bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3420Is there an association between Saharan dust events and acute coronary syndrome incidence?
Authors: Baez-Ferrer N , Dominguez Rodriguez A , Hernandez-Vaquero D , Rodriguez S , Avanzas P , Abreu-Gonzalez P , Cuevas E 
Published: October 2019

Abstract

Background
Asian dust and air pollution have been recently recognized as triggers in the incidence of acute myocardial infarction. The inflow of dust from the Sahara into Spain causes an increase in particulate matter (PM) levels in the atmosphere. The proximity to the Western Coast of Morocco and the Sahara Desert promotes the seasonality arrival of natural PM on the Canary Islands (Spain), leading to high concentrations of PM with an aerodynamic diameter over 10μm (PM10). The association of dust transport from the Sahara to the Atlantic Ocean and Mediterranean areas over the incidence of acute coronary syndromes (ACS), is unknown.

Purpose
The aim of the present study was to elucidate whether Saharan dust events in the dust belt - Canary Islands - is associated with the incidence of ACS.

Methods
We retrospectively collected data of hospitalizations due to ACS in 2416 consecutive patients from a tertiary care hospital in Tenerife (Canary Islands–Spain), from December 2012 to December 2017. Taking advantage of Canary Islands location, we characterized the Saharan dust events using PMx measurements and dust modeling. Concentrations of PM10 and reactive gases are measured in the Air Quality Network of the Canary Islands by using the European reference method. We applied the time-stratified case crossover design to examine the association between Saharan dust events and the incidence of ACS. This design allows us to adjust for individual confounders, season, time trend and the day of week. Using conditional Poisson regression models, we estimated the impact of PM10 Saharan dust events on the incidence of ACS. Because the effects of Saharan dust events could persist over the course of a few days, we examined the lag effect from Day 0 to Day 5.

Results
The occurrence of Saharan dust events observed 0–5 days before the ACS was not significantly associated with the incidence of ACS. PM10 (μg/m3) effect was: lag 0 (IRR: 0.999, 95% CI: 0.977–1.022), lag 1 (IRR: 1.025, 95% CI: 0.988–1.063), lag 2 (IRR: 0.98, 95% CI: 0.928–1.042), lag 3 (IRR: 0.976, 95% CI: 0.944–1.011), lag 4 (IRR: 0.996, 95% CI: 0.983–1.008) and lag 5 (IRR: 0.996, 95% CI: 0.984–1.007). (Figure 1)
Poisson regression model of PM10

Conclusions
This negative study, the first to assess the impact of Saharan dust events as a potential trigger in the onset of ACS, shows that African dust is unlikely to be associated with the incidence of ACS.
P3421Increased air pollution expressed as PM10 concentration and winter time are related to the frequency of percutaneous coronary interventions in patients with acute coronary syndromes
Authors: Januszek R J , Staszczak B S , Bartus J B , Plens K P , Surdacki A S , Bartus S B , Dudek D D 
Published: October 2019

Abstract

Background
According to epidemiological studies, increased air pollution has negative impact on the cardiovascular system. However, the extent of the air pollution's impact on the frequency of the occurrence of specific subtypes of coronary artery diseases (CAD) has not yet been established with absolute certainty.

Purpose
The aim of the study was to assess the relationship between increased air pollution expressed as particulate air matter (PM10) concentrations and the occurrence of acute coronary syndromes (ACSs).

Methods
Based on the data published by the Chief Inspectorate for Environmental Protection, we selected six cities (six catheter laboratories [cath labs]) with low pollution according to PM10 (“non-polluted”) and five cities (six cath labs) with the highest pollution (“polluted”). These locations served as a basis for the determination of 24/7 cath labs and the frequency of percutaneous coronary interventions in patients (PCIs) with subsequent types of CAD with special outlook on the ACSs. The current study accounted 10,239 patients in the polluted area and 5,648 patients from the non-polluted region treated with PCI and included patients with stable angina and ACSs. Analysing the period of 365 days, the number of patients undergoing angioplasty in monitored cath labs and the mean daily concentration of PM10 in all selected cities were calculated for each day. In order to better visualise air pollution trends and the frequency of performing PCI in patients with ACS, we have created new time intervals for weeks. Additionally, due to the difference in pollution levels, the analysed period was divided into winter (13 weeks) and non-winter weeks (39 weeks).

