bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3852Twenty-eight-year temporal trends of treatment strategy and short-term outcomes in patients with high-risk pulmonary embolism: impact of ESC guidelines changes
Authors: Hosokawa Y , Yamamoyo T , Tanida A , Matsuda J , Sangen H , Nakata J , Tara S , Shimizu W 
Published: October 2019

Abstract

Background
Thrombolysis has been recommended for high-risk pulmonary embolism (PE) in ESC guidelines, used as a reference in Japan. Recently, indication of thrombolysis for acute PE has been limited with recent guideline revision. Little is known regarding trends of treatment strategy and mortality in high-risk PE patients.

Purpose
To clarify temporal trends of treatment strategy and short-term outcomes in high-risk PE patients.

Methods
A retrospective analysis of therapeutic interventions and short-term outcomes was performed for 52 consecutive high-risk PE patients including cardiac arrest. According to timing of ESC guidelines update (2000, 2008 and 2014), patients were divided into four time periods: 1992 to 2000, 2001 to 2008, 2009 to 2014, and 2015 to 2018.

Results
Mean age and proportion of male were not different over the period. Nosocomial case decreased from 100% to 25% (p<0.01). Postoperative cases (relative contraindication for thrombolysis) included 43% of all patients. Cardiac arrest and VA-ECMO use were 42% and 21% of all patients. Any thrombolytic therapy including catheter-directed intervention showed a non-significant decrease trend (92%-87%-71%-44%, p=0.067). Temporary or retrieval IVC filter insertion showed a significant downward trend (36%-80%-54%-22%, p=0.025). The entire study 30-day mortality was 23%. There was no significant difference in 30-day mortality over the periods (14%-27%-14%-44%, p=0.303). However, major bleeding decreased significantly (71%-40%-7%-22%, p=0.004) (Table).
Table 1 1992–2000 (n=14) 2001–2008 (n=15) 2009–2014 (n=14) 2015–2018 (n=9) p Age (years) 54±12 59±17 64±13 65±16 0.224 Male 29% 13% 29% 44% 0.269 Any thrombolytic therapy 92% 87% 71% 44% 0.067 Catheter-directed therapy 86% 87% 71% 0% <0.01   with thrombolytics (92%) (83%) (90%)   without thromboloytics (8%) (17%) (10%) Only intravenous thrombolysis 8% 7% 7% 44% 0.038 Temporary/retrieval IVC filter 36% 80% 54% 22% 0.025 ICU stay (days) 15±14 10±18 5±4 8±8 0.206 30-day mortality 14% 27% 14% 44% 0.303 Major bleeding 71% 40% 7% 22% 0.004

Conclusion
The temporal analysis identified a decreased trend in any thrombolytic therapy and IVC filter insertion in high-risk PE. The study also found a decreasing trend in major bleeding.
P3853Mortality of surgical redo aortic valve replacement versus transcatheter aortic valve-in-valve implantation in patients with degenerated aortic bioprosthesis: a meta-analysis
Authors: Sanchez Recalde A , Pardo A , Salido Tahoces L , Mestre J L , Hernandez Antolin R , Sanmartin M , Zamorano J L 
Published: October 2019

Abstract

Background
Transcatheter valve-in-valve (tVIV) implantation for degenerated aortic bioprosthesis has become an alternative to surgical aortic valve replacement (sAVR) in the past few years. However, some concerns have been raised regarding to the long-term safety and efficacy of tVIV. The objective was to compare the clinical and echocardiographic outcomes of tVIV implantation with redo cAVR.

Methods
After an extensive search of PubMed we included 7 observational studies (3 used propensity score matching) comparing tVIV versus sAVR in 762 patients The primary endpoint was all-cause mortality determined from the longest available survival data. Other outcomes of interest were stroke, permanent pacemaker implantation, paravalvular leak, hospital stay and postoperative aortic valve gradient. The review was conducted according to the MOOSE recomendations. Der Simonian and Laird random effects model was used to estimate summary measures and their 95% CI.

