bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4337Construction and validation of the instrument “nutritional knowledge and feeding practice scale – QCPA” – for children, 7 to 11 years
Authors: Bozzetto-Silva A B S , Piccoli A , Dal Ri C S D R , Pellanda L C P 
Published: October 2019

Abstract

Introduction
The increase in the prevalence of obesity is one of the major public health problems. There is a weak relationship between nutritional knowledge and feeding practices. Studies have evaluated that the associations between obesity and the level of nutritional knowledge and feeding practices in children are scarce. The evaluation of nutritional knowledge and feeding practices should be carried out using validated instruments. Study showed the need to improve the instruments of habit research and feeding practices in children for better evaluation. Objectives: To develop and validate an instrument about nutritional knowledge and feeding practices for use in children from 7 to 11 years, based on the Food Guide for the Brazilian Population.

Methods
The study filled all the steps expected to validate an instrument: review on the subject, instrument elaboration, Content's Validity (Content Validity Index – CVI) with two groups of judges: 1° – nutritionists and, after adjustments, 2° – multidisciplinary group), FACE Validity, reliability analysis [Intraclass Correlation Coefficient (ICC) and Kappa (K), Internal Consistency Analysis - Cronbach's Alpha] and Validity of Construct (Exploratory Factorial Analysis - EFA) The sample was calculated, considering, at least, 10 subjects for each question of the questionnaire.

Results
Validation occurred in a final sample of 453 children, 46.4% boys and 53.6% girls, mean age 9.45 (SD = 1.44). The validity of the content presented CVI ≥0.80 for relevance in 62.3% of items for nutritionist group and 100% of items for multidisciplinary group), clarity (49.4%, 91.8%), Pertinence (58.8%, 98.4%), respectively. The test-retest had a level of agreement of 84.3% and K=0.740 for the Knowledge Dimension; and the ICC=0.754 for the Practices Dimension. Cronbach's Alpha, for internal consistency analysis, was α=0.589 for the Knowledge Dimension and α=0.618 for the Practices Dimension. The EFA with variance of 47.01% (7.81% at 10.85%), with varimax rotation, it defined five factors for the Practices Dimension: Involvement; Healthy Eating and drinking; Unhealthy eating and drinking; Basic food consumption; Attitudes during the meal.

Conclusion
The instrument QCPA demonstrated validity and reliability to evaluate nutritional knowledge and practices in children aged 7 to 11 years.
P4344An example that big data analysis is ready for the prime time
Authors: Cortina C , Sarrion M , Mora L , Suberviola V , Beltran C , Gomez E , Sanchez A , Dominguez M , Vaqueriza D , Giganto M , Munoz R 
Published: October 2019

Abstract

Introduction
Data about the epidemiology of valvular heart disease (VHD) is scarce. The increasing aging of the population may cause an augmented prevalence of VHD, with a great number of comorbidities that conveys a higher surgical risk. The aim of this study was to describe the prevalence of VHD in the patients attended at our institution from 2007 until 2017 and to describe the main characteristics of this population.

Methods
We used a new tool based on EHRead Technology to extract clinical relevant information from Electronic Health Records, designed for descriptive and predictive big data analysis. All medical reports generated at the outpatient clinic, ER or hospitalization ward were examined. Patients with a diagnosis of moderate or severe VHD were selected. The prevalence of VHD was also estimated in 2 quintiles, from 2008 until Feb 2013 and from March 2013 until Dec 2017.

