bluuebunny/crossref_metadata_2025_split huggingface dataset:
4971Blood viscosity and its relevance to the diagnosis and management of pulmonary hypertension: a new elephant in the cathlab
Authors: Kempny A , Dimopoulos K , Fraisse A E , Diller G P , Price L C , Rafiq I , McCabe C , Wort S J , Gatzoulis M A 
Published: October 2019

Abstract

Background
Pulmonary vascular resistance (PVR) is an essential parameter assessed during cardiac catheterization. It is used to confirm pulmonary vascular disease, to assess response to targeted pulmonary hypertension (PH) therapy and to determine the possibility of surgery, such as closure of intra-cardiac shunt or transplantation. While PVR is believed to mainly reflect the properties of the pulmonary vasculature, it is also related to blood viscosity (BV).

Objectives
We aimed to assess the relationship between measured (mPVR) and viscosity-corrected PVR (cPVR) and its impact on clinical decision-making.

Methods
We assessed consecutive PH patients undergoing cardiac catheterization. BV was assessed using the Hutton method.

Results
We included 465 patients (56.6% female, median age 63y). The difference between mPVR and cPVR was highest in patients with abnormal Hb levels (anemic patients: 5.6 [3.4–8.0] vs 7.8Wood Units (WU) [5.1–11.9], P<0.001; patients with raised Hb: 10.8 [6.9–15.4] vs. 7.6WU [4.6–10.8], P<0.001, respectively). Overall, 33.3% patients had a clinically significant (>2.0WU) difference between mPVR and cPVR, and this was more pronounced in those with anemia (52.9%) or raised Hb (77.6%). In patients in the upper quartile for this difference, mPVR and cPVR differed by 4.0WU [3.4–5.2].
Adjustment of PVR required

Conclusions
We report, herewith, a clinically significant difference between mPVR and cPVR in a third of contemporary patients assessed for PH. This difference is most pronounced in patients with anemia, in whom mPVR significantly underestimates PVR, whereas in most patients with raised Hb, mPVR overestimates it. Our data suggest that routine adjustment for BV is necessary.
4974Waitlist outcomes for Eisenmengers patients listed for bilateral sequential lung transplant or heart-lung transplant
Authors: Kearney K , Bart N , Khush K , Hayes D , Keogh A 
Published: October 2019

Abstract

Background
Eisenmenger's syndrome (ES) is the end-stage of a longstanding intracardiac shunt, commonly an atrial septal defect (ASD) or ventricular septal defect (VSD). Transplantation is the final option to address the pulmonary hypertension and right heart failure that results. Both combined heart-lung (HLTx) and bilateral sequential lung transplantation (BSLT) have been performed for ES. Overall, BSLT are performed more commonly than HLTx because of donor organ availability. We postulated that ES patients would have higher waitlist mortality and longer time to transplant compared to patients listed for other indications, and BSLT patients would have reduced waitlist mortality and reduced time to transplant compared to HLTx based on availability.

Aim
This study compared waitlist outcomes between ES ASD, ES VSD and all patients listed for BSLT or HLTx.

Methods
We analysed the Organ Procurement and Transplant Network (OPTN) database for all patients listed for BSLT or HLTx between October 1, 1987 and March 31, 2018. Mood's median test was used for all tests of significance.

Results
Table 1 summarises the results of the analysis. A total of 56,698 patients were on the waitlist for BSLT for all aetiologies, which included 176 ES ASD patients and 156 ES VSD patients. A total of 3231 patients were on the waitlist for HLTx for all aetiologies, which included 89 ES ASD and 176 ES VSD patients. Median time to transplant was significantly longer for all ES patients on the waitlist for BSLT or HLTx compare to patients listed for other indications. Comparing time to transplant for BSLT to HLTx for either ES ASD or VSD did not reach statistical significance. Waitlist mortality was substantially higher for all ES patients regardless whether they were listed for BSLT or HLTx compared to patients listed for other indications.
Table 1 ES ASD ES VSD All patients BSLT HLTx BSLT HLTx BSLT HLTx Total number of patients listed 176 89 156 176 56698 3231 Transplanted 58 (33.0%) 38 (42.7%) 41 (25.8%) 78 (44.3%) 36441 (64.3%) 1229 (38.0%) Median time to transplant in days 330 (24 to 2723)* 431 (11 to 4527)$ 517 (10 to 2345)# 292 (16 to 2399)& 99 (0 to 6592) 174 (0 to 3606) p=0.54 p=0.08 *p≤0.001, #p=≤0.0001 $p=0.000, &p=0.003 Wait list mortality 27 (15.3%) 25 (28.1%) 23 (14.5%) 46 (26.1%) 2366 (4.2%) 371 (11.5%)