Results
The annual average concentration of PM10 amounts to 50.95 μg/m3 in polluted cities and 26.62 μg/m3 in non-polluted ones, which was significantly different (p<0.01) (Fig. 1). It was proven that for both groups, the rise in PM10 pollution levels is connected with the increased frequency of PCIs in patients with ACSs (polluted p<0.01 and non-polluted p<0.01 areas). Moreover, we calculated that in the non-polluted regions, the increase in PM10 concentration by every 1 μg/m3 causes 0.22 additional ACS angioplasties per week. In polluted regions, the same increase in PM10 concentration causes 0.18 additional ACS angioplasties per week. In non-winter weeks, the mean number of ACS PCIs expressed in promiles was lower than in winter weeks in polluted (18.56±2.41 vs. 21.23±3.98, p=0.03) and non-polluted cities (18.68±2.98 vs. 20.88±2.57, p=0.02).
Figure 1. Biplot chart according to the extent of pollution expressed as PM10 and sample size for selected Cathlabs.

Conclusions
The study shows that the increase in air pollution expressed as PM10 concentration and winter time influences the frequency of ACS related PCIs.
P3425Alpha-linolenic acid may lower the rate of atherosclerotic cardiovascular disease in subjects with a low intake of marine n-3 fatty acids
Authors: Bork C S , Venoe S K , Lasota A N , Lundbye-Christensen S , Tjoenneland A , Overvad K , Schmidt E B 
Published: October 2019

Abstract

Introduction
Previous studies investigating the association between intake of the plant-derived n-3 fatty acid alpha-linolenic and atherosclerotic cardiovascular disease (ASCVD) have shown conflicting results. However, the effect of ALA intake on ASCVD may depend on the intake of marine n-3 fatty acids.

Purpose
We aimed to explore the association between ALA intake and risk of ASCVD in subjects consuming below and above the 10th percentile of marine n-3 fatty acids, respectively.

Methods
We followed men and women enrolled into the Danish Diet, Cancer and Health cohort (n=57.053) by linkage with nationwide registers and identified all incident ASCVD cases. All participants were aged 50 to 65 years at baseline. ASCVD was defined as the first registration of myocardial infarction, peripheral artery disease or ischemic stroke due to large artery atherosclerosis or small-vessel occlusions. Intake of ALA and marine n-3 fatty acids was assessed using a validated food frequency questionnaire and expressed as energy-adjusted intake. Statistical analyses were conducted using Cox proportional hazard regression.

Results
During a median of 13.4 years of follow-up, we identified a total of 3958 incident ASCVD cases including 366 cases among subjects in the lowest 10th percentile of consumption of marine n-3 fatty acids (<252 mg/day). In multivariable analyses, we found a statistically significant inverse association between ALA modelled as a restricted cubic spline and the rate of ASCVD (p=0.005) in subjects with a low intake of marine n-3 fatty acids, whereas no statistically significant association was found between ALA intake and ASCVD in subjects with a higher intake of marine n-3 fatty acids (p=0.155) (Figure).

Conclusion
Intake of ALA may be associated with a lower rate of ASCVD in subjects with a low intake of marine n-3 fatty acids.

Acknowledgement/Funding
The Danish Heart Foundation (17-R115-A7415-22060), Helene and Georg Jensens and Ethel Merethe and Christian Pontoppidan's Fund.
P3427Prognostic performance of echocardiography, electrocardiogram, albuminuria, plasma proBNP and hs-TnI in patients with type 2 diabetes
Authors: Busch N , Jensen M T , Goetze J P , Biering-Soerensen T , Fritz-Hansen T , Andersen H U , Gislason G , Vilsboell T , Rossing P , Joergensen P G 
Published: October 2019

Abstract

Background
A range of diagnostic tests including echocardiography, albuminuria, electrocardiogram (ECG), plasma measurement of high sensitivity troponin T (hs-TnI) and pro-brain natriuretic peptide (proBNP) have been suggested as cardiovascular (CV) risk predictors in patients with type 2 diabetes. In this study we examined prognostic yield from these risk markers.

Methods
A total of 1,030 out-patients followed at a large secondary care diabetes clinic were recruited. Echocardiography was considered feasible in patients in sinus rhythm with adequate image quality (n=886). Abnormal echocardiography was defined as a left ventricular ejection fraction (LVEF) <50%; a ratio of early diastolic mitral inflow velocity to early diastolic septal annular velocity (E/e'septal) ≥15; increased left ventricular mass index (>95 g/m2 for women and >115 g/m2 for men) or left atrial volume index >34 ml/m2. ECG was performed in 983 patients and was considered abnormal in the presence of abnormal Q-waves; ST-T segment deviation or bundle branch block. We measured urine albumin (n=1,009) and proBNP/hs-TnI (n=933). The end-point of CV event was a composite of CV death and hospitalization with myocardial infarction/revascularization, stroke, peripheral artery disease or heart failure.