Results
Patients in the tVIV group were significantly older (78 vs 73 y.o.) and had a higher baseline risk compared to those in the re-sAVR group (Euroscore 19.7 vs 14.3). There was no statistical difference in procedural or 30-day mortality 5.4% vs 5.3% in tVIV and sAVR, respectively (RR 0.98, 95% CI 0.54–1.80; p=0.96], and long-term mortality (from 6 month to 5 years) 18.7% versus 16.5% (RR 1.13, 95% CI 0.80–1.60; P=0.50). The risk of stroke was similar (1.5% in tVIV vs 2.4% in sAVR, p=0.47). tVIV was associated with a significantly lower rate of permanent pacemaker implantations 6.9% vs 12.1% (RR 0.58, 95% CI 0.36–0.94; P=0.03) and shorter hospital length stay (7 days vs 12 days, p=0.02). However, echocardiographic postoperative aortic valve gradients were lower in sAVR group than in tVIV (RR 1.83, 95% CI 0.75–2.91, p<0.001).
30-day and long-term mortality

Conclusion
This meta-analysis suggests that patients with aortic degenerated bioprosthesis treated with tVIV have similar 30-day and long-term mortality with lower need of permanent pacemaker and length stay than sAVR. Thus tVIV is a valid alternative to standard surgical treatment.
P4129cMR-Pulmonary transit time and pulmonary blood volume have an additional prognostic value over cMR-right ventricular ejection fraction in predicting mortality in HF-rEF patients
Authors: Houard L , Langet H , Militaru S , Rousseau M F , Pouleur A C , Gerber B L 
Published: October 2019

Abstract

Background
Assessment of congestion and cardiac function has been shown to have both therapeutic and prognostic implication for the management of patient with CHF. Pulmonary transit time (PTT) assessed by cMR is a novel parameter, which reflects not only hemodynamic congestion but also LV and RV function.

Purpose
We sought to explore the prognostic value of the pulmonary transit time assessed in seconds (PTT) and in beats (PTB) and the pulmonary blood volume indexed (PBVi) above conventional well-known risk factors including cMR-RVEF and estimated pulmonary artery pressure (eSPAP) in predicting outcomes. PBVi is defined by the product of PTB and the stroke volume indexed to body surface area.

Methods
401 patients in sinus rhythm with a LVEF <35% (age 61±13 years; 25% female) underwent a cMR and an echocardiography. Patients were followed for a primary endpoint of overall mortality.

Results
Average cMR-LVEF was 23±7%, cMR-RVEF was 43±15%, average estimated systolic pulmonary pressure (eSPAP) was 33±12mmH, average PTT was 11±6s, PTB 8.9±5.6 bpm and average PBVi 305.5±254.9ml/m2. After a median follow-up of 6 years, 182 reached the primary endpoint. In univariate cox regression, age, ischemic cardiomyopathy, hypertension, diabetes, NYHA class III-IV, eSPAP >40mmHg, E/A ratio, e/e'ratio, cMR-RVEF, LV scar, PTT, PTB, PBVi, GFR, beta blockers and diuretics were associated with overall mortality. For the multivariate analysis, a baseline model was created where age, ischemic etiology, NYHA functional class III-IV, eSPAP >40 mmHg, beta-blockers and cMR-RVEF were found to be significantly and independently associated with the primary endpoint. PTT (X2 to improve = 5.3, HR: 1.03; 95% CI: [1.01; 1.06]; P=0.015), PTB (X2 to improve = 11.8, HR: 1.06; 95% CI: [1.03; 1.09]; P<0.001) and PBVi (X2 to improve = 7.7, HR: 1.08; 95% CI: [1.03; 1.14]; P=0.002) showed a significantly additional prognostic value over the baseline model (p<0.001).

Conclusion
Pulmonary transit time and pulmonary blood volume provide higher prognostic information over well-known risk factors including cMR-RVEF and eSPAP with high power to stratify prognosis in HF-rEF and might be promising tools to identify patients at higher risk among HF patients.

Acknowledgement/Funding
Fond National de recherche scientifique (FNRS)
P4148Contemporary prognosis of patients hospitalised with a primary diagnosis of heart failure: a report from the national heart failure audit of England & Wales
Authors: Cleland J G F , Shote A , Hardman S , McDonagh T 
Published: October 2019

Abstract

Background
Since 2009, National Health Service hospitals in England & Wales have been required to participate in a national audit of people with a hospital death or discharge attributed primarily to heart failure. The data collection tool is web-based with >250 fields. Mandatory data include age, sex, deprivation-index, admission symptoms, aetiology and co-morbidity, electro- and echo-cardiographic data, standard laboratory tests and discharge medications. Patients are followed up for re-admissions and deaths through linkage to national records. Altogether >500,000 patients have been enrolled.

Purpose
To describe the contemporary in-patient and post-discharge mortality of patients with a primary death or discharge diagnosis of heart failure reported by hospitals in England & Wales, stratified by age, sex and left ventricular phenotype.

