bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3521Predicting 30-day mortality and 30-day re-hospitalization risks in patients with heart failure
Authors: Gambassi G , Li L , Baek J , Jesdale B M , Hume A , Caretti D , Goldberg R J , Lapane K L 
Published: October 2019

Abstract

Background
Heart failure (HF) is the leading cause of hospitalization among persons aged ≥65 years. In the USA, nearly one-quarter of these patients are discharged to skilled nursing facilities (SNFs). These patients are typically older, and have greater mortality and re-hospitalization risks compared with those discharged home. Despite the importance of SNFs as a post-acute care setting for patients with HF, little is known about factors that predict short-term mortality and re-hospitalization in these high risk patients.

Purpose
To develop and validate separate predictive models for 30-day all-cause mortality and 30-day all-cause re-hospitalization among HF patients discharged from acute care hospitals to SNF.

Methods
Using a nationwide dataset including Medicare claims data cross-linked with Minimum Data Set 3.0 (2011–2013), we identified 77,670 hospitalized patients with HF discharged to 11,529 SNFs; we randomly split the patients into development (2/3 of the sample) and validation (1/3 of the sample) cohorts. Using data on patient sociodemographic and clinical characteristics, health service use, functional status, and facility-level factors, we developed separate prediction models for 30-day mortality and 30-day re-hospitalization using logistic regression models in the development cohort.

Results
In the development cohort, the median age of patients was 84 years, 39.6% were men, 83.4% were Caucasian whites. The median Charlson index was 4 and the median length of hospital stay was 6 days. Functional disabilities were prevalent: 80.0% had moderate-to-severe physical limitations and 35.9% moderate or severe cognitive impairment. After admission to SNF, 6.8% died and 24.2% were re-hospitalized within 30 days in the development cohort. Of those who died, 56.1% were re-hospitalized and 13.6% were discharged to home or self-care before their death. Of those who were re-hospitalized, 18.5% were discharged to home or self-care before their readmission. Of 48 potential predictors, 13 patient-level factors remained in the final model for 30-day mortality and 10 patient-level factors for re-hospitalization with good calibration. Among the selected predictors, developing symptoms of dyspnea, having physical limitations, depression severity, BMI, Charlson index, number of hospitalizations in past 6 months and length of hospital stay contributed most. The area under receiver operating characteristic curves were 0.71 for 30-day mortality and 0.63 for re-hospitalization in the validation cohort.

Conclusions
Among HF patients discharged to SNFs, our predictive model based on administrative data may be used to identify those at risk for death within 30 days, which could aid clinicians in improving care during this vulnerable period. Further work identifying factors for re-hospitalization remains needed.

Acknowledgement/Funding
None
P3538Effect of beta-blockers on mortality in heart failure with mid-range and preserved ejection fraction: a meta-analysis
Authors: Fukuta H , Ohte N 
Published: October 2019

Abstract

Background
Despite the high mortality rate, there is no established therapy to improve survival in heart failure with mid-range ejection fraction (HFmrEF) or in heart failure with preserved ejection fraction (HFpEF). An individual patient-level analysis of major randomized controlled trials (RCTs) conducted by the Beta-Blockers in Heart Failure Collaborative Group (BB-HF) did not show clear mortality benefit of beta-blockers (BBs) in HFmrEF or HFpEF. However, due to the strict enrollment criteria, the patients who participated in these trials might represent a selected group of patients that is poorly representative of patients treated in routine clinical practice. In contrast, clinical characteristics of real-world patients are similar to those of patients enrolled in observational cohort studies (OCSs). Although many OCSs have examined the prognostic effect of BBs in HFmrEF/HFpEF, results are inconsistent due to limited power with small sample sizes and/or inadequate adjustment for known prognostic factors.

Purpose
We aimed to conduct a meta-analysis of OCSs and RCTs to determine the effect of BBs on mortality in HFmrEF/HFpEF.

Methods
A search of MEDLINE and EMBASE was conducted in November 2018. Clinical studies reporting the outcome of mortality for HF patients with EF≥0.40, being assigned to BB treatment and non-BB control group, were included.

