bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5265Magnetic resonance multilayer assessment of strain in patients with heart failure
Authors: Tanacli R , Hashemi D , Lapinskas T , Duengen H.-D , Edelmann F , Gebker R , Pieske B , Kelle S 
Published: October 2019

Abstract

Introduction
Muscular architecture of the heart is three dimensionally complex and contractility parameters vary widely. Cardiac magnetic resonance (CMR) feature tracking is a largely available and facile method to assess myocardial strain at different layers of the myocardium.

Purpose
Assessing and compare the myocardial longitudinal (GLS) and circumferential strain (GCS) at three distinct layers of the myocardium in patients with heart failure (HF).

Methods
59 patients with a clinical diagnosis of HF who were post-hoc subdivided according to the measured EF and echo assessment of diastolic impairment into 3 groups, following ESC guidelines, were included: (1) patients with HF with preserved ejection fraction (HFpEF) where EF >50% and diastolic dysfunction (E/e' ratio) is present and plasma levels of natriuretic peptides are elevated, (2) patients with HF with mid-range ejection fraction (HFmrEF), where EF = 40–49% and similar additional criterias are present, (3) patients with HF with reduced ejection fraction (HFrEF) where EF <40%. Exclusion criteria: valvulopathy, arrhythmias, insufficient acquisition and artefacts.

Results
Strain values are the highest in the Endo− and progressively lower in the Myo− and Epi− layers with a gradient present in all groups but decreasing in HFmEF and further in HFrEF. GLS decrease with the severity of the disease in all 3 layers Normal > HFpEF > HFmrEF > HFrEF (Endo−: −23.0±3.5 vs −20.0±3.3 vs −16.4±2.2 vs −11.0±3.2, p<0.001, Myo−: −20.7±2.4 vs −17.5.0±2.6 vs −14.5±2.1 vs −9.6±2.7, p<0.001, Epi−: −15.7±1.9 vs −12.2±2.1 vs −10.6±2.3 vs −7.7±2.3, p<0.001) (Figure A), GCS is not different between the Normal and HFpEF (Endo−: −34.5±6.2 vs −33.9±5.7, p=0.51; Myo−: −21.9±3.8 vs −21.3±2.2, p=0.39; Epi−: −11.4±2.0 vs −10.9±2.3, p=0.54) but markedly lower in systolic HF groups Normal > HFmrEF > HFrEF (Endo−: −34.5±6.2 vs −20.0±4.2 vs −12.3±4.2, p<0.001; Myo−: −21.9±3.8 vs −13.0±3.4 vs −8.0±2.7, p<0.001; Epi−: −11.4±2.0 vs −7.9±2.3 vs −4.5±1.9) (Figure B). ROC analysis renders Endo− GCS (AUC=0.89) and respectively Endo− GLS (AUC=0.74) as optimal to detect contractile impairment in HF with Youden's thresholds of −20.2 for Endo− GLS and, respectively, −28.1 for Endo− GCS. Endo− GCS is not different between control and HFpEF and GLS impairment is present only inconstantly in HFpEF.

Conclusions
Feature tracking CMR successfully assess layer-specific myocardial strain and emerges as a powerful tool in functional stratification of patients with HF. Strain amplitude varies consistently throughout the myocardium and its quantification warrants careful standardization. Sub-endocardial strain values of strain are comparatively the highest and show most predictive power to detect contractile impairment. Underlying systolic impairment is present only in a subgroup of patients with HFpEF and only GLS and not the GCS is for this purpose a useful diagnostic tool.
P5317Prevalence of cardiovascular diseases in the Middle-East: systemic review and meta-analysis
Authors: Shehab A , Bhagavathula A S 
Published: October 2019

Abstract

Background
Cardiovascular diseases are the leading cause of mortality in the world and CVDs are responsible for 34% of all deaths in the middle east population. To better understanding of the current CVD prevalence in the middle east population we conducted this systematic review and meta-analysis.

Aim
To assess the prevalence and risk factors of CVD among middle east adult population from the published literature.

Methods
Electronic data basis such as PubMed, Sciencedirect, Embase and Google scholar were searched, from the year 2011 to December 2018. All the original articles published in English and have investigated the prevalence of CVD and risk factors. Study characteristics, participants demographics and risk factors of CVD were recorded. To pull the CVD prevalence, we used random effect meta-analysis. we assess heterogeneity using both the formal tests and subgroup analysis. We also assessed the quality of the studies and examined the publication bias.