Methods
Descriptive. Patient characteristics are described as medians with inter-quartile ranges. Time to event analyses using Kaplan-Meier.

Results
Altogether, 253,981 unique patients (>75% of all relevant admissions) were entered into the registry between April 2014-March 2018, of whom 45% were women (median age of 82 (75–88) years; 45% with LVEF <40%) and 55% were men (median age of 78 (69–85); 65% with LVEF <40%. Amongst 45,772 patients surviving to discharge in 2017–18 with an LVEF <40%, 92% were discharged on a loop diuretic, 22% on digoxin, 72% on an ACE inhibitor, 23% on an ARB, 83% on an ACE inhibitor and/or ARB, 89% on a beta-blocker and 56% on an MRA. Patients who received disease-modifying agents were younger and had a better prognosis.
Age, but neither sex nor LVEF, was a strong determinant of both in-patient and post-discharge mortality. In-patient mortality ranged from 3.2% in those aged <45 years to 16.5% in those aged >85 years. One year mortality for patients who survived to discharge ranged from 10.4% in those aged <45 years to 45.6% in those aged >85 years (figure shows age-stratified, post-discharge, one-year mortality for people enrolled 2014–17).
Age-Stratified Post-Discharge Mortality

Conclusions
More than 60% of people hospitalised for heart failure in England & Wales are aged >75 years. In-patient and post-discharge mortality remain high for patients hospitalised with a primary diagnosis of heart failure. Treatment and outcome are strongly influenced by age.

Acknowledgement/Funding
The Healthcare Quality Improvement Partnership and National Institute for Cardiovascular Outcomes Research funded by UK Government
P4149Real world evidence (RWE) versus cardiology registries and clinical trials: a largely different epidemiological profile of a community setting of 13,168,444 subjects
Authors: Maggioni A P , Dondi L , Orso F , Pedrini A , Calabria S , Ronconi G , Piccinni C , Martini N 
Published: October 2019

Abstract

Aims
Patients with heart failure (HF) included in controlled trials (RCTs) or included in cardiology registries (CRs) do not fully represent the “real world”. This study describes the characteristics of HF by analyzing administrative data of more than 13,000,000 subjects.

Methods and results
Analyses were carried out from the ReS database, a population-based database linking demographic data, prescription records, hospital discharge records, outpatient examinations/procedures. Patients were selected when discharged with a diagnosis of HF (in year 2014). Clinical characteristics, pharmacological treatments, re-hospitalizations, and direct costs for the NHS were described during 1-year follow-up (FU).
Of the 13,168,444 subjects included in the database, 54,268 (0.4%) were hospitalized for HF. Table shows the patient characteristics compared to those of HF patients included in RCT or CR. During 1-year FU, 47.7% of patients had at least one re-hospitalization. Of total hospitalizations, 22% was due to HF, 51.7% was due to non-CV causes. Mean cost per patient per year was 10399€, of which 80.5% was related to hospitalizations.
Variable RCT: ASCEND-HF CR: HFA HF Long Term Big data: ReS database (2010) (2011–2014) (2014) No. of patients 7,141 6,629 54,268 Mean age 67 75 77 Females, % 34 37 47 Diabetes, % 41 39 34.7 Hypertension, % 72 66 65.2 COPD, % 15 19 55.7 Coronary disease, % 60 54 31# Renal dysfunction, % 30 25 23.6# Depression, % NR 7 23.2 Neoplasia, % NR 5 9 ACE-I/ARBs, % 60 79 65.8 Betablockers, % 58 89 65.2 MRAs, % 28 56 40.9 Ivabradine, % NR 3 6.4 #Defined as hospital admissions for the specific cause. NR = not reported.

Conclusions
RWE provides an epidemiological profile of HF that is largely different from that reported by RCTs or CRs. The high costs for the NHS are mainly driven by hospitalizations, which are more frequently due to non-CV reasons. These figures should be considered when the total burden of the HF is evaluated.
P4157Coronary flow reserve but not ischemia is a strong predictor of mortality in 551 outpatients referred for stress myocardial perfusion by Rubidium-82 PET imaging
Authors: Tavares Poppi N , Soares Junior J , Meneghetti J C , Mahler Mioto B , Giorgi M C P , Izaki M , Machado Cesar L A 
Published: October 2019

Abstract

Background
The assessment of myocardial ischemia in patients with suspected coronary artery disease (CAD) is encouraged by current guidelines. The ischemic burden is associated with impaired prognosis. Coronary flow reserve (CFR) is also an independent predictor of cardiovascular mortality but it is unclear which one of these two variables would be stronger to predict mortality.

