bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2276Sudden cardiac death in non-ischemic systolic heart failure: do we only need LVEF to decide ICD implantation?
Authors: Mercier T , Hebbar E , Fertin M , Marquie C , Lamblin N , De Groote P 
Published: October 2019

Abstract

Background
Implantable cardioverter defibrillator (ICD) is recommended in patients (pts) with non-ischaemic heart failure with left ventricular systolic dysfunction who receive optimal medical therapy (OMT) in order to prevent sudden cardiac death (SCD). However, the results of the DANISH study have recently shown the limits of these recommendations. It is therefore mandatory to reconsider the risk stratification of SCD in this population.

Purpose
The purpose of our study is to determine independent predictors of severe arrhythmic events (AE in pts with non-ischemic systolic heart failure.

Methods
Between January 1998 and December 2014, all consecutive outpatients with non-ischemic systolic heart failure, receiving OMT and without a history of significant arrhythmic events, were included. We performed to all the pts a clinical and biological evaluation, an echocardiography, a cardiopulmonary exercise test, a radionuclide angiography and a Holter-ECG. Follow-up was performed either by direct examination, by contact with the general practitioner or the cardiologist and by remote monitoring if available. The composite primary endpoint was the occurrence of SCD, recovered cardiac arrest, sustained ventricular tachycardia, or appropriate therapy by the ICD.

Results
We included 910 pts with a mean age of 53±12 years, 244 (27%) were women, LVEF was 36±10%. Most of the pts received renin-angiotensin blockers (97%) and betablockers (84%), 77% received diuretics and 41% spironolactone. During a median follow-up period of 6.33 [3.29–10.18] years, 160 (17.6%) pts presented the composite primary endpoint. The median time between the assessment and the occurrence of AE was 4.05 [1.68–7.85] years. The most powerful independent predictor of AE was non-sustained ventricular tachycardia (≥3 ectopic beats) (HR: 2.8 [1.66–4.72], p<0.0001). The other independent factors of AE were left atrial diameter (HR: 1.03 [1.01–1.06], p<0.0001); gender (HR: 0.71 [0.55–0.92], p=0.010); digoxin intake (HR: 1.63 [1.10–2.44], p=0.016); QRS duration (HR: 1.01 [1.00–1.01], p=0.022), sinus rhythm (HR: 0.70 [0.56–0.87], p=0.001). LVEF, as a quantitative parameter, was not an independent predictor of AE. However, LVEF dichotomized with a value of 35% was a modest predictor of AE (HR =1.38 [1.12–1.70], p=0.002). Neither the NYHA classification nor the parameters of the cardiopulmonary exercise test were independent factors of AE occurrence.

Conclusion
LVEF is not the most powerful predictor of severe arrhythmic events in outpatients with non-ischemic systolic heart failure receiving optimal medical therapy. New risk scores are required. We found that in addition to LVEF, gender, QRS duration, sinus rhythm, left atrial diameter and more particularly non-sustained ventricular tachycardia were independent predictors of AE. This score needs to be validated in an independent population.

Acknowledgement/Funding
None
P2280Incidence and predictors of alarms in patients with wearable cardioverter defibrillator (WCD) - results of the Austrian WCD Registry
Authors: Rohrer U , Manninger M , Odeneg T , Ebner C , Moertl D , Dirninger A , Keller H , Stix G , Alber H , Steinwender C , Binder R , Stuehlinger M , Zirlik A , Scherr D 
Published: October 2019

Abstract

Background
The wearable cardioverter-defibrillator (WCD) is a treatment option for patients at high risk for ventricular arrhythmia, either if the risk is potentially reversible or if an implantable cardioverter defibrillator (ICD) implantation is currently not possible.

Methods
We performed a retrospective analysis of all alarms in the cohort of the Austrian WCD registry between 2010 and 2018. Type of arrhythmias was assessed by independent review of two cardiologists.

