bluuebunny/crossref_metadata_2025_split huggingface dataset:
285Arrhythmias after transcatheter closure of persistent foramen ovale are related to the type and size of the implanted device
Authors: Komar M , Przewlocki T , Prochownik P , Gancarczyk U , Sobien B , Libiszewska N , Skoczek A , Olszowska M , Podolec P 
Published: October 2019

Abstract

Transient supraventricular arrhythmias may occur in patients following persistent foramen ovale (PFO) closure. Therefore, the aim of the study was to prospectively perform 24-hour ECG monitoring to assess the electrocardiographic effects of transcatheter closure of PFO depending on the type of implanted devices.

Material and methods
351 consecutive adult subjects (196 F, 155M; mean age: 40.9±15.3) were enrolled into the study to undergo PFO closure with an Amplatzer Septal Occluder - ASO (157 pts: 117 occluders – size 25; 40 pts – size 30), and Cardia device (194 pts: 163 occluders – size 25; 31 – size 30).
Holter monitoring was performed on all patients before, at 1 and 12 months after the procedure.

Results
The success rate of PFO closure was 97.8% (351 cases from 359 qualified in TEE), in 8 cases the PFO tunnels were too small to be forced by a catheter, in one case the PFO device caused an injury of the septum and an ASD Amplatzer device was implanted. During the procedure in 3 (0.85%) cases transient supraventricular arrhythmia and in 1 (0.28%) case bradycardia to 27 bpm occurred.
At 1 month: in 7 (2%) pts changes in AV conduction occurred: 1 pt (0.28%) had complete AV dissociation, 6 (1.7%) pts intermittent first degree AV block; paroxysmal atrial fibrillation (pAF) occurred in 6 (1.7%) pts, 2 of whom had pAF prior to closure.
A significant increase in the number of SVE premature beats/24h was noted at 1 month after the procedure: 1167.9±409 (27–9976) compared to baseline data 60.2±44 (0–601) (p<0.0001), at 12 months the SVE number decreased to 57.2±51 (7–752) and did not differ significantly from the baseline data.
There was no change in the mean number of ventricular arrhythmias/24h after the procedure.
There was a significant correlation between SVE premature beats/24h at 1 month after the procedure and device size (p<0.001 r=97211).
Pts with ASO device had a significantly higher number of SVE ectopy at 1 month after PFO closure (19123.9±70) compared to pts with Cardia device (811.9±324), p<0.0001.

Conclusions
1. Transcatheter closure of PFO is associated with a transient increase in supraventricular premature beats and a small risk of AV conduction abnormalities and paroxysmal atrial fibrillation in the early follow-up. There is regression of periprocedural arrhythmias after 12 months of PFO closure.
2. Transcatheter closure of PFO with Cardia device is related to a lower risk of supraventricular arrhythmias in the early follow-up.
3. The smaller device is implanted the lower risk of periprocedural arrhythmias is expected.
297Seeing is believing: the feasibility and acceptability of using wearable cameras to enhance self-management of heart failure
Authors: Cartledge S , Rogerson M , Singh T K R , Huynh Huu V , Phung D , Gurrin C , Neil C , Ball K , Maddison R 
Published: October 2019

Abstract

Introduction
For people with heart failure (HF), self-management (e.g., adhering to prescribed medication, management of fluid restrictions and daily weighing) and dietary management is critical for disease management. The rise of technologies (mobile phones, wearable cameras) for healthcare use offers potential support for people to better manage their disease. We aimed to test the feasibility and utility of wearable cameras for identifying self-management practices and to determine if these images can be used to enhance self-management in people with HF.

Methods
Participants wore the “narrative clip”, a small wearable camera for one month during waking hours; still images were taken every 30 seconds. Using state-of-the-art artificial intelligence techniques, we investigated automated image analysis of daily life activities to determine the potential of these systems to identify four categories of human activities: medication management, dietary intake, meal preparation and physical activity. Participants also completed a semi-structured questionnaire about acceptability and feasibility.