Conclusion
Our analysis identified longer waitlist time and higher mortality for all ES patients listed for BSLT or HLTx in the United States. These findings indicate current listing methods and prognostication place the ES population at disadvantage for thoracic transplantation.
4975Efficacy of pulmonary hypertension-targeted drugs for severe chronic thromboembolic pulmonary hypertension
Authors: Inami T , Kataoka M , Itoh J , Takeuchi K , Kikuchi H , Goda A , Soejima K , Satoh T 
Published: October 2019

Abstract

Background
High pulmonary vascular resistance (PVR) is a risk factor for reperfusion pulmonary edema by balloon pulmonary angioplasty (BPA). It has not been clarified whether improvement of hemodynamics by pulmonary hypertension (PH)-targeted drugs before BPA session is effective clinically. Severe chronic Thromboembolic pulmonary hypertension (CTEPH) patients have small vessel disease like pathological findings of idiopathic pulmonary arterial hypertension.

Objectives
The purpose of this study was to investigate the efficacy of PH-targeted drugs for patients with CTEPH before BPA.

Methods
This study included consecutive 147 CTEPH patients treated with PH-targeted drugs before BPA. All patients were divided into 2 groups such as severe group (PVR >12.5 wood units) and non-severe group (PVR <12.5 wood units).
PVR were compared between baseline and after treated with PH-targeted drugs. All data were expressed by median [25thpercentile-75thpercentile].

Results
The median age and male were 66 [53–74] years old and 42. Numbers of patients treated with phosphodiesterase V inhibitors, endothelin receptor antagonists and riociguat were 84 (57%), 92 (63%), and 43 (29%), respectively. PVR significantly decreased after treated with PH-targeted drugs in two groups (severe group: 16.3 [13.7–20.0] to 10.0 [7.2–13.3] wu, P<0.0001; non-severe group: 6.8 [4.9–8.9] to 5.7 [3.5] to 7.8, P<0.001). Changes of PVR in severe group were significantly larger than in non-severe group (−6.9 [−8.5 to −3.2] vs. −0.7 [−2.4 to 0.7], P<0.0001).
There was no significant difference in efficacy of BPA and numbers of dilated vessel between two groups (severe vs. non-severe group after BPA; PVR: 2.7 [1.9–3.5] vs. 2.1 [1.7–3.1] wu, P>0.05; numbers of dilated vessel: 18 [14–21] vs. 16 [10–21], P>0.05)

Conclusions
PH-targeted drugs may improve hemodynamics for severe CTEPH more effectively.
5033Effect of intraoperative hybrid surgery on incidence of CPB-AKI in children Congenital heart disease patients: a propensity score matched study
Authors: Guo S , Liu J , Duan X 
Published: October 2019

Abstract

Objective
Cardiopulmonary bypass-associated acute kidney injury (CPB-AKI) is a frequent complication after cardiac surgery in children patients. Intraoperative hybrid cardiac surgery (IPH) is a new technique which needed contrast administration. Contrast was also reported to induce AKI. Therefore, we hypothesized that the IPH would increase the occurrence of CPB-AKI in children Congenital heart disease patients.

