bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6397Ejection fraction by cardiac magnetic resonance 6 months after STEMI: impact on risk stratification in chronic phase
Authors: Merenciano Gonzalez H M , Marcos-Garces V , Gavara J , Rios-Navarro C , Ortiz J T , Rodriguez J , Mendieta G , Rodriguez-Palomares J F , Valente F , Garcia-Dorado D , Lopez-Lereu M P , Monmeneu J V , Nunez E , Nunez J , Bodi V 
Published: October 2019

Abstract

Background
Left ventricular ejection fraction (LVEF) has traditionally been used as the cornerstone for risk stratification after STEMI and it can be accurately quantified by cine cardiovascular magnetic resonance (CMR). In recent years, the additional prognostic value of contrast CMR-derived infarct size (IS) and microvascular obstruction (MVO) soon after infarction has been demonstrated. The usefulness of CMR-derived LVEF in chronic phase for risk stratification late after STEMI is unclear.

Purpose
We hypothesized that 6-month CMR-derived LVEF can contribute in the prediction of clinical events late after STEMI beyond pre-discharge LVEF, IS and MVO.

Methods
Data were obtained from a prospective registry of reperfused STEMI patients (n=456) who were stable 6 months after infarction and in whom 1-week and 6-month CMR-derived LVEF, IS and MVO were sequentially quantified. Major adverse cardiac events (MACE) were defined as a combined clinical end-point that included death or re-admission for acute decompensated heart failure (r-ADHF), whichever occurred first, occurring after the 6-month CMR.

Results
During a mean and median follow-up of 6 years, 56 late MACE (12%, 32 deaths and 24 r-ADHF) were registered. From 1-week to 6-month, CMR parameters exhibited significant dynamic changes (p<0.001): LVEF improved (52±12 vs. 56±13%), IS decreased (21±14 vs. 18±12% of LV mass) and MVO vanished (2±4 vs. 0±1% of LV mass). At 6-month CMR, 60 patients (13%) displayed reduced LVEF (<40%), 69 (15%) mid-range LVEF (40–50%) and 327 (72%) preserved LVEF (≥50%). Late MACE rates were 28% in patients with reduced LVEF, 14% in those with mid-range LVEF and 9% in those with preserved LVEF at 6-month CMR (p<0.001 for the trend). After adjustment for baseline characteristics and for 1-week and 6-month CMR parameters, more preserved LVEF at 6 months independently associated with a lower risk of MACE late after STEMI (hazard ratio 0.96 [0.94–0.98] per 1% increase).

Conclusions
Dramatic dynamic changes occur in CMR parameters within the first months after STEMI. Reassessment of CMR-derived LVEF in chronic phase in those patients who remain stable provides relevant prognostic information for long-term risk stratification.

Acknowledgement/Funding
Funded by “Instituto de Salud Carlos III”/FEDER (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants) and Generalitat Valenciana (GV/2018/116).
P6399Left atrial function determined by echocardiography predicts incident heart failure in STEMI patients treated with primary percutaneous coronary intervention
Authors: Modin D , Pedersen S , Fritz-Hansen T , Gislason G , Biering-Soerensen T 
Published: October 2019

Abstract

Objectives
To assess the comparative effectiveness of LA functional parameters (LAEF and MinLAVI) with that of LA volume index (LAVI) in predicting HF following STEMI.

Background
Heart failure (HF) is common following STEMI. Enlarged left atrial (LA) volume determined by echocardiography is associated with adverse outcome following STEMI. However, whether echocardiographic parameters of LA function, such as the LA emptying fraction (LAEF) and the minimal LA volume index (MinLAVI), are superior to LAVI for predicting prognosis following STEMI is unknown.

Methods
A total of 369 STEMI patients without atrial fibrillation or heart failure treated with primary percutaneous coronary intervention (pPCI) were prospectively enrolled in the period September 2006 to December 2008. Patients underwent echocardiography shortly after STEMI. The maximal and minimal LA volume were measured using the biplane area-length method. LAVI, MinLAVI (minimal LA volume indexed to body surface area) and LAEF [(maximal LA volume − minimal LA volume) / maximal LA volume] were calculated. End-point was incident HF.

