bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1954Prognostic value of the CHADS2 score for adverse cardiovascular events in acute myocardial infarction patients without atrial fibrillation: J-MINUET Substudy
Authors: Motozato K , Sakamoto K , Tsujita K , Nakao K , Ozaki Y , Kimura K , Ako J , Noguchi T , Suwa S , Fujimoto K , Nakama Y , Nishimura K , Miyamoto Y , Ogawa H , Ishihara M 
Published: October 2019

Abstract

Background
The CHADS2score has mainly been used to predict the likelihood of cerebrovascular accidents in patients with atrial fibrillation. However, increasing attention is being paid to this scoring system for risk stratification of patients with coronary artery disease. We investigated the value of the CHADS2 score in predicting cardiovascular events in Japanese acute myocardial infarction (AMI) patients without atrial fibrillation.

Methods
To elucidate the prognostic value of CHADS2score in AMI patients, we analysed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3,283 AMI patients, who were hospitalized within 48-hours of onset from July 2012 to March 2014. We calculated the CHADS2 scores for 3,044 patients without clinical evidence of atrial fibrillation. The presence of heart failure was substituted by Killip classification>2 on admission. Clinical follow-up data was obtained for 3 years. In addition to the in-hospital mortality,we evaluated cardiovascular events, defined as all cause deathor non-fatal MI during 3-year follow up periods.

Results
In this study, enrolled patients were classified into low- (point 0–1), intermediate- (point 2–3), and high-score (point 4–6) groups by calculating CHADS2 score. Overall patients with low, intermediate and high score were divided into 1,395, 1,393 and 256 patients, respectively. In-hospital mortality among low, intermediate, and high score groups were 2.8%, 7.4% and 14.8%, respectively (P<0.001). The incidence of cardiovascular eventsamong low, intermediate, and high score groups were 7.8%, 16.3%, 29.3%, respectively (P<0.001). Kaplan-Meier analysis showed a significant difference between the groups (Figure). The event rates were significantly higher in both high score and intermediate score group than in low score group (P<0.001). Multivariate Cox hazard analysis identified CHADS2 score (per 1 point) as an independent predictor of cardiovascular events in addition to chronic kidney disease and lower body mass index. (hazard ratio, 1.344; 95% CI, 1.239–1.459; P<0.001). Among the factors constituting CHADS2 score, heart failure and age were identified as independent predictors for in-hospital mortality. With respect to the cardiovascular event during 3 years, heart failure, age, and previous stroke were revealed as significant independent predictors.

Conclusion
This large cohort study indicated that the CHADS2 score is useful for the prediction of in-hospital mortality and the cardiovascular events during 3-year follow up in Japanese AMI patients without atrial fibrillation.
P1960Endothelial progenitor cells are associated with cardiovascular outcome in patients with peripheral artery disease
Authors: Pesau G , Hoebaus C , Zierfuss B , Koppensteiner R , Schernthaner G H 
Published: October 2019

Abstract

Background and introduction
Endothelial dysfunction and associated cells are an important cornerstone in the development and progression of peripheral artery disease (PAD). Endothelial progenitor cells (EPC) are released from the bone marrow and have exhibited the potential for cardiovascular repair. Higher EPC levels have been linked to longer event-free survival in coronary artery disease. Similar evaluation of EPC on mortality in PAD is lacking.

Purpose
The current study aimed to evaluate the possible association between EPC levels and mortality in PAD patients.

Methods
EPC were measured in 367 PAD patients (age 69.22±10.3, 66.5% male, Fontaine stage I-II) by flow cytometry using the cell surface marker CD34+ and CD309+. Patients were followed for seven years to assess all cause and cardiovascular mortality. Patients were categorized into quartiles according to EPC levels for further analyses. Statistics included Kaplan-Meier and Cox regression.

Results
89 patients died over the observation period. ICD-codes indicated a cardiovascular cause in 58 patients. The group with the highest count of EPC showed a trend towards higher all-cause mortality (p=0.070) and a significant association with cardiovascular mortality (p=0.002). Multivariable adjustment for age, c-reactive protein, systolic blood pressure, renal function (creatinine and urinary albumin), low density lipoprotein cholesterol, HbA1c, and smoking status revealed the EPC quartile to be an independent risk factor for cardiovascular mortality (p=0.016).