Purpose
To evaluate the predictors of death in symptomatic stable patients with suspected CAD referred for stress myocardial perfusion (MP) Rubidium-82 PET imaging.

Methods
551 consecutive patients (52% men, mean age 63 years) were enrolled in this study from February to October 2013. The primary endpoint was all-cause death. The event-free survival curves for the primary endpoint were obtained using the Kaplan-Meier method in four groups of patients based on whether ischemia was present and whether CRF was impaired (<2) (Figure). Univariate analysis was performed using Cox regression to identify the variables that were associated with mortality, and the Cox proportional-hazards regression model for the multivariate analysis adjustment.

Results
During a median follow-up period of 32 months there were 43 deaths giving an estimated cumulative event rate of 7.8%. Univariate predictors of death were: age, higher prevalence of DM and CKD, lower LVEF and BMI. Following a multivariate analysis, only CFR was independently associated with mortality (Table).
Predictors of death Variable Univariate model Multivariate model HR (95% CI) P value HR (95% CI) P value Age 1.03 (1.00–1.06) 0.036 1.01 (0.99–1.04) 0.324 Male sex 1.41 (0.76–2.56) 0.277 0.96 (0.70–1.32) 0.809 History of DM 2.12 (1,13–3,97) 0.019 – – History of CKD 4.95 (2,66–9,20) <0.001 – – BMI <30 1.14 (1.05–1.22) <0.001 2.22 (0.93–5.26) 0.071 Rest LVEF, % 0.98 (0.96–0.99) 0.029 0.99 (0.98–1.01) 0.477 Ischemia, % 1.02 (0.97–1.06) 0.436 0.99 (0.91–1.10) 0.990 Ischemia ≥10% 1.33 (0.59–2.99) 0.488 0.90 (0.40–2.05) 0.806 CFR 0.26 (0.15–0.43) <0.001 0.27 (0.16–0.46) <0.001 LVEF = left ventricular ejection fraction.
Survival curves for all-cause death.

Conclusions
In symptomatic outpatients with suspected CAD referred for stress MP Rubidium-82 PET imaging, CFR is the strongest predictor of mortality. Notably, neither the presence of ischemia nor the ischemic burden was associated with the outcome in question.
P4168Ischemic sudden cardiac deaths among victims under 50 years - Characteristics and autopsy findings
Authors: Vahatalo J H , Huikuri H V , Pakanen L , Kaikkonen K S , Tikkanen J , Perkiomaki J S , Junttila M J 
Published: October 2019

Abstract

Background
Sudden cardiac death (SCD) is one of the most prevalent cause of death in Western countries representing nearly 20% of total mortality. About 70–80% of SCDs are due to coronary artery disease (CAD). Especially among young victims, whose first cardiac event is often SCD, decent risk prediction and prevention strategies are sadly lacking.

Purpose
The aim of this study was to determine the characteristics and autopsy findings of ischemic sudden cardiac deaths among young victims under the age of 50 years.

Methods
The study population is derived from Fingesture study, consisting of prospectively collected consecutive victims of SCD in Northern Finland among whom post-mortem examinations were performed between years 1998–2017 (n=5,869). According to Finnish law, all unexpected deaths undergo medico-legal autopsy. All post-mortem examinations included histological examinations, as well as a toxicology investigation was carried out if needed. Information about the victims was collected from autopsy data, death certificates, medical records, standardized questionnaire to the closest family members of the victims and police reports about the conditions of the death. 10% off all SCDs occurred among victims aged under 50 years (607 victims).

Results
CAD was the most common underlying cause of SCD among young victims (265 victims, 44%), followed by obesity related (102 victims, 17%) and alcoholic cardiomyopathy (67 victims, 11%). The mean age of ischemic SCD victims was 44±4 years and they were mostly men (89%). 90% of victims had no history of CAD prior to death and 34% of these had a myocardial scar at autopsy indicating previously unrecognized MI. 26% of SCDs occurred during physical activity. Hypertrophied hearts (59%) and myocardial fibrosis (83%) were common findings among young ischemic SCD victims. 27% of victims had a history of heavy drinking and alcohol was found in toxicology investigations in 35% of victims. At least one cardiovascular risk factor (diabetes mellitus, hypertension, dyslipidemia, obesity) was present in 51% of cases.