Results
The total prevalence of VHD in our population was 1.04% (n=3431). Mitral regurgitation was the most frequent valvular lesion (0.4%, n=1318), followed by aortic stenosis (0.3%, n=967) and aortic regurgitation (0.28%, n=938). There was a clear female predominance (63%), and the median age was 76.4. In the 1st quintile the prevalence of VHD was 0.25%, and increased to 0.79% in the 2nd. This trend was consistent in all type of valvular lesions. The prevalence of comorbidities was higher than in other epidemiological studies (Table).
Prevalence of comorbidities Severe MR Severe AS Severe AR Euro Heart Valve Survey Hypertension 54,5% 69,1% 47,9% 49% Dyslipidemia 32,2% 40,6% 27,4% 35% Diabetes Mellitus 28,0% 31,5% 16,4% 15% Smoking (current) 5,6% 5,4% 13,7% 39% Coronary heart disease 12,0% 17,0% 12,3% 13% Stroke 7,0% 8,9% 5,5% 7% Chronic kidney disease 18,9% 16,9% 20,5% 15% Chronic obstructive pulmonary disease 11,2% 9,9% 11,0% 15% MR: Mitral regurgitation, AS: aortic stenosis, AR: aortic regurgitation, MS: mitral stenosis.
Sex Distribution

Conclusions
The older age and greater number of comorbidities seen in our series over the past ten years, compared to the Euroheart Valve Survey reinforce the idea that the percutaneous valvular therapies should play a major role in the treatment of patients with VHD. Although, the prevalence of VHD may be underestimated in our population, due to the methodology, it reflects an ever-growing pathology in an older and sicker population.
P4355Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up
Authors: Annone U , Omede' P , D'Ascenzo F , Montefusco A , Milan A , Moretti C , Grosso Marra W , Veglio F , Gaita F 
Published: October 2019

Abstract

Introduction
Prognosis in pulmonary hypertension (PH) is strictly linked to right ventricle (RV) failure, which results from uncoupling between RV and the superimposed pressure load; in first phases, coupling between these two actors still be preserved, at the price of augmented right ventricle wall tension (RVWT).

Purpose
We sought to describe how to estimate RVWT with echocardiography, how it correlates with RV hemodynamics and if it may predict prognosis.

Methods
A total of 190 patients without overt RV failure, with suspected pulmonary hypertension (PH) to a previous echocardiography, underwent to right heart catheterization (RHC) and nearly-simultaneous echocardiography. We estimated RVWT according to Laplace law (RV length × tricuspid regurgitation peak gradient [TRPG]), in order to predict initial RV stress, and was correlated with RV hemodynamic profile; its potential prognostic impact was tested along with canonical RV function parameters.

Results
In patients enrolled in our study, RVWT correlated significantly with invasive estimation of right ventricle end diastolic pressure (R 0.343, p<0.001); a significant relationship between RVWT and several hemodynamic variables was observed (mean pulmonary artery pressure, pulmonary artery compliance, transpulmonary gradient, pulmonary vascular resistance, RV telediastolic pressure, right atrial pressure, RV stroke work index; all p<0.001). At a mean follow up of five years and three months, only RVWT predicted all-cause mortality (p 0.036), while TAPSE, TAPSE/TRPG, RV fractional area change and RV S' wave did not.
Correlation: RWVT and RV hemodynamic Hemodynamic variable R R2 p value Mean pulmonary artery pressure 0.742 0.550 <0.001 RV differential pressure 0.794 0.630 <0.001 Pulmonary artery pulsatory pressure 0.740 0.547 <0.001 Mean right atrium pressure 0.326 0.106 <0.001 Cardiac index/right atrial pressure 0.209 0.044 0.012 RV stroke work index 0.588 0.346 <0.001 Pulmonary artery compliance 0.449 0.202 <0.001 Pulmonary vascular resistance 0.531 0.282 <0.001
Prognosis: different RV variables

Discussion
We identified a novel bedside echocardiographic predictor of altered RV hemodynamic, which results precociously altered in patients without overt RV failure, and able to predict all cause mortality at a long term follow up. Further studies are needed to confirm its role in PH patients.
P43673D analysis of mitral annular reshape with third generation MitraClip XTr in functional and degenerative mitral regurgitation
Authors: Toscano E , Altizio S , Cianfanelli L , Denti P , Stella S , Capogrosso C , De Bonis M , Buzzatti N , Godino C , Latib A , Montorfano M , Camici P G , Castiglioni A , Alfieri O , Agricola E 
Published: October 2019

