bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4366Application of 3D-dual volume layout imaging for rapid intraprocedural guidance in Mitraclip procedure
Authors: Gavazzoni M , Zuber M Z , Miura M M , Pozzoli A P , Taramasso M T , Ho E C H , Maisano F M 
Published: October 2019

Abstract

Introduction
Intraprocedural guidance and monitoring with transesophageal echocardiography (TEE) and invasive hemodynamic assessment are currently the best available options for evaluating procedural success of percutaneous mitral valve (MV) repair with Mitraclip System (Abbott Vascular, Santa Clara, CA, USA). However, despite its crucial importance, echocardiography has some limitations in immediate evaluation of residual jets after clip implantation, so that, in absence of validated method for double orifice effective regurgitant orifice (ERO) assessment, the most reliable parameter that is currently used is the mean trans-valvular gradient.

Purpose
This prospective study aimed to assess the role of a new echocardiographic parameter obtained from 3D-Color-Full volume imaging of MR for evaluation of outcomes of mitraclip procedures, comparing it with invasive LAP measurements.

Material and methods
We prospectively performed the computation of a new parameter in patients with symptomatic moderate-severe to severe primary or secondary mitral regurgitation (MR) underwent MitraClip procedure. This parameter is easy and fast to be obtained out of 3D dataset and represents the 2D area of the proximal isovelocity surface zone visualized from the ventricular view, without any imaging processing (“3D dual volume PISA area”) (figure). It was obtained as following: i) acquisition of 3D-zoomed-color image of MR jet with adequate frame rates; ii)displaying of the volume sampling in “dual volume layout” so one can see the “ventricular aspect” of the jet area corresponding to proximal isovelocity surface “zone”; iii) awareness of correct alignment to the direction of the flow in proximal zone; iiii) freezing and direct measurement of this area (summarize if more than 1 orifice) (1 attached). We compared the variation of this parameter from the beginning to end of procedure with the variation of LAP measurements, that is currently the most important parameter for assessing outcome of procedures.

Results
The study includes dataset of 11 patients. The baseline value of 3D dual volume PISA area was 1,191±0,40 cm2 and the mean change we obtained was 0,65±0,30 cm2 (mean of 77% of reduction until the end of procedure). Mean values of LAP were slightly decreased in all cases: basal m-LAP was 12±3,3 mmHg and decreased by 15%. Despite the small number of patients, we observed a significant correlation between the changes of LAP and the change of 3D dual volume PISA area (R: 0.6, p: 0,048).

Conclusions
This is the first demonstration of the usefulness of echocardiographic parameter obtained by 3Ddual volume layout imaging for rapid intraprocedural guidance in Mitraclip procedure. This parameter is related to hemodynamic variations that it currently considerable surrogate of outcomes. These data need to be confirmed by a larger study.
P4378Comparison between left bundle branch pacing and His bundle pacing using two-dimensional speckle tracking echocardiography
Authors: Cheng Y F , Chen H Y , Zhu M R , Chen X Y , Su Y G , Pan C Z , Shu X H , Ge J 
Published: October 2019

Abstract

Background
Although his bundle pacing (HBP) can achieve physiological electrical activation of the ventricles, its clinical use is limited by lower success rates, high and unstable pacing thresholds and loss of capture. Left bundle branch pacing (LBBP) has been proved to be able to correct Left bundle branch block (LBBB) and generate a narrower QRS duration than conventional RV pacing. However, its effects on ventricular synchronism and contraction function remains unknown. The current study is aimed to compare the echocardiographic characteristics between HBP and LBBP, and to explore whether LBBP leads to a comparable cardiac synchrony and deformation in comparison with HBP.

Methods
Forty-six pacing-indicated patients were prospectively enrolled. Twenty-nine patients underwent LBBP (17 male patients, mean age 69.6±13.7yrs, the LBBP group) and 17 patients underwent HBP (13 male patients, mean age 70.4±14.7yrs, the HBP group). LBBP was achieved by trans-septal method in the basal ventricular septum. Left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and tricuspid annulus plane systolic excursion (TAPSE) were obtained. Strains and time to peak strains of right ventricular free wall and 16 left ventricle segments were analyzed using two-dimensional speckle tracking echocardiography (2D STE). The standard deviation of time to peak strains of 16 left ventricular segments was calculated as PSD.