Results
25.540 automatically recorded ECGs in 605 patients (68%) were analyzed. 1125 ECGs showed sustained ventricular arrhythmias in 117 patients, 65 ECGs showed non sustained VTs.
24.415 ECGs in 488 patients showed inadequate alarms Reasons for inadequate alarms were artefacts (97%), pacemaker or t-wave oversensing (0,3%) and in 2,3% atrial fibrillation or SVTs.
5860 manually recorded ECGs in 608 patients (68%) were analyzed. 298 (5%) of these ECGs showed following arrhythmias: atrial fibrillation (34,7%), SVTs (28%), sinustachycardia (10,7%), non sustained VTs (12%) and sustained VTs or sustained slow VTs (6,7%), premature ventricular beats or bradycardia was identified in 8%. The remaining 5562 ECGs (95%) showed normal sinus rhythm.
Of the 895 patients (60±14 years, 20% female), 34 (3,8%) received a total of 65 automatically triggered shocks (median 2; range 1–5). 31/895 (3.5%) patients received 57 appropriate shocks (median 1, range 1–5) for 49 arrhythmic events, whereas 7/895 (0.8%) patients received 8 inappropriate shocks (median 1, range 1–2).
44 events were successfully terminated with the first shock (85,7%) and 4 events were terminated with the second shock. In one patient, a shock treatment for VF was not successful. The time from event onset to shock was median 60 [40; 1187] sec.
The median time from WCD prescription to a shock event was 8 days [1–151]. 23/ 34 patients (68%) received their first WCD shock within 30 days.
Seven patients (0.8%) received a total of nine inappropriate shocks due to different reasons: artefacts (2 inappropriate shocks), non-shockable rhythms (asystole, weak action, 3 shocks) and atrial fibrillation with a bundle branch block in two cases. In one patient VF terminated spontaneously before the WCD treatment was delivered.

Conclusion
The WCD is an effective treatment option in patients with a high SCD risk but it also triggers a significant amount of alarms. Although many inadequate alarms occurred, adequate alarms led to arrhythmia detection such as in VT/VF events which were successfully terminated by the WCD in 3,4% of patients.
P2431Stay on the safe side: in-silico assessment of ablation protocols to prevent steam pops during radiofrequency ablation
Authors: Petras A , Echeverria Ferrero M , Leoni M , Guerra J M , Jansson J , Gerardo-Giorda L 
Published: October 2019

Abstract

Background
Steam pops (SP) are among the most serious complications of radiofrequency ablation (RFA) due to its potential to cause myocardial tear or tamponade. SP occur when the tissue overheats, causing its water content to transform into steam and explode. Ablation parameters are critical in order to obtain an optimal lesion size while avoiding the occurrence of SP. However, the interaction between ablation settings and the physical parameters that predispose to SP occurrence during irrigated RFA are not fully understood.

Purpose
To characterize regularly used ablation protocols by means of a computational model, in order to achieve optimal lesion size while avoiding SP occurrence.

Methods
The in-silico evaluation is performed using our previously developed computational irrigated RFA model. Our model takes into account the blood-saline interaction as well as the mechanical deformation of the tissue due to the contact with the catheter tip. We test the effects of applied power and contact force on two catheter tip designs (spherical and cylindrical) and two substrates, simulated human atrium and ventricle, during 30 sec applications. A fixed blood flow and catheter-tip saline irrigation (0.5m/s and 17mL/min, respectively) are considered. We simulate human tissue by using the biophysical, mechanical and physiological properties found in the literature. SP occurrence is predicted when the temperature within the tissue reaches 100°C.

Results
Based on the interaction of power and contact force, four risk maps are constructed encompassing the two catheter-tip designs and the two simulated tissues. The maps allow the identification of those ablation protocols (contact force and delivered power) that can potentially result on SP. They correspond to that area of critical temperature values where the temperature within the tissue reach the established criteria for SP occurrence. We also present the lesion size dimensions of ablation protocols that avoid the formation of steam pops.

Conclusion
Our results indicate that the applied power has a strong impact in the formation of SP for a cylindrical catheter, while a combination of contact force and power is important to avoid risks in the case of the spherical catheter tip. The tissue characteristics do not affect significantly the SP occurrence, in agreement with experimental literature. However, the resulting lesion size appears to be larger in the simulated human atrium in comparison to the simulated human ventricle.

Acknowledgement/Funding
BERC 2018-2021, SEV-2017-0718
P2449Different associations of cardiovascular risk factors with markers of subclinical myocardial disease over the life course
Authors: Huynh Q , Venn A J , Magnussen C , Marwick T H 
Published: October 2019

Abstract

Background
Asymptomatic myocardial disease is the precursor to heart failure, but changes in myocardial markers such as global longitudinal strain (GLS), left ventricular hypertrophy (LVH), diastolic dysfunction and left atrial (LA) enlargement are not necessarily congruent. Cardiorespiratory fitness (CRF), body mass index (BMI) and mean arterial pressure (MAP) are common predictors of cardiovascular disease. This study investigated the association of markers of myocardial disease with these predictors across the life-course.

