bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2635Prevalence of appropriate treatment in elderly heart failure patients and impact on clinical outcomes: a subgroup analysis from REPOSI registry
Authors: Proietti M , Marra A M , Salzano A , Romiti G F , Mannucci P M , Nobili A , Cittadini A 
Published: October 2019

Abstract

Introduction
Therapeutic appropriateness in chronic diseases is a key factor in obtaining better clinical outcomes over clinical follow-up, in particular in elderly patients. Data about therapeutic appropriateness in elderly patients with heart failure (HF) are scarce.

Purpose
To describe the prevalence of appropriate treatment in elderly HF patients and its impact on clinical outcomes.

Methods
REgistro POliterapie SIMI (REPOSI) cohort was used to assess study aims. REPOSI is an Italian Nationwide Registry of elderly (≥65 years) hospitalized patients in Internal Medicine and Geriatric wards. HF diagnosis was assessed at hospital admission according to ICD-9 code 428.XX. Therapeutic appropriateness was defined according to International Guidelines.

Results
Among the 7003 patients originally enrolled, a total of 1095 (15.6%) patients reported a diagnosis of HF at hospital admission. At admission, 230 (21.0%) patients were considered as treated appropriately, with 245 (22.4%) treated appropriately during hospitalization and 249 (22.7%) at discharge (p=0.0.248). Focusing on patients aged ≥80 years, prevalence of appropriate treatment was respectively: 18.9% at admission, 20.3% during hospitalization and 21.0% at discharge (p=0.266). Among the 1095 patients with HF, 815 (74.4%) had available follow-up data. Patients appropriately treated at discharge, compared to those not treated appropriately, had a lower rate of CV death (5.1% vs. 11.9%, p=0.006) and all-cause death (7.2% vs. 26.1%, p<0.001) during follow-up, with no difference in rates of rehospitalization and CV rehospitalization. A logistic regression analysis adjusted for age, sex, risk factors, comorbidities and polypharmacy, showed that appropriate therapy at discharge was inversely associated with the risk of CV death and all-cause death (Table). In patients ≥80 years, appropriate HF treatment was inversely associated with risk of all-cause death (Table).
Logistic Regression Analysis All Patients ≥80 years OR (95% CI) OR (95% CI) CV Death 0.46 (0.23–0.94) 0.59 (0.26–1.36) All-Cause Death 0.26 (0.14–0.46) 0.27 (0.14–0.53) CI = Confidence Interval; CV = Cardiovascular; OR = Odds Ratio.

Conclusions
In elderly hospitalized HF patients, prevalence of therapeutic appropriateness was consistently low at admission, during hospitalization and at discharge, particularly in patients ≥80 years. Appropriate HF therapy was inversely associated with the risk of CV death and all-cause death in all patients and with the risk of all-cause death in patients ≥80 years.

Acknowledgement/Funding
None
P2646Determinants of aortic root dilatation over time in hypertensive treated patients: the Campania Salute Network
Authors: Canciello G , Mancusi C , Izzo R , De Luca N , Trimarco B , Barbato E , De Simone G , Losi M A 
Published: October 2019

Abstract

Background
We demonstrated that aortic root (AR) dilatation assessed by standardized difference between observed and predicted values is present at baseline in about 30% of treated hypertensive patients and predicts cardiovascular (CV) events independently of left ventricular (LV) hypertrophy (LVH).

Purpose
We investigate whether a CV phenotype exists predicting AR dilatation during follow-up of treated hypertensive patients.

Methods
5301 hypertensive treated patients (age 53±11 years, 42% women) without prevalent CV disease and with normal ejection fraction (≥50%) were studied. AR dimension was measured in the parasternal long-axis view at the level of sinus of Valsalva in end-diastole, using the leading-edge to leading-edge method at first and last available echocardiograms. The z-score of AR dimension (AOz) was generated based on the difference between observed AR and predicted AR dimension, divided by sex-specific observed SD.

Results
Initial AOz exhibited a normal distribution and was correlated positively with age, male sex, systolic and diastolic blood pressure (BP), BMI, fasting glucose, and glomerular filtration rate (GFR, by EPI-CKD) and negatively with pulse pressure (PP) and cholesterol (all 0.0375th percentile of the AOz distribution). Similar to baseline, initial SVi and BMI remained the most potent covariates of the final AOz (both p<0.0001), independently of significant effect of male sex, high diastolic BP, BMI, SVi, low PP, and low HDL-cholesterol. Variance inflation factor was <2 in both regression models. Figure shows initial SVi in relation with AR at follow up.

