bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5469Isolated systolic hypertension and combined systolic-diastolic hypertension for prediction of new-onset diabetes mellitus: Data from a 8-year-follow-up study
Authors: Liatakis I , Tsioufis C , Dimitriadis K , Konstantinidis D , Koutra E , Leontsinis I , Kouremeti M , Iliakis P , Vogiatzakis N , Karaminas N , Thomopoulos K , Tousoulis D 
Published: October 2019

Abstract

Background/Introduction
Isolated systolic hypertension (ISH) and combined systolic-diastolic hypertension (CH) are related with increased cardiovascular risk, while new-onset diabetes mellitus (NOD) is linked with atherosclerosis progression.

Purpose
The aim of the present study was to compare the predictive role of ISH and CH for the incidence of NOD in a cohort of essential hypertensive patients.

Methods
We followed up 1435 non-diabetic essential hypertensives with office systolic blood pressure (BP)≥140 mmHg [mean age 57 years, 730 males, office BP=153/92 mmHg] for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent echocardiographic study and blood sampling for estimation of metabolic profile. Patients with baseline ISH exhibited office systolic BP ≥140 mmHg and office diastolic BP <90 mmHg, while those with CH had office systolic BP ≥140 mmHg and office diastolic BP ≥90 mmHg. Moreover, NOD was defined if at one or more of the follow-up visits a previously non-diabetic patient reported being on insulin or an oral hypoglycemic drug or if casual plasma glucose concentration ≥200 mg/dl or fasting glucose concentration ≥126 mg/dl or 2-h post load glucose ≥200 mg/dl during an oral glucose tolerance test.

Results
The incidence of NOD over the follow-up period was 4.2% (n=60). Patients with ISH (n=460) compared to those with CH (n=975) were older (65±11 vs 54±10 years, p<0.0001), had at baseline lower waist circumference (94.5±11 vs 99±13 cm, p<0.0001), office systolic BP (149±12 vs 155±13 mmHg, p<0.0001), office diastolic BP (80±8 vs 98±6 mmHg, p<0.0001), while did not differ regarding left ventricular mass index, glucose and lipid levels (p=NS for all). Univariate Cox regression analysis revealed that baseline ISH (hazard ratio=2.143, p=0.016) and CH (hazard ratio=1.272, p=0.029) predicted NOD. However, in multivariate Cox regression model, age (hazard ratio=1.039, p<0.001), baseline glucose levels (hazard ratio 1.011, p=0.016), waist circumference (hazard ratio=1.067, p<0.001) and ISH (hazard ratio=1.651, p=0.029) but not CH turned out to be independent predictors of NOD.

Conclusions
In essential hypertensive patients, ISH but not CH exhibits independent prognostic value for NOD. These findings support that ISH constitutes a hypertensive phenotype of increased metabolic risk needing careful evaluation and treatment.
P5481Predictors of mortality in patients with non-anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Milasinovic D , Radomirovic M , Jelic D , Mehmedbegovic Z , Zobenica V , Dudic J , Zaharijev S , Zivkovic I , Pavlovic A , Obreski A , Dolicanin A , Vukcevic V , Asanin M , Stankovic G 
Published: October 2019

Abstract

Background
Previous studies have indicated that patients with non-anterior ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) have a more favorable prognosis compared with anterior STEMI, especially in the short term.

Purpose
Our aim was to identify predictors of increased 30-day mortality in patients with non-anterior STEMI undergoing primary PCI.

Methods
This analysis included 8188 patients referred to primary PCI during 2009–2017, from a prospective electronic registry of a high-volume catheterization laboratory, for whom 30-day follow-up was available. Non-anterior infarction was defined as presence of ST-segment elevation in inferior and/or lateral ECG leads or true posterior MI. Multivariable Cox regression was used to assess the mortality risk at 30 days.

