bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2492The impact of diabetes mellitus newly diagnosed by glycated hemoglobin on outcomes in patients undergoing percutaneous coronary intervention - five years prospective follow up study
Authors: Abu Tailakh M , Friger M , Zahger D , Sidi A , Mazor-Dray E , Novack V 
Published: October 2019

Abstract

Background
Following percutaneous coronary interventions (PCI), both short and long terms ischemic outcomes are worse in patients with Diabetes Mellitus (DM) compared to those without DM.

Methods
We prospectively enrolled consecutive patients undergoing PCI. Glycated Hemoglobin (HbA1c) levels were assessed during the index hospitalization and newly diagnosed DM was defined as HbA1c≥6.5% in the absence of the previous diagnosis. The primary outcome was Major Adverse Cerebro and Cardiovascular Events (MACCE) defined as death, stroke, PCI or acute myocardial infarction at five years.

Results
Diabetes was previously diagnosed in 391 (34%) patients (DM group), 221 (19%) had newly diagnosed DM based on the HbA1c level and 539 (47%) did not have diabetes (Non-DM). In DM group HbA1c was 7.80±1.36% as compared with 7.62±1.30% in patients with newly diagnosed DM (p<0.001). These patients were younger (62.0±11.3 years) compared to DM (67.9±10.4 years) and non-DM (63.7±13.0) patients, p<0.001. five years MACCE rates were 37.8%, 65.5% and 42.5% in the non-DM, newly diagnosed DM and DM groups, respectively (p<0.001). Multivariate analysis showed that compared to non-DM, the adjusted two year hazard ratios for MACCE were 1.83 (p<0.001), 1.47 (p=0.01) and 0.52 (p=0.01) respectively in patients with known DM, newly diagnosed DM, and patients with newly diagnosis DM who had DM treatment started after PCI.

Conclusion
Newly diagnosed DM based on peri-procedural HbA1c is common and associated with increased short and long term risk for adverse outcomes. Our results show that the diagnosis and early treatment of diabetes in patients undergoing PCI should be included into the routine practice.
P2498Exercise capacity and all-cause mortality in remote Indigenous and non-Indigenous populations
Authors: Chang D D , Kangaharan N , Forde J , Goh D , Elangovan H , Manek N , Arauz C , Brady S , Sanders P , Wong C X 
Published: October 2019

Abstract

Background
Exercise capacity is a powerful predictor of all-cause mortality. However, its association with Indigenous populations in Central Australia, who face disproportionate health burdens, is unclear. Given the isolation from tertiary centers, exercise testing could provide useful local risk-stratification.

Purpose
To characterize the association of exercise capacity with all-cause mortality in Indigenous and non-Indigenous individuals in remote Central Australia.

Methods
Demographic, medication, and all-cause mortality data were prospectively collected from patients undergoing exercise stress tests from 2007–2017.

Results
A total of 3,414 patients (34% Indigenous) were included. At 4.8±2.9 years of follow-up, 86 (2.5%) deaths had occurred. Each 1-MET increase in exercise capacity conferred a 14% lower risk for mortality among Indigenous individuals (HR 0.86, 95% CI 0.79–0.94) and 20% lower risk for mortality among non-Indigenous individuals (HR 0.80, 95% CI 0.73–0.89) after adjusting for age, comorbidities, and medications. Mortality risk reduction for each 1-MET increase in exercise capacity was similar (p=0.32) for Indigenous and non-Indigenous individuals.

Conclusions
Exercise capacity is a significant predictor of all-cause mortality in Indigenous and non-Indigenous individuals. These findings have important clinical implications towards exercise capacity for risk-stratification and preventative importance of physical activity.
P2507Role of “Walk with a doc” program practice in total risk approach to prevention of cardiovascular disease in RF
Authors: Bockeria O L , Kudzoeva Z , Khugaev S G 
Published: October 2019

Abstract

Background
It is known that life-style related factors are the main risk factors for CVD morbidity and mortality. In countries with economies in transition (such as Russia) many efforts were aimed at CVD diagnostic and treatment procedures improvement, but lack of primary prevention strategies is observed in general population. CVD morbidity and mortality could be prevented through population based strategies.

Purpose
To evaluate the feasibility and potency of implementing “Walk with a doc” program practice using newly-developed “Cardiac numbers Diary” for estimation of the individual risk on making decision about whether to initiate specific preventive action to reduce CVD morbidity.

