bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3372Prediction of outcome in functional mitral regurgitation using the average pixel intensity method
Authors: Kamoen V , El Haddad M , De Buyzere M , De Backer T , Timmermans F 
Published: October 2019

Abstract

Background
Functional mitral regurgitation (FMR) is a frequent finding in patients with systolic heart failure. However, the echocardiographic grading of MR is challenging and different severity cut-offs are recommended by international guidelines. We developed and validated a novel echocardiographic parameter to grade MR, the average pixel intensity (API) method, based on pixel intensity analysis of the continuous wave Doppler signal.

Purpose
In this study, we assessed the long-term predictive value of the API method on clinical endpoints in FMR.

Methods
Transthoracic echocardiography was performed in consecutive heart failure patients with reduced EF (HF-REF) (n=221). MR was assessed using the API method, vena contracta width (VCW), effective regurgitant orifice area (PISA-EROA) and regurgitant volume (PISA-RV). The primary clinical events were major adverse cardiac events (MACE: cardiovascular mortality, mitral valve surgery, percutaneous mitral intervention or heart failure hospitalization).

Results
The API method was feasible in 97% of all FMR patients, which was significantly higher than parameters such as VCW, PISA-EROA and PISA-RV. 84 patients (37%) had one or more clinical events during the follow-up period (cardiovascular mortality (20%), mitral valve surgery (5%), percutaneous mitral intervention (5%), heart failure hospitalization (16%) or heart transplantation (2%)). Based on ROC curves, an API cut-off of 121 au was defined as “severe” MVP-MR with an overall better sensitivity and specificity than current guideline-recommended parameters. On multivariate analysis, MR graded with API was independently predictive for clinical events, whereas PISA-based methods were not independent. In addition, pulmonary pressures and NYHA class were powerful independent predictors of clinical outcome in FMR on multivariate analysis.

Conclusions
The API method better predicts clinical events and outcome in FMR compared to established grading methods. Therefore, the API method may be considered for grading FMR severity in clinical practice.
P3379Diagnostic value of cardiac computed tomographic angiography in suspected prosthetic valve dysfunction
Authors: Youssef Hassan A , Kandil H , Heshmat H , Ali Salem M , Meshaal M , Shehata A 
Published: October 2019

Abstract

Background
Echocardiographic assessment of prosthetic mechanical valves is limited by shadows, artefacts and the need for cumbersome Doppler calculations. CT scan has the potential to overcome some of the limitations of echocardiography in assessment of prosthetic valves.

Objectives
Determine the incremental diagnostic value of cardiac computed tomographic angiography (CTA) over transesophageal echocardiography (TEE) in patients with suspected prosthetic valve dysfunction (PVD) and its impact on treatment decisions.

Methods
50 consecutive patients with suspected PVD underwent both 64-slice ECG-gated CT and TEE and the results were compared. Imaging was compared against surgical findings (Reference standard). Echocardiographic evaluation focused on the detection of signs of PVD: vegetations, new or increased paravalvular leakage (PVL), aortic root pseudoaneurysms or abscesses and occluder malfunction. The CT interpreter was blinded to the findings of TEE.

Results
ECG-gated CT showed findings that were not detected by TEE in fifteen patients (30%). Additional aortic root abscess in four patients (8%), additional aortic root pseudoaneurysm in four patients (8%), and sclero-degenerative change across one of occluder of aortic prosthesis as cause of PVL in another patient (2%) not detected by TEE. CT negated the presence of aortic root abscess in one patient (2%), negated the presence of PVL in another patient (2%) both were detected by TEE. CT diagnosed occluder malfunction in one patient (2%) and underlying cause in two patients (4%) both were not detected by TEE. CT diagnosed presence of aortic arch dissection in one patient (2%) with large aortic root pseudoaneurysm.
CT showed minor diagnostic change in six patients (12%). CT showed better delineation of site and periannular extension of aortic root abscess in four patients (8%). CT showed better assessment severity of PVL in one patient (2%) and cause of PVL across mechanical aortic prosthesis in another patient (2%).
CT resulted in change of treatment strategy in 14 patients (28%). This included surgical excision of additional aortic root abscess or aortic root pseudoaneurysm in four patients (8%), surgical removal of prosthesis for underlying pathology (vegetation, malfunction due to underlying thrombus or PVL) in four patients (8%), aortic arch replacement with tubular graft and reimplantation of coronaries in one patient (2%) and conservative treatment with antibiotic therapy for small aortic root abscess not detected by TEE in 2 patients (4%), proper anticoagulation therapy and close monitor of INR in one patient (2%).

