bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6366High blood pressure cut-off by 130/80 mmHg in middle-ages may be valid for predicting heart failure in ages of seventies
Authors: Sasaki N , Ozono R , Maeda R , Kihara Y 
Published: October 2019

Abstract

Background
ESC/ESH Guidelines (2018) recommended that treated BP values should be targeted to 130/80 mmHg or lower in most patients. However, it remains unclear whether this target in middle-aged population is associated with future development of heart failure.

Purpose
We conducted a retrospective analysis to determine whether high blood pressure cut-off by 130/80 mmHg in the middle-age predicts the risk of heart failure, detected by high N-terminal pro-brain natriuretic peptide (NT-proBNP) level, in the elderly in a cohort in which longitudinal blood pressure records exist.

Methods
The cohort consists of health check examinee who consulted the examination institute between 2015 and 2018 (n=8513), aged 70 years or older, and had previous institution-visit record at least once from 50 to 69 years old. We measured serum NT-proBNP level in the all examinee and defined the group of high NT-proBNP as ≥144 pg/ml [defined as the highest quartile, n=2135 (25%)]. The number of participants whose previous blood pressure records exists was 8123 (95%) for 65–69 years old, 6980 (82%) for 60–64 years old, 5233 (61%) for 55–59 years old, and 3018 (35%) for 50–54 years old, respectively. The each generation subgroups were divided into the three gradual categories according to the blood pressure records: SBP ≥140 and/or DBP ≥90, SBP130–139 and/or DBP80–89, and SBP <130 and DBP <80 mmHg.

Results
Categorization to high NT-proBNP group in ages of 70 or more was significantly associated with the categorization to high blood pressure, which was not only the SBP ≥140 and/or DBP ≥90 mmHg but also the SBP130–139 and/or DBP80–89 mmHg at any time points of previous blood pressure measurements. The multivariable adjusted odds ratios for having high NT-proBNP level in the elderly against the two high blood pressure categories based on the previous blood pressure measurements were shown in the Table.
Table 1. Multivariable adjusted OR for high NT-proBNP level in elderly Age N SBP 130–139 and/or DBP 80–89 SBP ≥140 and/or DBP ≥90 OR P OR P 65–69 8123 1.30 <0.001 1.68 <0.001 60–64 6980 1.26 0.002 1.55 <0.001 55–59 5233 1.25 0.013 1.41 <0.001 50–54 3018 1.32 0.023 1.58 <0.001 Model included age, gender, BMI, serum creatinine, hemoglobin, and presence of antihypertensive medications, and cardiac disease.

Conclusion
High blood pressure cut-off by 130/80 mmHg in the middle-age may be valid to predict the risk of heart failure in the elderly.
P6370Epidemiology of arterial hypertension in one of the regions of Russia
Authors: Smirnova E A , Yakushin S S , Terekhovskaya Y V , Vorobyev A N 
Published: October 2019

Abstract

Aim
To study the dynamics of the prevalence, awareness, risk factors (RF) and treatment of arterial hypertension (AH) among men and women according to a survey of a representative sample of the population of the Ryazan region (RR) in 2007–2016.

Materials and methods
In 2002, as a part of the Russian epidemiological “EPOCH” study, a representative sample of the RR population (2098 people, average age 44.8±18.6 years) was formed and surveyed using step-by-step randomization of medical institutions, medical districts and apartments. A repeated survey of the sample was conducted in 2007 (1,760 people, response 83.9%) and in 2016 (1,497 people, response 85.1%). The AH group included persons with blood pressure ≥140/90 mmHg detected during the double measurement and with normal blood pressure while receiving antihypertensive therapy. In individuals with AH the risk factors were assessed: smoking, alcohol abuse, salt abuse, obesity, burdened family history, low physical activity.

