up period, 65±58 months; age, 70±16 years; male sex; 64%; defibrillator, 55%). The mean CHADS2 score and CHA2DS2-VASc score were 1.8±1.1 points and 2.8±1.5 points, respectively. The mean HAS-BLED score was 1.7±1.2 points. During the follow-up, 23 of 348 patients (6.6%) had embolic stroke events. Thirteen patients (4.1%/year) and 10 patients (0.63%/year) had embolic stroke events with and without AF30, respectively. The comparison of characteristics among patients with and without embolic stroke events was shown in Table. In multivariate logistic regression analysis, independent predictors for embolic stroke events were new-onset episode of AF30 (odd ratio [OR] 5.3, 95% confidence interval [CI] 2.2–13, P=0.0003) and an enlarged left atrium ≥40mm (OR 3.1, 95% CI 1.2–7.9, P=0.016).

Conclusions
Embolic stroke events were common in Japanese patients with CIEDs. AF30 and enlarged left atrium were risk factors of embolic stroke events in this population. Therefore, when physicians detect new-onset AF in patients with CIEDs, they should consider a comprehensive assessment of the risk and benefit of prescribing an anticoagulant.