Results
The median follow-up was 4.7 years (interquartile range: 4.0 to 5.3) and 174 patients suffered an CVD event. All markers except hs-TnI were significantly (p<0.001) associated with the composite outcome: Abnormal echocardiogram: Hazard ratio (95% confidence interval): 2.39 (1.69–3.37); albuminuria 2.01 (1.47–2.76); abnormal ECG 2.35 (1.72–3.21); log2(proBNP) 1.60 (1.47–1.75) and hs-TnI 1.05 (0.92–1.19). The findings persisted after adjusting for clinical variables, but after adjusting for the other markers, only log2(proBNP) remained associated with the composite outcome (1.50 (0.20–1.73), p<0.001), figure. Measured by C-index model performance was highest with proBNP (0.70 (0.65–0.75)) and similar to clinical variables (0.71 (0.67–0.76)). Combining risk markers only resulted in very limited increase in C-index (echocardiogram, albuminuria, ECG and proBNP: 0.71 (0.66–0.76)).
Uni- and multivariables

Conclusions
This study identifies proBNP measurement in plasma over echocardiography, ECG and albuminuria for risk prediction in patients with type 2 diabetes. The diagnostic yield in considering more than one risk marker was limited in this population.
P3430Classification of pronounced subclinical atherosclerosis: deep learning approach of carotid intima media ultrasound images is superior to clinical risk factors
Authors: Nyman E , Karlsson M , Naslund U , Gronlund C 
Published: October 2019

Abstract

Background
Carotid ultrasound measurements of subclinical atherosclerosis is extensively used in the research field of cardiovascular disease. Increased intima media thickness (IMT) and plaque detection have predictive value for cardiovascular events when added to traditional risk factors. However, among studies different protocols for measuring IMT (projections, mean or max values and sites) are used and methodological difficulties of plaque detection, together result in conflicting results. Recently, Deep Learning image driven classification methods, has been successfully applied in several medical imaging applications. Here we hypothesize that ultrasound image texture of the intima media complex accurately reflects the disease burden without the need to measure IMT values or detect plaques.

Purpose
To evaluate classification accuracy of ultrasound based deep learning approach of the intima media complex image compared to traditional risk factors for participants with no vs pronounced subclinical atherosclerosis.

Methods
Subjects from the VIPVIZA study (Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention, n: 3532, 40, 50 and 60 year old, 53% women) were selected for analysis. Bilateral carotid ultrasound examinations were performed according to a standardized protocol. Subjects were categorized in two groups as 1) pronounced subclinical atherosclerosis (n: 401) – bilateral plaques and estimated vascular age 10 years older, or 2) No subclinical atherosclerosis (n: 592) – no plaques and estimated ordinary vascular age. Traditional risk factors for the participants were estimated by the SCORE risk chart. A 1-cm wide region of the distal common carotid artery intima media complex was automatically segmented from the original B-mode images. The images were fed to a Deep Learning model, convolution neural network (CNN), trained using transfer learning model with 60% training data set and 40% evaluation data set. Classification performance was quantified using accuracy of ROC analysis.

Results
The mean age was 58 and 56 years in groups 1 and 2, respectively (with 43% and 56% women, respectively). The mean SCORE was 1.74 in group 1 and 1.09 in group 2. Classification based on SCORE had an area under the curve of 0.69 with an accuracy of 38%. The Deep learning approach had an area under the curve of 0.89 with an accuracy of 78%.
Intima media image based classification

Conclusion
The results shows that ultrasound image texture of the intima media with Deep Learning approach can be used to detect pronounced disease without explicit measurement of IMT values or detection of plaques. With hard end-points, the approach could be used for risk stratification of subclinical atherosclerosis.

Acknowledgement/Funding
Västerbotten County Council, Swedish Research Council, Heart and Lung Foundation, Carl Bennet Ltd, Sweden.
P3431Machine learning applied to energy waveform ECG for prediction of subclinical myocardial dysfunction
Authors: Potter E , Liu Y , Teo S , Inouye M , Marwick T H 
Published: October 2019

Abstract

Background
Energy waveform (ew) ECG used continuous wavelet transforms (CWT) to create time-frequency energy characterisations. Although ewECG changes reflect myocardial disease, the optimal measures for prediction of subclinical left ventricular dysfunction (sLVD) are unclear.