Conclusion
ECG-gated CT and TEE are complementary in patients with prosthetic valve dysfunction. Therefore, CT imaging has to be considered after clinical routine workup and TEE in patients with a high suspicion on prosthetic valve dysfunction.
P3385Difference of vascular healing after percutaneous coronary intervention between 4 kinds of new generation drug-eluting stents: an optical coherence tomography analysis
Authors: Matsuhiro Y , Nishino M , Nakamura H , Yasumoto K , Tanaka A , Nakamura D , Matsunaga Y , Yano M , Yamato M , Egami Y , Shutta R , Tanouti J 
Published: October 2019

Abstract

Background
New generation drug eluting stents (DES) have improved target vessel failure as compared with early generation DES and bare metal stent. Contemporary several new generation DES are different each other regarding strut thickness and drug and polymer type. A little is known about which stent induces a more favorable vascular healing at follow up.

Purpose
In this study, we compared the vascular healing at 8-month follow up by optical coherence tomography (OCT) between 4 different kinds of new generation DES.

Methods
We enrolled 112 consecutive patients (121 lesions) who underwent PCI using 4 kinds of new generation DES including biodegradable-polymer everolimus-eluting stents (BP-EES), biodegradable-polymer sirolimus-eluting stents (BP-SES), durable-polymer everolimus-eluting stents (DP-EES) and durable-polymer zotarolimus-eluting stents (DP-ZES) and who underwent 8-month follow up angiogram and OCT between July 2016 and April 2018. We compared the OCT parameters including percentage of covered struts, uncovered struts, well-apposed and uncovered struts, malapposed strut and mean neointimal hyperplasia (NIH) thickness between them.

Results
BP-EES consisted of 29 lesions, BP-SES consisted of 25 lesions, DP-EES consisted of 38 lesions and DP-ZES consisted of 29 lesions. A total of 734 frames with 5163 struts in BP-EES, 481 frames with 4214 struts in BP-SES, 783 frames with 6119 struts in DP-EES and 583 frames with 4708 struts in DP-ZES were analyzed. As shown in a table, mean NIH thickness was significantly higher in BP-EES and BP-SES. Thus, we compared the OCT parameters between durable-polymer (DP) group including DP-ZES and DP-EES and biodegradable-polymer (BP) group including BP-EES and BP-SES. The percentage of uncovered struts was significantly lower and mean NIH thickness was significantly higher in BP group than DP group.
Results of OCT parameters BP-EES (n=29) BP-SES (n=25) DP-EES (n=38) DP-ZES (n=29) P value BP group (n=54) DP group (n=67) P value Covered struts (%) 89.5±13.6 92.4±8.6 85.5±17.5 85.0±17.7 0.29 90.9±11.6 85.3±17.4 0.08 Uncovered struts (%) 8.8±10.8 7.1±8.7 14.5±17.5 15.0±17.7 0.14 8.0±9.9 14.7±17.4 0.03 Well-apposed and uncovered struts (%) 7.9±9.9 5.9±7.7 11.7±13.1 12.3±14.0 0.15 7.0±8.9 11.9±13.4 0.04 Malapposed struts (%) 0.8±1.6 1.3±2.2 2.7±5.8 2.7±4.7 0.33 1.0±1.9 2.7±5.3 0.07 Mean NIH thickness (μm) 102±57 121±48 78±28 88±33 <0.01 111±53 82±31 <0.01

Conclusion
The present OCT study demonstrated that delayed neointimal healing characterized by the presence of uncovered struts and lower mean NIH thickness was less common in BP group than DP gruop. Biodegradable-polymer may be more favorable than durable-polymer from the point of view of vascular healing.
P3396Identification of patients at extremely-high cardiovascular risk within a very-high risk population from the TERCET Registry
Authors: Dyrbus K , Gasior M , Skrzypek M , Osadnik T , Desperak P , Banach M 
Published: October 2019

Abstract

Background
The latest guidelines from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) introduced a new “ultra-high risk” category of patients, for whom a low-density lipoprotein cholesterol (LDL-C) level <55 mg/dL (1.4 mmol/L) is advised.