Results
Compared to the baseline, time to peak longitudinal strain (TTPS) of apical septum, apical lateral wall were shortened after 6 months of HBP, while they didn't change significantly after 6 months of LBBP. After pacemaker implantation, the LBBP group had a delayed TTPS of apical septum, apical lateral wall and basal RV free wall than the HBP group (LBBP vs. HBP: apical septum,358.44±61.98ms vs. 296.43±29.47ms; apical lateral wall, 373.11±55.80ms vs. 299.00±83.45ms; basal RV free wall, 404.31±72.93ms vs. 334.50±39.95ms, all p<0.05).However, PSD was comparable between the two groups (p>0.05).
Compared to the baseline, global left ventricular longitudinal strain (LVGLS) and longitudinal strain of RV free wall (RVLS) were deteriorated after 6 months of HBP, while they were preserved in the LBBP group. After 6-month pacing, LVGLS and RVLS were significantly stronger in the LBBP group than those in the HBP group. (LVGLS, −16.10±3.75% vs. −13.18±4.11%; RVLS, −17.50±5.46% vs. −13.70±4.35%, both p<0.05).

Conclusion
Patients received LBBP had a comparable left ventricular synchronism and a better myocardial contraction compared to patients with HBP. LBBP may be a promising alternative pacing strategy. Two-dimensional STE is more sensitive than conventional echocardiography in assessing cardiac synchrony and segmental deformation.
P4387Environmental tobacco smoke exposure affects the QT interval during early infancy
Authors: Harada K , Harada Y 
Published: October 2019

Abstract

Background
The association between long QT interval and sudden infant death syndrome (SIDS) has been clearly established. Environmental tobacco smoke (ETS) exposure is associated with increased risk for SIDS. However, there has been little focus on the relationship between the QT interval and ETS exposure during early infancy. To clarify this, we examined the QT interval with ETS exposure during early infancy.

Methods
Electrocardiographic study was performed in 624 infants (age: 1–5 months) who have been exposed to tobacco smoking since intrauterine life and 1119 age-matched children without ETS exposure. QT data were extracted from the electrocardiogram monitor built-in echocardiogram. Recordings from lead II on the monitor ECG were used to measure the QT interval. The QT intervals of 5 consecutive beats were measured manually. The QT interval was measured on the first, second, third, fourth, and fifth month. The corrected QT interval (QTc) was calculated by dividing the QT interval by the square root of the RR interval (Bazett's formula). The data of the number of cigarettes per day were collected by a questionnaire.

Results
In the total study population, the mean QTc showed the highest peak at the second month. The mean QTc at the first and second month (399±21 and 402±18 msec) was significantly longer (p<0.05) than that at the third, fourth, and fifth month (394±19, 393±21, and 392±22 msec) as shown in Figure 1A. The mean QTc in ETS infants at the first, second and third month was significantly greater than that in infants without ETS (404±20 vs. 397±21 msec, 407±19 vs. 399±17 msec and 404±17 vs. 390±18 msec, p<0.01, respectively), but the mean QTc at the fourth and fifth was similar in the 2 groups as shown in Figure 1B. The QTc increased significantly as the category of number of cigarettes per day increased, with a significant prolongation as of the category 6–10 cigarettes per day as shown in Figure 1C.
Figure 1

Conclusions
The present study indicates that the QT interval during early infancy lengthens by ETS exposure. Further study is needed as to whether QT prolongation associated with ETS exposure is a risk factor for SIDS.
P4391Cardiovascular risk factor trends over two decades in patients presenting with acute myocardial infarction: a failure of smoking control, especially in women
Authors: Witassek F , Radovanovic D , Rickli H , Pedrazzini G , Erne P , Muller O , Eberli F R , Roffi M 
Published: October 2019

Abstract

Background
Hypertension, diabetes, dyslipidemia and smoking are established cardiovascular risk factors (CVRF). Little is known about the changes of risk factor profiles over time in patients presenting with acute myocardial infarction (AMI).

Purpose
To analyze the temporal trends of CVRF in patients presenting with AMI over the last 22 years in Switzerland.

Methods
We included data of all AMI patients enrolled between 1997 and 2018 in the Swiss nationwide AMIS Plus registry. The rates of hypertension, diabetes, dyslipidemia and smoking at presentation were descriptively analyzed dividing the data into 2-year periods. Trend analyses were performed using the CHI-square-test and ANOVA. A p-value of <0.005 was considered as statistically significant.

