bluuebunny/crossref_metadata_2025_split huggingface dataset:
P637Effects of cardiac rehabilitation as independent predictor for favourable long term postoperative evolution in patients undergoing coronary artery bypass grafting
Authors: Iliuta L 
Published: October 2019

Abstract

Aim
1. To evaluate whether a supervised cardiac rehabilitation (CR) program improves physical capacity and quality of life (QoL) of patients with LV systolic dysfunction undergoing coronary artery bypass grafting (CABG) compared to patients training by their own.
2. To investigate LV diastolic function dynamics according to the results of tissue Doppler imaging (TDI) in these patients.
3. To define the echographic predictors for long term prognosis in these patients and their adjusted value for calculation of a preoperative risk score.

Material and method
Prospective randomized study on 665 CABG patients with LV systolic dysfunction (LVEF<35%), comparing 12 weeks of supervised exercise training (SET) 3 times per week to home-based training based upon public health recommendations of minimum level of physical activity. Patients were evaluated including TDI preoperatively and till 5 years postoperatively. The primary endpoints were the composites of death from any cause or hospitalization for cardiac causes and the secondary endpoints were changes in peak oxygen uptake and in physical capacity (measured with cardiopulmonary exercise testing), changes in health-related QoL and changes in physical activity level (measured with International Physical Activity Questionnary). Stastistical analysis used SYSTAT and SPSS programs.

Results
1. SET was more efficient in rehabilitating CABG patients being an independent predictor for a more favourable postoperative evolution, mostly in patients with normal LV diastolic filling pattern (LVDFP) (97,27%) compared with restrictive LV filling (89.83%). At 5 years postoperatively, cardiovascular event-free survival was significantly higher in nonrestrictive LVDFP group (74.94%) compared with restrictive LVDFP (55,75%).
2. Conventional transmitral diastolic Doppler indices before and after CABG remained unchanged. TDI showed significant improvement in SET group at 3 and 12 months postoperatively of both LV systolic (S: 6.1±0.9, 7.5±1.1 and 7.3±1.2cm/s) and diastolic function (e': 7.2±1.8, 8.3±1.4 and 8.8±1.5cm/s.; E/e' ratio: 17.8±2.1, 13.1±1.7 and 11.3±1.8; Vp 3.2±0.55, 2.4±0.28 and 1.9±0.26)
3. The main predictors for unfavorable evolution at 5 years postoperatively were: age >75 years (RR=7.3), LV end-systolic volume (LVESV) >85cm3 (RR=6.4), restrictive LVDFP (RR=8.9) and pulmonary hypertension (PHT) (RR=5.2).

Conclusions
1. SET improves physical capacity and QoL in CABG patients, mainly in those with normal LVDFP, the restrictive LVDFP being associated with an early and late postoperative unfavourable evolution and difficult CR.
2. Exercise capacity and symptoms are more closely correlated with indices assessed by TDI which demonstrate significant improvement of LV systolic and diastolic function in SET patients, regardless of transmitral flow pattern
3. On long term postoperatively the unfavorable evolution was predicted by: age>75 years, LVESV>85cm3, restrictive LVDFP and severe PHT.
P640Sex differences in cardiovascular and all-cause mortality in middle-aged and older participants of a medically-supervised exercise program
Authors: Araujo C G , De Souza E Silva C G , Nishijuka F A , Laukkanen J A , Franca J F , Castro C L 
Published: October 2019

Abstract

Background
Physical inactivity has been shown to be associated with all-cause mortality in both healthy and unhealthy middle-aged and older individuals. While regular exercise is equally recommended for men and women, it is virtually unknown if sex influences the long-term survival among participants of a medically-supervised exercise program (MSEP).

Purpose
To evaluate if cardiovascular and all-cause mortality differs between men and women who participates in a MSEP.