Conclusion
Increased levels of CD34+CD309+ cells are independently associated with long-term cardiovascular mortality in PAD patients.
P1967Impact of strut thickness, of number of crown and connectors on clinical outcomes on patients treated with second generation DES
Authors: Gatti P , Iannaccone M , Barbero U , Bassignana A , Gallo D , De Benedictis M , Helft G , Morbiducci U , D'Oronzo B , D'Ascenzo F , Giustetto C 
Published: October 2019

Abstract

Introduction
In new generation drug eluting stents (DESs) era, the impact of stent geometry on freedom from recurrent events has been poorly explored. Impact of struts thickness, number of crowns and connectors on clinical outcomes was evaluated in the present study.

Methods
Randomized controlled trials comparing last generation DESs were selected. The primary endpoint was the rate of target lesion revascularization (TLR), while secondary was Definite Stent Thrombosis (ST).

Results
53 studies with 52006 patients were included. A struts thickness ≤81 nm was associated with a lower incidence of TLR (2.9%: 2.4–3.4 vs. 3.6%: 3.0–4.3) and ST (0.8%: 0.6–1.1 vs. 1.3%: 0.9–1.8). A mean number of connectors >2.5 was also associated with a lower incidence of TLR (3.2%: 2.8–3.6 vs. 3.5%: 2.9–4.2) and ST (1.0%:0.8–1.3 vs. 1.3%: 0.9–1.7 vs for ST). On the other hand, stents with average number of crowns <7.5 did not perform better than stents with higher average number of crowns.

Conclusions
The findings of the study support that lower struts thickness and higher numbers of connectors have a positive clinical outcome reducing stent thrombosis and target lesion revascularizations, while the average number of stent crowns plays a secondary role.
P2240CTA derived plaque characteristics and cardiac events in deferred lesions by invasive FFR
Authors: Motoyama S , Sarai M , Kawai H , Miyajima K , Muramatsu T , Takahashi H , Naruse H , Ishii J , Ozaki Y 
Published: October 2019

Abstract

Background
Fractional flow reserve (FFR) based strategy for coronary artery disease (CAD) is widely accepted. However, cardiac events could occur at deferred lesions after FFR. We previous reported that CT derived high risk plaque (HRP) and residual stenosis were the independent predictors of cardiac events.

Purpose
The purpose of this study was to investigate if plaque characteristics on CTA could predict cardiac events in deferred lesions after FFR.

Methods
We included 211 vessels of 193 patients who were deferred revascularization after CTA and invasive FFR. The presence of HRP and the stenosis grading on CTA were analyzed.

Results
Median follow-up period after CTA was 623 days (IQR 302–945). HRP and obstructive stenosis were detected in 58 (27.5%) and 87 (41.2%) lesions, respectively. Cardiac events were occurred in 10 lesions at 440±167 days in average (range: 150–770 days). Multivaliate cox hazard regression analysis revealed that HRP (HR8.01, p=0.0032) and obstructive stenosis with ≥70% (HR 34.93, p<0.0001) were the independent predictors of cardiac events after adjusted for age, sex, and FFR≤0.8. Of 21 lesions with both HRP and obstructive stenosis, 29% lesions resulted in cardiac events in 2 years.

Conclusions
Even in the deferred lesions by invasive FFR, lesions with HRP and obstructive stenosis showed high rate of cardiac events. These lesions should be treated with intensive medical therapy to prevent cardiac events.
P2246Maternal and foetal outcomes of anticoagulation in pregnant women with preconception venous thromboembolism
Authors: Soegaard M , Skjoth F , Nielsen P B , Beyer-Westendorf J , Larsen T B 
Published: October 2019

Abstract

Background
Anticoagulation is essential to prevent recurrent venous thromboembolism (VTE) during pregnancy in women with a history of preconception VTE. However, information on the safety of anticoagulant drugs in this setting is limited.

Purpose
To investigate the risk of maternal and foetal adverse outcomes associated with anticoagulant exposure during pregnancy.

Methods
Nationwide cohort of all pregnant women in Denmark with preconception VTE, 2000–2017. We linked individual-level data from nationwide registries on anticoagulant exposure, maternal and foetal outcomes.

