bluuebunny/crossref_metadata_2025_split huggingface dataset:
P777Changes in glycated hemoglobin in patients with heart failure with reduced ejection fraction treated with sacubitril/valsartan
Authors: Stassinos V , Bezati S , Leftheriotis D , Kardamis C , Dourvas P , Katsaras D , Loisiou M , Draganigos A , Klonou E , Flevari P 
Published: October 2019

Abstract

Introduction
Glycemic control reflected by glycated hemoglobin (HbA1c) is regarded as a risk factor and a strong predictor of mortality in patients with heart failure (HF). Hyperglycemia may contribute to oxidative stress, endotelial dysfunction and cardiac fibrosis and influence negatively heart failure prognosis in patients with or without diabetes. Treatment with neprilysin inhibitors in combination with angiotensin II receptor antagonist,(ARNIs) has shown beneficial effects in morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF).

Purpose
We sought to investigate eventual reductions in HbA1c in patients receiving the novel therapy.

Methods
We enrolled a total of 52 stable patients with HFrEF eligible for treatment with ARNIs. Patients were administered a target dose of 200mg bid (97mg sacubitril/103mg valsartan) and we measured HbA1c before, 3months and 6months after initiation of therapy. Changes in HbA1c levels were tested with General Linear Model Repeated Measures test. Spearmans' Rho correlation analysis was performed to investigate possible relationship between the above.

Results
Mean age was 62±10 years, 69,2% of patients were on New York Heart Association (NYHA) functional class II, 23,1% on NYHA III and 7,7% on NYHA IV. 57,7% had ischemic while 42,3% dilated cardiomyopathy, 25% chronic kidney disease and 38,5% diabetes mellitus. Mean Body Mass Index (BMI) was 29,88±4,66 kg/m2. Median value of baseline HbA1c was 5,8% (IQR 0,9). Compared to baseline values, HbA1c decreased to 5,6 (IQR 0,9) and 5,7 (IQR 0,83) (p=0,012) at three and six months of treatment, respectively. Change in HbA1c levels was associated significantly with the presence of diabetes mellitus (p=0,013) and diabetic patients showed greater relative reduction in HbA1c (8%) compared to non diabetic patients (1%). Spearmans' Rho test revealed statistically significant association between changes in HbA1c levels from initiation to three months of therapy, while changes between initiation to six months of administration did non correlate with the presence of diabetes.
Changes in HbA1c

Conclusions
HbA1c levels were reduced significantly during treatment with sacubitril/valsartan. Changes were independent of diabetes in six months of treatment.
P790Verification of selective arterial blood sampling for the assessment of in-hospital mortality in acute decompensated heart failure
Authors: Takahara K , Yasuda K , Oguri M , Ishii H , Murohara T 
Published: October 2019

Abstract

Background
Acidosis or lactate accumulation is frequently observed in patients with acute decompensated heart failure (ADHF). Although each value can be easily obtained and evaluated by arterial blood sampling, sampling to all patients is difficult in daily clinical practice. Therefore, the prognostic impact of acidosis or lactate accumulation on this condition remains to be identified definitively.

Purpose
The purpose of the study was to verify the effectiveness of selective arterial blood sampling at emergency department in patients with ADHF by evaluating an association with in-hospital mortality.

Methods
A total of 917 consecutive patients with ADHF from April 2012 to March 2017 were enrolled. We compared baseline characteristics and in-hospital mortality between patients with or without arterial blood sampling. Patients performed blood sampling were assigned to four groups according to the presence or absence of acidosis (PH <7.35) and lactate accumulation (>2.0 mmol/L), and predictive value of acidosis and/or lactate accumulation for in-hospital mortality was calculated by multivariable logistic regression analysis.

Results
Of all patients, 689 patients (75.1%) underwent blood sampling. Systolic blood pressure and heart rate at hospital arrival, use of emergency medical service, previous heart failure hospitalization, New York Heart Association classification grade IV, presence of jugular vein distention, and the prevalence of hypertension and dementia, were significantly different between the two groups (P<0.05). There was no difference in the occurrence of in-hospital mortality between patients with or without blood sampling (9.3% in patients with blood sampling versus 9.2% in those without blood sampling, respectively; P=0.972). In 689 patients who underwent blood sampling, we examined combined predictive value of acidosis and/or lactate accumulation for in-hospital mortality by multivariable logistic regression analysis with adjustments for covariates with P<0.05 (age, systolic blood pressure at hospital arrival, left ventricular ejection fraction, and cold profile), and showed that acidosis with lactate accumulation [adjusted odds ratio (OR) 3.30, 95% confidence interval (CI) 1.22–8.93, P=0.019], acidosis without lactate accumulation (adjusted OR 4.06, 95% CI 1.12–14.7, P=0.033), lactate accumulation without acidosis (adjusted OR 2.69, 95% CI 1.14–6.33, P=0.024) were significantly (P<0.05) associated with in-hospital mortality. Our results indicated that patients presenting acidosis without lactate accumulation revealed the highest in-hospital mortality among the four groups.

