bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2631Improved attitudes of non-cardiologists towards decreased left ventricular ejection fraction after marking “warning on echocardiography report”
Authors: Chen Q , Lin J , Kang Y , Zhang R , Zhang Q 
Published: October 2019

Abstract

Background
Echocardiography (echo) has become a well-accepted noninvasive examination for patients with confirmed or suspected cardiac structural and/or functional abnormalities, by not only heart doctors but also non-heart doctors. Left ventricular ejection fraction (LVEF) as the most important parameter of cardiac systolic function must be listed on every echo report. A LVEF of <50% has been regarded as LV systolic dysfunction with reduced ejection fraction.

Purpose
This study aimed to test whether a warning label as “reduced LVEF” on echo report would change the attitude or practice with regard to heart failure (HF) diagnosis and treatment in non-heart doctors.

Methods
From January to June, 2018, the program was conducted by adding a warning label as “reduced LVEF” next to the LVEF reading on echo report if it was <50%. The patients with a reported LVEF <50% and an echo request from non-heart doctors (cardiologists or cardiac surgeons) were selected (labeled group, n=359) for analysis, and a similar group of patients from January to June, 2017 were served as controls (unlabeled group, n=367). The rates of HF diagnosis, N-terminal-pro-B-type natriuretic peptide (NT-proBNP) test, cardiologist consultation and anti-HF medical therapy at discharge were compared between the 2 groups.

Results
There were no major differences in baseline characteristics between the 2 groups. The labeled group received more opportunities of cardiologist consultation (53.2% vs. 44.7%, p=0.02) and referral to cardiology outpatient clinic (57.9% vs. 50.1%, p=0.04) when compared with the unlabeled group. However, the difference was mainly found in patients with a LVEF of 40–49% (n=448, 53.2% of the labeled group vs. 44.7% of the unlabeled group, p=0.02). By pooling the data from the labeled and unlabeled groups, the patients who received cardiologist consultation (n=355) had a significant improvement in HF diagnosis and management than those who did not have a chance of cardiologist consultation (n=371), in terms of higher rates of NT-proBNP test (59.6% vs. 80.8%, p<0.01) and standardized anti-HF medication (Renin-anigotensin system inhibitors: 23.7% vs. 37.2%, p<0.01; β blockers: 22.1% vs. 33.8%, p<0.01; mineralocorticoid Receptor Antagonists: 27.5% vs. 35.5%, p<0.01).

Conclusions
An added warning label as “reduced LVEF” on echo report beside the LVEF reading would enhance the awareness of systolic HF and the appropriate management in non-heart doctors, in particular for patients with a LVEF of 40∼49%.

Acknowledgement/Funding
The study was supported by a research grant from the Science and Technology Department of Sichuan Province (project number: 2017SZ0059)
P2642Optimal blood pressure control in relation to target organ physiology in hypertensive men with erectile dysfunction
Authors: Angelis A , Aggeli K , Ioakeimidis N , Dimitroglou Y , Georgakopoulos C , Zisimos K , Aznaouridis K , Krommydas A , Terentes-Printzios D , Verveniotis A , Synodinos A , Gourgouli I , Vlachopoulos C , Tousoulis D 
Published: October 2019

Abstract

Background
Target organ damage (TOD) in essential hypertension relates to an adverse prognosis. Middle aged men are considered a population group where cardiovascular risk typically augments and erectile dysfunction (ED) that frequently accompanies both entities refers to a subclinical vascular damage process.

Purpose
To identify the optimal blood pressure (BP) levels in middle aged hypertensive males with ED in relation to TOD.

Methods
258 ED males (mean age: 56 yo) with essential hypertension under medical treatment enrolled the study. All underwent 2D echocardiography and carotid ultrasound evaluation to determine left ventricular mass index (LVMI) and intima – media thickness (IMT) respectively. Carotid – femoral pulse wave velocity (PWV) and augmentation index (AIx) were also assessed as indices of central vascular stiffness and wave reflection physiology (complior & sphygmocor devices). Office brachial blood pressure (BP) measurements where performed according to the current guidelines and an average of three consecutive values was computed. Erectile dysfunction was assessed by using the SHIM-5 score (range 0–25, lower values display a pronounced dysfunction).