Abstract
The 3rd generation Mitraclip XTr was recently introduced to improve device performance, through longer clip arms that should allow better grasping of the mitral leaflets, thus improving coaptation and results eventually. Several studies have demonstrated additional effects such as the reshape of the mitral annulus immediately after clip implantation.
The aim of our study was to evaluate the mitral valve (MV) annular remodelling with MitraClip XTr.
Between March 2018 and November 2018, 75 consecutive patients were enrolled. The population was divided in two groups: functional mitral regurgitation (FMR) and degenerative mitral regurgitation (DMR).
The 3D MV datasets at baseline and immediately after the procedure were acquired and then analysed with semiautomatic MVQ software (QLAB Cardiac 3DQ v.10.0; Philips Medical Systems).
The software provides the following parameters: annular diameters (antero-posterior, AP, and inter-commissural, IC), circumference, area, height and ellipsicity (IC/AP ratio as percentage); saddle-index, defined as annular height to IC diameter ratio was derived.
The 3D post-processing was feasible in 54 patients (108 3D datasets): 28 had FMR (52%) and 26 had DMR (48%).
An average of 1.8 clips per patient were implanted: 2 clips in 38 (70%), 1 clip in 14 (26%) and 3 clips in 2 (4%) patients. The position was central in 93% of the procedures.
Results are reported in table 1. In the FMR group, a reduction in the AP diameter (p=0.001), an increase in both IC diameter (p=0.001) and annular ellipsicity (p<0.001) were observed.
In the DMR group, an increase in annular ellipsicity (p=0,008) and in saddle-index (p<0.05) were observed.
Table 1 Functional mitral regurgitation (N=28) Degenerative mitral regurgitation (N=26) Pre-clip Post-clip P-value Pre-clip Post-clip P-value IC diameter (mm) 39.3±4.2 41.9±4.1 0.001 40.9±6.5 41.8±5.8 0.257 AP diameter (mm) 32.8±4.6 30.4±3.2 0.001 32.6±4.8 31.7±4.5 0.199 Annular Height (mm) 5.1±1.8 5.4±1.8 0.336 4.8±1.9 5.7±2.2 0.026 3D circumference (mm) 122.7±15.1 123.5±11 0.718 123.5±19.0 124.0±17.1 0.812 3D area (mmq) 1128.0±280 1113.7±206 0.752 1160±346.7 1156.8±318.0 0.926 Annular ellipsicity (%) 121.5±12.2 138.5±11.8 0.0005 125.9±9.6 132.4±10.7 0.008 Saddle index 13.0±4 13.0±4 0.957 11.8±4.2 13.6±4.2 0.048
Our study demonstrates that the XTr implantation produces a MV annular remodelling both in FMR and DMR probably with different mechanisms. In FMR the MV annulus resulted more elliptical, wheras in DMR the geometrical modifications involve both the ellipsicity and the saddle-shape morphology.
P4369Direct comparison of prognostic value of echocardiographic parameters of right ventricular dysfunction in normotensive patients with acute pulmonary embolism
Authors: Kurnicka K , Ciurzynski M , Hobohm L , Thielmann A , Sobkowicz B , Sawicka E , Kostrubiec M , Ptaszynska K , Lankeit M , Pruszczyk P 
Published: October 2019

Abstract

Background
Although various echocardiographic parameters of right ventricular dysfunction (RVD) were reported to be of prognostic value in normotensive patients with acute pulmonary embolism (APE), an optimal definition of RVD on echocardiography is missing.

Purpose
We performed a direct comparison of prognostic value of RV/LV ratio, TAPSE, and TRPG/TAPSE for complicated clinical course that included: in-hospital APE related mortality, hemodynamic collapse or rescue thrombolysis.

