bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2496Results cardiopulmonary exercise testing in patients with obesity and chronic heart failure
Authors: Zaletova T , Bogdanov A , Panova Y , Derbeneva S , Gioeva Z 
Published: October 2019

Abstract

Purpose
Determination of exercise tolerance in patients with obesity and chronic heart failure.

Methods
An exercise cardiorespiratory testing (CPET) was performed using a spiroergometer in combination with treadmill using the modified BRUCE protocol in 222 patients divided into the following groups: Group 1: obesity I-II grade – 60 patients; Group 2: obesity I-II grade + chronic heart failure (CHF) – 49 patients; Group 3: grade III obesity – 60 patients; Group 4: grade III obesity + CHF – 53 patients.

Results
The results of CPET showed that the reason for the decrease in tolerance to physical activity in patients with obesity without CHF is detraining. Patients with obesity and CHF were characterized by a more pronounced decrease in exercise tolerance, which was reflected in a decrease in peak oxygen consumption (VO2peak), which in patients with obesity I-II + CHF was equal to 72.7±3.4% (moderate decrease), and in patients with obesity III + CHF – 50±2.1% (marked decrease); differences when compared with the groups without CHF were 44.3% and 24.4% (p<0.001).The maximum aerobic performance of patients with obesity I-II + CHF was equal to 5.5±0.9 MET (moderate decrease), and in patients with obesity III + CHF – 3.8±0.4 MET (marked reduction); differences when compared with patients without CHF were significant at p<0.001. A small reduction in the global pumping function of the heart was found only in patients with obesity III + CHF – the oxygen pulse was 9.4±2.2 ml/beats and was significantly different from the group of patients without CHF. In addition, a decrease in alveolar gas exchange (VE/VCO2) was observed in the groups of patients with obesity and CHF, which was equal to 32.1±1.5 units in the group of patients with obesity I-II degree and 33.6±2.5 units in the group of patients with obesity Grade III (the norm is less than 32), which is probably due to the presence of pulmonary hypertension and a decrease in the ventilation-perfusion ratio.

Conclusion
The development of CHF in patients with obesity leads to impaired alveolar ventilation, a decrease in aerobic muscle power and tolerance to physical exertion. In addition, it was found that when performing a stress test in patients with obesity and CHF (unlike patients without CHF), the anaerobic threshold is reached before the stage corresponding to their average daily exercise. This means that the usual physical activity of patients does not allow them to carry out effective fat oxidation, which may be the metabolic cause of the progression of obesity in patients with CHF.

Acknowledgement/Funding
Research No. 0529-2019-0061 Diagnostics, prevention and dietaterapy of patients with alimentary-dependent diseases
P2506Prognostic importance of ventilatory efficiency in healthy subjects
Authors: Brown O I , Witte K , Shahi S , Clark A L 
Published: October 2019

Abstract

Background
Low cardiorespiratory fitness, defined by reduced maximal oxygen consumption (VO2), is a predictor of mortality in patients without chronic disease. However, the relation between ventilatory efficiency (as measured by the slope of the relation between ventilation (VE) and carbon dioxide production (VCO2)) and all-cause mortality is unknown.

Purpose
To assess the relation between variables derived from cardiopulmonary exercise testing and long-term survival in normal subjects

Method
We recruited 145 healthy subjects, with no history of chronic disease (57% male, mean age 63±12) from primary care at random. All participants underwent cardiopulmonary exercise testing at baseline. Participants were followed for 15.5±3.5 years. The primary end-point was all-cause mortality. Cox-proportional hazard models were used to assess the relationship between measures of exercise performance and outcome. Hazard ratios (HR) are reported with 95% confidence intervals (CI).