Methods
A total of 1509 consecutive patients (age≤3 year) undergoing on-pump cardiac surgery were enrolled in this study from November, 2017 to May, 2018. Multivariate logistic regression was performed in this retrospective study. Propensity score matched analysis was applied for confounding factors. Perioperative and interoperative characteristics and outcomes in IHP group with or without AKI are compared. CPB-AKI was determined by serum Creatinine (SCr) increased twice as much as preoperative or need dialysis within 7 days postoperatively.

Result
IPH was found to be an independent risks factor in the development of CPB-AKI development (OR 2.798, 95% CI 1.823–4.296, p<0.001). Other independent risk factors for CSA-AKI were: CPB time >100 min (OR 2.068, 95% CI 1.521–2.811, P<0.001), weight≤5 kg (OR 3.409, 95% CI 2.192–5.302, P<0.001). Cohort analysis revealed that AKI occurred more frequently in the IPH group before and after matching (30.4% vs. 12.97%, P<0.001; 32.2% vs. 18.3% %, P=0.015, respectively). IPH group also had higher prolonged length of postoperative stay in the hospital (11 vs 7.5, P<0.001; 10.9 vs 7.7, p=0.01), and higher length of mechanical ventilation support (27 vs 10, P<0.001; 26 vs 16, <0.001) before and after matching. Perioperative and interoperative characteristics and outcomes of patients with or without AKI are compared. Only CPB duration was an independent factor for AKI in IPH group.
Comparison of outcomes Variablesa Without PSM PSM IPH group (n=128) No IPH group (n=1381) P IPH group (n=117) No IHP group (n=117) P Median LOSPHOS (days) 11 (8.0, 13.0) 7.4 (6.5, 10.6) <0.001d 11.0 (8.0, 13.0) 7.5 (6.5, 14.7) <0.001d Median LOSMV (hours) 27 (19.0, 71.0) 10 (5, 24) <0.001d 27.0 (18.0, 71.0) 17 (3.0, 49.0) <0.001d Overall mortality n (%) 0 (0%) 14 (1.0%) 0.252c 0 (0%) 2 (1.7%) 0.156c Dialysis, n (%) 3 (2.4%) 23 (1.6%) 0.573c 3 (2.6%) 6 (2.6%) 1.000c AKI, n (%) 39 (30.4%) 176 (12.7%) <0.001b 37 (31.6%) 21 (17.9%) 0.015b aLOSPOHOS: length of postoperative stay in hospital; LOSMV: length of mechanical ventilation; CPB: cardiopulmonary bypass. bχ2 test. cFisher's exact test. dRank sum test.
Study flow

Conclusion
IPH was associated with a higher incidence of CPB-AKI.
5105A deep neural network predicts atrial fibrillation from normal ECGs recorded on a smartphone-enabled device
Authors: Galloway C , Treiman D , Shreibati J , Schram M , Karbaschi Z , Valys A , Albert D , Stavrakis S 
Published: October 2019

Abstract

Background
Electrocardiographic predictors of atrial fibrillation (AF) from a non-AF ECG–such as p wave abnormalities and supraventricular ectopy–have been extensively documented. However, risk prediction tools for AF utilize little if any of the wealth of information available from the ECG. Better AF prediction from the ECG may improve efficiency of screening and performance of AF risk tools. Deep learning methods have the potential to extract an unlimited number of features from the ECG to improve prediction of AF.

Purpose
We hypothesize that a deep learning model can identify patterns predictive of AF during normal sinus rhythm. To test the hypothesis, we trained and tested a neural network to predict AF from normal sinus rhythm ambulatory ECG data.

Methods
We trained a deep convolutional neural network to detect features of AF that are present in single-lead ECGs with normal sinus rhythm, recorded using a Food and Drug Administration (FDA)-cleared, smartphone-enabled device. A cohort of 27,526 patients with at least 50 ECGs recorded between January 7, 2013, and September, 19, 2018, and the FDA-cleared automated findings of Normal and Atrial Fibrillation associated with those ECGs, were used for model development. Specifically, we trained the deep learning model on 1,984,581 Normal ECGs from 19,267 patients with 1) only Normal ECG recordings, or 2) at least 30% ECGs with AF. Of the 27,526 patients, an internal set of 8,259 patients with 841,776 Normal ECGs was saved for testing (validation).

