bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1232A subpopulation of epicardium-derived cells are preprogrammed towards fibroblast differentiation in the atrial myocardium
Authors: Suffee-Mosbah N , Moore-Morris T , Mougeneot N , Dilanian G , Puceat M , Hatem S N 
Published: October 2019

Abstract

Context and objectives
Fibro-fatty infiltrations of the sub-epicardium is an important component of the atrial cardiomyopathy that paves the way of atrial fibrillation (AF). We previously reported that epicardium-derived cells (EPDCs) can be a source of adipocytes contributing to fat depot. Here, we examined if EPDCs can contribute also to the fibrotic remodeling of atrial subepicardium.

Methods
Surgical samples of human right atria were used for histological study and to harvest EPDCs. Clinical and histological data were analyzed using generalized linear models. A model atrial remodeling associated with ischemic heart failure was created in rats and in a genetic lineage tracing WT1CreERT2+/−/Rosa-tdT+/− mice to follow epicardial progenitor fate. Primary cell culture models were used to study EPDC differentiation. Flow cytometry assays and single cell sequencing were used to characterize subpopulations of EPDCs.

Results
In human atria, epicardium could be a thin cell monolayer or be thick in continuity with dense fibro-fatty infiltrates. The latter aspect predominated in old patient (>70 year) with valve mitral diseases or in AF, clinical conditions associated with an atrial remodeling. This was further established in rat and mouse experimental model of atrial remodeling characterized by a thickening of the epicardium observed one week following the onset of the cardiopathy and, then, followed by a dense fibrotic remodeling of the subepicardium. Cells co-expressing markers of epicardial progenitors and fibroblasts were detected in the subepicardium of diseased atria both in human and murine models. Moreover, a number of myo/fibroblasts from WT1CreERT2+/−/Rosa-tdT+/− mice were detected in diseased atria attesting of their epicardial origin. Distinct EPDC clusters were detected from cells harvested from epicardium whereas only PDGFRa-positive cells could differentiated into fibroblasts. Angiotensin-II induced the differentiation of only PDGFRa-positive cells into fibroblasts.

Conclusions
Activation of the epicardium is an early event during atrial remodeling that results in the triggering of differentiation of a subpopulation of epicardial progenitors into fibroblasts. Angiotensin-II is part of the signaling switch than regulate the fate of EPDC between fibroblastic or adipogenic lineage. Hence, epicardium by regulating the balance between adipose expansion and fibrosis accumulation appears as an important determinant of the atrial cardiomyopathy.

Acknowledgement/Funding
ANR-10-IAHU-05
P1238Acute re-distribution of myocardial work by cardiac resynchronization therapy determines long-term remodelling of the left ventricle
Authors: Duchenne J , Aalen J , Cvijic M , Larsen K , Galli E , Bezy S , Beela A S , Unlu S , Pagourelias E D , Winter S , Hopp E , Fehske W , Donal E , Smiseth O A , Voigt J U 
Published: October 2019

Abstract

Background
In patients with dilated cardiomyopathy and left bundle branch block (LBBB), different regions of the left ventricle (LV) have been shown to perform different amounts of work. In this study, we investigate the acute impact of cardiac resynchronization therapy (CRT) on regional LV work distribution and its relation to long-term reverse-remodelling.

Methods
We recruited 130 heart failure patients, referred for CRT. Regional myocardial work was calculated from non-invasive echocardiographic segmental stress-strain-loop-area before and immediately after CRT. The magnitude of volumetric reverse-remodelling was determined from the change in LV end-systolic volume (ESV), 11±2 months after implantation. Characteristics of patients with the lowest and highest quartile of LV ESV reverse remodelling (ΔLV ESV <−9% and ΔLV ESV >−48%) were compared.