Results
During follow up, 34 participants (23.4%) died. On univariable analysis, VE/VCO2 slope, peak VO2, respiratory exchange ratio at peak exercise, peak heart rate and 6-minute walk test distance were significant predictors of all-cause mortality (table 1). However, only VE/VCO2 slope (HR per unit increase: 1.13, 95% CI: 1.00–1.28, P=0.043) and peak heart rate (HR per 10 unit increase: 0.73, 95% CI: 0.57–0.93, P=0.010) were independent predictors of all-cause mortality on multivariable analysis.
Table 1. Cox regression analysis (univariable and multivariable) for cardiopulmonary exercise testing measures and all-cause mortality HR Presentation Univariable analysis Multivariable analysis HR 95% CI p value HR 95% CI p value Peak VO2 (ml/kg/min) Per unit increase 0.90 0.86–0.95 &lt;0.001 0.94 0.86–1.03 0.214 VE/VCO2 slope Per unit increase 1.08 1.01–1.17 0.049 1.13 1.00–1.28 0.043 Exercise RER Per 0.1 unit increase 0.46 0.31–0.67 &lt;0.001 0.72 0.45–1.17 0.185 Peak heart rate (bpm) Per 10 unit increase 0.73 0.65–0.81 &lt;0.001 0.73 0.57–0.93 0.010 6MWT (metre) Per 25 unit increase 0.92 0.86–0.98 0.009 1.02 0.86–1.17 0.789 Peak systolic BP (mmHg) Per 10 unit increase 1.13 0.98–1.31 0.101 – – – Multivariable analysis is adjusted for age, body mass index, sex, smoking, resting systolic blood pressure and forced vital capacity. Abbreviations: 6MWT, 6-minute walk test; CI, confidence interval; HR, hazard ratio; RER, respiratory exchange ratio.

Conclusions
Raised VE/VCO2 slope is an independent predictor of all-cause mortality in healthy patients with no history of chronic disease.
P2530Frailty assessment in atrial fibrillation patients with acute coronary syndromes: a subanalysis from LONGEVO-SCA registry
Authors: Esteve Pastor M A , Martin E , Alegre O , Castillo Dominguez J C , Formiga F , Martinez-Selles M , Diez-Villanueva P , Sanchis J , Ariza-Sole A , Marin F 
Published: October 2019

Abstract

Background
Different studies have observed a significant correlation between frailty, morbidity and mortality in elderly patients with cardiovascular diseases.Several scores have been developed to assess frailty in elderly patients. The FRAIL scale is a bed-side and easy tool that evaluates 5 items: fatigue, resistance, ambulation, concomitant diseases and weight loss. However, the evaluation of frailty status in AF patients with ACS is scarce.

Purpose
The aim of this study was to analyze the management of elderly patients with AF and ACS and the predictive value of frailty for adverse events.

Methods
The prospective multicentre LONGEVO-SCA enrolled unselected elderly patients hospitalized after non-STACS. In this substudy, we divided patients according to rhythm status (AF or sinus rhythm [SR]) and to frail status. We validated the predictive performance of FRAIL scores for adverse events at 6 months follow-up.

Results
We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis and 145 (27.3%) patients were frail. Frail AF patients had higher risk of global mortality [HR 2.61, (95% CI 1.28–5.31; p=0.008)], readmissions [HR 2.28, (95% CI 1.37–3.80); p=0.002)] and the composite endpoint [HR 2.28, (95% CI 1.44–3.60); p<0.001)] compared with non-frail SR patients. After multivariate adjustment, Frail score [HR 1.41; 95% CI (1.02–1.97); p=0.040] was independently associated with mortality. Kaplan Meier analysis showed that frail AF patients had significantly worse prognosis during the follow-up with high risk of global mortality (log rank p=0.024) and readmission (log rank p<0.001) followed closely by those frail SR patients.
Event Free Survival according Frailty

Conclusions
In the LONGEVO-SCA registry, frail AF patients have 2-fold risk of adverse events compared to non-frail SR patients. Frailty status was an independent condition associated with high risk of adverse events at 6 months of follow-up.
P2543QTc interval during head-up tilt testing in patients with neurocardiogenic syncope versus patients with orthostatic hypotensio
Authors: Vanerio G 
Published: October 2019

Abstract

Background
The QT interval reflects shifting from parasympathetic to sympathetic activity. During head-up tilt testing (HUTT) normal subjects show a QTc shortening, but during an abnormal response: 1) neurocardiogenic syncope or 2) orthostatic hypotension an altered balance between the parasympathetic to sympathetic is present and probably detected through changes in the QTc interval.