Results
Seven OCSs with propensity score (PS) analysis (16,295 patients), 6OCSs without PS analysis (15,275 patients), and 4RCTs (1222 patients) were included for this meta-analysis. Forest plot of the effect of BBs on mortality is shown in Figure 1. Use of BBs was associated with reduced risk of mortality in the pooled analysis of OCSs with PS analysis (RR [95% CI] = 0.83 [0.74–0.92], P<0.001) and in that of OCSs without PS analysis (0.70 [0.52–0.94], P<0.05), but not in that of RCTs (0.88 [0.62–1.24], P=0.45). Overall, use of BBs was associated with reduced risk of mortality (RR [95% CI] = 0.82 [0.75–0.89], P<0.001). No evidence of publication bias was found either in visual inspection of funnel plots or using the Egger test (P>0.1).
Figure 1

Conclusions
Our meta-analysis showed that treatment with BBs for the HF patients with EF≥0.40 was associated with reduced risk of mortality. Our findings emphasize the importance of conducting new well-designed studies such as registry-based RCTs to confirm our observed potential survival benefit of BBs in HFmrEF or HFpEF.
P3540The predictive value of global longitudinal strain in patients with heart failure mid-range ejection fraction
Authors: Wei-Ting C , Liao C T , Chen Z C 
Published: October 2019

Abstract

Background
Heart failure with mid-range ejection fraction (HFmrEF) was defined as the typical symptoms of HF with a left ventricular ejection fraction (LVEF) of 41% to 49%. However, till now the progression of LV function and the subsequent prognosis remains largely unknown. Speckle tracking echocardiography (STE) is a novel method to detect the early myocardial dysfunction and has been used to differentiate the outcomes of different phenotypes of cardiovascular diseases.

Purpose
Herein, we aim to investigate the application of STE in HFmrEF and its predictive values.

Methods
Retrospectively, we collected the medical records and echocardiography imaging of 250 patients diagnosed as HFmrEF during 2014 to 2018. LV longitudinal strain at diagnosis was evaluated and compared with the changes of LV during the follow-up period. Also, mortality and major adverse cardiovascular events (MACE) including myocardial infarction, heart failure requiring admission were recorded.

Results
Our result indicated that a reduced LV longitudinal strain at baseline was significantly associated with a subsequent declined LVEF beneath 40%. Also, the lower strain a baseline implied the higher mortality and MACE. Using −12% as the cut-off value LV strain presented the most significant impact on the prognosis compared with the other echocardiographic parameters in the logistic regression Regarding the guideline directed medications, blockers of renin-angiotensin-aldosterone system most significantly improved the cardiac remodeling compared with the others.

Conclusion
STE can predict the subsequent changes of LVEF and the cardiovascular outcomes in patients with HFmrEF.
P3556Segmental intramyocardial CMR Fast-SENC objectively quantifies cardiac dysfunction that causes symptoms based on NYHA classification before global longitudinal strain or ejection fraction
Authors: Montenbruck M , Kelle S , Esch S , Andre F , Korosoglou G , Steen H 
Published: October 2019

Abstract

Background
Global longitudinal strain (GLS) has become an alternative to ejection fraction (EF) in identifying reduced cardiac function. However, these global metrics are not able to characterize patients in which symptoms occur even while the heart compensates for regional dysfunction. More sensitive metrics are needed to detect subclinical regional dysfunction and determine the relationship to symptoms that may or may not be associated with cardiac causes. Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to global metrics GLS and LVEF based on NYHA classification.

Methods
A single center, prospective registry of MRI scans acquired with a 1.5T scanner were evaluated for conventional CMR diagnostics including biventricular EF, volumes and mass. In addition, fSENC scans were acquired and processed with the MyoStrain software to quantify intramyocardial LV & RV strain. Three short axis scans (basal, midventricular, & apical) were used to calculate strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3- & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. All metrics were compared based on NYHA classification.