Results
Among 8,259 patients in the test set, 3,467 patients had at least 30% of their ECGs with an automated finding of AF. When the deep learning model was run on 841,776 Normal ECGs, it was able to predict whether the ECG was from a patient with no AF or with 30% or more AF, with an area under the curve (AUC) of 0.80. Using an operating point with equal sensitivity and specificity, the model's sensitivity and specificity were 73.1%. Using an operating point with high specificity (90.0%), the model's sensitivity was 48.0%. When the model was applied to a randomly-selected, broader cohort of 15,000 patients (at least 50 ECGs recorded, any amount of AF), a positive, non-linear relationship between neural network output and AF burden per patient was observed (Figure).
Model Output vs AF Burden Per Patient

Conclusions
A deep learning model was able to predict AF from ECGs in normal sinus rhythm that were recorded on a smartphone-enabled device. The use of deep learning, if prospectively validated, may facilitate AF screening in patients with paroxysmal disease or warn patients who are at high risk for developing AF.

Acknowledgement/Funding
AliveCor
5193Percutaneous coronary intervention provided better result than optimal medical therapy in patients with chronic total occlusion: a metanalysis
Authors: Khanra D , Duggal B , Basu Ray I , Kumar B , Walia R 
Published: October 2019

Abstract

Background
Studies comparing the outcome of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) versus OMT alone in treatment of chronic total occlusion (CTO) are limited by observational design, variable follow up period, diverse clinical outcome, high drop-out and cross-over rate. Prematurely terminated DECISION CTO trail and the promising result of the most recent EUROCTO trial still left the quest unanswered. Previous metanalysis on the present context were restricted to studies with propensity-matched analysis only and did not incorporate the recent randomized trials.

Purpose
This study aims to conduct a meta-analysis of published data of observational as well as randomized studies comparing long term outcomes of PCI+OMT versus OMT alone.

Methods
The present protocol is registered in PROSPERO. PubMed, Embase and Cochrane databases were systematically reviewed. Fourteen studies meeting criteria were included in the meta-analysis. The Cochrane Risk of Bias scale was used to appraise the overall quality of the studies. Revman 5.3 software was used to analyse the data and random-effects model with inverse variance method was undertaken. R packages were used for assessment of bias and metaregression.

Results
Baseline parameters of both the groups were comparable. Major adverse cardiovascular events (MACE) which comprises of cardiac death, myocardial infarction, stroke, and unplanned revascularization [Figure 1] were significantly lower in the PCI+OMT group. (RR: 0.77; 95% CI: 0.61 to 0.97; P≤0.ehz746.00521; I2=85%). High heterogeneity was partially (14%) explained by age factor. However study design, follow up duration, LVEF, presence of TVD did not attribute significantly to heterogeneity, in isolation or any combination in metregression model. All cause mortality and cardiac death [Figure 2, 3 respectively] were significantly lower in the PCI+OMT group (P=0.29, p=0.63, respectively). Myocardial infarction (P=0.25) and stroke rates (P=0.15) were lower in the PCI+OMT group, however they did not reach statistical significance. Unplanned revascularization (of any vessel) showed a higher trend in the PCI+OMT group, without reaching statistical significance (P=0.46, I2=88%).

Conclusion
PCI of CTO is rewarded with better long term outcome, in terms of MACE and all-cause mortality but limited to greater unplanned revascularization.

Acknowledgement/Funding
None
5209Stereotactic radioablation of ventricular tachycardia guided by direct integration of 3D electroanatomic mapping: development and validation of a new method
Authors: Sramko M , Cvek J , Peichl P , Knybel L , Kautzner J 
Published: October 2019

Abstract

Background
Stereotactic body radiotherapy (SBRT) has emerged as a promising bailout therapy for recurrent ventricular tachycardia (VT) in patients with failed radiofrequency catheter ablation. However, SBRT can function only if the ablation target is precisely identified.

