bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1815The impact of PVB19 presence in myocardium in recent onset dilated cardiomyopathy
Authors: Krejci J , Hude P , Poloczkova H , Ozabalova E , Mlejnek D , Godava J , Honek T , Freiberger T , Zampachova V , Svobodova I , Spinarova L 
Published: October 2019

Abstract

Introduction
The most common virus in myocardium of patients with recent onset dilated cardiomyopathy (RODCM) is PVB19. Opinions on its pathogenicity are different. According to some, viral load has to be evaluated and if it is low, the PVB19 has no potential to induce inflammation. Others recommend assessment of viral replication, while “innocent” are those cases where replication activity is low.

Purpose
To compare the development of echocardiographic parameters in patients with RODCM with isolated presence of PVB19 in low viral load (below 500 copies per μg nucleic acid) against a group in which no virus was detected in the myocardium.

Patient and methods
243 patients with RODCM, in 151 cases (62%), the virus was detected in the myocardium (PCR+ group), in 92 cases the finding was negative (PCR−; ie 38%). In the PCR+ group, PVB19 was captured in 135 cases (89% of all PCR+), in 121 cases of them was PVB19 the only one isolated virus (PCRPVB19+; 80% of all PCR+). The viral presence was assessed by real time PCR.

Results
In the PCR− group, the left ventricular ejection fraction (LVEF) was 23.5±7.2%, in the PCRPVB19+ group 24.6±7.1% (p=0.26). Left ventricle end-diastolic diameter (LVEDD) in PCR− was 66.4±8.9mm vs 65.5±7.9mm in PCRPVB19+ (p=0.42), right ventricle diameter (RV) 33.1±5.7mm vs. 33.4±5.2mm (p=0.69), TAPSE 19.5±4.1mm vs 18.9±4.0mm (p=0.28) and E/é 14.0±5.7 vs. 14.9±7.0 (p=0.32). In the 12-month control, LVEF in the PCR− was 35.5±12.3% (p<0.001 for comparison with baseline), in PCRPVB19+ 35.3±12.3% (p<0.001 for comparison with baseline; p=0.92 for difference between groups); LVEDD in PCR− was 62.0±9.3mm vs 62.1±9.3mm in PCRPVB19+ (both p<0.001 for comparison with baseline, p=0.91 for difference between groups), RV 31.6±5.5mm vs. 31.6±5.4mm (p=0.033, resp. p=0.003 for comparison with baseline; p=0.98 for difference between groups), TAPSE 20.7±4.3mm vs. 20.7±4.4mm (p=0.026, resp. p<0.001 for comparison with baseline; p=0.98 for difference between groups), and E/e' 10.3±4.1 vs. 10.4±4.1 (both p<0.001 for comparison with baseline; p=0.93 for difference between groups).

Conclusion
PVB19 presence in myocardium had no effect on the development of echocardiographic parameters in RODCM patients in one-year follow-up.

Acknowledgement/Funding
Supported by Ministry of Health of Czech Republic AZV Grant 16-30537A
P1816Aortic root morphology in bicuspid aortic valve is related to the type of BAV
Authors: Masi P , Milleron O , Paul J F , Arnoult F , Ould Ouali N , Tchitchinadze M , Lansac E , Jondeau G 
Published: October 2019

Abstract

Background
Dilatation of the ascending aorta associated with bicuspid aortic valve (BAV) is common and has been associated with an increased risk of aortic dissection. However, the causal links between BAV types, aortic valve dysfunction and aorta phenotype are still poorly understood. Our hypothesis is that aortic root dilatation in BAV is an anatomic modification related to the BAV type.

Purpose
To assess whether the morphology and orientation of the aortic root can be predicted by the type of BAV.

Methods
86 patients with BAV without significant valvulopathy (aortic regurgitation <2 and no more than mild stenosis with mean gradient <10mmHg) referred for aortic aneurysm assessment and who had benefited from TTE and CT were studied.

