bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1809Impact of mitral regurgitation on clinical outcome in patients with cardiac sarcoidosis
Authors: Yoshikazu Y , Kimura H , Noumi H , Tsuchiya H , Hasegawa T , Yamamoto Y , Yanagisawa T , Ogiwara M , Tachibana T , Horigome M , Nouno Y , Koshikawa M , Kuwahara K 
Published: October 2019

Abstract

Background
Mitral regurgitation (MR) is sometimes observed in cardiac sarcoidosis (CS), and might be related to worsening heart failure. However, mechanism and clinical significance of MR associated with CS remains undetermined.

Methods
We retrospectively analyzed consecutive 51 CS patients, and identified 16 patients with moderate to severe MR evaluated by quantitative echocardiography. According to the assessment of coaptation point and tenting height, main mechanisms of the 16 patients with MR were classified into prolapse (P) in 5, and tethering in 11 (T). Prednisolone was started from 30 mg/day, gradually tapered over a period of 6 months to a maintenance dose of 5 to 10 mg/day and continued a lifetime.

Results
At the first visit, patients with MR showed higher incidence of NYHA class IV heart failure as compared to those without MR (56 vs. 9%, p<0.001). Abnormal uptake of fluorine-18 fluorodeoxyglucose in the papillary muscle was more frequent in patients with MR than those without MR (63% vs. 23%, p<0.05). Patients with tethering MR showed higher incidence of complete atrioventricular block (T: 74% vs. P: 40% vs. without MR: 31%, p<0.05), significantly reduced left ventricular (LV) ejection fraction (T: 33±7% vs. P: 52±9% vs. without MR: 52±16%, p<0.001) and increased LV end-diastolic volume index (T: 100±52ml/m2 vs. P: 66±23ml vs. without MR: 62±21ml, p<0.001). During the mean follow-up of 108 months, cardiac-event free survival was significantly worse in patients with tethering MR as compared to the other patients (log-rank; 11.7, p<0.001). Six of the 11 patients with tethering MR received cardiac resynchronization therapy, and then did not experience further hospitalization due to decompensated heart failure for at least 2 years. Multivariate analysis identified tethering MR as an independent predictor of cardiac event (HR: 6.7, p<0.05).

Conclusions
MR associated with CS has variety of mechanisms including prolapse, tethering and inflammation of the LV papillary muscle, and may be related to ventricular remodeling and poor clinical outcome.
P1811Association between the autonomic dysfunction and biomarker levels in patients with chagas disease without evidence of structural heart disease
Authors: Chirino D A , Guthmann M G , Iglesias D , Volverg V , Dizeo C , Calderon G 
Published: October 2019

Abstract

Background
Several studies have shown autonomic dysfunction in early stages of Chagas disease (ChD). These alterations may be involved in the progression of the disease. The Valsalva Ratio (VR) is one of the most used tests to evaluate parasympathetic function, because it is easy and reproducible. On the other hand, the Higth Sensitive T troponin (HS-TnT) and the N-terminal pro B-type natriuretic peptide (NT-proBNP) are specific markers of myocardial damage and elevation of filling pressures, respectively. Both elevations are asociated with higher risk.
The association between autonomic dysfunction and biomarker levels in ChD without evidence of structural heart affection, has been poorly studied.

Purpose
The aim of this study is to evaluate the presence of abnormal VR as an expression of disanutonomy in patients with Chagas without evidence of structural heart disease and its association with HS-TnT and NT-proBNP levels.

Methods
A prospective study was performed, which included outpatients with positive serology for Chagas, with electrocardiogram, ergometry, holter and Doppler echocardiogram within normal parameters. The exclusion criteria were the following: history of ischemic heart disease, neurological diseases, chronic renal failure (clearence <30 ml/min), arterial hypertension and diabetes mellitus. All patients underwent a valsalva maneuver (VM), with continuous recording of the R-R interval by electrocardiogram. The VR was calculated dividing the longest RR interval after VM over the shortest RR interval during VM. Abnormal VR was considerated as a value <1.1. In addition, HS-TnT and NT-proBNP were measured in all patients.