Results
In bivariate analysis brachial systolic blood pressure (bSAP) was positively and strongly associated with LVMI (r=0,6), PWV (r=0,65), AIx (r=0,67, all p<0,001) and IMT (p<0,05, r=0,55). Erectile performance as assessed by the SHIM-5 score was negatively related to PWV, AIX and IMT (r=−0,58, r=−0,45 and r=−0,65 all p<0,001) pointing out the underlying vascular detriment. Interestingly, there were no such correlations regarding the diastolic blood pressure values. Multiple linear regression analysis was performed and the relation of bSAP with LVMI, PWV, AIx and IMT remained significant after adjustment for age, BMI, smoking habits and presence of diabetes mellitus (all p<0,05). We further subdivided our population into three groups according to the values of office bSAP for normal blood pressure (≤129mmHg, n=143,55%), high normal (130–139mmHg, n=59, 23%) and high (≥140mmHg, n=56,22%). In patients with high-normal bSAP, the parameters of PWV and LVMI were significantly higher than in patients with normal BP (independent sample t-test, p: 0,032 and 0,016 respectively). Patients of the high bSAP group as expected, had more extensive cardiac and vascular damage (LVMI, PWV and AIx).

Conclusion
In essential hypertensive middle aged men with erectile dysfunction, guiding therapy toward normal systolic blood pressure values as compared to the high normal benefits target organ physiology. It is clinically important to identify this vascular patients group in order to adjust regimens and further therapeutic strategies.
P2644Coronary atherosclerotic burden and risk of major adverse cardiac events in hypertensive patients with erectile dysfunction
Authors: Ioakeimidis N , Vlachopoulos C , Terentes-Printzios D , Georgakopoulos C , Oikonomou E , Aznaouridis C , Tousoulis D 
Published: October 2019

Abstract

Purpose
Aim of the study is to assess the prevalence of angiographically coronary artery disease (CAD) and the incidence of future cardiovascular (CV) events among hypertensive males with erectile dysfunction (ED) on the basis of calculated total CV risk at first presentation.

Methods
A total of 392 hypertensive ED patients without diabetes or known cardiovascular disease underwent a comprehensive evaluation for presence of target organ damage (TOD) and stratified into three total CV risk categories based on blood pressure (BP) category, CV risk factors, TOD and presence of chronic kidney disease. Total testosterone (TT) and peak systolic velocity (PSV) at penile arteries were measured as markers of ED severity and predictors of CV risk. All patients underwent exercise treadmill test and stress echocardiography to reveal myocardial ischemia. Men with positive one or both of the two tests were referred for coronary angiography in order to document CAD. Our primary outcome was a composite measure which included acute myocardial infarction (AMI), stroke, congestive heart failure, revascularization with either percutaneous coronary intervention or coronary artery bypass graft surgery. All patients were followed from cohort entry until major CV event, or end of study period (December 2018), whichever occurred first.

Results
The whole population was divided into high (n=176), intermediate (n=120) and low (n=96) total CV risk groups. The three groups had similar mean age (57 yrs). The prevalence of angiographically documented CAD was significantly higher among patients in the high risk group (n=32, 18%), compared to intermediate (n=15, 12.5%) and low risk (n=4, 4.1%) (overall P<0.05). Furthermore, there was a progressive decrease in penile PSV and TT levels from low to moderate and high total CV risk (35 vs 31 vs 28 cm/s and 5.1 vs 4.3 vs 3.8 ng/ml, respectively, overall P<0.001), indicating significant microvascular damage and androgen deficiency in men with a higher CV risk category. Interestingly, Kaplan-Meier analysis revealed a comparable incidence of major CV events in patients who were at high and intermediate total CV risk at entry (12.5% vs. 11%, respectively, log-rank =0.57) and a greater incidence of major CV events compared to that of low CV risk patients (3.2%), (log-rank P=0.004, for all comparisons) during a 9-year follow-up period (figure).
CV events during a 9-year follow-up