Definitions

Typical BAVs have a horizontal valve opening (type I L-R and type 0 anteroposterior) while atypical BAVs have a vertical valve opening (type I N-R and type 0 lateral) (Figure). Asymmetry of the root is evaluated in type I BAV using the normalized diameter ND = sinus to commissure diameter/mean of the 3 sinus to commissure diameters.
We compared, in the typical (n=64) and atypical (n=22) BAVs, using CT, the asymmetry of the root using the normalized diameter, the orientation of the bicuspid aortic valve opening and the orientation of the largest diameter of the aortic root using the sagittal plane as a reference (Figure).

Results
Patients with typical and atypical BAVs were comparable for age, sex, weight, height, aortic root surface area and maximum aortic root diameter.
Aortic root asymmetric modifications were related to the type of BAV with: – a predominant non coronary sinus dilatation in type I L-R (Non coronary sinus to commissure normalized diameter = 1.02 in Type I l-R vs 0.98 in type I R-N; p=0.0004). – a predominant left coronary sinus dilatation in type I L-N (left coronary sinus to commissure normalized diameter = 1.07 in type I R-N vs 1.01 in type I L-R; p<0.0001). – a significantly larger anteroposterior diameter in type 0 typical BAVs (45mm vs 40mm p=0.02) and a significantly larger lateral diameter in type 0 atypical BAVs (48mm vs 39mm p=0.0003). The orientation of the aortic valve opening is correlated with the type of BAV: Using the sagittal plan as a reference, this angle is 144,9° for the typical BAVs vs 56,6° for the atypical BAVs p<0.0001 (Figure). The orientation of the maximal aortic diameter is correlated with the type of BAV: Using the sagittal plan as a reference, this angle is 64.3° for the typical BAVs and 143,1° for the atypical BAVs p<0.0001 (Figure 1).
Figure 1

Conclusion
The morphology and orientation of the aortic root in BAVs are strongly correlated with the type of BAV, suggesting anatomical modifications rather than aortopathy.
P1822Pocket-size mobile echocardiographic device screening for thoracic aortic aneurysm in asymptomatic hypertensive patients
Authors: Lee A P , Yang F , Fan Y T , Wong M C , Wong R H 
Published: October 2019

Abstract

Background
Patients with hypertension may develop thoracic aortic aneurysm (TAA) that can be asymptomatic but potentially life-threatening. We sought to assess the prevalence of asymptomatic TAA among hypertensive patients and define the effectiveness of a TAA point-of-care screening program using pocket-size mobile echocardiographic (PME) devices.

Methods
We prospectively performed transthoracic echocardiography for TAA screening using a PME device on 1529 hypertensive patients (age, 62y [30y to 85y], 824 men) who attended our hypertension specialist clinic between June 2016 and July 2018. Measurement of the dimensions of the aortic sinus, sinotubular junction, ascending aorta, aortic arch, and descending thoracic aorta were obtained through multiple standard echo views.

Results
The prevalence of TAA (defined as maximum aortic diameter of ≥4.5cm and/or >50% diameter of the adjacent aorta) in our study population was 7.3% (111/1529), with distal ascending aorta as the most frequent location (Figure). Multiple logistic regression analysis identified male gender, older age, and presence of heart valve disease as independent factors associated with TAA (all p<0.05).
Figure 1

Conclusions
Asymptomatic TAA is common among asymptomatic hypertensive patients. Point-of-care use of PME device is effective in detecting TAA in a clinic setting. Such approach may be useful for early detection of TAA among at-risk patients allowing aggressive blood pressure control and early surgical intervention to prevent catastrophic complications such as aortic dissection or rupture.

Acknowledgement/Funding
Health and Medical Research Fund of the Hong Kong Government
P1837HFpEF reverses in more than a quarter of patients after thoracoscopic AF ablation
Authors: Kougioumtzoglou A M , Neefs J , Wesselink R , Terpstra M M , Van Den Berg N W E , Berger W R , Meulendijks E R , Krul S P J , Piersma F R , De Jong J S S G , Van Boven W J P , Driessen A H G , De Groot J R 
Published: October 2019

Abstract

Purpose
To evaluate the proportion of patients in whom parameters that define the diagnosis of HFpEF and HFmrEF persist versus normalize upon elimination of AF.

