bluuebunny/crossref_metadata_2025_split huggingface dataset:
P604Clinical feasibility assessment of a novel Quantitative Multi-contrast Atherosclerosis Characterization (qMATCH) sequence for carotid plaque quantification
Authors: Cho I , Jung M S , Jung H G , Xie Y , Wang N , Kim W D , Li D , Chang H J 
Published: October 2019

Abstract

Background
Conventional protocol contrast MRI (cMRI) for evaluating carotid artery atherosclerosis is clinically under-utilized due to complex scanning procedures and long scan time. Recently, the Quantitative Multi-contrast Atherosclerosis Characterization (qMATCH) has been proposed, which allows comprehensive and quantitative assessment of atherosclerosis including MRA, dark-blood vessel wall morphology, and T1/T2 mapping with an 8-minute single scan (Figure1). However, the diagnostic accuracy and feasibility of qMATCH has not been validated in clinical circumstances.

Purpose
To evaluate the diagnostic accuracy of quantitative plaque analysis of qMATCH compared with cMRI

Method
We prospectively enrolled 43 patients who have carotid plaques diagnosed by carotid ultrasound. cMRI was performed along with qMATCH scan. All imaging data were acquired with a clinical 3T scanner using a 64-channel head & neck coil. In the current analysis, we evaluated the diagnostic accuracy of qMATCH in the quantitative assessment of carotid plaque. Plaque area measurements using dark-blood wall images with qMATCH were compared with corresponding cross-sectional T1/T2-weighted images with cMRI as references values (Figure 2). These inter-technique comparisons included linear regression with Pearson correlation and Bland-Altman analyses to assess the mean inter-technique differences (biases) and limits of agreements.

Result
Among 90 segments, mean plaque areas measured by cMRI and qMATCH were 43.83±21.21 mm2 and 42.47±19.23mm2, respectively (mean differences, −1.36±8.12mm2; p for a paired t-test, 0.073). Correlation coefficient showed excellent correlation between plaque areas measured by cMRI and qMATCH (r=0.943, p<0.001) (Figure 3). Bland-Altman plot showed excellent agreement in plaque areas between the two methods (Figure 4).

Conclusion
Quantitative carotid plaque burden analysis by a novel sequence with qMATCH is feasible and accurate compared with conventional MRI. Given that qMATCH can reduce scan time and allow quantitative relaxometry mapping, fast and accurate carotid plaque analysis would be feasible. Further studies to evaluate the accuracy of qualitative plaque analysis should be performed to confirm the “all-in-one” assessment of carotid atherosclerosis using qMATCH.
P613Cardiac magnetic resonance imaging derived left ventricular mechanical function in patients with atrial fibrillation and left atrial low voltage zones
Authors: Ulbrich S , Schoenbauer R S , Kirstein B , Tomala J , Huo Y , Mayer J , Richter U , Piorkowski J , Gaspar T , Mascherbauer J , Piorkowski C 
Published: October 2019

Abstract

Background
The relation of left atrial low voltage zones (LVZ) to left ventricular function in patients undergoing pulmonary vein isolation (PVI) is not known.

Objective
To explore the relationship of left atrial low voltage zones (LVZ) on left ventricular function in patients with atrial fibrillation.

Methods
From June to Nov. 2018, 107 (mean age 67y, 70 men, 73 persistent AF) consecutive patients with symptomatic AF underwent a PVI with LVZ mapping. Before PVI the left ventricular ejection fraction (EF) and stroke volume (SV) were measured by cardiac magnetic resonance imaging (CMR). From feature-tracking of CMR-cine images left ventricular global, systolic and diastolic longitudinal strains (GLS), circumferential strains (GCS) and radial strains (GRS) were calculated.

Results
Of 59 patients CMR scanning in sinus rhythm was performed, LVZ were present in 24 patients.
LVEF was significantly lower in patients with left atrial LVZ (62±9% vs. 55±15%) (p=0,03). Left ventricular stroke volume was significantly decreased by the extent of LVZ (94±23 vs. 72±21ml), (p=0,03).
The left ventricular diastolic strains during ventricular filling (caused by atrial contraction) of GLS (r=−0,52), GCS (r=−0,65) and GRS (r=−0,65) were highly signifcantly correlated to the occurence and extent of LVZ (each p<0,001 respectively).
The only systolic ventricular strain was GLS, which decreased (r=−0,3, p=0,03) by the occurance of atrial low voltage.

