bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4163Long term comparison between homograft vs stented bio-prostheses for pulmonary valve replacement in tetralogy of Fallot patients
Authors: Cocomello L , Meloni M , Baquedano M J , Ordonez M V , Biglino G , Bucciarelli C , Rapetto F , Pieles G , Benedetto U B , Caputo M 
Published: October 2019

Abstract

Background
Tetralogy of Fallot (TOF) repair results in long term chronic pulmonary regurgitation requiring pulmonary valve replacement (PVR). Homograft and stented bio-prosthesis are currently used for PVR but whether one should be considered superior to another remains unknown.

Aim
To compare echocardiographic and clinical outcomes after PVR with Homograft vs stented bioprosthesis in patients with previous TOF repair.

Methods
137 patients who underwent PVR with stented bioproshesis were compared with 80 patients who received an homograft using Mixed linear model and multivariate Cox regression.

Results
Homograft were associated with a significantly lower transpulmonary gradient postoperatively (P=0.04) and after a mean follow-up 6 years (table). Homograft were associated with a significantly lower risk of reintervention (HR 0.24; 95% CI 0.07–0.85, p=0.026) while long term mortality was comparable between the two groups (P=0.1).
Echocardiographic findings BIO HOMOGRAFT P N 137 80 Preoperatively   TV regurgitation (mean, sd) 1.80 (0.63) 1.94 (0.81) 0.353   TV regurgitation pressure drop (mean,sd) 35.15 (15.49) 45.34 (25.24) 0.009   PV regurgitation (mean,sd) 3.63 (0.52) 3.34 (0.64) 0.004   PV systolic peak gradient (mean, sd) 25.07 (17.05) 30.68 (21.70) 0.138 Early postoperatively   TV regurgitation (mean,sd) 1.52 (0.54) 1.54 (0.55) 0.858   TV regurgitation pressure drop (mean,sd) 30.10 (13.82) 29.13 (13.98) 0.733   PV regurgitation (mean,sd) 1.50 (0.54) 1.64 (0.53) 0.224   PV systolic peak gradient (mean,sd) 24.05 (11.10) 20.16 (14.19) 0.045 Latest follow_up   TV regurgitation (mean,sd) 1.63 (0.61) 1.83 (0.80) 0.195   TV regurgitation pressure drop (mean,sd) 37.46 (18.84) 32.58 (13.47) 0.233   PV regurgitation (mean,sd) 2.06 (0.77) 2.07 (0.94) 0.982   PV systolic peak gradient (mean,sd) 32.22 (18.17) 21.25 (13.47) 0.001 TAPSE: Tricuspid annular plane systolic excursion; TV: tricuspid valve; PV: pulmonary valve.
PV re-intervention

Conclusions
When compared to stented bio-prostheses, homografts were associated better early and late hemodynamic profile and a significantly lower risk of re-intervention. Homograft should be considered the first choice in patients undergoing PVR after TOF repair.
P4171Population characteristics, interventions and outcomes in hospitalized orthotopic heart transplant patients with sudden cardiac arrest: a nationwide United States analysis from 2007 to 2015
Authors: Jazayeri M.-A , Mohammed M , Mastoris I , Sheldon S , Reddy M , Haglund N , Sauer A , Shah Z 
Published: October 2019

Abstract

Background
Sudden cardiac arrest (SCA) is a leading cause of death in the United States (US), claiming up to 450,000 lives annually and accounting for ∼25% of deaths following orthotopic heart transplantation (OHT),

Purpose
We sought to characterize OHT patients suffering SCA and their subsequent management, in comparison to the general, native heart (NH) population, using a large national inpatient database.

Methods
A cross-sectional analysis was performed among US OHT & NH patients hospitalized with incident SCA or ventricular fibrillation/flutter. We analyzed demographics, baseline characteristics, procedural utilization and outcomes. Groups were compared with standard statistical techniques. A P-value <0.05 was considered significant.

