bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3774Prediction of left atrial appendage thrombosis in nonvalvular atrial fibrillation by means of predictors not related to CHA2DS2-VASc score
Authors: Gizatulina T , Khorkova N Y , Belokurova A V , Kharats V E , Martyanova L U 
Published: October 2019

Abstract

Background
Nonvalvular atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia and the most frequent cause of cardio-embolic stroke. It is well known that left atrial appendage thrombi (LAAT) are the source of most embolic strokes in patients with AF, and can be easily identified by transesophageal echocardiography (TEE).

Purpose
To determine additional LAAT predictors not included in the CHA2DS2-VASc score in patients with nonvalvular AF.

Methods
Retrospective study enrolled 636 patients with nonvalvular AF (400 males) aged 24–84 years (mean age 57.8±9.1), admitted to our Research Center in 2014–2017 for catheter ablation or electrical cardioversion. All patients had scheduled transthoracic echocardiography (TTE), as well as TEE performed to exclude LAAT. Four forms of cardiac geometry were revealed with the help of TTE according to Recommendations of ASE and EACI: normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy.

Results
According to TEE results, LAAT (6.6%) was detected in 42 patients from 636. Patients with LAAT more often had persistent and permanent AF (assigned as “AF stability”), had bigger sizes and volumes of left and right cardiac chambers, lower left ventricular ejection fraction, more expressed LV hypertrophy and lower blood flow velocity in the LA appendage compared to patients without LAAT. Remodeling types also varied: less LAAT patients had normal cardiac geometry and more LAAT patients had LV eccentric hypertrophy. To analyze factors associated with AF, we used a multivariable logistic regression model, involving the potential independent, clinically relevant variables and echocardiographic parameters. Logistic regression analysis identified the latter three as independent predictors for LAAT (Table 1). According to ROC-analysis the quality of the received model was assessed as good: AUC=0.763 (p<0.01), sensitivity – 75.8%, specificity – 72.2%.
Table 1 Predictors B Wald statistics χ2 P OR 95% CI AF stability 0.913 4.143 0.042 2.491 1.034–6.000 LA diameter, mm 0.149 8.684 0.003 1.160 1.051–1.281 Eccentric hypertrophy 1.440 7.411 0.006 4.222 1.497–11.908 Constant −10.613 24.088 0.000

Conclusion
From risk factors, not included in the CHA2DS2-VASc score, in addition to such predictable values as AF stability and left atrial diameter, such predictor as eccentric left ventricular hypertrophy was revealed, which in our study was associated with more than a 4-fold increase in the risk of LAAT.
P3782Frailty to predict unplanned hospitalizations, stroke, bleeding and death in atrial fibrillation
Authors: Meyre P , Gugganig R , Aeschbacher S , Leong D P , Blum S , Coslovsky M , Beer J H , Moschovitis G , Mueller D , Rodondi N , Stempfel S , Mueller C , Kuehne M , Conen D , Osswald S 
Published: October 2019

Abstract

Aim
We investigated the prevalence of frailty, and the relationships between frailty and the risk of adverse clinical outcomes in patients with atrial fibrillation (AF).

Methods
Patients with known AF were enrolled in a nation-wide observational cohort study in Switzerland. Information on medical history, medication, lifestyle factors and clinical measurements were obtained. The primary outcome was unplanned hospitalizations, secondary outcomes were all-cause mortality, bleeding and stroke. The frailty index (FI) was measured using a cumulative deficit approach according to previously published criteria. Participants were divided into three groups (non-frail, pre-frail and frail) according to their FI at study entry. The association between frailty and clinical outcomes was assessed using multivariable adjusted Cox proportional hazard models.

Results
We included 2369 patients with a mean age of 73±8 years (27.3% female). The prevalence of frailty and pre-frailty was 10.6% and 60.7%, respectively. Frailty was associated with unplanned hospitalization (adjusted hazard ratio [HR] 3.59; 95% confidence interval [95% CI], 2.78–4.63; p<0.001), all-cause mortality (adjusted HR 16.72; 95% CI 7.75–36.05; p<0.001), bleeding (adjusted HR 2.46; 95% CI 1.61–3.77; p<0.001), and stroke (adjusted HR 3.29; 95% CI 1.29–8.39; p=0.01) (Figure). Similarly, pre-frailty was significantly associated with unplanned hospitalization (adjusted HR 1.82; 95% CI 1.49–2.22; p<0.001), all-cause mortality (adjusted HR 5.07; 95% CI 2.43–10.59; p<0.001) and bleeding (adjusted HR 1.53; 95% CI 1.11–2.13; p=0.01), but not with stroke.
Cumulative incidence of adverse events

Conclusion
In our cohort, more than two thirds of AF patients were either pre-frail or frail. These patients have a high risk of unplanned hospitalizations and other adverse outcomes, indicating that frailty is a powerful tool to predict adverse clinical outcomes in AF patients.