Purpose
Based on the above, we aimed to identify the proportion of patients, who are at ultra-high/extremely-high cardiovascular (CV) risk.

Method
Finally, we analyzed the data of 19,781 consecutive patients included in theHyperlipidaemia Therapy in the tERtiary Cardiological cEnTer (TERCET) Registry admitted to the Polish tertiary cardiovascular centre between 2006 and 2018. Among them, there were 7,319 patients admitted with ACS: 3,085 due to ST-segment elevation myocardial infarction (STEMI), 2,256 due to non-ST-segment elevation myocardial infarction (NSTEMI), and 1,978 due to unstable angina (UA), as well as 12,462 due to stable angina (SA). According to the European Society of Cardiology (ESC), all patients included in the Registry are at very high CV risk. All of the patients included in the registry underwent coronary angiography during the hospital stay. On the basis of the multivariate analysis, we aimed at determining the subgroup of the patients with the most unfavourable 12-month outcomes and therefore to indicate the risk factors responsible for extremely-high CV risk.

Results
According to the results of the multivariate analysis performed with stepwise backward regression, we identified the following risk factors: LVEF<40% (odds ratio [OR]=3.51, 95% CI: 2.87–4.29), prior stroke (OR=2.28, 95% CI: 1.65–3.01), diabetic nephropathy (OR=2.16, 95% CI: 1.68–2.77), age>75 years (OR=1.84, 95% CI: 1.33–2.55), atrial fibrillation (OR=1.81, 95% CI: 1.45–2.25), acute MI at admission (OR=1.56, 95% CI: 1.26–1.95), multivessel CAD (OR=1.40, 95% CI: 1.15–1.72), prior MI (OR=1.31, 95% CI: 1.07–1.60) and lower body-mass index (OR=1.02 per 1 kg/m2+ less, 95% CI: 1.00–1.04) that might help to define the group of very high risk patients, who should be considered as of extremely-high cardiovascular risk (all p<0.05). The aggregate summary of risk factors associated with “ultra-high” risk is presented in the attached Figure.
Multivariate analysis results

Conclusions
To our best knowledge, the presented study is the first such an analysis conducted on such a large population of very-high cardiovascular risk patients gathered in the registry of secondary cardiovascular prevention. In very-high cardiovascular risk patients, potential risk factors were identified that might help to establish the group of individuals at extremely high CV risk what contributes to higher 12-month mortality.

Acknowledgement/Funding
None
P3405Association between heart rate thresholds for cardiovascular risk defined by new ESC/ESH Guidelines and neuroadrenergic markers
Authors: Seravalle G , Dell'oro R , Gardini M , Quarti Trevano F , Marro G , Mancia G , Grassi G 
Published: October 2019

Abstract

Background
The ESC/ESH Guidelines for hypertension issued in 2018 identify resting heart rate (HR) values greater than 80 beats/minute as predictors of cardiovascular risk, with the undocumented evidence that this detection might represent the occurrence of a sympathetic cardiovascular overdrive.

Purpose
In the present study we tested this hypothesis throughout the use of direct and indirect markers of sympathetic neural function.

Methods
In 167 untreated and uncomplicated mild-to moderate essential hypertensives recruited for different investigations and aged 51.8±3.2 years (mean±SEM) without other cardiovascular or non-cardiovascular disease, we measured clinic and ambulatory blood pressure (BP), HR (EKG), venous plasma norepinephrine (NE, HPLC assay) and efferent postganglionic muscle sympathetic nerve traffic (MSNA, microneurography). We then subdivided the study population in 2 groups according to HR values ≤ or >80 beats/minute.