Results
One hundred and forty four patients were included, with 45±8 years old, 44% fameles. The VR was 1.22±0.12, HS-TnT 6.44±3.8 ng/L and the NT-proBNP was 55±44 pg/ml. Abnormal VR was found in 29.1% of patients (n=42).
The abnormal VR group showed a higher level of HS-TnT (8.11±3.8 versus 5.7±3.5 ng/L, p=0.0006) and higher level of NT-proBNP (78±54 versus 45±36 pg/ml, p<0.0001). In addition, the abnormal VR group presented a greater E/e'ratio (9.48±2.5 versus 7.1±1.8, p<0.0001) and greater s wave (0.08±0.02 versus 0.10±0.02 cm/sec, p=0.02).
In the multivariate análisis, abnormal VR was asociated with higher HS-TnT (OR 1.22 (CI 95% 1.04–1.43), p=0.01) and higher E/e'ratio (OR 1.54 (CI95% 1.17–2.02), p=0.001), but not with NT-proBNP (p=0,09).

Conclusions
About one third of patients with ChD without evidence of cardiopaty had autonomic dysfunction. The patients with abnormal VR had higher leves of HS-TnT and NT-proBNP, but in the multivariate analisys only the HS-TnT had associated with abnormal VR.
P1817Assessment of carotid stiffness indices in patients with ischemic stroke
Authors: Youssef G , Mekkawy D , El-Fayoumy N , Abbas A , Allam M 
Published: October 2019

Abstract

Background
Arterial stiffness is considered as an emerging new important risk factor for stoke development. Measuring carotid stiffness is easy and non-invasive and thus can be widely applicable.

Purpose
To evaluate the carotid stiffness indices in patients with ischemic stroke compared to normal healthy subjects.

Methods
Included in this study are 60 patients (group 1) with ischemic stroke and 60 healthy control subjects (group 2). Participants were exposed to routine clinical examination and Duplex assessment of both carotid arteries. A specific wall tracking system was used for the semiautomatic calculation of the carotid stiffness indices, which included; compliance coefficient (CC), distensibility coefficient (DC), carotid pulse wave velocity (PWV) and carotid intima media thickness (IMT). Results from both carotid arteries were averaged and data from group 1 patients were compared to group 2 subjects.

Results
The mean age was (60.1±6.9 years) in group 1 compared to (60.1±6.6 years) in group 2 (p=0.9). A significant difference was found between both groups in all carotid stiffness indices; including average CC (0.64±0.29 vs 0.82±0.36 m2/kpa, p=0.004); average DC (11.69±5.42 vs 18.61±11.87 1/kpa, p<0.001); average PWV (16.5±0.6 vs 12.5±3.7 m/s, p<0.001) and average IMT (0.78±0.13 vs 0.68±0.18 mm, p=0.001). Only the carotid PWV was found to be a predictor of vascular stroke (p=0.001)

Conclusion
Patients with vascular stroke have higher carotid stiffness indices than age matched control subjects. Measuring carotid stiffness indices in patients who have atherosclerotic risk factors may help predict those at risk of vascular stroke and thus guide a tighter and a more efficient risk factors control.
P1847Comparing outcomes and complications between transfemoral TAVI performed with or without echoguided puncture
Authors: Bouteau J , Bourguignon T , Caze C , Quilliet L , Ivanes F , Desveaux B , Clerc J M , Saint Etienne C 
Published: October 2019

Abstract

Objective
Transcatheter Aortic Valve Replacement (TAVI) has become the reference procedure in intermediate or high surgical risk patients with degenerative aortic stenosis. Vascular complications are associated with poorer outcomes in patients after TAVI. Transfemoral (TF) echoguided puncture (EGP) became a routine procedure in our center in May 2017. We conducted a retrospective analysis to compare outcomes between patients whose TAVI was performed with or without routine EGP in our population.

Methods
We included all patients with TF TAVI performed in our center between January 2016 and December 2018. Since May 2017, all TF TAVI were performed using TF EGP for the main access and transradial puncture for the secondary access. Patient population was divided into two historical groups: fluoroscopic guided puncture (FGP) and EGP. Patients whose TAVI were performed in May 2017 were excluded due to operators learning curve. Post procedure mortality and vascular complications were retrospectively extracted from our institution data system.

Results
Among the 611 TAVI performed between January 2016 and December 2018, 28 did not have TF access. Twelve patients with procedure in May 2017 (learning curve) were excluded. Thus, 573 patients were analyzed. Age was not significantly different between FGP and EGP groups (84.9±5,7 vs. 83.8±6.6 years, p=0.051). No significant differences in in-hospital and 1 month mortality were observed between FGP and EGP groups (1.9 vs. 1.5%, p=0.74 and 3.2 vs. 1.8%, p=0.26). Minor vascular complications were not significantly different between groups (12.5 vs. 12.3%, p=1) but major vascular complications were significantly less frequent in EGP (5.6 vs. 10.2%, p=0.046). After introducing EGP, surgical TF access were also less frequently needed (2.8 vs. 0.3%, p=0.02).

