bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4612Elevated pentraxin-3 level is associated with impaired post procedural myocardial perfusion assessed by quantitative blush evaluator in patients with acute STEMI undergoing primary PCI
Authors: Parlautan A , Sukmawan R , Dharma S 
Published: October 2019

Abstract

Background
Long Pentraxin-3 (PTX3) has been known as an emerging cardiac biomarker and has potential diagnostic and prognostic value in coronary heart disease. Whether plasma PTX3 level is associated with post procedural myocardial perfusion assessed by quantitative blush evaluator (QuBE) in acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) is unknown.

Purpose
This study sought to evaluate the association between plasma PTX3 level and post procedural myocardial perfusion assessed by QuBE in patients with acute STEMI undergoing primary PCI.

Methods
We enrolled 217 patients with acute STEMI who underwent primary PCI (men=191, women=26). Post procedural myocardial perfusion was evaluated using QuBE. PTX3 level was measured at admission by an ELISA method. We used 0.33 ng/mL for PTX3 level as a cut off point for future worse clinical outcome as shown by previous study. Impairment of myocardial perfusion was defined as QuBE <9 arbitrary unit as also shown by previous studies.

Results
Plasma PTX3 level had an inverse correlation with QuBE score (r=−0.64, p<0.001). Patients in elevated PTX3 group (≥0.33 ng/mL; N=80) had lower median QuBE score compared with lower PTX3 group (<0.33ng/mL; N=137), with QuBE score (8.6 arbitrary unit vs. 15.1 arbitrary unit, P<0.001). Multivariate logistic analysis showed that plasma PTX3 level ≥0.33 ng/mL (OR=7.65, p<0.001) along with Diabetes Mellitus (OR=2.30, p=0.04), and Killip class II-IV (OR=2.57, p=0.04) were independent predictors of impaired myocardial perfusion, as shown by QuBE score <9 arbitrary unit.
Analysis between PTX3 and low QuBE score Variables Multivariate OR (95% CI) P value PTX3 ≥0.33 ng/mL 7.65 (3.37–17.36) <0.001 Diabetes Mellitus 2.30 (1.01–5.23) 0.04 Hypertension 1.15 (0.47–2.82) 0.75 Killip class II-IV 2.57 (1.04–6.35) 0.04 IRA LAD 3.79 (1.64–8.78) 0.002 Thrombus grade 4 & 5 3.36 (1.06–11.98) 0.04 Post PPCI TIMI flow <3 5.29 (2.09–13.36) 0.001 PTX3, pentraxin-3; QuBE, quantitative blush evaluator; IRA, infarct related artery.

Conclusions
Patients with acute STEMI with high plasma PTX3 level were associated with reduced myocardial perfusion after primary PCI shown by low QuBE score. Elevated PTX3 level may be used as a marker for persistent impairment of myocardial perfusion after primary PCI in STEMI
P4626Neuronal nitric oxide sintetase polymorphism increases sympathetic activity and recurrent cardiovascular events after myocardial infarction
Authors: Oliveira E K , Munhoz D B , Carvalho L S F , Moura F A , Machado-Silva W , Figueiredo V N , Nobrega O T , Sposito A C 
Published: October 2019

Abstract

Background
The expression and activity of neuronal nitric oxide sintetase (nNOS) in central and peripheral nervous system attenuate the sympathetic response and promote other cardioprotective effects in animal models. However, in humans those effects are uncertain. Recently, a polymorphism at the sequence rs41279104 G/T has been associated with a reduced expression of nNOS, but its clinical impact has never been studied in the context of ST elevation myocardial infarction (STEMI) in humans.

Purpose
We investigated the impact of the T allele at rs41279104 in sympathetic activation after STEMI and its influence in the incidence of recurrent major cardiovascular events (MACE). We sought to determine a pathway to autonomic nervous system modulation during STEMI and its possible clinical impact.

Methods
297 patients were admitted in the first 24h (D1) after STEMI and followed prospectively. Blood samples and an electrocardiogram were obtained upon D1 and fifth day (D5). We assessed glycosylated hemoglobin, glucose, insulin, C-peptide, lipid profile and nitric oxide (NOx) plasma levels. We genotyped rs41279104 and grouped patients according to carrier status (GT+TT vs. GG). The heart rate variability was obtained with a 15min electrocardiogram recording and processed into spectral analysis variables including low (LF) and high frequencies (HF) and LF/HF ratio. Flow-mediated dilation (FMD) was performed after 30 days. Clinical follow–up was carried over until two years after MI and the endpoint was a composite of major cardiovascular events (MACE) consisting of fatal MI, non-fatal MI, unstable angina with hospitalization and cardiac sudden death.