Methods
The program has successfully started in Moscow, RF in July 2012 as a Russian branch of the global “Walk with a doc” activity. As of January 2019 there are 1576 participants in the database. Special “Cardiac numbers Diary” was developed and includes special charts to allow the introduction of the total risk stratification approach for management of CVD. The charts use a modelling approach with age, sex, physical activity, smoking, blood pressure, body weight, blood glucose and cholesterol. With support of center specialists the weekly events are carried out in different open space grounds and include the assessment of the above risk factors, life style modifying counseling including lectures and 35–40 minutes' walk at the moderate pace. 150 participants participated in more than 20 walks mean age 58,2 years old (±17,1) were assessed in this prospective study. They were assessed for risk factors modifying in 6 months follow-up period. At the moment of inclusion 37.5% participants had arterial hypertension, 12.1% were smokers, 20.2% were overweight. The official Walk-with-a-doc movement is registered in RF. Special Web site provides information on future events, physician team, life-style, diet, physical activity recommendations, photo materials and etc.

Results
After 6 month of regular walking the number of hypertensive participants decreased to 20.2%. 9.4% of all participants were able to lose weight by 1–6 kg, and 33.3% quit smoking. 75% of people who walked noticed an increase in the level of physical activity. 17.3% of them underwent inpatient treatment using high-tech medical care. Ther were no major events in the above cohort of patients.

Conclusions
“Walk with a doc” program practice using newly-developed individual “Cardiac numbers Diary” for a predicted individual risk with regular professional counseling can be a useful guide for making clinical decisions on the intensity of preventive interventions to reduce cardiovascular risk factors in general population.

Acknowledgement/Funding
None
P2512Effects of two different preventive counselling programs with remote support on added sugar and refined carbohydrates intake pattern in coronary patients with abdominal obesity
Authors: Pogosova N , Salbieva A O , Sokolova O Y , Yufereva Y M , Ausheva A K , Karpova A V , Yusubova A I 
Published: October 2019

Abstract

Background
Restricting added sugar and refined carbohydrates is essential for a healthy diet, especially for overweight or obese patients (pts). Pts education has a potential to improve dietary patterns in coronary artery disease (CHD).

Purpose
To assess the impact of 2 preventive counselling programs with subsequent remote support resulted after hospitalization on salt intake in pts with CHD and obesity.

Methods
A prospective randomized parallel-group study in hospitalized nonsurgical pts with confirmed stable CHD and concomitant abdominal obesity. Most hospitalizations were due to elective percutaneous coronary intervention. Pts were randomized (1:1:1) into 3 groups. Before discharge, Groups 1 and 2 received comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1–3) and then monthly (Months 4–6). Group 3 received standard advice only. Self-reported sugar/refined carbohydrates intake was assessed by consumption of added sugar, sugar-sweetened beverages and pastry.

Results
A total of 120 pts (mean age±SD, 57.75±6.25 years, men, 83.4%) were enrolled. The table presents self-reported dietary habits at baseline and at 12 months. At 1 year, significant improvements of relevant dietary habits vs control were seen in both intervention groups.
Group 1 Group 2 Group 3 (control) Group 1 vs 3, Group 2 vs 3, (n=40) (n=40) (n=40) P for change from baseline P for change from baseline Amount of sugar added per cup tea or coffee, teaspoons, mean ± SD   Baseline 2.65±0.77 2.45±0.81 2.48±0.72   At 12 months 2.08±0.83** 1.95±0.64** 2.47±0.69 <0.01 <0.01 Pts avoiding sugar-sweetened beverages, %   Baseline 37.50 32.50 25.00   At 12 months 92.50** 90.00** 13.16 <0.01 <0.01 Pts restricting pastry to no more than 1–2 times a week, %   Baseline 37.5% 47.5% 57.5   At 12 months 70.0%** 72.5%** 39.47 <0.01 <0.05 **p<0.01 vs baseline within group.

Conclusion
Pre-discharge preventive counselling with subsequent remote support in coronary patients with abdominal obesity resulted in significant improvement of dietary habits in terms of added sugar, sugar-sweetened beverages and pastry intake.
P2515Cardiac rehabilitation in patients with refractory angina: preliminary results
Authors: Dourado L , Assumpcao C R A A , Jordao C P , Vieira M L C , Gowdak L H W , Cesar L A M , Matos L D N J 
Published: October 2019

Abstract

Introduction
Refractory angina (RA) implies important impairment of quality of life. Cardiac rehabilitation (CR) is still not recommended by guidelines due to few evidence regarding its effects in this population. This study evaluated the impact of CR on physical performance and on angina/ischemia threshold.