Background
Atrial fibrillation (AF) and heart failure with preserved or mid-range ejection fraction (HFpEF or HFmrEF) concur in many patients. Distinction between these two diagnoses remains challenging as one can cause or exacerbate the other. Adequate patient selection for invasive AF treatment is crucial to improve rhythm outcome.

Methods
Patients underwent thoracoscopic ablation, consisting of pulmonary vein isolation (PVI) alone or PVI with additional lines in the case of persistent AF. Patients were prospectively followed-up. HFmrEF or HFpEF was defined as left ventricular ejection fraction (LVEF) ≥40% or ≥50% respectively and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels >125 pg/ml. Patients who remained free from AF, or any atrial tachycardia of more than 30 seconds, at 6 months postoperatively, were included in this study. Patients with AF recurrences during this period were excluded. The primary outcome was the change of NT-proBNP at 6 month follow-up.

Results
From 2008 to 2017, 92 patients undergoing thoracoscopic AF ablation fulfilled the aforementioned criteria and were included. Of these patients, mean age was 61±8 years and 66 (72%) were male. Median NT-proBNP was 366 pg/ml (128–2916) and mean LVEF was 53±7%. Thirty (35%) patients had a LVEF of 40–49%. Six months after elimination of AF, NT-proBNP was <125 pg/ml (Figure 1A: median 87 (50–122) vs 459 (137 – 2916) pg/ml at baseline; p<0.001) in 26 patients (28%), whereas in the remaining patients NT-proBNP was unchanged (Figure 1B: median 298 (126–1568) vs. 318 (128–2387) pg/ml at baseline; p=0.011).
Figure 1. NT-proBNP alterations after thoracoscopic AF ablation from baseline to 6 month follow-up. A. Patients with normalization of NT-proBNP. B. Patients with unchanged high levels of NT-proBNP.

Conclusion
In 28% of patients the diagnostic criteria of HFpEF/HFmrEF are caused by AF and normalize upon elimination of AF with thoracoscopic ablation.
P1869A novel risk score to predict mortality in patients with atrial fibrillation: the BLACCK (AF) death risk score
Authors: Samaras A , Kartas A , Fotos G , Vasdeki D , Dividis G , Paschou E , Tsoukra P , Forozidou E , Kotsi E , Goulas I , Karvounis H , Giannakoulas G , Tzikas A 
Published: October 2019

Abstract

Background
Prior risk stratification schemes for atrial fibrillation (AF) have extensively focused on stroke as the principal outcome. However, an accurate estimation of the risk of death in patients with AF has received disproportional attention.

Purpose
The aim of this study was to develop and validate a risk score for predicting mortality in patients with AF who underwent a hospitalization for cardiac reasons.

Methods
The new risk score was developed and internally validated in 887 patients with AF, who were followed up for a median of 2 years. The outcome measure was all-cause mortality. Biomarker samples, echocardiographic data and renal function values were obtained at the date closest to hospital discharge. A Cox-model that determined the variables that significantly contributed to the prediction of all-cause mortality, was adapted to a risk points system through weighting of the model coefficients. The model was internally validated by bootstrapping, assessing both discrimination and calibration.