Conclusion
The incidence of future CV events is considerably high among hypertensive ED patients with a intermediate total CV risk at first evaluation. Such patients may require a comprehensive evaluation to reveal occult CAD and they need an aggressive management of BP and concomitant risk factors to reduce their CV risk and improve their sexual life.
P2648Uncontrolled hypertension is common among patients with implanted pacemaker
Authors: Sharma V , Tasgaonkar M , Abeyratne A 
Published: October 2019

Abstract

Background
Given the significance of hypertension (HTN) as a major risk factor for cardiovascular disease, stroke, HF, and mortality, uncontrolled HTN remains a large public health problem. Pacemaker patients are well trapped in the healthcare system, and hence are expected to have a lower rate of uncontrolled HTN than general HTN patient population. However, incidence of uncontrolled HTN in pacemaker patients is not well characterized.

Purpose
We sought to characterize the prevalence of uncontrolled HTN in pacemaker patients using real-world EHR data.

Methods
Patients who received an implanted pacemaker were identified from a large EHR de-identified database of a cohort of patients with or at risk of cardiovascular disease from 01/2007 to 03/2017. The data were queried to determine prevalence of uncontrolled HTN.

Results
From a total of 11,472,727 patients in the EHR dataset, a total of 140,701 (1.23%) had implanted pacemaker with implant date available. Of these 72,846 (51.8%) had systolic blood pressure (SBP) available within 60 days of device implant. Depending on SBP cut-off, the proportion of patients with uncontrolled HTN ranged from 32.9% (SBP>140 mmHg) to 11.5% (SBP>160 mmHg) at the time of implant. A subset (11,676, 16%) had SBP available at implant and one-year post-implant. At one year time point uncontrolled HTN in these patients ranged from 20.8% (SBP>140 mmHg) to 2.4% (SBP>160 mmHg) (Figure).

Conclusion
A significant proportion of pacemaker patients have uncontrolled HTN at the time of implant. While there is a decline in this proportion at one year, substantial proportion of pacemaker patients remain with uncontrolled HTN. In addition to better guideline directed medical therapy, there may be an opportunity for better monitoring and alternative therapeutic strategies in these patients.

Acknowledgement/Funding
Medtronic Inc.
P2655ST-elevation myocardial infarction in women: a more satisfactory outcome?
Authors: Ferreira J , Freitas F , Ferreira C , Milner J , Alves P , Marinho V , Domingues C , Monteiro S , Baptista R , Goncalves L 
Published: October 2019

Abstract

Background
Despite all the advances registered in the last decade regarding acute myocardial infarction with ST-segment elevation (STEMI) treatment, this entity remains prevalent and highly lethal. Women constitute a lower proportion of STEMI patients, however, they show important differences when compared to men. Thanks to the lower representation of women in STEMI trials, less is know about this patient subpopulation.

Purpose
To determine and understand gender differences in patients admitted with STEMI in a coronary care unit (CCU).

Methods
Observational retrospective study of patients admitted with STEMI in a CCU, between 2006 and 2017. Patients were split between groups according to gender and were assessed in terms of risk factors, diagnosis, treatment, complications and mortality.

Results
A total of 2516 patients were included in the study. 1833 were men (72.9%) and 682 were women (27.1%). Mean age was superior in women (73.3±13.2 vs. 64.1±12.8 years, p<0.001), and displayed a greater cardiovascular comorbidity burden such as hypertension (79.6% vs. 66.2%, p<0.001) and diabetes (55.8% vs. 45.3%, p<0.001). At admission time women registered a higher mean TIMI (2.79 vs. 2.62, p=0.009) and GRACE score (166.3 vs. 146.3, p<0.001) which did not reflect in a higher hospital stay (mean 4.75 vs. 5.29 days, p=0.043). Before admission women were less treated with aspirin (26.4% vs. 33.2%, p=0.014) and statins (36.8% vs. 46.5%, p=0.001). There were no differences regarding access to revascularization (98% vs. 96.5%, p=0.105) but women presented more normal coronary angiographies (10.2% vs. 3.6%, p<0.001). During hospital stay, women evolved more to Killip-Kimball (KK) class III (4.5% vs. 1.9%, p<0.001) and KK class IV (15.9% vs. 11.2%, p<0.001). Intra-hospital (13.9% vs. 8.2%, p<0.001), 1-month (18.4% vs. 13.2%, p<0.001), 6-month (22.2% vs. 16.1%, p<0.001) and 1-year mortality (25.7% vs. 17.8%, p<0.01) was superior in women. After multivariate analysis heart failure on admission (OR 9.2, CI 95% 6.7–12.8), intravenous amiodarone use (OR 3.5, CI 95% 2.5–4.8), diabetes (OR 2.3, CI 95% 1.8–2.8), female gender (OR 1.6, CI 95% 1.3–2.0) and peak serum creatinine during hospital stay (OR 1.7, CI 95% 1.6–1.9) were independent predictors of 1-year mortality. After adjustment for age, diabetes, hypertension, previous acute myocardial infarction and initial KK, female gender maintained its potency as a significant 1-year mortality predictor.

