bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6389Infection and type 2 myocardial infarction: a large observational study from emergency department
Authors: Putot A , Buet-Derrida S , Avondo A , Ray P , Maza M , Zeller M , Cottin Y 
Published: October 2019

Abstract

Background
Troponin elevation is frequent in patients with acute infection (AI) admitted to emergency unit (EU). Acute infection (AI) has been suggested as a common trigger in type 2 myocardial infarction (T2MI), corresponding to a myocardial oxygen supply-demand mismatch without atherothrombosis. We aim to characterize risk factors of T2MI occurrence and in-hospital mortality among patients admitted to an EU with AI and elevated troponin.

Methods
Among the medical records of all the patients admitted from January 2014 to December 2016 in a university hospital EU (n=82 543), patients with a diagnosis of AI and elevated troponin Ic (≥0.10μg/L) (n=714) were systematically adjudicated as T2MI in the presence of symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes).

Results
Among the 714 patients included (aged 85, 50% male), 185 (26%) were classified as T2MI, of whom infection site was pulmonary tract (n=111), urinary tract (n=27), skin (n=15), digestive tract (n=9) or other or indefinite site (n=23). By multivariate analysis, a history of chronic obstructive pulmonary disease (COPD) (OR (95% CI): 0.53 (0.30–0.96)), high temperature (OR: 0.86 (0.74–0.99) per °C) and elevated creatinine (0R 0.998 (0.996–1.000) per μmol/L) were associated with a lower risk of T2MI, whereas age, site of infection, C-reactive protein and troponin rates were not predictors of T2MI. Death rate was similar among patients with or without T2MI (21 vs 23%, p=0.6). In contrast, age, troponine, creatinine or C-reactive protein elevations were independent co-variates associated with mortality.

Conclusions
Our large real-life study shows that in patients admitted to an EU with AI and troponin elevation, T2MI is a common feature, in the absence of temperature elevation, renal insufficiency or history of COPD. In such patients, inflammatory and cardiac biomarkers levels were independently associated with early mortality.
P6415Combined assessment of contrast-enhanced ultrasound of carotid plaque and carotid intima-media thickness improves the prediction of future coronary events in patients with coronary artery disease
Authors: Deyama J , Nakamura T , Ono S , Kobayashi A , Horikoshi T , Yoshizaki T , Watanabe Y , Uematsu M , Kobayashi T , Fujioka D , Saito Y , Nakamura K , Kawabata K , Obata J , Kugiyama K 
Published: October 2019

Abstract

Background
This study examined whether combined ultrasound assessment of plaque size and intraplaque neovascularization in the carotid artery had an additive effect for predicting coronary events in patients with coronary artery disease (CAD).

Methods
CEUS of the carotid plaques using perfluorobutane microbubbles as an ultrasound contrast agent and Ultrasound assessment of carotid plaque maximum intima-media thickness (max IMT) was performed in 221 patients with CAD and carotid plaque IMT over 2mm. Intraplaque neovascularization was identified on the basis of microbubbles within the carotid plaque and graded as: G0, not visible; G1, moderate; or G2, extensive microbubbles. All study patients were followed up prospectively for 5 years or until the occurrence of a cardio-vascular event.

Result
During the follow-up period, 53 coronary events (9 cardiac deaths, 44 ACSs) were occurred. Multivariate Cox hazards analysis showed that max IMT and CEUS grade were independent predictors of coronary events (HR 1.59, 95% CI 1.15–2.21 p=0.005 and HR 2.26, 95% CI 1.52–3.36 p<0.01) that were independent of age, gender, diabetes and LDL-C levels. C-statistics for logistic models predicting future coronary events using conventional risk factors with or without the addition of max IMT alone, CEUS grade alone, and both max IMT and CEUS grade in combination (area under the ROC curve; 0.55,0.61,0.69 and 0.71, respectively). The addition of the plaque enhanced intensity to traditional risk factors resulted in net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI 0.42, p=0.002; and IDI 0.04, p=0.002).
CEUS grade and ROC curve for 3models