Results
During a median follow-up of 66 months (interquartile-range: 50–73 months), 68 patients (18%) were admitted for HF. In univariable analysis, both reduced LAEF and increased MinLAVI were significantly associated with an increased risk of HF (LAEF: HR 1.18, 95% CI 1.08–1.29, per 5% decrease, p<0.001) (MinLAVI: HR 1.35, 95% CI 1.09–1.67, per 5 mL/m2 increase, p=0.006) (Figure). In contrast, LAVI was not significantly associated with the development of HF (HR 1.03, 95% CI 0.87–1.22, per 5 mL/m2 increase, p=0.73) (Figure). Following adjustment for clinical, biochemical and echocardiographic variables, LAEF and MinLAVI remained independent predictors of HF, while the lack of association between LAVI and HF persisted (LAEF: HR 1.14, 95% CI 1.02–1.27, per 5% decrease, p=0.019) (MinLAVI: HR 1.31, 95% CI 1.02–1.69, per 5 mL/m2 increase, p=0.036) (LAVI: HR 1.05, 95% CI 0.86–1.29, per 5 mL/m2 increase, p=0.61). These results were replicated when treating death from all causes as a competing event in competing risk regression.
PY, person-years

Conclusion
In STEMI patients treated with pPCI, LAEF and MinLAVI measured by echocardiography shortly after infarction are superior to LAVI for predicting incident HF.
P6400Risk for heart failure after acute myocardial infarction, a nationwide report on 73 303 patients with and without diabetes 2012–2017 in the SWEDEHEART-SCAAR registry
Authors: Ritsinger V , Lagerqvist B , Saleh N , Nystrom T , Norhammar A 
Published: October 2019

Abstract

Background
Impressive improved one-year survival rates after acute myocardial infarction (AMI) have been achieved the last decades while long-term cardiovascular events still are a challenge particularly when diabetes is present. Recently several glucose lowering drugs with preventive effects on heart failure (HF) and MACE have entered the market however still used in low proportion by cardiologists.

Purpose
To explore the real-life complication rates of HF after AMI in patients with and without diabetes.

Methods
All patients with AMI admitted for coronary angiography in Sweden 2012–2017 were followed for time to first hospitalisation with HF diagnosis (ICD-10 code I50) until December 2017. Kaplan-Meier curves were used to estimate the cumulative heart failure event stratified by previous MI. Hazard ratios (HR) were calculated in a Cox proportional hazard regression model adjusting for age, gender, smoking, creatinine, previous CABG/cancer/dementia/dialysis/hypertension/COPD/renal failure/stroke, year, indication, hospital, angiographic findings, primary decision after angiography, cardiac chock, medications at discharge.

Results
Of 73 303 patients, mean age was 69 years (SD±12), 69% were men and 24% had diabetes. In all, HF occurred in 14% with a higher rate in patients with diabetes than those without (22% vs 12%). The highest HF rates were seen in patients with previous MI (33% if diabetes was present vs. 23% if no diabetes). After adjustments, patients with diabetes without previous MI had about the same HF risk (HR 1.52 [95% CI 1.44–1.61]) as patients without diabetes with previous MI (1.48 [1.40–1.57]) where patients without diabetes and previous MI served as a reference. The same pattern was seen regardless of STEMI/NSTEMI and also after excluding patients with previous HF (n=4567, 6%; Figure; patients with diabetes without previous MI 1.48 [1.40–1.57] and patients without diabetes with previous MI 1.27 [1.19–1.36]).

Conclusion
Heart failure is a common complication after AMI in patients with diabetes, particularly if previous MI, and regardless of previous reported heart failure. Diabetes increases the risk of heart failure by 30–50% compared to those without diabetes. These data indicate the existence of a large diabetes population at heart failure risk after AMI where heart failure protective glucose lowering drugs could be suitable.

Acknowledgement/Funding
The Swedish Heart and Lung foundation, Department of Research and Development Region Kronoberg, the Kamprad Family Foundation
P6406Platelet reactivity in Hepatitis C virus infected patients on dual antiplatelet therapy for acute coronary syndrome
Authors: Scudiero F , Valenti R , Marcucci R , Sanna G D , Gori A M , Migliorini A , Vitale R , Giusti B , De Vito E , Corda G , Paniccia R , Parodi G 
Published: October 2019

Abstract

Background
Coronary artery disease (CAD) has been recognized as a serious and potentially life-threatening complication of Hepatitis C Virus (HCV) infection. High on treatment platelet reactivity has been associated with high risk of ischemic events in patients with CAD, but data regarding the association with HCV infection are still lacking.

Purpose
We sought to assess platelet reactivity on dual anti-platelet therapy and long-term outcome of acute coronary syndrome (ACS) patients infected with HCV.