Results
A total of 977 scans in 779 patients were included in the study; this population included 210 myocarditis, 46 dilated cardiomyopathy, and 30 ischemic cardiomyopathy cases. Patients had an average (± stdev) age of 55 (17) yrs and BMI of 26 (5) kg/m2; 48% had arterial hypertension, 12% diabetes mellitus, 33% valve disease, 24% cancer, 7% atrial fibrillation, 13% pulmonary disease, 5% left bundle branch block, 35% hypercholesterolemia, and 24% coronary artery disease. Figure 1 shows the relationship between segmental strain, calculated as the percent of normal LV segments (longitudinal & circumferential) based on intramyocardial fSENC <−17%, versus GLS and LVEF. All metrics were compared based on NYHA classification.
Figure 1

Conclusion
Segmental fSENC identified changes in NYHA classification well before changes in EF or GLS. Measuring segmental fSENC provides an objective view of symptomatic heart failure progression and can serve as surrogate endpoints for trials instead of purely relying on quality of life and subjective symptom perception.
P3567Genetic screening for monogenic hypertension in hypertensive individuals in a clinical setting
Authors: Bao M , Zhong J , Cai J , Yang X 
Published: October 2019

Abstract

Objectives
Monogenic hypertension describes a series of hypertension syndromes inherited by Mendelian law and present with complex phenotypes.

Methods
1179 cases with monogenic hypertension potential were evaluated by sequencing 37 causative genes. Pathogenic variants were classified by using American College of Medical Genetics guidelines. Additionally, 49 variants of unknown significance were selected to receive functional analysis. The yield of combined genetic and functional analysis was evaluated.

Results
21 deleterious variants were identified in 33 of 1179 (2.80%). Functional analysis for 49 unknown significant variants showed 32 variants harbored by 61 individuals led to abnormally expressed protein levels. Overall, combining genetic screening with functional analysis promoted diagnostic yield to 8.73%. The main etiology established was primary aldosteronism, with CACNA1H harboring the greatest mutation burden. Logistic regression analysis showed hypertension complicated with special manifestations had the strongest correlation with disease causing variants detection (p=0.03).
Sequencing Results Summary Number of variants Number of individuals* Percentage† Individuals with no variant 0 524 44.44% Individuals with variants identified 592 655 55.56% Individuals with single contributing variant 297 480 40.71% Individuals with two or multiple contributing variants 295 175 14.84% Number of variants identified   Pathogenic and likely pathogenic variants 21 33 2.80%   Variants of unknown significance 570 634 53.77%   Benign or likely benign variants 1 1 0.08% Type of variant   Frameshift deletion 8 15 1.27%   Frameshift insertion 5 5 0.42%   Nonframeshift deletion 10 10 0.85%   Nonframeshift insertion 6 12 1.02%   Nonsynonymous SNV 546 607 51.48%   Stopgain SNV 18 30 2.54% WES, whole-exome sequencing. *The statistics in this table was based on 1179 individuals. †The percentage was calculated by the number of individuals in each category.
A flow chart of this study.

Conclusion
Our findings demonstrate an enhanced diagnostic ability by combining genetic analysis with functional evaluation and enables targeted treatment and prevention of hypertension.

Acknowledgement/Funding
This work was supported by National Basic Research Program of China (973 Program, 2014CB542300, 2014CB542302).
P3573Different contribution of sympathetic nerve activity to pulse wave velocity and arterial velocity pulse index in healthy subjects
Authors: Sugimoto H , Murai H , Hamaoka T , Mukai Y , Inoue O , Okabe Y , Tokuhisa H , Takashima S , Kato T , Usui S , Furusho K , Takamura M 
Published: October 2019

Abstract

Background
Pulse Wave Velocity (PWV) is associated with the net effect of arterial stiffness and sympathetic nerve activity. Recent study demonstrated the significant relationship between PWV and muscle sympathetic nerve activity (MSNA). Arterial Velocity pulse Index (AVI) is a newly developed parameter, which could evaluate vascular reflected wave, regardless of aortic form. Vascular reflected wave is considered to be associated with sympathetic nerve activity, however little is known about the relationship between AVI and MSNA.

Purpose
The purpose of this study was to evaluate the relationship between AVI or PWV and MSNA in healthy subject.

Method
21 healthy subjects were included in this study. AVI was measured by NAS-1000 (Nihon Koden, Japan), calculated from the time series of occlusive cuff pressure in the left upper arm. Brachial-ankle PWV (baPWV) was measured by BP-203RPEIII (Omron Healthcare, Japan). MSNA was recorded from left peroneal nerve by microneurography using tungsten microelectrode. All measurements were performed in the same day morning.

Results
The mean age was 31+5 years and body mass index (BMI) 22.5+3.0 kg/m2. In regression analysis, baPWV was significantly associated with age (r=0.64 P<0.05) but not with MSNA or BMI. AVI was significantly associated with MSNA (r=0.73, P<0.05) but not with age and BMI.

