bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6584Prevalence of early repolarization in Thailand and long term risk of cardiac mortality
Authors: Yodteerug S , Vathesatogkit P , Ngamukos T , Apiyasawat S , Chandanamattha P 
Published: October 2019

Abstract

Introduction
Early repolarization syndrome is associated with long-term cardiac mortality in Western countries. However, there is no study of this association in Southeast Asian population.

Purpose
To determine the prevalence of early repolarization and long term risk of cardiac mortality in general Thai population.

Methods
A total of 2,756 consecutive individuals participating in from the electricity generating authority of Thailand (EGAT) study between 1997 and 2015 were included in this study. Early repolarization pattern (ERP) was defined either as “notching” or “slurring” and was localized into inferior leads, lateral leads, or both. Mortality endpoints included cardiovascular (CV) events and all-cause mortalities. Multivariable Cox-proportional hazard model, adjusted for all major CV risk factors, was used to determine the association between ERP and outcomes.

Results
Out of 2756 individuals,2,689 had complete data (80% male, mean age 55). ECGs and risk factor profiles were included for analysis. Mean follow up duration was 11.2±6.7 years. There were 444 (16.5%) cases with early repolarization pattern (slurr 54.3%, notching 38.3% and both 7.4%). Inferior leads were the most common localization at 49.8%, followed by lateral leads (35.6%) and both (14.6%). Five-hundred and sixty-six participants were dead during the follow-ups. Of these, 21 were sudden death. ERP was not associated with a greater likelihood of all causes of deaths, 20.5% in ERP and 21.2% in non-ERP (hazard ratio,1.04; 95% confidence interval (CI), 0.81 to 1.34; p=0.75). The death rates from coronary heart disease were 7.2% in ERP and 7.6% in non-ERP (HR,1.06; 95% CI, 0.71 to 1.56; p=0.79). The death rates from cardiovascular disease were 11.7% in ERP and 12.0% respectively (HR,1.03; 95% CI, 0.75 to 1.41; p=0.872) and sudden cardiac death was not difference between both groups 1.2 and 1.4% respectively.

Conclusion
The prevalence of early repolarization in Thai middle-aged population is relatively high. Over a long-term follow-up of 18 years, we did not find any differences in sudden cardiac death or death from any causes between an early repolarizationgroup and non-early repolarization group.
P6589Genetic risks for arrhythmia phenotypes in dilated cardiomyopathy
Authors: Gigli M , Merlo M , Graw S , Barbati G , Rowland T , Stolfo D , Slavov D , Dal Ferro M , Sweet M , Altinier A , Brun F , Mc Kenna W , Taylor M , Sinagra G , Mestroni L 
Published: October 2019

Abstract

Background
Genotype-phenotype correlations in dilated cardiomyopathy (DCM) and in particular the effects of gene variants on clinical outcomes remain poorly understood.

Purpose
To investigate the prognostic role of genetic variant carrier status in a large cohort of DCM patients.

Methods
We analyzed 487 DCM patients by next-generation sequencing and categorized the disease genes into functional gene groups. The following composite outcome measures were assessed: 1) all-cause mortality, heart transplantation or left ventricular assist device (D/HTx/VAD); 2) sudden cardiac death or malignant ventricular arrhythmias (SCD/MVAs); 3) heart failure related death, heart transplantation or left ventricular assist device implantation (DHF/HTx/VAD).

Results
A total of 187 pathogenic/likely pathogenic variants were found in 180 patients (37%): 55 (11%) TTN; 19 (4%) LMNA; 24 (5%) structural cytoskeleton-Z disk genes; 16 (3%) desmosomal genes; 47 (10%) sarcomeric genes; 8 (2%) ion channels genes; 11 (2%) other genes. The occurrence of D/HTx/VAD was no different between variant carriers and non-carriers (p=0.17). However, carriers of desmosomal and LMNA variants experienced the highest rate of SCD/MVA, which was independent of the left ventricular ejection fraction.

Conclusions
Desmosomal and LMNA gene variants identify the subset of DCM patients at greatest risk for SCD and life-threatening ventricular arrhythmias, regardless the left ventricular ejection fraction.