Conclusion
The active, atrial part of diastolic left ventricular filling properties is impaired by the occurrence and extent of left atrial LVZ. In patients with left atrial LVZ the left ventricular stroke volume and ejection fraction is decreased already in sinus rhythm. It seems possible that atrial mechanical dysfunction and presence of atrial low voltage maybe predicted by LV diastolic strain analysis.
P632Long-term benefits of cardiac rehabilitation in patients with diabetes mellitus after percutaneous coronary intervention
Authors: Romero Reyes M J , Rodriguez Delgado R , Esteve Ruiz I , Otte Alba C , Mora Pardo J A , Molano Casimiro F J 
Published: October 2019

Abstract

Introduction
After percutaneous coronary intervention (PCI), patients with diabetes have a worse prognosis than non-diabetics and are at increased risk of recurrent cardiovascular events, hospitalization and higher mortality.

Purpose
The aim of our study was to evaluate the impact of cardiac rehabilitation (CR) in this high-risk group of patients.

Methods
We performed a retrospective cohort study of 318 consecutive patients with type 2 diabetes mellitus (DM2) who underwent PCI in our hospital between 2004 and 2011. We classified the patients in two cohorts according to their participation (n=154) or not (n=164) in a CR programme. We collected the events ocurring during a median follow-up of 9 years.

Results
Using multivariate logistic regression, we found that CR participation was associated with significantly reduced all-cause mortality (53% vs 23%, OR 2.10; IC 95%; 1.16–3.82; p 0.014) and cardiac mortality (3.9% vs 23.8%, OR 8.69; IC95% 2.80–26.99; p<0.0005). CR aslo associated with a singnificant decrease in a heart failure hospitalization (26.6% vs 10.6%, OR 2.4; IC 95% 1.06–5.52; p<0.035). No significant differences were observed in non fatal myocardial infarction, stent restenosis and non fatal stroke.
Basal characteristics Rehabilitation (n=153) No Rehabilitation (n=164) P vaule Male sex 138 (86.4%) 100 (61.0%) <0.0005 Age (years) 59 (38–74) 65 (47–74) <0.0005 Hypertension 113 (73.9%) 111 (67.7%) NS Hypercholesterolemia 112 (73.7%) 115 (70.1%) NS HbA1c ≥7% 88 (66.2%) 73 (64.6%) NS Prior myocardial infarction 24 (15.6%) 32 (19.5%) NS Chronic kidney disease 6 (3.9%) 19 (11.6%) 0.012 FEVI <50% 30 (20%) 39 (25%) NS Three vessel disease 53 (34.4%) 58 (35.4%) NS Incomplete revascularization 80 (51.9%) 81 (49.4%) NS Drug-eluting stent 110 (78.6%) 127 (80.4%) NS Stent length 22.4±11.9 24.6±14.8 NS Stent diameter 2.7±0.3 2.8±0.4 NS

Conclusion
CR participation after PCI is associated with lower all-cause mortality, cardiac mortality and heart failure hospitalization rates in patients with DM2 during long-term follow-up.
P647An audit of possible familial hypercholesterolaemia in general practice
Authors: Gallagher J , McGuckin M , Behan D , Harrington P 
Published: October 2019

Abstract

Background
Familial hypercholesterolaemia (FH) is an autosomal dominant condition associated with elevated total cholesterol and low-density lipoprotein (LDL). It confers an increased risk of premature cardiovascular disease and associated mortality. It is estimated that the majority of patients with FH in Ireland are undiagnosed and structured care programmes are not available.

Purpose
To undertake an audit of those patients in a general practice with possible FH

Methods
A retrospective audit was carried out on the patients attending a GP practice. Inclusion criteria for the study were as follows:
LDL level >4.9mmol/L
Triglyceride level (<2mmol/L)
Data was collected from the patients' clinical notes and patients were interviewed to acquire additional details not available in the clinical notes where possible. A Dutch Lipid Clinic Network Score (DLCNS) was calculated for each patient.