Results
30 participants (mean age 73.6 years, 60% male) with HF NYHA Class II-III were recruited. A total of 629,603 images were available for analysis. Higher order analyses were conducted to determine precision of identifying correct images for the pre-defined self-management categories. Precision of identifying the correct images was highest in dietary intake (average 49%, range 13–94%) followed by meal preparation (average 40%, range 1–99%) and physical activity (average 31%, range 0–95%). Medication management had the lowest precision (average 6%, range 6–22%). Manual review of images revealed substantial periods of sedentary time, typically paired with screen time (watching television, playing cards on a computer). All participants agreed the camera was easy to use and felt they had privacy when using the camera. The majority of participants felt comfortable wearing the camera (93%) and thought this technique will help people with HF in the future (93%).

Conclusions
Images from wearable cameras provided rich contextual data to better understand the lived experiences of people with HF and the device was acceptable to participants. Automated machine learning tools require more annotated data for training to enhance precision, which will be achieved via further annotation, fine-tuning and retraining the data analysis model. Despite these challenges, the data collected can be used as an adjunct to traditional data collection methods such as self-report. Once data analysis techniques are refined, objective data from wearable cameras may also prove useful for nurses to provide tailored education for self-management.

Acknowledgement/Funding
Heart Foundation Vanguard Grant, Australia (101348)
410Heart failure risk stratification and efficacy of dapagliflozin in patients with type 2 diabetes mellitus
Authors: Berg D , Wiviott S , Scirica B , Gurmu Y , Mosenzon O , Murphy S , Bhatt D , Leiter L , McGuire D , Wilding J , Johansson P , Langkilde A , Raz I , Braunwald E , Sabatine M 
Published: October 2019

Abstract

Background
Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing heart failure (HF). Treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors reduces the risk of hospitalization for HF (HHF) in patients with T2DM.

Purpose
To develop and validate a practical, multivariable clinical risk score for HHF in patients with T2DM and assess whether this score can identify high-risk patients with T2DM who have the greatest reduction in risk for HHF with an SGLT2 inhibitor.

Methods
We developed a clinical risk score for centrally-adjudicated HHF using independent clinical risk indicators of HHF in 8212 patients with T2DM in the placebo arm of SAVOR-TIMI 53. Candidate variables were assessed using multivariable Cox regression and independent clinical risk indicators achieving statistical significance of p<0.001 were included in the risk score and given weights proportional to the regression coefficients. We externally validated the score in 8578 patients with T2DM in the placebo arm of DECLARE-TIMI 58. Discrimination was assessed using Harrell's c-index. The relative and absolute risk reductions in HHF with the SGLT2 inhibitor dapagliflozin were assessed by baseline HHF risk.

Results
The 5 independent clinical risk indicators were prior heart failure, atrial fibrillation, coronary artery disease, estimated glomerular filtration rate (eGFR), and urine albumin/creatinine ratio (UACR) (Figure, left). A simple integer-based scheme using these predictors identified a strong >16-fold gradient of HHF risk (p-trend <0.001) in both the derivation and validation cohorts, with c-indices of 0.81 and 0.78, respectively. Whereas relative risk reductions were similar across the risk score (25–34%), absolute risk reductions were greater in those at higher baseline risk (interaction p-value for absolute risk reduction <0.01), with high-risk (2 points) and very high-risk patients (≥3 points) having 1.5% and 2.7% absolute risk reductions in HHF at 4 years with dapagliflozin, translating into NNTs of only 65 and 36, respectively (Figure, right).

Conclusion(s)
Risk stratification using a novel clinical risk score for HHF in patients with T2DM identifies patients at higher risk for HHF who derive greater benefit from treatment with the SGLT2 inhibitor dapagliflozin.