Results
We retrieved 2931 potentially relevant papers through searches of electronic and gray literatures, of which 44 articles met inclusion criteria after the screening and were included in systematic review and meta-analysis (N=191,979). The weighted pooled prevalence of CVD was 13.7% (95% CI: 11.1%-16.3%) in the Middle-East. The prevalence of cardiovascular disease risk factors such as dyslipidemia accounts 43.1% (95% CI: 17%-69.3%), diabetes mellitus 32.3%, 95% CI: 23.8%-40.8%), hypertension 30.7% (95% CI: 25.2%-36.3%). Other traditional CVD risk factors, smoking 16.3% (95% CI: 12.9%-19.7%), and family history of CVDs 18.7% (95% CI: 15.2%-22.2%).

Conclusion
A high CVD prevalence of 13.7% was identified and dyslipidemia remain to be a significant independent risk factor for CVD in the Middle-East. Interventional strategies are urgently required for primary prevention of CVD and its associated risk factors in Middle East population.
P5354Echocardiographic findings in pregnant indigenous Australians: under utilised?
Authors: Marangou J , Ferguson D , Ilton M , Remenyi B 
Published: October 2019

Abstract

Background
The Indigenous population of Australia has one of the highest prevalence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) globally. RHD is more common in females and the incidence peaks in the 3rd to 4th decade of life, corresponding with child-bearing age. It is the number one cause of cardiac complications in pregnancy globally. Signs and symptoms of normal pregnancy may overlap with those of cardiac pathology. Significant valvular disease can complicate pregnancy and delivery. Current practice sees pregnant women referred for echocardiography if there are signs or symptoms of possible cardiac pathology or a history of RHD.

Aim
To assess the current practice of echocardiography in pregnant women in a region with a high prevalence of rheumatic heart disease.

Method
A retrospective study of all echocardiograms requested for an indication relating to pregnancy over a three-year period were reviewed in the Northern Territory of Australia. Data collected included patient demographics, echocardiography indication, history of RHD, ARF or other cardiac disease, echocardiographic parameters, location of delivery, peri-partum morbidity and mortality.

Results
The total number of patients reviewed were 257. The 158 Indigenous Australian women had a mean age of 25 years and the 99 non-indigenous women had a mean age of 30 years. The Indigenous women had a higher rate of abnormal echocardiograms, 36.1% compared with 9.1% for non-indigenous women. Table 1 outlines echocardiography indications and outcomes. Indigenous women had extremely high rates of ARF or RHD representing 37% of echocardiography referrals, with 17.1% (27/158) having moderate or severe valve lesions. 5 cases (3.2%) had a history of prior valve surgery. 10 (6.3%) Indigenous patients required transfer to a tertiary centre with valve intervention services available for delivery. There was one maternal death, one post-partum stroke and one foetal death in utero.
Echocardiogram indications and outcomes Incidental murmur Cardiac symptoms Other cardiac disease History of RHD and/or ARF Normal study Rheumatic heart disease Congenital heart disease Other heart disease Indigenous (n=158) 60 (38%) 15 (9.4%) 24 (15%) 59 (37.3%) 101 (63.9%) 47 (29.7%) 7 (4.4%) 3 (1.9%) Non-indigenous (n=99) 44 (44.4%) 24 (24.2%) 31 (31.3%) 0 90 (91%) 2 (2%) 3 (3%) 4 (4%)

Conclusion
In the Top End of Australia, Indigenous patients have a very high rate of abnormal echocardiograms during pregnancy compared with their non-indigenous counterparts, mainly as a result of RHD. Data suggests that pregnant Indigenous women are being under serviced by the current medical model and referral practices. Guidelines are urgently needed in relation to echocardiography and pregnancy in populations that are burdened by RHD.
P5360Cardiovascular adaptation characteristics in women with preeclampsia
Authors: Buzdugan E C , Goidescu C , Nemeti G , Goidescu I , Procopciuc L M , Crisan S , Radulescu D , Muresan D , Caracostea G 
Published: October 2019

Abstract

Introduction
Even in normal pregnancies, physiologic functional and structural cardiovascular adjustments are required for progression of a successful pregnancy. In preeclamptic patients, these pregnancy-induced adaptive processes are intensified. It has been suggested that preeclampsia should be regarded as a failed stress test, a marker for increased later life cardiovascular risk.