Results
From 2007–2015, 920 SCA admissions were identified among 121,083 (0.8%) OHT hospitalizations, compared to 1,731,658 (0.6%) in the general population (P<0.001). OHT patients were younger (P<0.001) and predominantly men (P<0.001). More OHT patients had diabetes (P=0.01), while the NH group had more coronary disease (P=0.01). Mechanical circulatory support use was similar in both groups overall, and OHT patients were more likely to undergo transplantation (P=0.015). Pacemaker/defibrillator implants were more common in NH than OHT patients (P<0.001). Acute kidney injury and in-hospital mortality were significantly greater in OHT patients.
Table 1. SCA in OHT & general populations Orthotopic Heart Transplant General Population P-value (N=121,083) (N=278,463,550) Sudden cardiac arrest (SCA) events, n (%) 920 (0.8%) 1,731,658 (0.6%) <0.001 Age, mean (SD) 57 (17) 66 (16) <0.001 Male sex, n (%) 644 (72%) 1,004,362 (58%) <0.001 Coronary artery disease, n (%) 275 (30%) 675,908 (39%) 0.012 Mechanical circulatory support, n (%) 64 (7%) 104,151 (6%) 0.230 Repeat heart transplantation, n (%) 5 (0.5%) 1199 (0.1%) 0.015 Pacemaker or defibrillator implant, n (%) 45 (5%) 136,314 (8%) <0.001 In-hospital mortality, n (%) 555 (60%) 932,812 (54%) 0.014 Cardiogenic shock, n (%) 78 (8%) 208,778 (12%) <0.001 Acute kidney injury, n (%) 418 (45%) 608,035 (35%) 0.003

Conclusions
SCA hospitalizations occur more often and with higher mortality in OHT patients compared to the general population. Earlier recognition of at-risk patients may result in improved utilization of potentially life-saving therapies.
P4358The role of the “halo sign” for the accurate quantification of atrial septal defect size by 3D TEE
Authors: Aggeli C , Dimitroglou I , Kastellanos S , Drakopoulou M , Moldovan K , Latsios G , Vavuranakis M , Toutouzas K , Tousoulis D 
Published: October 2019

Abstract

Introduction
In patients undergoing percutaneous closure of secundum atrial septal defect (ASD), device selection is based on defect sizing by transoesophageal echocardiography (TEE) and in particular 3D measurement as well as 2D balloon-stretched derived measurements. We sought to investigate whether in patients with the presence of the “halo sign”, defined as increased tissue thickness at the edge of the ASD rims, there is an agreement between the aforementioned sizing methods with a view to avoid balloon sizing.

Methods
Consecutive patients referred to our department for single ASD closure without complex anatomy were included in our study. TEE was performed in all patients before and during the intervention. 3D datasets for ASD quantification as well as X-PLANE data sets for measurement of balloon-stretched 2D dimensions were acquired and analysed offline. During the analysis of 3D datasets, researchers were blinded to the 2D balloon-stretched measurements. Patients were stratified according to the presence of the halo sign and the correlation between 3D dimensions and balloon-derived diameter was calculated.

Results
Thirty-eight patients (14 males, 36.8%) with median age 46 [32–56] were included in our study. The “halo sign” was present in 16 patients (42.1%). In the whole study population, the median maximal and median minimal diameter measured by 3D TEE were 1.79cm [1.54–2.10] and 1.57cm [1.15–2.00] respectively while median circumference and area were 5.26cm [4.14–6.44] and 2.20cm2 [1.25–3.30] respectively. Median balloon-stretched diameter was 1.8cm [1.4–2.1]. In patients with the “halo sign” there was no significant difference between the medians of the ASD diameter calculated from 3D measurements and the 2D derived diameter (1.53cm; 1.6cm, p=0.170) whereas in patients with no “halo sign” there was significant difference (1.79cm; 2.0cm, p=0.001) (figure 1). The discrepancy between the aforementioned diameters was significantly lower in patients with the halo sign (0.04cm; 0.19cm, p=0.001). There was a good correlation between closure device size and 3D derived ASD circumference in the whole study population (R2=0.897) which was even higher in patients with the halo sign (R2=0.981). In this subgroup, the selected size of the closure device would not have differed significantly even without balloon sizing (p=0.414).
Figure 1

Conclusion
The ASD sizing by 3D echocardiography is accurate in patients with the “halo sign”. This study justifies further investigation concerning the reliability of 3D imaging in this population for the selection of the ASD device size with a view to avoid balloon sizing, decrease procedural time and thus simplify the procedure.
P4373Post systolic shortening in the apex of the left ventricular is a typical finding in patients with PLN mutation
Authors: Bruin De- Bon H A C M , Verstraelen T E , Taha K , Brink Van Den R B A , Tan H L , Amin A S , Wilde A A M , Bouma B J 
Published: October 2019

Abstract

Introduction
The p.Arg14del founder mutation in the gene encoding phospholamban (PLN) is associated with an increased risk of malignant ventricular arrhythmia and heart failure. Ejection fraction (EF) is the gold standard of systolic left ventricular (LV) function, however new technics using global longitudinal strain (GLS) are able to detect LV dysfunction early, e.g. in patients with chemotherapy. Moreover, strain analysis on post systolic shortening (PSS) can show distinct pattern in various diseases, e.g. patients with myocardial fibrosis and amyloid. The goal of this study was to investigate whether speckle tracking (GLS and PSS) of the LV can detect LV dysfunction in patients with PLN mutations and whether these patients have a specific PSS pattern.