Aim
Using machine learning, we investigated whether ewECG could predict sLVD in community subjects at risk of heart failure (HF).

Methods
Asymptomatic community subjects aged ≥65 yrs. with ≥1 non-ischaemic risk factor for HF underwent clinical evaluation, MyoVista (HeartSciences, Southlake, TX) ewECG and echocardiographic evaluation. sLVD was defined as systolic (global longitudinal strain, GLS≤16%) or diastolic (E/e' ≥15, E/e'>10 with left atrial enlargement, or impaired relaxation with other changes). A gradient boosting algorithm (supervised machine learning) with regularisation was implemented to predict sLVD using 362 ewECG features. The performance was assessed by precision, recall, F measure, precision-recall (PR) curve and receiver operating characteristic (ROC) curve. Feature importance was inspected by information gain node splitting.

Results
Of 97 subjects (age 71 (68–73) yrs., 53% female) 56 (58%) had sLVD. For prediction of sLVD, ewECG showed areas under PR and ROC curves of 0.86 and 0.8 respectively. The feature of greatest importance, with twice the importance of the second was a CWT frequency related to depolarisation.
Baseline characteristics Hypertension (%) 83 (86) Diabetes Mellitus (%) 34 (36) Atrial Fibrillation (%) 8 (8) BMI (IQR) 31 (27–34) LVMi (SD) 73 (23) Ejection fraction (SD) 60 (6) GLS (SD) 18 (3) E/e' (IQR) 8 (7–10) LAVi (IQR) 33 (28–40) IQR, Interquartile range; BMI, body mass index; LVMi, left ventricular mass index; GLS, global longitudinal strain; LAVi, left atrial volume index.
Prediction model performance

Conclusion
ewECG shows good predictive performance for sLVD in elderly subjects at risk of HF. HF prevention strategies incorporating ewECG to select individuals for echocardiographic evaluation should be considered.

Acknowledgement/Funding
Baker Heart and Diabetes Institute
P3440Can pre-operative echocardiography predict RV failure post-LVAD implantation in children?
Authors: Cardoso B , Heads-Baister A , Johnson A , Wake J , Chila T , Simpson E , Hasan A , O'sullivan J , Reinhardt Z , Khushnood A 
Published: October 2019

Abstract

Background
One of the most frequent complications of left ventricular assist device (LVAD) implantation is the development of right ventricular (RV) failure, which occurs in 10%-40% of patients. It is, therefore, essential to identify which LVAD candidates are at risk for RV failure and will require additional RV mechanical support with a biventricular assist device (BiVAD). However, the echocardiographic assessment of the RV is challenging due to its complex geometry and marked load dependence of its function indices. To our knowledge, there is no published evidence regarding which specific RV echocardiographic parameters should inform this decision in the paediatric population.

Aims
We sought to determine which pre-operative RV echocardiographic parameters best correlate with the need for a BiVAD, as opposed to LVAD alone, in a paediatric population undergoing VAD insertion at a tertiary care institution.

Methods
Retrospective review of the pre-operative echocardiograms of children (<18 years) with dilated cardiomyopathy undergoing elective VAD implantation at our institution, from November 2007 to December 2018. Preoperative quantitative and qualitative RV echocardiographic parameters described in the literature to be associated with RV failure after LVAD implantation in adults were collected. Moreover, qualitative RV function was independently assessed by three echocardiographers, blinded to the outcome of the patients.

Results
89 patients were included, 39 (43.8%) males, median age = 1.7 years (IQR = 6.9), median weight = 11.6 kg (IQR = 13.8). 49 (55.1%) patients had an LVAD implanted, whereas 40 (44.9%) were deemed to need biventricular support. 45 (50.6%) patients received an EXCOR Berlin Heart, 16 (18%) a HeartWare HVAD and 28 (31.4%) a Levitronix Centrimag device. Requirement of BiVAD support was significantly more common in patients with moderate to severe RV impairment, as per expert assessment (OR = 2.864; 95% CI: 1.188–6.903, p=0.018), and tricuspid regurgitation > grade III (OR = 3.154; 95% CI: 1.124–8.850, p=0.025). All the other parameters collected – tricuspid annular plane systolic excursion (TAPSE), tricuspid regurgitant jet velocity, tricuspid regurgitation duration corrected for heart rate, RV tissue Doppler indices, RV fractional area change, and RV/LV diameter ratio– were not significantly different among groups.