Acknowledgement/Funding
SAVOR-TIMI 53 and DECLARE-TIMI 58 were sponsored by AstraZeneca.
483Blood pressure and white matter lesions in patients with atrial fibrillation
Authors: Aeschbacher S , Blum S , Meyer-Zurn C , Vischer A S , Meyre P , Rodondi N , Beer J H , Moschovitis G , Moutzouri E , Sticherling C M , Wurfel J , Bonati L H , Osswald S , Conen D , Kuhne M 
Published: October 2019

Abstract

Background
Hypertension (HTN) is one of the most common cardiovascular risk factors in patients with atrial fibrillation (AF). As a potential risk factor for cerebral white matter lesions (WML), HTN might explain the increased risk of cognitive dysfunction in AF patients.

Methods
In a multicenter cohort study of patients with documented AF in Switzerland, systolic and diastolic blood pressure (SBP, DBP) was measured up to three times in a supine position and the mean was calculated. HTN was defined as controlled, when SBP was <140 and DBP <90 mmHg with treatment, and uncontrolled when SBP was ≥140 or DBP ≥90 mmHg with treatment. All patients underwent brain magnetic resonance imaging. Volumes of WML were assessed and graded using the Fazekas scale. A Fazekas score of ≥2 was defined as moderate or severe WML. Multivariable adjusted regression models were used to assess the association between BP and WML.

Results
Overall, 1738 patients were enrolled in this cross-sectional analysis (mean age 73 years, 73% males). Mean BP was 135/79 mmHg, 69% had a history of HTN. Any WMLs were found in 99% of the patients and 54% had at least moderate WMLs. The prevalence of Fazekas ≥2 was 47%, 50% and 61% among AF patients with SBP <120, 120–140 and ≥140mmHg (p<0.001), respectively. Volumes of WMLs significantly increased across the same SBP categories (2943, 3512 and 4988 mm3, p<0.001). Among patients with normotension, controlled and uncontrolled HTN, moderate or severe WMLs were present in 173 (42.5%), 345 (55%) and 307 (61%), respectively. SBP was associated with Fazekas ≥2 and WML volume after multivariable adjustment (Table). Compared to normotension, both controlled and uncontrolled HTN were significantly associated with higher WML volume (Table).
Association between blood pressure and white matter lesions Blood pressure Fazekas ≥2 OR (95% CI) Volume WML β-coefficient (95% CI) <120 mmHg Ref Ref 120–140 mmHg 1.17 (0.88; 1.55) 0.14 (−0.01; 0.30) ≥140 mmHg 1.49 (1.11; 2.00) 0.28 (0.12; 0.43) Continuous, per SD 1.20 (1.09; 1.36), p<0.001 0.12 (0.06; 0.18), p<0.001 Normotension Ref Ref Treated hypertension 1.26 (0.94; 1.68), p=0.12 0.22 (0.07; 0.38), p=0.005 Treated, uncontrolled hypertension 1.52 (1.13; 2.05), p=0.005 0.38 (0.21; 0.54), p<0.001 Regression analyses were adjusted for age, sex, BMI, smoking status, stroke, diabetes, coronary heart disease, AF type, and antihypertensive treatment. One standard Deviation (SD) of SBP = 18 mmHg. Volume of WML was log-transformed.

Conclusion
Moderate or severe cerebral WMLs are highly prevalent in AF patients and strongly associated with SBP. Our data suggests that optimal treatment of HTN might play an essential role in preventing WMLs.

Acknowledgement/Funding
Swiss National Science Foundation
P301Preserved global longitudinal strain predicts left ventricular reverse remodeling one year after edge-to-edge mitral valve repair in functional mitral regurgitation
Authors: Papadopoulos K , Ikonomidis I , Chrissoheris M , Chalapas A , Kourkoveli P , Chrysohoou C , Avgeropoulou A , Parissis J , Vardas P , Spargias K 
Published: October 2019

Abstract

Background
Percutaneous edge-to-edge mitral valve repair (PMVR) has emerged as an effective treatment modality for high surgical risk patients with severe functional mitral regurgitation (FMR). Novel echocardiographic parameters, such as deformation imaging and their predictive significance have not been analyzed in this group of patients.

