bluuebunny/crossref_metadata_2025_split huggingface dataset:
P341Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EURObservational Research Programme
Authors: Tilz R , Dagres N , Arbelo E , Blomstroem Lundqvist C H , Pokushalov E , Crijns H J , Kirchhof P , Kautzner J , Temporelli P L , Laroche C H , Pisapia A , Pehrson S , Lip G Y H , Brugada J , Tavazzi L 
Published: October 2019

Abstract

Aims
Great heterogeneity in rhythm control management of patients with atrial fibrillation (AF) has been described. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection.

Methods
Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC-EORP EHRA AFA-LT) Registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC-EORP EHRA AF-Gen) PilotRegistry. Data collection was performed using a web-based system.

Results
In the AFA and in the AFG pilot registries 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger,more commonly male, and had significantly less co-morbidities. Lone AF was predominant in AFA patients who were at lower risk of stroke (CHA2DS2-VASc >5: 2.9% vs. 24.5%, all P<0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P<0.001) but with EHRA scores >1 and more prevalentAF-related symptoms such as palpitations, fatigue and weakness (all p<0.001)as compared to the general AF patients. AFA patients were significantly more often male, had higher LV ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P<0.001 each).

Conclusions
The comparison of the patient chorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and otherwise relatively healthy patients.

Acknowledgement/Funding
Abbott Vascular Int.; Amgen Cardiovascular, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb and Pfizer Alliance
P591Insights from Exercise Cardiac Magnetic Resonance Imaging (ExMR) With Cardiopulmonary Testing in HIV Patients
Authors: Patterson A , Sarode A , Shaver L , Al-Kindi S , Alaiti A , Zullo M Z , Longenecker C , Jenkins T , Rajagopalan S 
Published: October 2019

Abstract

Background
Cardiac magnetic resonance imaging in conjunction with exercise (exMR) and cardiopulmonary testing (CPET) to evaluate cardiopulmonary function has the potential of uncovering poorly understood mechanisms of dyspnea in patients that cannot be otherwise discerned with a single imaging modality.

Purpose
We prospectively evaluated the value of this technique in dyspneic patients with HIV without obvious cardiopulmonary etiologies to comprehensively assess mechanisms of dyspnea.

Methods
Thirty-six HIV patients with dyspnea without obvious cardiopulmonary causes [normal chest x-ray, normal resting LVEF and resting pulmonary artery (PA) pressures <40 mm Hg on echo] and exercise limitation [Modified Medical Research Council (MMRC) dyspnea scale >2] underwent testing using a novel combined exMR/CPET platform (Figure 1). Resting and exercise magnetic resonance imaging (MRI), including flow velocities across the pulmonary artery together with CPET was evaluated at pre and post peak stress. We analyzed the correlation between CPET and MRI pre and peak exercise variables.

Results
The mean age was 51 years; 60% were male; and mean absolute CD4 count was 718. Ventilator efficiency at peak exercise (Peak VO2) did not correlate with exMR parameters. Peak VE/VCO2 was negatively associated with peak LV and RV stroke volume (p values 0.002 & 0.005 respectively). There was a positive relationship between peak petCO2and LV cardiac output (p=0.02), peak exercise RV stroke volume (p=0.003), peak exercise LV stroke volume (p=0.02). Absolute CD4 count was positively correlated with post exercise pulmonary artery velocity (p=0.045). We found no correlation between absolute CD8 count and CMR and CPET exercise parameters.
Figure 1. MRI-CPET setting

Conclusion
HIV patients appear to have an impairment of ventilatory efficiency, exemplified by the association of VE/VCO2and PetCO2 with exMR parameters in the context of normal RV/LV contractile reserve and no evidence of Pulmonary arterial hypertension. A combined CPET/exMRI platform may provide new insight into cardiopulmonary function and the factors influencing exercise tolerance in symptomatic HIV patients.