Conclusions
We demonstrate that both volume (SVi) and pressure loads (diastolic BP) influence AR enlargement over time, AR dilatation is predictable in male obese patients with diastolic hypertension and other metabolic disturbances.
P2650Antihypertensive treatment with calcium channel blockers in patients with moderate or severe aortic stenosis: relationship with all-cause mortality
Authors: Saeed S , Mancia G , Rajani R , Parkin D , Chambers J B 
Published: October 2019

Abstract

Background
Hypertension is prevalent in patients with aortic stenosis (AS) and optimal blood pressure (BP) control is advised to reduce arterial load and avoid cardiovascular events. Whether calcium channel blockers (CCB) are safe is not known.

Methods
A total of 314 patients (age 65±12 y, 68% men) with moderate or severe asymptomatic AS were included.

Results
The prevalence of hypertension was 73.6%, and 65% took antihypertensive treatment. Patients who used a CCB (25%) (CCB+) were older, had higher clinic systolic BP, were more likely to have hypercholesterolemia and coronary artery disease (CAD), and to use a diuretic or alpha blocker compared to CCB- patients (all p<0.05) (Table). During the baseline ETT, patients who used a CCB achieved a lower peak heart rate, a shorter exercise time and were more likely to have a blunted BP response compared to those who did not use a CCB (all p<0.05) (Table). Event-free survival was significantly lower in CCB+ than CCB- patients (Fig) (all-cause mortality 16 [20.3%] versus 13 (5.6%); p<0.001). In a multivariable Cox regression model, CCB+ was associated with a 6.8-fold increased hazard ratio (HR) for all-cause mortality (HR 6.77 95% CI 1.66–27.54, p=0.008), independent of age, gender, systolic BP, hypertension, diabetes, CAD, hypercholesterolemia and aortic valve area.
Table 1. Baseline characteristics of patients CCB− (n=234) CCB+ (n=80) p Age, y 64±12 70±10 <0.001 CAD, % 45 66 0.006 Hypercholesterolemia, % 62 78 0.015 Clinic systolic BP, mmHg 139±19 150±17 <0.001 Left atrial diameter, cm 3.7±0.7 3.9±0.6 0.007 LV end-diastolic diameter, cm 4.5±0.7 4.8±0.6 0.002 LV mass index, g/m2.7 50±17 57±17 0.007 Aortic valve area, cm2 0.94±0.22 0.93±0.22 0.716 LV stroke work, g-m/bmp 155±46 175±69 0.046 Peak HR at baseline ETT, bmp 138±24 120±25 <0.001 Blunted BP response, % 33 49 0.013 Exercise duration, min 10.1±4.5 8.3±3.7 0.001 Double Product, mmHg·bmp 1.85±0.43 2.08±0.54 <0.001
Figure 1

Conclusion
The use of calcium channel blockers was associated with an adverse effect on treadmill exercise and reduced survival in apparently asymptomatic patients with moderate or severe AS.

Acknowledgement/Funding
None
P2651Seasonal variations in the pathogenesis of acute coronary syndromes
Authors: Kurihara O , Takano M , Yamamoto E , Yonetsu T , Kakuta T , Soeda T , Yan B P , Crea F , Higuma T , Minami Y , Adriaenssens T , Nef H M , Lee H , Mizuno K , Jang I K 
Published: October 2019

Abstract

Background
Seasonal variations in acute coronary syndrome (ACS) has been known with the winter being the peak in incidence and mortality. However, underlying pathophysiology for this variation has not been studied.

Purpose
We sought to compare pathobiology of the culprit lesions assessed by optical coherence tomography (OCT) among the four seasons.

Methods
Patients with ACS who underwent OCT were recruited from 6 countries in the Northern Hemisphere. The prevalence of 3 most common pathologies, plaque rupture, plaque erosion and calcified plaque, and other features of coronary plaques were compared among the four seasons.