Conclusion
We found that different contribution of MSNA to baPWV and AVI and revealed that AVI was associated with MSNA in healthy subjects. These results suggest that AVI could reflect sympathetic nerve activity compared to baPWV.
P3586Influence of morphological features of intracoronary thrombi on ST segment resolution in patients with STEMI after primary PCI
Authors: Besh D , Sokolov M , Zerbino D , Kyyak Y 
Published: October 2019

Abstract

Background
Coronary artery thrombosis is a key element in the onset of STEMI and its further course. Coronary clots significantly vary in their morphological features and types. Perhaps, it may be caused by individual differences in thrombus formation that could have a strong influence on STEMI course and prognosis.

Purpose
To elucidate the influence of morphological features of intracoronary thrombi (IT) on ST-segment resolution (the outcome) after primary PCI in patients with STEMI.

Methods
The study included 100 patients with STEMI (female 22%, male 78%) aged 57.81±10.26 years, who underwent PCI with manual thromboaspiration within the first 12 hours (mean 7.22±3.74 h) after the onset of symptoms. The obtained ITs were examined morphologically after hematoxylin & eosin staining by the standard method and by the method proposed by prof. Zerbino that allows determining the antiquity of fibrin according to its color. Each IT was classified by five morphological features: 1) “old” or “fresh” (according to Zerbino's staining); 2) with or without layered structure; and presence or absence of 3) microchannels, 4) peripheral infiltration with neutrophil leukocytes, 5) elements of atherosclerotic plaque. Correlations between these features and incidence of ST-segment resolution in 60 minutes after primary PCI for more than 50% from baseline were analyzed.

Results
Neither IT antiquity nor presence of the atherosclerotic plaque elements had any significant correlations with ST-segment resolution. Significant positive correlation was revealed with peripheral neutrophil infiltration (r=0.42, p<0.05), and negative correlations were found with layered arrangement IT (r=−0.31, p<0.05) and presence of microchannels (r=−0.56, p<0.05). Statistically significant mathematical prognostic model of ST-segment resolution was obtained after analysis of the co-influence of all five morphological features on the outcome using logistic regression method. It included three IT features significantly correlating with ST-segment resolution:
Z = 1.13 − 0.51*V1 − 0.57*V2 − 0.94*V3
where V1 – IT with layered arrangement of fibrin, V2 – IT with microchannels' formation, V3 – IT with peripheral areas of infiltration by the neutrophil leukocytes (1 for the presence of the feature, 0 for its absence).
“Old” IT with layered structure

Conclusions
Morphological features of IT in patients with acute STEMI appear to have significant influence on the primary PCI outcomes. They may be important predictors of the disease course and treatments efficacy. Further investigations of the IT peculiarities and their influences on the course of STEMI may help to improve therapy.

Acknowledgement/Funding
Study financial support was made by authors
P3591Residual atherothrombotic burden after primary percutaneous coronary intervention and myocardial reperfusion - An optical frequency domain imaging study
Authors: Roule V , Schwob L , Lemaitre A , Bignon M , Ardouin P , Sabatier R , Blanchart K , Beygui F 
Published: October 2019

Abstract

Background
The clinical significance of residual in-stent atherothrombotic burden (ATB) after primary percutaneous coronary intervention (PCI) remains unclear. Several methods of ATB quantification using optical frequency domain imaging (OFDI) exist.

Objectives
We aimed to assess the relationship between residual ATB after primary PCI measured in OFDI using different methods and myocardial blush grade (MBG).

Methods
We prospectively included 60 ST-elevation myocardial infarction patients pre-treated with aspirin and ticagrelor. OFDI volumetric quantification using planimetry (with intervals every frame or every millimeter) and semi-quantitative score were used to determine ATB. Patients were divided into two groups according to final MBG 3 or <3.