Results
Sixty-eight patients displayed resting HR >80 beats/minute while the remaining 99 below this threshold value, the 2 groups showing superimposable age values and gender distribution. Body mass index, clinic and ambulatory BP were similar in the 2 groups this being the case also for LVMI and metabolic variables. In contrast MSNA values were significantly greater (P<0.02) in the former than in the latter group both when expressed as bursts incidence over time (49.2±1.8 vs 39.5±1.4 bs/min) and when corrected for HR (60.7±3.0 vs 51.4±2.5 bs/100 hb). NE showed a tendency to be greater in the former group without achieving, however, statistical significance. In the whole population there was a significant direct relationship between MSNA and HR values (r=0.61, P<0.01)

Conclusions
Thus hypertensive patients displaying HR >80 beats/minute are characterized by a marked sympathetic overdrive, particularly when direct adrenergic markers are employed. This finding suggests that cardiac and peripheral sympathetic activation may participate at the increased cardiovascular risk detected in this group of patients.
P3408The signal peptide of CNP is a novel predictor of MI, MACE and bleeding risk in chest pain patients
Authors: Pemberton C J , Lee J A , Aldous S , Appleby S , Chew-Harris J , Than M , Troughton R W , Richards A M 
Published: October 2019

Abstract

Aim
CNP is an important vascular and cardiac derived member of the natriuretic peptide family. We have previously provided the first reports that the signal peptide of CNP (CNPsp) is present in the human circulation and is elevated in those with chest pain suspicious of ACS. Here, show that CNPsp levels are highly predictive of new MI, MACE and post-index bleeding in patients presenting with potential ACS.

Methods
We prospectively recruited 493 patients presenting with the primary complaint of acute chest pain to our hospital ED. Patients were adjudicated as ACS by 2 independent cardiologists in accordance with ESC guidelines with hsTnI as biomarker. Plasma EDTA samples taken at presentation and 2 hours after were interrogated for CNPsp measurements using our validated, specific assay. Clinical data/variables, standard biochemistry analytes, hsTnT and NT-proBNP (both Roche Cobas e411) were also measured. Statistical assessments were made using SPSS v23. Data for all biomarkers were treated as continuous variables and are presented as median (interquartile range, (IQR)). Statistical assessment of the comparative abilities of CNPsp, hsTnT, NT-proBNP and hsTnI (log values) to predict new MACE, MI, bleeding and mortality within 2 yrs of index presentation was undertaken using a logistic regression base model (95% CI) that included all clinical variables and hsTnI and hsTnT and NT-proBNP, with CNPsp added to into the multivariate analyses.

Results
Of the 493 recruited patients (median age 63 (IQR: 54–73, 35% female), 148 were adjudicated to have ACS (30%, 109 MI, 39 UAP). Presentation CNPsp levels were not higher in those with adjudicated ACS versus non-ACS (51, (45–65) vs. 50, (42–63) pmol/L, P=0.412), did not correlate with hsTnI, hsTnT or NT-proBNP, but were significantly lower in those with a history of MI (49, (42–59) vs. 51, (43–64) pmol/L, P=0.044). In contrast, they were significantly higher in those with ECG ST-depression (56, (47–85) vs. 50 (42–62) pmol/L, P=0.038). In the multivariate regression model of all 493 patients, lower values of CNPsp were a significant multivariate predictor of new MI (n=37, 95% CI: 0.06–0.89, P=0.038), MACE (n=64, 95% CI: 0.08–0.81, P=0.020) and new bleeding (n=40, 95% CI: 0.05–0.63, P=0.005) within 2 years of presentation. This predictive ability was additive and independent from NT-proBNP and troponin.

Conclusion
This is the first report that CNPsp measurement provides meaningful and independent risk assessment of important outcomes in ACS patients. In particular, the fact that lower levels of CNPsp are predictive of negative MI, MACE and bleeding outcomes suggests that CNPsp may have an unappreciated protective role in the cardiovascular system.

Acknowledgement/Funding
Health Research Council of New Zealand; Heart Foundation of New Zealand
P3418The relationship between circulating vitamin d3 and subclinical atherosclerosis in elderly asian: contributor or bystander?
Authors: Lu Y , Chou R , Tsai Y , Huang P 
Published: October 2019

Abstract

Background
Vitamin D deficiency had been suggested to be the risk factor of cardiovascular diseases and metabolic disorders. However, current evidence about the association between vitamin D deficiency and atherosclerosis are conflicted and inconclusive.

Purpose
We tried to investigate the relationship between serum vitamin D concentrations and subclinical atherosclerosis in the elderly Asian population.