Objective
Compare dynamic changes of the QT, QTc intervals during head-up tilt test (HUTT) in patients with neurocardiogenic syncope (NCS) and with orthostatic hypotension due to autonomic failure (OH)

Methods
We studied 78 patients. 45 (51%) were female. All were symptomatic and had an abnormal HUTT according to each definition. We divided the population into two groups depending on the response, 1) NCS n=61 2) OH n=17. In all patients; heart rate, QT and QTc, were measured on a continuous 12-lead electrocardiogram

Results
NCS patients were significantly younger with female prevalence. The max HR and the SD of the HR were significantly higher. The QTc interval during positive HUTT was very different. In the NCS the QTc shortened from 407±25 to 367±49 (p=0.001) and in OH group the QTc prolonged from baseline 427±37 ms to HUTT 442±52 ms; p=0.001).

Conclusion
HUTT revealed significant QTc differences in patients with OH and NCS. Patients with a NCS the QTc interval shortened; but in those with OH the QTc significantly prolonged. This finding is in accordance with the autonomic imbalance and could explain the increase in sudden death observed in the OH population.
P2558PDE4 regulates cardiac pacemaker function
Authors: Mika D , Gomez A M , Fischmeister R , Vandecasteele G 
Published: October 2019

Abstract

Background
Numerous epidemiological and clinical studies have revealed a positive correlation between heart rate (HR) and cardiovascular morbimortality. The autonomic nervous system is the major extracardiac determinant of HR. During sympathetic stimulation, the activation of β-adrenergic receptors (βAR) induces an increase in cAMP levels, leading to positive chronotropic effect. Among the 5 cardiac cAMP-PDE families, PDE4 is critical for controlling excitation-contraction coupling (ECC) during βAR stimulation in atrial and ventricular cells. PDE4 may also be important for automaticity. 3 genes encode for PDE4s: pde4a, pde4b, pde4d. Their respective contribution to the regulation of pacemaker activity remains ill-defined.

Purpose
Define the role of PDE4 isoforms in the regulation of cardiac pacemaker activity

Methods
Total PDE activity was determined in mouse sinoatrial node (SAN) tissue as the cAMP-hydrolytic activity measured in the absence of PDE inhibitor and the fraction corresponding to PDE4 activity was assessed by including the PDE4 inhibitor Ro-20-1724. The in vitro pacemaker activity was assessed by measuring spontaneous Ca2+ transients in Fluo4-loaded-SAN tissue. Images were obtained using confocal microscopy.

Results
Ro-20-1724 increased beating rate of intact SAN and increased PKA-phosphorylation of key ECC actors (ryanodine receptor, phospholamban and contractile proteins). PDE4 activity was found to account for 60% of the total cAMP-PDE activity in SAN (n=3 independent experiments). PDE4A, PDE4B and PDE4D isoforms were found to be expressed in mouse SAN (n=5 independent experiments). In PDE4D-, but not in PDE4B-deficient mice, Ca2+ homeostasis was altered in control conditions (ctrl) and after βAR stimulation with isoprenaline (iso). Indeed, ablation of PDE4D induced decreased beating rate (ctrl: 1.00±0.08 s–1 vs 1.57±0.05 s–1; iso: 1.71±0.17 s–1 vs 2.39±0.08 s–1, p<0.0001) and increased Ca2+ spark frequency (ctrl: 15.9±5.2 sparks/s/100 μm vs 1.9±0.4 sparks/s/100 μm; iso: 22.9±7.1 sparks/s/100 μm vs 0.6±0.2 sparks/s/100 μm, p<0.0001) (Figure).
Calcium Homeostasis in SAN cells

Conclusion
PDE4 controls pacemaker function in mice and PDE4D ablation strongly perturbs normal SAN activity.