Conclusions
CAD was the most common cause of SCD among victims under 50 years. Most ischemic SCDs among young occurred without previously diagnosed CAD, and yet severe findings were seen at autopsy.

Acknowledgement/Funding
Sigrid Juselius Foundation, Finnish Foundation for Cardiovascular Research, Aarne Koskelo Foundation
P4169The crucial role of the bystander in out-of-hospital cardiac arrest resuscitation
Authors: Campos T , Baert V , Hubert H , Wiel E , Benameur N 
Published: October 2019

Abstract

Background
Out-of-hospital cardiac arrest (OHCA) is a major public health concern in France, given that there are 61.5 cases per 100,000 inhabitants a year. The impact of bystander action, performed before the arrival of emergency medical services (EMS), on survival has never been studied in France.

Purpose
Determine whether bystander cardiopulmonary resuscitation (CPR), performed before the arrival of EMS, was correlated with an increased 30-day survival rate after an OHCA.

Methods
24,885 out-of-hospital cardiac arrests witnessed in France from 1 January 2012 to 1 May 2018 were analysed to determine whether CPR, performed before the arrival of EMS, was correlated with survival. Data from the Electronic Registry of Cardiac Arrests was used. The association between the effect of CPR performed before the arrival of EMS and 30-day survival rate was studied, using propensity analysis (which included variables such as age and sex of the patient, location, cause, and year of cardiac arrest, initial cardiac rhythm, EMS response time and no-flow time).

Results
CPR was performed before the arrival of EMS in 14,904 cases (59.9%) and was not performed in 9,981 cases (40.1%). The 30-day survival rate was 10.2% when CRP was performed by bystanders versus 3.9% when CRP was not performed before the EMS arrival (p<0.001). CPR performed by bystanders was associated with an increased 30-day survival rate (odds ratio 1.269; 1.207 to 1.334).
The effect of bystander CPR on survival

Conclusion
Bystander CPR performed before the arrival of EMS was associated with an increased 30-day survival rate after an out-of-hospital cardiac arrest in France.
P4172Prevalence and potential genetic determinants of young sudden unexplained death victims with suspected arrhythmogenic mitral valve prolapse
Authors: Giudicessi J , Tester D , Ackerman M 
Published: October 2019

Abstract

Background
Mitral valve prolapse (MVP) is largely considered a benign condition. Recently, arrhythmogenic MVP, a sudden cardiac death (SCD)-predisposing condition characterized clinically by frequent/complex ventricular arrhythmias likely secondary to prolapsing leaflet-induced fibrosis of the left ventricle (LV), has emerged as an underappreciated cause of sudden unexplained death in the young (SUDY).

Objective
To determine the prevalence and potential genetic underpinnings of suspected arrhythmogenic MVP in a referral cohort of SUDY cases.

Methods
In this retrospective necropsy study, the medical records, autopsy reports, and whole exome molecular autopsy (WEMA) results for 77 SUDY victims (27 females; average age at death 20.6±8.9 years) were reviewed. Evidence of myxomatous MVP and concomitant LV pathology were noted. Variants detected in the pre-specified 164 WEMA gene panel with a frequency <0.001 in public exomes were classified using the 2015 American College of Medical Genetics (ACMG) guidelines.

Results
Overall, 6/77 (7.8%; 2 females; average age at death 20.7±6.9 years) SUDY cases had MVP as the lone abnormal post-mortem finding. The majority had bileaflet involvement (5/6; 83%) and microscopic LV fibrosis (5/6; 83%). Two SUDY cases (33%) were diagnosed with MVP by echocardiography prior to death. No gross hypertrophy, myocyte disarray, or fibrofatty replacement was noted. Unexpectedly, an ACMG pathogenic/likely pathogenic (P/LP) was more likely to be detected in SUDY cases with MVP than those without [3/6 (50%) vs 9/71 (13%); p<0.05]. Interestingly, the three variants identified in MVP-positive SUDY cases localized to genes associated previously with a cardiomyopathy/channelopathy predisposition (p.E1518fsX25-DMD, p.S285N-RYR2, and p.R109X-TTN).

Conclusion
This WEMA series provides additional evidence that the combination of bileaflet MVP and microscopic LV fibrosis underlies an unexpected number of SUDY cases. Whether P/LP variants in cardiomyopathy/channelopathy-susceptibility genes function as contributing factors or if unrelated, but poorly understood, molecular mechanisms account for the distinct cardiomyopathy-like phenotype observed in arrhythmogenic MVP requires further investigation.