bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3543Rehospitalization burden in heart failure with mid-range ejection fraction and morbidity burden. Is it a distinct phenotype?
Authors: Santas Olmeda E , De La Espriella R , Minana G , Valero E , Palau P , Amiguet M , Gonzalez J , Soler M , Sanchis J , Chorro F J , Nunez J 
Published: October 2019

Abstract

Heart failure with mid-range ejection fraction (HFmrEF) has been recognized as a distinct HF phenotype, but wether patients on this category fare worse, similarly, or better than those with HF with reduced EF (HFrEF) or preserved EF (HFpEF) in terms of rehospitalization risk over time remains unclear. We therefore sought to characterize the mordibity burden of HFmrEF patients by evaluating the risk of recurrent hospitalizations following an admission for acute HF.

Methods
We prospectively included 2,961 consecutive patients discharged for acute HF in our institution from 2004 to 2017. Patients were categorized according to their ejection fraction (EF) obtained by an echocardiography during the index admission: HFmrEF (EF 41–49%), HFrEF (EF≤40%) and HFpEF (EF≥50%). Negative binomial regression method was used to evaluate the association between EF status and recurrent all-cause and HF-related admissions. Risk estimates were expressed as incidence ratio ratios (IRR).

Results
Mean age of the cohort was 73.9±11.1 years, 49% were women, and 46.0% had suffered from previous HF admissions. 472 patients (15.9%) had HFmrEF, 956 (32.3%) had HFrEF, and 1,533 (51.8%) had HFpEF. At a median (interquartile range) follow-up of 2.4 (4.4) years, 1,821 (61.5%) patients died and 6,035 all-cause readmissions were registered in 2,026 patients (68.4%), being 2,163 of them HF-related. Rates of all-cause readmission per 100 patients-years of follow-up were 43.4, 47.1 and 50.1 per HFrEF, HFmrEF and HFpEF categories, respectively. After multivariable adjustment, and compared to patients with HFrEF, HFmrEF status was not associated with a higher risk of all-cause or HF-related recurrent admissions (IRR=1.06; 95% confidence interval (CI), 0.93–1.20; p=0.89), and IRR=1.07; 95% CI, 0.91–1.26; p=0.389, respectively), whereas HFpEF status was associated with a non-significant increase in the risk of all-cause recurrent admissions but a similar risk of HF-related readmissions (IRR=1.10; 95% confidence interval (CI), 0.99–1.22; p=0.06, and IRR=1.01; 95% CI, 0.88–1.16; p=0.900, respectively)

Conclusion
Following an admission for acute HF, patients with HFmrEF have a similar all-cause and HF-related rehospitalization burden when compared to patients with HFrEF, by means of recurrent events analysis.
P3547Real world experience of sacubitril/valsartan: insights on tolerability and outcome from a specialised heart failure clinic
Authors: Neoh K C , Rasoul D , Hunt F , Chong D W S 
Published: October 2019

Abstract

Background
Sacubitril/Valsartan has been shown to improve symptoms and outcomes in patients with heart failure (HF) reduced ejection fraction in a single large randomised controlled trial. However, real-world data on its effect is limited.

Purpose
Our centre operates a dedicated HF clinic for the initiation and titration of Sacubitril/Valsartan in suitable patients. We report on patient tolerability and incidence of adverse effects. We also assessed change in New York Heart Association (NYHA) class and left ventricular ejection fraction (LVEF) post-treatment, as well as HF hospitalisation and mortality at 6 months.

Methods
We conducted a retrospective review of all patients seen in the clinic between January 2016 to January 2019. Patient demographics and pre-initiation treatments were recorded. We compared NYHA class and LVEF category as measured by echocardiography, at initiation and post-titration to the maximum tolerated dose. Data on HF admissions were obtained from electronic hospital records and mortality from a national database.