Acknowledgement/Funding
ANR, Fondation Lefoulon Delalande, CORDDIM
P2591Circulating pro fibrotic protein promotes fibrosis in liver and heart
Authors: Tsukano Y , Shimizu I , Yoshida Y , Ikegami R , Hayashi Y , Suda M , Katsuumi G , Wakasugi T , Nakao M , Minamino T 
Published: October 2019

Abstract
Analyzing two sets of DNA micro array data with bioinformatics, we identified a secreted form pro-fibrotic protein (sPFP) expressed in dysfunctional brown adipose tissue (BAT) in mice. Testing our biobank samples, we found this protein increased in plasma of non-alcoholic steatohepatitis (NASH) patients or aged individuals. We generated a murine obese NASH model by imposing a high fat diet in C57BL/6NCr mice for 9–10 months since 4 weeks of age, and found that sPFP is produced predominantly by BAT. In this model, we also found that sPFP increased in plasma. We generated a murine systemic sPFP knockout (KO) model and found that liver fibrosis ameliorated in sPFP-KO model. We also suppressed circulating sPFP with a peptide vaccine targeting this molecule, and found that sPFP vaccination therapy inhibited liver fibrosis. Next, we generated sPFP gain of function (GOF) model by the administration of plasmid encoding sPFP into skeletal muscle. Liver fibrosis augmented in sPFP-GOF model, and these results suggested that sPFP has causal role for the progression of fibrotic response in liver. In the obese NASH model, we found that cardiac fibrosis also developed and it ameliorated in sPFP-KO model, indicating that sPFP may have pathological roles for heart failure with preserved ejection fraction (HFpEF) related with age-related disorders. In addition to an increase in circulating sPFP in aged individuals, we found that sPFP increased in BAT of chronological aged mice model. In vitro studies with differentiated brown adipocytes showed that c-Fos upregulated sPFP in transcript level. Our results suggest that sPFP contributes for the progression of fibrotic responses in obese or aged models. Inhibition of sPFP may become a therapy for NASH or HFpEF.
P2595The role of epicardial fat thickness and other parameters of visceral adiposity in right ventricular diastolic function in patients with metabolic syndrome
Authors: Sedaia E , Revenco V 
Published: October 2019

Abstract

Background
Abdominal obesity is associated with an increased risk of cardiovascular disease and all-cause mortality especially in patients with metabolic syndrome (MetS). Despite the undeniable importance of right ventricle (RV) function, little is known about RV diastolic function implication in obesity and MetS.

Purpose
The objective of our study was to evaluate the role of epicardial fat thickness (EFT) and other parameters of visceral obesity in diastolic function of RV in patients with MetS.

Methods
The study included 70 subjects with MetS (mean age 52.6±9.4 years) and 70 controls without MetS (mean age 53.8±7.5 years). MetS was defined by ≥3 criteria of International Diabetes Federation and American Heart Association/National Heart, Lung, and Blood Institute. We assessed RV diastolic function by pulsed wave and tissue Doppler echocardiography and determined the ratio of early (TV E) and late (TV A) trans-tricuspid valve inflow velocities (TV E/A), early tricuspid valve (TV) annular tissue Doppler velocity (TV e'), the TV E/e' ratio and TV deceleration time (DT). Anthropometric and sonographic parameters of visceral adiposity included: waist circumference (WC), waist-to-hip ratio (WHR), visceral adiposity index (VAI), intraabdominal fat thickness (IFT), abdominal wall fat index (AWFI) and epicardial fat thickness (EFT).