Results
Among 5,099 pregnancies in 3,246 women with preconception VTE (mean age 31 years, 41% nulliparous), 36.4% were exposed to anticoagulants during first trimester (66.4% low-molecular-weight heparin (LMWH), 31.9% VKA, and 1.8% NOAC (Table). No maternal deaths occurred. Maternal outcomes were comparable among LMWH and unexposed women, whereas recurrent VTE and foetal loss was more prevalent in VKA and NOAC exposed women. Foetal risk was lowest in unexposed and LMWH exposed, whereas preterm birth was prevalent in VKA and NOAC exposed.
Table 1. Maternal and foetal outcomes in pregnant women with preconception VTE according to first trimester anticoagulant exposure Maternal outcomes No anticoagulants LMWH VKA NOAC Total pregnancies/singleton foetuses, N 3,244/2,722 1231/1,124 591/442 33 /26 Recurrent VTE, % (N) 2.7 (89) 3.3 (41) 6.4 (38) – (<5) Antenatal bleeding, % (N) 2.3 (73) 2.7 (33) 1.5 (9) 0 Preeclampsia, % (N) 3.0 (98) 2.1 (26) 4.4 (26) – (<5) Foetal loss, % (N) 13.4 (436) 6.6 (81) 22.2 (131) 21.2 (7) Foetal outcomes in live singleton births, except stillbirth   Stillbirth, % (N) 0.6 (17) 0.6 (7) – (<5) 0   Mean gestational age, days/birthweight, gram 246/3,458 246/3,471 238/3,212 243/3,138   Preterm birth (<37 weeks), % (N) 41.1 (1,111) 38.3 (428) 63.2 (277) 57.7 (15)   Very preterm birth (<28 weeks), % (N) 0.9 (24) 1.3 (14) 2.7 (12) 0   Small for gestational age, % (N) 4.2 (109) 4.5 (49) 4.8 (20) – (<5)   Mean 5-minute Apgar score, (sd) 9.8 (0.8) 9.8 (0.7) 9.8 (1.0) 9.7 (1.0)   Congenital defects 8.4 (226) 9.0 (100) 10.0 (44) – (<5) Counts are supressed in cells with <5 observations to prevent disclosure of potentially identifiable information.

Conclusion
Our findings are reassuring and in support of the recommendation of LMWH for pregnant women with prior VTE. Few women were exposed to NOAC during pregnancy, and the safety of NOACs cannot be substantiated with the current level of evidence.

Acknowledgement/Funding
The Obel Family Foundation partly funded this research by an unrestricted grant.
P2261The impact of a short-term cardiac rehabilitation program on activities of daily living in elderly patients with chronic heart failure
Authors: Paneroni M , Scalvini S , Simonelli C , Rivadossi F , Pavesi C , Rainoldi F , Lovagnini M , La Rovere M T , Ambrosetti M , Pedretti R 
Published: October 2019

Abstract

Introduction
A high proportion of elderly patients with Chronic Heart Failure (CHF) experience dyspnea and fatigue during the activities of daily living (ADLs).

Purpose
We aimed to determine 1) the VO2 peak of some basic ADLs comparing it to VO2 peak at CardioPulmonary Exercise Test (CPET) and 2) the effects of 3-week inpatient cardiac rehabilitation program on ADLs' performance.

Methods
At entry and at the end of a 20-day cardiac rehabilitation program patients performed an ADL-test consisting of five task-related ADL activities and two time-related ADL activities while wearing a metabolimeter mobile device (K5, Cosmed). Task-related activities were: 1) to put on and take off socks, shoes and jacket (ADL 1); 2) to fold eight towels (ADL 2); 3) to put 6 bottles on a shelve (ADL 3); 4) to make a bed (ADL 4); 5) to go up and down 1-floor stairs (ADL 5). Time-related ADL activities were: 1) to sweep the floor for 4 minutes (ADL 6) and 2) to walk for six minute (6MWT). Metabolic load, oxygen uptake, ventilation, heart rate and symptom of dyspnea were computed for each ADL. During the program, patients performed a CPET.

Results
Fifty-six CHF patients [89% men; age 72±6 years; Ejection Fraction (EF) 38±12%; 66% with EF<40%] were enrolled. At entry, the least demanding ADL [expressed as proportion of peak oxygen uptake (VO2 peak) reached at CPET] was ADL 3 with 53,14±18.53%, while the most challenging was the 6MWT with 116.81±34.48%. Forty-two (75%) patients reached the VO2peak of CPET during 6MWT. After rehabilitation, there was a significant decrease in the time required to perform the task-related activities (ADL 1–5) [from 382.25±114.90 to 354.48±116.92 seconds, p=0.0175] and a significant increase in the distance covered during 6MWT [from 421.35±81.64 to 448.84±89.69 meters, p=0.000]. Moreover, following rehabilitation a significant decrease of heart rate in ADL1, ADL 3 and ADL 5 and a significant decrease of dyspnea in ADL 5, ADL 6 and 6MWT was recorded.