Results
T-allele carriers showed a decreased parasympathetic activity and an increased sympathetic activity between D1 and D5 (ΔLF −68.43 (median) [IQR −324.76 to −6.29] vs −4.49 [−190.29 to 72.03], p<0.001; ΔHF −19.40 [−185.55 to 6.21] vs −10.73 [−79.53 to 137.53], p=0.004; ΔLF/HF 0.07 [−2.32 to 1.44] vs −0.11 [−1.14 to 0.96], p<0.001). Decreased FMD (6.9±4.7 vs 7.5±4.9, p=0.046) was also detected among T-allele carriers. In the Cox -regression analysis adjusted by sex, age, betablocker use and mean simvastatin dose, T-allele carriers had a relative risk for MACE of 2.112 (95% CI: 1.133–3.938; p=0.019).

Conclusions
The presence of the T allele at nNOS gene rs41279104 sequence is associated with increased sympathetic tone at acute phase of STEMI and a higher incidence of recurrent MACE.
P4630Prognostic impact of previous Beta-blocker use in STEMI patients
Authors: Faria Da Mota T , Fernandes R , Costa H , Sousa Bispo J , Azevedo P , Guedes J P , Santos W , Mimoso J , Jesus I 
Published: October 2019

Abstract

Introduction
Current guidelines support the use of beta-blockers (βB) in patients with Coronary Artery Disease, especially after a Myocardial Infarction (MI). This use is sustained by their ability to block adrenergic hyperstimulation, reducing the potential for arrythmias, myocardial oxygen consumption and infarct extension. However, questions have been raised regarding the impact βB therapy in patients admitted for ST elevation Myocardial Infarction (STEMI).

Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for STEMI in a country's Cardiology Departments between the 1st of October 2010 and the 8th of January 2019. A 1-year (1y) follow-up was made through registry consultation and phone call by a Cardiologist. Baseline demographic and clinical characteristics of patients previously medicated with βB (pre- βB) were compared to patients not medicated with βB. The authors performed a univariate and multivariate statistical analysis of in-hospital mortality, as well as 1y mortality and re-admission rate, using SPSS 24,0.

Results
A total of 7818 patients were included, 1931 (24,7%) of which 1931 (24,7%) were female, with a mean age of 64±14 years. In the studied sample, 1109 patients (14,2%) were previously medicated with βB, which was more common in women (18,1 vs. 12,8%) and patients over 65-years old (16,9% vs. 11,4%). βB were also more prescribed in patients with hypertension, diabetes, dyslipidaemia, previous MI, previous stroke or peripheral atherosclerosis, and renal failure. This group of patients was more frequently medicated with anti-platelets, anti-hypertensives, statins and diuretics (p<0,001). Additionally, they presented more frequently with Left Bundle Branch Block, Atrial fibrillation, Killip-Kimball class >1 and BNP >400 (p<0,001), and had significantly higher rates of ventricular systolic disfunction (p=0,003). These patients were also more commonly diagnosed with multivessel disease (p<0,001), but no differences could be identified regarding success of revascularization. During hospital stay, no significant divergences were found regarding incidence of shock, mechanical complications and AV block, but a higher rate of haemorrhage and transfusion was objectified (p<0,001).
Regarding outcomes, on univariate analysis, pre-βB was a strong predictor of higher 1-year mortality (p=0,049) and 1-year readmission (both global and cardiovascular, with p=0,049 and p=0,033, respectively). On multivariate statistical analysis however, pre-βB showed to be a strong independent predictor of lower in-hospital mortality (p=0,023) with differences between groups who suspended and ditn't suspend βB at admission, but had no significant impact on 1-year outcomes.

Conclusion
In the present study, previous βB therapy showed to have an independent positive impact on in-hospital mortality, but not on 1-year outcomes.
P4631Eosinopenia an inflammatory marker of adverse clinical outcomes in patients presenting with acute myocardial infarction
Authors: Alkhalil M , Kearney A K , Hegarty M H , Stewart C S , Devlin P D , Owens C O , Spence M S 
Published: October 2019

Abstract

Background
Inflammation is an indicator of worse clinical outcomes following acute myocardial infarction. Eosinopenia was identified as a surrogate of inflammation in sepsis and obstructive airway disease. Whether this readily-available marker has any impact on long term outcomes following ST-segment elevation myocardial infarction (STEMI) is yet to be determined.