Results
Mean values of WC (p=0.030), WHR (p=0.008), VAI (p=0.001), IFT (p=0.035), AWFI (p=0.013) and EFT (p=0.012) were significantly higher in the group with MetS vs. controls. RV diastolic function parameters were also significantly changed in the group with MetS vs controls (tab.1). TV E/e' was positively correlated with WC (r=0.297, p<0.01), WHR (r=0.238, p<0.05), VAI (r=0.271, p<0.05), IFT (r=0.556, p<0.01), AWFI (r=0.604, p<0.01) and EFT (r=0.795, p<0.01). Using multivariate regression analysis EFT, WC and plasma glucose level were the most important predictors for RV diastolic dysfunction in subjects with MetS (p<0.05 for all parameters).
Table 1. RV diastolic function Variables MetS (n=70) Controls (n=70) p TV E, cm/s 48±11.1 52.1±14 0.025 TV A, cm/s 56.54±11 52.3±11.7 0.034 TV E/A 0.92±0.4 1.07±0.44 0.029 TV e', cm/s 10.6±2.7 10.7±3.5 0.001 TV E/e' 5.84±1.04 4.59±0.82 0.001 DT, ms 227.9±12.4 217±17.8 0.009

Conclusion
Our findings support that EFT and WC play an important role in RV diastolic dysfunction in patients with MetS.
P2601Trans-catheter or surgical mitral valve procedure versus conservative treatment in heart failure patients with preserved ejection fraction
Authors: Sun X , Nkomo V T , Pislaru S V , Lin G 
Published: October 2019

Abstract

Background
Secondary mitral regurgitation (SMR) impacts outcomes in heart failure with reduced ejection fraction (HFrEF) but whether it is a specific therapeutic target in heart failure patients with preserved ejection fraction (HFpEF) is less clear.

Purpose
The aims of this study were to investigate whether surgical or trans-catheter intervention reduces SMR and improves outcomes compared to optimal medical therapy in HFpEF patients.

Methods
We retrospectively identified 120 HFpEF patients with moderate-to-severe or greater SMR from January 1, 2007, until December 31, 2017. Moderate-to-severe SMR was defined as an effective regurgitant orifice area of >0.3cm2, and/or a regurgitation volume of >45ml per beat. Those with primary mitral regurgitation, endocarditis, HFrEF, hypertrophic cardiomyopathy, congenital heart disease, and history of valve intervention were excluded. All-cause mortality was analyzed and correlated to clinical and echocardiographic characteristics. Amongst the 120 patients, 36 received surgical or trans-catheter procedure in addition to medical therapy (procedure group) and 84 patients received optimal medical therapy only (conservative treatment group). The median follow-up period was 864 (15–3553) days.

Results
Patients in the procedure group were younger (75±8 vs 81±10, P=0.0002) and with fewer comorbidities (Charlson Comorbidity Index 7.0±2.4 vs 8.0±2.0, P=0.022) compared to the conservative treatment group. In addition, the procedure group had larger left ventricular end-diastolic diameters and higher SMR volume at baseline. During follow-up, SMR decreased by ≥2 grades in 75% of patients (27/36) in the procedure group compared to 20% of patients (12/60) in the conservative treatment group. After adjusting for age and comorbidities, the procedure group showed better overall survival compared to the conservative treatment group (HR 0.37; 95% CI 0.17–0.80; P=0.011). On multivariate analysis for the different groups (procedure group vs. conservative treatment group) (HR 0.40; 95% CI 0.17–0.91; P=0.019), increasing Charlson Comorbidity Index (HR 1.16; 95% CI 1.02–1.32; P=0.028) and average mitral E/e' ratio (HR 1.06; 95% CI 1.01–1.11; P=0.031) were independent predictors of increased all-cause mortality.
Kaplan-Meier Survival Curve

Conclusion
Among heart failure patients with preserved ejection fraction and moderate-to-severe or severe SMR, surgical or trans-catheter mitral-valve repair or replacement resulted in lower all-cause mortality compared to conservative treatment after 9 years of follow-up.
P2625Pathophysiology of diaphragm involvement in systolic heart failure: insights from diaphragm ultrasound and phrenic nerve stimulation studies
Authors: Spiesshoefer J , Tuleta I T , Giannoni A G , Boentert M B 
Published: October 2019

Abstract

Background
Diaphragm ultrasound allows for assessment of both diaphragm excursion and thickness. Cervical and cortical magnetic stimulation (CEMS and COMS) with recording of the diaphragmatic compound motor action potential (CMAP) is diagnostically useful to evaluate the conductive properties of the inspiratory pathway. Systolic heart failure (HF) is characterized by a loss of systolic pump function. Diaphragm weakness in HF has been reported to potentially contribute to exercise intolerance