Results
A total of 179 patients were initiated on Sacubitril/Valsartan and included in the study. Mean age was 71 years (41–90), and 138 (77%) were male. Half of the patient cohort (89) had an ischaemic aetiology. Prior to initiation, all patients were established on an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Almost all were on a beta-blocker (99%) and mineralocorticoid receptor antagonist (98%). 56 patients (31%) had a Cardiac Resynchronisation Therapy (CRT) device and 31 (17%) had an Implantable Cardioverter-Defibrillator (ICD).
Only 4 patients (2%) had to discontinue treatment completely due to an adverse reaction. Among them, 3 patients sustained an acute kidney injury (AKI) while 1 patient had increased breathlessness. 40 patients (22%) reported symptomatic hypotension which required dose reduction. 7 patients (4%) sustained an AKI. 2 patients reported a rash and 1 patient reported nausea.
Figure 1 shows the change in NYHA class after establishment on Sacubitril/Valsartan. Data on change in LVEF post establishment of Sacubitril/Valsartan was available in 124 patients and is shown in figure 2.
A total of 133 patients had completed titration of treatment by July 2018 and included in the analysis of 6-month outcome. 13 patients had one HF hospitalisation and all-cause mortality was 4.5% (6 patients). Only 1 patient had heart failure documented as the primary cause of death.
Change in NYHA class and LVEF

Conclusion
In our cohort of well treated HF patients with reduced ejection fraction, 40% of patients experienced an improvement in NYHA class after establishment on Sacubitril/Valsartan while 35% of patients also experienced a significant improvement in LVEF. Treatment was well tolerated and the discontinuation rate was low when managed in a dedicated HF clinic focused on initiation of Sacubitril/Valsartan.
P3550Changes in intrarenal venous flow and right ventricle-pulmonary circulation coupling from in-hospital admission to discharge in decompensated heart failure patients
Authors: Labate V , Vella A , Carenini G , Losito M , Caracciolo M M , Rovida M , Bandera F , Guazzi M 
Published: October 2019

Abstract

Background
Intrarenal venous blood flow (IRVF) has been used to assess renal haemodynamics in heart failure (HF). In stable euvolemic HF patients, IRVF patterns are correlated with clinical outcomes independently of conventional prognostic factors. No studies are available about the use of IRVF in decompensated HF (DHF).

Purpose
We aimed at establishing the possible clinical use of IRVF and his relationship with right ventricle (RV)-pulmonary circulation (PC) coupling in a cohort of DHF patients admitted at our clinic.

Methods
15 DHF patients (mean age 72.6±9.8 years) with signs and symptoms of volume overload underwent a transthoracic echocardiography followed by renal ultrasonography and routine laboratory tests at admission and at pre-discharge (in stable euvolemic state after diuretic treatment). The IRVF was evaluated by Venous Impedance Index (VII).

Results
At discharge after depletive treatment resulted in clinical decongestion, we observed a reduction of VII (from 0.74±0.28 to 0.42±0.40; p=0.016) associated with reduction of pulmonary pressures and better RV to PC coupling (TAPSE/PASP ratio from 0.33±0.18 to 0.46±0.15; p=0.031). No significant differences in resistive index (RI), LVEF and renal function laboratory tests were detected. Results are shown in Table 1.
Patients characteristics Admission Discharge p Value VII 0.74±0.28 0.42±0.40 0.02 LVEF (%) 43.7±17.5 42.7±16.3 0.87 TAPSE (mm) 14.9±4.1 17.1±3.6 0.14 PASP (mmHg) 51.9±15.2 39.4±11.6 0.02 TAPSE/PASP (mm/mmHg) 0.33±0.18 0.46±0.15 0.03 RI 0.8±0.1 0.7±0.1 0.11 Creatinine (mg/dL) 1.1±0.3 1.1±0.3 0.74 eGRF (mL/min/1.73 mq) 68.2±17.7 67.1±21 0.89 NT-proBNP (ng/L) 5663±5805.4 2047.2±2090.5 0.05 LVEF = left ventricular ejection fraction; BNP = natriuretic peptide; PASP = Syst art pulm press; RI = resistance index; TAPSE = tricuspid annular plane systolic excursion.