Methods
ACS patients infected with HCV were matched to ACS patients without HCV for age, sex, diabetes, hypertension and renal function. Primary and secondary study endpoints were the proportion of patients with high on treatment platelet reactivity (HTPR) and long-term outcomes, respectively.

Results
HCV-infected ACS patients had higher levels of platelet reactivity (ADP10-LTA: 56% ± 18% vs. 44% ± 22%; p=0.002; Arachidonic Acid-LTA: 25% ± 21% vs. 16% ± 15%; p=0.011) and higher rate of HTPR on clopidogrel and aspirin compared with non-HCV patients. Multivariable analysis demonstrated HCV-infection to be an independent predictor of HTPR. At follow-up, estimated major adverse clinical events (MACE: cardiac death, non fatal myocardial infarction and any revascularization) were 57% vs. 37%, p=0.006 in HCV-infected ACS and non-HCV, respectively. Also, TIMI major bleeding rates were higher in HCV-infected subjects (11% vs. 3%; p=0.043) as compared with non-infected patients.
Platelet function according to HCV status

Conclusions
ACS patients with HCV infection have increased on treatment platelet reactivity, higher rate of HTPR, MACE and bleedings as compared with non-HCV patients.
P6413Aging increases the plaque vulnerability in non-ischemic non-culprit lesions of diabetic patients, data from COMBINE OCT-FFR study
Authors: Kedhi E , Berta B , Ijsselmuiden A , Alfonso F , Kauer F , Hermanides R , Wojakowski W , Roleder T 
Published: October 2019

Abstract

Background
Little is known about age-related differences in baseline atherosclerotic plaque morphology and composition in patients with diabetes mellites (DM).

Purpose
For this purpose, we studied DM patients from the Combine trial.

Methods
COMBINE (OCT-FFR, NCT02989740) is a multi-center, prospective study focusing on the natural history of non-ischemic, non-culprit coronary lesions and evaluate whether certain OCT-assessed variables could predict future adverse events originating from these lesions in a DM population. OCT analysis identifies plaque composition, estimates calcium arc (o), lipid arc (o), and measures thickness of the fibrous cap covering the lipid core. Moreover, OCT records the presence of typical plaque vulnerability traits like thin fibrous cap atheroma (TCFA), plaque erosion (PE), plaque rupture (PR), calcification nodule (CN), heterogeneous tissues (a probably healed plaque rupture), and macrophages accumulation (bright spots). A dedicated software estimated the interpolated percentage area stenosis (AS, %) measuring the minimal lumen area (MLA) and reference vessel area. The present analysis reports the baseline morphology of these lesions respectively in young (<70 years) vs. old (≥70 years) DM patients.

Results
OCT imaging was performed in 300 patients (361 lesions) from the COMBINE study, of which 203 lesions assessed in young and 158 lesions in old DM patients. There were no significant differences in MLA (mm2) 2.40 (1.85–315 vs. 2.30 (1.80–3.00), p=0.92), lesions length (mm 24.11 (15.10–33.10) vs. 24.20 (15.10–35.10), p=0.78), AS% (%) 63 (1.85–3.15) vs. 64 (56–73), p=0.41; lipid arc (o), 182 (140–250) vs. 175 (128–240), p=0.35), fibrous cap thickness covering the lipid arc (μm), 117 (65–193) vs. 110 (64–168), p=0.45, in the prevalence of TCFA 37 (18%) vs. 33 (21%), p=0.53, PR 17 (18%) vs. 15 (10%), p=0.71, heterogenous tissue 39 (19%) vs. 31 (20%), p=0.92, and bright spots 98 (48%) vs. 69 (44%), p=0.38. The patients ≥70 years had a higher prevalence of calcified plaques 171 (84%) vs. 143 (90%), p=0.08 and wider calcium arc. These lesions included more PE 7 (3%) vs. 13 (8%), p=0.05, CN 73 (36%) vs. 75 (47%), p=0.03, and CN associated with overlying thrombus 11 (5%) vs. 20 (13%), p=0.02.

Conclusion
Non-ischemic, non-culprit lesions in elderly DM patients present the same prevalence of soft, vulnerable plaques as it is a younger cohort, however, they have a higher prevalence of calcified plaque including complex calcified plaques as eroded plaques and calcification nodules with overlying thrombus. Whether these complex calcified plaques are associated with a higher risk of adverse events remains questionable and could be further elucidated from longer follow-up data of the COMBINE trial.
P6416Lower serum syndecan-1 level is associated with higher prevalence of vulnerable plaque in patients with coronary artery disease
Authors: Nemoto T , Minami Y , Yamaoka-Tojo M , Sato T , Muramatsu Y , Kakizaki R , Hashimoto T , Fujiyoshi K , Meguro K , Shimohama T , Ako J 
Published: October 2019

Abstract

Introduction
Syndecan-1 is a component of endothelial glycocalyx which maintains vascular integrity. Thus, it may be impaied in patients with coronary artery disease (CAD).