Acknowledgement/Funding
National Institutes of Health grants R01 HL69071, HL116906, and AHA17GRNT33670495
P6603The predictive role of T786C single nucleotide polymorphism in endothelial no-synthase gene in late left ventricular remodeling after ST-segment elevation myocardial infarction
Authors: Petyunina O , Kopytsya M P , Berezin A E , Berezin A A 
Published: October 2019

Abstract

Introduction
Endothelial NO-synthase (eNOS) is constitutive enzyme, which is expressed in mature endothelial cells and promotes direct vascular dilatation. Single nucleotide polymorphism (SNP) of T786C in eNOS gene may influence on adverse cardiac remodeling after ST-elevation myocardial infarction (STEMI).

Purpose
To investigate possible associations between SNP T786C in eNOS gene and adverse cardiac remodeling after STEMI

Methods
177 acute STEMI patients treated with primary and facilitate percutaneous coronary intervention that were admitted to intensive care unit of a Therapy National Institute were enrolled in the study. Anthropometry, cardiovascular risk assay, coronary angiography, echocardiography and biomarkers' measure were performed at baseline. The DNA extraction was performed with a commercial kit using real-time polymerase chain reaction PCR. All procedures performed in the study involving human participants were in accordance with the ethical standards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and approved by the local ethics committee (Protocol No. 8, 29.08.2016). Written informed consent was obtained from each patient.

Results
There were correlations between 786CC polymorphism in eNOs gene and adverse cardiac remodeling (r=0.48; p=0.001), LDL cholesterol (r=0.32; p=0.012), type 2 diabetes mellitus (r=0.30; p=0.042), diastolic BP (r=−0.26; p=0.048), unstable angina prior to STEMI (r=0.25; p=0.047) and total quantity of complicated STEMI (r=0.23; p=0.042). Additionally, there were not significant relations between 786CC polymorphism in eNOs gene and multiple coronary vessel injury, STEMI localization, levels of circulating biomarkers of myocardial injury, and amount of damaged coronary arteries. Using univariate and multivariate regressive logistic analysis we found that 786CC genotype of eNOS was independent predictor for late adverse LV remodeling (β-coefficient = 1.57342; odds ratio = 4.8231; 95% confidence interval = 1.5349–15.1552; p=0.0071).

Conclusions
The polymorphism 786CC in eNOs gene was found as an independent predictor for late adverse cardiac remodeling after STEMI.

Acknowledgement/Funding
None
90Risk-adjusted comparison of in-hospital outcomes of transcatheter and surgical aortic valve replacement
Authors: Stachon P , Kaier K K , Heidt T H , Zehender M Z , Bode C B , Von Zur Muehlen C M 
Published: October 2019

Abstract

Background
Transcatheter aortic valve replacement (TAVR) is recommended for patients suffering from aortic valve stenosis at increased operative risk or age over 75 years. Beyond that patients with different co-morbidities could profit from TAVR.

Purpose
The present study analyzes in-hospital outcomes of aortic valve replacement procedures in order to identify subgroups of patients in which TAVR might be preferable.

Methods
For all 33,789 isolated transfemoral TAVR and SAVR procedures performed in Germany in 2014 and 2015, co-morbidities and in-hospital outcomes were identified by ICD- and OPS-codes.

Results
Patients undergoing TAVR were older with more co-morbidities and at increased estimated risk (logistic EuroSCORE TAVR: 13.9±10.3%; SAVR: 5.3±4.7%; p<0.001). In order to allow comparison of outcomes after TAVR and SAVR, a covariate and propensity-adjusted analysis was performed in different subgroups. The risk of mortality is significantly lower in patients undergoing TAVR with an age over 80 years (TAVR vs. SAVR 80–84: OR 0.55; p=0.002; ≥85 OR 0.42, p=0.006) and at high operative risk (patients with EuroSCORE >9: OR 0.62, p=0.001). No significant difference in in-hospital mortality occurs between TAVR and SAVR in patients under 80 and intermediate or low risk (<75: OR 0.85; p=0.404; 75–79 OR 0.82, p=0.219; EuroSCORE <4: OR 1.44, p=0.308; EuroSCORE 4–9: OR 0.81, p=0.156). In contrast, patients with advanced renal failure and patients in NYHA-class III/IV had better outcomes after TAVR (GFR<30: OR 0.45, p=0.005; NYHA III/IV: OR 0.72, p=0.015). Female sex, previous CABG, peripheral arterial disease, COPD, pulmonary hypertension, and diabetes were not found to be factors which favor a treatment strategy. Patients undergoing TAVR suffered more often from strokes and acute kidney failure. After risk-adjustment TAVR was associated with a lower risk for acute kidney injuries (OR 0.62, p<0.001). Risk for stroke was similar (OR 1.07, p=0.558). Risk of bleeding (OR 0.17, p<0.001) and requiring prolonged mechanical ventilation (>48h, OR 0.21, p<0.001) was decreased in patients undergoing TAVR. As expected, the TAVR procedure is associated with an increased risk for pacemaker implantations (OR 4.61, p<0.001).