Acknowledgement/Funding
7R01HL125060-03
P593Oxygen sensitive cardiac magnetic resonance in demonstrating myocardial ischaemia of the right ventricle in patients with pulmonary artery hypertension
Authors: Sree Raman K , Stokes M , Shah R J , Walls A D , Steele P M , Burdeniuk C , De Pasquale C G , Celermajer D S , Selvanayagam J B 
Published: October 2019

Abstract

Background
Progressive right ventricular (RV) dysfunction is a natural progression of pulmonary arterial hypertension (PAH) which is associated with adverse clinical outcomes. The main contributor to progressive RV dysfunction is RV ischemia. Oxygen-sensitive (OS) cardiovascular magnetic resonance (CMR) has been used to determine the in-vivo myocardial oxygenation of the left ventricle (LV).

Purpose
The aim of the present study was to (1) Determine the feasibility of RV targeted rest/stress OS-CMR imaging in PAH patients and normal volunteers; (2) To define the presence and extent of RV myocardial ischaemia in patients with known PAH.

Methods
We prospectively recruited 20 patients with right heart catheter proven PAH and 9 normal (NC), age matched controls with no heart disease. The CMR examination involved standard functional imaging and OS-CMR imaging. OS-CMR images were acquired using a T2* sequence at rest and adenosine-induced stress vasodilatation. The RV was divided into 3 segments - RV anterior, RV free-wall and RV inferior. An OS-CMR signal intensity (SI) index (stress/rest signal intensity) was acquired at RV anterior, RV free-wall and RV inferior segments.

Results
All the PAH patients tolerated and completed the adenosine induced stress OS-CMR without any complications or adverse effects. In NC, reliable OS signal intensity changes was only obtained from the RV inferior segment. As RV dysfunction in PAH is a global process, hence this segment was used in both patients and NC for further comparison. RV OS-CMR signal intensity change between rest and stress in the normal volunteers was 17±4% (mean ± SD). 9 out of twenty (45%) of the PAH patients had a mean BOLD signal intensity change of less than 9% (or 2SD different from the mean values in normal volunteers). Overall, RV OS SI index between the PAH patients and controls was 11±9% vs 17±5% (p-value = 0.045) in RV inferior segment.

Conclusion
Pharmacological induced OS-CMR is a feasible and safe technique to identify and study myocardial oxygenation in the RV of PAH patients.
P600CMR Fast-SENC segmental intramyocardial LV strain detects heart disease progression based on ACC/AHA Heart Failure stage before global longitudinal strain or ejection fraction
Authors: Montenbruck M , Kelle S , Esch S , Andre F , Korosoglou G , Steen H 
Published: October 2019

Abstract

Background
Global longitudinal strain has become an alternative to ejection fraction in identifying reduced cardiac function in the left (LV) or right (RV) ventricles. However, these global metrics are not able to characterize patients in which the heart compensates for regional dysfunction. More sensitive metrics are needed to detect subclinical regional dysfunction before cardiac remodeling results in changes in ejection fraction (EF) and global longitudinal strain (GLS). Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to global metrics GLS and LVEF based on modified ACC/AHA Heart Failure Stage that categorized differing levels of structural heart disease for Stage B and C.

Methods
A single center, prospective registry of MRI scans acquired with a 1.5T scanner were evaluated for conventional CMR diagnostics including biventricular EF, volumes and mass. In addition, fSENC scans were acquired and processed with the MyoStrain software to quantify intramyocardial LV & RV strain. Three short axis scans (basal, midventricular, & apical) were used to calculate strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3- & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. All metrics were compared based on ACC/AHA Heart Failure Stage determined by full CMR exam.

Results
A total of 977 scans in 779 patients were included in the study; this population included 210 myocarditis, 46 dilated cardiomyopathy, and 30 ischemic cardiomyopathy cases. Patients had an average (± stdev) age of 55 (17) yrs and BMI of 26 (5) kg/m2; 48% had arterial hypertension, 12% diabetes mellitus, 33% valve disease, 24% cancer, 7% atrial fibrillation, 13% pulmonary disease, 5% left bundle branch block, 35% hypercholesterolemia, and 24% coronary artery disease. Figure 1 shows the relationship between segmental strain, calculated as the percent of normal LV segments (longitudinal & circumferential) based on intramyocardial fSENC <−17%, versus LVEF based on ACC/AHA Heart Failure stage.
Figure 1