Purpose
To differentiate between cardiovascular remodelling patterns in preeclamptic vs. normal pregnancies, using echocardiography and digital photoplethysmography.

Material
We conducted a single-center case–control study, performing cardiovascular assessment during last trimester of pregnancy in 56 pregnant women with preeclamsia (PE) and 62 healthy pregnant women, without CV risk factors.
Echocardiography was performed to characterize left ventricular (LV) remodelling patterns and to assess LV systolic and dyastolic function. Also, digital photoplethysmography was used to determine stiffness index (SI) and vascular age (VA). Data between groups were compared.

Results
The two groups were matched by age (30.42±6.37 vs 29.96±5.18 y/o, p=0.74), body mass index (29.84±5.31 vs. 28.53±5.33g, p=0.30), and parity (primiparous 33 vs. 25, p=0.47, multiparous 23 vs. 27, p=0.78). The prevalence of LV hypertrophy, expressed as LV mass (185.75±39.61 vs. 144.85±28.81 g, p=0.0023) and LV relative wall thickness (0.49±0.08 vs. 0.42±0.069), was higher in preeclamptic women, corresponding to higher blood pressure values (systolic blood pressure 164.27±20.09 vs 114±18.04 mmHg, p=0.0014, dyastolic blood pressure 103.22±14.13 vs. 72.83±11.34 mmHg, p=0.0015). The most common remodeling type in preeclamptic group was concentric hypertrophy (28/56, 50%), while in normal pregnancy group, normal geometry (21/62, 34%) and concentric remodeling (21/62, 34%), were more frequently encountered. No significant differences between groups were found in terms of LV ejection fraction, while dyastolic LV function, depicted through transmitral flow parameters, varied only when E/A ratio was measured (1.38±0.34 vs. 1.62±0.46, p=0.03). In preeclamptic women, SI was increased (9.27±1.86 vs. 7.13±1.86 m/s, p=0.0091), with a significantly higher VA also (47.44±21.61 vs. 28.75±7.51y/o, p=0.0001), for a similar maternal age of the study groups.

Conclusions
We documented a higher prevalence of LV hypertrophy, with the concentric remodelling pattern predominance, as well as a significantly advanced vascular age due to an increased arterial stiffness, among preeclamptic group. Follow-up of these patients may reveal features, or cut-off values, useful to early identify a population that may benefit from early interventions to prevent cardiovascular disease.
P5364Safety profile of bempedoic acid: pooled analysis of 4 phase 3 clinical trials
Authors: Ballantyne C M , Banach M , Catapano A L , Duell P B , Laufs U , Leiter L A , Mancini G B J , Ray K K , Bloedon L T , Sasiela W J , Ye Z , Bays H E 
Published: October 2019

Abstract

Background/Introduction
Bempedoic acid (BA), an oral, first-in-class, ATP-citrate lyase inhibitor, lowers low-density lipoprotein cholesterol (LDL-C) in patients who do not achieve sufficient lipid lowering with guideline-recommended first-line therapies.

Purpose
We evaluated the safety profile of BA in phase 3 trials.

Methods
Data were pooled from 4 randomised, double-blind, placebo-controlled studies that enrolled patients with hyperlipidaemia who were receiving stable lipid-lowering therapy (LLT; maximally tolerated statins +/− nonstatin therapies) and required additional LDL-C lowering. Patients were randomised (2:1) to BA 180 mg or placebo daily for 12 to 52 weeks.