Methods
This study followed 562 participants from childhood (aged 7–15 years in 1985) who were followed-up into adulthood at aged 26–36 years during 2004-06 and 39–49 years during 2017-19. CRF, BMI and blood pressure were measured at baseline and follow-up. Echocardiogram was used to identify asymptomatic myocardial disease at the latest follow-up, including abnormal GLS (GLS greater than −18% in 102/562 participants), LVH (55/562), dilated LA (LA volume index >34 in 268/562) and increased LV filling pressure (E/e' >8 in 32/562).

Results
Current physical measurements were generally stronger than previous measurements in predicting myocardial function and structure. Abnormal GLS was associated with childhood CRF (OR=0.77 [95% CI: 0.62, 0.96]) independently of adult CRF. While the association of abnormal GLS with BMI was influenced primarily by the most current BMI, its association with MAP appeared to be similar over the life-course. Dilated LA was associated with childhood CRF (OR=1.32 [95% CI: 1.08, 1.60]) independently of adult CRF, and was not associated with BMI or MAP in either childhood or adulthood. The associations of LVH with CRF, BMI and MAP were primarily dependent on current rather than earlier CRF, BMI and MAP. LV filling pressure was not associated with any childhood measurements but was associated with current BMI and MAP.

Conclusions
Different aspects of myocardial physiology appear to have different associations over the lifecycle, supporting the concept of different phenotypes of asymptomatic myocardial disease.
P2454Left atrial strain and recurrence of atrial fibrillation after thoracoscopic atrial fibrillation surgery
Authors: Baalman S W E , Van Den Berg N W E , Neefs J , Berger W R , Meulendijks E R , De Bruin-Bon R.H.A.C.M , Van Boven W J P , Driessen A H G , De Groot J R 
Published: October 2019

Abstract

Background
Left atrial (LA) strain has a prognostic value for atrial fibrillation (AF) recurrence after AF ablation. The value of LA strain as a predictor of AF recurrence after thoracoscopic AF surgery in patients in sinus rhythm (SR) or AF during echocardiography is unknown.

Purpose
To assess the association between LA strain and AF recurrence after thoracoscopic surgery for AF in both patients in SR and AF during baseline echocardiography.

Methods
Patients participating in the AFACT trial (n=240) with baseline transthoracic echocardiography (TTE) suitable for LA strain analysis were included in this subanalyses. All patients underwent thoracoscopic pulmonary vein isolation (PVI) with left atrial appendage (LAA) exclusion, and were randomized to ganglion plexus (GP) or no GP ablation. LA strain and mechanical dispersion (MD) of the LA reservoir, conduit and contraction phase were determined retrospectively from TTE images of both patients in AF and SR before thoracoscopic AF surgery. AF recurrence was defined as any recorded atrial tachyarrhythmia lasting >30 sec during a one year FU period.

Results
A total of 204 patients (58.6±7.8 years, 73% male, 57% persistent AF) were included. Of the 204 patients 121 (59%) were in SR and 83 (41%) were in AF during baseline TTE. Patients in SR during TTE had higher LA strain values and lower MD compared to patients in AF. Of all patients, those with AF recurrence had lower LA strain of the reservoir phase (13.0% vs. 16.6%; p=0.003) and contraction phase (7.4% vs. 11.5%; p=0.012). MD of the contraction phase was increased in patients with AF recurrence (65.1msec vs. 19.2 msec; p=0.003). Multivariable cox regression analysis showed an association between LA strain, MD and AF recurrence (figure).

Conclusions
Left atrial strain and mechanical dispersion prior to thoracoscopic AF surgery are associated with recurrence of AF. LA strain showed to be a valuable tool to add in the decision making for thoracoscopic AF surgery regardless rhythm during baseline echocardiography.
P2474Noninvasive estimation of pulmonary capillary wedge pressure by novel 3D speckle tracking echocardiography and validation study by cardiac catheterization
Authors: Yoshizane T , Tanaka R , Kawasaki M , Otsuka M , Shoji T , Nagaya M , Hattori K , Murayama M , Yagasaki H , Minatoguchi S , Ono K , Tanihata S , Arai M , Noda T , Okura H 
Published: October 2019

Abstract

Background
We previously reported that pulmonary capillary wedge pressure (PCWP) was noninvasively evaluated by 2D speckle tracking echocardiography (STE). Recently, novel software was introduced to examine volume and function of left ventricular and left atrium (LA) by 3D-STE automatically.