Conclusions
In our paediatric population, expert assessment of RV function and degree of tricuspid regurgitation were strong predictors of RV failure among patients undergoing LVAD implantation, allowing for pre-emptive RVAD implantation and improving patient outcomes.
P3452Differential implication of gender on future thromboembolic risk in patients with and without atrial fibrillation
Authors: Choi K.-J , Cho M S , Do U , Kim J , Nam G B , Kim Y H 
Published: October 2019

Abstract

Background
Gender difference in stroke risk by the presence of atrial fibrillation was not well evaluated.

Purpose
We hypothesized that the gender showed different impacts on future thromboembolic risk in patients with and without atrial fibrillation.

Methods
The study population comprised of 26,226 patients (mean 56.3 years old, 52.6% male) with (n=3147, 12.0%) or without (n=23079, 88.0%) atrial fibrillation who underwent cardiac evaluations consisted of electrocardiography, echocardiography, and holter monitoring in our center. The main study outcomes were thromboembolic events defined as composite of ischemic stroke and systemic embolism.

Results
During mean follow-up period of 2.8 years, thromboembolic event occurred in 610 patients (2.3%). In the overall population, the 3-year rate of thromboembolic event of female patients was lower than males (2.2% vs. 2.8%, P=0.011). However, when the population was divided according to the presence of AF, females showed higher rate of thromboembolic events in those with AF (6.7% vs 3.1%, P<0.001), whereas lower rate in those without AF (1.7% vs. 2.7%, P<0.001, P for interaction between gender and AF <0.001). After multivariable adjustment, female gender was at higher risk of future thromboembolic events in those with AF (HR 1.61, 95% CI 1.13–2.29, P<0.001), whereas at lower risk in those without AF (HR 0.75, 95% CI 0.62–0.91, P=0.003). The interaction between gender and AF was significant in those who had one or more components of CHA2DS2-VASc score other than gender (CHA2DS2-VA score ≥1, P for interaction = 0.001), but not in those without (P for interaction = 0.196)

Conclusion
Female gender demonstrated differential thromboembolic risk according to the presence of AF.

Acknowledgement/Funding
None
P3455Trends, untilization of therapies and outcomes of females with history of breast cancer admitted for STEMI
Authors: Mastoris I , Shah Z , Vuddanda V , Mohammed M , Haglund N , Sauer A , Porter C 
Published: October 2019

Abstract

Background
Real world experience of treatment of female patient with history of breast cancer suffering from STEMI is lacking

Purpose
To study the trends, utilization of therapies and outcomes of STEMI in females with history of breast cancer from a large, national, multicenter US database.

Methods
We analyzed Nationwide Inpatient Sample from years 2007 to 2014 to identify all females with primary discharge diagnosis of STEMI and secondary diagnosis of breast cancer. We then analyzed the use of various therapies and outcomes.

Results
Of 476,462 females with STEMI hospitalizations, 17, 357 (3.65%) had history of breast cancer. In this patient cohort the mean age was 75.81±11.82 years and 85% were Caucasians, hypertension, diabetes mellitus, chronic kidney disease and peripheral vascular disease was present in 29.5%, 70.3%, 12.4% and 8.3% respectively. 50% of the patients underwent percutaneous coronary intervention (PCI) and 3% underwent coronary artery bypass surgery (CABG). Intra-aortic balloon pump was used in 5.2% and percutaneous LVAD (PLVAD) in 0.5%. 15.3% patients developed cardiogenic shock (CS) and 6.2% had ventricular fibrillation/cardiac arrest (Vfib/CA). The in-hospital mortality was 12.3%.
Comparison of female patients for STEMI with and without history of breast cancer Group Patients No Age (mean) PCI CABG IABP PLVAD CS Vfib/CA Mortality STEMI / Breast cancer − 495,105 69±14 54% 4.5% 6.5% 3% 9.42% 8.1% 9.7% STEMI / Breast cancer + 17,357 75.8±11.8* 50%* 3%* 5.2%* 0.5%* 15.3%* 6.2%* 12.3%* *P<0.05.

Conclusion
The STEMI/breast cancer cohort is significantly older with underutilization of PCI, CABG, and mechanical circulatory support. This population exhibits higher mortality rates.

Acknowledgement/Funding
None