Conclusion
Segmental fSENC detects subclinical LV dysfunction well before changes in EF or GLS. Incorporating both longitudinal and circumferential components into segmental fSENC metrics provides an alternative metric that shows consistent changes in heart failure progression irrespective of risk factors or underlying cardiac disease.
P621Variation of global longitudinal strain (2D STE) with passive leg lifting maneuver: a marker of myocardial functional reserve?
Authors: Nobre De Matos Pereira Vieira M J , Campos D , Carrington M , Goncalves L , Teixeira R 
Published: October 2019

Abstract

Introduction
In a normal heart, the passive leg lifting maneuver (LLM) will result in an increase in myocardial contractility, according to the mechanistic concept of the Frank-Starling law. With the progression of myocardial disease this ability is impaired and the myocardial functional reserve (mFR) is reduced (Figure1 – Panel A). The variation of left ventricular global longitudinal strain (as an index of contractile function) with LLM may thus represent a marker of left ventricular mFR.

Purpose
To assess the variation of left ventricular global longitudinal strain (LV GLS) with LLM as a marker of mFR in a healthy population and in patients with myocardial disease (hypertrophic myocardiopathy - HCM and systolic dysfunction patients – SystDysf.

Methods and results
We evaluated the variation of LV GLS by 2-dimensional Speckle Tracking Echocardiography (2D-STE), in response to passive LLM, in a population of 103 individuals (54 healthy individuals, 28 HCM patients and 21 left ventricular SystDysf patients). Clinical, demographic and echocardiographic parameters (including LV longitudinal mechanics obtained with 2D-STE before and after LLM) were described. The population had a mean age of 46±18 years and 55% were women. Increased venous return to the heart during LLM was confirmed by an increase in the maximal diameter of the inferior vena cava (15,1±3,6 vs 20,6±3,8 mm, p<0.001).
There was a significant variation of LV GLS in healthy individuals submitted to LLM (−20,58±3,0 vs −21,5±2,6%, p=0,02, Δ 0,6%, 95% CI 0,1–1,1%). Regarding the HCM and SystDysf groups, no significant change in LV GLS was observed with LLM (−13,2±2,8 vs −12,3±2,9%, p=0,12, Δ +0,6%, 95% CI −1,4 to 0,18% and −10,2±2,5 vs 10,2±2,7%, p=0,79, Δ 0,08%, 95% CI −0,7 to 0,5%, respectively). Figure 1 (Panel B)

Conclusion
To our knowledge, this is the first report describing the use of LV GLS and LLM to assess mFR in this clinical setting. The absolute increase of LV GLS in the healthy population suggests that this may be a reliable method and a sensitive marker to assess the mFR. Conversely, patients with HCM and with SystDysf show poor or no response to the LLM, suggesting, as expected, a low myocardial functional reserve. Given the non-invasiveness and cost-effectiveness nature of this technique, we suggest that this maneuver could pose a feasible way to assess mFR. Further studies are needed to validate this technique and to assess the role of mFR by 2D-STE as a prognostic marker.
P623Regional Longitudinal Strain for Prediction of Left Ventricular Thrombus Formation following Acute Myocardial Infarction
Authors: Olsen F J , Pedersen S , Galatius S , Fritz-Hansen T , Gislason G , Biering-Sorensen T 
Published: October 2019

Abstract

Background
Left ventricular thrombus (LVT) formation is a dangerous complication to acute myocardial infarction (MI).

Purpose
We hypothesized that regional strain impairment was predictive of LVT formation.

Methods
We included 373 prospectively enrolled patients with ST-segment elevation MI treated with primary percutaneous intervention. All patients had an echocardiogram performed a median of 2 days post-MI. Using logistic regression, we investigated the predictive value of left ventricular (LV) speckle tracking, conventional echocardiographic measures and well-known echocardiographic features of LVT formation including LV smoke, aneurysm and valvular regurgitations.