Results
Median exposure for 3621 patients (2424 BA, 1197 placebo) was 363 days. Background LLT included a statin +/− other LLT (83.8%), nonstatin LLT alone (9.4%), or none (6.8%). Adverse event (AE) and serious AE rates were similar between groups (Table). The most common AEs in the BA and placebo groups were nasopharyngitis (7.4% vs 8.9%), myalgia (4.9% vs 5.3%), and urinary tract infection (4.5% vs 5.5%). Rates of new-onset/worsening diabetes were 4.0% for BA and 5.6% for placebo. No AEs leading to discontinuation differed by ≥0.5% between treatments. All fatal AEs were judged by the investigator as unrelated to treatment. A trend was observed for a lower 3-component major adverse cardiac event rate with BA vs placebo (hazard ratio, 0.85; 95% confidence interval: 0.53 to 1.37). Changes in uric acid, creatinine, and haemoglobin were apparent at week 4, stable over time, and reversible after stopping BA. Gout occurred in 1.4% and 0.4% of patients in the BA and placebo groups, respectively. The safety profile of BA was consistent across background therapies, demographics, and disease characteristics.
Table 1. Safety summary Placebo (n=1197) BA (n=2424) Any AE / SAE, % (n) 72.5 (868) / 13.3 (159) 73.1 (1171) / 14.1 (341) Drug discontinuation due to an AE, % (n) 7.8 (93) 11.3 (273) AE with a fatal outcome, % (n) 0.3 (4) 0.8 (19) Aminotransferase elevation >3 x ULN, % (n) 0.3 (3) 0.7 (18) Aminotransferase elevation >5 x ULN, % (n) 0.2 (2) 0.2 (6) Creatine kinase elevation >5 x ULN, % (n) 0.2 (2) 0.3 (8) Creatinine, mean change at week 12, mg/dL −0.002±0.11 0.046±0.12 Uric acid, mean change at week 12, mg/dL −0.02±0.82 0.82±0.97 Haemoglobin, mean change at week 12, g/dL 0.06±0.69 −0.31±0.71

Conclusion(s)
BA added to LLT was well tolerated, with a safety profile comparable to placebo.
P5390Adipolin/C1q/Tnf-related protein 12 attenuates adverse cardiac remodeling in a mouse model of myocardial infarction
Authors: Takikawa T , Ohashi K , Fang L , Kawanishi H , Otaka N , Ogawa H , Murohara T , Ouchi N 
Published: October 2019

Abstract

Background
Ischemic heart disease is one of leading causes of death worldwide. Obesity is closely linked to the development of cardiovascular diseases including ischemic heart disease. Adipose tissue produces various secretory bioactive proteins called as adipokines, and dysregulation of adipokine production contributes to the pathogenesis of obesity-related complications. Previously we identified adipolin, also referred to as C1q/Tnf-related protein12, as an insulin-sensitizing adipokine that is down-regulated in obesity. Here, we investigated the effects of adipolin on cardiac remodeling in a mouse model of myocardial infarction (MI).

Method
Male adipolin-knockout (APL-KO) and wild-type (WT) mice were subjected to the permanent ligation of the left anterior descending coronary artery to create MI. Echocardiographic and histological analyses were performed to evaluate cardiac function and myocardial remodeling at 4 weeks after MI. Apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Cardiomyocyte cross sectional area was evaluated by Wheat Germ Agglutinin staining. Perivascular fibrosis was assessed by Masson's trichrome staining. Neonatal rat ventricular myocytes were used as cultured cardiac myocytes for in vitro study.

Results
APL-KO mice exhibited increased ratios of the heart weight/body weight and lung weight/body weight after MI compared with WT mice. APL-KO mice showed increased left ventricular diastolic diameter and decreased fractional shortening after MI compared with WT mice. APL-KO mice had increases in myocardial apoptosis, cardiomyocyte hypertrophy and perivascular fibrosis at the remote zone of infarct hearts as compared with WT mice. Treatment of cultured cardiomyocytes with adipolin protein reduced apoptosis in response to 24 hours of hypoxia. Treatment with adipolin protein also increased the phosphorylation of Akt in cardiomyocytes. Inhibition of PI3 kinase/Akt signaling by LY294002 reversed the anti-apoptotic effects of adipolin in cultured cardiomyocytes.

Conclusion
Our data indicate that adipolin prevents pathological myocardial remodeling after chronic ischemia, at least in part, by suppressing myocardial apoptosis through an Akt-dependent mechanism.
P5444Plasma Indoleamine 2,3-dioxygenase is highly predictive of cardiac remodeling after myocardial infarction
Authors: Vodovar N , Saadi M , Paven E , Sadoune M , Mercadier J J , Launay J M , Logeart D 
Published: October 2019

Abstract

Background
Acute myocardial infarction (MI) is associated with a strong inflammatory response resulting from the cardiac insult. On the other hand, such an inflammation may lead and/or worsen adverse left ventricular (LV) remodeling after MI. Among the markers of inflammation is Indoleamine 2,3-dioxygenase (IDO), which production is induced upon inflammation. IDO catalyzes the transformation of tryptophane into kynurenine.

Purpose
We tested plasma IDO activity as a predictor of LV remodeling post-MI.

