bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3138Age based outcomes after implantable cardioverter-defibrillator extraction
Authors: Sharedalal P , Shah N S , Cubberley A C , Saltzman H S , Kutalek S K 
Published: October 2019

Abstract

Background
There are growing numbers of defibrillator implantations for prevention of sudden cardiac death. As such, there has been a concomitant need for lead extraction. This procedure is often indicated in the setting of device or systemic infection, device upgrade, lead malfunction or elective extraction in cases of abandoned leads. Lead Extraction is associated with increased morbidity and mortality. The comparative safety and effectiveness of lead extraction in various age groups has not been well evaluated.

Purpose
The average age of patients undergoing lead extraction in our single center database is (65.5±15.9). There are lack of studies on age associated outcomes with lead extraction. We intend to evaluate differences in major in minor adverse outcomes in patients undergoing lead extraction stratified by age.

Methods
We identified 1,297 patients who underwent lead extraction between January 2003 and April 2016 at a major metropolitan center and evaluated procedural outcomes stratified by age. Age groups were stratified as <55, 55–64, 65–74, 75–84, and >85 years old. Baseline characteristics including history of coronary artery bypass graft (CABG), hypertension (HTN), congestive heart failure (CHF), hyperlipidemia (HLD), diabetes mellitus (DM) and coronary artery disease (CAD) were evaluated using chi-squared analysis. Adverse events were identified as major complications (death, cardiac arrest, cardiac perforation, coronary venous dissection, pericardial tamponade, or urgent cardiac surgery), and minor complications (coronary sinus dissection, pneumothorax, pocket bleeding requiring drainage, worsening tricuspid valve function, vegetation embolization, venous thrombosis, requirement of blood transfusion or lead migration). Subgroups for age were also analyzed using chi squared analysis to prevent type 1 error.

Results
There was no statistically significant difference in overall major and minor complications amongst different age groups (P>0.05). An overall statistically significant difference was noted in baseline characteristics of CABG, HTN, HLD, DM, and CAD (P<0.05). Within each age subgroup, no statistically significant difference was noted for major or minor complications post lead extraction (P>0.05).

Conclusion
This study shows lead extraction can be performed safely in patients of all age groups without significant overall risk of major or minor complications.

Acknowledgement/Funding
None
P3393Comparison of intermediate-term vascular response to new-generation biodegradable polymer and durable polymer-based drug-eluting stents: optical coherence tomographic study
Authors: Kawamura A , Nishino M , Matsuhiro Y , Nakamura Z , Yasumura K , Yasumoto K , Tanaka A , Matsunaga Y , Nakamura D , Yano M , Yamato M , Egami Y , Syutta R , Tanouchi Z 
Published: October 2019

Abstract

Background
Over the last decade, drug-eluting stents (DES) have undergone substantial modifications with thinner struts and more biocompatible durable polymer (DP) or biodegradable polymer (BP). In DP-based DES, after drug elusion has been completed, DP remnants may trigger of local inflammatory vascular reactions and promote delayed healing, leading to accelerated neoatherosclerosis (NA). Thus, BPs have been developed to reduce the above-mentioned risks. Recently, poor strut coverage and in-stent NA are increasingly recognized the cause of late stent failure, but it is unclear whether BPs can reduce the incidence of NA and the poor stent coverage as compared to DPs.

Objectives
The purpose of this study was to compare the incidence of NA and the stent coverage using optical coherence tomography (OCT) between the DPs and the BPs.

Methods
Between July 2016 and April 2018, 127 consecutive patients with new-generation DES who underwent 8-month follow up OCT imaging were enrolled. Patients were divided into the two groups: DP group who had the new-generation durable polymer everolimus-eluting and zotarolimus-eluting stents and BP group who had the new-generation biodegradable polymer sirolimus-eluting and everolimus-eluting stents. We compared patient characteristics including hypertension, dyslipidemia and diabetes mellitus and 8-month follow up OCT findings including NA, uncovered struts and malapposed struts between the two groups.

