bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2243CTCA alone demonstrates superior diagnostic accuracy, prognostic utility and is less expensive than CTCA combined with subsequent multi-modality functional imaging in patients with ischaemic symptoms
Authors: MacLean E , Sehmi J , Kanaganayagam G S , Ngee T , Nicol E 
Published: October 2019

Abstract

Background
The evaluation of suspected ischaemic symptoms incorporates multi-modality anatomical and functional imaging tests. The 2016 update to the UK's NICE guidelines recommends CT coronary angiogram (CTCA) first line in patients without known coronary artery disease. Additive multi-modality functional imaging may provide synergistic diagnostic and prognostic information.

Purpose
To investigate the diagnostic accuracy, prognostic utility and cost of CTCA combined with subsequent multi-modality functional testing versus (vs) CTCA alone.

Methods
772 consecutive patients were referred to a single UK tertiary centre with symptoms suggestive of ischaemia. 657 individuals (“CTCA group”) underwent CTCA alone, and 115 individuals (“Combined group”) underwent CTCA and then either perfusion cardiac MRI (n=25), stress echocardiogram (n=16), or myocardial perfusion scintigraphy (n=74). Patients underwent invasive angiography (n=79) +/− revascularisation at the discretion of the referring clinician. All readers and operators were aware of previous imaging findings. Revascularised patients (n=52) were excluded from long term follow-up. The remaining patients were followed-up for a mean of 38.1±17.4 months and the incidence of major adverse cardiovascular events (MACE) recorded. Costs were derived from the NICE guidelines.

Results
Baseline characteristics were similar between groups. The Combined group underwent significantly more invasive angiograms than the CTCA group (29.6% vs 6.8%, p=0.0001) with no significant difference in the rate of revascularisation (73% vs 67%, p=0.72). Mean time from CTCA to angiogram was significantly longer in the Combined group (81.2 vs 38.1 days, p=0.0001). Both sensitivity and specificity were lower in the Combined group than in the CTCA group (sensitivity: 70% vs 93%, specificity: 75% vs 100%). The rate of long term MACE was significantly higher in the Combined group (8.7% vs 2.6%, p=0.0026). Multivariate analysis of CTCA and functional imaging findings found that CTCA-derived four vessel aggregate stenosis score (0–12) was the strongest predictor of MACE for the whole cohort (OR 4.4, p<0.0001), and also for those with negative functional tests (OR 3.9, p<0.0001). Per patient, a combined strategy was more expensive than CTCA alone (£1551 vs £368, p=0.0001).
CTCA and functional data vs outcomes

Conclusions
Combining multi-modality functional testing with CTCA increased costs but did not improve diagnostic accuracy or long term outcomes. Further reductions in both MACE and unnecessary invasive angiography are desirable; CT-derived functional data such as FFRCT may be implicated.
P2466The impact of circumferential pulmonary vein isolation on global and regional left atrial function in patients with paroxysmal atrial fibrillation
Authors: Blendea D , Istratoaie S , Pop S , Mansour M 
Published: October 2019

Abstract

Introduction
The effect of circumferential pulmonary vein isolation (PVI) for atrial fibrillation (AF) on left atrial (LA) function has not been well defined.

Purpose
The aim of this study was to evaluate the immediate impact of ablation on parameters of global and regional LA function using intracardiac echocardiography (ICE)

Methods
We studied 26 consecutive patients (age 56±10 years, 19 men) with paroxysmal AF using ICE before and immediately after circumferential PVI. All pulmonary veins were isolated in all patients. ICE measurements included LA fractional area shortening, peak A wave on transmitral Doppler flow, peak emptying velocity on the left atrial appendage (LAA) Doppler flow, as well as tissue Doppler myocardial velocities at the level of the posterior LA wall, interatrial septum, and lateral wall, which were used as parameters of regional LA function.

Results
The mean radiofrequency ablation time was 37±22min. Post ablation there was a significant reduction of the LA fractional area shortening from 27±8% to 22±6% (p<0.01). The tissue Doppler velocity of atrial contraction at the posterior wall decreased significantly post ablation: from 8.9±1.8 cm/s to 6.9±1.4 cm/s (p<0.01). There were no significant differences between the pre and post ablation values for tissue Doppler velocities at the level of the interatrial septum or LA lateral wall. The post ablation peak transmitral A wave and peak LAA Doppler velocities did not differ significantly from the pre ablation values.