Results
The prevalence of AH over the past 9 years has increased from 39.3% to 43.9%, p<0.001. The age-standardized prevalence of AH among women is higher than among men as in 2007 (42.1% versus 34.8%, p<0.001) and in 2016 (46.9% vs. 41.8%, p<0.05). Women's awareness about having AH increased from 83.9% to 88.9%, p<0.05, in men it decreased (84.0% against 77.4% in 2007, p>0.05). In the group of persons with AH, the more common risk factors are older age (56.8%), hereditary predisposition (58.9%), low physical activity (96.0%) and obesity (34.3%) compared with persons without AH (12.9%, 48.2%, 84.5% and 9.2%, respectively), they smoke less often (10.7% versus 23.2%) and use extra salt less often (29.5% against 38.4%), p<0.001. The number of patients taking antihypertensive drugs reached 91.2% against 84.0% in 2007, p<0.001. There was a decrease in the number of AH patients who: are treated intermittently (from 12.3% to 3.6%, p<0.001), who take drugs only when blood pressure is high (from 16.2% to 6.2%, p<0.001). The most frequently used antihypertensive drugs are still ACE inhibitors (64.8%), beta-blockers (48.9%), diuretics (42.5%), ARBs (29.2%) and calcium channel blockers (21.3%). The ratio of effectively treated AH patients increased in men from 14.6% to 27.8%, p<0.001, in women from 25.0% to 39.5%, p<0.001. A negative influence on the effectiveness of therapy was caused by smoking (RR 1.23; CI 1.11–1.37, p=0.005), salt abuse (RR 1.11; CI 1.06–1.23, p=0.04) and obesity (RR 1.16; CI 1.06–1.27, p=0.003).

Conclusion
Over the past nine years, the prevalence of hypertension in both the men and women has significantly increased in the Ryazan region. Increased treatment coverage and positive changes in drug therapy led to an increase in the number of effectively treated patients (from 21.4% to 35.5%, p<0.001). Obesity, smoking, salt abuse are associated with an increased risk of non-effectiveness of hypertension therapy.
P6373Serum amyloid A and left ventricular mass in psoriasis patients treated with infliximab
Authors: Midtboe H , Tveit K S , Gerdts E , Ueland P M , Meyer K , Jonsson R 
Published: October 2019

Abstract

Background
Serum amyloid A (SAA) is an acute phase reactant associated with amyloid tissue deposition. Chronic skin inflammation in psoriasis could cause increased production of SAA in the liver and subsequent deposition in cardiac tissue.

Purpose
To assess if higher SAA is associated with higher left ventricular (LV) mass in psoriasis patients treated with infliximab

Methods
Data from 47 psoriasis patients treated with the tumour necrosis factor-α blocker infliximab (mean age 47±14 years, 66% men) was compared to 106 age and sex-matched control subjects (mean age 47±11 years, 70% men). LV mass was assessed by echocardiography and index to height m2.7. SAA was analysed by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight mass spectrometry.

Results
Psoriasis patients were more likely to be smokers than controls (38% vs. 16%, p=0.005), while other cardiovascular risk factors and SAA levels were similar. Psoriasis patients had lower LV mass index than controls (35.6±9.6 g/m2.7 vs. 40.3±9.8 g/m2.7, p=0.008). In the total study population, higher SAA level (β=0.23, p=0.003) was associated with higher LV mass index independent of presence of psoriasis (Table). In psoriasis patients, higher SAA level (β=0.48, p<0.001) was associated with higher LV mass index after adjustment for age and body mass index in multivariable analysis (Table). No association between SAA and LV mass index was found in controls.
Table 1. Multivariable associations of LV mass index in the total study population and in psoriasis patients Total study population Psoriasis LV mass index LV mass index R2=0.33, p<0.001 R2=0.43, p<0.001 β P β P Psoriasis −0.21 0.006 na na SAA, μg/ml 0.23 0.003 0.48 <0.001 BMI, kg/m2 0.39 <0.001 0.50 <0.001 Age, years 0.18 0.03 0.11 0.35 Female gender −0.11 0.15 – – Hypertension 0.08 0.35 – – Smoking 0.03 0.75 – – BMI, body mass index; LV, left ventricular; SAA, serum amyloid A; na, not applicable.

Conclusion
In psoriasis patients on infliximab treatment, higher SAA level was associated with greater LV mass index, pointing to a potential role of chronic inflammation and SAA production in the development of subclinical cardiac disease in psoriasis.

Acknowledgement/Funding
Western Regional Health Authority of Norway, Hjertefondet
P6380The impact of coronary artery disease to predict mortality and neurological outcome in post-cardiac arrest patients
Authors: Matsuda J , Nitta G , Kato S , Kono T , Ikenouchi T , Murata K , Kanoh M , Takamiya T , Inamura Y , Negi K , Inaba S , Sato A , Yamato T , Matsumura Y 
Published: October 2019

Abstract

Background
Some studies reported that performing coronary angiography (CAG) for patients with out-of-hospital cardiac arrest (OHCA) is effective for the prognosis and neurological outcome. However, the impact of complexity of coronary artery disease (CAD) on CAG findings has not been evaluated sufficiently.