Conclusions
The present study analyzing over 33.000 real-world procedures confirms that TAVR is the safer procedure in clinical practice for patients with severe aortic valve stenosis at increased operative risk, over 80 years, in NYHA-class III/IV, and with renal failure.
98Mitral annular calcification, mitral valve diseases and clinical outcomes in patients undergoing transcatheter aortic valve replacement for severe aortic stenosis
Authors: Okuno T , Asami M , Praz F , Heg D , Lanz J , Kassar M , Hoeller R , Khan F , Raeber L , Stortecky S , Windecker S , Pilgrim T 
Published: October 2019

Abstract

Background
Mitral annular calcification (MAC) and mitral valve diseases (MVD) have been identified as strong predictors of mortality in patients undergoing transcatheter aortic valve replacement (TAVR). However, the association between MAC and MVD, and the prognostic implications in these patients remain unclear.

Purpose
This study sought to investigate the association between severity of MAC and the prevalence of MVD as well as to assess the prognostic impact of MAC depending on the presence or absence of MVD in patients undergoing TAVR.

Methods
We identified 967 patients who have comprehensive echocardiographic and computed tomographic assessment of MVD and MAC from our institutional registry that is a part of the Swiss TAVI registry (NCT01368250) between August 2007 and June 2017.

Results
Among these patients, mild or moderate MAC was present in 45.2% and severe MAC was present in 17.8%. The prevalence of MVD was significantly higher in severe MAC patients, while the prevalence in patients with mild and moderate MAC was similar to patients without MAC. Compared to patients without severe MAC and MVD, an increased risk of all-cause death at 1 year was observed in patients with severe MAC and MVD (hazard ratio [HR]: 2.81, 95% confidence interval [CI]: 1.72–4.59, p<0.001) as well as in patients with non-severe MAC and MVD (HR: 2.80, 95% CI: 1.87–4.20, p<0.001) but not in patients with severe MAC and non-MVD (HR: 0.68, 95% CI: 0.27–1.70, p=0.409). In a multivariable analysis, severe MAC concomitant with MVD was found to be an independent predictor of new permanent pacemaker implantation after TAVR (Odds ratio: 2.08, 95% CI: 1.27–3.41, p=0.004).

Conclusions
Severe MAC was associated with higher prevalence of MVD. Severe MAC concomitant with MVD was associated with increased risks of mortality at 1 year and conduction abnormalities after TAVR, whereas severe MAC without MVD was not.
100Culprit plaque morphology in patients with and without preinfarction angina: an optical coherence tomography imaging study
Authors: Vergallo R , Porto I , Ricchiuto A , Buonpane A , Coletti F , Di Muro F , La Porta Y , D'Amario D , Montone R A , Niccoli G , Leone A M , Aurigemma C , Burzotta F , Trani C , Crea F 
Published: October 2019

Abstract

Background
The relation between culprit plaque morphology and the clinical presentation of an acute myocardial infarction (AMI) has not been examined in detail.

Purpose
To study the culprit plaque morphology in patients with AMI with or without preinfarction angina using optical coherence tomography (OCT) imaging.

Methods
A total of 102 patients with AMI (32 STEMI, 70 NSTEMI) who underwent OCT imaging before percutaneous coronary intervention were enrolled. Patients were classified as: i) having either intermittent chest pain in the six hours preceding the final episode of pain, or unstable angina (or both) in the week preceding AMI (preinfarction angina group); or ii) having a single episode of chest pain without unstable symptoms in the preceding week (no preinfarction angina group). Culprit plaque was classified as plaque rupture (PR) or intact fibrous cap (IFC), as previously described. Prati thrombus score was calculated, and the prevalence of calcification, neovascularization, and OCT-defined macrophage accumulation was assessed.