Results
Overall, the mean age was 62 years, 75% were male, 5% had prior MI, and 48% had anterior infarcts. Mean LVEF was 46% and absolute global longitudinal strain (GLS) was 12%.
Of 373 patients, 31 (8%) developed LVT in follow-up echocardiograms. Patients with LVT more frequently had anterior infarcts, prior MI, lower LVEF, lower e', lower GLS and regional strain, and these were all univariable predictors of LVT formation.
In multivariable analysis (including anterior infarcts, prior MI, LVEF, e'), GLS and regional strain remained independent predictors of LVT formation (GLS: OR: 1.17 [1.00; 1.36], midventricular strain: OR: 1.19 [1.03; 1.38], apical strain: 1.12 [1.00; 1.25], p<0.05 for all) (figure)
In a combined diagnostic model, including anterior infarct, impaired LVEF (<42%) and apical strain (<8%), the sensitivity and negative predictive value was 100%, with a specificity and positive predictive value of 38 and 13%, respectively.
Regional strain and risk of LVT

Conclusion
In MI patients, anterior infarct, LVEF and apical strain were strong predictors of LVT formation. Reduced apical strain indicates a markedly increased LVT risk.
P639Benefits and safety of exercise training in patients with severe three coronary vessels disease
Authors: Rojano J , Ilarraza Lomeli H , Garcia Saldivia M , Rius Suarez M , Lopez Garcia A , Perez Gamez J C , Franco Ojeda E , Chavez Dominguez R 
Published: October 2019

Abstract

Background
Coronary heart disease is the leading cause of death in the world. Nowadays, there are still patients with untreatable coronary obstructions and exercise therapy could be an option to improve their quality of life and probably diminish mortality. Cardiac rehabilitation programs are recommended worldwide due its effectiveness and safety. However very high risk patients are often not included.

Purpose
To evaluate the benefit and safety of exercise therapy as a part of a cardiac rehabilitation program in patients with untreatable severe coronary heart disease.

Methods
A cohort of patients with coronary heart disease included in a cardiac rehabilitation program were studied. Those with severe coronary heart disease (Syntax score ≥33, group A) were identified. Patients were stratified using clinical records and cardiopulmonary exercise testing. They trained for 30 minutes, five times a week of aerobic exercise (cycle ergometer) and this therapy was complemented with general strength, coordination, balance and flexibility maneuvers. After twenty exercise sessions, a second cardiopulmonary exercise test was performed. Symptom limited cardiopulmonary exercise testing was undertaken using a ramp Balke protocol and cardiopulmonary variables were recorded. These patients were compared with their counterparts without severe coronary heart disease (Control group, group B). Studied variables were presented as frequencies (%), mean (SD), median (range) as appropriate. Comparisons between groups were made using chi square or paired T test as needed. All p values <0.05 were considered stochastically significant.

Results
From a total of 546 patients, seventy-one had severe coronary heart disease (Syntax score ≥33). There were no significant differences between groups on change of METs value and number of sessions assisted. No major adverse cardiovascular outcome was observed. The percentage of exercise induced arrhythmias was 75% in very high risk group vs 76% in control group, (p>0.05). Results are shown in table 1.
Table 1. Characteristics between groups Patients Group A (n=75) Group B (n=471) p value Assisted training sessions 15±7 14±6 ns Increment in MET (ml/kg/min) 1.32±1.34 1.35±1.56 ns Arrhythmias, n (%) 56 (75) 370 (76) ns Angor/ST depression, n (%) 11 (15) 15 (3) <0.01 Differences in workload (Watts) 20±13 22±13 ns

Conclusion
Exercise training could be performed in an effective and safe manner in patients with very high risk untreated coronary heart disease.
P641Patient characteristics and treatment patterns in patients on lipid-lowering therapies following an acute coronary syndrome in France
Authors: Bruckert E , Desamericq G , Khachatryan A , Ngo P , Gusto G , Sorio Vilela F 
Published: October 2019

Abstract

Background introduction
Many patients, especially those at very high cardiovascular (CV) risk, do not reach low-density lipoprotein cholesterol (LDL-C) targets for at least 2 reasons: they may not receive a sufficiently intensive regimen, and/or they may not adhere to their medication.

Purpose
Describe demographic, clinical characteristics and treatment intensity and adherence in patients on lipid lowering therapies (LLT) following an Acute Coronary Syndrome (ACS) in France.