Purpose
We sought to study the incidence and relationship between eosinopenia and infarct severity and whether low eosinophil had impact on clinical outcomes following STEMI.

Methods
606 consecutive STEMI patients undergoing primary PCI from a large volume single centre were enrolled. Low eosinophil count was defined as <40 cells/ml from samples within 2 -hours post reperfusion. Primary endpoint was defined as composite of death, MI, stroke, unplanned revascularisation, re-admission for heart failure over 3.5 years follow up.

Results
65% of patients had eosinopenia. Patients in the low eosinophil group had larger infarct size as measured by troponin value [2934 vs. 1177ng/L, P<0.001] and left ventricle (LV) systolic function on echocardiography [48% vs. 50%, P=0.029]. Thehre was a modest correlation between eosinophil count and both troponin (r=−0.25, P<0.001) and ejection fraction (r=0.10, P=0.017). The primary endpoint was higher in eosinopenic patients (28.8% vs. 20.4%, HR 1.49, 95% CI 1.05 to 2.13, P=0.023) (Figure). The difference was mainly driven from higher percentage of unplanned revascularisations (8.2% versus 2.9%, P=0.012) (Table). Low eosinophil count was an independent predictor of adverse cardiovascular events, beyond infarct severity, in elderly, non-diabetic patients (HR 2.04, 95% CI 1.04 to 4.01, P=0.038).
Incidence rate of major clinical Clinical characteristics Low eosinophil Normal eosinophil P value Long term clinical events 28.8% (112) 20.4% (42) 0.026 Long term mortality 14.1% (55) 11.1% (23) 0.31 Long term MI 6.9% (27) 4.9% (10) 0.32 Long term unplanned revascularisation 8.2% (32) 2.9% (6) 0.012 Long term re-admission CCF 6.7% (26) 4.9% (10) 0.37 Long term stroke 2.6% (10) 1% (2) 0.19

Conclusions
Eosinopenia is a readily-available marker which was associated with a larger infarcts and worse clinical outcomes over long term follow up.
P4635Long term risk and costs of bleeding in men and women treated with triple antithrombotic therapy
Authors: Holm A C , Henriksson M , Alfredsson J , Janzon M , Johansson T , Swahn E , Vial D , Sederholm Lavesson S 
Published: October 2019

Abstract

Background
Triple antithrombotic therapy (TAT) is known to increase bleeds and its relevance is questioned. No study has observed the long-term risk of bleeding and health care costs from a sex perspective, in a total TAT population. We investigated the rate of all bleeds in patients receiving TAT at index hospitalization and within one year. We explored early discontinuation of TAT and potential sex disparities. We also assessed health care costs related to bleeding complications.

Methods
All patients discharged with TAT registered in SWEDEHEART in the County of Östergötland 2009–2015 were included. Information about bleeds during one-year follow-up were retrieved from the medical records. All bleeds receiving medical attention were included. Resource use associated with bleeds were assigned unit cost to estimate the health care costs associated with bleeding episodes.

Results
Among 272 identified patients, 156 bleeds occurred post-discharge, of which 28.8% were gastrointestinal. In total 54.4% had at least one bleed during or after the index event and 40.1% bled post discharge of whom 28.7% experienced a TIMI major or minor bleeding. Women discontinued TAT prematurely more often than men (52.9 vs 36.1%, p=0.01) and bled more (48.6 vs. 37.1%, p=0.09). One-year mean health care costs were EUR 575 and EUR 5787 in non-bleeding and bleeding patients, respectively.

Conclusion
The very high bleeding incidence in patients with TAT is a cause of concern, especially in women. There is a need for an adequately sized randomized, controlled trial to determine a safe but still effective treatment for these patients.
P4638Impact of a prior history of stroke on long-term cardiac mortality in patients with acute coronary syndrome treated with percutaneous coronary intervention
Authors: Takeuchi M , Ogita M , Tsuboi S , Yasuda K , Nishio R , Takahashi N , Iso T , Sonoda T , Yatsu S , Wada H , Dohi T , Suwa S , Daida H 
Published: October 2019

Abstract

Background and objective
A prior history of stroke is associated with increased adverse cardiovascular outcomes in patients with acute coronary syndrome (ACS), however the prognostic impact on long-term outcomes remains unclear.