Conclusion
In patients with paroxysmal atrial fibrillation, circumferential PVI results in an immediate decrease in LA function without a significant change in LAA function.
P2485Cardiac abnormalities and vascular damage in young adults with type 1 diabetes mellitus: incidence and associations with kidney dysfunction
Authors: Medvedev D , Mahamat K , Soseliya N , Efimova V , Safarova A , Kobalava Z 
Published: October 2019

Abstract

Background
In contrast to type 2 diabetes mellitus (DM), cardiac and vascular abnormalities in type 1 DM (T1DM) are not well investigated. We aimed to evaluate occurrence of cardiac remodeling, arterial stiffness and blood pressure (BP) phenotypes in T1DM patients.

Methods
The cross-sectional study consecutively included T1DM patients 18–44 y.o. without known CVD, in whom 24-hour monitoring of peripheral and central BP (ABPM) with BPLab Vasotens, applanation tonometry and conventional and speckle tracking echo were performed. BP phenotypes were determined according to current guidelines, PWV and CBP - according to individual reference values. Presence of systolic dysfunction was defined as global longitudinal strain (GLS) <20%, left ventricular hypertrophy (LVH) as LV myocardial mass index (LVMI) >95/>115 g/m2 for women/men, LV remodeling (LVR) as RWT ≥0.43. P<0.05 was considered significant.

Results
A total of 125 patients with T1DM (mean age 29,2±7,6 years, 60% male, median duration of DM 6,9 [2; 11] years, HbA1c 9.9 [6; 12] %, mean BMI 23±3 kg/m2, smoking 39%, median GFR 100 [86; 117] ml/min/1.73 m2, GFR <60 ml/min/1.73 m2 – in 8.8%, median albuminuria 19 [8; 24] mg/g (moderate and high albuminuria in 14.6% and 2.2%) were investigated.
According to office BP and ABPM hypertension (HTN) was diagnosed in 28% patients (true and masked in 4.8 and 23.2%, respectively) and true normotension in 72%.
Isolated nocturnal HTN was observed in 14.4%. Majority of the patients were dippers (51.2%), non-dippers and night-peakers profiles were registered in and 43.2% and 5.6%, respectively. Central SBP and PWV elevation were observed in 17.6% and 57.6% (PWV >10 m/s - only in 2.4%). Cardiac abnormalities were revealed in 72.4% of patients: GLS<20%, LVH, LVR and diastolic dysfunction (DD) in 71.2, 12, 39.2 and 16.8% patients, respectively. Isolated GLS <20% was detected in 30%, combination of GLS<20% with LVH (or LVR) and DD in 47.2%.
Patients with vs without HTN were characterized by higher PWV (7.8±1.5 vs 6.9±1.2, p<0.001), LVMI (89.9 [75; 96] vs 71.5 [64; 77] p<0.001), incidence of DD (29.6 vs 12.2%, p=0.03), LVH (28 vs 6%, p=0.002), trend towards higher rate of central SBP increase (32.7% vs 17.4%, p=0.08), lower incidence of LVR (26 vs 44%, p=0.002) and similar GLS (p=0.16).
Groups with vs without nocturnal HTN did not differ by PWV, central SBP, GLS and LVMI. PWV increase was associated only with higher LVMI (88.2 [69; 95] vs 77.6 [68; 83], p=0.042).
Correlations (p<0.05) with albuminuria were observed for GLS (r=−0.26), DD (r=0.22) and non-dipping state (r=−0.34). GFR correlated (p<0.05) with GLS (r=−0.32) and PWV (r=−0.32).

Conclusion
Incidence of prognostically unfavourable phenotypes of HTN, cardiac remodeling and arterial stiffness (even in patients without HTN) were relatively high in T1DM population. GLS and non-dipping state correlated with albuminuria, GLS and PWV with GFR
P2583Endothelial cell-derived extracellular vesicles promote M2 polarization of THP-1 cells
Authors: Fruehwald D , Zietzer A , Nickenig G , Werner N , Jansen F 
Published: October 2019

Abstract

Introduction
The intercellular transfer of biologically active molecules in extracellular vesicles (EVs) has recently been discovered as an important mechanism, which regulates cardiovascular health and disease. In the context of atherosclerosis, endothelial cell-derived EVs have been shown to modulate the phenotype of EV recipient cells in a relevant manner. Under pro-atherogenic conditions e.g. hyperglycemia, the export of numerous signal molecules in EVs is altered and so are EV-dependent effects on recipient cells. While the effect of endothelial-cell derived EVs on other endothelial cells and vascular smooth muscle cells is well characterized, little is known about the vesicle-based interaction of endothelial cells and monocytes under pro-atherogenic conditions. This is particularly relevant as monocytes are crucial modulators of vascular regeneration and inflammation. Our aim was therefore to investigate, whether EVs from endothelial cells have a significant effect on the differentiation and polarization of monocytes and how this process is affected by pathologic conditions as mentioned above.