Conclusion
Arterial blood sampling at emergency department could be beneficial for stratifying high risk patients with ADHF. Furthermore, routine blood sampling could be allowed in patients with ADHF if we can secure safety.
P810Novel scoring system for takotsubo syndrome
Authors: Di Vece D , Kato K , Bacchi B , Candreva A , Cammann V L , Szawan K A , Hermes-Laufer J , Micek J , Wischnewsky M , Ghadri J R , Templin C 
Published: October 2019

Abstract

Background
Scoring systems for risk stratification in takotsubo syndrome (TTS) are lacking.

Purpose
The present study aimed to develop a score to predict the overall mortality in TTS.

Methods
TTS patient were enrolled from a multicenter registry. Parameters known to be associated with adverse outcomes in TTS were identified based on current literature. A multivariable analysis including these parameters was conducted and those which were found to be significantly associated with mortality were considered in the scoring system. For each patient, the prognostic score was derived by summing the respective points of each prognostic factor. Based on cut-off values, patients were categorized into four groups including low, intermediate, high, and very high risk.

Results
A total of 1160 patients (90.8% females; mean age 66.5±13.0 years) were included in the present study. Regarding triggering factors, an emotional trigger was identified in 32.6% of TTS patients while 32.1% had preceding physical activities, medical conditions, or procedures and 5.7% had preceding neurologic disorders. The remaining patients (29.7%) had no identifiable triggering factors. According to the results from multivariable analysis, points were assigned to each parameter that was independently associated with long-term mortality: 15 points for neurologic trigger, 10 points for the other physical trigger, 8 points for Age >70 years, 7 points for male sex, 7 points for left ventricular ejection fraction ≤45%, 6 points for diabetes mellitus, 5 points for heart rate >94 bpm on admission, 5 points for systolic blood pressure >140 mmHg on admission, and 2 points for no identifiable trigger. Based on the total points, patients were categorized into four prognostic groups: low-risk ≤15 points (43.5%), intermediate-risk 16–22 points (28.0%), high-risk 23–29 points (18.0%), and very high-risk >29 points (10.5%).

Conclusion
This novel score for risk stratification in TTS only requires easy-obtainable variables to clinicians even in the acute phase and could identify low to very high risk of overall mortality. Thus, it could potentially serve as a useful clinical tool to predict prognosis in patients with TTS.
P813Iatrogenic takotsubo syndrome: incidence and impact
Authors: Ong G J , Stansborough J , Nguyen T H , Horowitz J D 
Published: October 2019

Abstract

Background
Although Takotsubo syndrome (TTS) was once considered to be rare and largely benign, it is now recognised to represent a major cause of cardiac morbidity and mortality, especially in aging women. The biochemical precipitant of attacks of TTS is an increase in catecholamine concentrations within the myocardium, engendering inflammatory activation via biased post-receptor signalling at myocardial β2-adrenoceptor level. Cases of TTS have been reported in patients treated with catecholamines, and with antidepressants which limit catecholamine re-uptake. In the current investigation, we sought to delineate the extent and potential impact of this “iatrogenic” form of TTS.

Methods/Results
Patients' data from a regional registry of 272 consecutive cases of TTS were evaluated. After exclusion of patients (n=14) in whom TTS has occurred in association with life threatening extracardiac disease states, a total of 47 (18%) of patients were identified as having antecedent exposure to potentially “iatrogenic” agents (antidepressants in 29 cases, β2-adrenoceptor agonists in 14). Demographics, including proportion of male patients, did not differ significantly between patients with and without “iatrogenic” TTS, but plasma concentrations of the catecholamine metabolite normetanephrine tended to be greater (median 1160 vs. 950 pmol/L; p=0.07). Long-term survival (median follow-up 3.5 years) was marginally (p=0.09) worse for patients with “iatrogenic” TTS.