Purpose
The purpose of this study is to identify echocardiographic predictors of response in patients with FMR undergoing PMVR.

Methods
We retrospectively analyzed 44 consecutive patients with ischemic or dilated cardiomyopathy, reduced ejection fraction and severe functional MR (FMR), aged 71±9 years, 71% males, LVEF 30.9±8.7%, mitral valve effective regurgitant orifice area (EROA)>20mm2, regurgitant volume (RV) >30ml and logistic EuroSCORE 22±14.7%. At baseline and 1-year after PMVR we assessed echocardiographic parameters such as LV longitudinal strain (LVGLS) and peak left atrial longitudinal strain (PALS) using speckle tracking echocardiography, LV end-systolic and end-diastolic volumes (LVESV, LVEDV), LA volume, MR severity by Doppler echocardiography along with BNP levels, NYHA class and 6 minute walking distance.

Results
One year after edge-to-edge repair there was a significant reduction of MR (74.2% had mild to moderate MR, 22.6% moderate-to-severe MR and 3.2% severe MR) and BNP levels (933±943pg/ml to 669±824pg/ml), improvement of NYHA class (3.11±0.55 to 2.0±0.6, P<0.05) and increase of the 6 minute walking distance (251±141 to 296±148m, P<0.05). LA volume was reduced (132.5±62.1ml to 115.2±57.7ml) and PALS was improved (6.89±3.47 to 7.94±5.27) (P<0.05 for all comparisons). Baseline LVGLS did not change significantly post intervention (−8.8±4.1 vs. −8.8±3.9, P=0.7) but the baseline value predicted the percentage difference in LVEDV (r=−0.61, P<0.01), LVESV (r=−0.47, P=0.03), BNP (r=0.45, P=0.04) and NYHA class (r=0.63, P<0.01). The best reverse LV remodeling was found in patients with GLS better than −10% and the trend was that the better the GLS the greater the LVEDV and LVESV reduction post-intervention. Additionally, patients with GLS between −10% and −5% had the largest improvement in BNP (P<0.05) and NYHA class (P=0.005).

Conclusions
Edge-to-edge repair is effective in reducing MR in patients with severe functional MR and has a positive impact in patients' clinical status at one year follow up. A preserved LVGLS seems to be a good predictor of reverse modeling and clinical improvement post intervention.
P585Intra left ventricular hemodynamics assessed using 4D flow MRI in the patient with left ventricular thrombus
Authors: Sakakibara T , Suwa K , Kaneko Y , Akita K , Sato R , Mogi S , Naruse Y , Ohtani H , Saitoh T , Saotome M , Urushida T , Maekawa Y 
Published: October 2019

Abstract

Background
Early detection of left ventricular mural thrombus (LVT) in patients with reduced ejection fraction (EF) is crucial in prevention of arterial embolism. 3D-cine phase-contrast magnetic resonance imaging (4D flow MRI) can visualize the intra-LV vortex flow in diastole and quantify the maximum flow velocity (Vmax) at the apex. it remains, however, unknown whether 4D flow MRI is useful for detecting LVT.

Purpose
The purpose of our study is to examine the intra-LV vortex formation and flow velocity in patients with severe LV dysfunction using 4D Flow MRI, and to compare differences in intra-LV flow dynamics between patients with and without LVT. We also examined the diagnostic accuracy to detect LVT by 4D flow MRI.

Methods
Twenty-nine patients with impaired LV function (LVEF 25.8±7.4%, 62.5±12.3 years old, 24 males, 11 with ischemic cardiomyopathy, 9 with LVT) underwent 4D flow MRI from January 2012 to August 2018 in our institution. Intra-LV vortex size was evaluated as vortex/LV area ratio by streamline imaging (Figure 1). The diagnostic accuracy to predict LVT by vortex size and Vmax at the apex was determined by ROC analysis.