Purpose
We sought to develop a novel method for direct integration of electroanatomic mapping (EAM) data to an SBRT work station for radioablation of VT.

Methods
Candidates for SBRT were patients with recurrent, drug-resistant VT who underwent ≥2 previous radiofrequency catheter ablations (CARTO 3, Biosense-Webster, Diamond Barr, CA) and continued to have inducible clinical VT or clinical recurrences of VT. At the end of the last catheter ablation, the operators performed additional EAM to obtain landmarks for image registration: aorta with the ostium of the left main coronary artery or left atrium with ostia of pulmonary veins. Correct position of the catheter at the landmark was verified by intra-cardiac echocardiography. VT substrate–defined by a combination of voltage mapping, pace mapping, and detection of local abnormal ventricular activity and/or late potentials was marked by custom tags as a target for SBRT. The CARTO maps were exported and converted to 3D shells with encoded EAM properties (VTK format). On the following day, the patients underwent contrast-enhanced computer tomography (CT) of the heart. Using 3D Slicer software 4.10 (slicer.org), the EAM-derived anatomical structures with the marked ablation target were projected onto CT images by landmark registration with manual correction. The CT study with the projected contours of the EAM-detected ablation target was imported as a DICOM-RT format into a stereotactic radiotherapy planning work station (Multiplan 3.5, Accuray, Sunnyvale, CA). SBRT was performed using a contemporary radiosurgery system with real-time motion tracking of the ablation target (CyberKnife 8.5, Accuray). The prescribed (X-ray) dose was 25 Gy during a single session.

Results
The proposed work-flow was verified in four patients with structural heart disease and drug-resistant VT who had 2–3 unsuccessful radiofrequency catheter ablations (all males; age: 68–78 years; left ventricular ejection fraction: 20–25%; ischemic/non-ischemic cardiomyopathy: 2/2). Integration of EAM data with CT was achieved in all patients. None of them experienced acute radiotoxicity after SBRT. At a follow-up checkup at one month, three of the patients remained arrhythmia-free. One patient experienced VT recurrence one day after SBRT, but no VTs recurred during the following month of follow-up.
Figure 1

Conclusions
This is the first report demonstrating the feasibility of SBRT of VT guided by direct integration of EAM. The proposed method is best suited as a bailout procedure for patients with previously failed catheter ablation.

Acknowledgement/Funding
M.S. was supported by ESC Research Fellowship 2018
5225Bystander cardiopulmonary resuscitation and survival in out-of-hospital cardiac arrest of non-cardiac origin
Authors: Christensen D M , Rajan S , Kragholm K , Sondergaard K B , Hansen O M , Gerds T A , Torp-Pedersen C , Gislason G H , Lippert F K , Barcella C A 
Published: October 2019

Abstract

Background
Knowledge about the effect of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-cardiac origin is lacking. We aimed to investigate the association between bystander CPR and survival in OHCA of presumed non-cardiac origin.

Methods
From the Danish Cardiac Arrest Registry and through linkage with national Danish healthcare registries we identified all adult patients with OHCA of presumed non-cardiac origin in Denmark (2001–2014). These were categorized further into OHCA of medical and non-medical cause. We analyzed temporal trends in bystander CPR and 30-day survival during the study period. Multiple logistic regression was used to examine the association between bystander CPR and 30-day survival and reported as standardized 30-day survival chances with versus without bystander CPR standardized to the prehospital OHCA-factors and patient characteristics of all patients in the study population.