Methods
Retrospective cohort study on the PGRx (the Pharmacoepidemiologic General Research eXtension program)-ACS dataset in France, with data collected retrospective and prospectively via physicians, prescription records and patient interviews. Patients were accrued prospectively and/or retrospectively by centres from the PGRx Cardiology and General Practitioners networks. We included adult patients (≥18 years) suffering an ACS between 2013 and 2016 who received LLT at or within 92 days of their ACS hospital discharge. Follow-up was censored at time of new CV event, death, lost to follow-up or interview date (mean duration 12.4 months). Outcomes of interest included LLT intensity (high, moderate and low intensity statins with or without ezetimibe) and adherence measured as proportion of days covered (PDC).

Results
2695 eligible patients were included (77% men); mean age (SD) 63.1 (12.8), 18% had diabetes mellitus, mean (SD) LDL-C 112.1 (46.4) mg/dl. Treatment with LLT at discharge is summarised in table below. Age and baseline LDL-C were drivers of treatment intensity with higher proportion of patients on high intensity statins in younger patients and in those with higher baseline LDL-C. Overall 70% of patients were adherent (PDC≥80%). Patients on moderate intensity were more adherent (76%) than those on low (63%) or high intensity statins (67%).
Treatment patterns with LLT after an ACS LLT following ACS N (%) PDC at 1 year, Mean (SD) Adherent, N (%) Not Adherent, N (%) Ezetimibe 34 (1.3%) 82.8% (31.3%) 26 (76.5%) 8 (23.5%) Low intensity statins 64 (2.4%) 74.8% (33.8%) 40 (62.5%) 24 (37.5%) Moderate intensity statins 993 (37.1%) 82.0% (30.9%) 751 (75.6%) 242 (24.4%) High intensity statins 1515 (56.6%) 74.6% (36.2%) 1007 (66.5%) 508 (33.5%) Statin + ezetimibe 59 (2.2%) 75.9% (34.7%) 40 (67.8%) 19 (32.2%) Overall 2695 (100%) 77.6% (34.3%) 1871 (69.9%) 807 (30.1%)

Conclusion(s)
Our data show a substantial proportion of patients in France are not treated with high intensity statins after an ACS despite guidelines recommendation. Adherence to LLT is acceptable in patients after an ACS although it appears to worsen when high intense statins are used

Acknowledgement/Funding
Study has been funded by Amgen GmbH
P649Validation of clinical diagnostic criteria of familial hypercholesterolemia in Japan: evidence from a comprehensive genetic analysis
Authors: Tada H , Okada H , Nomura A , Nohara A , Kawashiri M , Takamura M 
Published: October 2019

Abstract

Background
Although awareness of familial hypercholesterolemia (FH) is increasing, this common, potentially fatal, treatable condition remains underdiagnosed. Japanese clinical diagnostic criteria of FH include LDL cholesterol level ≥180 mg/dl, Achilles tendon thickness (ATT) ≥9.0 mm, and family history of FH or premature coronary disease. Despite FH being a genetic disorder, genetic testing is rarely used, few data exist regarding the validation of those criteria, especially, by studies using comprehensive genetic analyses.

Methods
This study included 680 subjects (344 men, mean LDL cholesterol = 175 mg/dl) who underwent the full assessments for FH, including LDL cholesterol measurement, Achilles tendon X-ray, investigations for family history, and comprehensive genetic analyses on FH-associated genes (LDL receptor, PCSK9, APOB, and LDLRAP1) in our University Hospital since 2006 to 2018. The area under curve (AUCs) of receiver-operating characteristic (ROC) curve analyses predicting FH-mutation positive were compared among those determined by each component.

Results
ROC analyses revealed the optimal cutoff LDL cholesterol value for predicting the presence of FH-mutation was 181 mg/dl, and that of ATT was ≥7.0 mm. AUCs of each component (ATT, LDL cholesterol, and family history) were 0.827, 0.889, and 0.906, respectively, and the combination of all components increased it to 0.975. When adopting ATT ≥7.0 mm as one of the clinical diagnostic criteria, 13 individuals (2%) were newly classified as true-FH, whereas, 27 (4%) individuals were newly misclassified as FH.

Conclusion
The current Japanese clinical diagnostic criteria of FH were pretty well validated in our independent cohort. However, the threshold of ATT could be lowered to 7.0 mm to raise the sensitivity of its criteria.