Results
The vortex was smaller (vortex/LV area ratio; 30.6±7.0% vs. 45.1±9.0%, p<0.05) and Vmax at the apex was lower (0.20±0.04 m/s vs. 0.28±0.09 m/s, p=0.013) in patients with LVT compared to those without LVT. The AUC was 0.789 for Vmax (cut-off value=0.226 m/s, sensitivity=0.889, specificity=0.650) and was 0.900 for vortex/LV area ratio (cut-off value=34.7%, sensitivity=0.889, specificity=0.850).
Figure 1

Conclusion
The smaller size of intra-LV vortex and the lower flow velocity at the LV apex may have association with LVT formation in patients with reduced EF. 4D flow MRI might be useful to predict LVT formation. Large scale longitudinal study is warranted to evaluate the incidence of LVT in the patients with lower flow velocity.

Acknowledgement/Funding
None
P624The prognostic value of myocardial deformation in patients with congenital aortic stenosis
Authors: Van Grootel R W J , Van Den Hoven A T , Bowen D , Ris T , Roos-Hesselink J W , Van Den Bosch A E 
Published: October 2019

Abstract

Background
Congenital aortic stenosis (AoS) is associated with significant mortality and morbidity but predictors for clinical outcome are scarce. Strain analysis provides a robust and reproducible method for early detection of left ventricular (LV) dysfunction, which might be of prognostic value. Therefore we aimed to assess the prognostic value of LV global longitudinal strain (GLS) and global longitudinal early diastolic strain rate (GLSre) with regard to cardiovascular events.

Methods
This prospective study, included clinically stable patients with congenital AoS between 2011–2013. LV GLS and GLSre was performed in the apical 4, 3 and 2-chamber views using Tomtec software. The endpoint was a composite of death, heart failure, hospitalization, arrhythmia, thrombo-embolic events and re-intervention.

Results
In total 138 patients were included (33 [26–43] years, 86 (62%) male), NYHA class I: 134 (97%). Mean LV GLS was −15.3±3.2%, GLSre 0.66±0.18 s–1. Both correlated with NT-proBNP, LV volumes and ejection fraction (strongest LV GLS with LV EF: r −0.539, p<0.001, strongest LV GLSre with age: r −0.376 p<0.001). During median follow-up of 5.9 [5.5–6.2] years, the endpoint occurred in 53 (38%) patients: 4 patients died, 9 developed heart failure, 22 arrhythmias, 8 thrombo-embolic events and 35 re-interventions. Both LV GLS (standardized HR (sHR 0.62 (95% CI 0.47–0.81) and GLSre (sHR 0.62 (95% CI 0.47–0.83) were associated with the endpoint. Additional multivariable analysis showed that both GLS and GLSre were associated independent of left atrial volume, NT-proBNP and prior re-interventions.
Figure 1

Conclusion
Left ventricular GLS and GLSre are reduced in adult patients with congenital AoS. Both markers are associated with adverse cardiac events and have clear clinical relevance

Acknowledgement/Funding
Erasmus Thorax Foundation
P633Comparative analysis of exercise programmes with aerobic moderate and high-intensity interval training in patients after coronary artery bypass grafting
Authors: Kakuchaya T , Pachuashvili N V , Dzhitava T G , Kuular A M , Filatova A G , Bockeria L A 
Published: October 2019

Abstract

Background
High-intensity interval training is emerging as a potential time efficient strategy in contemporary cardiac rehabilitation. According to current guidelines 150 minutes of moderate physical activity per week is reduced by half to 75 minutes if the week's activity is done at a vigorous intensity. Objective: The main goal of our study was to assess and compare high-intensity interval training (HIIT) with moderate-intensity continuous training (MICT) within cardiac rehabilitation after coronary artery bypass grafting.