Method
72 Patients (49 female, mean age 32 years) diagnosed with the genetic PLN mutation p.Arg14del and 21 controls (10 female, mean age 27 years) underwent complete Echocardiographic exam including LVEF, GLS and PSI of all LV segments. LVEF <50% was considered as LV dysfunction. The diagnostic characteristics of GLS and PSI were determined.

Results
Pearson correlation is in PLN patients between PSI apex and EF 0.677 (P <.0001) PSI apex and GLS 0.692 (P <.0001)
PLN patients appeared to have a typical pattern with a high PSI in the apical segments. An apical PSI >20 was the strongest diagnostic parameter indicating LV dysfunction.
Apical PSI >20 and LVEF <50% have a sensitivity and specificity of 78% and 85%.
Diagnostic characteristics PLN Controls P-value LVEF, % 55.2 59.3 0.033 GLS, % 15.5 17.3 0.163 PSI basal 8.5 10.1 0.326 PSI mid 5.6 2.9 0.070 PSI apical 15.6 2.1 0.01 LVEF, left ventricular ejection fraction; GLS, Global longitudinal strain; PSI, post systolic index.
PSI

Conclusion
PLN patients have a typical pattern of high PSI in the apex of the left ventricular which can be used as a diagnostic test to detect LV dysfunction.
P4381Improvement of the PISA method in the setting of mitral regurgitation of complex geometry
Authors: Papolla C , Adda J , Habib G , Rieu R 
Published: October 2019

Abstract

Background
Doppler echocardiographic methods, such as proximal isovelocity surface area (PISA) are used to quantify mitral regurgitations. However, their accuracy and reproducibility are still discussed, especially in case of mitral regurgitations of complex geometry.

Purpose
The aim of this study was to test in-vitro the accuracy of the PISA method depending on the shape and number of regurgitant flows.

Methods
Several regurgitant volumes (RV) were produced through various regurgitation severities and shapes in a left heart double activation simulator. Circular mitral regurgitation (MR) was performed with a circular orifice in a rigid plate. Triangular and oblong MR were performed by suturing the extremity of a bioprosthesis leaflet to the annulus. Multiple jets regurgitation was performed by suturing centrally the two leaflets of an anatomically shaped mitral valve made of hydrogel. A transesophageal echocardiography probe was used to acquire the data. The RV was calculated with the classical PISA method (hemispheric assumption), or by considering the PISA as a hemicylinder or a double hemisphere. It was then compared to a reference value obtained from an electromagnetic flowmeter measurement (accuracy ± 2 ml/min).

Results
A central and circular orifice was correctly quantified, as expected, with the hemispheric assumption (bias 0.2±1.9 ml, p=0.46). For a triangular central jet, the hemispheric assumption best estimated the RV (−3.5±14.8 ml, p=0.10). An oblong MR was underestimated with the hemispheric assumption (−18.3±14.9 ml, p<0.01) whereas the hemicylindrical assumption was more accurate (−0.2±5.8 ml, p=0.85). In case of 2 regurgitant jets, considering only the largest jet led to an important underestimation (−10.9±5.6 ml, p<0.01), whereas adding the two RV was more accurate (−1.2±8.2 ml, p=0.50).

Conclusions
In case of a single central orifice, the hemispheric assumption correctly quantified the MR. In case of an oblong orifice, the hemicylindrical assumption provided a good quantification with simple measurements. In case of multiple jets of different sizes, it was more accurate to consider both jets for RV calculation.

Acknowledgement/Funding
Képhalios part of Affluent Medical
P4397Health related quality of life is not reduced in elder familial hypercholesterolemia patients
Authors: Souto A C , Coutinho E , Miname M H , Jannes C E , Pereira A , Santos R D 
Published: October 2019

Abstract

Background
Familial hypercholesterolemia (FH) is a genetic disorder associated with high risk of early major cardiovascular events (MACE) that can impact on elderly's self-appraisal of health-related quality of life (HRQoL), however, this association is unclear.

Purpose
This study evaluated HRQoL of elder individuals (from 60 to 88 years old), index cases (IC) and first-degree relatives (FDR) at high risk of FH.

Methods
From 1030 participants of FH genetic cascade screening, 250 were ≥60 and 205 were eligible for this study. Data collection was performed before awareness of molecular diagnosis results. Individuals were divided into 4 groups according to molecular diagnosis: IC with (IC+) and without (IC-) identified mutations (n=38 and n=54, respectively), and their affected (FDR+, n=74) and non-affected (FDR-, n=39) FDR. HRQoL measurements, mental (MCS) and physical component (PCS) scores, were carried out with the SF-12 questionnaire. Associations were tested by multivariate models.