Methods and results
Human Coronary Arterial Endothelial Cells (HCAECs) were cultured in high-Glucose-medium (30 mM) for 72h. PBS was used as a control. Large EVs were isolated from the culture supernatant by differential centrifugation (1 x 1500 g / 15 min + 2 x 2ehz748.0909 g / 40 min). The harvested large EVs were characterized by Immunoblotting, Nanoparticle Tracking Analysis as well as Transmission electron microscopy and were shown to be mostly between 80 and 500 nm in size. Specific surface markers including Annexin V and Flotillin-1 were highly enriched in the isolated EVs. The EVs were used for co-culture with THP-1 cells with and without previous phorbol-12-myristate-13-acetate (PMA) stimulation. After 4h as well as after 24 h of incubation with EVS, total RNA was isolated from the THP-1 cells and qPCR was performed to assess polarization towards M1 by TNF-α gene expression or M2 by IL-10 expression. While EV treatment of THP-1 cells without previous PMA-stimulation showed no measurable effect, a significant decrease in the expression of TNF-α was detected after 4 h of treatment from Glucose injured HCAECs. Similar results were obtained without glucose stimulation, the most significant reduction of TNF-α expression however was seen at 24 h. In regard to IL-10 no significant expression changes were detected in EV treated THP-1 cells.

Conclusion
We showed that glucose injury does not relevantly affect vesicle release or size. Furthermore, endothelial cell derived EVs cause a reduction of TNF-α expression, which indicates a polarization towards an M2 macrophage phenotype, irrespective of prior hyperglycaemic injury. As the M2 phenotype has been described as pro-regenerative, we conclude that endothelial cell derived EVs can exert a protective function during the invasion of monocytes in cardiovascular disease and remodeling.
P2597Heart failure and atrial tachyarrhythmia on abiraterone: a characterization using pharmacovigilance databases
Authors: Salem J E , Lebrun-Vignes B , Pariente A , Shaffer C M , Malouf G G , Dureau P , Potey C , Funck-Brentano C , Roden D M , Moslehi J J , Bretagne M 
Published: October 2019

Abstract

Background
Abiraterone and enzalutamide are recently approved androgen deprivation therapies (ADT) for metastatic prostate cancer. The cardiac safety profile for the two drugs is unknown.

Methods
Using French and World Health Organization (WHO) pharmacovigilance databases, we performed a disproportionality-analysis of suspected adverse-drug-reactions (ADR) to evaluate the reporting-odds-ratio (ROR) of cardiac ADR associated with abiraterone compared to enzalutamide, other ADT used in prostate cancer, and entire database. Clinical and demographic characterization of patients with ADT-induced cardiac ADR was performed.

Results
In the 5,759,781 ADR reports in men, 55,070 pertained to ADT. The ROR of AT for abiraterone was of 4.1 [3.1–5.3] vs. enzalutamide, 3.7 [3–4.5] vs. other ADT, and 3.2 [2.7–3.7] vs. entire database. The corresponding ROR for HF were of 2.5 [2–3], 1.5 [1.3–1.7], and 2 [1.7–2.3], respectively. Mean time to AT and HF onset was shorter on abiraterone (5.2±0.8 and 4.5±0.6 months, respectively) vs. other ADT (13.3±3.2 and 9.2±1.1 months; p<0.05). Cases on abiraterone vs. other ADT were more frequently associated with ≥2 ADR-terms including AT, HF, hypokalemia, hypertension and edema (13.6% vs. 6%, p<10–4). For abiraterone, age but not dose was associated to reporting of AT/HF vs. any other ADR.
Table 1 Number (available data) AT HF Hypokalemia Edema Hypertension Age (y) 5989 r: 0.03, p: 0.02 r: 0.05, p≤0.0001 r: 0.06, p≤0.0001 r: 0.04, p≤0.01 ns Dose of hydrocortisone equivalent (mg/day) 3828 ns ns ns r: −0.07, p≤0.001 r: −0.12, p≤0.0001 Dose of abiraterone (mg/day) 6285 ns ns ns ns ns Details concerning correlation (r) between clinical covariates and reporting for AT, HF, hypokalemia, edema and hypertension within overall adverse drug reaction on abiraterone (n: 9203) extracted from VigiBase (through 08/2017).
Time to onset