Conclusions
VII is a new non-invasive index that could identify renal hemodynamics alterations in HF patients. A high VII may be indicative of a congestive cardio renal syndrome in which an aggressive diuretic strategy can be set up with greater scientific evidence and the possibility of instrumental monitoring of its efficacy. Moreover, the development of drugs aimed at the improvement of the RV to PC coupling could lead to a better outcome in HF.
P3564Percutaneous intervention with stent improves blood pressure and renal function in patients with transplanted renal artery stenosis
Authors: Galhardo A , Kanhouche G , Feitosa G R S , Campos H O , Faccinetto A C B , Barteczko M L M , Cirenza C , Tedesco H , De Paola A , Medina J P , Barbosa A H P 
Published: October 2019

Abstract

Background
Transplanted renal artery stenosis (TRAS) is the main vascular complication of patients undergoing kidney transplantat, with a reported incidence ranging from 1% to 23%. Clinically important TRAS is associated with refractory hypertension, graft dysfunction and increased peak systolic velocity (PSV) above 200 cm/s. Percutaneous intervention (PI) of TRAS with or without stent is widely accepted as a viable and safe treatment option.

Purpose
To evaluate blood pressure and renal function in patients with TRAS undergoing PI in the following year.

Methods
Between January 2007 and December 2014, 310 patients with suspected TRAS underwent consecutive angiography. Of these, 173 presented significant stenosis (>60%) and were submitted to PI. Endpoints were systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine (Scr), number of blood pressure medications and PSV with one month and one year post intervention.

Results
The mean age was 42.89±15.03 years, 78% of the population were male, 84% received kidneys from decesed donors, 94% having received a stent. The angiographic success and complication rates were 98% and 8,4% respectively. 98.7% were on blood pressure medications with 2.13±1.05 drugs/patient. Pre-intervention values of SBP, DBP and Scr were 152.8±25.28 mmHg, 92.67±16.43 mmHg and 3.04±2.75 mg/dL, respectively. After 1 month, there was a significant reduction in SBP (138.34±19.71; p<0.0001), DBP (82.52±12.2; p<0.0001) and Scr (2.13±1.39 mg/dl, p<0.0001). Following 01 year, SBP, DBP and Scr were 133.55±17.51, p<0.0001; 83.51±11.23, p<0.0001 (Figure); and Scr 1.94±1.09 mg/dL, p<0.0001 respectively. There was a significant reduction in post-intervention PSV when compared to baseline results (422.2±148.8 vs. 237.1±104.6 m/s, p<0.0001). There was no significant difference in the number of blood pressure medications pre and post intervention (2.13 vs 2.05; p=0.68).
Evolution of Blood Pressure

Conclusion
PI with stent of TRAS was effective in improving blood pressure and renal function levels on month 1 and on year 1 with a low rate of complications.
P3574Association of the plasma aldosterone, arterial stiffness and left atrium volume index in hypertensive patients
Authors: Shavarova E , Kravtsova O A , Chomova I A , Kobalava Z D 
Published: October 2019

Abstract

Relative aldosterone excess is related with arterial stiffness, endothelial dysfunction and profibrotic effects on the heart. We aimed to evaluate the association of plasma aldosterone and pulse wave velocity (PWV) with left ventricular (LV) diastolic function in patients with uncomplicated arterial hypertension (AH).

Methods
The study included 74 patients (41% male), mean age 62.0±8.2 years. Among these patients 22 (30%) had diabetes mellitus, 60 (81%) had dyslipidemia, 8 (11%) were smokers. All patients undergone clinical and laboratory evaluation, echocardiography and applanation tonometry. Plasma aldosterone concentration (PAC) was measured by using overnight fasting blood sampling between 7 am and 9 am.