Methods
36 RA patients undergoing optimal medical therapy were randomly assigned to a 12-week exercise based CR program or stablished clinical follow-up (CF). Clinical evaluation, exercise bicycle stress echocardiography (SE) and cardiopulmonary exercise testing (CP) were performed before and after the protocol. CR group performed in-hospital exercise sessions, and the aerobic training prescription was based on CP parameters or ischemia/ angina threshold. Each CR class was 60 min in duration (5min warm-up, 30min aerobic and 5min cooldown, 15min low load resistance training and 5min stretching). Bonferroni multiple comparison and t test were used in statistical analysis.

Results
Baseline characteristics didn't differ between groups. In RC group, 40% presented CCS 2, 25% CCS 3 and 35% CCS 4, while in CF group, 41%, 23.5% and 35.5%, respectively (p=0.5). There was no change in CCS between groups after intervention. CR group presented an increase in ischemic threshold in SE when compared to CF group (234.6±87.9s to 293.8±130.9 s vs. 200.9±78.6s to 203.7±93.7s, p=0.044), increase in angina threshold in SE (156.00±62.2s to 260.1±152.8s vs. 190.6±96.6s to 152.9±76, 7s, p=0.041) and increase in CP total duration (347.9±143.2s to 489.8±170.2s vs. 331.7±128.5s to 323.5±101.0s, p=0,016).
Baseline characteristics in both groups Variables CR group (n=19) CF group (n=17) p Male sex (%) 63.2 58.8 0.8 Age, years (mean ± SD) 61.2±8.7 62.9±8.8 0.6 LVEF, % (mean ± SD) 55.7±7.3 50.0±10.4 0.08 SBP, mmHg (mean ± SD) 125.6±18.0 122.6±14.5 0.6 DBP, mmHg (mean ± SD) 77.5±9.6 76.2±13,1 0.7 HR, bpm (mean ± SD) 60.5±6.2 60.6±7.1 0.9 BMI, kg/m2 (mean ± SD) 28.8±4.1 26.1±10.9 0.4 Fasting glucose, mg/dl (mean ± SD) 136.4±33.6 153.6±64.7 0.3 HBA1C, % (mean ± SD) 6.8±1.2 7.2±1.6 0.4 LDL-c, mg/dl (mean ± SD) 77.8±29.0 84.7±28.6 0.5

Results
CR seems to be an effective adjuvant treatment in RA, increasing ischemia and angina threshold, improving physical performance.

Acknowledgement/Funding
FAPESP
P2516Cardiac rehabilitation program - experience and outcomes in a tertiary center
Authors: Castelo A , Rio P , Alves S , Silva A S , Mano T , Ferreira V , Bras P , Ferreira R 
Published: October 2019

Abstract

Introduction
Cardiac rehabilitation (CR) programs are effective in improving functional capacity and reducing mortality. The level of adherence to them seems to be less than the ideal, and some factors can predict non-compliance with impact on outcomes.

Purpose
The aim was to characterize the population of the cardiac rehabilitation (CR) appointment, determine factors predictive of compliance with the standard CR exercise program and evaluate the benefits of the program.

Methods
Retrospective analysis of patients in a CR appointment at a single center between 2014 and 2017. Patients (P) were divided into two groups: compliance >80% of the program (GI) and non-compliance (GII). We assessed clinical, laboratory, and echocardiographic characteristics and determined predictors for compliance and compared the follow-up to date.

Results
270P (83% men) were included, with a mean age of 57 years. The P had a median follow up of 35 months, with an interquartil interval of 28 months. The majority (92.5%) had at least one cardiovascular risk factor (25.1% diabetes, 57.1% hypertension, 72.8% dyslipidemia, 75.8% obesity or weight excess, with mean body mass index (BMI) 27.3±3.46, 16.7% family history, 19.8% acute myocardial infarction (AMI), 48.2% smoking). 99% of the patients were medicated (93.7% acetylsalicylic acid, 67.3% clopidogrel, 24.1% ticagrelor, 95.6% beta-blocker, 93.7% ACEI/ARB, 95.5% statin). 144P (53.3%) were not from Lisbon. Most patients (77%) were referred after AMI, 8.9% with heart failure (HF), 8.5% with stable or unstable coronary disease and 1.9% with valvulopathy. 69P (25.6%) attended >80% of the CR program. Death occurred in 4.4% of the P (71.4% cardiovascular causes) and 27% had at least 1 hospitalization. Age, sex, economic insufficiency and residence local (Lisbon or non-Lisbo) were not predictors of non-compliance (p=0.859, p=0.656, p=0.914 and p=0.515 respectively). Predictors of non-compliance were higher IMC (CC=-0.141, p=0.014), higher cholesterol (CC=-0.140, p=0.016), higher C reactive protein (CC=-0.120, p=0.043), higher HbA1c (CC=-0.170, p=0.008) and CR for heart failure (HF) (OR = 0.715, IC [0.659–0.775], p=0.002). Of these, higher HbA1C (p=0.018) and CR for HF (p=0.034) were independent predictors. Compliance with>80% of the program was associated with lower overall mortality (OR = 0.732, IC [0.679–0.788], p=0.037), but not as an independent factor (p=0.378). The only independent predictor of mortality were BNP (p<0.0001).