Conclusion
A comprehensive cardiac rehabilitation program can improve ADL performance due to the change of some physiological variables during effort. Further studies about the role of dedicated rehabilitation program (i.e. occupational rehab) are necessary.
P2268Incidence and prognostic impact of sepsis in patients with acute myocardial infarction complicated by cardiogenic shock - Results of the CULPRIT-SHOCK study and registry
Authors: Zeymer U , Desch S , Akin I , Ouarrak T , De Waha S , Thiele H 
Published: October 2019

Abstract

Background
Patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) have a high mortality. It has been proposed that one component is a systemic inflammatory response to shock. Some of these patients even develop sepsis. Therefore,we analyzed a large cohort of patients with AMI and CS and sought to determine the incidence of sepsis and its impact on outcome.

Methods
The CULPRIT-SHOCKtrial and registry included 1009 patients with AMI complicated by CStreated with early PCI. In the trial 686 patients were randomized to immediate multivessel PCI or culprit lesion only PCI. In the current subanalysis patients were compared in those developing sepsis during the ICU phase to thosewithout sepsis.

Results
From the total of 1009 patients 103 (10%) developed sepsis. The baseline characteristics and 30-day outcomes are shown in the table.
Sepsis (n=103) No sepsis (n=906) p-value Age (yrs) 68 68 0.8 Women 22.3% 25.3% 0.5 Diabetes 34.3% 29.7% 0.3 GFR <60 ml/min 5.8% 6.4% 0.8 CPR 54.4% 54.2% 0.8 Lactat >5 mmol/l 54.2% 50.8% 0.6 Mechanical support device 35.0% 29.1% 0.2 Bleeding 28.2% 18.8% 0.02 Need for renal replacement therapy 37.9% 9.6% <0.0001 Mortality 54.4% 45.7% 0.08

Conclusion
About 10% of patients with AMI complicated by CSdevelop sepsis. Sepsis is associated with a higher incidence of the need for renal replacement therapy, bleeding and and a trend towards higher mortality. Therefore,further research is needed to improve outcome of these very high risk patients.
P2275Left-sided deviation and fibrous-fatty infiltration of the right bundle branch in the elderly: implication for transcatheter aortic valve implantation (TAVI) procedure
Authors: Cabrera J A , Porta-Sanchez A , Nunez Pernas D , Rubio J M , Navarro F , Salvador-Montanes O , Macias Y , Nevado-Medina J , Sanchez-Quintana D 
Published: October 2019

Abstract

Introduction
Permanent and irreversible damage to the conduction tissue is one of the most common complications of TAVI. Detailed knowledge of the anatomy of the atrioventricular (AV) bundle is crucial to minimize the potential for injury to the His bundle branch block or complete AV block.

Purpose
Preexisting anatomic location and damage of the right bundle branch (RBB) may have important unrecognized clinical implications.

Methods
The myocardial arrangement and the presence of fibrous and fatty tissue infiltration of the AV conduction axis and right bundle branch were examined by dissection techniques and histological sections in 57 structurally normal human heart specimens (48 males, 77±7 years).

Results
The AV conduction axis enters the AV component of the membranous septum and is encircled by the fibrous tissue of the central fibrous body. The AV bundle is divided in a non-branching portion and a branching portion. After a short distance of the non-branching component along the septal crest, the RBB arises at the end of the branching portion of the conduction axis and is located superficially in the muscular ventricular septum. The RBB takes off from the bundle at the level of origin of the superior fascicle of the left bundle, passing then through the thickness of the ventricular septum to emerge beneath the medial papillary muscle of the tricuspid valve. In 22 hearts (49%) in which we found to have a relatively left-sided deviation of the AV bundle in relation to the interventricular membranous septum the RBB runs intramyocardial along the muscular interventricular septum. In the remaining 51% of the hearts the RBB runs subendocardially in the crest of the interventricular muscular septum. We found connective tissue and fatty infiltration along the right bundle branch in 23 hearts (40%) from its origin to its distal part. A significant correlation was found between age and the presence of RBB fibrosis (85% of hearts from individuals with age >80 years). These 2 conditions may make the RBB very vulnerable to self-expanding aortic valves during or after TAVI (figure).
RBB and its critical region

Conclusions
The presence of an intramyocardial location of the RBB with a lef-sided deviation and the fibro-fatty infiltration found in the mayority of senescent hearts are relevant anatomic determinants that may increase the risk of complete AV block following a TAVI procedure.
P2279First clinical evaluation of subcutaneous implantable cardiac defibrillator in Brugada patients
Authors: Probst V , Clerici G , Babuty D , Badenco N , Marquie C , Leenhardt A , Maury P , Blangy H , Deharo J C , Tfelt-Hansen J , Rudic B , Behar N , Mansourati J , Sacher F , Gourraud J B 
Published: October 2019

Abstract

Background
Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of SCD. While Subcutaneous ICD (S-ICD) is a seductive approach to treat these patients, questions raised on the risk of inappropriate shock in this specific population.