Results
A total of 57,995 patients were included in the analysis (73.6% male). The mean age was 66.0 years (males: 64.0 years, females 71.6 years) and did not differ over the study period. The mean CVRF rates over the study period were as follows: diabetes 20.5% (males: 19.4%, females: 23.6%), hypertension 60.2% (males: 57.0%, females: 69.0%), dyslipidemia 59.4% (males: 60.5%, females: 56.4%), and smoking 39.3% (males: 43.0%, females: 28.7%). While there was no significant change over time in the rates of diabetes for both genders, there were significant increases in the rates of hypertension and dyslipidemia for both males and females (p<0.001 for all comparisons). In terms of smoking, there was no significant trend for males while there was a significant increase in the rate of smoking for females (p<0.001). As a result, the gap in smoking rates between men and women decreased from 19.9% (45.3% vs. 25.4%) in 1997/98 to 7.9% (41.2% vs. 33.3%) in 2017/18.
Trends in the rate of smokers

Conclusions
Among patients presenting with AMI in Switzerland over two decades, the prevalence of hypertension and dyslipidemia increased in both men and women, while diabetes at presentation did not change over the years. We documented a failure of smoking control, with a lack of a reduction in the smoking prevalence among males and a striking increase among women.
P4405Impact of longitudinal changes in metabolic syndrome status over two years on 10-year incident type 2 diabetes mellitus
Authors: Koh K , Kim J 
Published: October 2019

Abstract

Background
Metabolic syndrome (MetS) is a known predictor of diabetes mellitus (DM), but whether longitudinal changes in MetS status modify the risk for incident DM remains unclear. We investigated whether temporal changes in MetS status over two years modify the 10-year risk of incident DM.

Methods
A prospective cohort study was conducted in 7,317 adults aged 40–70 years without DM at baseline. Subjects were categorized into four groups based on repeated longitudinal assessment of MetS status over two years, as defined by the Adult Treatment Panel III guidelines: non-MetS, resolved MetS, incident MetS, and persistent MetS. The hazard ratio (HR) of new-onset DM during 10 years was calculated in each group using Cox models.

Results
During the 10-year follow-up, 1,099 (15.0%) developed DM. Compared to the non-MetS group, the fully adjusted hazard ratios (95% confidence interval) for new-onset DM were 1.27 (1.01–1.61) in the resolved MetS group, 1.78 (1.43–2.22) in the incident MetS group, and 1.85 (1.52–2.26) in the persistent MetS group (P for trend <0.001). The 10-year risk of DM in subjects with resolved MetS was attenuated compared to those with persistent MetS over two years (P<0.001). In addition, the adjusted hazard ratio for 10-year incident DM gradually increased according to the number of MetS components two years later.

Conclusions
Temporal changes in MetS status over two years influenced the 10-year risk of incident DM. Our findings suggest determining the status of MetS regularly and strictly controlling MetS are important in preventing DM.
P4412Association of sleep duration with cardio-metabolic risk leading to development of atherosclerotic cardiovascular disease
Authors: Matsuo R , Tani S , Atsumi W , Matsumoto N 
Published: October 2019

Abstract

Background
Sleep duration, mostly of short duration, has emerged as a potential factor in adverse cardio-metabolic risk. We investigated the relationship between sleep duration and cardio-metabolic risk leading to atherosclerotic cardiovascular disease (ASCVD).

Purpose
We examined the association between sleep duration and cardio-metabolic risk in Japanese men.

Methods
This cross-sectional study was conducted using a sample of 6,907 apparent healthy men who had undergone medical examinations at the Health Planning Center of Nihon University Hospital between April, 2015 and May, 2016. The relationship between waist circumference, homeostasis model assessment of insulin resistance (HOMA-IR), HbA1c, non-high-density lipoprotein cholesterol (non-HDL-C) level, and sleep duration was evaluated.