Conclusion
(1) A potentially iatrogenic component of precipitation (via iatrogenic elevation of catecholamine levels and β2-adrenoceptor stimulation) is present in a substantial proportion of patients.
(2) In such patients there is an implication of increased long-term mortality risk, potentially accentuated by continued administration of the precipitating agent(s).
P815Tako-Tsubo Cardiomyopathy: clinical correlations of typical and atypical left ventricular contraction patterns
Authors: Gaede L , Herchenbach A , Troebs M , Marwan M , Achenbach S 
Published: October 2019

Abstract

Background
Takotsubo cardiomyopathy (TCM) is diagnosed in 1–2% of all patients presenting with acute coronary syndrome (ACS). Clinical differences in individuals presenting with either the typical (apical) or atypical (midventricular, basal and focal) localization of left ventricular contraction abnormalities are not well understood.

Methods
We retrospectively analyzed 102 consecutive patients diagnosed with TCM based on clinical presentation, coronary angiography, and laevocardiography. Patients with different contraction abnormality patterns were compared regarding sex, clinical presentation, trigger for TCM, LV-function and LV enddiastolic pressure (LVEDP) as well as coronary artery disease.

Results
Of all TCM 102 patients, 69 (68%) presented with the typical pattern of apical contraction abnormality. 33 patients (32%) had an atypical pattern: 22 (22%) with the midventricular type, 2 (2%) with the basal type and 9 (9%) with a focal type. There was no difference in sex distribution among the different types of TCM (female: typical 86% vs atypical 85% p=0.83).
Presentation as a ST-elevation ACS was more common in patients with atypical compared to typical TCM (21% vs. 17%; p=0.85), but without statistical significance. Cardiogenic shock (typical 6% vs atypical 3%; p=0.91) as well as intra-hospital death (typical 3% vs atypical 3%; p=0.56) were rare in both types.
A trigger was not more common in patients with typical TCM (58% vs atypical 55%; p=0.91). The trigger was more often physical in typical (73%) and atypical TCM (78%) than psychological, but the distribution did not differ between the two types (p=0.92).
83.6% of the patients showed an impaired LV-EF. Median LV-EF in patients with typical TCM (35% (IQR 25–40)) tended to be lower than in patients with atypical TCM (40% (IQR 25–40); p=0.63; LV-EF ≤30% typical TCM 45% vs. atypical TCM 39%; p=0.75). In 72% (73/102) of the patients the LVEDP was determined. In 75% (55/73) the LVEDP was elevated (>15mmHg). LVEDP tended to be more often elevated in patients with typical TCM (83% vs. atypical 52%; p=0.11).
Extent of coronary artery disease did not differ in the different types of TCM. Coronary stenosis >50% was rare (typical TCM 20% vs atypical TCM 9%; p=0.26), whereas exclusion of coronary artery disease was common in both types (typical TCM 71%; atypical TCM 76%; p=0.79).

Conclusion
While an apical contraction anomaly is the most common type of presentation in TCM, atypical contraction patterns are found in 32% of the patients. Overall, psychological triggers are not found as frequently in TCM as previously described. Patients with typical and atypical TCM do not differ in clinical presentation, LV-EF, LVEDP and extent of coronary artery disease.
P818Incidence of coronary heart disease in patients with familiar hypercholesterolemia compared to age- and sex- matched controls
Authors: Svendsen K , Walaas Krogh H , Igland J , Holven K B , Mundal L , Tell G S , Leren T P , Retterstol K 
Published: October 2019

Abstract

Background
Familial hypercholesterolemia (FH) is caused by mutations leading to high levels of low-density lipoprotein cholesterol (LDL-C) in the blood. The primary aim was to describe mutations in a large sample of individuals with FH, and compare risk of first-time hospitalization for coronary heart disease (CHD) and acute myocardial infarction (AMI) between FH mutation carriers and healthy controls. The secondary aim was to compare risk of death and re-hospitalization among FH mutation carriers and controls with a first event of CHD and AMI.

Methods
This study is a prospective matched cohort study comprising a sample of 5691 persons with FH and 119 511 age- and sex- matched controls randomly selected from the general Norwegian population. Information on CHD and AMI were obtained from Norwegian Patient Registry, the Cardiovascular Disease in Norway project and the Norwegian Cause of Death Registry. Endpoints are defined according to the International Classification of Diseases, version 9 (ICD9) or version 10 (ICD10). Risk among persons with FH will be compared to healthy controls in terms of hazard ratios (HR) from Cox regression with follow-up time calculated from time of FH-diagnosis for the person with FH in each matched set.