Objective
The aim of this study was to evaluate the safety and the effectiveness of the S-ICD in BrS patients.

Methods
We prospectively enrolled 112 BrS patients implanted with S-ICD in 17 European centers. During the screening at least 2 vectors must be suitable but it was not necessary to check for the suitability of the ECG during sodium channel blocker or exercise test. S-ICD indications follow the current guidelines.

Results
Mean age of patients was 45±13 years, with 95 (85%) males. Implantation was performed in 91 (83%) patients for primary prevention and in 18 (16%) patients for secondary prevention. There is an indication of ICD replacement for 16 patients (14%): 13 lead defect (81%), 1 infection (6%) and 2 ICD end of life (13%). In this cohort, 57 patients (51%) had spontaneous type I BrS, 60 patients (55%) were symptomatic: 10 resuscitated SCD (17%) and 48 (83%) syncope.
Implantation was performed under general anesthesia in 79 patients (71%). The mean operation time was 56±19 min. The lead was placed at the left side of the sternum in 102 patients (92%) and at the right side in 9 (8%). Sensing configuration was the primary vector for 46 patients (41%), secondary vector for 57 (51%) and alternative vector for 9 (8%). No complications occurred during implantation.
During a mean follow-up of 15.6 months (0–39 months), 6 patients (5%) had at least one appropriate shock (n=9). The rate of appropriate shock was 4.5%/y. All the VF episodes were successfully treated with the first shock. One patient had VF ablation for recurrent VF. Among the 6 patients who received an appropriate shock, 3 (50%) were implanted for secondary prevention and 3 (50%) were implanted for primary prevention including 2 patients with a history of syncope and one asymptomatic patient.
Twelve patients (11%) had at least one inappropriate shock (n=22) including 2 patients with respectively 8 and 4 inappropriate shocks due to T-wave oversensing. With the SMART pass system the first patient had no more inappropriate shock for now 2 years. The rate of inappropriate shock was 9%/y. One patient died of myocardial infarction.
Five patients (4%) were hospitalized for complications (4 pocket or scar infections and 1 electrode failure).

Conclusion
Our initial experience showed that S-ICD is efficient to treat VF episode in BrS patients. In this population, the rate of inappropriate shock was 9%/y. In view of these results, S-ICD implantation seems to be efficient to protect BrS patients against SCD.

Acknowledgement/Funding
Investigator-Sponsored Research program, Boston Scientific
P2435Non-invasive thermal imaging identifies left ventricular remodeling in mice
Authors: Brzezinski R Y , Ovadia-Blechman Z , Lewis N , Zimmer Y , Levin-Kotler L , Shaihov-Tepper O , Naftali-Shani N , Tsoref O , Grossman E , Leor J , Hoffer O 
Published: October 2019

Abstract

Purpose
Thermal infrared imaging is a non-invasive tool with the potential to screen physiological processes and diseases. The use of this technique to image internal organs, such as the heart, has not yet been investigated. We aimed to determine the ability of a novel algorithm for thermal image-processing to detect structural and functional changes in a mouse model of cardiac remodeling.

Methods
We randomized 12 male mice (weight 20–25 gr) to treatment with either angiotensin-II (2 mg/kg/day, n=6) or saline (n=6) pump-infusion for 28 days. We measured blood pressure weekly, together with serial trans-thoracic echocardiography studies and histopathological evaluation of the hearts. We captured thermal images with the commercially available FLIR One camera, and processed images by our novel algorithm.

Results
Angiotensin infusion increased blood pressure together with cardiac hypertrophy and fibrosis. Thermal imaging identified an increase in the fraction of the skin heated by the heart in angiotensin-treated mice, at day 28 of the experiment. Thermal image findings were correlated to left ventricular mass and volume by echocardiography (r=0.6, p=0.07 and r=0.8, p<0.01). By thermal imaging, all angiotensin-treated hearts displayed a unique triangle-like shape of heat distribution. This finding was absent in controls, indicating remodeling in the hypertensive heart.
Visual Abstract

Conclusion
Our preliminary findings suggest, for the first time, that a thermal camera with a new image-processing algorithm, identifies cardiac structural changes in mice. Our findings propose a new, simple, and non-invasive tool to diagnose and monitor adverse cardiac remodeling.