Results
Mean PWV was 11.3±2.4 m/s, heart rate (H) was 72±10 bpm, aortic systolic BP was 160±21 mm Hg, aortic diastolic BP was 89±10 mm Hg, aortic pulse pressure was 60±19 mm Hg, augmentation index normalized for HR of 75 beats/min (AIx75) was 15±10%, LVMI was 124±33 g/m2, LAVI was 36±6 ml/m2, E/e' was 10.8±4.6. In simple analysis PAC significantly (p<0.05) correlated with brachial (r=0.29) and aortic diastolic BP (r=0.27), LAVI (r=0.32), E/e' (r=−0.41). After adjustment in multivariate regression model gender, waist circumference, creatinine, AIx, LV global longitudinal strain relationship between E/e' and PAC was lost. E/e' was significantly associated only with female gender (β=0.64, p=0.0008). Also multivariate regression analysis showed significant association of LAVI with brachial systolic BP (β=0.41, p<0.0001), PWV (β=0.94, p<0.0001), and PAC (β=0.75, p<0.0001).

Conclusion
Brachial systolic BP, PWV and PAC were independently associated with LAVI in patients with uncomplicated AH and herewith LAVI was more dominantly influenced by increased arterial stiffness and plasma aldosterone.
P3590Impact of right ventricular branch slow flow phenomenon post percutaneous coronary intervention for acute coronary syndrome to predict sustained right ventricular dysfunction
Authors: Setoyama K , Inoue K , Miura T , Shimizu A , Anai R , Sanuki Y , Tsuda Y , Araki M , Sonoda S , Otsuji Y 
Published: October 2019

Abstract

Background
Although Right Ventricular dysfunction (RVD) is one of the predictor of poor prognosis, it is believed that ischemic RVD after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) restores quickly. Because right ventricular perfusion has more ischemic preconditioning compared with left ventricle, due to their complex perfusion system. However, little is known about the time courses of RVD after ACS-PCI andtheir prognosis. We evaluated the relationship between right ventricular branch slow flow phenomenon (RVB-SF) post ACS-PCI in right coronary artery (RCA) and RVD at 6–8 months follow-up.

Method
We retrospectively analyzed consecutive 82 patients who underwent PCI for ACS in proximal or mid portion of RCA from August 2011 to March 2018 in our institution. Finally, both baseline and follow-up data were obtained from 70 patients. We analyzed TIMI frame count (TFC) to confirm the presence of RVB-SF (TFC ≥40 frame) after PCI. We also analyzed right ventricular fractional area change (RVFAC) at baseline and follow-up using echocardiography to detect sustained RVD (RVFAC ≤35%).

Result
We divided the patients into two groups (RVB-SF: 36 patients, RVB non-SF: 34 patients). Patient clinical characteristics were similar in both groups (sex, age, risk factors, medication, onset to balloon time, left ventricular stroke volume, max creatine kinase). Baseline RVFAC and follow-up RVFAC was significantly smaller in RVB-SF than in RVB non-SF, respectively. (27.1±1.7% vs. 38.3±1.8%, 31.4±1.0% vs. 48.7±1.1%, P<0.0001). However, ΔRVFAC (follow-up RVFAC – baseline RVFAC) was similar between groups. The size of inferior vena cava and systolic pulmonary artery pressure at follow-up were similar in both groups (12.1±0.6 mm vs. 11.7±0.7 mm, P=0.67, 25.7±1.5 mmHg vs. 25.2±1.5 mmHg, P=0.82). In RVB non-SF, 10 patients (29.4%) were diagnosed clinical RVAMI. However, follow-up RVFAC were similar and preserved in both groups (RVAMI: 48.1±1.3%, non-RVAMI: 49.9±1.9%, P=0.85). In RVB-SF, 19 patients (52.7%) were diagnosed clinical RVAMI. Follow-up RVFAC did not improved significantly in both groups (RVAMI: 30.4±1.4% vs. non-RVAMI: 32.6±1.5%, P=0.70). Multivariate analysis showed RVB-SF was the only independent predictor of sustained RVD at 6–8 months follow-up after ACS-PCI.