Conclusion
Compared to other ADT, abiraterone was associated with a higher reporting of AT and HF associated with hypokalemia, hypertension and edema. These findings are consistent with the hyper-mineralocorticism induced by abiraterone and not with other ADT.
P2614Comparison of global longitudinal strain and ejection fraction in correlation to NT-proBNP in ischemic and non-ischemic heart failure
Authors: Ablasser K , Von Lewinski D , Kolesnik E , Gangl M , Kattnig L , Habenicht V , Manninger M , Scherr D , Schmid J , Fruhwald F , Zirlik A , Verheyen N 
Published: October 2019

Abstract

Background
In chronic heart failure (CHF) NT-proBNP and left ventricular ejection fraction (LVEF) by echocardiography are standard diagnostic as well as follow-up markers and are known to correlate with prognosis. Speckle-tracking echocardiography is a more recent technique to quantify myocardial deformation as a measurement of left ventricular function with potential benefits over LVEF.

Purpose
The purpose of this investigation was to analyse the cross-sectional relationship between 2D speckle tracking-derived global longitudinal strain (GLS) and NT-proBNP plasma levels in a prospective cohort of ischemic and non-ischemic CHF patients.

Methods
We enrolled 205 patients with chronic heart failure. Major inclusion criteria were age over 18 years, stable disease with absence of unplanned hospitalization or change in medication or device therapy in the previous month or major surgery in the previous 3 months. CHF treatment had to be according to the recommendations of the ESC CHF guidelines 2016 and LVEF had to be below 50%.
Patient history, physical examination and an extensive echocardiography exam were performed. Lab results included NT-proBNP. Manual longitudinal strain was calculated using EchoPAC (General Electric Medical Systems, Horten, Norway) by a single and blinded examiner. LVEF was measured using Simpson's biplane method.

Results
205 patients included in the study. The baseline characteristics included mean age 65.0 years and 75% male. Mean GLS was −9.6% (SD ±4.5%) and median NT-proBNP 1269.5 (IQR 379.5–2759.5) ng/ml. The CHF aetiology was 70.0% ischemic vs 30.0% non-ischemic.
There was a significant negative correlation between GLS and NT-proBNP (Pearson r=0.239, p=0.029), this was not significant for LVEF and NT-proBNP (Pearson r=0.149, p=0.228).In a multivariate regression analysis adjusted for age, sex, NYHA classification and HF aetiology, GLS remained significantly correlated with NT-proBNP (adjusted beta-coefficient= 0.289, p=0.011). Furthermore, in contrast to LVEF, GLS showed a significant correlation to NT-proBNP in patients with ischemic (Pearson r=0.266, p=0.049) as well as non-ischemic aetiology of heart failure (Pearson r=0.434, p=0.034).

Conclusion
Global longitudinal strain, not LVEF, was significantly correlated with NT-proBNP in patients with CHF, independently of age, sex, symptoms or heart failure aetiology. This shows that speckle-tracking might be superior to LVEF for the assessment of left ventricular function in CHF.
P2647Impact of hypertension on extent of non-obstructive coronary artery disease (The NORIC registry)
Authors: Berge C , Eskerud I , Almeland E B , Larsen T H , Pedersen E R , Rotevatn S , Lonnebakken M T 
Published: October 2019

Abstract

Background
In non-obstructive coronary artery disease (CAD), increasing extent of disease is associated with a worse prognosis. Statin therapy has been suggested to improve the prognosis. Whether hypertension, a modifiable CV risk factor, affects the extent of non-obstructive CAD in patients with stable angina is less explored.

Purpose
To assess the association between hypertension and extent of non-obstructive coronary artery disease.

Methods
We identified 1117 patients (mean age 62±10 years, 48% women) from the Norwegian Registry for Invasive Coronary angiography (NORIC). All subjects had stable angina and non-obstructive CAD defined as 1–49% stenosis in any coronary artery segment by coronary computed tomography angiography (CCTA). The extent of non-obstructive CAD was assessed as coronary artery segment involvement score (SIS) on CCTA. Extensive non-obstructive CAD was defined as SIS≥4.