Results
The mean age was 68±7 years, 32.2% were men, MACE had occurred in 47.8%. HRQoL dimensions measure (variance of physical, mental and health quality component scores) did not differ between FH and non-FH individuals. Lower PCS were associated with female sex (p=0.043), lower education (p=0.047), previous MACE occurrence (p<0.001), arterial hypertension (p=0.005), depression (p=0.004) and Alzheimer's disease (p=0.016). Lower MCS were associated with the previous diagnosis of depression (p<0.001) and Alzheimer's disease (p=0.011). Lower HQS were associated with lower education level (p=0.001), previous MACE (p<0.001), arterial hypertension (p<0.001), depression and Alzheimer (p=0.004 and p=0.006). MACE and hypertension were predictive of lower PCS (p=0.003 and p=0.035). Depression was predictive of lower MCS (p<0.001). Education, MACE and depression were predictive of health quality self-appraisal. No association was found with either molecular defect or lipid-lowering therapy.

Conclusion
HRQol in elder suspected FH individuals relates more to a consequence of elevated cholesterol levels i.e. MACE and co-morbidities rather than molecular defects or pharmacological treatment.
P4408Cardiovascular response in diabetic patients submitted to treadmill electrocardiographic exercise stress test
Authors: Faia Carvalho Dias G , Oliveira M , Faria B , Von Hafe P , Cardoso A F , Almeida F , Lourenco A 
Published: October 2019

Abstract

Introduction
Diabetes mellitus (DM) is an entity commonly associated with neuropathy, a factor that may have repercussions on the cardiovascular system, specifically in its capacity to respond to stimuli.

Objectives
To evaluate the cardiovascular response to exercise in diabetic patients, comparing it with a control group.

Methods
Patients who underwent treadmill eletrocardiographic exercise stress test (EST) between January 2016 and November 2018 without the influence of negative chronotropic medication were included.

Results
A total of 187 patients were identified, having a mean age of 57±13 years, of whom 120 (64%) were of the male gender. Eighty-four (45%) were diabetic. The group of diabetic patients had a higher prevalence of arterial hypertension, however the number of classes of antihypertensive drugs was not significantly different between diabetic and non-diabetic patients. There were no significant differences in the remaining demographic variables. Patients with DM presented lower maximal heart rates (HR) (141±14 vs 148±19 beats/minute, p=0.015), lower HT reserve (59±16 vs 67±21 beats/minute, p=0.005), as well as a lower rate of HR fall in the recovery period (13±5 vs 16±5 beats/minute2, p<0.001). Total EST time was also lower in diabetic patients (median 7.0 IQR=3 vs 7.3 IQR=3.5 minutes, p=0.044). Additionally, the number of years since the time of diagnosis of DM was inversely correlated with the degree of increase in systolic blood pressure (SBP) with exercise (r=−0.22, p=0.045), and the pre-test SBP (median 135 IQR=24 vs 130 IQR=20 mmHg, p=0.048) and post-test SBP (median 150 IQR=20 vs 140 IQR=25 mmHg, p=0.007) were higher in patients with DM.

Discussion
In this study it was found that patients with DM present an impaired chronotropic response, both in exercise and recovery periods, and it was observed that the capacity to increase SBP is inversely correlated to the duration of DM. These data may reflect the neuropathic involvement in DM and its influence in the cardiovascular response to exercise.
P4427Cardiovascular outcomes among runners of a marathon race - a 17 years' experience
Authors: Poon W L , Lee K L , Chan K 
Published: October 2019

Abstract

Introduction
Over the past 17 years (2002–2018), 898,831 people participated in the Hong Kong Standard Chartered Marathon (HKSCM).

Purpose
We aim to study the incidence of marathon-related sudden cardiac arrest (SCA) and non-fatal myocardial injury (NFMI).

Methods
All the HKSCM related admissions between 2002 and 2017 were retrieved from the accident and emergency department admission records. We reviewed the data of HKSCM runners admitted for SCA and NFMI.