Acknowledgement/Funding
Swiss National Science Foundation; Foundation for Cardiovascular Research Basel; University of Basel
P3799Experimental model of interatrial block by Bachmann bundle conduction block
Authors: Guerra Ramos J M , Vilahur G , Bayes De Luna A , Casani L , Cabrera J A , Martinez-Selles M , Mendieta G , Baranchuk A , Badimon L , Sanchez-Quintana D 
Published: October 2019

Abstract

Background
The recognition of advanced IAB is becoming an important clinical landmark due to its association with atrial fibrillation, the so-called Bayes' syndrome. The electrocardiographic (ECG) criteria of interatrial block (IAB) have been established. A P-wave duration ≥120 ms is considered partial IAB and if there is a biphasic P-wave in the inferior leads advanced IAB. The pathophysiology of this ECG finding has been largely discussed. IAB has been explained as the result of the retrograde activation of left atrium due to complete block in the Bachmann bundle (BB).

Purpose
To assess the ECG changes resulting of blocking BB conduction in an experimental healthy animal model. Additionally, to compare the pattern of activation of the left atrium before and after the block.

Methods
Six open-chest anesthetized healthy adult swine were studied. A twelve-lead ECG was continuously recorded. The BB was epicardially accessed at the traversus sinus of the pericardium. At that level, monopolar electrosurgical energy (3 animals) and radiofrequency energy (3 animals) (Boston Scientific Blazer™ II XP, 8 mm tip) was applied until extensive tissue disruption was present and permanent P-wave changes observed. An electroanatomical map CARTO® XP (Biosense Webster Inc) of the right and left atrium was performed in two animals before and after energy deployment. Finally, animals were sacrificed, and tissue samples collected for anatomopathological examination.

Results
After energy application, all animals showed a significant prolongation of P-wave duration from 59±11 msec to 115±13 msec (p<0.001) with appearance of a biphasic P-wave pattern in the inferior leads. The CARTO® maps showed a change in left atrial activation, cranio-caudal at baseline and caudo-cranial at the end of the procedure. (Figure) The histological analysis showed transmural lesions at the level of the BB in all the specimens.
ECG/CARTO maps: Baseline and after block

Conclusion
IAB ECG pattern, accompanied by a marked change in the activation of the left atrium, develops after blocking the conduction at the level of the BB in an experimental healthy animal model. These results confirm the association of IAB and BB conduction block and suggest that IAB represents an independent entity.

Acknowledgement/Funding
Fundaciό Privada Daniel Bravo Andreu
P3812The economic burden of heart failure in Denmark from 1998 to 2016
Authors: Bundgaard J S , Mogensen U M , Christensen S , Ploug U M , Roerth R , Ibsen R , Kjellberg J , Koeber L 
Published: October 2019

Abstract

Background
Heart failure (HF) imposes a large burden on the individual as well as society and the aim of this study was to investigate the economic burden attributed to direct and indirect costs of patients with HF before, at, and after time of diagnosis.

Methods
Using Danish nationwide registries we identified all patients >18 years with a first-time diagnosis of HF from 1998–2016 and matched them 1:1 with a control group from the background population on age, gender, marital status, and educational level. The economic analysis of the total costs after diagnosis was based on direct costs including hospitalization, procedures, medication, and indirect costs including social welfare and lost productivity to estimate the annual cost of HF.

Results
We included a total of 176,067 HF patients with a median age of 76 years, and 55% were male. Patients with HF incurred an average of €17,039 in sum of total annual direct (€11,926) and indirect (€5,113) health-care costs peaking at year of diagnosis compared to €5,936 in the control group with the majorityattributable to inpatient admissions. The total annual net costs including social transfer after index HF were €11,957 higher in patients with HF compared to controls and the economic consequences increased markedly 2 years prior to the diagnosis of HF (Figure 1).