Results
Before CRT, myocardial work showed significant differences among the walls of the LV (Figure 1A). CRT caused an acute re-distribution of myocardial work, on average with most increase in the septum and most decrease laterally (all walls p<0.05) and lead to a homogeneous work distribution (Figure 1B). The acute change in the difference between lateral and septal wall work (Δlateral − septal work) correlated best and significantly with LV ESV reverse-remodelling (r=0.62, p<0.0001). The smallest changes in work were seen in the patients with the least LV ESV reverse remodelling (Figure 1C, red markers), while patients with the most LV ESV reverse remodelling showed the largest changes in work (Figure 1C, green markers). In a multivariate-linear-regression-analysis, including pre-implant QRS duration, LVEF, LV EDV and GLS, the re-distribution of work remained as the strongest determinant of volumetric reverse-remodelling after CRT (r=0.63, p<0.0001).
Figure 1

Conclusions
The acute re-distribution of regional myocardial work between the septal and lateral wall of the left ventricle is the main determinant of long term reverse-remodelling after CRT-implantation. Our data suggest that modification of regional loading is the mode of action of CRT treatment.
P1241Five-year risk of death and readmission for heart failure after implantation of de novo and upgrade cardiac resynchronization therapy devices
Authors: Engelbrecht M L , Madelaire C , Sindet-Pedersen C , Kober L , Torp-Pedersen C , Bo Lindhardt T , Biering-Sorensen T , Haider Butt J , Ruwald A C , Andersson C , Gislason G , Schou M 
Published: October 2019

Abstract

Background
De novo implantation of cardiac resynchronization therapy devices with and without an implantable cardiac defibrillator (CRT-D and CRT-P, respectively) is associated with a reduced risk of death and re-admission for heart failure (HF). Whether upgrade to CRT-P/D from a brady pacemaker or an implantable cardiac defibrillator is associated with a similar long-term clinical benefit as de novo implantations is unknown.

Purpose
To compare risk of death and HF readmission in patients receiving a de novo versus upgraded CRT-P/D device.

Methods
From the Danish nationwide administrative registers, we identified all patients who had a CRT-D or CRT-P implanted from 2006 through 2016. Patients were excluded if they had endocarditis within 12 months before implantation. The patients were divided into groups based on whether implantation was an upgrade of a previous device or a de novo implantation. The primary endpoint was the composite of all-cause mortality and HF readmission. Risk of the primary endpoint was assessed with Kaplan Meier estimator and multivariable Cox regression models adjusted for age, sex, ischemic heart disease, diabetes and chronic obstructive pulmonary disease.

Results
The study population comprised 6,324 patients, median age 70 years [25th-75th percentile: 63–77], 22% women. In total, 3,635 patients had a CRT-D, of whom 749 (20.6%) were upgraded from an implantable cardioverter defibrillator device and 2,689 patients had a CRT-P, of whom 496 (18.4%) were upgraded from brady-pacemakers. For patients with CRT-D, five-year event-free survival probability was 35.3% for de novo and 20.4% for upgrades (log-rank p-value<0.001). For patients with CRT-P, five-year event-free survival probability was 38.4% for de novo and 33.7% for upgrades (log-rank p-value=0.29) (Figure 1). In the CRT-D group, upgrade was associated with an increased risk of the primary endpoint, hazard ratio (HR): 1.49 (95%-confidence interval (CI): 1.34–1.65, p<0.001). In the CRT-P group, no significant difference between upgrade and de novo was observed, HR: 1.02 (95%-CI: 0.89–1.18, p=0.72).
Figure 1

Conclusions
Upgrade to a CRT-P was associated with a similar long-term clinical outcome as de novo device implantation. This was in contrast to upgrade CRT-D, which was associated with a worse outcome than de novo implantation. To understand the factors underlying this increased risk, more studies are warranted.
P1244Survival after septal myectomy in male and female patients with hypertrophic obstructive cardiomyopathy
Authors: Huurman R , Schinkel A , Van Slegtenhorst M , De Jong P , Hirsch A , Michels M 
Published: October 2019