Results
In 1113 patients with ACS, 284 (25%) patients were admitted in spring, 243 (22%) patients in summer, 290 (26%) patients in autumn and 296 (27%) patients in winter. The proportion of underlying 3 pathologies was significantly different in each season (prevalence of plaque rupture, plaque erosion, calcified plaque was 50%, 39%, and 11%, respectively in the spring; 44%, 43%, and 13% in the summer; autumn: 49%, 39%, and 12% in the autumn; 57%, 30%, and 13% in the winter; P=0.039). The proportion of plaque rupture was higher in winter but lower in summer, and that of plaque erosion was higher in summer, but lower in winter. Maximum and minimum temperatures on the day of OCT procedure were significantly lower in the plaque rupture group than in the plaque erosion group (P=0.02 and P=0.012, respectively). In the rupture group, the prevalence of hypertension was significantly higher in winter, but in the erosion group, it was not different among the four seasons.
Figure 1. The proportion of culprit lesion characteristics were significantly different among the 4 season groups. (P=0.039) The proportion of plaque rupture was significantly higher in winter but lower in summer. In contrast, the proportion of plaque erosion was higher in summer, but lower in winter.

Conclusions
Seasonal variation of the underlying mechanisms of ACS reflects different pathobiology. The proportion of plaque rupture is highest in winter and the proportion of plaque erosion is highest in summer. A different approach may be needed for the prevention and treatment of ACS depending on the season of its occurrence.
P2669Prognostication in out-of-hospital cardiac arrest
Authors: Pimenta D , Barakat M F , Obika B D , Mitchell A C , Lockie T P E 
Published: October 2019

Abstract

Background
Out-of-hospital cardiac arrest (OOHCA) remains an area where little progress has been made in outcomes despite significant advances in cardiac care. The OOHCA cohort requires a large amount of resources, including primary coronary intervention and intensive care, often with poor eventual outcomes. A clinical prognostic scoring system would allow resources to be focused on OOHCA patients who are likely to survive; rather than expensive and futile treatments in those who are not. Several different scoring systems have been published but have not been compared in a real world cohort of OOHCA patients.

Method
The Cardiac Arrest Hospital Prognosis (CAHP) score that utilises 7 variables and a simpler three-factor prognostic score derived by Hirt et al were applied retrospectively to a cohort of 157 consecutive OOHCA patients presenting to a regional Centre in our city, UK between 2016 and 2018. For each patient the CAHP score was calculated where a score of >200 predicts a Cerebral Performance Category (CPC) outcome of 3–5 (severe disability, vegetative coma or death). They were also categorised using the Hirt algorithm into “Futile”, “Approaching Futility” and “Non-Futile” groups. CPC outcomes were then compared using both scores and diagnostic accuracy assessed.

Results
A CAHP score of >200 predicted a CPC outcome of 3–5 with 97% specificity and a positive predictive value of 92%. A CAHP score >200 predicted 30-day mortality with 96% specificity, and a positive predictive value of 89% (Fig. 1A). The same cohort categorised by the Hirt algorithm was less accurate; in those patients sorted into the “futile” category 15% of patients survived, and in the “approaching futility” group survival was 100% (Fig. 1B). The specificity and PPV of predicting futility was 94% and 85% respectively.

Conclusion
Although a simple three-factor prognostic score as suggested by Hirt et al is attractive in this cohort of OOHCA patients it did not discriminate those patients who were likely to survive and, the CAHP score was more accurate in predicting outcome. Further validation is required in prospective, multi-centre studies to ensure that application of these scores are reproducible in real-world OOHCA populations in decision making for emergency coronary angiography.

Acknowledgement/Funding
None
P2670Predictors of survival to discharge in the acute myocardial infarction patients presenting with out-of-hospital cardiac arrest after return of spontaneous circulation
Authors: Wu Y.-C , Lin J.-L , Liu Y.-H 
Published: October 2019