Methods
Retrospective data from an open cohort of individuals aged 36 to 85 years old (66% men) who participated in a private MSEP between March 1994 and December 2018 were analyzed. The participants were free to attend the exercise sessions anytime from 6 a.m. to 9:30 p.m. (Monday to Friday) or 7 a.m. to 4 p.m. (Saturday). In median, the participants completed 47 sessions (1 to 5992 sessions) and attended for 6 months. Exercise sessions last between 60–80 minutes on average and included aerobic, muscle power, flexibility and balance exercises for all participants. Depending on clinical condition, gross and fine motor coordination, inspiratory muscle and isometric handgrip training were also performed under direct supervision of a multiprofessional team. Before each exercise session, the participant was briefly assessed by the exercise physician amd the aerobic exercise part was individually prescribed based on pre-participation evaluation/previous session data. Kaplan-Meier survival curves were separately determined for men and women - cardiovascular and all-cause mortality - and statistically compared by log rank test.

Results
Men and women had identical mean ages of 62.5 years-old (p>0.99) and median follow-up was 11 years, ranging from 0.1 to 24.8 years. From a total of 2,238 participants wit different disorders (68% with coronary artery disease), 465 died (21%), with almost three times higher death rate for men (15.1%) as compared to women (5.7%) (p<0.001). Cardiovascular deaths were 27% of total and also proportionally more frequent in men than women (HR 0.63, 95% CI 0.44–0.9; p=0.012). Women had a higher long-term overall survival rate than men (83% vs. 77%, respectively, HR 0.66, 95% CI 0.55–0.80; p<0.001).

Conclusion
Long-term cardiovascular and all-cause mortality were much higher in men than women that participated in a MSEP and these differences could not be explained by age. Future studies are needed to explain these findings and to analyze if men and women in MSEP would need similar dose of exercise for better survival benefit.

Acknowledgement/Funding
CNPq/FAPERJ/Health State Secretary
P644Relative fat mass (RFM) is a better predictor of dyslipidemia and metabolic syndrome than body mass index (BMI)
Authors: Kobo O , Leiba R , Avizohar O , Karban A 
Published: October 2019

Abstract

Background
The best adiposity measure to help predict cardiovascular risk factors has remained controversial. Relative fat mass (RFM), had been recently developed. We aimed to examine RFM predictability to various cardiometabolic risk factors, compared to BMI.

Methods
Observational, cohort study, among patients who visited the Periodic Examinations Institute [PEI]. We analysed the correlation between BMI and RFM to hypertension, impaired fasting glucose, high LDL, low HDL and metabolic syndrome, by gender. Using ROC curves, we identified the ideal value of RFM for identification of metabolic syndrome.

Results
During study years, 20,167 patients visited the PEI and included in the trial. Compared to BMI, RFM showed significantly better predictability (HR, [95% CI, p value]) of high LDL [1.618 (1.441–1.816, p<0.001) vs 0.732 (0.67–0.8, p<0.001) in men; 1.572 (1.377–1.794, p<0.001) vs. 0.938 (0.849–1.163, p=0.94) in women], low HDL [2.944 (2.569–3.373, p<0.001) vs. 2.177 (2–2.369, p<0.001) in men, 2.947 (2.519–3.448, p<0.001) vs 1.9 (1.658–2.176, p<0.001) in women], high triglycerides [4.019 (3.332–4.847, p<0.001) vs 1.994 (1.823–2.181, p<0.001) in men, 3.93 (2.943–5.247, p<0.001) vs. 2.24 (1.887–2.62, p<0.001) in women] and metabolic syndrome [7.479, (4.876–11.47, p<0.001) vs 3.263 (2.944–3.616, p<0.001) in men, 16.247 (8.348–31.619, p<0.001) vs 5.995 (5.099–7.048, p<0.001) in women]. There was no significant difference in the predictability of BMI and RFM to hypertension and diabetes mellitus. The ideal values of RFM for identification of metabolic syndrome were 27.7 for men and 39.8 for women.