Results
Patients with preinfarction angina showed a significantly higher prevalence of IFC than PR, while those without preinfarction angina showed a significantly higher prevalence of PR than IFC (Figure). PR in patients with preinfarction angina were more frequently associated with macrophage accumulation, while those in patients without preinfarction angina were not (Figure). White thrombus tended to be more frequent in patients with preinfarction angina than in those without (85.7% vs. 63.6%, p=0.097), and Prati thrombus score tended to be lower [22.0 (15.8–30.3) vs. 38.5 (12.8–67.5), p=0.145]. Calcifications were significantly less frequent in patients with preinfarction angina than in those without (22.0% vs. 40.4%, p=0.045), while neovascularization tended to be more frequent (58.0% vs. 42.3%, p=0.113).

Conclusions
Patients with preinfarction angina have a distinct culprit plaque phenotype, frequently characterized by IFC and a relatively lower thrombotic burden, probably reflecting a prevalence of reparative mechanisms and spontaneous thrombolytic activity in these patients.
129Elevated plasma xanthine oxidoreductase activity predicts cardiovascular events in patients with heart failure with preserved ejection fraction
Authors: Watanabe K , Watanabe T , Otaki Y , Shishido T , Kato S , Tamura H , Nishiyama S , Takahashi H , Arimoto T , Watanabe M 
Published: October 2019

Abstract

Background
The pathophysiology of heart failure with preserved ejection fraction (HFpEF) remains poorly understood, although reactive oxygen species (ROS) is reportedly involved in underlying mechanisms. Xanthine oxidoreductase (XOR) is the rate-limiting enzyme of purine metabolism that plays an important role in producing uric acid, and also generates the ROS. However, the impact of plasma XOR activity on the clinical outcomes in patients with HFpEF remains unclear.

Purpose
The aim of this study was to assess whether plasma XOR activity predicts cardiovascular events in patients with HFpEF.

Methods and results
We measured plasma XOR activity in 257 patients with HFpEF. The patients were divided into 3 groups based on XOR activity: low XOR group (<33 pmol/h/mL, n=45), normal XOR group (33 - 120 pmol/h/mL, n=160), and high XOR group (≥120 pmol/h/mL, n=52). During a median follow-up period of 809 days, there were 74 major adverse cardiovascular events (MACEs). Kaplan-Meier analysis demonstrated that the patients with high XOR activity were at greatest risk for MACEs. A multivariate Cox proportional hazard regression analysis showed that high XOR activity was significantly associated with MACEs after adjustment for confounding factors. Furthermore, we divided the patients into 4 groups according to the presence of high XOR activity and/or hyperuricemia. Cox multivariate hazard regression analysis revealed that the patients with high XOR activity were associated with cardiovascular events in patients with HFpEF, regardless of whether hyperuricemia was present or not.

Conclusions
Elevated plasma XOR activity is significantly associated with adverse clinical outcomes in patients with HFpEF. Inhibition of XOR could be a potential therapy for HFpEF.
194SGLT-2 inhibitors versus GLP-1 receptor agonists and risk of mortality, chronic kidney disease and hospitalisation for heart failure in patients with type 2 diabetes
Authors: Noergaard C , Torp-Pedersen C , Vestergaard P , Wong N , Gerds T , Starkopf L , Bonde A , Fosbol E , Kober L , Lee C 
Published: October 2019

Abstract

Background
Two promising classes of second-line glucose-lowering drugs, the sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), have both been shown to lower the risk of cardiovascular (CV) outcomes in patients with type 2 diabetes, however no head-to-head comparisons exist.

Purpose
The aim of this study was to examine the risk of CV and all-cause mortality, incident chronic kidney disease (CKD) and hospitalisation for heart failure (HF) in association with SGLT-2i versus GLP-1RA use.

Methods
New users of SGLT-2i and GLP-1RA, with no prior use of drugs from the comparison class, were identified between 2012–2016, using individual-level linkage of Danish nationwide registries. The absolute risk of CV was calculated using the Aalen-Johansen Estimator with non-CV mortality as competing risk. The hazard ratios (HR) of CV and all-cause mortality, incident CKD and hospitalisation for HF were estimated using Cox regression and adjusted for age, sex, diabetes duration and other outcome specific risk factors.