Abstract
In recent years, studies have debated the impact of gender on the presentation and clinical course of HCM, with research showing that at time of myectomy, women are older, have worse diastolic function and more advanced cardiac remodeling. The clinical impact of these differences is unknown.
We included 221 HCM patients (57% men) who underwent septal myectomy and are followed in our center. Time to treatment was calculated in relation to symptom onset. Pre- and post-operative clinical and echocardiographic data were collected. Gender differences were assessed at baseline and in survival analyses for the composite endpoint of all-cause mortality, cardiac transplantation, re-intervention and aborted sudden cardiac death.
Women were older at time of myectomy, but time until treatment was similar (table). Pre-operative echocardiographic indices were comparable among groups, but were significantly higher in women when correcting for body surface area. At three months, no differences were found in clinical and echocardiographic results. After 6.1 [2.9–10.1] years, 24% of women and 23% of men had reached the composite endpoint (p=0.30, figure).
Gender comparison pre- and post-myectomy Men (n=125) Women (n=96) p value Age 49±14 54±17 0.02 Maximal wall thickness, mm 19.9±4.7 19.8±5.8 0.97 Indexed maximal wall thickness, mm/m2 9.8±2.5 11.5±4.5 0.001 Left atrial diameter, mm 48.1±7.3 45.9±7.3 0.06 Indexed left atrial diameter, mm/m2 23.5±3.5 26.5±7.5 0.002 LV end-diastolic diameter, mm 45.4±7.6 42.8±5.6 0.04 Indexed LV end-diastolic diameter, mm/m2 22.1±3.7 23.6±3.0 0.02 Gradient reduction, %* 75.1±25.0 72.9±28.6 0.63 Improvement in symptoms*† 97 (95%) 64 (89%) 0.34 MWT = maximal wall thickness; LV = left ventricle. *At three months follow-up; †Defined as a reduction of ≥1 NYHA class, measured in 102 men and 72 women.
Survival after myectomy
Although women present later in life and seem to have more advanced disease at time of myectomy, time to treatment is similar and survival after myectomy is excellent for both men and women.
P1246Myocardial transit time (MTT) - a novel and easy-to-perform CMR parameter to assess microvascular disease
Authors: Chatzantonis G , Bietenbeck M , Florian A , Meier C , Holtstiege V , Reinecke H , Yilmaz A 
Published: October 2019

Abstract

Background
Myocardial microvascular disease is primarily characterized by arteriolar obliteration and capillary rarefaction, and may occur during the disease course of different disorders. With the present study, we introduce a novel and easy-to-perform cardiovascular magnetic resonance (CMR) parameter named “myocardial transit time” (MTT).

Methods
N=20 patients with known hypertrophic cardiomyopathy (HCM) and N=20 control patients without relevant cardiac disease underwent dedicated CMR studies on a 1.5-T MR scanner (Ingenia, Philips, Best, The Netherlands). The CMR protocol comprised cine and late-gadolinium-enhancement (LGE) imaging and first-pass perfusion acquisitions at rest for MTT measurement: an imaging plane covering both the aortic bulbus and the coronary sinus was planned in order to track the flooding of gadolinium. MTT was defined as the time interval between first appearance of gadolinium in the aortic bulbus and the subsequent appearance of gadolinium in the coronary sinus reflecting the transit time of gadolinium in the myocardial microvasculature (in the absence of epicardial coronary artery disease).

Results
There was no significant difference in left ventricular ejection fraction (LV-EF) between both groups: 61% (55–68%) in HCM patients vs. 60% (58–67%) in controls (p=ns) whereas LV mass was significantly higher in HCM patients (79g/m2 (63–98g/m2) vs. 50g/m2 (45–56g/m2) in controls, p<0.001). The extent of LGE was 17% (6–22%) in HCM patients while there was no LGE at all in the control group (p<0.001). MTT at rest was substantially longer in HCM patients: 11.0sec (9.1–14.5sec) vs. 6.5sec (4.8–8.4sec) in controls (p<0.001). Correlation analyses revealed a significant relationship between LV mass and MTT (r = +0.64, p<0.001) as well as between LGE extent and MTT (r=0.75, p<0.001). ROC analysis resulted in an area-under-curve (AUC) of 0.90 for MTT and showed an optimal sensitivity/specificity cut-off of 7.85sec to differentiate HCM from controls.
Patient characteristics HNCM patients (N=20) Control group (N=20) p-value Absolute MTT, sec 11.0 (9.1–14.5) 6.5 (4.8–8.4) <0.001 MTT indexed to heart rate 0.159 (0.100–0.198) 0.081 (0.063–0.106) <0.001 No. of patients with MTT <7.85 sec, n (%) 2 (10) 15 (75) <0.001 MTT = Myocardial Transit Time, HNCM = Hypertrophic Non obstructive Cardiomyopathy.
Multiple images illustrating MTT method

Conclusion
“Myocardial transit time” (MTT) is a novel and easy-to-perform CMR parameter that allows a quick assessment of the extent of myocardial microvascular disease. This novel CMR parameter may open new vistas in the assessment of microvascular disease - not only in HCM patients. Future studies will show the usefulness and clinical relevance of this novel CMR parameter.
P1463Cardiology, cardiovascular clinical and economical beneficiary outcomes of tele-cardiology, e-audio-visual cardiology and m-cardiology: TEAM study at multi cardiac centre in India
Authors: Sen N , Tanwar S , Jain A , Shetty D , Cherian G , Kalra B , Mehta A 
Published: October 2019

Abstract

Background
Telemedicine has beneficiary aspect to manage health and reduce the burden of illness. It represent health promotion with support of many ways like tele (distance mode), e (electronic mode), audio visual mode and m (mobile or smart phones) mode etc.