Methods
We conducted an observational cohort study of ACS patients underwent primary percutaneous coronary intervention (PCI) between January 1999 and May 2015 at our hospital. The aim of the present study is to evaluate the overall prevalence and clinical impact of a history of stroke. The primary outcome was cardiac death during the median follow-up period of 5yrs.

Results
Among 2562 ACS patients of the current cohort, 268 patients (10.5%) had a history of stroke at the onset of ACS. The cumulative incidence of cardiac death was higher in patients with a history of stroke (11.4% vs. 19.7%, log-rank p<0.0001). Multivariate Cox regression analysis showed a history of stroke was significantly associated with higher cardiac mortality. (adjusted HR 1.47, 95% CI 1.03–1.92, p=0.0309).
Kaplan-Meier curve

Conclusion
Among ACS patients treated with primary PCI, a history of stroke was not rare and was associated with increased long term cardiac mortality.
P4646Prospective study for antenatal diagnosis of coarctation of the aorta
Authors: Meysonnier Marechal C , Di Filippo S , Pangaud N , Galoin Bertail C , Joly H , Massardier J , Martin Bonnet C , Massoud M 
Published: October 2019

Abstract

The objective of this study was to define echocardiographic (ECHO) parameters during fetal life, to predict postnatal aortic coarctation (COA).

Material and methods
This prospective single-center study from 2010 to 2018 included all fetus diagnosed with isolated ventricular and/ or great vessels asymetry (right heart dominance). Complex CHD were excluded. The cohort was divided in patients with coarctation after birth (COA) and those free from coarctation (noCOA). Left heart, aortic and ductus measurements were collected serially at second trimester (T2), third trimester (T3) ad Z-scores were assessed. COA and noCOA were compared, sensitivity (Se) and specificity (Spec) and ROC curves (cut-off values) were assessed for each parameter.

Results
67 cases were included: 34 (50.7%) ranged in group COA and 33 (49.3%) in noCOA. Coarctation occurred more frequently if suspected at T2 (70.6% in COA vs 30.3% in noCOA, p=0.001). Mitral annulus (T3) was 8.6mm in COA vs 10.3mm in noCOA (p=0.002) with cut-off <7.3mm (Se= 50%, Spec= 93.6%, OR= 14.5). Aortic annulus diameter (T3) was 4.8mm in COA vs 6mm in noCOA (p=0.005), with cut-off <5.4mm (Se= 65%, Spec= 77%, OR= 6.3). Aortic isthmus diameter (T3) was 1.4mm in COA vs 2.8mm in noCOA (p=0.003), with cut-off <3mm (Se= 91%, Spec= 65%, OR= 18.9). Ductus arteriosus/ aortic isthmus ratio (T3) was 2.5 in COA vs 1.8 in noCOA (p=0.01) with cut-off >1.57mm (Se= 90.5%, Spec= 62%, OR= 15.4).

Conclusion
Mitral annulus <7.3mm, aortic annulus <5.4mm, aortic isthmus <3mm and ductus/isthmus ratio >1.57 assessed during 3rd trimester of fetal life may help to predict postnatal coractation of the aorta. These results have to be confirmed by larger prospective studies.
P4648Retrograde flow in aortic isthmus in fetuses with congenital heart defects and computer flow dynamic modeling
Authors: Chen Z , Lin S H , Amy T , Han J C , Yang X , Ge S H P , He Y H 
Published: October 2019

Abstract

Background and objectives
Retrograde flow (RF) in the aortic isthmus is frequently observed in fetuses in various hemodynamic states including congenital heart defects (CHD). This study sought to: 1) establish the association between this observation and variables of CHD by fetal echocardiography (FE); and 2) to computer flow dynamic (CFD) model to probe the causes and mechanisms underlying this observation.

Methods
A total of 256 (gestational age (GA) 26.3±9.8 weeks) fetuses with CHD and 168 (GA: 25.8±10.3weeks) with normal FE were examined from January, 2011 to May, 2016. The study group was divided into: 1) no RF, 2) end systolic RF, end diastolic RF, systolic RF, diastolic RF, and systolic and diastolic RF sub-groups (Figure upper). GA, cerebroplacental ratio (CPR) of pulsatility index (PI) in middle cerebral and umbilical arteries, cardiothoracic area ratio (CTR), left and right atrial dimensions (LA/RA), left and right ventricular dimensions (LV/RV), aortic and pulmonary artery dimensions (AO/PA), and aortic isthmus and ductal arch dimensions (AI/DA), velocity ratio of aorta and pulmonary artery (AO/PAv), aortic isthmus and ductal arch in systolic (AI/DAvs) and diastolic (AI/DAvd). Using principal component analysis (PCA), the component score coefficient matrix and optional variance percent (OVP) was calculated by PCA and the RF pattern was simulated by CFD (Figure lower).