Results
The DP group comprised 64 patients (50.4%. The incidence of NA, uncovered struts and malapposed struts were similar between the two groups (DPs vs BPs, 1.56% vs 7.94%, P=0.11; 7.80% vs 5.88%, P=0.16 and 2.76% vs 2.01%, P=0.43, respectively) (table). The other parameters were also similar between the two groups.
Table 1 DP group (n=64) BP group (n=63) P value Hypertension 44 (68.8%) 50 (79.4%) 0.2251 Dyslipidemia 39 (60.9%) 37 (58.7%) 0.8573 Diabetes mellitus 25 (39.1%) 30 (47.6%) 0.3731 8 month OCT follow up findings   Neoatherosclerosis 1 (1.6%) 5 (7.9%) 0.1147   Uncovered struts 7.8% (2.8–20.4) 5.9% (0.7–16.7) 0.1616   Malapposed struts 0.2% (0–2.8) 0% (0–2.8) 0.4392

Conclusions
The new-generation DP based-DES may have similar effects on vascular response compared to the new-generation BP-based DES during 8-month follow-up period.
P3449Revealing the burden of acute cardiac and arterial complications in 715 patients diagnosed with Lemierre syndrome
Authors: Valerio L , Sacco C , Zane F , Granziera S , Russo M , Konstantinides S , Pecci A , Barco S 
Published: October 2019

Abstract

Background
Lemierre syndrome is a potentially life-threatening condition occurring in otherwise healthy children and adolescents with head/neck bacterial infections (usually tonsillitis due to anaerobe bacteria). Peculiar complications are neck vein thromboses contiguous to the site of infection and multiple septic embolization. Arterial thrombosis and cardiac complications have been described as possible clinical manifestations of Lemierre syndrome: however, in light of the rarity of this condition (one case/1,000,000 person-years), no comprehensive analysis has ever been conducted.

Purpose
To describe the frequency and the patterns of acute cardiac and arterial complications in patients with Lemierre syndrome.

Methods
We identified 715 cases of Lemierre syndrome (years 2000–2016) and retrieved complete individual patient-level data. Study outcomes assessed on admission or during hospitalization were: i) objectively diagnosed ischemia or arterial infarction/thrombosis, arterial stenosis due to inflammatory process, and septic aneurysms; ii) new objectively diagnosed cardiac complications; iii) all-cause death.

Results
Of the 715 patients with Lemierre syndrome, 56 (7.6%, 95% confidence interval [CI]: 6.1%–10.0%) experienced cardiac or arterial complications. Median age was 19 (interquartile range [IQR]: 16–25) years and 35 (62.5%) were men. Intracranial ischemia or infarction was found in 23 patients, corresponding to 3.2% of the whole study population. Carotid artery thrombosis, stenosis, or septic aneurysm occurred in 28 (3.9% of total), pericardial disease in 11 (1.5% of total), and infective endocarditis in 5 (0.7% of total) (Figure). A total of 32 (57.1%) patients developed these complications during the course of hospitalization after a median of 6 (IQR: 3–12 days) days from admission. A total of 37 (66.1%) patients received anticoagulation. Fatality rate was 10.7% (95% CI: 5.0%–21.4%; n=6).
Cardiac and arterial complications.

Conclusions
An unexpectedly high proportion of patients with Lemierre syndrome developed acute cardiac or arterial complications. In this group, the fatality rate was substantial. Our observation that most of the cardiovascular events occurred during the course of hospitalization may have implications for the development of diagnostic and management strategies. It remains unclear whether antithrombotic therapies may influence prognosis.
P3456'Heart, arteries and women', an innovative healthcare pathway based on collaboration between gynecologists and cardiologists for women at cardiovascular risk: design and evaluation at five years
Authors: Madika A , Nasserdine P , Langlet S , Letombe B , Devos P , Mounier Vehier C 
Published: October 2019

Abstract

Introduction
In women, cardiovascular diseases are the leading cause of death worldwide. Prevention and diagnosis typically occur at late stages and less frequently than is men and treatments are not optimal in women. Preventive measures must be implemented, and management approaches improved. To this end, an innovative coordinated healthcare pathway was initiated at the our University Hospital for women at risk of cardiovascular diseases.

Purpose
The objective of this study was to describe the design of the healthcare pathway and to assess its relevance to improve prevention, diagnosis and treatment in women at cardiovascular risk.