Conclusions
Women presenting with STEMI register poorer outcomes compared to men. In our study, female gender was considered a good independent predictor of short-term and long-term mortality.
P2656Real-world Outcomes for STEMI in octogenarians and nonagenarians: A 5-year review from an Irish primary PCI centre
Authors: Kumar R , Homer C E , Buckley A , Kumar J , O'conner C , Chongprasertpon N , Arnous S , Ullah I , Kiernan T 
Published: October 2019

Abstract

Background
Progress made by modern healthcare has led to improved life expectancy across the globe. This progress, however, also means that individuals are living with more chronic illnesses and co-morbidities than in previous generations. Due to this aging population, we can expect increasing rates of STEMI in octogenarians and nonagenarians in the future. The challenge of older patients with STEMI is that they are particularly high-risk for complications. At present, very little is known about the outcomes of STEMI in the very old population because they were under-represented in previous studies. Many cardiologists around the world have been hesitant in performing primary percutaneous coronary intervention (PPCI) in octogenarians and nonagenarians due to fear of complications and poor outcomes.

Purpose
To review the trend of octogenarians and nonagenarians presenting with STEMI and to assess the 30-day and 1-year mortality rates.

Methods
A single-centre retrospective observational study was conducted. All patients presenting with STEMI between January 2012 and December 2017 were reviewed. Individuals aged 80 years or older were included for the purpose of this analysis. Patient level data was collected by chart review and individuals were identified using the local STEMI database. Standard Bayesian statistics were employed for analysis.

Results
1,268 patients presented with STEMI during this period. 172 (13.6%) were 80 years or older. Of this subgroup, 159/172 (92.4%) were true STEMI (figure 1). 124/159 (77.9%) patients were brought to the catheterization lab and 35/159 (22%) were managed medically on the ward.107/159 (67.29%) were treated with PPCI. Patients in the PPCI group had a 30-day mortality rate of 20.6% while those in the medically managed group had a mortality rate of 37.1%; with a trend towards statistical significance (p=0.07). The one-year mortality rate in patients treated with PPCI was 22.4% which was significantly lower than those who received medical management 48.6% (p=0.005).

Conclusions
This review demonstrates that there is a high mortality rate with STEMI in those aged 80 years or above, however, patients who are treated with PPCI tend to do better and have a significantly lower mortality rate at 1-year. The incidence of STEMI in the very old cohort is likely to continue to rise and this may prove challenging. PPCI remains the most feasible treatment approach towards STEMI and this should not be biased based on age, however, interventionists will need to take into account patient suitability on a case-by case basis. Octogenarians who undergo angiography and PPCI as required have 77.6% survival at 1 year (figure 1) with 92.4% likelihood of going home and don't require long term nursing home care.

Acknowledgement/Funding
University Hospital Limerick
P2657Prognostic impact of skeletal muscle mass in upper and lower extremities in patients with ST-segment elevation myocardial infarction
Authors: Satou R , Akiyama E , Konishi M , Matsuzawa Y , Kimura Y , Okada K , Maejima N , Iwahashi N , Hibi K , Kosuge M , Ebina T , Tamura K , Kimura K 
Published: October 2019

Abstract

Introduction
Sarcopenia, characterized by the loss of skeletal muscle mass and muscle strength, has been demonstrated the importance in cardiovascular diseases including ST-segment elevation myocardial infarction (STEMI). However, there is few data comparing the effects on the prognosis of skeletal muscle mass of upper and lower extremities in STEMI patients.