Results
Both unusually short and long sleep durations were associated with waist circumference, impaired glucose tolerance and high non-HDL-C level (Figure). Compared with men sleeping 7 to 8 hours, the relative risk of abdominal obesity (defined according to the Japanese criteria for metabolic syndrome as a waist circumference of 85cm≥) among men sleeping ≥8 h was 1.27 (95% Confidence interval (CI), 1.05–1.55, p<0.01); the relative risk of a high HOMA-IR (2.0≥) level among men sleeping <5 h was 1.43 (95% CI, 1.00–2.05, p<0.05); among men sleeping ≥8 h the relative risk was 1.38 (95% CI, 1.08–1.77, p=0.01); the relative risk of a HbA1c level of ≥5.6% (defined as “high” by a specialized life style checkup program for the detection of symptoms of metabolic syndrome in Japan) among men sleeping <5 h was 1.39 (95% CI, 1.01–1.65, p<0.05); the relative risk of a non-HDL-C level of ≥170 mg/dL (defined as “high” by the Japanese Arteriosclerosis Society based on a lipid control target value for the primary prevention of ASCVD) among men sleeping ≥8 was 1.40 (95% CI, 1.13–1.76, p<0.01). These analyses were adjusted for age, psychological stress, and the use of cholesterol-lowering, blood-pressure lowering, and anti-diabetic medications.

Conclusion
The results suggest that unusually short and long sleep durations may increase cardio-metabolic risk. To further reduce the risk of ASCVD, it may be of particular importance to emphasize adequate sleep duration.
P4422Myocarditis: a deceitful but not infrequent athletes' enemy
Authors: Pizzamiglio F , Casella M , Dessanai M A , Chihade F , Riva S , Pontone G , Andreini D , Basso C M , Tondo C , Delo Russo A , Zeppilli P 
Published: October 2019

Abstract

Introduction
Myocarditis represents a not negligible cause of sudden death (SD) in athletes, representing the cause of 4%-14% cardiac arrests and deaths in athletes. Preparticipation screening including 12-leads basal electrocardiogram could drastically reduce SD in athletes and screening programs are therefore now recommended by most medical and sport association. At the moment, no data in literature are available about incidence of concealed myocarditis in athletes but there is general consensus about disqualification from competitive sport in the presence of myocardial fibrosis (MF).

Purpose
Purpose of our study was to quantify incidence of MF consistent with past myocarditis in athletes that referred to our Sport Cardiology Center for ventricular arrhythmias (VA) +/− repolarization abnormalities (RA) detected at preparticipation screening.

Methods
In our study we retrospectively evaluated all athletes with VA +/− RA and we quantified how many were found to have MF consistent with myocarditis at cardiac MRI. Furthermore, we evaluated characteristics of presentation in terms of clinical symptoms of myocarditis and frequency and morphology of VA. Finally, we analyzed findings of invasive diagnostic workout when performed.

Results
In the last two years we evaluated 111 athletes for VA +/− RA and we found MF consistent with myocarditis in 18 (16%) of them. Only 2/18 referred past febrile status probably correlated with myocarditis and 1 had symptoms consistent with acute myocarditis. Number of VA was not correlated with MF fibrosis, while polymorphic VA and exercise-correlated VA were the most frequent finding. 5/18 (28%) had also rest and/or exercise induced RA. 10/18 (55%) athletes underwent electrophysiological study without any induction of arrhythmias. 7/18 (39%) underwent also electroanatomical mapping (EAM) with pathological findings in 5/7 (71%). All of these 5 underwent endomyocardial biopsy guided by EAM and in 2 cases bioptic findings were consistent with arrhythmogenic cardyomyopahty (ACM). All 18 athletes were disqualified from competitive sport as for Italian Sport Medicine protocols.

Conclusion
MF consistent with past myocarditis is a not infrequent finding in athletes with VA with or without RA. Morphology and exercise behavior of VA are the most important “alarm bell”, while VA number is not correlated with MRI pathological findings. Sometimes MF interpreted as consistent with past myocarditis is actually the manifestation of ACM. Identification of these diseases is of extreme importance for athletes' safety.
P4429Cardiac magnetic resonance characteristics of professional athletes and hypertrophic cardiomyopathy patients in the grey zone of hypertrophy
Authors: Czimbalmos C , Csecs I , Dohy Z , Toth A , Suhai F , Szabo L , Horvath V , Sydo N , Kiss O , Becker D , Merkely B , Vago H 
Published: October 2019