Results
Of 5,438 patients with a LDL recorded 284 patients fulfilled the inclusion criteria. 52.4% were female. Mean age 60 years old (range: 19–95 years). The highest LDL level recorded for these patients ranged from 5.0 - 8.6 mmol/L, with a mean value of 5.4 mmol/L. The mean most recent LDL level was 3.6mmol/L (range: 1.0–6.3 mmol/L). 42 patients (14.8%) had a family history of premature coronary and/or vascular disease in line with DLCNS criteria. 9 patients (3.2%) had a personal history of premature cardiovascular disease. The DLCNS was calculated for each patient based on the information available. 225 patients (79.2%) had a score of 3, 36 patients (12.7%) had a score of 4, 12 patients (4.2%) had a score of 5 and 6 patients (2.1%) had a score of 6. This equates to 273 patients (96.1%) with a possible diagnosis of FH, and 6 patients (2.1%) with a probable diagnosis of FH. The mean most recent systolic blood pressure reading for these patients was 128mmHg, and diastolic 76mmHg. 51 patients (18%) were current smokers, 83 (29.2%) were ex-smokers, and 111 (39%) had never smoked. Smoking status was unknown for 38 patients (13.4). 128 patients (45%) were on lipid-lowering treatment at the time of this audit. 60 (21.1%) were on high intensity treatment, 68 (23.9%) were on medium intensity treatment and none were on low intensity treatment. 24.3% of patients were at target LDL. There were 5 patients (1.8%) currently receiving ezetimibe and 1 (0.4%) on fenofibrate.

Conclusion
A significant number of patients had a LDL >5mmol/l in this audit. Only 45% were on lipid lowering treatment and 24.3% were at a target LDL. This highlights the needs for structured programmes for screening and management of FH in primary care.

Acknowledgement/Funding
Funded by an unrestricted grant from Amgen
P648Screening and treatment of familial hypercholesterolemia in a French sample of ambulatory care: a retrospective longitudinal cohort study
Authors: Ferrieres J , Banks V , Pillas D , Ricci L , Dova-Boivin M , Vannak J V , Desamericq G 
Published: October 2019

Abstract

Background
Familial hypercholesterolemia (FH) is largely underdiagnosed as there are typically no clinical symptoms prior to the first cardiovascular (CV) event. We conducted a study which utilised ambulatory care electronic medical record (EMRs) to alert physicians to possible cases of FH. Specifically, physicians were alerted to LDL-C levels >190 mg/dL (suggesting a risk of FH) and invited to complete the Dutch Lipid Clinic Network score (DLCN).

Purpose
Describe characteristics, comorbidities and clinical management of patients diagnosed with definite or probable FH in an ambulatory care setting.

Methods
All patients with a DLCN score of definite/probable FH (score higher or equal than 6; index event) between January 2016 and September 2018 were identified in the THIN® database (The Health Improvement Network; an anonymized EMR powered by GERSDATA, a Cegedim Health Data Division). These fully anonymized data were collected by 2000 General Practitioners (GP), 130 cardiologists and 40 endocrinologists, receiving 5.5 million patients regularly in their office. Sociodemographic, laboratory measurements, comorbidities, lipid-lowering therapies (LLT), visits to specialists, LDL-C and hospitalizations were collected and analysed at baseline, and 1, 2, 3, 6 months, and 1 year thereafter.

Results
From 999 anonymous patients with a DLCN score, 98 (10%) FH patients were identified (38 [39%] definite FH, 60 [61%] probable FH) while remaining fully anonymous, 9 (9%) of whom already had genetic testing. Mean (SD) age was 57.4 (14.3) years; 56 (57%) patients were female, half (51/98 [52%]) were diagnosed with pure hypercholesterolemia (ICD-10 code: E78.0) and 9 (9%) had a personal history of CV event. 93 patients (95%) had a LDL-C measurement prior to DLCN assessment (definite FH, 36/38 [95%]; probable FH, 57/60 [95%]). Among screened FH patients, 61.2% had LDL-C between 190 to 250 mg/dL and 16.3% had LDL-C higher than 250 mg/dL. At the time of DLCN assessment, one third (30/98 [31%]) of patients were not receiving any LLT, one third ([35%] 34/98) were receiving statins alone, 19% (19/98) receiving LLT combination with statin, and 15% (15) other LLTs. Moderate statin intensity was prescribed in 20% (20/98) of patients; high intensity statin, 17%, (17/98); low intensity, 10% (10/98). No improvement on LLT use (including use of high statin intensity) was observed over the 12-month follow-up.

Conclusion
This is the first study in France that use EMR to screen possible FH patients and support GPs in identifying patients that need to be treated. Our data highlight the need to screen, diagnosis and treat potential FH patients in ambulatory care settings. Longer follow-up is needed to evaluate the impact of FH assessment on referral to specialists, LLT and clinical outcomes.