Conclusion
Of the patients referred to the CR consultation one fourth concludes the program. Several factors can predict non-compliance, with higher HbA1c and CR for HF being independent predictors. Compliance with the CR program is associated with lower overall mortality.
P2520Predictors of success of biofeedback in the rehabilitation of patients after acute myocardial infarction
Authors: Leonova I , Boldueva S , Yarmosh I , Suvorov N 
Published: October 2019

Abstract

In current work, it were evaluated clinical predictors for the success of biofeedback (BF) sessions during cardiorespiratory training (CT) by cardiac rhythm for the development of cardiorespiratory synchronization (CRS) in addition to standard therapy in patients with myocardial infarction (MI) in early periods.
The study included 50 patients with uncomplicated MI on 6–10 days of disease. 21 patients developed stable CRS during training in the hospital. All patients underwent general clinical examination: control of blood pressure, heart rate, ECG, echocardiography, assessment of heart rate variability (HRV).
Using of discriminant analysis of initial clinical parameters, heart rate variability parameters and cardiorespiratory training, a mathematical model was constructed that allows predict the success of CT in patients in early period of MI with a probability of 96.7%.
f = −8.85 + 0.21X1 + 3.87X2 − 4.96X3 − 1.72X4 + 3.5X5 − 1.57X6 − 1.58X7 − 0.69X8 + 1.63X9 + 0.008X10 − 0.069X11 + 0.089X12 + 2.71X13 − 2.61X14 + 5.65X15 where X1 is the left ventricular ejection by echocardiography, X2 is the number of MI, X3 is the presence of previous history of coronary artery disease, X4 is diabetes, X5 is smoking, X6 is thrombolysis, X7 is coronary artery stenting, X8 is SDNN by HRV, X9 – CV by HRV, X10 – TP by HRV, X11 – HR in the first active test, X12 – diastolic blood pressure in the first inactive test, X13 – change in the HRV in the first active test as compared to the first inactive test, X14 – change in systolic blood pressure in the last inactive test compared to with the first inactive test, X15 – change in diastolic blood pressure in the last inactive test compared to with the first inactive test. The threshold value is f = −0.21. If the patient's IM value is greater than the threshold value, the patient will belong to the CRS successful group. If the patient's IM value is less than the threshold value, the patient will belong to the CRS unsuccessful group.

Conclusion
the developed mathematical model allows predict the effectiveness of cardiorespiratory training in patients in early period of uncomplicated MI.
P2522A new scoring system to stratify post-surgical valvular patients during cardiovascular rehabilitation: derivation and validation study
Authors: Maranta F , Pistoni A , Cartella I , Cianfanelli L , Cerea P , De Bonis M , Castiglioni A , Alfieri O , Cianflone D 
Published: October 2019

Abstract

Background
Guidelines underline the importance of Cardiovascular Rehabilitation (CR) in post-surgical valvular patients both for the functional recovery and the monitoring of complications. However, there are no established indicators to better categorise their risk and to identify the real probability of recovery.

Purpose
The aim of this study is to propose and validate a scoring system to appropriately stratify post-surgical valvular patients in order to individualise CR programmes.

Methods
A retrospective study was conducted on 1480 post-surgical valvular patients hospitalized in our CR Unit (902 M – 578 F; median age of 64 years, IQR 53–73). 485 patients underwent single heart valve repair, 408 single heart valve replacement, 237 single heart valve surgery and additional interventions, 249 multiple valve interventions and 101 multiple heart valves and additional interventions. Subjects were randomised in two groups for data analysis: a Derivation (D; n=1000) and a Validation (V; n=480) group. Initially, in group D we assessed the predictive value of anamnestic, clinical and laboratory variables for major complications and functional recovery. We created two scoring systems for these outcomes and, subsequently, we validated them on group V. Finally, we interlaced them in an operative algorithm.