Conclusions
Combined ultrasound assessment of carotid plaque IMT and intraplaque neovascularization has an additive value on the prediction of coronary events.
P6434Evaluation of the nociceptive flexor reflex, as a new method for the diagnosis of microvascular angina
Authors: Petrova V B , Boldueva S A , Leonova I A , Petrova A B 
Published: October 2019

Abstract

The purpose of this study was to study the diagnostic value of the nociceptive flexor reflex (NFR) method in patients with microvascular angina.

Materials and methods
The study included 49 patients with MVA (main group), 40 patients with classical angina II-III f.c. (comparison group 1), 42 patients with silent myocardial ischemia (comparison group 2) and 32 healthy volunteers (control group). Criteria for inclusion in the group with MVA: chest pain, positive stress test, unchanged coronary arteries according to coronary angiography, the presence of myocardial perfusion disturbance and reduction of the coronary reserve according to positiron-emission tomography of the myocardium at rest, with adenosine and cold one test. Chest pain syndrome was observed in all 49 patients. All subjects studied the functional activity of nociceptive and antinociceptive systems using the nociceptive flexor reflex method on the equipment of expert class electromyography system, the pain threshold (Pb) values, the reflex threshold (Pr) were calculated and the ratio of pain and reflex threshold was calculated to calculate the pain threshold / threshold reflex (Pb/Pr), which in healthy people is about 0.9–1.0.

Results and discussion
In te study of NFR in patients with MVA in the group as a whole, a decrease in the pain threshold, reflex threshold and Pb/Pr ratio compared with normal values were found. The pain threshold in patients in the group was lower (statistically significantly) when compared with the group 1, the group 2 and the control group (p<0.0001; p<0.0001; p<0.0001, respectively). The reflex threshold in patients of the MCC group was also significantly lower when compared with the group 1, the group 2 and the control group (p<0.001; p<0.0001; p<0.001, respectively). Due to the fact that the low pain threshold was found in 84.4% of the examined patients with MVA who had microvascular dysfunction according to positron-emission tomography, we evaluated the prognostic value of the NFR method for diagnosing the disease. To do this, an assessment was made of the odds ratio (OR) of identifying MVA in groups of patients with different levels of index K (the ratio of the pain threshold value to the reflex threshold value). We have chosen the value of index K with the highest specificity and high sensitivity equal to 0.8892.
Based on the data obtained, the diagnostic value of the NFR method was calculated during the verification of the MVA. When conducting a mathematical analysis, it was found that this technique has high sensitivity (84.4%), specificity (95.12%), positive (90.48%) and negative predictive value (91.76%). We have not found information in the literature on the use of the NFR assessment method and its diagnostic value in MVA.

Findings
Due to the high diagnostic value of determining the NFR, we propose to include this method in the MVA diagnostic algorithm as an additional one.
P6435A diagnostic prediction model of coronary artery disease in patient with chest pain using machine learning
Authors: Rha S W , Choi B G , Choi S Y , Byun J K , Cha J A , Park T S 
Published: October 2019

Abstract

Background
Chest pain is a major symptom of coronary artery disease (CAD), which can lead to acute coronary syndrome and sudden cardiac death. Accurate diagnosis of CAD in patients who experience chest pain is crucial to provide appropriate treatment and optimize clinical outcomes.

Objective
This study was to develop a machine learning model which can predict and diagnose CAD in patients complaining of chest pain based on a large real-world prospective registry database and computing power.

Method
A total of 10,177 subjects with typical or atypical chest pain who underwent a coronary angiography at the cardiovascular center of our University Hospital, South Korea between November 2004 and May 2014 were evaluated in this study. The generation of the diagnostic prediction model for CAD used the classification application by technical support of MATLAB R2017a. The performance evaluation of the learning model generated by machine learning was evaluated by the area under the curve (AUC) of the receiver-operating characteristic (ROC) analysis.