Results
In total 51.8% (n=61866) of the combined sample were women with mean age 49.0±20.3 years, whereas 48.2% (n=57645) were men with mean age 46.8±19.6 years. There were 236 different FH mutations registered among the FH mutation carriers. The most frequent mutation was 313+1g>A, that accounted for 20.7% (n=1178) of the total, followed by C210G with 12.1% (n=690). Results for incidence of CHD, AMI, and mortality after CHD and AMI and readmission rates are not yet available but will be presented at the conference.

Acknowledgement/Funding
The study is funded by South-Eastern Norway Regional Health Authority
P824The clinical impact of polyunsaturated fatty acid on clinical outcomes in acute coronary syndrome with dyslipidemia: HIJ-PROPER sub-analysis
Authors: Nakawaza M , Arashi H , Nomura H , Kawada-Watanabe E , Ogiso M , Sekiguchi H , Yamaguchi J , Ogawa H , Hagiwara N 
Published: October 2019

Abstract

Background
Polyunsaturated fatty acids, especially omega-3 and -6 series, are key essential nutrients that play an important role in humans to maintain cell membranes and function. A recent randomized trial reported that adding eicosapentaenoic acid (EPA) to statins was beneficial to cardiovascular disease patients who had a residual risk factor. Further, several studies have reported that the low baseline value for EPA to arachidonic acid (AA) ratio is related to worse clinical outcome and plaque vulnerability in coronary artery disease patients. However, effects of baseline EPA/AA ratio on clinical outcomes in ACS patients have not been thoroughly evaluated.

Objectives
This study aimed to examine the impact of baseline eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio on clinical outcomes of acute coronary syndrome (ACS) patients and how lipid-lowering therapy affects serum EPA/AA levels in these patients.

Methods
This is a sub-analysis of HIJ-PROPER assessing the effect of aggressive low-density lipoprotein cholesterol (LDL-C)-lowering treatment with pitavastatin+ezetimibe in 1,734 ACS patients with dyslipidemia. Patients were divided into two groups based on EPA/AA level on admission (cut-off: 0.34 μg/mL; median of baseline EPA/AA level) and clinical outcomes were examined.

Results
Percent reduction of LDL-C from baseline to follow-up and mean LDL-C level during follow-up were similar regardless of baseline EPA/AA ratio. In the low EPA/AA group, the Kaplan–Meier estimate for the primary endpoint at 3 years was 27.2% in the pitavastatin+ezetimibe group, compared with 36.6% in the pitavastatin-monotherapy group [hazard ratio (HR), 0.69; 95% confidence interval (CI), 0.52–0.93; P=0.015). However, in the high EPA/AA group, there was no significant reduction in the primary endpoint by pitavastatin+ezetimibe therapy (HR, 0.92; 95% CI, 0.70–1.20; P=0.52).

Conclusions
Aggressive lipid-lowering therapy with ezetimibe had a positive effect on clinical outcomes in the low EPA/AA group of ACS patients with dyslipidemia, but not in the high EPA/AA group. This effect was independent of LDL-C reduction and suggests that EPA/AA measurement on admission in ACS patients contributes to a “personalized” lipid-lowering approach.
P828Low-density lipoprotein cholesterol lowering therapy and target level attainment after a recent myocardial infarction - nationwide cohort study
Authors: Allahyari A , Jernberg T , Lautsch D , Lundman P , Hagstrom E , Schubert J , Boggs R , Salomonsson S , Ueda P 
Published: October 2019

Abstract

Background
Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of cardiovascular disease after a myocardial infarction (MI). The European Society of Cardiology (ESC) guidelines recommend lipid lowering therapy to reach LDL-C treatment targets after an MI.

Purpose
To assess LDL-C target level attainment according to the ESC guidelines among patients with a recent MI in Sweden.

Methods
We used data from nationwide registers in Sweden and included patients aged 18–74 years admitted to a hospital with MI (1 January 2013–1 October 2016). Among patients who were alive and had LDL-C data available, we assessed LDL-C target achievement at 6–10 weeks (n=21,505) and 12–14 months (n=17,957) after the MI by category of lipid lowering therapy (no statin; low/moderate-intensity statins; high-intensity statins; any statin plus ezetimibe). The target was defined as an LDL-C of <1.8 mmol/L and a ≥50% reduction from the baseline if LDL-C was 1.8–3.5 mmol/L and the patient was not already receiving statins.