Conclusion
RVB-SF findings after ACS-PCI for RCA could predict sustained RVD at mid-term follow-up, which may indicate future prolonged RVD.
P3593Improving the performance of high-sensitivity cardiac troponin for the diagnosis of myocardial infarction
Authors: Anand A , Shah A S V , Strachan F E , Lee K K , Chapman A R , Bularga A , Stewart S , Ferry A , Marshall L , Newby D E , Mills N L 
Published: October 2019

Abstract

Background
The Universal Definition of Myocardial Infarction (UDMI) mandates a rise and/or fall in high-sensitivity cardiac troponin (hs-cTn) concentration with at least one measure above the 99th centile of a healthy reference population. However, the 99th centile varies by age, sex, and prevalence of comorbid disease within reference populations, and the application of a single threshold may create diagnostic uncertainty in unselected patients attending the Emergency Department.

Purpose
To compare performance of hs-cTnI at the 99th centile with a model that includes additional clinical variables, for the diagnosis of type 1 myocardial infarction.

Methods
The High-Sensitivity Troponin in the Evaluation of patients with Acute Coronary Syndrome (High-STEACS trial) was a stepped wedge cluster randomised controlled trial of 48,282 consecutive patients across 10 hospitals in Scotland. We evaluated the positive predictive value (PPV) of a hs-cTnI >99th centile for a diagnosis of type 1 myocardial infarction. Patients with ST-segment elevation myocardial infarction (STEMI) were excluded, and all were adjudicated according to the 4th UDMI. The study population was randomly divided into derivation (80%) and internal validation (20%) cohorts. Using generalised additive modelling, we tested the effect of adding clinically relevant variables to hs-cTnI for the prediction of type 1 myocardial infarction in the derivation cohort, and assessed performance of the final model in the validation cohort.

Results
We included 47,101 consecutive patients (61±17 years, 47% female), of whom 9,057 (19%) had at least one hs-cTnI >99th centile (7,207 in derivation and 1,850 in validation cohorts). There were 4,087 (45%) patients with type 1 myocardial infarction, with 3239 (45%) and 848 (46%) in the derivation and validation cohorts, respectively. Across the study population, PPV for type 1 myocardial infarction reduced markedly with increasing age (Figure). Age, sex, chest pain, ischaemia on the electrocardiogram, creatinine and rate of change of hs-cTnI were included in the model. Comorbidities (ischaemic heart disease, diabetes, stroke and hyperlipidaemia) did not improve model performance. In the validation cohort, the area under the curve (AUC) for type 1 myocardial infarction using the 99th centile alone was 0.72 (95% CI 0.70–0.74), whereas the AUC for the optimised model was 0.84 (95% CI 0.82–0.85) (p<0.001 by DeLong's test for difference, see Figure).
Figure 1

Conclusion
The diagnostic performance of the 99th centile for type 1 myocardial infarction is poor, particularly in older populations. A simple model including readily available clinical features improves diagnostic performance and with further external validation could support more individualised treatment decisions.

Acknowledgement/Funding
British Heart Foundation
P3601Association of cdkn2b rs2891168 polymorphism with wall motion index score and the development of major adverse cardiovascular events within one year following ST elevation myocardial infarction
Authors: Magamedkerimova F A , Magamedkerimova F A , Ivantsov E N , Khasanov N R , Valeeva E V , Ibrahim M 
Published: October 2019

Abstract

Introduction
According to the GRACE registry the largest amount of deaths occurs in the first year after ST elevation myocardial infarction (STEMI).

Purpose
To investigate the incidence of Major Adverse Cardiovascular Events (MACE), which include cardiovascular death, nonfatal myocardial infarction, nonfatal stroke one year after STEMI and Wall Motion Index Score (WMSI) in patients with different genotypes A/G of rs2891116 polymorphism in CDKN2B gene.