Acknowledgement/Funding
Amgen
P658CHA2DS2-VASc score calibration in anticoagulated vs non-anticoagulated patients in a healthcare area
Authors: Baluja A , Lopez-Canoa N , Rodriguez-Manero M , Lopez-Pardo E , Agra-Bermejo R , Cordero-Fort A , Garcia-Seara J , Fernandez-Lopez X A , Varela-Roman A , Gonzalez-Melchor L , Alvarez-Escudero J , Martinez-Sande J L , Gonzalez-Juanatey J R 
Published: October 2019

Abstract

Introduction
Atrial fibrillation (AF) is a highly prevalent heart disease, affecting a significant proportion of patients over 65 years old. The CHA2DS2-VASc score predicts 1 year risk of a thromboembolic (TE) event and is well validated against several populations. However, calibration may vary if there is subgroup heterogeneity.

Purpose
To compare the CHA2DS2-VASc score calibration, in patients with or without anticoagulation (AC) in a real population of AF patients in our healthcare area.

Methods
Patients with an episode with atrial fibrillation/flutter were selected from a general population in a healthcare area (383,000 subjects), with 21/12/2013 as a cut-off date. Patients with valve disease, anticoagulation or antiplatelet therapy were identified.
The CHA2DS2-VASc score was calculated as stipulated in the European Society of Cardiology guidelines. A CHA2DS2-VASc score of 0 is considered to be low risk for TE events (0% at 1 year), score of 1 intermediate risk (0.6% rate at 1 year), and greater than 1 high risk (3% rate at 1 year).
Quantitative variables are presented as mean and standard deviation (SD). Categorical variables were presented as frequencies and percentages. A logistic regression was fitted to predict 1-year risk TE outcomes with CHA2DS2-VASc as the only covariate. Model calibration was assessed using the predicted versus actual probabilities of TE events. All analyses were performed using R v.3.4 (R Core Team, Vienna, Austria) with the packages rms and ggplot2.

Results
CHA2DS2-VASc was calculated in 7990 patients with AF. A total of 1824 patients were excluded either due to valvular disease (846) or due to previous antiplatelet treatment (1047). From them, 143 patients were excluded for an incomplete follow-up time (<1 year).
As of December 31, 2015, 67 stroke cases had been notified from 6023 patients (1.1%) (Table 1). Mortality rate was 181 (3%) at 1 year.
Patients presented overall low risks of stroke with a poor score calibration. Higher scores presented risks that were lower than predicted by CHA2DS2-VASc. Event rate at 1 year was similar regardless of the AC regime at the initial date, and also similar to a previous cohort of anticoagulated patients (Lip et al.). This similarity may indicate confounding by later AC therapy initiation, before the final assessment date.
Table 1. Comparison of thromboembolic event rates in several studies % (No-AC) % (AC) % Lip 2010 % Poli 2011 % Friberg 2012 % Okumura 2014 0.01 0.01 0.02 4.5 4.5 1 AC: anticoagulation.
CHA2DS2VASc score calibration

Conclusion
Higher CHA2DS2-VASc scores are not associated to higher risks of stroke in our healthcare area, in patients with non-valvular AF and without antiplatelet therapy.
P687Is sacubitril/valsartan useful in patients with cancer and heart failure? Data from HF-COH Spanish multicenter registry
Authors: Martin Garcia A , Mitroi C , Chaparro M , Moliner P , Martinez-Monzonis A , Martin-Garcia A C , Asla C , Castro A , Gual-Capllonch F , Marco I , Sanchez-Pablo C , Antunez Ballesteros M , Lopez Sendon J L , Sanchez P L , Lopez-Fernandez T 
Published: October 2019

Abstract

Current guidelines recommend sacubitril/valsartan (S/V) for patients (p.) with heart failure and reduced left ventricular ejection fraction (LVEF) but there is lack of evidence of its efficacy and safety in p. with cancer and heart failure. Our aim was to analyze the potential benefit of S/V in specific cardio-oncology clinics.

Methods
We performed a retrospective multicenter registry (HF-COH) in six Spanish hospitals with cardio-oncology clinics including all p. treated with S/V. Clinical and echocardiographic data, NYHA functional class, type of neoplasms and anti-tumoral treatment were described. Median follow-up was 7.2 [7.9] months.