Conclusion
Patients with HF impose significantly higher total annual health-care costs compared to a matched control group with findings evident more than 2 years prior to HF diagnosis

Acknowledgement/Funding
Novartis
P3821Resting heart rate in late adolescence and long term risk of cardiomyopathy - A nationwide study of one million Swedish men
Authors: Lindgren M , Robertson J R , Adiels M A , Schaufelberger M S , Aberg M A , Toren K T , Waern M W , Aberg N D , Rosengren A R 
Published: October 2019

Abstract

Background/Introduction
Elevated resting heart rate (RHR) is a known risk factor for HF. Whether elevated RHR is also associated with cardiomyopathy (CM), a common cause of heart failure in the young, is unknown.

Purpose
To investigate the association of resting heart rate (RHR) measured in late adolescence with long term risk of various subtypes of CM with special attention to cardiorespiratory fitness (CRF), an important predictor of RHR and myocardial dysfunction.

Methods
We followed a cohort of Swedish men enrolled for conscription in 1968–2005 (n=1,008,485; mean age=18.3 years) until December 2014. Outcomes of CM were collected from the national inpatient- (IPR), outpatient- (OPR) and cause of death registries and were divided into categories: 1) dilated, 2) hypertrophic, 3) alcohol/drug-induced, and 4) other. Cox proportional hazard models were used to analyze the longitudinal association between RHR and outcomes while adjusting for potential confounders, including body mass index (BMI), arterial blood pressure and cardiorespiratory fitness (CRF). CRF was measured by maximum capacity ergometer testing as part of the enlistment protocol.

Results
During a mean follow up of 34 years, there were 3500 cases of a first hospitalization for CM (mean age at diagnosis, 50.1 years). Comparing the highest with the lowest quintile of the RHR distribution, we found a positive association between RHR and dilated CM (hazard ratio (HR) = 1.58 [confidence interval (CI) = 1.37–1.82]) after adjustment for BMI, age at conscription, conscription year, test center, and baseline comorbidities (diabetes, hypertension, congenital heart disease). There no significant association with alcohol/drug-induced (HR=1.32 [CI=0.94–1.85]) or other categories of CM.

Conclusion
Adolescent RHR is associated with future risk CM, independently of blood pressure, BMI and CRF. The association was driven by dilated CM. These findings are suggestive of a causal pathway between elevated heart rate and adverse cardiac remodeling that warrants further investigation.

Acknowledgement/Funding
The Swedish Heart and Lung Foundation, the Swedish Research Council, the Swedish Council for Health, Working Life and Welfare
P3823Body mass index or waist and hip circumference as predictors of outcome in the UK biobank
Authors: Pellicori P , Stanley B , Iliodromiti S , Celis-Morales C A , Lyall D M , Anderson J , Gray S , Mackay D F , Nelson S M , Welsh P , Pell J P , Gill J M R , Sattar N , Cleland J G F 
Published: October 2019

Abstract

Background
Controversies exist about the relationship between body habitus and mortality, especially for patients with cardiovascular disease.

Purpose
We evaluated the relations between different anthropometric indices and mortality amongst participants with and without cardiovascular (CV) risk factors, or established CV disease (stroke, myocardial infarction and/or heart failure), enrolled in the UK Biobank.

Methods
The UK Biobank is a large prospective study which, between 2006 and 2010, enrolled 502,620 participants aged 38–73 years. Participants filled questionnaires and had a medical history recorded, physical measurements done and biological samples taken. The UK Biobank is routinely linked to national death registries and updated on a quarterly basis. Data on death were coded according to the International Classification of Diseases, 10th Revision (ICD-10). The primary end-point was all-cause mortality (ACM) across three subgroups of men and women: those with, or without, one or more CV risk factors (smoking, diabetes and/or hypertension), and those with CV disease (history of stroke, myocardial infarction and/or heart failure) at recruitment. Presence, or absence, of CV risk factors and diagnoses of CV disease were self-reported by participants at enrolment. Associations between anthropometric indices (body mass index (BMI), waist circumference (WC), waist to hip ratio (WHiR), and waist to height ratio (WHeR)) and the risk of all-cause mortality were analysed using Cox regression models.