Objectives
To evaluate the cardiovascular land economical outcomes of tele-cardiology, e-cardiology, audio-visual cardiology and m-cardiology in large population and to review with increase awareness and application of telemedicine.

Methods
We enrolled 12872 patients from different cardiac centres in india and registered in TEAM (Tele-cardiology, E-cardiology, Audio-visual cardiology and M-cardiology) registry from 2008 to 2018. We included tele diagnosis, tele assistance, tele monitoring, tele therapy, electronic remot media, audio visual media and mobile apps for management of different category of cardiovascular disease like coronary heart and structural heart disease, hypertension, heart failure and congenital heart disorders. We compared TEAM registry with usual group (n=13229) at the platform of beneficiary outcomes regarding diagnostic, therapeutic significance, economical burden, mortality and rate of hospitalization.

Results
Our data revealed that 34% more correction of the diagnosis of congenital heart diseases, 29% reduction of unnecessary transport of acute coronary syndrome and non cardiac chest pain from primary to higher cardiac centre. 38% patients of ST elevation of myocardial infarction were benefited by facilliated angioplasty and 50% mortality risk reduction in TEAM registry as compare usual group. In heart failure patients, 12 months clinical outcomes revealed that there was a significant reduction in rehospitalizations in the TEAM group compared with the usual-care group (19.6% versus 33.7%,) and also found 29% stroke reduction in TEAM group. Usual group showed 2.5 fold higher economical burden than TEAM registry.

Conclusion
Total approach of telemedicine in cardiology service may diagnose correctly at root level, prevent clinical instability, reduce rehospitalization and lower the cost of managing heart patients.
P1464Adoption of feedback to validate a machine learning model for single lead STEMI detection
Authors: Mehta S , Fernandez F , Villagran C , Matheus C , Ceschim M , Vieira D , Torres M A , Mazzini J , Quintero S , Pisana L , Nola F , Safie R , Munguia A , Krisciunas S , Sunkaraneni S 
Published: October 2019

Abstract

Background
We have explored the performance of a single lead EKG with Artificial Intelligence (AI) based algorithms in STEMI diagnosis, thus far lead V2 has yielded the best results. Anticipating the performance of the LUMENGT-AI model, we designed a feedback strategy with healthcare centers to expand the validation of our work.

Purpose
To create a pragmatic alternative to the existing gold standard, a 12-lead EKG, for STEMI diagnosis.

Methods
An observational, retrospective, case-control study. Sample: 2,543 exclusively STEMI (anterior, inferior and lateral wall) diagnosis, EKG records. Feedback: From healthcare centers, confirming STEMI diagnosis and location, was obtained (thrombolysis, primary Percutaneous Coronary Intervention (PCI), pharmaco invasive therapy or coronary artery bypass surgery). Records excluded other patient and medical information. Sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes using the wavelet system, segmentation of each EKG into individual heartbeats (53,667 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented; “STEMI” and “Not-STEMI” classes were considered for each heartbeat per lead; individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.

Results
V2 was the most precise lead with an Accuracy of 93.6%, a Sensitivity of 89%, and a Specificity of 94.7%.

Conclusions
The strategic adoption of feedback from healthcare centers provided strong validation of our model. The results of AI-augmented, single lead EKG are encouraging. We anticipate that this approach will become a promising methodology in STEMI detection.
P1472Predicting significant ventricular arrhythmias in STEMI patients in middle-range and preserved EF
Authors: Krljanac G , Trifunovic D , Asanin M , Savic Spasic L , Aleksandric S , Dudic J , Cucic L , Sulovic V , Mrdovic I 
Published: October 2019

Abstract

Background
Predicting malignant ventricular and sudden cardiac death (SCD) in STEMI patients with middle-range and preserved EF is challenge.