Methods
Prospective cohorts of APE patients normotensive at admission, managed according to the ESC Guidelines 2014 were merged in a collaborative database. Transthoracic echocardiography was performed at admission, as soon as possible. All studied parameters were available in each patient. AUC in ROC analysis were assessed for each parameter and were compared between them. Multivariable Cox regression analysis was performed to assess the combination of echo-parameters.

Results
Overall, 490 pts were included in the study (229F), aged 64±18 years. Clinical endpoint occurred in 31 pts including 8 APE related deaths. AUC for SAE of RV/LV, TAPSE and TRPG/TAPSE were similar (Figure 1). TAPSE <16mm compared to other echo-parameters showed the highest PPV and NPV (Table 1). Cox regression analysis including SBP, HR, age, elevated troponin and echo-parameters showed that only blood pressure, RV/LV >1 and TAPSE <16mm were identified as independent predictors of outcome (HR 0.98 (95% CI: 0.96–0.99), p=0.03; 2,53 (95% CI: 1.2–5.7), p<0.03 and 3,76 (95% CI: 1.74–8.11), p<0.001).
Table 1. Predictive values of proposed cut offs of echocardiographic parameters Parameter Sensitivity Specificity PPV NPV TAPSE <16mm 52% 85% 18% 96% RV/LV >1.0 74% 63% 12% 95% TAPSE<20 & TRPG/TAPSE >4.5 10% 94% 10% 94%
Figure 1

Conclusions
Although all TAPSE, RV/LV ratio and TRPG/TAPSE showed similar performance for prognosticating of in-hospital outcome in normotensive PE patients, TAPSE<16mm showed the highest predictive value for identification of patients at risk of complicated clinical course.
P4376Circumferential ascending aortic strain in healthy adults aged 24 to 75 years
Authors: Shi J , Wang Y S , Zhao W P , Pan C Z , Shu X H 
Published: October 2019

Abstract

Background
Two-dimensional speckle-tracking echocardiography (2D-STE) for the measurement of circumferential ascending thoracic aortic strain (CAAS) in healthy adults is not elucidated. We aimed to establish normal adult STE-derived CAAS and to evaluate associations with age, gender and other physiologic parameters.

Methods
One hundred eighty-one healthy subjects aged 24–75 were prospectively gathered and examined with two-dimensional echocardiography. The global peak CAAS was the parameter used, and an average of six segments of arterial wall deformation was calculated. The corrected CAAS was calculated as the global CAAS/pulse pressure (PP). Aortic stiffness (β2) index was assessed according to ln(Ps/Pd)/CAAS.

Results
We included 171 healthy subjects (age 44.3±10.9 years, 50% female, CAAS16.0±6.9%). The CAAS was independently predicted by age (β=−0.387, P<0.001), and gender (β=−2.701, P=0.001). The corrected CAAS was independently predicted by age (β=−0.009, P<0.001), SAC (β=−0.206, P<0.001) and gender (β=−0.068, P=0.001). The β2 index was independently predicted by age (β=0.136, P<0.001), and PP (β=0.059, P=0.007).

Conclusion
CAAS using 2D-STE can be performed on a clinical basis and may become an important method for the assessment of aortic mechanical parameter. Age, gender and LV afterload-related variables were the most import determinants of 2D-STE global CAAS. Therefore, these factors should be taken into account for strain interpretation in clinical practice.
P4380Echocardiographically determined myocardial work An emerging bioassay for clinical studies Results from the STAAB cohort study
Authors: Morbach C , Sahiti F , Tiffe T , Cejka V , Breunig M , Eichner F , Gelbrich G , Heuschmann P U , Stoerk S 
Published: October 2019

Abstract

Introduction
A novel echocardiographic method to non-invasively determine myocardial work based on speckle-tracking derived longitudinal strain and blood pressure has recently been validated and offers new opportunities to study the mechanistic associations. Heart failure patients with prolonged electrical conduction (ie, left bundle branch block) exhibit reduced myocardial global work efficiency (GWE) due to an increase in global wasted work (GWW), which could be improved by biventricular pacing. We here investigated the association of ETI and myocardial work in a non-diseased population.