Purpose
To assess the association between serum syndecan-1 level and the severity and vulnerability of CAD.

Methods
A total of 259 consecutive patients with stable angina requiring percutaneous coronary intervention (PCI) were prospectively enrolled. Patients were classified into 2 groups according to the median syndecan-1 value (Lower syndecan-1 group [syndecan-1 <99.0], n=130; Higher syndecan-1 group [syndecan-1 ≥99.0], n=129). Severity of CAD and focal plaque vulnerability in target lesion was evaluated using findings of angiography and optical coherence tomography (OCT), respectively. Thin-cap fibroatheroma (TCFA) was defined as a lipid-rich plaque covered with thin fibrous cap (<65 μm).

Results
There was no significant difference in baseline clinical characteristics between the lower syndecan-1 group and the higher syndecan-1 group other than the prevalence of family history of ischemic heart disease (19 vs. 32%, p=0.022) and prior PCI history (45 vs. 60%, p=0.015). The prevalence of multivessel disease (70 vs. 68%, p=0.627), left main disease (4 vs. 5%, p=0.748) and chronic total occlusion (15 vs. 15%, p=0.959) was comparable between the 2 groups. On the other hand, the prevalence of lipid-rich plaque (40 vs. 19%, p=0.004) and TCFA (20 vs. 6%, p=0.006) was significantly higher in the lower syndecan-1 groupthan the higher syndecan-1 group (Figure). The lower syndecan-1 was independently associated with the higher prevalence of lipid-rich plaque (Table).
Table 1. Multivariate analysis for lipid-rich plaque Odds ratio 95% CI pvalue Lower syndecan-1 2.981 1.448–6.411 0.003 Dyslipidemia 1.693 0.738–4.142 0.218 Chronic kidney disease 1.354 0.669–2.765 0.400 Smoking 0.975 0.453–2.154 0.951 Diabetes mellitus 0.819 0.400–1.661 0.580

Conclusions
Lower syndecan-1 level was associated with higher prevalence of vulnerable plaque in patients with CAD. Serum syndecan-1 may have a potential as a marker for the presence of vulnerable coronary plaque.
P6420Can machine learning help us improve risk stratification of diabetic patients with acute coronary syndromes? The answer will blow your mind
Authors: Milner J , Monteiro S , Monteiro P , He M , Simpson C , Zaslavskiy M , Balazard F , Li L , Rousset A , Schopf S , Dellamonica D , Goncalves L 
Published: October 2019

Abstract

Background
Risk stratification following an acute coronary syndrome (ACS) is of utmost importance, in order to identify patients at higher risk of subsequent cardiovascular events. Diabetic patients have a significantly worse prognosis, so new risk prediction tools are important to better identify and risk stratify high risk patients within this important ACS subpopulation.

Aim
The aim of this study was to identify the best predictors of a new ACS, in a single-center database of ACS, resorting to machine learning and artificial intelligence, and to compare the Global Registry of Acute Coronary Events (GRACE) risk score's relevance for risk discrimination in a general ACS population versus a subpopulation of diabetic patients.

Methods
In a single center, 5977 patients admitted due to ACS between 2004 and 2017 and alive at discharge were studied. In the subpopulation of diabetic patients (n=3429), each covariate present in the database was analyzed separately with a Cox proportional hazard model with three terms – subpopulation belonging indicator, covariate, interaction term. The p-value of the interaction term was used to rank variables. The more significant the interaction term, the stronger the change in relationship between patients in the subpopulation and the risk of a new ACS, compared to the one in the general population.

Results
During long term follow-up, 13% of patients (n=771) experienced a second event. Kaplan-Meier curve represents how ACS free-survival depends on the GRACE risk score and group of interest. In the general population and in the subpopulation of diabetic patients, the GRACE score was used to further divide patients into 3 terciles, of which only the lower and upper tercile are shown (GRACE ≤113 and GRACE >144, respectively). The solid lines represent Kaplan-Meier curves for diabetic patients, and the dotted lines in the general population. Pink or grey colour of the curves represent the stratification level of the covariate.