Results
After excluding those with history of cancer at baseline (n=45,222), 453,046 participants were included (median age: 58 (interquartile range: 50 - 63) years; 53% women), of whom 150,732 had at least one CV risk factor, and 17,884 established CV disease.
During a median follow-up of 5 years, 6,319 participants died. Baseline BMI had a U-shaped relationship with ACM, with higher nadir-values for those with CV risk factors or CV disease, for both sexes (figure). WC, WHiR and WHeR (measures of central distribution of body fat) had more linear associations with ACM, regardless of CV risk factors, CV disease and sex.

Conclusions
For adults with or without CV risk factors or established CV disease, measures of central distribution of body fat are more strongly and more linearly associated with ACM than BMI. WC, or WHiR, rather than BMI, appear to be more appropriate variables for risk stratification.
P3842One-year efficacy and safety of prasugrel and ticagrelor in patients with Acute Coronary Syndromes: results from a prospective and multicenter ACHILLES Registry
Authors: Esteve Pastor M A , Ruiz-Nodar J M , Rivera-Caravaca J M , Sandin Rollan M , Lozano T , Vicente-Ibarra N , Orenes-Pinero E , Macias-Villanego M J , Pernias-Escrig V , Carrillo-Aleman L , Candela E , Veliz-Martinez A , Tello-Montoliu A , Martinez-Martinez J G , Marin F 
Published: October 2019

Abstract

Background
Prasugrel and Ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with Acute Coronary Syndrome (ACS). However, the long-term prognosis and different clinical characteristics related with the type of antiplatelet prescription in current clinical practice ACS patients have not been analyzed in depth.

Purpose
The objective of this study was to analyze the clinical profile of ACS and the efficacy and safety of new antiplatelet drugs (NAD) in current clinical practice patients discharged after an ACS.

Methods
We collected data from ACHILLES registry, and observational, prospective and multicenter registry of patients discharged after an ACS. We analyzed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow-up, ischaemic and major bleeding events were analyzed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted.

Results
Of 1,717 consecutive patients, 1,294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. NAD was indicated in 47%. Patients treated with clopidogrel were elderly (69.1±13.4 vs. 60.4±11.5 years; p<0.001) and with a higher prevalence of cardiovascular risk factors. GRACE and CRUSADE score were higher in the clopidogrel than in NAD group (p<0.001). After 1 year of follow-up, 64 (5.0%/year) patients had a new myocardial infarction, 127 (10.0%/year) had a MACE and 78 (6.1%/year) patients died. Patients treated with clopidogrel had significantly higher annual rate of cardiovascular mortality, MACE and all cause-mortality (all of them p<0.001) without differences in major bleeding (p=0.587) compared with NAD therapy. After multivariate adjustment for the main clinical variables related with adverse prognosis in ACS patients, the discharge with NAD was independently associated with lower risk of all-cause mortality [HR 0.49, 95% CI (0.24–0.99); p=0.043] and lower risk of MACE [HR 0.65, 95% CI (0.43–0.99); p=0.049].
Event Free Survival according NAD Use

Conclusions
In this prospective, observational and current clinical practice ACS registry, the use of NAD was associated with a reduction of adverse events compared with clopidogrel in patients with ACS. NAD prescription at discharge was independently associated with lower all-cause mortality and MACE without differences in bleeding events. However, clopidogrel remained the most common P2Y12 inhibitor employed for ACS, especially in older and high risk population.
P3857Validation of the cardiac damage classification and additional effects of albumin levels in a large cohort of patients undergoing transcatheter aortic valve replacement
Authors: Berkovitch A , Barbash I M , Finkelstein A , Assali A R , Denenberg H , Fefer P , Maor E , Zhitomirsky S , Orvin K , Steinvil A , Barsheset A , Halkin A , Guetta V , Kornowski R , Segev A 
Published: October 2019

Abstract

Background
Risk stratification in patients undergoing transcatheter aortic valve replacement (TAVR) is limited and based on clinical judgment and surgical AVR scoring systems. Recently, extent of cardiac damage using an echocardiographic classification was purposed to assess prognosis of patients undergoing TAVR. We aimed to validate this new scoring system in a real-world cohort and to examine the addition of baseline albumin in risk assessment.