Conclusion
Our single center retrospective study suggests that using TF EGP to perform TAVI is safe and may reduce both the rate of major vascular complication and the need for surgical TF access.

Acknowledgement/Funding
None
P1853Comparative evaluation of risk model performance for prediction of 30-day mortality in transcatheter aortic valve replacement
Authors: Wolff G , Klein K , Parco C , Lin Y , Maier O , Karathanos A , Brockmeyer M , Zeus T , Polzin A , Westenfeld R , Jung C , Blehm A , Lichtenberg A , Kelm M , Veulemans V 
Published: October 2019

Abstract

Background and purpose
EuroSCORE (ES) and Society of Thoracic Surgeons (STS) risk prediction models are routinely used to guide decision-making for transcatheter aortic valve replacement (TAVR), however their accuracy remains limited, especially in very old and high-risk patients. New and updated scoring models have thus been developed to improve risk stratification. We performed a comparative evaluation of classical and new risk scoring models for prediction of 30d mortality in transcatheter aortic valve interventions.

Methods and results
A total of 1,569 patients undergoing transfemoral (TF, n=1.235) or transapical (TA, n=334) TAVR from 2009 to 2018 were included in a single-center all-comer analysis. Six risk scoring models (logES_I, ES_II, STS-PROM, FRANCE-2, OBSERVANT, GAV-2) were calculated for all patients and evaluated for prediction of 30d mortality in their model discrimination (c-indices with 95% confidence intervals (CI)) and calibration (graphical evaluation). Mean classical risk scores confirmed an intermediate-to-high-risk patient collective (logES_I 27.0±16.9%; STS-PROM 7.0±6.4%), mean 30-day mortality was 3.4% (TF 2.3%; TA 7.8%). Overall discrimination performance was best in FRANCE-2 (c-index 0.73, 95% CI 0.67–0.80), followed by STS-PROM (c-index 0.68, 95% CI 0.62–0.75), OBSERVANT (c-index 0.68, 95% CI 0.61–0.76), ES_II (c-index 0.64) and logES_I and GAV-2 (both c-indices 0.63). FRANCE-2 discriminated best in TF TAVR (c-index 0.72; range of c-indices 0.63 to 0.72), while OBSERVANT performed best in TA TAVR (c-index 0.70; range of c-indices 0.61 to 0.70). All risk scoring models – with the exception of lowest-risk deciles of STS-PROM and ES_II – showed an overestimation of mortality probability in all risk strata.

Conclusion
FRANCE-2 and OBSERVANT risk models showed superior discrimination performance to classical risk scoring models in TF and TA TAVR, however all models tended to overestimate mortality probability.
P1857Risk calculator for prediction of iatrogenic atrial septal defect persistence following percutaneous mitral valve repair
Authors: Maier O , Hellhammer K , Boenner F , Afzal S , Spieker M , Zeus T , Horn P , Westenfeld R , Kelm M , Veulemans V 
Published: October 2019

Abstract

Background
The rising number of new percutaneous interventions for left-sided heart disease leads to increased occurrence of iatrogenic atrial septal defect (iASD). The percutaneous mitral valve repair (PMVR) for severe, symptomatic mitral regurgitation (MR) also requires intraprocedural puncture of the interatrial septum. In some cases iASD is persisting and becomes haemodynamically relevant with enhanced right heart overload due to significant left-to-right-shunting.

Purpose
This study aimed to evaluate pre- and periprocedural factors that may favour persistence and haemodynamic relevance of iASD in patients after PMVR.

Methods
In 2015, 75 consecutive patients with severe MR (age 74.8±10.5y) and following PMVR were enrolled. After 12 months, 57 patients completed their follow up (FU) including clinical conditions, transthoracic echocardiography (TTE), and cardiovascular magnetic resonance (CMR) whenever feasible. We evaluated the impact of comorbidities as well as intraprocedural, haemodynamic and functional characteristics that may favour persistence of iASD by multivariate analysis. Haemodynamic relevance of iASD was defined as right heart overload with predominantly significant enlargement of the right atrium (RA), impairment of right heart function as defined by fractional area shortening (FAC), and ratio of pulmonary to systemic blood flow (Qp/Qs>1) when available.

