bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4762What do atrial fibrillation ablation procedural volume differences across European centers reflect? An ESC EORP registry: atrial fibrillation long-term
Authors: Pagourelias E , Vassilikos V , Blomstrom-Lundqvist C , Kautzner J , Maggioni A P , Pokushalov E , Tavazzi L , Dagres N , Brugada J , Arbelo E 
Published: October 2019

Abstract

Background
Data from the European Atrial Fibrillation (AF) Ablation Long-Term Registry suggest that there are significant differences in the volume of AF ablation procedures performed across different centers even in the same country. If these differences in AF ablation volume between centers reflect regional, socioeconomic, infrastructural/technical or other disparities has not been addressed till now.

Purpose
The aim of this study was to investigate patient and non-patient related differences among European AF ablation centers according to the volume of AF ablations performed.

Methods
Data for this analysis originate from the European AF Ablation Long-Term Study, a prospective registry designed to describe the clinical epidemiology of patients undergoing AF ablation. Based on 25th and 75th percentiles of AF ablation numbers performed, the participating centers were classified into high volume (HV) (≥250 procedures/year), medium volume (MV) (<250 and ≥58/year) and low volume (LV) (<58/year). Patient (demographics, comorbidities) and non-patient (center infrastructure, procedural characteristics) related differences were assessed.

Results
A total of 91 centers in 26 European countries enrolled 3368 patients. There were no significant differences concerning regional distribution, hospital/cardiology facilities or services provided among centers with the exception of electrophysiology procedures and labs which were more abundant in HV centers (p=0.02 and <0.001 respectively). HV and MV centers ablate twice more cases of long-standing persistent and persistent AF compared to LV centers, in which paroxysmal AF reaches 78.9% of all cases (Figure A). Accordingly, first AF ablation procedure was far more frequent in LV centers compared to MV and HV (85.8% vs 76.0% vs 76.1% respectively, p<0.001). Even though HV centers ablate significantly more high risk patients (CHA2DS2-VASc score ≥2 51.4% in HV vs 46.5% in MV vs 37.2% in LV, p<0.001) (Figure B) with accompanying comorbidities, applying more elaborate ablation techniques, fluoroscopy time and radiation dose were higher among patients undergoing AF ablation in LV centers (p<0.001 for all). Despite the above-mentioned dissimilarities, Kaplan-Meier survival analysis, based on adjusted data, demonstrated non-significant differences in complication rate (p=0.402) or AF recurrence rate (p=0.363) among HV, MV and LV centers.

Conclusions
Volume of AF ablations in a center is not correlated with regional or infrastructural characteristics. The higher volume in HV centers consists mainly by more long-term persistent AF and higher risk patients, suggesting that differences in volume reflect differences in experience and personnel's commitment towards AF ablation.
P4790Haematuria is not elevated in AF patients treated with NOACs versus VKAs: GARFIELD-AF study
Authors: Verstraete S , Virdone S , Bassand J P , Cools F , Pieper K , Kayani G , Kakkar A K 
Published: October 2019

Abstract

Background
Haematuria in atrial fibrillation (AF) patients taking oral anticoagulants (OACs) is usually viewed as less serious than intracranial and gastrointestinal bleeding. It is speculated that haematuria may result from renal excretion of active new oral anticoagulants (NOACs) causing a direct anticoagulating effect in the urinary tract. Vitamin K antagonists (VKAs) such as warfarin, on the other hand, undergo hepatic metabolism and may pose lower risk of haematuria. This large registry study investigated whether NOACs more likely cause haematuria compared with VKAs.

Purpose
To assess whether there is any difference in the incidence rate of haematuria in AF patients taking NOACs versus VKAs using data from the GARFIELD-AF registry.