Results
The diagnostic prediction model of CAD had been generated according to the user's accessibility such as the general public or clinician (Model 1–4). The performance of the models has ranged from 0.78 to 0.96 by the AUC of ROC analysis. The prediction accuracy of the models ranged from 70.4% to 88.9%. The performance of the diagnostic prediction model of CAD by machine learning improved as the input information increased.
Figure 1. Study Flow Chart

Conclusion
A diagnostic prediction model of CAD using the machine learning method and the registry database was developed. Further studies are needed to verify our results.
P6444Cardiovascular secondary prevention setting and lipid controlu, update data from PINNACLE BRAZIL REGISTRY
Authors: Saraiva J F K , Cordeiro Mattos A , Saraiva G B F , Pinto I M , Rombaldi A R , Kato N H , Gomes Da Silva L F , Minelli C , Carvalho I T N , Dantas J M M , De Souza Filho J M , Figuinha F C R , Segre C A W , Fonseca H A R , Avezum A 
Published: October 2019

Abstract

Introduction
Lipid control is highly effective and improves clinical outcomes in coronary artery disease (CAD) patients, thus is one of the pillars of the cardiovascular secondary prevention.

Purpose
The aim of this preliminary analysis was to describe the lipid management in CAD patients in Brazil after one year of the clinical practice registry.

Methods
Patients with documented CAD were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated

Results
Currently, PINNACLE-Brazil enrolled individuals, with 2234 (29.4%) patients with CAD. Prescription of statin therapy was identified in 85.6% baseline and 78.3% follow-up. CAD patients with LDL-c <100 mg/dL were 47.3% baseline and 38.5% follow-up and at least one lipid profile assessment occurred in 60.9% baseline and 51.2% follow-up. CAD patients who have an LDL-c result <100 mg/dL, or >100 mg/dL with a documented plan to achieve LDL-c <100 mg/dL, were 48.1% (baseline) and 38.5% (follow-up).

Conclusion
The preliminary results of PINNACLE-Brazil show that, despite the relatively high prescription rate of statin therapy, LDL-c targeted level for CVD secondary prevention has not been achieved in the majority of patients after 01 year of follow-up. Nationwide knowledge translation initiatives are needed to improve the CVD burden in Brazil

Acknowledgement/Funding
ACC Foundation
P6450Plasminogen activator inhibitor type-1 (PAI-1) expression relates to the presence of myocardial inflammation in patients with nonischemic cardiomyopathy
Authors: Escher F , Agirbasli M , Lassner D , Aleshcheva G , Schultheiss H P 
Published: October 2019

Abstract

Background
Plasminogen activator inhibitor type-1 (PAI-1) is an important inhibitor of the fibrinolytic pathway and an acute phase reactant in response to inflammatory cytokines, resulting in thrombosis, arteriosclerosis, and tissue fibrosis. It has been identified as a potential biomarker for coronary artery disease and metabolic syndrom. However, so far, nothing is known about its importance in nonischemic cardiomyopathy.

Aims
To analyzed PAI-1 expression in patients with different forms of cardiomyopathies and evaluate possible influence of PAI-1-dependent pathomechanisms in patients with intramyocardial inflammation.

Methods and results
In this study, endomyocardial biopsies (EMBs) from 309 patients (mean age 48.0±13.9 years) with different forms of cardiomyopathies were enrolled, including 123 patients with dilated cardiomyopathy (DCM) (mean LVEF 28.01±9.06%) and 186 patients with EMB-proven virus-negative inflammatory cardiomyopathy (DCMi) (mean LVEF 31.76±14.14%). 10 patients (mean LVEF 60.50±4.76%) without viral or inflammation in EMB served as controls. Hemodynamic parameters were measured by catheterization and echocardiography. EMBs were performed at first admission after exclusion of ischemic of valvular heart disease. In EMBs PAI-1 was assessed by immunohistology including digital imaging analysis. PAI-1 expression was significantly higher in patients with DCMi in contrast to DCM patients and controls (0.517±2.20 vs. 0.187±0.598 vs. 0.023±0.032% Area Fraction; p=0.0002). PAI-expression correlates significantly with lymphocytic infiltrates (for CD3 r=0.56, p<0.0001, and LFA-1 r=0.59, p<0.0001). This was found to be independent of hemodynamic parameters, and age.