Methods
The PREGICA cohort recruited prospectively patients who were admitted because of first acute myocardial infarction. Blood samples were collected on admission, at day 4 and at day 6. Echocardiography and cardiac MRI were obtained at day 4 and at 6 months. To be included, the number of akinetic LV wall segments had to be ≥3 on 17 at day 4. IDO activity was the ratio between kynurenine and tryptophane measured by high pressure liquid chromatography coupled with fluorimetric detection. Remodelers were identified as patients with a variation of end-diastolic left ventricular volume (EDLVV) between day 4 and 6 months post-MI >20%.

Results
Among the 292 patients studied (mean age 57y, mean necrosis size 26% on MRI), the median increase in EDLVV was 16.7% and 137 (47%) were classified as remodelers. On admission as well as at day 4, IDO activity was significantly higher in remodelers (8.2±4.2% vs 5.3±2.5% and 8.7±5.7% vs 5.6±4.4%, p<0.001) and remained higher at 6 months post-MI. IDO activity at day 4 was highly predictive of LV remodeling (Figure): AUC = 87% [95% CI 83–91%]; IDO threshold of 5.8% resulted in specificity = 81%, sensitivity = 89%, negative predictive value = 89%, positive predictive value = 80%. In contrast, blood levels of NTproBNP, ST2, Galectin 3 or CRP at day 4 were poorly predictive. In multivariate analysis including other predictive variables at day4 (primary angioplasty, EDLVV, LVEF, necrosis size), increase in IDO activity was significantly associated with LV remodeling (OR 1.21 [95% CI 1.11–1.33].

Conclusions
IDO activity appears as a promising biomarker for the prediction of LV remodeling after MI. Its specific role in postMI remodeling pathways requires further investigation.

Acknowledgement/Funding
PHRC national
P5461Left atrial dysfunction is a potent predictor of ischemic complications in hypertensive patients
Authors: Shorikova D , Shorikov E , Khukhlina O 
Published: October 2019

Abstract

Arterial hypertension (AH) is associated with abnormalities morphology and function of heart. The research of left ventricle size in patients with AH is mandatory and included in Guidelines. But enlargement of left atrium (LA) is common finding in AH. Despite of this fact, most AH studies ignore LA size. At the same time LA size is often used as a surrogate marker and considered risk factor cardiovascular events.

Materials and methods
298 patients with AH were included in the study (2011–2017), all the inhabitants of Bukovina region of Ukraine. In 28 patients from this cohort was registered episode of Transient Ischemic Attack (TIA) or Ischemic Stroke (IS). The patients with atrial fibrillation (all types) were excluded. LA volumes were calculated from apical four-chamber and two-chamber views by biplane Area-Length method - LA volume index, LA passive emptying volume (PEV), LA passive emptying fraction (PEF), LA active emptying volume (AEV), LA active emptying fraction (AEF), LA total emptying volume (TEV), LA total emptying fraction (TEF). Data were analyzed by SPSS version 20.

Results
LA diameter and indexed AEV and TEV were significantly higher in the group with TIA/IS compared with non-complicated AH (p<0.05), table. PEF and TEF were significantly lower at hypertensive patients with ischemic complications. There were no significant differences in indexed PEV and TEF (p>0.05), table. According to multivariate analysis was set the reliable linear regression between LA diameter, AEV and TEV with age (p<0.05), body mass index (p<0.05), glucose intolerance (p<0.05) and smoking (p<0.05) in all hypertensive patients, independently of TIA/IS complications.
LA parameters in comparison groups AH (n=270) AH, complicated TIA/IS (n=28) p LA diameter (mm) 35.6±4.1 37.4±4.9 <0.03 PEV (ml/m2) 7.4±2.8 7.6±3.1 0.72 AEV (ml/m2) 5.4±2.4 6.8±1.9 0.003 TEV (ml/m2) 12.9±2.2 14.9±3.1 <0.001 LA PEF (%) 32.3±8.4 28.9±7.3 0.04 LA AEF (%) 40.7±6.9 42.1±7.4 0.31 LA TEF (%) 64.1±5.9 61.3±4.2 <0.001 AH, Arterial Hypertension; TIA, Transient Ischemic Attack; IS, Ischemic Stroke.

Conclusion
LA function can be easily and non-invasively determined by performing 2D echocardiography and becoming parameter of interest as a marker of overall cardiac function. LA size and volume enlargement, LA dysfunction may be a good predictor of cardiovascular outcomes such as Transient Ischemic Attack or Ischemic Stroke in patients with arterial hypertension.