Results
59.4% (n=4863) of the included patients presented with a non-anterior STEMI. Mortality rate was significantly lower in patients with non-anterior vs. anterior STEMI (4.2% vs. 8.3%, p<0.001). Older age (> median of 61, HR 2.2, p=0.002), baseline renal failure (eGFR <60, HR 4.0, p<0.001), Killip class ≥2 (HR 3.8, p<0.001), previous stroke (HR 1.8, p=0.004), non-culprit chronic total occlusion (CTO, HR 2.0, p<0.001) and final TIMI flow grade <3 in the infarct-related artery (HR 3.1, p<0.001) were independently associated with an increased risk of 30-day mortality in non-anterior STEMI. The presence of at least one of these high-risk factors was noted in 61.2% of patients with non-anterior STEMI and was associated with a significantly higher risk of 30-day mortality (HR 18.2, p<0.001), similarly to the overall risk associated with anterior STEMI (HR 22.9, p<0.001), as compared with patients with non-anterior STEMI but without any of the here identified high-risk factors (Figure).
Figure 1

Conclusions
Crude mortality rate was significantly lower in patients with non-anterior vs. anterior STEMI. However, the majority of non-anterior STEMI patients had at least one of the high-risk factors (older age, previous CVI, baseline renal failure, Killip class ≥2, non-culprit CTO or final TIMI flow <3), which predisposed these patients to a similar increase in short-term mortality risk as in patients with anterior STEMI.
P5490Sex-related differences in intrahospital outcome of patients undergoing PCI
Authors: Lezha M , Ceka A , Alimehmeti I , Goda A 
Published: October 2019

Abstract

Background
Cardiovascular diseases remain the number one cause of mortality in the world despite modern scientific and therapeutic advancement. Gender difference pathophysiology, treatment and outcome have been hypothesized and studied. Whether there are sex differences in the outcome after PCI remains controversial.

Aim of the study
We undertook this study to assess whether there are sex-related differences in intrahospital outcome of patients undergoing percutaneous coronary intervention.

Materials and methods
This is a prospective observational study. We enrolled consecutively all patients undergoing PCI in UHC “Mother Theresa” from April to October 2018 and were followed in the 1st Clinic of Cardiology. Data for 352 patients were collected, 261 males and 91 females. We excluded from the study patients that could not be followed.

Results
Women were older (5.27; 95% CI: 2.98–7.6; p<0.001), had more hypertension (p≤0.001), Diabetes Mellitus (p≤0.001), while men were more likely to be smokers (p≤0.001). Female sex had a higher unadjusted mortality rate (5.5% vs. 1.5%, p=0.039) which vanished after adjustments for age, co-morbidities and procedural or infarct related complications (p=0.237). The age-group with the highest mortality rate was that of 61–70 years. Women had more procedure related complications like inguinal hematomas (p=0.02), pseudo aneurisms (p=0.005) and contrast induced nephropathy (p=0.021). Female gender was associated with more severe peri-procedural arrhythmias in the setting of AMI (p=0.039). Total hospital stay was longer for women (p=0.001), after elective PCI (p=0.01) and after primary PCI (p=0.007). After multivariate analysis and adjustment, female gender remained an independent factor for prolonged hospitalization.

Conclusion
Female sex seems to have a tendency for higher mortality even after losing its significance after multivariate adjustments. Females get more myocardial infarction and procedural related complications and have longer hospital stays than men.
P5498Comparison of outcomes of acute coronary Syndrome in women above 80 years versus below 80 years in Israel from 2000 to 2016
Authors: Rubinstein R , Matetzky S , Beigel R , Iakobishvili Z , Goldenberg I , Shechter M 
Published: October 2019

Abstract

Background
While women≥80 years old have a high prevalence of coronary artery disease (CAD), little data exist regarding their outcome following acute coronary syndrome (ACS).

Methods
In a retrospective study based on data of 3518 ACS women patients who were enrolled in the ACS Israel Survey (ACSIS), we first evaluated and compared the clinical outcomes of 858 ACS women ≥80 years with 2660 ACS women <80 years, hospitalized during 2000–2016. Secondly, we evaluated the clinical outcome of 450 women ≥80 years hospitalized during 2000–2006 (“early period”) and compared them with 408 ACS women of the same age group hospitalized during 2008–2016 (“late period”).