Results
311 all-cause deaths were reported during 1755 person-years of follow-up (incidence rate 17.7 events per 100 person-years). The most important predictors of death were N-terminal pro B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin-T (hs-TnT), left atrial area indexed to body surface area (LAAi), prior cardiac arrest, kidney impairment, congestive heart failure and age, and were included in the BLACCK (AF) death risk score. The score was well-calibrated (observed probabilities adjusted to predicted probabilities) and showed good discriminative ability [c-index 0.87 (95% CI 0.85–0.90)]. The internal validation of the score reported minimal over-fitting (optimism-corrected c-index of 0.85). The 1, 2 and 3-year risk of death derived by the score's total points may be calculated immediately through the nomogram (Figure 1).
BLACCK (AF) risk score nomogram

Conclusions
We developed a simple, well-calibrated and internally validated novel risk score for predicting 1, 2 and 3-year risk of death in patients with AF after a hospitalization for cardiac reasons. The BLACCK (AF) death risk score included both cardiac biomarkers and clinical information, performed well and may assist physicians in decision-making when treating patients with AF.
P1874Novel predictors of atrial fibrillation progression
Authors: Tarzimanova A I , Podzolkov V I , Pisarev M V , Gataulin R G 
Published: October 2019

Abstract

Objective
To identify predictors of progression of atrial fibrillation (AF) in patients with hypertension, coronary heart disease (CHD) and chronic heart failure (CHF) with recurrent AF.

Materials and methods
The study included 312 patients with recurrent AF. The patients were divided into 3 groups according to the leading underlying condition: essential hypertension (n=136), CHD (n=112), and CHF (n=64). The average follow-up duration was 60±3 months. “Progression” of AF was defined as development of persistent or permanent AF.

Results
During the 5-year prospective follow-up in all the groups of patients with recurrent AF, progression of arrhythmia from paroxysmal or persistent to permanent form was noted. The rate of AF progression in patients with CHF was significantly higher, and its percentage was 59%. The progression percentage after 5 years was 46% (p=0.002) in patients with hypertension and 51% (p=0.008) in patients with CHD. AF progression in patients with hypertension correlated significantly with left ventricular hypertrophy (OR 1.25; 95% CI, 1.03 to 1.52) and increased vascular wall stiffness (OR 2.3; 95% CI, 1.95 to 2.65). Independent predictors of arrhythmia worsening in patients with CHD were history of myocardial infarction (OR 1.23; 95% CI, 0.9 to 1.5), irreversible left ventricular (LV) hypokinesis (OR 1.41; 95% CI, 1.1 to 1.7), and increased plasma N-terminal pro–A-type natriuretic peptide (NT-proANP) (OR 1.16; 95% CI, 0.8 to 1.4). Reduced LV ejection fraction (EF) (OR 0.84; 95% CI, 0.7 to 0.89) and increased plasma N-terminal pro–B-type natriuretic peptide (NT-proBNP) (NT-proBNP) (OR 2.3; 95% CI, 1.93 to 2.67) were independent predictors of AF progression from persistent to permanent form in patients with heart failure with reduced ejection fraction.

Conclusions
Progression of AF is related to the underlying cardiovascular disease. Early vascular aging syndrome and LV hypertrophy are the main factors of AF progression in patients with hypertension. Previous myocardial infarction with irreversible hypokinesis is associated with AF progression in patients with CHD. Reduced LVEF and increased plasma BNP predict AF progression in patients with CHF.
P1881High-sensitivity cardiac troponin T in patients with acute atrial fibrillation
Authors: Arbucci R , Haseeb S , Campos R , Trivi M , Costabel J P 
Published: October 2019

Abstract

Background
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice and confers a significant burden to morbidity and mortality. High-sensitivity cardiac troponin T (hs-cTnT) levels have provided a significant contribution in the early diagnosis of cardiovascular events; however, the significance of hs-cTnT elevation in the setting of acute AF is not clearly understood.

Purpose
The aim of this study was to evaluate the factors associated with hs-cTnT elevation and its prognostic implication in patients with acute AF.

Methods
This single-center prospective study included 406 consecutive patients who presented to the emergency department (ED) with acute AF. Acute AF was defined as a rapid, irregular, and chaotic atrial activity of <48 hours' duration including both the first symptomatic onset of chronic or persistent AF, and episodes of paroxysmal AF. The association between hs-cTnT and outcomes were evaluated using multivariate analyses.