Methods
The healthcare pathway “Heart, arteries and women” implemented at our University Hospital since January 1st, 2013 is based on collaboration between gynecologists and cardiologists. Women after an adverse pregnancy outcome and women at menopause with increased cardiovascular risk were referred by the gynecologist to the cardiologist for complete cardiovascular evaluation if eligible (Figure 1). Screening for both traditional and nontraditional cardiovascular risk factor and cardiovascular diseases if indicated, lifestyle counseling and adjustment of medical treatment were performed for each woman. The present study focused on post-menopausal women at risk or high cardiovascular risk according to American Heart Association (AHA) classification who had a complete cardiovascular evaluation through the healthcare pathway between January 1st, 2013 and December 31st, 2017.

Results
We included 690 post-menopausal women with a mean age of 58±8 years. According to AHA classification, 339 women (50,8%) were at high risk and 351 (49,2%) at risk. Cardiovascular risk control was poor with 146 current smokers (21,2%) and 264 obese women (38,3%). Only 320 women (46,4%) reached the targeted blood pressure of <140/90 mmHg and 169 (24.5%) attained their low-density lipoprotein (LDL)-cholesterol target. Among the 212 women treated for diabetes, 45,3% achieved the glycated haemoglobin (HbA1c) target of <7.0%. Lower extremity artery disease was newly diagnosed in 46 women, renal artery disease in 51 women and ischemic heart disease in 62 women. Statins, renin-angiotensin system inhibitors and antiplatelet agents were significantly more prescribed according to guidelines after the cardiovascular evaluation (p<0.001).

Conclusion
Our coordinated healthcare pathway based on partnership between gynecologists and cardiologists allowed to improve assessment of specific cardiovascular risk, screening, prevention and treatment of cardiovascular diseases in women. Enhanced collaboration between gynecologists and cardiologists offers a real opportunity to improve cardiovascular heath in women.
P3480Tissue-specific regulation of the mitochondrial proteome by adiponectin receptor 1
Authors: Gollmer J , Koentges C , Pepin M , Pfeil K , Wende A R , Bode C , Zirlik A , Bugger H 
Published: October 2019

Abstract
Lack of the adiponectin target receptor adiponectin receptor 1 (AdipoR1) impairs gene expression of mitochondrial OXPHOS proteins due to impaired AMPK-SIRT1-PGC-1α signaling. Since decreased adiponectin serum levels in diabetes mellitus should thus compromise AdipoR1 signaling, we hypothesized that impaired AdipoR1 signaling may causally contribute to typically observed mitochondrial defects in diabetes complications. Thus, we performed comparative proteomics in cardiac, renal and hepatic tissue of AdipoR1−/− mice using LC-MS/MS. Using principal component analysis, heatmapping and hierarchical clustering, a significant separation of genotypes was observed across tissues. Enrichment analysis of differentially expressed proteins revealed disproportionate representation of proteins involved in oxidative phosphorylation, TCA cycle and fatty acid oxidation in all tissues. While 121 or 98 or 78 proteins were differentially regulated in cardiac or renal or hepatic tissue, respectively, only 15 proteins were regulated in the same direction across all tissues. Pathway analysis identified HNF4, NRF1, LONP, RICTOR, SURF1, insulin receptor and PGC-1α as most likely upstream regulators. Importantly, we found a dramatic downregulation of AdipoR1 expression in heart (−70%), liver (−90%) and kidney (−80%; all p<0.05) of high fat-fed and prediabetic non-transgenic mice compared to low fat-fed mice. In addition and beyond diabetes, AdipoR1 expression was also decreased in endstage failing hearts of non-diabetic human subjects compared to non-failing donor hearts. Thus, we conclude that AdipoR1 signaling regulates mitochondrial protein composition across all tissues in a functionally conserved, yet molecularly distinct, manner. Impaired AdipoR1 signaling may causally contribute to mitochondrial defects in diabetic complications and even human heart failure.
P3482Leptin, receptor to leptin and expression in adipocytes isolated from different adipose depots in patients with ischemic heart disease
Authors: Dyleva Y A , Gruzdeva O , Uchasova E , Belik E , Brel N , Kokov A , Sinitsky M , Kozyrin K , Barbarash O 
Published: October 2019

Abstract

Purpose
To study the peculiarities of the content of leptin and the leptin receptor in adipocyte culture of subcutaneous (SAT), epicardial (EAT) and perivascular (PVAT) adipose tissue and the expression of their genes.