Results
Fourteen and thirty-nine runners were admitted for SCA (Mean age 38±13 years-old, 12 men) and NFMI (Mean age 42±12 years-old; 34 men) respectively.
Among the SCA runners, the arrest rhythms could not be retrieved in 3 cases. In the remaining 11 SCA runners, the arrest rhythms were ventricular fibrillation (VF) (N=6), pulseless-electrical activity (PEA) (N=3), and asystole (N=2). Nine of the 14 SCA runners were successfully resuscitated. Only 2 out of the 14 SCA runners had significant atherosclerotic coronary artery disease (CAD) requiring coronary angioplasty. Among the SCA runners, the etiologies of cardiac arrest were myocardial infarction (MI) (N=2), ischemic cardiomyopathy with VF (N=1), idiopathic VF (N=3), malignant coronary anomaly (N=1), and idiopathic (N=5). Percutaneous coronary intervention (PCI) was performed in 2 SCA runner with MI. Implantable cardioverter-defibrillators were implanted in 1 resuscitated runner with VF. Postmortem examination of the 3 deceased runners showed significant CAD in two and was unrevealing in one.
Among the 39 NFMI runners, coronary angiograms (CAG) or CT coronary angiogram were performed in 14 cases (36%), which showed minor CAD or unremarkable findings in 7 runners, and significant CAD in 7 runners. PCI and coronary artery bypass were performed in 5 and 2 NFMI runners respectively. Only 8 out of 39 NFMI runners reported chest pain. Significant ischemic ECG changes were detected in 9 out of 39 NFMI runners. Invasive CAGs were not performed in the remaining NFMI runners due to low pre-test likelihood of CAD and normal non-invasive test results.

Conclusions
The incidence of SCA and mortality among HKSCM runners was 1.56 per 100,000 and 0.56 per 100,000 respectively. The incidence of NFMI was 4.3 per 100,000. Coronary artery disease, coronary anomaly and idiopathic VF were the commonest etiologies of SCA.
P4428Physical exercise during uncontrolled systemic arterial hypertension
Authors: Urbano Pagan L , Gomes M J , Damatto R L , Cezar M D M , Reyes D R A , Damatto F C , Campos D H S , Lima A R R , Polegato B F , Fernandes A A H , Laurindo F R , Okoshi M P , Okoshi K 
Published: October 2019

Abstract

Introduction
Physical exercise reduces systemic arterial blood pressure and improves cardiac remodeling. However, the effects of exercise during uncontrolled arterial hypertension remains poorly understood. This study evaluated the influence of physical training on cardiac remodeling in untreated spontaneously hypertensive rats (SHR).

Methods
Four experimental groups were used: sedentary (W-SED n=27) and trained (W-EX, n=31) normotensive Wistar rats, and sedentary (SHR-SED, n=27) and exercised (SHR-EX, n=32) hypertensive rats. At 13 months old, the exercise groups underwent treadmill exercise five days a week, for four months. Echocardiogram was performed to evaluate cardiac structures and function. In vitro myocardial function was analyzed in left ventricular (LV) papillary muscle preparations. Myocardial collagen was quantified by histology and hydroxyproline concentration and antioxidant enzyme activity was assessed by spectrophotometry. NADPH oxidase activity was analyzed by lucigenin reduction. Protein expression was quantified by Western blot. Matrix metalloproteinases (MMP) activity was evaluated by zymography. Statistical analyzes: two factor ANOVA and Bonferroni or Kruskal-Wallis and Dunn tests.

Results
Systolic blood pressure was higher in SHR groups. Exercised groups had greater physical capacity. Frequency of heart failure features was higher in hypertensive groups than controls; SHR-EX had a lower frequency of pleural effusion and tachypnea than SHR-SED. Echocardiogram showed lower LV wall thickness, LV relative wall thickness, left atrium diameter, and relaxation time in SHR-EX than SHR-SED. Myocardial function was better in SHR-EX (positive derivative of developed tension) than SHR-SED. SHR-EX had higher antioxidant enzyme activity than SHR-SED. Lipid hydroperoxide concentration, myocyte diameters, and phosphorylated JNK and total IkB protein expression were higher in hypertensive than control groups. Hydroxyproline, malondialdehyde, NADPH oxidase activity, and protein expression of collagen III, lysyl oxidase, TIMP-1, total JNK, phosphorylated p38, phosphorylated and total p65, and phosphorylated IkB did not differ between groups. Interstitial collagen fraction, MMP-2 activity, and protein expression of total p38, and total and phosphorylated ERK were higher in SHR-SED than W-SED. Exercise reduced MMP-2 activity and phosphorylated ERK in hypertensive rats.

Conclusion
Physical exercise improves physical capacity, reduces the frequency of heart failure features, and attenuates cardiac remodeling in spontaneously hypertensive rats. In addition, exercise increases antioxidant enzyme activity, decreases ERK phosphorylation and MMP-2 activity, and attenuates total ERK protein expression.

Acknowledgement/Funding
Fapesp, CNPq, Capes and UNESP