Materials and methods
A total of 141 patients, diagnosed with STEMI based on the Third Universal Definition of Myocardial Infarction (ESC, 2013) were included in the study, composed of 52 females and 89 males. The study group mean age was 63.8±11.8 years. Informed consent was obtained. During hospitalization echocardiography was performed and a blood sample was taken for genetic testing. Over the one-year period MACE were recorded. 17 patients were lost to follow up. Data was analysed using Kaplan-Meier estimator; to compare differences between groups log-rank test was applied; continuous data analysis was performed by Mann-Whitney test. The measured genotype frequencies fit the Hardy-Weinberg equilibrium (p>0.05).

Results
Kaplan-Meier survival analysis revealed that in patients with AA genotype the proportion of individuals who experienced MACE over the one year period after STEMI was higher in comparison with AG genotype carriers (log rank p=0.022). Participants with GG genotype did not show significant differences compared to other genotypes carriers (Picture 1). WMSI value in patients with AA genotype was higher (Me = 1.25; Q(0.25) = 1.13; Q(0.75) = 1.56) than in AG genotype carriers (Me = 1.13; Q(0.25) = 1.13; Q(0.75) = 1.25; p=0.037). In participants with GG genotype compared to AA and AG the WMSI value was not significantly different (Me = 1.19; Q(0.25) = 1.13; Q(0.75) = 1.32).
Picture 1

Conclusions
Genotype AA in CDKN2B gene rs2891168 in patients after STEMI is associated with higher probability of the development of MACE over the one year period after the index event, compared to AG genotype carriers. Participants with AA genotype exhibited a higher WMSI value after STEMI compared to patients with AG genotype.
P3611The effect of concomitant AF on in-hospital clinical outcomes of NSTE-ACS related hospitalizations in the United States: an analysis of rates, trends and predictors from 2004 to 2014
Authors: Mohamed M O , Kirchhof P , Vidovich M , Savage M , Rashid M , Kwok C S , Thomas M , El Omar O , Al Ayoubi F , Fischman D , Mamas M A 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia in patients presenting with acute coronary syndrome (ACS).

Purpose
We sought to examine the rates, trends, and clinical outcomes of non-ST Elevation acute coronary syndrome (NSTE-ACS) related hospitalisations in the United States in patients with AF compared to those with sinus rhythm (SR).

Methods
We analysed the Nationwide Inpatient Sample (NIS) database from 2004 to 2014 for patients with a primary discharge diagnosis of NSTEMI or UA, and further stratified the cohort on the basis of diagnoses into SR and AF groups. Multivariate analysis was performed to identify the association between AF and MACCE (composite of mortality, stroke and cardiac complications), mortality, stroke, and bleeding.

Results
A total of 4,668,737 NSTE-ACS admissions were included in our analysis. The proportions of SR and AF groups were 82.4% (3,848,202) and 17.6% (820,535), respectively. The incidence of AF increased significantly over time from 16.5% in 2004 to 19.3% in 2014 (p<0.001). The AF group was at a greater risk of adverse outcomes with higher overall rates and adjusted relative risk of MACCE (12.9% vs. 5.3%; RR: 1.74 [1.72, 1.75]), mortality (6.5% vs. 3.3%. RR: 1.12 [1.11, 1.13]), stroke (2.7% vs. 1.5%; RR: 1.32 [1.30, 1.34]) and bleeding (14.7% vs. 8.8%; RR: 1.42 [1.41, 1.43]). The AF group was less likely to receive coronary angiography (47.1% vs. 58%) and PCI (18.7% vs. 32.6%) and more likely to undergo CABG (13.9% vs. 7.6%) in comparison to SR.
Figure 1. Crude rates of adverse events

Conclusion
The prevalence of concomitant Atrial Fibrillation amongst patients presenting with NSTE-ACS has increased over a decade. However, this high-risk group remains less likely to receive invasive coronary management for NSTE-ACS than patients with sinus rhythm, independent of their comorbidities, and are associated with worse clinical outcomes.