Purpose
Our purpose was to examine whether skeletal muscle mass of upper and lower extremities affect the prognosis after STEMI.

Methods
A total of 432 patients with STEMI were enrolled in this study. Dual-energy X-ray absorptiometry scan was performed before discharge. Each of upper and lower extremity skeletal muscle masses was indexed by height squared (kg/m2), and divided into two groups using the first quartile value for each sex. All patients were followed up for the primary composite outcome of all-cause death, nonfatal myocardial infarction, nonfatal ischemic stroke, hospitalization for congestive heart failure, and unplanned revascularization.

Results
During a median follow-up of 32 months, 68 patients experienced primary composite outcome. The event rate was significantly higher in patients with low-lower extremity skeletal muscle mass index (LESMI) than in those with high-LESMI (24.3% vs 12.9%, log-rank p<0.001), as well as in those with low-upper extremity muscle mass index than in those with high-upper extremity muscle mass index (UESMI) (19.6% vs 14.5%, log-rank p=0.047). However, after adjustment for age, gender, renal function, diabetes mellitus, infarct size, body mass index, and body fat percentage, only low-LESMI was independently and significantly associated with the primary composite outcome (adjusted hazard ratio for LESMI 2.11, 95%-confidence interval 1.06–4.14, p=0.034, adjusted hazard ratio for UESMI 1.04, 95%-confidence interval 0.52–2.08, p=0.906,).

Conclusions
Decreased muscle mass of lower extremity, rather than upper extremity, might have prognostic impact in patients with STEMI.
P2668Causes and predictors of 30 and 90 days readmission after cardiac arrest: insights from the nationwide readmission database
Authors: Elkaryoni A , Thakker J , Barakat A F , Ellakany K , Khan G , Elkafrawy A , Younis M 
Published: October 2019

Abstract

Background
Cardiac arrest (CA) is a lethal condition with high public health burden and grave long-term implications. We aimed to evaluate the rate and predictors of readmission after CA

Methods
We used the Nationwide Readmission Database 2014 to determine patient with index admission CA by using relevant ICD-9 codes. We excluded patients <18 years and admissions in October, November, and December to allow 90 days readmission follow up. We evaluated rates and causes of 30 and 90 days readmission. We investigated disposition options for CA survivors and rates of readmissions. Multivariable analysis was done for relevant variables to demonstrated predictors of readmission.

Results
A total cohort of 71,780 patients suffered CA and survived to hospital discharge. Mean age was 63.9±15 years and 61.3% were males. Mean length of stay was 14.2±18.3 days, primary payer was Medicare 58%, 42.2% were discharged home, 33% to skilled nursing/intermediate care facility, 18.5% to home with home health services, 5% to short term hospital, and 0.8% left against medical advice (AMA). All-cause 30 and 90 days readmission rates were 18% and 28.9%, respectively. According to each disposition group 30/90 days readmission rates were; home 13.6/23%, facility 22/35.7%, home health 21/31.9%, short term hospital 16.8/24.1%, and 33.7/42.4% left AMA. The most common causes of readmission at 30 and 90 days were congestive heart failure and infection (11% each). CA on readmission was 1.5% at 30 and 90 days. The most common predictors of readmission were CHF odds ratio (OR) 1.3, (95% CI: 1.3–1.4; P<0.001), renal failure OR 1.7, (95% CI: 1.7–1.8; P<0.001), chronic lung disease OR 1.3, (95% CI: 1.2–1.; P<0.001), and depression OR 1.1 (95% CI: 1.1–1.2; P<0.001).

Conclusion
Readmissions are common at 30 and 90 days in CA survivors and are associated with high cost. CHF and infection are the most common causes of 30 and 90-day readmission, while renal failure is the strongest predictor of readmission after adjusting for unbalanced covariates. Discharge to home was the most common disposition, and had the lowest rate for readmission. Leaving AMA had the highest rate of readmission.