Purpose
We sought to investigate the complexity of CAD to predict the prognosis and neurological outcome in patients with OHCA.

Methods
A total of 1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 252 cardiovascular arrest patients achieving the return of spontaneous circulation (ROSC) were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, we performed CAG for 160 patients. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, coronary anatomical angiographical findings.

Results
Ventricular fibrillation (VF) (P=0.001), younger age (P=0.007), pre-hospital ROSC (P<0.001) and normal coronary artery on CAG findings (P=0.014) were associated with low 30-days mortality in hospital. VF (P=0.003), younger age (P=0.004), pre-hospital ROSC (P<0.001), bystander cardiopulmonary resuscitation (CPR) (P=0.043) and normal coronary artery (P=0.001) were associated with good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. We further investigated 100 patients who had any coronary artery stenosis on CAG findings. Among these patients, 55 patients (55.0%) had multi-vessel coronary artery disease and 29 patients (29.0%) had at least a chronic total occlusion lesion. VF survivor (P=0.035), without previous history of CAD (P=0.008), pre-hospital ROSC (P=0.013), and Syntax score (P=0.002) were associated with low 30-days mortality. In multivariate analysis, Syntax score (OR 0.94; 95% confidence interval (CI) 0.88–0.99; P=0.042) was independent predictor of mortality. Bystander CPR (P=0.001), pre-hospital ROSC (P<0.001) were associated with good neurological outcome at 30 days. Bystander CPR (OR 5.92; 95% CI 2.01–17.5; P<0.001) and pre-hospital ROSC (OR 9.22; 95% CI 3.34–25.5; P<0.001) were predictive for good neurological outcome.

Conclusions
OHCA patients with any coronary stenosis had high mortality and bad neurological outcome in comparison with those who had normal coronary arteries. OHCA patients with CAD had complex lesions such as multi-vessel disease or chronic total occlusion lesions. The coronary complexity in patients with OHCA was a predictor of in-hospital 30-days mortality. However, pre-hospital care such as bystander CPR and pre-hospital ROSC were the most important to achieve good neurological outcome at 30 days in the present study.
P6393Differences in coronary inflammation between the culprit and non-culprit vessels assessed by fat attenuation index on computed tomography in patients with acute coronary syndromes
Authors: Sugiyama T , Hoshino M , Kanaji Y , Horie T , Yuki H , Hirano H , Kanno Y , Hada M , Ohya H , Sumino Y , Yamaguchi M , Yonetsu T , Kakuta T 
Published: October 2019

Abstract

Background
Inflammation is linked with progression of coronary atherosclerosis. Recent studies have reported the association between elevated perivascular fat attenuation index (FAI) on computed tomography (CT) and worse cardiac outcomes in patients with coronary artery disease.

Purpose
We aimed to investigate the differences in FAI-defined peri-coronary inflammation status between the culprit and non-culprit vessels in patients with acute coronary syndromes (ACS).

Methods
A total of 78 ACS patients with left anterior descending coronary arteries (LAD) as a culprit vessel who underwent coronary CT angiography and invasive coronary angiography were studied. Proximal 40-mm segments of the LAD and the right coronary artery (RCA) were traced. Coronary inflammation was assessed by the FAI defined as the mean CT attenuation value of perivascular adipose tissue (−190 to −30 Hounsfield units [HU]) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel. All patients were divided into two groups according to the values of FAI in the LAD: high FAI group (FAI-LAD > median; n=39) and low FAI group (FAI-LAD ≤ median; n=39). Patient characteristics, angiographic and CT findings were compared between the two groups.

Results
In a total of 78 patients, median FAI in the LAD was −70.20 (interquartile range, −74.81 to −64.58) HU. High FAI group was associated with male sex and lower left ventricular ejection fraction compared with Low FAI group. Minimal lumen diameter, reference diameter, diameter stenosis, and lesion length on quantitative coronary angiography analysis and coronary artery calcium score on CT was not different between the groups. FAI in the RCA was also higher in High FAI group than that in Low FAI group (−67.64±8.31 vs. −76.47±6.25 HU, P<0.001). Paired t-test comparison demonstrated that culprit vessel showed higher FAI than the non-culprit vessel (−69.85±7.74 vs. −72.11±8.54 HU, P=0.013).