Abstract
Approximately 70% of survivals of out-of-hospital cardiac arrest (OHCA) have coronary artery disease, with acute vessel occlusion observed in 50%. Predictors of mortality in acute myocardial infarction (AMI) patients successfully resuscitated for OHCA were not well-determined.
Between May, 2016 and July, 2018, 1428 consecutive patients with OHCA visited the emergency department of Far Eastern Memorial Hospital, New Taipei City, Taiwan. A total number of 117 patients with return-of-spontaneous-circulation (ROSC) were diagnosed of AMI, mostly confirmed by coronary angiography. The mean age was 60.0±13.6 (mean SD) with male gender 105/117. Endpoint was survival to discharge. The survival rate was 55.6%.
Shockable rhythm (Ventricular tachycardia or fibrillation) during CPR (correlation coefficient, CC: 0.635; p<0.001), ST elevation myocardial infarction (CC: 0.550; p=0.003), sinus rhythm on first ECG (CC: 0.474; p=0.012) and higher HDL (CC: 0.471; p=0.0027) were associated better outcome (survival and neurological recovery). However, older age (CC: −0.564; p=0.002), ST depression on first ECG post resuscitation (CC: −0.481; p=0.011), hyperglycemia (CC: −0.419; p=0.030), higher HbA1C level (CC: −0.569; p=0.007), and hyperkalemia (CC: −0.612; p=0.001) were associated with worse outcome (Mortality).
In conclusion, in the AMI patients presenting with OHCA after ROSC, unshockable rhythm during CPR, older age, non-sinus rhythm and ST segment depression on first ECG post resuscitation, hyperglycemia, higher HbA1C level, lower HDL level, and hyperkalemia were associated with higher hospital mortality.
P2674Rapid rule-out of myocardial infarction with a novel high precision point-of-care troponin assay appears safe and effective
Authors: Aldous S , Pickering J , Young J , George P , Watson A , Troughton R , Pemberton C , Richards M , Cullen L , Than M 
Published: October 2019

Abstract

Background
High sensitivity troponin assays were developed to improve analytical sensitivity and precision at the decision cut-points for the diagnosis and rule out of acute myocardial infarction (AMI). Central laboratory assays have achieved this but point of care assays, which have the ability to accelerate decision making due to much shorter turnaround times, have remained lacking.

Purpose
To ascertain the threshold for decision making and subsequent clinical utility for ruling out AMI on presentation in patients attending the emergency department acutely with chest pain, using a high precision point of care troponin assay (TnI Nx), (i-STAT, Abbott).

Methods
We measured arrival TnI-Nx concentrations in stored plasma samples in adults presenting acutely to the emergency department with chest pain. The primary outcome was an AMI or cardiac death on index admission or within 30 days. We used 2000 bootstrapped data sets to derive and validate a suitable threshold for TnI-Nx before calculating diagnostic test performance. We pre-specified this threshold must have a <1% false negative rate for the primary outcome. We compared this with a core laboratory high sensitivity troponin I (hs-TnI) (Abbott Architect) using the early rule-out cut-point (European Society of Cardiology) at the limit of detection (2 ng/L).

Results
We recruited 1320 patients of whom 192 (14.1%) had the primary outcome. The TnI-Nx threshold was determined to be 8 ng/L with subsequent sensitivity of 99.0% (95% confidence interval: 97.3% to 100%), negative predictive value of 99.7% (99.2% to 100%) and specificity of 59.0% (56.0% to 62.0%). The hs-TnI had a sensitivity of 99.5% (98.2% to 100%), negative predictive value of 99.7% (99.0% to 100%), and specificity of 28.4% (25.8% to 31.2%) at 2ng/L.

Conclusion
A high precision point of care assay, TnI-Nx, with a decision threshold of 8ng/L, has comparable rule out performance compared with a core laboratory high sensitivity assay and therefore could potentially be used for early decision making in the assessment of acute chest pain.

Acknowledgement/Funding
Research grant from Abbott Point of Care. Senior Research Fellowship from ECF, CMRF and CDHB. Clinical Research Fellowship from NZ HRC
P2675Validation of a 0/1h diagnostic algorithm using a point of care high-sensitivity troponin I assay
Authors: Soerensen N , Neumann J T , Ojeda F , Giannitsis E , Spanuth E , Blankenberg S , Westermann D , Zeller T 
Published: October 2019

Abstract

Background
The numbers of patients presenting to emergency departments with suspected acute myocardial infarction (AMI) are increasing worldwide. The use of point of care (POC) troponin assays with an increased sensitivity – equal to laboratory-based high-sensitivity immunoassays – might enable faster decision making in this high-risk population.

Objective
To validate a rapid diagnostic algorithm using a novel point of care (POC) high-sensitivity troponin I (hs-TnI) assay in comparison to a laboratory-based hs-TnI assay.