Results
Chronic kidney disease (OR 2.588; 95% CI 1.232–5.436; p=0.012), sternal surgical re-synthesis (OR 7.757; 95% CI 2.042–29.471; p=0.003), post-surgical transfusions (OR 2.419; 95% CI 1.407–4.161; p=0.001) and Troponin T peak >1400 μg/L (OR 2.441; 95% CI 1.418–4.200; p=0.001) were independent predictors for the occurrence of major complications in group D. Age (OR 0.958; 95% CI 0.9339–0.977; p<0.001), post- surgical transfusions (OR 1.981; 95% CI 1.160–3.380; p<0.001) and METS at admission (OR 0.032; 95% CI 0.017–0.061; p<0.001) were independent predictors of a higher functional recovery in group D. When the two scoring systems were validated on group V, we obtained a z score of 0.07 (p=0.941) for the major complications risk score and a z score of 1.23 (p=0.219) for the functional recovery stratification system, respectively, indicating a very reliable model. We proceeded to build an operative algorithm to stratify patients and propose personalised CR strategies.

Conclusions
We identified predictors to stratify the risk of complications and to define the probability of recovery in post-surgical valvular patients undergoing CR. The proposed final operative algorithm may be a unique tool to support the cardiologist to tailor rehabilitation programmes. This may lead to better outcomes and reduction of healthcare expenditure with optimisation in the use of available resources.

Acknowledgement/Funding
None
P2532Incidence and outcome of perioperative myocardial infarction/injury after non-cardiac surgeries diagnosed by high-sensitivity cardiac troponin I
Authors: Gualandro D M , Puelacher C , Hidvegi R , Cardozo F A , Marbot S , Yu P C , Vogt R , Calderaro D , Gueckel J , Strunz C , Bolliger D , Rentsch K , Caramelli B , Mueller C 
Published: October 2019

Abstract

Background
In order to differentiate perioperative myocardial infarction/injury (PMI) after non-cardiac surgery from preexisting cardiomyocyte injury from chronic disorders, recent studies have shown the importance of using an acute absolute increase as a criterion for PMI. For high-sensitivity troponin T (hs-cTnT), PMI defined as an absolute increase of 14ng/L (the 99th percentile) has been shown to be strongly associated with 30-day mortality. Until now, no data on hs-cTnI are available. This is a major unmet clinical need, as relevant differences between hs-cTnT and hs-cTnI have recently been identified and, as worldwide hs-cTnI is more commonly used as compared to hs-cTnT. We hypothesized that applying the same criterion to hs-cTnI, would reveal a similar association with outcomes.

Purpose
To evaluate the incidence and outcome of PMI diagnosed by hs-cTnI after non-cardiac surgery.

Methods
We included prospectively consecutive high cardiovascular risk patients undergoing non-cardiac surgery. Hs-cTnI concentrations were measured before surgery and, daily after surgery, for three days. PMI was defined as an absolute rise of ≥26ng/L (the 99th percentile of the assay studied) from baseline values. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, acute heart failure and arrhythmias, and the secondary outcome was all-cause mortality, within 30 days and one year.

Results
We included 2,018 patients submitted to 2,551 surgeries. Patients had median age of 73 years (IQR 68–79) and 56% were male. After surgery, 231 patients (9%, 95% CI 8–10%) fulfilled PMI diagnostic criterion. Patients with PMI had higher rates of MACE than patients without PMI, at 30 days (13% vs. 2%; P<0.001) and, at one-year follow-up (25% vs. 8%; P<0.001). All-cause mortality was also higher in PMI patients within 30 days and one year (9% vs. 1.5% and, 22% vs. 8%, respectively; P<0.001). In multivariate cox regression analysis, PMI showed a hazard ratio (HR) of 4.7 (95% CI, 2.9–7.6; P<0.001) within 30 days, and a HR of 2.7 (95% CI, 2.0–3.7; P<0.001) within one year for the occurrence of MACE. For total mortality, PMI showed a HR of 3.8 (95% CI, 2.1–6.8; P<0.001) within 30 days and a HR of 2.0 (95% CI, 1.4–2.7; P<0.001) after one year.

Conclusion
PMI is frequent and associated with high rates of MACE and mortality in short- and long-term follow-up after non-cardiac surgery, regardless of the high-sensitivity troponin assay used for diagnosis.

Acknowledgement/Funding
Swiss Heart Foundation, University basel, Abbott, Astra zeneca, Forschungsfond Kantonsspital Aarau, Cardiovascular Research Foundation Basel, FAPESP