Results
Implementation of the ACS AHA/ACC/ESC therapeutic guidelines was lower in ACS women ≥80 years compared with women <80 years. Multivariate Cox regression analysis demonstrated a worse 1-year survival rate in the ACS women ≥80 years compared with those <80 years. During the late period women >80 years were treated more frequently with guideline-recommended therapies compared with patients from the same age group who were hospitalized in the early period. A significant decline in in-hospital mortality rates in ACS women ≥80 years hospitalized in the late compared with the early period was demonstrated. However, 7-day, 30-day and 1-year mortality rates were not significantly changed.
1-year survival by age groups

Conclusion
Adverse outcome rates of ACS women ≥80 years were significantly higher compared with those <80 years. In-hospital survival rates of ACS women patients >80 years improved during the 2000–2016 period; however, long-term survival rates were not significantly changed.

Acknowledgement/Funding
None
P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis
Authors: Seguchi M , Sakakura K , Yamamoto K , Taniguchi Y , Wada H , Momomura S , Fujita H 
Published: October 2019

Abstract

Background
Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians.

Methods
We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38).

Results
Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01).
Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase.
Flow-chart

Conclusions
The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed.

Acknowledgement/Funding
None
P5524Influence of bundle branch block in the long-term outcome of patients with acute coronary syndrome
Authors: Garcia Acuna J M , Cordero Fort A , Martinez A , Antunez P , Perez Dominguez M , Gonzalez Ferrero T , Cacho Antonio C , Torrelles A , Iglesias Alvarez D , Rigueiro Veloso P , Agra R , Pedreira Perez M , Gonzalez Juanatey J R 
Published: October 2019

Abstract

The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. This consideration is not taken into account in the management of patients with coronary syndrome without ST elevation (NSTEMI). We evaluate the evolution of patients with acute coronary syndrome and long-term bundle branch block.

Patients and methods
We included 8771 patients admitted to two tertiary hospitals between 2003 and 2017 with an acute coronary syndrome, 5673 NSTEMI (64.3%) and 3098 STEMI (35.7%). All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB). Long-term follow-up was performed (median 55 months) to assess mortality.

Results
A total of 8771 patients were included with a mean age of 66.1 years, 72.5% males, 4.1% (362) with LBBB and 5% (440) with RBBB. Patients with BBB were older, with more previous history of myocardial infarction and coronary revascularization and higher prevalence of cardiovascular risk factors. Medical treatment was similar but they were less often submitted to angioplasty. During the acute phase, patients with RBBB and LBBB presented a higher rate of heart failure than those without branch block (4.8% vs 9.1% vs 3.5%, p=0.0001); higher mortality (8.4% vs 10.5% vs 3.0%, p=0.0001); higher stroke rate (2.5% vs 1.4% vs 0.8%, p=0.001); higher rate of renal failure (8.2% vs 9.7% vs 3.9%, p=0.0001) and higher rate of reinfarction (3.0% vs 4.1% vs 1.7%, p=0.001). Patients who had a RBBB or an LBBB had a worse prognosis throughout the follow-up. Heart failure was present in 17.7% of the group with RBBB, 29.6% of LBBB and 11% in the group without branch block (p=0.0001). Mortality during follow-up was 31% in RBBB, 40.6% in LBBB and 18.7% without branch block (p=0.0001). In multivariate analysis of Cox, both RBBB (HR 1.55, 95% CI 1.23–1.98, p=0.0001) and LBBB (HR 1.48, 95% CI 1.22–1.53, p=0.001) were an independent predictors of all-cause mortality (adjustment for GRACE score, gender, treatment with betablockers, angiotensin conversor enzym inhibitors, statin and coronary revascularization).
Cox regression model multivariate

Conclusions
The presence of RBBB or LBBB in the ECG of patients with an ACS is associated with a worse prognosis both during the hospital phase and in the long term. In addition, both bundle branch blocks are independent predictors of long-term mortality in patients with ACS.
P5548Hypertrophic cardiomyopathy and exercise restrictions: time to let the shackles off?
Authors: Liao Y W , Rasoul D , Cooper R M 
Published: October 2019

Abstract

Introduction
Physical activity is well known to have many health benefits. However, patients with hypertrophic cardiomyopathy (HCM) might carry an increased risk of sudden cardiac death (SCD) during physical activity. This threat has to be considered in the risk versus benefit analysis of physical activity versus a more sedentary lifestyle. Current guidelines focus primarily on what level of activity should be entirely excluded and what level is considered safe. However, it does not quantify nor qualify the amount of physical activity which should actively be undertaken. We aimed to analyse current evidence in attempt to answer this question.