Methods
A diagnostic 0/1h algorithm for the POC hs-TnI assay (PATHFAST hs-cTnI, LSI Medience) was derived in a dataset of 669 patients with suspected AMI, aiming for a negative predictive value (NPV) ≥99.5% for rule-out and a positive predictive value (PPV) ≥75% for rule-in of non-ST-elevation myocardial infarction (NSTEMI). The performance of the developed algorithm was tested in a validation cohort of 610 patients. Diagnostic accuracy of the POC hs-TnI assay was compared to an established hs-TnI assay (Abbott ARCHITECT) using an ESC guideline-recommended 0/1h diagnostic algorithm.

Results
The derived 0/1h algorithm consisted of an admission POC hs-TnI <4 ng/L and a delta from 0h to 1h <3 ng/L for rule-out and an admission POC hs-TnI ≥90 ng/L or a delta from 0h to 1h ≥20 ng/L for rule-in of NSTEMI. Application of the algorithm in the validation cohort showed a NPV of 99.7% (Confidence Interval (CI) 98.1%-100.0%) and 48.0% of patients ruled out, while 14.6% were ruled in with a PPV of 86.5% (CI 77.6%-92.8%). The diagnostic performance of the POC hs-TnI assay was comparable to guideline-recommended use of a laboratory-based hs-TnI assay (Figure 1).

Conclusion
The clinical application of a 0/1h diagnostic algorithm based on a novel POC hs-TnI assay showed good diagnostic performance and was comparable to a laboratory-based hs-TnI assay.

Acknowledgement/Funding
German Center of Cardiovascular Research, Abbott Diagnostics, DIAneering GmbH, German Heart Foundation/ German Foundation of Heart Research
P2701Comparison of myocardial ischemia assessed by contrast-flow quantitative flow ratio (cQFR) and by stress MRI in patients with stable coronary artery disease
Authors: Lenk K , Schwarzbach V , Antoniadis M , Blum M , Hagendorff A , Lavall D , Laufs U 
Published: October 2019

Abstract

Background
Contrast-flow quantitative flow ratio (cQFR) is a new technology for evaluation of coronary stenosis. cQFR allows to derive the fractional flow reserve (FFR) from coronary angiograms. Based on a three dimensional coronary model, FFR is calculated from computational fluid dynamics. Head to head comparisons with FFR showed an overall diagnostic accuracy of 85%. cQFR does not require coronary wires or hyperemia. However, the ability of cQFR to detect myocardial ischemia is unknown. Therefore, the aim of this study was to evaluate the relationship between cQFR and myocardial ischemia assessed by stress magnetic resonance imaging (stress MRI).

Methods
cQFR analysis was performed in patients selected from the hospital database who received stress MRI and coronary angiography. A relevant ischemia on stressMRI was defined as a perfusion deficit in ≥2 of 16 segments. The cQFR was based on 3-dimensional quantitative coronary angiography (3D-QCA) using the QAngio XA 3D 1.1, Medis Medical Imaging System, Leiden, The Netherlands. Two blinded investigators analysed all 3 main coronary vessels of each patient measuring diameter stenosis (DS), area stenosis (AS) and cQFR. A cQFR of ≤0.8 was considered abnormal. The primary endpoint was sensitivity and specificity of cQFR using stress MRI as a reference standard.

Results
125 vessels of 53 patients could be fully analysed by cQFR (78.6%). The sensitivity of cQFR in detecting significant epicardial stenoses of coronary vessels with documented ischemia in stress MRI was 75%, the specificity was 87%. The 3D-QCA-derived diameter stenoses and area stenoses in vessels with positive stress MRI were significantly higher than in vessels without ischemia (see Table 1).
Table 1. Means of diameter stenosis (DS) und area stenosis (AS) with interquartile range (IQR) Total (n=125) Ischemia (n=32) No Ischemia (n=93) p-value DS [%] 42.3 (28.3–53.1) 57.1 (47–68.5) 37.7 (27.6–45.1) <0.0001 AS [%] 51.8 (32.4–69.7) 68.9 (56.8–85.9) 46.5 (29.7–62.7) <0.0001

Conclusion
The analysis reveals a high correlation between relevant coronary stenosis measured by cQFR and ischemic areas detected by stress MRI. Differences between the two methods are plausible because stress MRI detects ischemia due to other reasons than epicardial stenosis. Further randomized studies are mandatory to verify the prognostic significance of the cQFR measurements.