Purpose
We sought to compare the PCWP estimated by conventional 2D-STE (2D-ePCWP) and by novel 3D-STE (3D-ePCWP), and validate those values by cardiac catheterization.

Methods
Echocardiography and catheterization were performed in 29 patients (age 72±2) (7 ischemic heart disease, 2 hypertensive heart disease, 5 dilated cardiomyopathy, 12 valvular heart disease and 3 primary pulmonary hypertension).The ePCWP (mmHg) is noninvasively obtained as 10.8 − 12.4 x Log (left atrial active emptying function/minimum volume) as we previously reported. Echocardiography was performed just before the catheterization and we analyzed the 2D and 3D data by novel off-line software. 3D data was automatically analyzed and the border settings were fixed at default (ES60, ED30) (Figure).

Results
2D-ePCWP and 3D-ePCWP had a good correlation with PCWP invasively obtained by catheterization (r=0.87 and 0.83, respectively, both p<0.001). There was an excellent correlation between 2D-ePCWP and 3D-ePCWP (r=0.94, p<0.001) and there was a good correlation between 2D-LA volume index and 3D- LA volume index (r=0.80, p<0.001). Bland-Altman analysis revealed a good agreement between 2D-ePCWP and 3D-ePCWP, and between 2D-ePCWP and 3D-ePCWP without fixed and proportional bias.

Conclusion
This study demonstrated that PCWP might be noninvasively assessed by not only 2D-STE but also 3D-STE with reasonable accuracy and 3D-STE might have utility and value in the routine clinical practice.
P2478Prognostic impact and severity assessment of combinational elastography in heart failure patients
Authors: Sakamoto T , Ito S , Uchida K , Kuroda H , Minoji T , Endo A , Yoshitomi H , Tanabe K 
Published: October 2019

Abstract

Background
Heart failure (HF) causes liver congestion, which is thought to increase liver stiffness. Elastography is a noninvasive method of measuring organ stiffness that was originally developed to evaluate fibrosis caused by liver diseases such as cirrhosis. There are two main techniques of elastography: shear wave imaging and strain imaging. Shear wave imaging varies significantly due to the influence of not only fibrosis but also congestion, inflammation, and jaundice. In contrast, strain imaging in chronic liver disease reflects only the progression of liver fibrosis. We previously presented a method that is measuring both shear wave and strain imaging (combinational elastography) for assessing liver congestion. This study demonstrates the prognostic impact and severity assessment of combinational elastography in HF patients.

Methods
This study included 144 HF patients (age 76.4±12.3, men 67). The velocity of shear wave (Vs) values was measured with shear wave imaging. Fibrosis index (F Index) was calculated by measuring both shear wave and strain imaging.

Results
During a median follow-up of 161 days, 14 deaths or hospitalization for HF was observed. A multivariable cox regression analysis demonstrated that high vs values was dependently correlated with higher mortality rate and HF hospitalization (hazard ratio: 2.31; 95% confidence interval: 1.09–4.89; p=0.029). The Kaplan-Meier analysis demonstrated that high vs (>1.87 m/s) was associated with higher hospitalization rates for HF compared with low vs (≤1.87 m/s, log rank test, p<0.001). F index showed graded elevation as stage of HF progressed (stage A or B, C, D: 1.19±0.43, 1.38±0.56, 2.8±1.32; p<0.001).

Conclusion
Combinational elastography can predict the severity of HF.
P2483Differential effects of novel antidiabetics on arterial stiffness in patients with type 2 diabetes mellitus
Authors: Bletsa E , Antonopoulos A , Siasos G , Stampouloglou P K , Batzias K , Paschou S A , Oikonomou E , Gouliopoulos N , Tsigkou V , Kassi E , Thanopoulou A , Vryonidou A , Tentolouris N , Pallantza Z , Tousoulis D 
Published: October 2019

Abstract

Background
Arterial stiffness flags increased cardiovascular disease risk in type 2 diabetes mellitus (T2DM) patients. There is limited data on how novel anti-diabetic agents affect arterial stiffness.