Results
The mean age of the population was 67.3±12.2 and 74% were male. The median time from the onset of symptoms to ED consultation was 230 minutes (interquartile range: 123–450 minutes). The median hs-cTnT value was 12 ng/L, with 39% of patients with values above the 99 thpercentile. AF was reverted to sinus rhythm in 76% of the patients (83% attempted cardioversion). At one-year, AF recurrence was observed in 38% of the patients and major adverse cardiovascular events (MACE) (death, myocardial infarction, acute coronary syndrome or stroke) were observed in 6% of the patients. After adjusting for demographic and clinical characteristics in multivariate analysis, hs-cTnT elevation was associated with increasing age and left atrial area (p=0.001). Hs-cTnT levels were not associated with 1-year AF recurrence (p=0.132) or with AF reversion (p=0.869). Hs-cTnT levels were significantly higher in patients who experienced MACE at 1-year (12 ng/L vs 24 ng/L, p=0.001) and hs-cTnT was a predictor of MACE on multivariate analysis (OR 3.486, 95% CI 1.256–5.379, p=0.009).
Variable Result AF rate 110 (90–118) Atrial area, cm2 22 (19–27) Cardioversion attemped 82.5%

Conclusions
Hs-cTnT elevation accounted for a large proportion of patients with acute AF. Elevated levels of hs-cTnT were not associated with AF reversion or with 1-year AF recurrence, however hs-cTnT was highly predictive of MACE at 1-year.
P1908Left common pulmonary vein in atrial fibrillation ablation with cryoballoon. A meta-analysis
Authors: Gionti V , Negro M C , Longobardi M , Storti C 
Published: October 2019

Abstract

Background
Conflicting results regarding the impact of left common pulmonary (LCPV) vein on clinical outcome of atrial fibrillation (AF) ablation with cryoballoon technology have been reported. In the present study, we sought to investigate the performance of the 28 mm cryoballoon advance (CB-A) on left common pulmonary vein (LCPV) in terms of post procedural outcome.

Methods
We systematically searched on PubMed and Cochrane library for the articles that compared the recurrence rate of AF after cryoballoon ablation between patients with four separate and distinct pulmonary vein ostia and with LCPV.

Results
A total of 5 studies with 1052 patients met our predefined inclusion criteria. Recurrence of AF after CB-A ablation was similar in both groups (Log OR 0.45; 95% CI: −0.03, 0.94; I=48%, p=0.08), Fig 1.
Figure 1

Conclusion
LCPV doesn't affect clinical outcome of AF ablation with cryoballoon technology.
P1919The assessment of the application and the efficacy of pulmonary vein isolation with cryoballoon for non-paroxysmal atrial fibrillation
Authors: Nitta G , Inaba O , Kato S , Kono T , Ikenouchi T , Murata K , Matsuda J , Kanoh M , Inamura Y , Takamiya T , Negi K , Sato A , Yamato T , Matsumura Y , Nitta J 
Published: October 2019

Abstract

Background
Pulmonary vein isolation (PVI) using second generation cryoballoon (CB) ablation has become an established treatment for paroxysmal atrial fibrillation (PAF) patients. On the other hand, PVI with radiofrequency (RF) has been an established treatment for non-PAF patients, in addition to PAF patients.

Purpose
The data on second generation CB ablation for non-PAF patients is limited. We assessed the application of PVI with CB for non-PAF patients and compared the outcomes of success rate, radiational time, and procedural time.

Methods
A total of 2632 AF patients (age 64±10; 1873 males) underwent initial PVI from September 2014 to June 2018. Second-generation CB was employed to 1587 patients (CB-PAF: 80%, CB-non-PAF: 20%) and RF using irrigation-tip catheter was employed to other 1045 patients (RF-PAF: 40%, RF-non-PAF: 60%). In CB group, PV touch-up ablation with RF was needed for 113 patients (7%) (CB-PAF: 6%, CB-non-PAF: 13%; p<0.001). After PVI, additional ablation for non-PV foci was undergone after the induction by using ISP infusion and rapid atrial pacing.