Method
For this review, we focused on non-athletes who made up the majority of HCM patients. However, we found that majority of the current evidence were geared towards athletes. In total, we analysed 27 papers.

Results
Obesity is a well documented aetiology of many diseases and patients with HCM have been observed to have higher BMI. When considering physical activity of patients with HCM, both patients and current guidelines tend to focus on avoidance of risk and restriction of exercise. This is understandable given the consequence of SCD in HCM patients. A retrospective review of 78 patients found that at the time of cardiac catastrophe, 46 of them were engaged in sedentary activities. This is further backed up by a UK study which found only 35 of 185 patients died during exertion. A meta-analysis of 3449 non-athletes found only 7.8% had SCD caused by HCM. These results suggest that prescribed exercise can be safe in non-athletes.
A cross-sectional study of 187 HCM patients with left ventricular hypertrophy investigated if a history of vigorous exercise was associated with adverse events including ventricular arrhythmias. It found that vigorous exercise was not associated with ventricular arrhythmias. Saberi et al conducted the first randomised controlled trial (RCT) designed to investigate the effect of prescribed training in HCM patients. 136 patients were randomised into a normal activity group and a 16 week prescribed moderate- intensity training group. At 16 weeks, there was an absolute increase of 6% in the mean change in peak oxygen consumption (peak VO2) between the groups. This was an important finding as the HF-ACTION trial found that every 6% increase in peak VO2 was associated with an 8% lower risk for cardiovascular mortality.
Modified Mitchell's classification

Conclusion
Current guidelines on exercise for patients with HCM are very restrictive. The recommendations for level of exercise are focused on prohibition rather than encouraging a safe and sensible level of exercise. RESET-HCM is the first RCT of its kind which successfully shows that carefully guided exercise is not only safe but can also be beneficial for patients. With more studies targeting the role of exercise and activity in these patients, it is only a matter of time before our focus switches from restricting activity to sensible exercise prescription.
P5551Comparison of prognostic predictors of heart failure admission and progression to end-stage in hypertrophic cardiomyopathy
Authors: Nakagawa S , Okada A , Hamatani Y , Amano M , Takahama H , Amaki M , Hasegawa T , Kanzaki H , Yasuda S , Izumi C 
Published: October 2019

Abstract

Background
Heart failure (HF) is a common complication within the clinical spectrum of hypertrophic cardiomyopathy (HCM). HCM-related HF is recognized to be multifactorial, including outflow obstruction, diastolic dysfunction, or progression to end-stage; however, prognostic predictors of HF events are not fully understood. We sought to investigate predictors for various HF outcomes in HCM.

Methods
We studied 289 consecutive HCM patients with EF≥50%. Patients with outflow obstruction (peak pressure gradient ≥30mmHg) were defined as obstructive HCM. HF events assessed in this study were 1) HF admission and 2) progression to end-stage (EF<50%).

Results
The mean age was 63±16 years, 53% male, EF 61±5%, NYHA class 1.8±0.7, and 39% obstructive. During a median follow up of 5.2 [3.7–7.0] years, 48 HF admission and 19 progression to end-stage were observed. Only 8/48 (17%) patients with HF admission had progressed to end-stage; while 11/19 (58%) patients with progression to end-stage remained free from HF admission. Univariate Cox regression hazard analysis showed different prognostic predictors between HF admission and progression to end-stage (Table). Multivariate Cox regression hazard analysis showed atrial fibrillation was an independent predictor of HF admission (adjusted HR 2.711 [1.094–7.389], P=0.031); while LV end-systolic dimension was an independent predictor of progression to end-stage (adjusted HR 1.114 [1.018–1.229], P=0.025).
Cox hazard analysis for predicting event HF admission Progression to end-stage HR (95% CI) P value HR (95% CI) P value Age, 1 year 1.042 (1.017–1.071) <0.001 1.002 (0.975–1.035) 0.89 Male sex 1.052 (0.595–1.882) 0.86 2.853 (1.034–10.02) 0.043 Atrial fibrillation 3.247 (1.809–6.608) <0.001 1.434 (0.570–3.559) 0.44 Non-obstructive 0.850 (0.481–1.531) 0.58 5.439 (1.558–34.30) 0.005 LV end-diastolic dimension, 1mm 1.027 (0.981–1.077) 0.25 1.120 (1.035–1.218) 0.005 LV end-systolic dimension, 1mm 1.059 (1.008–1.110) 0.023 1.167 (1.080–1.258) <0.001 EF, 1% 0.974 (0.926–1.032) 0.36 0.894 (0.825–0.980) 0.018 LA volume, 1ml/m2 1.012 (1.001–1.020) 0.044 1.006 (0.978–1.023) 0.64 Transmitral E wave, 1m/s 1.013 (1.002–1.024) 0.025 1.006 (0.987–1.023) 0.50 Transmitral DcT, 1msec 0.999 (0.995–1.003) 0.59 0.985 (0.974–0.994) <0.001 E/e', 1.0 1.062 (1.012–1.109) 0.015 1.089 (1.010–1.164) 0.027