Results
Sixty-one p. were included (median age was 64 [21] years old; 64%women, 43% hypertensive, 54% dyslipidemics and 28% diabetics). Most of p. (97%) had cancer therapy related cardiac dysfunction (CTRD) with a median time from anti-cancer therapy to CTRD of 40 [132] months. Breast (46%) and hematological (38%) cancers were the most frequent neoplasms, 31% of p. had metastatic disease and 71% had been treated with anthracyclines. In 5% S/V was initiated at CTRCD diagnosis while in 95% S/V was started to improve clinical status in p. already treated with ACE inhibitors or ARBs. 87% were on beta-blocker therapy and 74% on mineralocorticoid receptor antagonists.Maximal S/V titration dose was achieved in 8.2% of p. (24/26mg: 43%; 49/51mg: 33%) S/V was discontinued in 4 p. (reasons: 2 hypotension; 1: renal failure; 1: pruritus)
Baseline NT-proBNP levels, functional class, and LVEF improved at the end of follow-up in p. who continued with S/V (all p values ≤0.01). No statistical differences were found in creatinine clearance or potassium serum levels. Table
Patient parameters before and after S/V Before S/V After S/V P value LVEF (%) 33 [7] 39.5 [15] <0.001 Creatinine (mg/dl) 0.9 [0.4] 0.9 [0.5] 0.15 Creatinine clearance (ml/min) 73 [30] 75 [37] 0.22 Potassium serum levels (mg/dl) 4.5 [0.5] 4.5 [0.6] 0.42 Systolic arterial pressure (mmHg) 116 [23] 112 [27] 0.025 Diastolic arterial pressure (mmHg) 70 [13] 68 [10] 0.498 NT-proBNP (pg/ml) 1831 [3132] 842 [1919] 0.007 NYHA 2.2±0.6 1.6±0.62 <0.001 Values are median [interquartile range] or mean ± standard derivation; S/V: sacubitril-valsartan; LVEF: left ventricle ejection fraction.

Conclusions
Our experience suggests that S/V is well tolerated and improves functional class and left ventricular function parameters in patients with CTRCD.
P701The role of a phosphoinositide-3 kinase inhibitor in vascular inflammation
Authors: Chaudhry H , Cerutti C , Kodji X , Argunhan F , Ridley A , Brain S D 
Published: October 2019

Abstract

Background/Introduction
Cardiovascular inflammation is associated with endothelial damage, resulting in leukocyte trafficking and oedema formation, which results in a positive-feedback loop of inflammatory events.

Purpose
The phosphoinositide 3-kinase (PI3K) pathway has been shown to be upregulated in vascular disease conditions whereby its inhibitors potentially have beneficial effects. Hence this study was designed to examine the actions of PI-103, a PI3K non-selective inhibitor, on inflammatory responses.

Methods
Permeability assays were undertaken to quantify the effect of TNF-a in the presence and absence of PI-103 using FITC-dextran (40 kDa, 0.1 mg/ml) to measure levels of permeability in trans-wells plates using human microvascular endothelial cells (HMVEC).
In vivo analysis was carried out per the UK Home Office Animals (Scientific Procedures) Act 1986. CD1 mice were anaesthetised, to test PI-103 in a zymosan-induced model of dorsal skin inflammation on neutrophil accumulation (measured by myeloperoxidase) and oedema formation (measured by Evans Blue accumulation).
All data were analysed using 1-way or 2-way ANOVA with post-hoc test.

Results
PI-103 significantly reduced TNF-α induced microvascular endothelial cell permeability (Graph), thus impeding in vitro cytokine-induced inflammation. Whilst there was no effect on neutrophil accumulation in vivo, there was significant reduction in weight of treated areas and oedema formation, which was inhibited by PI-103 (Table 1).
Effect of PI-103 in vivo Control 30 mg/kg PI-103 Tyrode solution Zymosan (μg/ml) Tyrode solution Zymosan (μg/ml) 10 30 100 10 30 100 MPO/Protein (U/mg) 0.66±0.26 1.42±0.07 1.40±0.14 1.68±0.12* 0.60±0.11 1.23±0.32 1.36±0.25 1.59±0.21* Oedema Volume (mm3) 0.00±0.00 3.26±1.76 11.70±2.21 21.50±4.67 2.20±1.53 1.05±1.05 3.27±0.74 5.52±1.58 Mice were pre-treated with PI-103 i.p. for 30 min, i.d injected with zymosan (50 μl/site) for 4 hr, followed by ex vivo MPO assay, weight and oedema volume measurements. Oedema was quantified by measuring: width (x), height (y) and depth (z) from each of the i.d. sites; volume of oedema = ((π/6)xyz). N=6 independent experiments in duplicates; *p<0.05 between Tyrode solution vs zymosan groups.
Effect of PI103 in vitro on permeability

Conclusions
Our findings show that the PI3K non-selective inhibitor, PI-103 (as well as a PI3K α-selective inhibitor), reduces endothelial activation and inhibits inflammatory oedema formation. We conclude that there is a potential for PI3K inhibitors to act as anti-oedema agents in cardiovascular-related inflammatory conditions.

Acknowledgement/Funding
British Heart Foundation