Methods
29 patients with coronary heart disease were examined. Adipocytes were isolated from SAT, EAT and PVAT samples obtained during coronary artery bypass grafting, followed by evaluation (after 24 hours) of the leptin concentration (Human resistin ELISA, R&D Systems, USA) and leptin gene expression in cell culture. Magnetic resonance imaging (MRI) was used to determine the area of the visceral (VAT) and subcutaneous adipose tissue (SAT) of the abdominal region, the thickness of epicardial adipose tissue (EAT). The calculation of the free leptin index (FLI) was determined by the formula: leptin/SOB-R * 100. Leptin resistance was defined as an FLI >0.25. 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.

Results
In adipocytes of EAT, leptin secretion was 1.2 times higher than in adipocytes of PVAT, which is consistent with the expression of the leptin gene. The content of leptin soluble receptor was opposite in the adipocytes of PVAT higher than in EAT and SAT 2.3 and 3.1 times, respectively. At the same time, the index of free leptin was higher in SAT adipocytes 1.3 and 3.2 times in comparison with EAT and PVAT. The correlation analysis confirmed the relationship between EAT thickness and the serum concentrations of leptin. Thus, in patients with VO, the leptin concentration had a negative dependence on the thickness of the left and right ventricle (r=−0.28, p=0.02; r=−0.33, p=0.02, respectively). A negative dependence on the EAT thickness was also established for the FLI (r=−0.28; p=0.03). PVAT of the abdominal aorta is similar to the properties of visceral AT. An analysis of the possible relationship between perivascular adipocytes and adipokine exchange rates showed a direct relationship between the volume PVAT of the abdominal aortic ventricle and leptin (r=0.44, p=0.01), as well as the FLI (r=0.56; p=0.03).

Conclusion
Adipocytes SAT, EAT and PVAT differed in the level of secretion of leptin. In epicardial and, to a greater extent, in perivascular adipocytes, a protective mechanism against a high concentration of leptin was observed due to increased secretion of the soluble receptor to leptin. The high content of leptin and the low soluble receptor for leptin led to the development of leptin resistance, which was more pronounced in the culture of adipocytes SAT. Meanwhile, the EAT thickness was inversely related to the concentration of leptin and the FLI index (one of the main leptin-resistance markers).
P3512Sex differences in rats with heart failure with preserved ejection fraction and the effect of autonomic modulation
Authors: Stavrakis S , Elkholey K , Morris L , Li Y , Po S S 
Published: October 2019

Abstract

Background
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for 50% of HF and sudden death is the leading cause of mortality. There are considerable sex differences in cardiac structure and function, which may be related to outcomes in HFpEF. Transcutaneous vagus nerve stimulation (tVNS) is antiarrhythmic.

Purpose
To describe sex differences in mortality, autonomic tone and ECG parameters in rats with HFpEF and examine the effect of tVNS on these outcomes.

Methods
Dahl salt sensitive (DS) rats of either sex were randomized into high salt (HS, 8% NaCl) or low salt (LS) diet (0.3% NaCl) at 7 weeks of age. After 6 weeks of LS or HS diets, HS rats were randomized to receive active or sham tVNS, 30min daily (20Hz, 3mA) for 4 weeks. The rats were monitored daily for 4 weeks for the development of HFpEF. ECG and echocardiogram were performed at 13 weeks (baseline) and 17 weeks (endpoint). Heart rate variability (HRV) was calculated at the respective time points. ECG and HRV parameters were analyzed in a blinded fashion. Logistic regression analysis was performed to identify independent predictors of mortality.