Conclusions
Different prognostic predictors were found for HF admission and progression to end-stage, suggesting the difficulty and multifactorial nature of HCM-related HF.
P5553Right ventricular involvement in hypertrophic cardiomyopathy: insights from a tertiary centre
Authors: Pereira A R , Cruz I , Almeida A R , Marques A , Alegria S , Gomes A C , Briosa A , Lopes L R , Ramalho M , Pereira H 
Published: October 2019

Abstract

Introduction
Hypertrophic cardiomyopathy (HCM) is the main cause of sudden cardiac death in the young and a cause of heart failure (HF) and death at any age. Nevertheless, adverse long-term outcomes are not easy to predict.

Objectives
To assess the prevalence and prognostic value of right ventricular (RV) involvement in patients (pts) with HCM.

Methods
Retrospective single-centre study of consecutive pts with HCM evaluated in a specialized consultation. Selected those submitted to cardiac magnetic resonance imaging (CMR) as the gold-standard for RV assessment. The primary endpoint (PE) was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, ventricular arrhythmias with hemodynamic instability and unplanned HF admission.

Results
Of a total of 181 pts, 104 fulfilled the inclusion criteria (mean age at first consultation 62.1±9.7 years, 63.5% male). Septal asymmetric phenotype was the most frequent (73.1%) and 24 pts (23.1%) had rest LV outflow tract obstruction. Mean value of maximum wall thickness was 18.8±4.6 mm. Regarding CMR parameters (Fig A), 5.8% had RV dysfunction and 2.9% RV free wall hypertrophy; no patient presented RV dilation. Late gadolinium enhancement (LGE) of joint points was observed in 47.1%. During follow-up (FU, mean 56.6±29.5 months), survival free of RV dysfunction was 94.3%. Only 5 pts developed RV compromise assessed by echocardiographic parameters: TAPSE 12.0±3.4 mm and pulsed tissue Doppler systolic annular velocity (tricuspid S') wave 7.3±0.9 cm/s. These pts were significantly older (p<0.01) and had higher values of average tissue doppler E/E' ratio at diagnosis (p<0.01). Global RV involvement (at diagnosis or during FU) were associated with increased values of indexed left atrial area (p<0.01), LV dysfunction (p=0.01), LGE of joint points (p=0.01) and higher values of NT-proBNP (p=0.01). In multivariate logistic regression, left atrial enlargement was the only independent predictor of global RV dysfunction (OR 1.9, 95% CI 1.1–3.2, p=0.01) and average E/E' ratio an independent predictor of RV dysfunction during FU (OR 1.3, 95% CI 1.1–1.5, p<0.01). PE rate was 10.6%. It was significantly higher in pts with global RV involvement and there was a significant difference in survival analysis (Fig B). Average E/E' ratio (OR 1.5, 95% CI 1.1–1.9, p=0.01) and RV ejection fraction (OR 0.8, 95% CI 0.7–0.9, p=0.01) were independent predictors of the outcome.

Conclusions
Although not common, RV dysfunction was associated with a higher rate of cardiovascular events. Average E/E' ratio, as a measure of left ventricular filling pressure, was a risk factor for both RV dysfunction and PE. Higher values of RV ejection fraction were protective of adverse events occurrence. Together, these results support a potential role of RV function in the risk stratification of HCM pts.