Methods
The Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study carefully characterized a representative sample of the population of a medium-sized town in Germany, aged 30–79 years and free from heart failure. Off-line analysis of the standardized, quality-controlled transthoracic echocardiograms regarding myocardial work yields the following parameters: global constructive work (GCW): work performed during shortening in systole and adding negative work during lengthening in isovolumic relaxation; global wasted work (GWW): negative work performed during lengthening in systole adding work performed during shortening in isovolumic relaxation; and global work efficiency (GWE): GCW/(GCW+GWW).

Results
We performed myocardial work analysis in 935 individuals from the sample of the first planned STAAB interim analysis who were in sinus rhythm, had preserved left ventricular ejection fraction and were free from significant valvular disease (51% female, 53±12 years). In linear regression including age, sex, heart rate, and ETI, we found increasing heart rate (64±10 bpm), QRS width (95±12 ms), QT interval (414±28 ms), and PQ interval (164±28 ms) associated with lower GWE (−0.11, −0.02, −0.03, and −0.001, respectively; all p<0.05) and higher GWW (+2.64, +0.29, +0.79, +0.16 mmHg%, respectively; all p<0.05).

Conclusion
In subjects free of overt cardiac disease, GWE strongly associated with ETI. Prolonged atrio-ventricular and intra-ventricular coupling and repolarization was associated with an increase in wasted work, while constructive work was not affected. These findings not only suggest a positive effect on myocardial energetics by reducing the heart rate, but also advocate the concept of myocardial work as a bioassay that is responsive to subtle changes. Myocardial work holds promise to be further studied in diseased patient groups.

Acknowledgement/Funding
German Ministry of Research and Education within the Comprehensive Heart Failure Centre Würzburg (BMBF 01EO1004 and 01EO1504)
P4416Influence of rosuvastatin on the secretion of leptin and its receptor by adipocytes isolated from different adipose depots in patients with ischemic heart disease
Authors: Dyleva Y A , Gruzdeva O , Uchasova E , Borodkina D , Belik E , Sinitsky M , Kozyrin K , Karetnikova V , Barbarash O 
Published: October 2019

Abstract

Obesity is still a major health, social and economic problem throughout the world. Recently, it is important to study the role of adipokines of adipose tissue of various localization in the development of cardiovascular diseases, as well as methods for their pharmacological correction.

Purpose
The study was to evaluate the effect of rosuvastatin on the secretion of leptin and its receptor by adipocytes of different localization, as well as on the expression of their genes in patients with ischemic heart disease.

Methods
29 patients with coronary heart disease which will be held coronary bypass surgery. Adipocytes were isolated from the samples of SAT, EAT and PVAT obtained during coronary artery bypass grafting, which were cultured for 24 hours with rosuvastatin 1 μmol/l and 5 μmol/l. A day later, the concentration of leptin and the leptin receptor in cell culture was determined. All study was carried out in compliance with the Helsinki Declaration, and its protocol was approved by the Ethical Committee of Research Institute. Statistical analysis was performed using Statistica 10.0. All patients gave written informed consent to participate in the study.

Results
1 μmol/l of rosuvastatin increased the level of leptin 1.6 and 2.9 times higher in adipocytes SAT compared with EAT and PVAT, respectively, and 1.8 times higher in EAT than in PVAT, which is consistent with the results of expression leptin gene. The concentration of rosuvastatin 5 μmol/l had an effect only on adipocytes SAT, increasing the level of leptin 1.6 and 2.2 times in comparison with adipocytes EAT and PVAT. Rosuvastatin had no significant effect on leptin receptor soluble levels. The free leptin index was higher in adipocytes SAT in the presence of 1 μmol/l of rosuvastatin 1.6 and 2.8 times in comparison with adipocytes of EAT and PVAT.