Conclusions
In ACS patients with culprit LAD lesions, FAI-defined peri-coronary inflammation status is higher in the culprit vessel than in the non-culprit vessel.
P6414DNA hydroxymethylation combined with carotid plaques as a novel biomarker for coronary atherosclerosis
Authors: Zhang D , Jiang D A N , Ge P I N G 
Published: October 2019

Abstract

Background
Accumulating evidence has shown the association between DNA methylation and hydroxymethylation and the development of atherosclerosis. However, little is known about the diagnostic value of DNA methylation and hydroxymethylation for coronary atherosclerosis. Carotid plaque has a significant correlation with coronary atherosclerosis, which is a common marker for coronary atherosclerosis.

Purpose
The major aim of the present study is to determine whether DNA methylation and hydroxymethylation combined with carotid plaques can be useful to the diagnosis of coronary atherosclerosis.

Methods
113 patients undergoing carotid ultrasound were enrolled into the study and measured the levels of 5-methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC). Crouse score and Gensini score were used to evaluate the severity of carotid and coronary atherosclerosis, respectively.

Results
With the increasing of severity of carotid plaque and Crouse score, a stepwise upward trend was observed in 5-mC and 5-hmC levels, which were significantly correlated with the risk factors such as FPG and HbA1c levels, Crouse score and Gensini score. Crouse score and 5-hmC, not 5-mC, were the risk factors for coronary atherosclerosis after adjustment for the risk factors. Receiver operating characteristic (ROC) analysis for comparing their diagnostic value for coronary atherosclerosis indicated that 5-hmC combined with Crouse score was the diagnostic biomarker for coronary atherosclerosis, with the highest areas under the curve (AUC), valuable sensitivity and specificity.
Logistic regression analysis Variables Univariate analysis Multivariate analysis OR (95% CI) P OR (95% CI) P History of DM 3.680 (1.645–8.235) 0.002 4.487 (0.227–88.680) 0.324 FPG (mmol/L) 1.782 (1.219–2.605) 0.003 0.972 (0.307–3.071) 0.961 HbA1c (%) 1.785 (1.191–2.674) 0.005 2.861 (0.717–11.422) 0.137 TC (mmol/L) 1.171 (0.913–1.502) 0.214 LDL-c (mmol/L) 1.383 (0.939–2.036) 0.100 hs-CRP (mg/L) 1.099 (1.020–1.184) 0.014 1.268 (1.013–1.588) 0.038 Crouse score 1.795 (1.445–2.230) <0.001 1.863 (1.053–3.297) 0.033 5-mC (%) 3.221 (1.851–5.604) <0.001 0.983 (0.386–2.505) 0.972 5-hmC (%) per 0.01% 1.484 (1.265–1.741) <0.001 1.767 (1.250–2.499) 0.001

Conclusions
These findings suggest 5-hmC level combined with Crouse score may provide the meaningful information for coronary atherosclerosis diagnosis.

Acknowledgement/Funding
National Natural Science Foundation of China (No.81570212, No.31800976)
P6417Increasing the accuracy of a machine learning algorithm for STEMI diagnosis by incorporating demographic variables
Authors: Mehta S , Botelho R , Fernandez F , Villagran C , Frauenfelder A , Ceschim M , Matheus C , Vieira D , Torres M A , Pinto G , Quintero S , Jacobucci R , Marin M A , Funatsu C , Vallenilla I 
Published: October 2019

Abstract

Background
Our previous work demonstrated the diagnostic value of Artificial Intelligence (AI) -driven algorithms for ST-Elevation Myocardial Infarction (STEMI). In the present research, we explore the importance of demographic data inclusion, in order to achieve a more accurate diagnosis.

Purpose
To demonstrate that incorporation of demographic variables into the sample records will augment the accuracy of AI-based protocols for STEMI diagnosis.

Methods
An observational, retrospective, case-control study. Demographic data (age and gender) male/female ratio 1.3, ages 98–18 years was added to the sample records. Sample: 8,511 EKG records, previously diagnosed as normal, abnormal (over 200 conditions) or STEMI. Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (90,592 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with Nvidia GTX 1070GPU, 8GB RAM.

Results
The model yielded an accuracy of 97.1%, a sensitivity of 96.8%, and a specificity of 97.5%.