Results
Most patients were treated with high-intensity statin monotherapy (84.2% and 72.0%) or any statin with ezetimibe (2.1% and 10.4%) at 6–10 weeks and 12–14 months after the MI, respectively. In total, 37.7% (6–10 weeks) and 38.3% (12–14 months) had attained their LDL-C target. The proportion of patients attaining their LDL-C target at 6–10 weeks was 12% (no statin), 30% (low/moderate-intensity statins), 39% (high-intensity statins), and 49% (any statin plus ezetimibe). The corresponding numbers at 12–14 months were 16% (no statin), 29% (low/moderate-intensity statins), 39% (high-intensity statins), and 58% (any statin plus ezetimibe). A total of 11.8% at 6–10 weeks and 12.3% at 12–14 months reached an LDL-C level of <1.8 mmol/L, but did not reach their LDL-C target level due to the ≥50% reduction criteria. (Figure 1)
Figure 1

Conclusions
In this large population-based study using nationwide data, more than half of patients with a recent MI did not achieve the ESC guidelines LDL-C target levels, despite a large proportion with high-intensity statin therapy. In patients treated with statins and ezetimibe, four out of ten did not reach the ESC LDL-C target level. Our findings indicate that there may be a need for additional LDL-C lowering therapy if the target level is to be attained in all patients.

Acknowledgement/Funding
This project was supported by funding from Merck Sharp & Dohme.
P832LDL-C levels on statins and cardiovascular event risk in stable coronary artery disease: An observation from the REAL-CAD study
Authors: Toyota T , Morimoto T , Iimuro S , Iwata H , Miyauchi K , Inoue T , Nakagawa Y , Daida H , Ozaki Y , Sakuma I , Furukawa Y , Ohashi Y , Matsuzaki M , Nagai R , Kimura T 
Published: October 2019

Abstract

Background
The relation between very low on-treatment low-density lipoprotein cholesterol (LDL-C) level and the cardiovascular event risk is still unclear in patients receiving the same doses of statins.

Methods
From the REAL-CAD study comparing high-dose with low-dose pitavastatin therapy in Japanese patients with stable coronary artery disease, 11105 patients without reported non-adherence for the study drug were divided into 3 groups according to the on-treatment LDL-C level at 6-month (<70 mg/dL, 70–100 mg/dL, and ≥100 mg/dL; N=1016, N=3078, and N=1665 in the pitavastatin 1 mg/day stratum; N=2431, N=2524, and N=391 in the pitavastatin 4 mg/day stratum). Primary outcome measure was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, or unstable angina requiring emergent admission.

Results
In the pitavastatin 1 mg/day stratum, cumulative 4-year incidence of the primary outcome measure was not significantly different across the 3 groups (5.0%, 5.7%, and 5.2%, P=0.51), while in the 4 mg/day stratum, it was significantly higher in the LDL-C ≥100 mg/dL group than in other groups (4.5%, 3.4%, and 9.1%, P<0.001). The adjusted risks of the LDL-C <70 mg/dL group relative to the LDL-C 70–100 mg/dL group (reference) remained insignificant for the primary outcome measure in both 1 mg/day and 4 mg/day strata (HR 0.84, 95% CI 0.58–1.18, P=0.32, and HR 1.25, 95% CI 0.88–1.79, P=0.22). The adjusted risk of LDL-C ≥100 mg/dL group relative to the reference group was not significant for the primary outcome measure in the 1 mg/day stratum (HR 0.82, 95% CI 0.60–1.11, P=0.21), while it was highly significant in the 4 mg/day stratum (HR 3.32, 95% CI 2.08–5.17, P<0.001). In the on-treatment LDL-C ≥100 mg/dL group in the 4 mg/day stratum, LDL-C increased by 6.3 mg/dL from baseline to 6-month despite dose escalation of pitavastatin from 1 mg/day to 4 mg/day, suggesting the presence of unreported poor adherence in this small subgroup.
Adjusted Effects of On-treatment LDL-C

Conclusions
Very low on-treatment LDL-C level (<70 mg/dL) was not associated with lower cardiovascular event risk compared with moderately low on-treatment LDL-C level (70–100 mg/dL) in patients receiving the same doses of statins. Too much emphasis on the target LDL-C strategy might mislead the clinical practice.

Acknowledgement/Funding
The Comprehensive Support Project for Clinical Research of Lifestyle-Related Disease of the Public Health Research Foundation.