Conclusions
RFM provides high predictability for dyslipidemias and metabolic syndrome in men and women.
P656Risk of major gastrointestinal bleed in relation to vascular disease risk in 0.5M UK Biobank participants
Authors: Hammami I , Mafham M , Armitage J , Parish S 
Published: October 2019

Abstract

Background
Low-dose aspirin is of established benefit for secondary prevention of cardiovascular events but in primary prevention the benefit is finely balanced with the hazard of major bleeds, and in particular gastrointestinal (GI) bleeds.

Purpose
To investigate non-vascular, non-genetic risk factors for major GI bleeds and derive a score for GI bleed risk which may help identify who will receive most net benefit from aspirin.

Methods
In the UK Biobank prospective study of 0.5M participants aged 40–69 at recruitment, prior history of cardiovascular disease, bleeds and other medical conditions was ascertained from self-reported diagnoses and electronic heath records (EHR) prior to recruitment. Major GI bleed during 6 years of follow-up was defined based on coded diagnoses and duration of hospital stay. Non-vascular risk factors for bleed were identified from amongst 100 baseline and prior disease factors using a stepwise regression with adjustment for established vascular risk factors, aspirin and warfarin use. 10-way cross-validation was used when making risk scores.

Results
Among the primary prevention population without prior intracranial bleed, serious extracranial bleed or gastrointestinal ulcer in the 6 months prior to recruitment, 1682 (0.06%/y) participants had a major GI bleed (1006 upper GI, 676 lower GI) with a mean stay in hospital of 3.2 days. Antiplatelet use (in 11%) and anticoagulant use (in 1%), were associated with 1.5 and 4 fold risks of GI bleed, respectively. Stepwise regression identified a non-vascular risk score for major bleed with a 4-fold risk ratio across fifths (Figure). But the score was also associated with a 2-fold risk ratio for major vascular events.

Conclusions
Major GI bleeds cause substantial morbidity. A 4-fold difference in bleed risk across quintiles was distinguishable by a score based largely on EHR prior disease information and frailty measures. This score is applicable in other contexts and will be applied in the ASCEND randomised trial of daily aspirin to provide randomized evidence of the net benefit of aspirin in different risk categories. However, vascular risk factors predicted risk of GI bleeds, and non-vascular risk factors for GI bleed predicted risk of major vascular events; so the net benefit from aspirin may vary only modestly across categories by vascular and bleed risks.
P665Incidence and predictors of intracerebral haemorrhage recurrence in patients with and without atrial fibrillation: a cohort study
Authors: Overvad T F , Andersen S D , Larsen T B , Lip G Y H , Soegaard M , Skjoeth F , Nielsen P B 
Published: October 2019

Abstract

Background
Intracerebral haemorrhage is a devastating vascular event. Clinical predictors of recurrence facilitating individualised post-bleeding patient management are sparsely described. Concomitant atrial fibrillation is common in patients with intracerebral haemorrhage due to widespread use of oral anticoagulation in this specific population.

Objective
We aimed to describe incidence of intracerebral haemorrhage recurrence and explore the prognostic value of 25 clinical predictors for recurrence in patients with and without atrial fibrillation, including various comorbidities, civil status, lifestyle, medication, and measures of bleeding severity reflected by the Scandinavian Stroke Scale score.

Methods
Cohort study of patients with incident intracerebral haemorrhage diagnosed from 2003–2016 identified using nationwide Danish administrative registries. Results reported as cumulative incidence of intracerebral recurrence accounting for competing risk of death. Univariate and multivariate predictors of recurrence were estimated using Cox regression analyses (hazard ratios [HRs], 95% confidence intervals [CI]).