Results
The study included a total of 8,304 SGLT-2i users (median age: 63 years [interquartile range (IQR): 54–70], males: 63%, dapagliflozin: 60.5%, empagliflozin: 36.5%) and 13,318 GLP-1RA users (median age: 60 years [IQR: 50–68], males: 54%, liraglutide: 97.4%) with a median follow-up time of 2.0 [(IQR): 1.5–2.9] years and 3.6 [IQR: 2.1–5.0] years, respectively. At baseline 29% of SGLT-2i and 30% of GLP-1RA users had CV disease. The absolute risks are shown in Figure 1. Compared with GLP-1RA, initiation of SGLT-2i was in adjusted analyses associated with a lower risk of CV mortality (HR: 0.49 [confidence interval (CI): 0.37–0.65]), all-cause mortality [HR: 0.79 [CI: 0.68–0.93], incident CKD (HR: 0.42 [CI: 0.34–0.53] and hospitalisation for HF (HR: 0.68 [CI: 0.59–0.78]).
Figure 1

Conclusion
SGLT-2i use was associated with a significantly lower risk of CV and all-cause mortality, incident CKD and hospitalisation for HF in comparison with GLP-1RA use.

Acknowledgement/Funding
The Danish Heart Foundation (18-R125-A8381-22082)
219Serum Trimethylamine N-Oxide levels and 16S rRNA gut microbiota profiling in patients with heart failure and preserved ejection fraction and healthy individuals
Authors: Kaburova A N , Poyarkov S V , Makarov V V , Drapkina O M , Uydin S M , Pokrovskaya M S , Koretsky S N , Efimova I A , Matskevich L A , Gomiranova N V 
Published: October 2019

Abstract

Introduction
Recent evidence suggests the role of gut microbiota dysregulation in the pathophysiology of chronic heart failure (HF). Elevated levels of Trimethylamine N-Oxide (TMAO) have shown to increase the risk of cardiovascular events and HF. Among patients with HF and preserved ejection fraction (HF-pEF) the link between TMAO levels and ventricular fibrosis was observed in studies, however, the data regarding 16S rRNA microbiome profiling in this particular group of HF are lacking.

Purpose
The research was aimed at investigating the gut microbiome diversity and composition as well as the serum TMAO levels among two groups of patients: healthy controls (HC) and HF-pEF.

Methods
44 patients with HF-pEF and 45 HC with body mass index <35 kg/m2, no history of acute coronary syndrome, myocardial infarction or diabetes were enrolled in the study. All patients underwent transthoracic echocardiography with Doppler study to exclude diastolic dysfunction (E/e' <8 cm/s) or to prove HF-pEF (according to the recent ESC guidelines based on E/e' ratio, N-terminal pro-B type natriuretic peptide >125 pg/ml and symptoms of HF). The intestinal microbiome was investigated using high-throughput sequencing of bacterial 16S rRNA gene. TMAO levels were determined by liquid chromatography tandem mass spectrometry.

Results
The age in HC was 57,5 [48; 63] (28% men), age in HF-pEF group was 67 [64; 74] years (52% men). The serum concentration of TMAO in HC was 3.72 uM, in HF-pEF was 5.24 uM. The group of HF-pEF had significantly higher levels of the marker, p=0,003. Bacterial communities of both groups were dominated by the Firmicutes and Bacteroidetes phyla. The most abundant genus in both groups were Bacteroides. The Shannon index, the Chao 1 estimator, and the Simpson index assessing α diversity were not significantly different between groups. However, Bacteroides, Alistipes, Pseudomonas, and Fusobacterium were enriched in the common core microbiota of HF-pEF patients, while Lachnospira, Roseburia, Eubacterium, Methanobrevibacter and Faecalibacterium were depleted. To note, Lactobacillus and Bifidobacterium were depleted in HF-pEF patients too.
TMAO levels in HC and HF-pEF groups

Conclusions
We have shown significant structural alterations of the intestinal microbiome and increased TMAO levels in HF-pEF patients' serum compared to HC. These findings may enable deeper understanding of the complex multifactorial pathogenesis of HF-pEF for the future development of personalized microbiome-based diagnostics and therapies for individuals at risk.