Methods
14 patients with systolic HF (11 men, 3 women; 64±12 years, NYHA 2±0.9, LVEF 36.1±5.6%) and 12 healthy controls matched for age and gender (4 men, 8 women; 56±8 years) underwent spirometric lung function testing and assessment of diaphragm excursion (during tidal breathing, TB, voluntary sniff, VS and deep breathing, DB) and thickness of the right hemidiaphragm by ultrasound. COMS and CEMS of the phrenic nerves with simultaneous bilateral recording of the diaphragm CMAP using surface electrodes was performed in 9 patients.

Results
Compared to controls, HF patients showed reduced forced vital capacity (75.46±18.05% vs. 107.62±17.13%, p<0.05). Diaphragm excursion amplitude was significantly reduced in HF patients (4.29±1.35 cm vs. 7.34±2.10 cm, p<0.05). Diaphragm contractility was impaired too, as reflected by the diaphragm thickening ratio (DTR; 2.01±0.46 vs. 2.53±0.74, p<0.05). Diaphragm CMAP following COMS and CEMS of the phrenic nerves revealed normal latencies in HF patients compared to controls (COMS Latency; 19.05±2.37 msec vs. 18.97±3.59 msec, p= n. s.).

Conclusions
Diaphragm involvement in systolic HF is reflected by reduced FVC and impaired ultrasound parameters of diaphragm function. Diaphragmatic pathology is likely to be myopathic because magnetic phrenic nerve conduction studies show no abnormalities. Diaphragm ultrasound may be useful as a diagnostic tool for assessment of diaphragm function in systolic HF.

Acknowledgement/Funding
This study was supported by Sanofi-Genzyme, Neu-Isenburg, Germany. The funders had no role in study design, data collection and analysis, preparation.
P2637Hypertension as a risk factor for all-cause and cardiovascular mortality in women compared with men: a systematic review and meta-analysis of prospective cohort studies
Authors: Wang Y , Nie J , Yu H 
Published: October 2019

Abstract

Background
What is more, some recent meta-analysis have demonstrated the sex difference between smoking, diabetes, and atrial fibrillation, and the risk of CVD mortality. Whether and to what extent the excess risk of cause-specific mortality from CVD death conferred by hypertension differs among women and men remain unclear.

Objective
A systematic review with meta-analysis was performed to explore whether and to what extent the excess risk of cause-specific mortality from CVD death conferred by hypertension differs among women and men.

Methods
PubMed and EMBASE was systematically searched for prospective cohort studies published from inception to 7 October 2017. Eligible studies reported sex-specific relative risk (RR) estimates for mortality of all-cause, CVD, coronary heart disease (CHD) and stroke associated with hypertension. The data were pooled using random effects models with inverse variance weighting, and estimates of the women-to-men ratio of RRs (RRR) for each outcomes were derived.

Results
Twenty-four studies with 2,939,659 participants were included in this meta-analysis. The RR for CHD mortality associated with hypertension compared with no hypertension was 2.24 (95% CI 2.03–2.46) in women and 1. 72 (1.61–1.84) in men. The multiple-adjusted RRR for CHD mortality was 22% greater in women with hypertension than in men with hypertension (RRR 1.22, 95% CI 1.03–1.44) with no significant heterogencity between studies (I2=45%, P=0.11, Figure 1). No evidence was observed sex difference in the relationship between hypertension and the mortality from all-cause, CVD and stroke. Furthermore, the subgroup analyses showed that the pooled RRR for all-cause mortality, CVD and stroke mortality were not significantly associated with cohort region, the duration of follow-up, mean age of participants and the publication year of studies.

Conclusions
Hypertension is a major risk factor for all-cause, CVD, CHD and stroke among women and men. Moreover, women with hypertension have more than a 22% higher risk of CHD mortality compared with men with hypertension. Further studies need to identify the biological and/or lifestyle mechanisms involved in sex differences driving these associations.