Results
MBG 3 was identified in 28 (46%) patients. Altogether, 13318 OFDI cross-sections were analyzed. The mean ATB was 10.08±5.21%. ATB was lower in patients with normal final MBG compared to those with impaired MBG, regardless of the method used (8.15±5.58 vs 11.77±4.28%; p=0.007 for quantification per frame; 7.8±5.19 vs 11.07±4.07%; p=0.009 for quantification per mm and 11.21±11.75 vs 22.91±17.35; p=0.003 for the semi-quantitative thrombus score, respectively).
Table 1. Post stenting OFDI findings OFDI measures All Final Blush <3 Final Blush 3 p n=60 (100%) n=32 (53%) n=28 (47%) Stent volume (mm3) 219.42±135.76 226.08±168.69 211.82±86.57 0.68 Evaluation per frame   Atherothrombotic volume (mm3) 21.66±16.81 25.83±18.86 16.89±12.83 0.035   Atherothrombotic burden (%) 10.08±5.21 11.77±4.28 8.15±5.58 0.007 Evaluation per millimeter   Atherothrombotic volume (mm3) 20.71±16.16 24.57±18.15 16.29±12.43 0.042   Atherothrombotic burden (%) 9.5±4.88 11.07±4.07 7.8±5.19 0.009 Thrombus score 17.45±16 22.91±17.35 11.21±11.75 0.003
Optical frequency domain imaging example

Conclusion
Residual post-stenting ATB remains substantial after primary PCI in STEMI patients, even when pre-treated with ticagrelor and aspirin. Mostly, it appears as an important surrogate of clinical outcome as patients with normal myocardial reperfusion presented lower residual ATB.
P3596The role of MSCT and SPECT in patients with acute coronary syndromes and non-obstructive coronary artery disease
Authors: Vorobyeva A , Mochula A V , Zavadovsky K V , Ryabov V V 
Published: October 2019

Abstract

Background
Approximately 1–14% of patients with ACS not have obstructive changes in the coronary arteries according to the data of invasive coronary angiography (ICA) is myocardial infarction (AMI) with non-obstructive coronary artery- MINOCA. MSCT has the ability to assess the lumen of the vessel, visualize the artery wall, the structure of the atherosclerotic plaque. SPECT is used to detect myocardial ischemia, determine the functional significance of atherosclerotic plaques, and evaluate regional tissue perfusion. There are no data on a research of a structurally functional condition of a coronary blood-groove by means of MSCT, SPECT.Aim. To study the role of MSCT and SPECT in patients with MINOCA, to compare MSCT with invasive coronarography.

Material and methods
The study is registered on ClinicalTrials.gov. Inclusion criteria are listed on the site. All patients underwent CT, SPECT, on the 6th day from the beginning of the index event. All MSCT and SPECT studies were performed on a 64-section combined single-photon-emission and X-ray computer tomograph GE Discovery NM/CT 570C. Endpoint: Frequency of occurrence of atherosclerosis, frequency of occurrence of unstable plaques according to MSCT, the magnitude of a transient defect in myocardial perfusion according to SPECT.

Results
The study included 14 patients with MINOCA, women predominate – 11 (78.6%), the average age was 61.1±14 years. The risk of GRACE was moderate in 8 (57%) pts. 12 (85.7%) pts were hospitalized within the first 6 hours of the onset of the disease.Thrombolytic therapy was performed in 3 (21.4%) pts, 2 of them were effective (14%). 57% of patients at admission were troponin-positive.According to the results of ICA, intact coronary arteries were detected in 9 (64.3%) pts, 5 (35%) had stenosis up to 50%. Coronary slow flow (TIMI 2) was determined in 11 (78.6%) pts, of which 8 (57%) pts have coronary slow flow and intact coronary arteries. Coronary spasm was in 1 (7.1%) patient. According to MSCT, the proportion of pts with intact coronary arteries decreased (9 (64.3%) → 5 (35.7%)) and the proportion with non-obstructive atherosclerosis increased (5 (35%) → 9 (64.3%)). All pts had a positive remodeling index, soft-tissue, predominantly calcified stenoses and eccentric plaques. The average Segment Involvement Score was 2.1 (0; 5), the Segment Stenosis Score was −2.4 (1; 3). 12 pts (85%) had transitory perfusion defects. The median SSS values were 7.5 (4; 13), SRS 4.7 (1.0; 9.0), SDS 4.7 (3.0; 8.0).

Conclusion
In 78% of pts had a slowing of the coronary blood flow and intact coronary arteries according to ICAG. However, according to MSCT, only 36% of the patients did not have plaques. MSCT allows to identify eccentric soft tissue atherosclerotic plaques that have a high risk of rupture/erosion, and, accordingly, the high risk of the development of AMI in this group. Using SPECT revealed a statistically significant transient perfusion defect.