Abstract

Differentiation between athlete's heart and hypertrophic cardiomyopathy (HCM) may cause difficulties especially in patients in the grey zone of hypertrophy.
We aimed to determine conventional cardiac magnetic resonance (CMR) parameters such as left ventricular (LV) ejection fraction (EF), BSA-corrected end-diastolic (EDVi), end-systolic and stroke volume (SVi), mass (Mi), derived CMR parameters such as maximal end-diastolic wall thickness to LVEDVi ratio (EDWT/LVEDVi), LVM to LVEDV ratio (LVM/LVEDV), and CMR based strain values (global longitudinal (GLS), radial (GRS) and circumferential strain (GCS)) in male HCM patients and athletes.
We consecutively enrolled male HCM patients with only slightly elevated EDWT (13–18 mm) and highly trained healthy athletes (n=30, 18.7±1.2 training hrs/week) with marked LV hypertrophy. HCM patient group was divided into sedentary (n=30, <7 training hrs/week) and athletic HCM group (n=10; >7 h/week, 12.7±7.3 h training hrs/week).
Both sedentary and athletic HCM patients showed higher LVEF, lower LVEDVi and LVESVi and higher EDWT compared to the healthy athletes. LVMi of both healthy athletes and athletic HCM patients was significantly higher than in sedentary HCM patients, respectively (98.9±11.4; 94.5±7.8 vs 78.1±14.4 /m2). EDWT/LVEDVi ratio was higher in both sedentary and athletic HCM patients compared to healthy athletes, respectively (0.19±0.04; 0.17±0.04 vs 0.11±0.02). LVM/LVEDV also showed significant difference between HCM patients and healthy athletes. GLS and GRS showed no significant difference between the three groups, GCS was higher in athletic HCM compared to healthy athletes (−20.7±2.2 vs −17.8±2.3%).
Figure 1. Feature tracking analysis of a healthy athlete and a patient with HCM.
CMR characteristics of athletic and sedentary HCM may fundamentally alter. Our preliminary data suggest that besides conventional CMR parameters, derived parameters such as EDWT/LVEDVi and LVM/LVEDV ratios and deformation imaging may also help the differentiation between pathological and physiological hypertrophy.

Acknowledgement/Funding
National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277). Project no. NVKP_16-1-2016-0017
P4431Cardiopulmonary exerscise stress tests vs standard exercise stress tests in the rational prescription of physical activity in men
Authors: Stuto A , Armaro B , Cosentino E , Canonico G , Ambu A , Raineri F , Lo Giudice A , Cascone G , Canonico S , Cassarisi S , Ierna S , Basile G 
Published: October 2019

Abstract

Background
The standard exercise stress test (ET) provides direct measurement of the load tolerated by the subject, but the cardiopulmonary exercise stress test (CPET) in addition to the measurement of the work load also provides direct measurement of the corresponding oxygen consumption.

Objective
The aim of the present study was to estimate the differences between the estimated oxygen consumption based on the load (ET) and the one directly measured with the CPET, and to highlight and quantify the inaccuracies of the indirect estimate of oxygen consumption and its consequences on the rational prescription of physical activity.

Material and method
The tests performed on 7544 males from January 2007 to October 2018 were analyzed. For each test the sustained load, the consumption of direct oxygen, and the estimated oxygen consumption based on the load sustained with the use of a formula provided by the American College of Sports Medicine and reported below:
VO2max (ml/kg/min) = (10.51 x Watt) + (6.35 x weight in kg) − (10.49 x Età) + 519.3.
The total population of the subjects examined was divided into two groups: Group A: 1358 subjects without signs of heart disease, and Group B: 6186 subjects with heart disease.

Results
In the total population the oxygen consumption (VO2) estimated on the basis of the load was overestimated in 22% of subjects, underestimated in 55% of subjects and overlapping in 23% of subjects. In Group B the calculated VO2 was overestimated in 38%, underestimated in 54% and overlapping in 8% of the subjects. In group A the calculated VO2 was overestimated in 33%, underestimated in 54% and overlapping in 9% of subjects.

Conclusions
In subjects with heart disease the VO2 calculated on the basis of the sustained load is overestimated or underestimated in 92% of subjects. The CPET through direct measurement of oxygen consumption provides a precise estimate of functional capacity, an essential prerequisite for a correct rational prescription of physical activity. Because of this peculiarity, the CPET is absolutely irreplaceable in cardiac patients in which a correct rational prescription of physical activity is crucial.