Results
Hypertension was present in 44% and patients with hypertension were older with a higher prevalence of diabetes, obesity, smoking and statin therapy (all p<0.05). Coronary artery SIS and calcium score were higher in patients with hypertension compared to those without hypertension, (3.1±2.0 vs. 2.6±1.7, p<0.001 and 41 (116) vs. 32 (91) HU, p<0.05), respectively. There was no significant sex difference in the prevalence of hypertension. In univariable analysis, hypertension, age, calcium score and statin treatment were significantly associated with extensive non-obstructive CAD (Table). Hypertension remained a strong, independent predictor of extensive non-obstructive CAD after adjusting for other known covariables (Table).
Table 1. Covariables of extensive non-obstructive CAD in univariable and multivariable logistic regression analysis Univariable analysis Multivariable analysis OR 95% CI p-value OR 95% CI p-value Hypertension 1.57 1.21–2.04 0.001 1.47 1.03–2.10 0.035 Age 1.06 1.05–1.08 <0.001 1.04 1.01–1.06 0.001 Calcium score 1.02 1.01–1.02 <0.001 1.01 1.01–1.02 <0.001 Statin treatment 1.34 1.03–1.75 0.029 1.20 0.83–1.70 0.341 Smoking 1.33 1.00–1.77 0.052 1.24 0.86–1.78 0.251 Diabetes mellitus 1.34 0.86–2.12 0.191 1.10 0.57–2.09 0.781 Obesity 1.03 0.76–1.41 0.839 1.19 0.79–1.80 0.425

Conclusions
Hypertension is associated with extensive non-obstructive CAD in patients with stable angina, suggesting that early and aggressive antihypertensive treatment may impact disease progression.
P2681The impact of modifiable life style risk factors on inflammation in patients with coronary artery disease: modelling a target population for anti-inflammatory treatment
Authors: Blaum C , Brunner F J , Braetz J , Kroeger F , Gossling A , Lorenz T , Karakas M , Schnabel R , Westermann D , Blankenberg S , Seiffert M , Waldeyer C 
Published: October 2019

Abstract

Introduction
Modifiable lifestyle risk factors (modRF) of coronary artery disease (CAD) such as smoking, lack of physical activity (PA) and poor diet are associated with high inflammatory burden. An optimisation of modRF might significantly affect the target population for pharmacological anti-inflammatory treatment (AIT) as determined by a hsCRP ≥2 mg/l.

Aim
To analyse the influence of modRF on hsCRP in a contemporary CAD cohort and model the effect of modRF optimisation on hsCRP in a target population with high inflammatory burden.

Methods
We included all patients with angiographically documented CAD from an observational cohort study ongoing since 2015 and excluded patients with recent myocardial infarction, malignancy, infectious disease, and immunosuppressive medication. ModRF were assessed by questionnaire at enrolment. Lack of PA was defined as PA <1.5 h/week and poor diet as ≤12 points of an established Mediterranean diet score (MDS, range 0–28 points). The Kruskall-Wallis Test was used to compare hsCRP levels depending on the number of modRF. We performed univariate and multivariate linear regression with log(hsCRP) as the dependent variable. Based on the latter we recalculated hsCRP for each patient assuming optimisation of individual modRF.

Results
Of the 1003 patients (mean age 69 years, 72% male) included, 48% (N=479) had a hsCRP ≥2 mg/l. HsCRP increased with the incremental number of modRF (median hsCRP-values for 0–3 modRF: 1.1, 1.6, 2.1, 2.7 mg/l, p<0.001). Univariate and multivariate linear regression showed a significant association between log(hsCRP) and each of PA ≥1.5 h/week, MDS >12, and smoking (Table 1). Recalculation of hsCRP levels identified 21% (N=102/479) of patients with hsCRP ≥2 mg/l who could achieve a hsCRP <2 mg/l assuming optimisation of present modRF.
Table 1. Linear regression results Univariate Multivariate exp(β) (95% CI) p-value exp(β) (95% CI) p-value PA ≥1.5 h/week 0.63 (0.54, 0.72) <0.001 0.76 (0.66, 0.88) <0.001 MDS >12 0.74 (0.65, 0.86) <0.001 0.83 (0.73, 0.96) <0.010 Smoking 1.16 (1.01, 1.34) <0.040 1.19 (1.03, 1.36) <0.017 Impact of modifiable lifestyle risk factors on hsCRP in 1003 CAD patients. Multivariate analyses are adjusted for age, sex, diabetes, body mass index and intake of cholesterol lowering drugs.

Conclusion
Modifiable lifestyle risk factors are independently associated with hsCRP levels in CAD patients. A relevant portion of patients with high inflammatory burden might achieve a hsCRP <2 mg/l by lifestyle changes alone. This should be considered in view of the cost and side-effects of pharmacological AIT and for the design of future intervention studies in this field.