Aim
To identify the best parameters to predict composite end-point defined as secondary VF, sustained/non-sustained VT and sudden death, 48h after and during the first year of follow up after STEMI in patients with middle-range and preserved EF.

Methods
In the 192 consecutive STEMI patients (pts) 57.8±10.4yr, 69.9% males, in PREDICT-VT study (NCT03263949) treated with pPCI, with EF ≥40%, early echo (5±2 days) was done including conventional parameters and comprehensive speckle tracking left ventricle (LV) deformation analysis with longitudinal (L), circumferential (C) strain (S; %) strain rate (SR, 1/sec), index mechanical dispersion (IMD) and rotational LV mechanics.

Results
Thirteen patients (8.3%) reached the end-point. Classical parameters of LV systolic function, including LVEF, wall motion score index and parameters of diastolic dysfunction were not significant predictors of the malignant arrhythmias. IMD of late rotation rate (63.7 vs. 40.7ms, p=0.055) and late diastolic untwisting rate (−48.85 vs. −63.18°/s, p=0.059) had trend to become the significant predictors. CS in papillary muscle level in endo and mid layers predicted the primary end-point (endo: −20.5±11.8 vs. −24.9±4.6, mid: −14.6±3.9 vs. −17.0±2.1, epi: −10.1±3.3 vs. −11.8±1.8) (table).
Parameter of circumferencial mechanics ROC area 95% CI p Cutt-off Sens Spec PM endo (%) 0.302 0.146–0.458 0.038 −22.75 70 67 PM mid (%) 0268 0.153–0.383 0.015 −15.65 80 62

Conclusion
Myocardial deformation imaging offers deeper insight into complex mechanical abnormalities during LV contraction and relaxation in STEMI patients with middle-range and preserved EF that predicts serious arrhythmic events.
P1479Deterioration in right ventricular strain precedes occurrence of pulmonary hypertension in patients with preclinical diastolic disfunction
Authors: Chilingaryan A L , Tunyan L G , Adamyan K G 
Published: October 2019

Abstract

Preclinical diastolic disfunction (PDD) often progresses to heart failure and distinct clinical predictors for this transformation are yet to be defined. Since deterioration of longitudinal strain (LS) can occur before the changes of more conventional parameters, we assumed that right ventricular free wall longitudinal strain (RVLS) might start deteriorating before the pulmonary hypertension can be established.

Methods
We followed up 243 patients (143 female) 67±9 years with PDD for 3 years. All patients had an impaired relaxation or pseudo normal transmitral patterns and E/e' 8–13 at rest, normal NT-proBNP values, and systolic pulmonary artery pressure (sPAP) ≤30 mm Hg. PDD was diagnosed by stress echocardiography (SE) if E/e' ≥13, transmittal E wave deceleration time reduction >50ms, systolic pulmonary artery pressure (sPAP) <30 mmHg, and patients remained asymptomatic during SE. RVLS as average of RV free wall 3 segments values, left atrial peak reservoir LS (LALS) as average of two LA basal segments in four chamber view and left ventricular peak systolic global LS (LVGLS) were measured by speckle tracking (ST). ST and SE was performed with 6 months intervals. 35 healthy subject served as controls.

Results
Patients with PDD had higher RVLS, LVGLS, and lower LALS compared with controls (RVLS –23.2±4.2% vs –27.3±5.1%, p<0.001; LVGLS –17.8±5.2% vs –21.9±2.8%, p<0.001; LALS 39.7±3.7% vs 44.1±4.9%, p<0.002). 76 (31.3%) patients developed sPAP increase >30 mmHg at rest or SE during follow up of which 34 (44.7%) had dyspnea. Patients with increased sPAP had higher RVLS and lower LALS values at baseline compared with the rest of PDD patients without significant differences in other parameters (RVLS –17.9±2.8% vs –24.8±3.6%, p<0.002; LALS 37.7±2.3% vs 41.5±3.6%, p<0.003; LVGLS –17.4±4.8% vs –18.2±5.1%, p>0.05). Both LALS and RVLS correlated with LA end diastolic volume index (LALS r=0.51, p<0.01; RVLS r=0.54, p<0.01). Additionally RVLS was an independent predictor of sPAP rise (OR=2.7; 95% CI=2.43–6.92; p<0.01).

Conclusion
RVLS is an independent predictor of sPAP increase in patients with PDD.