Conclusions
In our model, the GRACE risk score was found to be a better discriminator of risk of futher ACS in diabetic patients than in the general ACS population. Strikingly, a higher GRACE score predicts a lower rate of readmission, probably because many patients will die in the index hospitalization or out of hospital. This finding reinforces the usefulness of the GRACE score in high risk patients and may improve risk stratisfication in diabetic post-ACS patients, making sure that they are closely followed and submitted to optimal risk factor management, in order to improve their post-ACS prognosis.
P6428The waist-to-body mass index ratio is a better predictor for cardiovascular outcome in patients with established atherosclerotic cardiovascular disease - No u-shaped phenomenon
Authors: Hsuan C F , Lin F J , Tseng W K , Wu Y W , Yin W H , Yeh H I , Chen J W , Wu C C 
Published: October 2019

Abstract

Background
Many studies have observed an “obesity paradox” in patients with established atherosclerotic cardiovascular disease (ASCVD), in which the body mass index (BMI)-mortality curve is U-shaped.

Purpose
To search a better anthropometric parameter to predict the cardiovascular events in patients with ASCVD.

Methods
The study was conducted from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. Adult patients with stable ASCVD were enrolled. The primary composite endpoint of this study is the time of the first major cardiovascular event, defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Dose response association between primary outcome events and various traditional anthropometric parameters and a new parameter, the waist-to-BMI ratio, was examined using the Cox proportional hazards regression model. We used restricted cubic spline regression to investigate the potential nonlinear relationship between each anthropometric measure and primary outcome events.

Results
A total of 6921 patients with ASCVD were included in this analysis, and were followed up for a median of 2.5 years. Multivariable Cox proportional hazards regression showed a significant positive association between the waist-to-BMI ratio and the primary outcome events (adjusted hazard ratio 1.67, 95% CI 1.12–2.49, p=0.01). Other traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, did not showed significant associations (p=0.10, 0.31, 0.90, and 0.52, respectively). In the restricted cubic spline regression, the positive dose response association between the primary outcome and the waist-to-BMI ratio persisted across all the waist-to-BMI ratio, and was non-linear (the likelihood ratio test for nonlinearity was statistically significant, p<0.001) with a much steeper increase in the major cardiovascular event for the waist-to-BMI ratio >3.6 cm m2/kg.
Dose response curve of waist/BMI ratio

Conclusion
This study found the waist-to-BMI ratio to be a better predictor for major adverse cardiovascular events in established ASCVD patients than other traditional anthropometric parameters.
P6432Predictive value of rest-MCG and stress-MCG in patients with angina pectoris
Authors: Brala D , Morita S , Landmesser U , Park J.-W 
Published: October 2019

Abstract

Background
Thousands of patients present themselves annually to the emergency department or private clinic with chest pain. Categorizing different types of angina is clinically important and is one of the cornerstones for pre-test-probability.
In patients with angina pectoris, symptoms mostly occurred during physical exertion and usually lasted a short time. This paper examines Magnetocardiography (MCG) in patients with angina pectoris. Cardiac electromagnetic activity is recorded by MCG which is a non-invasive, non-contact, and radiation-free multichannel mapping technique. We present results focusing on resting- and stress-MCG in order to detect true coronary artery disease.

Method
We examined 131 patients (66±12 yrs., 94 male) with angina pectoris who were asymptomatic during the time in the emergency department. Troponin and ECG were in normal range. These patients had complex cardiovascular risk factors – arterial hypertension in 87%, hyperliproteinemia in 63%, nicotine consumption in 23%, diabetes mellitus in 14%.
The cardiac magnetic field was registered over the anterior chest wall with a 64-channel gradiometer system in a magnetically shielded room (CS-MAG III, BMP GmbH). Rest- and Stress-MCG measurement were performed before patients received an invasive ischemia investigation. We calculated in total 9 MCG parameters that could serve as indicators in the diagnosis of ischemia and coronary artery disease (CAD): T-wave dispersion, T-wave vectors MCG (VMCG), T-Scores, ST-Fluc-Score and PLP-Score.

Results
All of the 131 patients received an invasive diagnostic. 43 patients exhibited a CAD. Resting MCG could identify 28/43 patients correctly (SENS of 65%, NPV of 66%). Stress-MCG was able to identify 42/43 correctly (SENS 98%, NPV 88%).

Conclusions
Stress-MCG seems to be a highly sensitive method in detecting CAD in patients with stable angina. In diagnostics, it should be complemented by other indicators such as troponin to improve its specificity.