Results
18 out of 57 patients (32%) showed a persistent iASD (+iASD), being associated with a specific combination of comorbidities as well as pre-procedural and periprocedural factors that can be summarised by a multifactorial iASD risk calculator (+iASD vs. -iASD: 6.3±2.9 vs. 3.9±2.7; p=0.0058). 11 iASD (61%) became haemodynamically relevant (+hd iASD) with a significant right heart overload (RA area +hd iASD vs. -hd iASD: baseline 23.1±4.1 vs. 23.2±4.3; FU 30.7±6.3 vs. 20.1±4.6; p<0.0001), reduced RV function (FAC +hd iASD vs. -hd iASD: baseline 41.0±10.3 vs. 29.9±7.2; FU 25.3±7.2 vs. 29.1±13.2; p<0.0156) and left-to-right shunting (Qp/Qs -iASD vs. +hd iASD vs. -hd iASD: 1.0±0.3 vs. 1.7±0.4 vs. 0.8±0.1 L/min; p=0.0011).

Conclusion
This study shows for the first time, that persistence of iASD can be predicted by pre- and periprocedural factors using a risk calculator that may additionally guide careful follow up imaging and therapeutic action after PMVR to avoid development of progressive heart failure.
P1868Risk of arrhythmias after myocardial infarction in patients with left ventricular systolic dysfunction according to mode of revascularization: a CARISMA substudy
Authors: Thomsen A , Pedersen S , Jacobsen P K , Huikuri H V , Bloch Thomsen P E , Jons C 
Published: October 2019

Abstract

Introduction
The CARISMA trial was the first study to use continuous monitoring for documentation of long-term arrhythmias in post-infarction patients with left ventricular dysfunction. During the study duration (2000–2005), primary PCI (pPCI) as treatment of acute myocardial infarction was introduced approximately midway (2002) on the enrolling centres.

Purpose
The aim of this study was to describe the influence of mode of revascularization after myocardial infarction (AMI) on long-term risk of risk of new onset atrial fibrillation, ventricular tachyarrhythmias and brady arrhythmias.

Methods
The study is a sub-study on the CARISMA study population that consisted of patients with AMI and left ventricular ejection fraction ≤40%, which received an implantable loop recorder and was followed for 2 years. After exclusion of 15 patients who refused device implantation and 26 with pre-existing arrhythmias, 268 of the 312 patients were included. Choice of revascularization was made by the treating team independently of the trial and was retrospectively divided into primary percutaneous intervention (pPCI), subacute PCI (24 hours to 2 weeks after AMI), primary thrombolysis or no revascularization.
Endpoints were new-onset of arrhythmias and major cardiovascular events (MACE). The Kaplan-Meier (figure 1) and Mantel-Byar methods were used for time to first event risk analysis.

Results
A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received PCI. At two-years follow up patients treated with any PCI had a significant lower risk (0.40, n=63) of any arrhythmia compared to patients treated with trombolysis (0.60, n=30) or no revascularization (0.68, n=16) (p<0.001, unadjusted) (figure 1). Risk of MACE was significant higher in patients with any arrhythmia (0.25, n=76) compared to no arrhythmia (0.11, n=93) at two years follow-up (p=0.004, unadjusted).
Figure 1

Conclusion(s)
The long-term risk of new onset arrhythmias after AMI was significantly lower in patients treated with any PCI compared to patients not revascularized or treated with thrombolysis. Risk of MACE was significantly higher in patients with new onset arrhythmias compared to patients with no arrhythmias.
P1875Nonspecific intraventricular conduction delay is associated with future occurrence of atrial fibrillation in patients with structurally normal heart and sinus rhythm
Authors: Uhm J S , Jin M N , Kim I S , Bae H J , Yu H T , Kim T H , Kim J Y , Joung B , Pak H N , Lee M H 
Published: October 2019

Abstract

Background
This study aimed to elucidate long-term prognosis of nonspecific intraventricular conduction delay (NIVCD) in patients with structurally normal heart.

Methods
We included 107,838 patients (age, 52.1±15.5 years; men, 46.8%) who underwent electrocardiography in outpatient clinics or medical checkup (model 1). NIVCD was defined as QRS duration ≥110 ms and incompatibility with bundle branch block. The patients with structurally normal heart and sinus rhythm were assigned to the NIVCD group and normal QRS group according to propensity score with matching variables of age, sex, hypertension, and diabetes (model 2), and additional PR interval (model 3). Baseline characteristics, electrocardiographic parameters, and clinical outcomes were compared in model 1, 2, and 3, respectively.