Results
AF free survival rate was almost equivalent in both non-PAF group (2-years Kaplan-Meir event rate, CB-non-PAF 66.3%, RF-non-PAF 69.8%; log-rank p=0.297). There was significantly difference in procedural time (CB-non-PAF 132±56min, RF-non-PAF: 189±52min, p<0.001), and radiation time (CB-non-PAF: 47±40min, RF-non-PAF: 75±31min, p<0.001). The percentage of patients with non-PV foci was significantly higher in CB group (CB-non-PAF 41%, RF-non-PAF 54%, p<0.001), and after excluding the patients with non-PV foci, AF free survival rate was almost equivalent in both group (2-years Kaplan-Meier event rate, CB-non-PAF 75.4%, RF-non-PAF 78.8%; log-rank p=0.577). On the other hand, in patients in CB, AF free survival rate was significantly superior in PAF group (2-years Kaplan-Meir event rate, CB-PAF 83.3%, CB-non-PAF 65.2%; log-rank p<0.001). There was significantly difference in procedural time (CB-PAF: 117±47min, CB-non-PAF: 132±56min, p<0.001), and radiation time (CB-PAF: 38±22min, CB-non-PAF: 46±27min, p<0.001). The percentage of patients with non-PV foci was significantly higher in non-PAF group (CB-PAF 30%, CB-non-PAF 41%, p<0.001), and after excluding the patients with non-PV foci, AF free survival rate was also significantly superior in PAF group (2-years Kaplan-Meier event rate, CB-PAF 85.1%, CB-non-PAF 69.8%; log-rank p<0.001).

Conclusions
For non-PAF patients with PV triggers, PVI with CB might be non-inferior to PVI with RF. Our study showed the efficacy of CB in terms of the shortening of procedural time, and the reduction of radiational exposure. PVI with CB for non-PAF patients was inferior to that for PAF patients.
P1956Geriatric nutritional risk index as predictor for long-term survival and cardiovascular or limb events in peripheral arterial disease patients
Authors: Matsuo Y , Kumakura H , Shirakura T , Ichikawa K , Funada R , Yagi H , Iwasaki T , Ichikawa S , Kurabayashi M 
Published: October 2019

Abstract

Background
The geriatric nutritional risk index (GNRI) is a simple tool to assess the nutritional risk and associated with mortality. However, there are no reports focusing GNRI in peripheral artery disease (PAD) patients.

Purpose
The purpose of this study was to examine the effects of GNRI for long-term survival, cardiovascular and limb events in PAD patients.

Methods
A prospective cohort study was performed in 1219 PAD patients. Baseline GNRI was calculated from serum albumin level and body-mass-index. The patients were divided into four groups by GNRI level (G1: >98; G2: 92–98; G3: 82–91; G4: <82). The endpoints were overall survival (OS) and freedom from major adverse cardiovascular and limb events (MACE and MACLE).

Results
The median follow-up was 73 months. There were 626 deaths (51.4%) during follow-up. The rate of cardiovascular death among dead was 51.3%. The OS rates markedly depended on GNRI level (p<0.01). The 5-year OS rates were G1: 80.8%, G2: 62.0%, G3: 40.0%, G4: 23.3%, respectively. In multivariate analyses, GNRI, age, low ankle brachial pressure index (ABI), low estimated glomerular filtration rate (eGFR), and high C-reactive protein (CRP) levels were independent factors associated with OS (<0.05). GNRI, age, low ABI, diabetes mellitus, coronary artery disease, lower eGFR and higher CRP levels were associated with MACE and MACLE (p<0.05, respectively). Besides, statins improved OS, MACE, and MACLE (<0.01, respectively).

Conclusions
GNRI was an independent predictor for OS, MACE, and MACLE in PAD patients. Furthermore,statins improved OS, MACE and MACLE in patients with PAD.