Results
RF modeling by CFD was feasible (Figure B). Component analysis by PCA showed that four types of variables were associated with RF: 1) Structural variables contribute 23.7% OVP, including LV/RV, LA/ RA, AO/PA, and IS/DA; 2) Resistance variables 16.8% OVP, i.e. CPR; 3) Growth variables 12.2% OVP, i,e, GA and CTR; and 4) Velocity variables 10.9% OVP, i.e. AO/PAv, AI/DAvd.
Retrograde flow by fetal echo and CFD

Conclusions
Retrograde flow in the aortic isthmus is associated with structural, resistance, growth, and velocity variables in fetal circulation in various CHD and normal 3rd trimester pregnancies. Simulation and modeling by CFD is feasible and may be useful to understand the causes and mechanisms of retrograde flow and its utility in diagnosis and prognosis in CHD.

Acknowledgement/Funding
Research on prevention and control of reproductive health and major birth defects
P4667Loss of function in PCSK9, atherogenic lipoprotein concentrations, and calcific aortic valve stenosis
Authors: Perrot N , Moschetta D , Boekholdt S M , Valerio V , Martinsson A , Capoulade R , Mass E , Mathieu P , Bosse Y , Pibarot P , Smith J G , Camera M , Theriault Y , Poggio P , Arsenault B 
Published: October 2019

Abstract

Background
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition reduces plasma concentrations of most atherogenic lipoproteins such as low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)]. Atherogenic lipoprotein concentrations have also been linked with calcific aortic valve stenosis (CAVS).

Purpose
1) To determine the association between genetic variants in PCSK9 and lipoprotein-lipid levels, 2) to determine whether loss of function (LOF) in PCSK9 is associated with CAVS and 3) to evaluate if PCSK9 could be implicated in aortic valve interstitial cells (VICs) calcification.

Methods
We built a weighted genetic risk score (wGRS) using 10 single nucleotide polymorphisms at the PCSK9 locus associated with LDL-C in the Global Lipids Genetics Consortium. We determined the association between the wGRS and LDL-C, apoB and Lp(a)] in 9692 participants of the EPIC-Norfolk study using linear regression. We investigated the association between the LOF PCSK9 R46L variant and CAVS risk in a meta-analysis of published (three Copenhagen studies, 1463 cases and 101,620 controls) and unpublished studies (UK Biobank, 1350 cases and 349,043 controls, Malmö Diet and Cancer study, 682 cases and 5963 controls and EPIC-Norfolk, 508 cases and 20,421 controls) prospective, population-based studies using logistic regression adjusted for age and sex. We evaluated PCSK9 expression and localization in explanted aortic valves by capillary Western blot and immunohistochemistry in patients with and without CAVS. Von Kossa staining was used to visualize aortic leaflet calcium deposits. We also assessed VICs calcification potential under oxidative stress condition.

Results
In EPIC-Norfolk, the wGRS was significantly associated with TC, LDL-C, and apoB (all p<0.0001), but not with VLDL-C, HDL-C, triglycerides apoA-I, or Lp(a). Carriers of the R46L variant were at lower CAVS risk (odds ratio=0.71 (95% CI, 0.57–0.88, p<0.001)). Aortic valves of patients with aortic sclerosis (n=12) and CAVS (n=8) presented elevated PCSK9 levels (log2 fold change [FC]=+28.6±5.1, p=0.008 and FC=+39.3±15.2, p=0.02, respectively) compared to controls (n=4).In calcified leaflets, PCSK9 expression co-localized with calcium deposits. PCSK9 expression in VICs was induced by oxidative stress (FC=+2.3±0.4, p=0.02), and subsequent increment in calcification potential was observed.

Conclusion
PCSK9LOF variants are associated with lifelong reductions in non-Lp(a) apoB-containing lipoprotein levels and a lower risk of coronary artery disease and CAVS. PCSK9 is abundant in fibrotic and calcified aortic leaflets. Oxidative stress increases PCSK9 expression in VICs. These results support randomized clinical trials of PCSK9 inhibition in the prevention of CAVS.