Conclusion
Myocardial inflammation is associated with a significant increase in PAI-1 expression in DCMi independently of the hemodynamic conditions. This new pathophysiological axis could be a potiential therapeutic target in future treatment stategies in DCMi.
P6459Comparison of the new BLLADS score with other scores for the prediction of major bleeding in patients with acute pulmonary embolism
Authors: Subotic B , Dzudovic B , Novicic N , Matijasevic J , Salinger S , Obradovic S 
Published: October 2019

Abstract

Background
Hemorrhagic complications are a major obstacle for aggressive antithrombotic therapy in patients with acute pulmonary embolism (PE).

Objectives
We aimed to develop a simple risk score for predicting major bleeding (MB) in patients with acute PE using medical history and laboratory data at admission, including the potential influence of thrombolytic therapy, and to compare its predictive power to bleeding risk scores previously developed for patients with atrial fibrillation or venous thromboembolism.

Methods
A total of 630 consecutive patients treated for PE in six Serbian University hospitals were followed up for the occurrence of MB over a 90-day period after admission. A 6-component bleeding risk score was developed after Cox regression analysis of possible variables presented at admission. The use of thrombolytic therapy was also tested as a risk factor for bleeding and was integrated into the score. The ATRIA, HAS BLED, RIETE and VTE-BLEED scores were calculated for each patient at baseline and the predictive performances were compared with new score using c-statistics.

Results
MB occurred in 61 (9.7%) patients during the 90-day follow-up, with no increased risk of all-cause mortality (p=0.108). Six independent factors associated with MB were included in the final model (previous bleeding, leukocyte count ≥14x109/L, receipt of thrombolytic therapy, anemia, drugs associated with bleeding, and recent surgery; BLLADS). For the six- and five-variable models (without points for thrombolysis), C-indices were 0.774 (95% confidence interval [CI], 0.713–0.835, p<0.001) and 0.713 (95% CI, 0.639–0.788, p<0.001), respectively. The predictive power of the BLLADS score was found to be superior in comparison with other four scores: c-index 0.779 (95% CI 0.716–0.841, p<0.001), 0,614 (95% CI 0.535–0.692, p=0.005), 0.591 (95% CI 0.518–0.664, p=0.025), 0.589 (95% CI 0.518–0.659, p=0.029), 0.586 (95% CI 0.508–0.664, p=0.035), for continuous BLLADS, RIETE, VTE-BLEED, ATRIA and HAS BLED scores, respectively.

Conclusion
A simple six-variable score including the use of thrombolysis was developed with sufficient discriminative capacity comparing to current available scores for the prediction of 90-day MB for non-selected PE patients.
P6463Prognostic value of respiratory index (RI) in hemodinamically stable patients with acute pulmonary embolism: the RI-MODEL study
Authors: Vedovati M C , Cimini L A , Pierpaoli L , Vanni S , Cotugno M , Pruszczyk P , Di Filippo F , Stefanone V , Guirado Torrecillas L , Kozlowska M , De Natale M G , Mannucci F , Agnelli G , Becattini C 
Published: October 2019

Abstract

Background
The accuracy of the 2014 ESC model to predict 30-day mortality in hemodynamically stable patients with acute pulmonary embolism (PE) is relatively limited.