Results
In model 1, the frequencies of male and preexisting atrial fibrillation (AF) were significantly higher in the NIVCD group than in the normal QRS group. In model 2, sinus rate and PR interval were significantly slower and longer in the NIVCD group than in the normal QRS group. In model 3, cumulative incidence of AF was significantly higher in the NIVCD group than in the normal QRS group during follow-up of 8.8±2.9 years (Figure). NIVCD significantly increased risk of AF (hazard ratio, 2.571; 95% confidence interval, 1.074–6.156; p=0.034). NIVCD did not significantly increase risk of sick sinus syndrome, complete atrioventricular block, and heart failure.
Atrial fibrillation-free survival

Conclusions
NIVCD is associated with slow sinus rate and prolonged PR interval. NIVCD is an independent risk factor of AF in patients with structurally normal heart.
P1880Entropy-based algorithm for atrial fibrillation detection using photoplethysomgraphic signal recorded by a smart watch
Authors: Chiang J Y , Fu C M , Lin Y C , Ku B W , Hsu S U , Wu C K , Lin L Y , Lin J L , Chiang F T , Juang J M 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia, and its paroxysmal and short duration nature makes its detection challenging. The most important limitation of current smartwatches is that patients need to touch to the sensor of the watch to record signals when patients feel discomfort. We developed a wearable smart watch and evaluated its accuracy to differentiate AF from sinus rhythm, which can continuously detecting heart rhythm without hand touching the device.

Methods and results
A wearable smart watch with PPG sensor and electrocardiogram (ECG) recording function was used for signal acquisition. A total 399 patients with a mean age of 67 years old were enrolled in the study, of whom 237 (81.5%) were male, and 101 have been diagnosed with AF. Pulse wave extracted from the green light spectrum of the signal and ECG were recorded for about 10 minutes for each patient. Pulse-to-pulse intervals (PPI) were automatically identified. All ECG signals were verified by two cardiologists. The correlation between R-to-R interval on ECG and PPI were excellent, with a correlation coefficient R >0.99 (p<0.05). An entropy-based algorithm which combined Shannon entropy of successive difference of PPI and sample entropy of PPI was used to discriminate between AF and sinus rhythm. This method had high sensitivity and specificity (96% and 98%, respectively), the area under receiver operating characteristic curve reached 0.98.

Conclusions
We developed an entropy-based algorithm for AF detection with PPG signal recorded by a wearable smart watch. This algorithm discriminates AF from sinus rhythm accurately. This advance in technology overcomes an important clinical obstacle and can increase the AF detection rate tremendously.
P1883Arrhythmias in transplanted hearts: Lessons from Europes largest cohort of patients who underwent orthotopic heart transplantation
Authors: Bergau L , El-Hamriti M , Molatta S , Alzain K , Rubesch-Kuetemeyer V , Fox H , Sommer P , Sohns C 
Published: October 2019

Abstract

Introduction
Cardiac arrhythmias are regulary seen in patients following orthotopic heart transplantation (OHT). So far, there is no data available about the prevalence in a large cohort.

Methods
We retrospectively screened our database for subjects with OHT who received inpatient or outpatient treatment in our center between January 2000 and December 2018. All these patients were carefully reviewed with special attention to rhythm disturbances after successful transplantation.

Results
We identified a total number of 1890 subjects with history of OHT being treated in our center during the pre-defined time-period. The prevalence of supraventricular tachycardias was as follows: atrial fibrillation/atypical flutter and atrial ectopy 10%, AV-node-re-entry tachycardia 3%, typical atrial flutter 2% and higher degree AV-Block or Sick-Sinus-Syndrom (SSS) was 6%. Sustained ventricular tachycardia or ventricular premature contractions were present in 2%. Regarding the patients with arrhythmias, 13% received catheter ablation for arrhythmias, thereof 53% an atrial ablation (24% left atrial ablation), the remainder received a ventricular ablation.

Conclusion
In this very large cohort and following a long observational time, there was a higher incidence of atrial arrhythmias in patients following OHT as reported in healthy subjects with an emphasis on atrial fibrillation and flutter. This data gives a valuable background information on morbidity following OHT.