Results
We identified 10,761 OHCAs of presumed non-cardiac origin. Bystander CPR was associated with an increased 30-day survival chance of 3.4% (95% confidence interval [CI]: 2.9–3.9) versus 1.8% (95% CI: 1.4–2.2) with no bystander CPR, corresponding to a significant difference of 1.6% (95% CI: 0.9–2.3). During the study period, the overall bystander CPR rates increased from 13.6% (95% CI: 11.2–16.5) to 62.7% (95% CI: 60.2–65.2). 30-day survival increased overall from 1.3% (95% CI: 0.7–2.6) to 4.0% (95% CI: 3.1–5.2). Similar findings were observed in subgroups of medical and non-medical OHCA.
Table 1. Patient and arrest characteristics according to cause of out-of-hospital cardiac arrest Overall Medical OHCA Non-medical OHCA Patient characteristics   Total patients 10761 7625 3136   Median age,y 67 70 50   Male, n (%) 6357 (59.1) 4154 (54.5) 2204 (70.4) OHCA factors   Witnessed arrest, n (%) 4306 (40.0) 3574 (46.9) 732 (23.3)   Public location, n (%) 6979 (64.9) 5494 (72.1) 1485 (47.4) OHCA, out-of-hospital cardiac arrest; CPR, cardiopulmonary resuscitation.
Figure 1. Temporal trends

Conclusion
Bystander CPR was associated with a higher chance of 30-day survival among OHCA of presumed non-cardiac origin regardless of the underlying cause (medical/non-medical). Rates of bystander CPR and 30-day survival improved during the study period.
5227Effects of witness status and time to cardiopulmonary resuscitation by emergency medical services on neurological outcomes in out-of-hospital cardiac arrest patients with non-shockable rhythm
Authors: Funada A , Goto Y , Okada H , Maeda T , Takamura M 
Published: October 2019

Abstract

Background
Data on the effects of witness status and time from an emergency call to initiation of cardiopulmonary resuscitation (CPR) by emergency medical service (EMS) providers on neurological outcome in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm according to the first documented rhythm are limited.

Purpose
We aimed to determine the effects of witness status and time from an emergency call to CPR initiation by EMS providers on neurologically intact survival in OHCA patients according to the type of non-shockable rhythm (pulseless electrical activity [PEA] and asystole).

Methods
We analysed the records of 583,431 adult OHCA patients with non-shockable rhythm (191,905 bystander-witnessed arrest and 391,526 unwitnessed arrest). Data were derived from the prospectively recorded All-Japan OHCA registry between 2011 and 2016. Call to EMS-CPR interval was defined as the time from an emergency call to CPR initiation by EMS providers. The primary outcome was 1-month neurologically intact survival (cerebral performance category 1 or 2; CPC 1–2) and secondary outcome was presence of PEA.

Results
The rates of 1-month CPC 1–2 were 1.21% (2,326/191,905) for bystander-witnessed arrest and 0.24% (959/391,526) for unwitnessed arrest. When divided into 4 groups based on witness status and initial documented rhythm, these rates were 2.42% (1,869/77,190) for bystander-witnessed arrest with PEA (group A), 0.40% (457/114,715) for bystander-witnessed arrest with asystole (group B), 1.51% (679/44,926) for unwitnessed arrest with PEA (group C) and 0.08% (280/346,600) for unwitnessed arrest with asystole (group D). Multivariate logistic regression analysis revealed each 1-min delay of Call to EMS-CPR interval to be significantly associated with decreased chances of 1-month CPC 1–2 for groups A, B and D (adjusted odds ratio [OR]: 0.95, 0.91 and 0.96, respectively; 95% confidence interval [CI]: 0.93–0.96, 0.88–0.94 and 0.93–0.99, respectively). However, for group C, there was no significant relationship between these variables (adjusted OR: 1.00; 95% CI: 0.98–1.02). The proportion of PEA was 40.2% (77,190/191,905) for bystander-witnessed arrest and 11.5% (44,926/391,526) for unwitnessed arrest. Multivariate logistic regression analysis revealed that, as Call to EMS-CPR interval lengthened (per 1-min delay), the number of OHCA patients with PEA decreased for bystander-witnessed arrest (adjusted OR: 0.94; 95% CI: 0.93–0.94) and for unwitnessed arrest (adjusted OR: 0.96; 95% CI: 0.96–0.97).

Conclusions
The 1-month CPC 1–2 rate differed by witness status and initial documented rhythm in OHCA patients with non-shockable rhythm. Shortening of Call to EMS-CPR interval is crucial for improving 1-month CPC 1–2 rate and sustaining PEA, particularly in bystander-witnessed arrest.