Purpose
The aims of this study in hemodynamically stable patients with acute PE were i) to evaluate the prognostic value of a novel respiratory index (RI) (oxygen saturation in air to respiratory rate ratio) and ii) to assess the accuracy of the RI-model (simplified Pulmonary Embolism Severity Index [sPESI] + RI), both in predicting 30-day mortality.

Methods
A collaborative database of hemodynamically stable patients with PE was divided into two cohorts (derivation and validation) with equal numbers of patients, based on a temporal criterion. Study outcome was 30-day all-cause-death. Discrimination and calibration were assessed in the derivation and validation cohorts by the c-statistics and by the Hosmer-Lemeshow test, respectively.

Results
30-day all-cause-death occurred in 7.5% of the 319 patients in the derivation cohort (mean age 72 years, females 53%). The RI was an independent predictor of 30-day mortality (p=0.004). A RI ≤3.8 was associated with an increased death rate compared to higher RI values (15.4% vs 5.0%, OR 3.4, 95% CI 1.5–8.1). When the RI≤3.8 was integrated in the sPESI, the novel RI-model showed a good discriminatory power (c-statistics 0.703, 95% CI 0.603–0.803).
In the 319 patients of the validation cohort (30-day mortality 6.9%, mean age 71 years, females 55%) the discriminatory power of the RI-model was confirmed (c-statistics 0.838, 95% CI 0.768–0.907).
The RI-model and the 2014 ESC model had a c-statistics of 0.772 (95% CI 0.709–0.834) and of 0.687 (95% CI 0.620–0.753) in the overall population, respectively.

Conclusion
In this study, the RI independently predicted 30-day mortality in hemodynamically stable patients with acute PE. A clinical model including RI showed a better discriminatory value than 2014 ESC model and could be used for risk stratification in these patients.
P6483Predictors of contractile reserve on dobutamine stress echocardiography in patients with classical low-flow, low-gradient aortic stenosis
Authors: Emer Egypto Rosa V , Ribeiro H B , Samapio R O , Morais T C , Rosa M E E , De Santis A S A L , Fernandes J R C , Spina G S , Vieira M L C , Pomerantzeff P M A , Rochitte C E , Mathias Jr W , Tarasoutchi F 
Published: October 2019

Abstract

Background
There is a lack of information on factors that influence contractile reserve (CR) on dobutamine stress echocardiography (DSE) in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS).

Purpose
This study sought to evaluate the predictors of CR in patients with LFLG-AS.

Methods
Prospective study including 43 consecutive LFLG-AS patients (aortic valve area [AVA] ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction [LVEF] <50%) with true severe aortic stenosis. All patients underwent dobutamine stress echocardiography and T1-mapping cardiac magnetic resonance (CMR). CR was defined as an increase ≥20% in the left ventricular stroke volume at peak stress. Patients with pseudo-severe aortic stenosis were excluded.

Results
All of the patients in the study had degenerative aortic stenosis, with a median age of 67 [60–74] years, most of them being male (83.7%). A high prevalence of comorbidities was found, highlighted by diabetes (42%), hypertension (70%), atrial fibrillation (25%) and coronary artery disease (38%). Mean transaortic gradient was 25 [20–33] mmHg, AVA was 0.88 [0.68–0.95] cm2, LVEF was 35 [28–43]% and 32.6% had moderate/severe functional mitral regurgitation. CMR myocardium extracellular volume fraction (ECV) was 28.8 [26.3–33.0] %, indexed ECV was 35.4 [25.0–41.2] ml/m2, 32.6% had positive transmural delayed-enhancement images and 25.6% had positive mesocardial delayed-enhancement images. On DSE, 30 patients (69.7%) had CR and 13 patients (30.3%) had no CR. Global longitudinal strain was 10 [7–12] %, Δ indexed flow rate was 25 [3–38] ml/m2.seg and Δ mean gradient was 10 [3–16] mmHg. By multivariate analysis, moderate/severe functional mitral regurgitation (HR 0.122, 95% CI 0.020–0.759, p=0.024) and AVA (HR 0.606, 95% CI 0.396–0.925, p=0.020 [for each increase of 0.05 cm2]) were the only factors associated with CR. ECV, indexed ECV and positive transmural or mesocardial delayed-enhancement images were not associated with CR in the univariate analysis.