Results
We identified 9,255 patients with incident intracerebral haemorrhage (median age 73 years, 46.6% females, 16% with atrial fibrillation). Five-year risks of intracerebral haemorrhage recurrence were approximately 10% in the study population, although slightly higher for patients without atrial fibrillation (Figure). Predictors of recurrence were broadly similar for patients with and without atrial fibrillation. Age in categories <60 years (reference), age 60–70 years (HR 1.30, 95% CI 1.03–1.65), age 70–80 years (HR 1.60, 95% CI 1.27–2.01), age >80 years (HR 1.20, 95% CI 0.91–1.57), nursing home residency (HR 1.48, 95% CI 1.03–2.15), and Scandinavian Stroke Scale score (“mild” versus “moderate” (HR 1.40, 95% CI 1.13–1.72) and “severe” (HR 1.94, 95% CI 1.59–2.37) were the strongest predictors of intracerebral haemorrhage recurrence.

Conclusions
Intracerebral haemorrhage recurrence risk after five years was approximately 10%. Robust clinical predictors of recurrence were few and broadly similar for patients with and without atrial fibrillation, with age and measures of bleeding severity being the most important.

Acknowledgement/Funding
The study was supported by “The BMS/Pfizer ERISTA Program 2016”. The sponsor had no role in the preparation of the manuscript
P669Frequency of venous thromboembolic risk evaluation and adequate in-hospital thromboprophylaxis administration
Authors: Galindo S , Juan Esteban Gomez Mesa J E G 
Published: October 2019

Abstract

Introduction
The most common in-hospital complication is venous thromboembolism (VTE). High risk patients have an incidence of VTE as higher as 18.3%. Padua and Caprini Scores allow to identify the thromboembolic risk for each type of patients. Thromboprophylaxis administration reduces VTE risk, but as low as 16–33% of medical patients and 25–44% of surgical patients receive this intervention during hospitalization.

Purpose
This study aims to identify basal adherence to evidence-based recommendations for thromboprophylaxis in hospitalized patients (annual evaluation) and its variation following monthly thromboprophylaxis risk evaluation.

Methods
A prospective, descriptive and observational study that included data from annual VTE risk evaluation (Padua/Caprini scores) and thromboprophylaxis administration (from 2015 to july 2018) followed by monthly risk assessments and thromboprophylaxis administration (August to November/2018) in 2.140 medical/surgical hospitalized patients.

Results
A total of 1290 patients (54,15%) had high risk for VTE: 787medical patients (Padua Score) and 503 surgical patients (Caprini score) and therefore they required thromboprophylaxis administration. In total population, adequate thromboprophylaxis administration inceased from 55% (annual evaluation) to 81,4% (monthly evaluation). In medical patients, adequate thromboprophylaxis increased from 59% (Annual evaluation) to 81,3% (monthly evaluation). In surgical patients, adequate thromboprophylaxis increased from 49% during annual evaluation to 81.5% during monthly evaluation (Figure 1).
Figure 1. Correct thromboprophylaxis (2018)

Conclusions
Annual thromboprophylaxis risk evaluation and thromboprophylaxis administration can be improved in medical patients when performed on a monthly basis. This difference does not apply to surgical patients, where monthly evaluations and interventions remains stable. Besides that, more aggressive risk evaluation should be implemented in order to reach thromboprophylaxis administration rates higher than 90%, and this can be done with weekly or daily measurement and intervention.

Acknowledgement/Funding
None
P672Ischemic and bleeding risk after an acute coronary syndrome in patients with prior history of cancer treated with dual antiplatelet therapy
Authors: Munoz Pousa I , Raposeiras Roubin S , Abu-Assi E , Manzano Fernandez S , D'Ascenzo F , Simao Henriques P J , Saucedo J , Ariza Sole A , Cambronero Sanchez F , Flores Blanco P J , Cespon Fernandez M , Caneiro Queija B , Cobas Paz R , Iniguez Romo A 
Published: October 2019

Abstract

Introduction
Very few patients with history of cancer are included in clinical trials. With this study from real-life patients, we try to analyze the ischemic and bleeding risk of patients with history of cancer who were treated with dual antiplatelet therapy (DAPT) after an acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Methods
The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without previous history of recent cancer. The impact of prior cancer in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction (AMI), whereas for bleeding risk we have considered major bleeding (MB) defined as bleeding requiring hospital admission. All events occurred with DAPT, as follow-up time was censored by DAPT suspension/withdrawal.