Conclusion
The concentration of rosuvastatin 1 μmol/l had a more pronounced effect on adipocytes compared to a concentration of 5 μmol/l and increased the level of leptin and its expression in cell culture. At the same time, a high content of leptin under conditions of low expression of a soluble receptor to leptin in the presence of rosuvastatin 1 μmol/l can lead to leptin resistance, more pronounced in SAT adipocytes.
P4418Temporal analysis of leukocyte extravasation and morphological activation after standard cardiopulmonary exercise testing in patients with heart failure with reduced ejection fraction
Authors: Bahls M , Kia S , Kaczmarek S , Lehnert K , Urbaneck I , Landmesser U , Felix S E , Doerr M , Kraenkel N 
Published: October 2019

Abstract

Introduction
Long-term exercise training reduces the systemic inflammatory load in patients with cardiovascular diseases. Acutely, however, an exercise challenge can trigger pro-inflammatory responses. The underlying cardiac syndrome might also influence the response of the adaptive and innate immune system to an acute exercise challenge.

Purpose
We compared the acute response to a standardized cardiopulmonary exercise test (CPET) in patients with heart failure with reduced ejection fraction (HFrEF) and age matched controls.

Methods
Patients with HFrEF (n=8; left ventricular ejection fraction [LVEF] ≤40%) and controls (n=9, LVEF ≥50%) participated in a CPET. Blood samples were taken before, immediately after and 2 hours after the test. Quantitative and morphological changes in leukocyte subpopulations, and formation of leukocyte-platelet aggregates were assessed in fresh blood samples by flow cytometry. Results are given as median and inter-quartile range (IQR).

Results
HFrEF (mean LVEF: 34%) and controls (mean LVEF: 57%) were 59 (range: 41 to 80) and 57 (range: 50 to 65) years old, respectively. In both groups acute exercise increased total leukocytes per mL of blood (control: 1.37-fold [IQR: 1.16 to 1.49]; HFrEF: 1.24-fold [IQR: 1.20 to 1.32]), relative abundance of circulating NK cells (controls: 2.11-fold [IQR: 1.30 to 3.13]; HFrEF: 1.67-fold [IQR: 1.56 to 1.71] and NK-T cells (control: 1.69-fold [IQR: 1.52 to 3.60]; HFrEF: 1.62-fold [IQR: 1.60 to 2.53]). Contrarily, only in HFrEF patients CD4+ (control: 1.15-fold [IQR: 0.84 to 1.54]; HFrEF: 1.45-fold [IQR: 1.10 to 1.98]) and CD8+ T cells (control: 1.33-fold [IQR: 1.01 to 1.68]; HFrEF: 1.70-fold [IQR: 1.25 to 2.15]) were augmented. Circulating monocyte and neutrophil numbers did not change in response to CPET. Aggregation of thrombocytes with monocytes (control: 0.86-fold [IQR: 0.78 to 1.49]; HFrEF: 1.59-fold [IQR: 1.05 to 7.30-fold]), T-lymphocytes (control: 1.27-fold [IQR: 1.05 to 1.68]; HFrEF: 1.49-fold [IQR: 1.03 to 2.64]) and neutrophils (control: 1.08-fold [IQR: 0.87 to 1.25]; HFrEF: 2.13-fold [IQR: 1.62 to 2.19]) increased 2 hour post-exercise in HFrEF patients, but not in controls.

Conclusion
Patients with HFrEF show a differential leukocyte response to an acute exercise challenge, with an increase in T-lymphocyte abundance, a degranulation response in the intermediate monocyte subpopulation and an increased formation of neutrophil-platelet-aggregates compared to control subjects. Our data suggest differences in release and organ-homing of innate versus adaptive immune cells, thus underlining the importance of inter-organ communication in the acute adaption to physical exertion in HFrEF.