Methods
Sixty three patients (48 male, 15 female, at the mean age of 57±12 years) after coronary artery bypass grafting were recruited into exercise training program on cycle ergometer. The training course started 2 weeks after surgery, lasted 4 weeks and then continued in an outpatient care after 3–6 months. MICT was considered as 50% to 75% of VO2 max (maximal oxygen consumption) or 50–75% of heart rate reserve, while HIIT was considered as ≥85% of VO2 max or ≥85% of heart rate reserve. Training protocols included constant load and ramp interval programs. Control group comprised 40 patients without exercise training program. The safety of HIIT/MICT was the primary end point in our study. Secondary end-points included body mass index, echo and hemodynamic parameters, NT-proBNP and HbA1c levels along with standard cardiorespiratory fitness indicators.

Results
Significant increase in anaerobic threshold (by 16.9%), VO2 max (by 18.6%) and tolerance of physical load in MET (by 6.4%) were mentioned in study groups compared to equivalent measurements in control group (9.7%, 7.9% and 5.4% correspondingly). Substantial changes were also observed in following variables compared to control group: body mass index reduced (p=0.0032), end diastolic diameter decreased (p=0.0315), LV ejection fraction improved (p=0.045), NT-proBNP reduced (p=0.0015) and HbA1c improved (p=0.023). While analyzing aerobic capacity alterations due to HIIT versus MICT by standardized mean difference (95% CI), HIIT was significantly superior to MICT. Aerobic capacity covered VO2 max (ml/kg/min), anaerobic threshold (%), work rate (Wt) and EQo2=VE/Vo2.

Conclusions
High-intensity interval training proved to be as safe as a moderate-intensity training in patients after coronary artery bypass grafting. It appeared to be significantly superior to moderate-intensity continuous training in improving cardiorespiratory fitness. Obtained results allow implementing aerobic interval training individually after open-heart surgery and shorten rehabilitation period.
P650Lipopolysaccharide-nuclear factor-kappa B pathway and lipoprotein apheresis effects in patients with familial hypercholesterolemia and coronary artery disease
Authors: Liu H , Zhu C G , Cui C J , Cao Y X , Sun D I , Wu N Q , Guo Y L , Gao Y , Dong Q T , Santos R D 
Published: October 2019

Abstract

Abstract

Background
Inflammation may play an important role in atherosclerosis in familial hypercholesterolemia (FH). Lipopolysaccharide (LPS)-nuclear factor-kappa B (NF-κB) pathway is a routine signal process activated in inflammatory status.

Purpose
This study aimed to examine the LPS-NF-κB axis status and the impact of lipoprotein apheresis (LA) on this pathway in patients with FH and coronary artery disease (CAD).

Methods
In this matched case-control study a genetically diagnosed FH cohort who presented stable CAD (n=63) was compared with 63 non-FH CAD and 63 non-FH non-CAD controls matched by sex and age. Plasma LPS levels and NF-κB activity were compared among the three groups. In addition, we studied in vitro LPS-induced interleukin-6 (IL-6) production by mononuclear cells from 16 FH cases without previous statin use and compared them with their respective matched control groups. Subsequently, these 16 FH patients underwent LA. Blood samples were taken immediately before and regularly after LA for measuring LPS and NF-κB.

Results
FH plus CAD had higher LPS levels and NF-κB activity than CAD and non-CAD controls (all p values <0.01). LPS-induced IL-6 production by mononuclear cells of FH plus CAD was also much higher compared with CAD and non-CAD controls (both p values <0.01). Moreover, plasma LPS levels (p<0.001) and NF-κB activity (p<0.01) were dramatically reduced after apheresis in FH patients.

Conclusion
Genetically confirmed FH patients with CAD had a marked activation of LPS-NF-κB axis, while LA significantly attenuated this key inflammatory pathway, suggesting that inflammation may be an important therapeutic target for FH patients.