Results
A total of 58 rats were included (5 male LS, 6 female LS, 22 male HS and 25 female HS). HS rats developed significant hypertension and signs of HFpEF, while 24% of females and 53% of males died (P=0.004). There were 4 sudden cardiac deaths in males (with ventricular tachycardia documented in 1 rat), whereas all the females died of HF or stroke. Corrected QT (QTc) at baseline significantly prolonged in HS compared to LS rats (250.5±14.4ms vs. 226.8±13.9ms, respectively, p=0.0007), while all other ECG parameters did not differ significantly between groups. In HS rats, QTc prolongation was significantly more pronounced in males compared to females (259.4±20.6ms vs. 243.8±14.5ms, respectively, P=0.002). In univariate analysis, prolonged baseline QTc (OR=1.04; 95% CI 1.01–1.06, p=0.003) and male sex (OR=3.21, 95% CI 1.19–8.66, p=0.016) predicted mortality. However, in multivariate analysis, QTc was the only significant predictor of mortality (OR=1.04; 95% CI 1.01–1.06, p=0.003). After 4 weeks of treatment, active tVNS significantly decreased QTc compared to sham (244.6±13.8ms vs. 255.8±14.0ms, respectively, p=0.017) in both male and female rats in a similar manner. The low frequency to high frequency ratio (LF/HF) of HRV, which reflects sympathovagal balance, was significantly decreased in active tVNS rats compared to sham (0.21±0.13 vs. 0.54±0.14, respectively; p=0.001) in both male and female rats in a similar manner.

Conclusions
Male rats with HFpEF exhibit worse survival compared to females and are at higher risk for sudden death. QTc prolongation accounts for the increased risk of sudden death in males compared to females. Autonomic modulation with tVNS attenuates the unfavorable changes in QTc and HRV induced by HS diet and may be used to prevent ventricular arrhythmias in patients with HFpEF.
P3535Prognostic value of congestion status by bioelectrical impedance analysis and natriuretic peptide levels in acute heart failure with preserved versus reduced left ventricular ejection fraction
Authors: Yazaki Y , Iijima R , Hara H , Moroi M , Nakamura M 
Published: October 2019

Abstract

Background
N-terminal pro-brain natriuretic peptide (NT-proBNP) is a well-known predictor of acute heart failure (HF). Congestion volume status estimated by bioelectrical impedance analysis (BIA) is also associated with adverse cardiovascular events in HF patients. However, it is unclear whether these biomarkers reflecting pathophysiological pathways are different between HF with preserved (HFpEF) and reduced ejection fraction (HFrEF).

Purpose
The aim of this study was to investigate whether the prognostic value of NT-proBNP and extracellular water/free fat mass (ECW%) assessed by BIA is different between HFrEF and HFpEF in acute HF patients.

Methods and results
One hundred-and-forty-three patients admitted for acute HF between November 2013 and January 2015 were estimated for NT-proBNP levels and ECW% by BIA on admission. A total of 49 HFrEF (LVEF<40%) and 75 HFpEF (LVEF≥50%) patients were included in this study (mean age: 76±14 years, male: 63%). The median of NT-proBNP levels in HFrEF patients was higher than in HFpEF (6022 [IQR: 2531–9163] pg/mL and 3179 [1076–6054] pg/mL, respectively, p=0.012). Conversely, ECW% was similar between HFrEF and HFpEF (29.0 [25.7–33.7] % and 31.7 [27.3–38.8] %, respectively, p=0.088). The primary endpoint was the composite of all-cause mortality and/or hospitalisation due to HF. During a median follow-up of 5.9 months, 16 (35.6%) and 35 (50.7%) patients were observed to have composite events in HFrEF and HFpEF, respectively, (p=0.111). Elevated NT-proBNP levels in HFrEF patients were associated with an increased risk of composite events after adjustment for traditional risk factors (hazard ratio [HR]: 2.39; 95% Confidence interval [CI]; 1.04–5.47; p=0.040), but not in HFpEF (p=0.063). Meanwhile, a high ECW% in HFrEF patients was associated with increasing composite events risk (HR: 3.30; 95% CI; 1.32–8.25; p=0.011), as well as in HFpEF patients (HR: 1.62; 95% CI; 1.03–2.55; p=0.037). Furthermore, the ECW% in addition to NT-proBNP in HFpEF patients resulted in a significant improvement in prediction for composite events (net reclassification improvement 0.67 [95% CI 0.24–1.11]; p=0.002 and integrated discrimination improvement 0.12 [0.004–0.20]; p=0.004).

Conclusion
Elevated levels of NT-proBNP in acute HF were predictive for mortality and hospitalisation due to HF in HFrEF but may not be for HFpEF patients, and ECW% had a better predictive value than NT-proBNP in HFpEF patients.