Conclusions
The ability of AI-guided algorithms to diagnose STEMI is increased by expanding the morphological variables with demographic data. This approach may be applied to improve the EKG diagnosis of other cardiovascular entities and improve clinical management.
P6418The continued proficiency of artificial intelligence for interpreting EKG: single lead EKG for STEMI culprit lesion localization
Authors: Mehta S , Fernandez F , Villagran C , Ceschim M , Matheus C , Pinto G , Mazzini J , Pisana L , Quintero S , Nola F , Safie R , Aboushi H , Munguia A , Cecilio E , Lopez C 
Published: October 2019

Abstract

Background
Traditionally, the 12-lead electrocardiogram (EKG) has been used for diagnosing ST-Elevation Myocardial Infarction (STEMI) and for identifying the culprit lesion. We have previously demonstrated the impact of combining a Single Lead approach with Artificial Intelligence (AI) to replace tasks previously dominated by the 12 lead EKG. This research explores the role of the single lead EKG in identifying a culprit lesion.

Purpose
To test the use of a single lead approach to accurately locate the culprit vessel.

Methods
An observational, retrospective, case-control study. Sample: 2,542 exclusively STEMI diagnosis EKG records that included post discharge feedback from healthcare centers, confirming diagnosis and culprit vessel (Left Main Coronary Artery [LMCA]; Left Anterior Descending [LAD]; Right Coronary Artery [RCA]; Left Circumflex Artery [LCX]; Saphenous Vein Graft [SVG]). Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing:detection of QRS complexes using a wavelet system, segmentation of each EKG into individual heartbeats (27,125 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented; “LCMA”, “LAD”, “CX”, “RCA”, “SVG”, and “No Information” classes were considered for each heartbeat per lead; individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.

Results
Accuracy: 77.4% Lead III; Sensitivity: LMCA (Lead aVL 25%); LAD (Lead aVF 87.8%); RCA (Leads V1, V3 92.9%); LCX (Lead aVL 21.7%).

Conclusions
Our results yielded the dominance of a specific single lead to each culprit vessels, aVF for LAD and V1 and V3 for RCA. We continue testing with different algorithms to search for reliable results for the LMCA and LCX. Nonetheless, conjugating a Single Lead EKG with an AI-augmented algorithm enables faster and easier management for patients that present with STEMI affecting the LAD and RCA territories.
P6419Machine learning in critical care: the role of diabetes and age in acute coronary syndromes
Authors: Cenko E , Van Der Schaar M , Yoon J , Vasiljevic Z , Kedev S , Vavlukis M , Bergami M , Scarpone M , Milicic D , Manfrini O , Badimon L , Bugiardini R 
Published: October 2019

Abstract

Background
Patients with diabetes and non-ST elevation acute coronary syndrome (NSTE-ACS) have an increased risk of mortality and adverse outcomes following percutaneous coronary intervention (PCI).

Purpose
We aimed to investigate the impact of early, within 24 hours PCI compared with only routine medical treatment on clinical outcomes in a large international cohort of patients with NSTE-ACS and diabetes.

Methods
We identified 1,250 patients with diabetes and NSTE-ACS from a registry-based population between October 2010 and April 2016. The primary endpoint was 30-day all-cause mortality. The secondary endpoint was the composite outcome of 30-day all-cause mortality and left ventricular dysfunction (ejection fraction <40%). We undertook analyses to explore the heterogeneity of treatment effects using meta-classification (MC) algorithms followed by propensity score matching and inverse-probability-of-treatment weighting (IPTW) from a landmark of 24 hours from hospitalization.

Results
Of 1,250 NSTE-ACS first-day survivors with diabetes (median age 67 years; 59%, men), 470 (37.6%) received early PCI and 780 routine medical treatment. The overall 30-day all-cause mortality rates were higher in the routine medical treatment than the early PCI group (6.3% vs. 2.5%). The prediction results of the MC algorithms accounted for only one interaction term that was statistically significant: age ≥65 years. After propensity-matched analysis as well as IPTW, early PCI was associated with reduced 30-day all-cause mortality in the older age (OR: 0.35; 95% CI: 0.14 to 0.92 and 0.43; 95% CI: 0.21 to 0.86, respectively), whereas younger age had no association with the primary endpoint. Similar results were also obtained for the secondary endpoint.

Conclusions
Among patients with diabetes hospitalized for NSTE-ACS, an early, within 24 hours, PCI strategy is associated with reduced odds of 30-day mortality only for patients aged 65 years or over. MC algorithms provide accurate identification of treatment effect modifiers.