Results
From the 26,076 ACS patients, 1,661 have prior history of cancer (6.4%). Patients with cancer were older, and with more cardiovascular risk factors. DAPT with prasugrel/ticagrelor was less frequently prescribed in patients with cancer in comparison with the rest of the population (14.5% vs 22.4%, p<0.001). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), and 640 AMI (2.5%) and 685 MB (2.6%) were reported. The unadjusted cumulative incidences of AMI and MB were higher in patients with prior cancer (5.1 and 5.2 per 100 patients/year, respectively) than in those with prior cancer (2.4 and 2.6 per 100 patients/year, respectively). After propensity-score matching, we obtained two matched groups of 1,656 patients. Patients with prior cancer showed a significant higher risk of AMI (sHR 1.44, 95% CI 1.01–2.04, p=0.044), but not higher risk of MB (sHR 1.21, 95% CI 0.88–1.68, p=0.248), in comparison with those without prior cancer.

Conclusions
In ACS patients discharged with DAPT after PCI, prior history of cancer is an independent factor of higher ischemic risk – in terms of AMI, but it is not an independent predictor of increased hemorrhagic risk.
P678Pericardiocentesis in thrombocytopenic cancer patients
Authors: Lee M , Gill C , Serauto Canache A , Donisan T , Balanescu D , Marah N , Stone D , Stone J , Boone D , Cervoni Curet F , Agha A , Iliescu C , Palaskas N 
Published: October 2019

Abstract

Background
Pericardial effusion is a known complication in cancer patients, resulting in chest pain, cardiac tamponade, and cardiogenic shock. Although technological advances allow for early detection, treatment options are limited for those also suffering from thrombocytopenia.

Purpose
Our study aims to evaluate survivorship of thrombocytopenic cancer patients who underwent pericardiocentesis.

Methods
From 2008 to 2019, we assessed overall mortality and follow-up post-pericardiocentesis in cancer patients with concurrent thrombocytopenia (<150,000 cells/microliter) at our cancer center. Thrombocytopenia grading was determined on the procedure day via serology platelet cell count with the following thresholds: Grade 1 (<50x103 cells/mL), Grade 2 (51–100x103 cells/mL), and Grade 3 (101–149x103 cells/mL).

Results
In 137 patients, we identified 65 (47%) patients with Grade 1, 30 (22%) with Grade 2, and 42 (31%) with Grade 3 thrombocytopenia. The calculated platelet count average was 66x103 cells/mL, median was 59x103 cells/mL, and range was 6 to 147x103 cells/mL. Of note, 7 (5%) patients had platelets <10x103 cells/mL. One patient developed a hematoma at the percutaneous site of pericardial drain, no other complications were noted. Kaplan Meier survival analysis by log-rank (mantel-cox) showed statistical significance (p=0.025). Comparatively, the cumulative survival of patients at 30 days was 63% in Grade 1, 67% in Grade 2, and 83% in Grade 3 patients. At one year, it was 26% in Grade 1, 37% in Grade 2, and 48% in Grade 3 patients.

Conclusion
Pericardiocentesis offers rapid symptomatic relief and can be life-saving in cardiac tamponade. In cancer patients, the development of pericardial effusions and thrombocytopenia increases due to the underlying malignancy and cancer therapeutics. Although thrombocytopenia is thought to increase peri-procedural risks, in this cohort there was only one minor complication and this occurred in Grade 2 thrombocytopenia. For thrombocytopenic cancer patients suffering from large pericardial effusions, high pre-operative risk scores often exclude them from receiving surgical pericardial windows. Although mortality was higher in severe thrombocytopenia, this is likely due to the competing risk of more severe cancer; there were no complications with Grade 1 thrombocytopenia. Especially noteworthy, no complications in those with platelets <10,000 cells/uL. Our study shows that in this population of patients, pericardiocentesis is a feasible intervention with low complication rate to help improve quality of life and potentially life-saving treatment.