Methods
The I-Lan longitudinal study (ILAS), 1798 community-dwelling adults older than 50 years old were enrolled and divided into two groups according to serum vitamin D level (sufficient, ≥20 ng/mL, and deficient <20 ng/mL). The concentrations of serum vitamin D3 was measured by chemiluminescence immunoassay and demographic data recorded from chart review. The carotid intima-media thickness (cIMT) was measured at bilateral common carotid arteries. Subclinical atherosclerosis was defined as mean cIMT more than 0.81mm, which had been proved to be associated with an increased risk of stroke and coronary events.

Results
Subjects with vitamin D deficiency (n=604, 33.6%) were younger, composed of more woman, smoker, with a higher incidence of hypertension, dyslipidemia, and metabolic syndrome. Compared with subjects without vitamin D sufficiency, patients with vitamin D deficiency were associated with lower risk of subclinical atherosclerosis (crude OR: 0.63, 95% CI: 0.50–0.81, p<0.001) in the univariate analysis. However, after adjusting gender and age, vitamin D deficiency was no more associated with risk of subclinical atherosclerosis.
Risk of vitD3 and cIMT Subclinical Atherosclerosis (cIMT >0.8mm) Odds Ratio 95% Confidence Interval p-value Model 1   Vit D3 normal (≥20) Reference – –   Vit D3 deficiency (<20) 0.63 0.50–0.81 <0.001 Model 2   Vit D3 normal (≥20) Reference – –   Vit D3 deficiency (<20) 0.81 0.62–1.06 0.127 Model 3   Vit D3 normal (≥20) Reference – –   Vit D3 deficiency (<20) 0.93 0.69–1.24 0.599 Model 1: adjust for vit D3 (univariate); Model 2: adjusted for age, vit D3, Gender; Model 3: adjusted multivariate significantly in univariate analysis.

Conclusion
Vitamin D deficiency was not an independent risk factor for subclinical atherosclerosis in the elderly Asian population. The association observed in the univariate analysis may be confounded by gender difference or comorbidities.
P3428Algorythm for estimation of long-term prognosis for patients with AMI complicated with acute cardiorenal syndrome
Authors: Siverina A , Skorodumova E A , Kostenko V A , Skorodumova E G , Pivovarova L P , Ariskina O B , Fedorov A N , Rysev A V , Malishev M 
Published: October 2019

Abstract

Objective
To develop medical and statistical model to assess the long-term prognosis (1,5 years) in patients with myocardial infarction (MI) and acute kidney injury (AKI).

Materials and methods
227 patients treated in our Institute of emergency care were examined. in 2016 about MI. Sex distribution included 60,2% males and 39,8% females. Average age: 67,1±4,2 years. 1st group included 105 patients with MI had AKI, 2nd one – 122 patients without AKI. Cohorts were comparable by sex and age. Patients were followed-up for 18 months: 15 patients died (12 with in the 1st group, 3 in the 2-nd).At the hospital biochemical and haematological tests (glucose, serum creatinine and WBC levels) were performed, as well as polymorphisms of the NOS3 gene T786C were detected. Results were statistically processed.

Results and discussion
Medico-statistical model was created for the total sample of deaths in the long term period using the method of the classification trees (see Fig. 1). Data obtained showed that the first order node was the distribution of genotypes of polymorphism T786C of NOS3 gene. Patients with the homozygous genotype CC died 10 times more often - 27,8%, people's with the genotypes TT and TC mortality was 2,6%. In patients with the genotype CC elevated levels of WBC in the blood was found, and their levels in frames of 9,9–12,0×109/l were correlated with mortality increased by 97,8%, and further WBC elevation up to 12 ×109/l led to 100% mortality. A third-order node can be considered as the level of serum creatinine at the time of discharge. It's elevation >127 μmol/l correlated with increased mortality in patients with TT and TC genotype by 21,4%, and with associated hyperglycemia >9,3 mmol/l reached 100%. Leukocytosis in patients with TT and TC genotype and serum creatinine >127 μmol/l increased mortality up to 15,5%. The obtained model was tested with the use of ROC-analysis. The area under the curve was – 0,97, which corresponds to the expert assessment as “excellent”. The sensitivity of the model was 93,9%, specificity 83,5%.
Figure 1. Model of long-term prognosis assessment

Conclusion
The proposed medical-statistical model, which includes biochemical (serum creatinine), haematological (WBC) and genetic (polymorphism T786C of NOS3 gene) markers, allows to predict unfavorable outcomes in patients with MI and AKI for a long-term period up to 1,5 years.