Conclusions
In our study, the absence of moderate/severe functional mitral regurgitation and AVA were predictors of CR on DSE in patients with LFLG-AS. As AVA was smaller in patients with CR, our finding contradicts the hypothesis that more severe aortic stenosis could also contribute to the lack of CR. Other possible factors that are surrogate of myocardium fibrosis, as ECV, indexed ECV and positive delayed-enhancement images, were not associated with the absence of CR.

Acknowledgement/Funding
FAPESP
P6501Recurrent genetic aberrations in bicuspid aortic valve disease patients with isolated severe aortic regurgitation
Authors: Wang Y , Wu B , Li J , Wang C , Shu X , Ge J 
Published: October 2019

Abstract

Background
The etiology of bicuspid aortic valve disease (BAVD) is still unclear. Recent studies have demonstrated elevated prevalence of genetic defects in BAV patients with root phenotype, which includes aortic regurgitation and root-predominant dilatation.

Purpose
The present study intended to illustrate the feature of genetic defects among early-onset BAV patients with isolated severe aortic regurgitation.

Methods
From June 2015 to December 2017, whole exome sequencing was performed upon 27 BAVD patients with isolated severe aortic regurgitation under 45 years in our institution. Patients were categorized into right-left (R-L, n=16) and non-RL (n=11) cusp fusion types, and those with complex cardiac defects were excluded from the present study.

Results
Among 27 patients with a median age of 30.5 (18–44) years, only one was female with a rare left-non-coronary cusp fusion type. The prevalence of root phenotype was markedly higher in RL patients (56.3% vs 9.1%, p=0.018). In RL patients, the numbers of rare genetic variants (RGVs) were 15 in extracellular matrix genes, 8 in TGF-β signaling pathway genes, 2 in smooth muscle cell contraction apparatus genes, and 3 in familiar BAV related genes. In non-RL patients, the number of RGVs were 15, 3, 4, and 5, respectively. On the other hand, the number of RGVs in above gene clusters were 9, 6, 3, 2 in patients with a root phenotype, and 21, 5, 3, 6 in those without. Eight recurrent genetic variants were identified in 6 genes (see Table). An interesting observation was that ADAMTS2 variants were exclusively found among non-RL patients without root phenotype, as FBN2 variants among RL patients with root phenoype.
Recurrent Rare Genetic Variants Gene Reference sequence Variant 1000G 1000G-East Asia Patients TGFBR2 NM_001024847.2 p.Val216Ile/c.646G>A 0.004 0.018 A16, A23 TGFBR2 NM_001024847.2 p.Thr340Met/c.1019C>T 0.003 0.015 A03, A05, A07 ADAMTS2 NM_014244.4 p.Gly1169Val/c.3506G>T 0.0044 0.021 A03, A15 FBN2 NM_001999.3 p.Gly475Val/c.1424G>T 0.0004 0.002 A19, A24 ELN NM_001278939.1 p.Pro93Leu/c.278C>T 0.0014 0.0069 A22, A26 COL4A5 NM_033380.2 p.Gly953Val/c.2858G>T 0.0079 0.03 A11, A17 MYLK NM_053025.3 p.Ser243Trp/c.728C>G 0.0002 0.001 A01, A02 MYLK NM_053025.3 p.Asp717Tyr/c.2149G>T 0.0024 0.011 A04, A21

Conclusion
Recurrent genetic variants could be identified in a cohort of early-onset BAVD patients with isolated severe aortic regurgitation and staggering male predominance. The incidence and clinical relevance of these variants should be validated in an extended real-world BAV cohort.