Purpose
To investigate the effects of novel anti-diabetic agents on arterial stiffness in T2DM patients.

Patients and methods
We enrolled 64 consecutive patients under stable antidiabetic therapy who did not achieve therapeutic targets. Subjects were assessed to receive an additional antidiabetic agent to optimize glucose control; dipeptidyl peptidase-4 inhibitor (DPP4i, n=14), glucagon like peptide-1 receptor agonist (GLP1RA, n=21), sodium/glucose cotransporter-2 inhibitor (SGLT2i, n=21) or long-acting insulin (n=8). Glycosylated hemoglobin (HbA1c) as well as carotid-femoral pulse wave velocity (PWV) and augmentation index (Alx) were measured (as indices of arterial stiffness) were measured at baseline and 3 months after treatment intensification.

Results
There were no differences between the study groups in traditional risk factors, or baseline HbA1c, PWV and Alx levels (p=NS for all). All groups achieved better glycemic control in terms of HbA1c values between baseline and follow-up (for DPP4i: 7.4±0.2% vs 6.7±0.2%, for GLP1RA: 8.3±0.2% vs 6.9±0.1%, for SGLT2i: 7.5±0.1% vs 6.7±0.1% and for insulin 9.8±0.5% vs 7.7±0.4%, p<0.001 for all). PWV decreased from 10.0±0.84 to 9.1±0.43 m/sec (p=0.092) in the DPP4i group, from 11.7±0.72 to 10.2±0.74 m/sec (p<0.001) in the GLP1RA group, from 1.3±0.54 to 9.6±0.59 m/sec (p=0.001) in the SGLT2i group and from 11.6±1.04 to 11.1±1.02 m/sec (p=0.219) in the insulin group. Alx was also decreased from 34.2±1.89 to 31.5±2.17% (p=0.023) in the DPP4i group, from 29.1±1.52 to 25.6±2.09% (p<0.001) in the GLP1RA group, from 29.9±1.44 to 24.2±1.48% (p<0.001) in SGLT2i group, and from 28.2±2.33 to 26.2±1.64% (p=0.153) in insulin group.

Conclusions
These preliminary data provide evidence that treatment intensification -particularly with GLP1RA, and SGLT2i- benefits vascular properties, a finding which could partly explain the positive findings of recent randomized clinical trails in this field.

Acknowledgement/Funding
None
P2493Change in cardiovascular health and incident type 2 diabetes and prediabetes: The Whitehall II Study
Authors: Climie R , Van Sloten T T , Perier M C , Tafflet M , Fayosse A , Dugravot A , Singh-Manoux A , Empana J P 
Published: October 2019

Abstract

Background
Most previous studies on cardiovascular health (CVH) and incident type 2 diabetes (T2D) used a single measure of CVH and none investigated the association with incident prediabetes. This study aimed to examine whether changes in CVH are associated with incident T2D and prediabetes.

Methods
Within the prospective Whitehall II study, CVH was examined serially every 5 years from 1991/93 until 2015/16. Subjects with 0–2, 3–4 and 5–6 ideal metrics of CVH from the American Heart Association (non-smoking, and ideal levels of body mass index, physical activity, diet, blood pressure, and total cholesterol, fasting glycaemia was not considered),were categorized as having low, moderate or high CVH.

Results
There were 6234 participants without prior cardiovascular disease and T2D (mean age 49.8±6.0 years, 70% male) including 5015 who were additionally free of prediabetes (49.6±6.0 years, 67% male) at baseline. Over a median follow-up of 24.8 (IQR 24.0 to 25.2) years, 895 and 1703 incident cases of T2D and prediabetes occurred respectively. Change in CVH between 1991/93 and 2002/04 was calculated among 4470 participants without CVD and T2D in the interval, and among 2798 participants additionally free of prediabetes. In multivariate analysis, compared to those with stable low CVH, risk of T2D was lower in those with initially high CVH (HR=0.23; 0.09, 0.56), those who had persistently moderate CVH or changed from moderate to high CVH (moderate-moderate/high; HR=0.42; 0.33, 0.54), low-moderate/high (HR=0.50; 0.36, 0.69) and moderate-low (HR=0.63; 0.48, 0.83). Results were similar for prediabetes, but effect sizes were smaller.

Conclusions
Among participants without previous CVD, T2D or prediabetes, change in CVH was related to the risk of incident T2D and prediabetes.