Methods
We investigated 2,608 patients undergoing TAVR. All subjects had an echocardiography test prior to TAVR. Subjects were divided into five groups based on their echocardiography findings: stage 0 – 758 (29%) patients, stage 1 – 769 (30%), stage 2 – 730 (28%), stage 3 – 320 (12%) and stage 4 (1.2%). Patients were further assessed by incorporating baseline albumin.

Results
Mean age of study population was 82±7 years. Kaplan-Meier's survival analysis showed that the cumulative probability of mortality was significantly higher among subjects with increased stage compared to the lower stages (p<0.001). Multivariable analysis demonstrated that each increase in stage was associated with significant increased risk of 1-year mortality (HR 1.37, 95% CI 1.23–1.54, p<0.001). Among patients at increased stage (3–4), incorporation of baseline of albumin identified the highest risk group, such that each 1 decrement in albumin levels was associated with more than triple increase in mortality among patients at stage 3 and 4 (HR 2.77, 95% CI 1.48–5.18, p-value=0.001)[figure]. When added to the scoring risk prediction model, albumin allowed more accurate risk stratification: continuous NRI analysis showed an overall improvement of 11% (95% CI 6%-16%) in the accuracy of classification.
KM according to stage and albumin

Conclusions
Cardiac damage classification is validated in a real-world cohort of patients undergoing TAVR. Incorporation of low baseline albumin may further identify patients at the highest risk group.
P4152Implications of the ACC/AHA risk score for heart failure risk prediction and its comparison with existing heart failure risk prediction models: A prospective population-based cohort study
Authors: Arshi B , Van Den Berge J C , Van Dijk B , Deckers J W , Ikram M A , Kavousi M 
Published: October 2019

Abstract

Background
In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) developed a score for assessment of cardiovascular risk. Due to between study variability in ascertainment and adjudication of heart failure (HF), incident HF was not included as an endpoint in the ACC/AHA risk score.

Purpose
To assess the performance of the ACC/AHA risk score for HF risk prediction in a large population-based cohort and to compare its performance with the existing HF risk prediction models including the Atherosclerosis Risk in Communities (ARIC) model and the Health Aging and Body Composition (Health ABC) model.

Methods
The study included 2743 men and 3646 women from a prospective population-based cohort study. Cox proportional hazards models were fitted using risk factors applied by the ACC/AHA model for cardiovascular risk, the ARIC model and the Health ABC model. Independent relationship of each predictor with 10-year HF incidence was estimated in men and women. Next, N-terminal pro-b-type natriuretic peptide (NT-pro-BNP) was added to the ACC/AHA model.
The performance of all fitted models was evaluated and compared in terms of discrimination, calibration and the Akaike Information Criterion (AIC). In addition, area under the receiver operator characteristic curve (AUC), sensitivity and specificity of each model in predicting 10-year incident of HF was assessed. The incremental value of NT-pro-BNP to the ACC/AHA model, was assessed using the continuous net reclassification improvement index (NRI).

Results
During a median follow-up of 13 years (63127 person-years), 387 HF events in women and 259 in men were recorded. The Optimism-corrected c-statistic for ACC/AHA model was 0.76 (95% confidence interval (CI): 0.73–0.79) for men and 0.76 (95% CI: 0.74–0.79) for women. The ARIC model provided the largest c-statistic for both men [0.82 (95% CI: 0.80–0.84)] and women [95% CI: 0.81 (0.79–0.83)] among the three models. Calibration of the models was reasonable.
Addition of NT-pro-BNP to the ACC/AHA model considerably improved model fitness for men and for women. The AIC improved from 3104.62 to 2976.28 among men and from 5161.63 to 4921.51 among women. The c-statistic also improved to 0.81 (0.78–0.84) in men and 0.79 (0.77–0.81) in women. The continuous NRI for the addition of NT-pro-BNP to the base model was 5.3% (95% CI: −12.3–28.6%) for men and 15.9% (95% CI: 2.7–24.7%) for women.

Conclusions
Compared to HF-specific models, the ACC/AHA model, containing routine clinically available risk factors, had a reasonable performance in prediction of HF risk. Inclusion of NT-pro-BNP in the ACC/AHA model strongly increased the model performance. To achieve a better model performance for 10-year prediction of incident HF, updating the simple ACC/AHA risk score with the addition of NT-pro-BNP is recommended.