Methods
GARFIELD-AF is an international prospective registry of nonvalvular AF patients with at least one additional risk factor for stroke, followed for at least 2 years. Macroscopic haematuria was identified by local investigators. Event rates were estimated by Poisson model. Adjusted hazard ratio (HR) for haematuria between treatment groups was calculated using overlap-weighted Cox model including a range of patient demographics and clinical parameters as variables. Only the first haematuria occurrence was considered. Patients who were not treated with either VKAs or NOACs were excluded.

Results
Among a registry population of 34,926 patients 24,079 were anticoagulated and 24,061 had available follow-up data. Baseline characteristics were evenly balanced between the VKAs and NOACs subgroups, except a somewhat higher proportion of VKA patients than NOAC patients received concomitant antiplatelet therapy. Rate of haematuria was similar between the two groups: VKAs, 115/12,307 cases (0.9% over study period; 0.55 [95% CI, 0.46–0.65] per 100 patient-years); NOACs, 119/11,754 cases (1.0% over study period; 0.49 [95% CI, 0.41–0.59] per 100 patient-years). Over 2 years cumulatively, adjusted HR for haematuria in NOAC group versus VKA was 0.85 (95% CI, 0.63–1.15; p=0.29). Most haematuria cases (approximately 94%) were minor or clinically relevant non-major bleeds, occurring at a similar rate in both subgroups. Major bleeds were very rare. No intervention was necessary in two thirds haematuria cases (65.2%); surgical procedures were performed in only 8.3%. No haematuria-related deaths were observed.
Incidence of haematuria

Conclusions
The incidence and severity of haematuria were not increased in AF patients taking NOACs versus VKAs. Haematuria may occur in approximately one in 100 AF patients on long-term OACs therapy and is usually non-serious.

Acknowledgement/Funding
The GARFIELD-AF registry is funded by an unrestricted research grant from Bayer AG.
P4796Risk prediction of atrial fibrillation in the community combining biomarkers and genetics
Authors: Boerschel C , Ohlrogge A , Geelhoed B , Niiranen T , Havulinna A S , Palosaari T , Blankenberg S , Zeller T , Salomaa V , Schnabel R B 
Published: October 2019

Abstract

Background
Classical cardiovascular risk factors (CVRF), biomarkers and genetic variation have been suggested for risk assessment of atrial fibrillation (AF).

Purpose
To evaluate their clinical potential, we analysed their individual and combined effectiveness in AF prediction.

Methods
In N=6945 individuals of the FINRISK 1997 cohort, we assessed the predictive value of CVRF, N-terminal pro B-type natriuretic peptide (NT-proBNP) and 145 recently identified single nucleotide polymorphisms (SNPs) for incident AF.

Results
Over a median follow-up of 17.8 years, N=551 participants (7.9%) developed AF. In multivariable-adjusted Cox proportional hazard models, NT-proBNP (hazard ratio (HR) per standard deviation (SD) 1.90, 95% confidence interval (CI): 1.71–2.11, P<0.001) and the polygenic risk score (PRS) (HR per SD 1.66, 95% CI: 1.51–1.84, P<0.001) were significantly related to incident AF. The discriminatory ability improved asymptotically with increasing numbers of SNPs. Compared to a clinical model, AF risk prediction was significantly improved by addition of NT-proBNP and the PRS. The C-statistic for the combination of all CVRF, NT-proBNP and the PRS reached 0.82 compared to 0.77 for CVRF only (P<0.001). Comparing the highest versus lowest quartile, age remained the strongest risk factor with a 15-fold increased risk of AF. The highest quartiles of NT-proBNP and the PRS both showed an approximately 3-fold increased AF risk compared to the lowest quartiles.
C-Index for AF prediction

Conclusions
The PRS and the established biomarker NT-proBNP predicted incident AF comparably. Both provided incremental predictive value over standard clinical variables. Further improvements for the PRS are likely with the discovery of additional SNPs.

Acknowledgement/Funding
European Research Council, German Ministry of Research and Education, DZHK, European Union Seventh Framework Programme, CHANCES, THL
4937Global longitudinal strain by feature tracking predicts adverse remodeling in ST-elevation myocardial infarction incremental to
Authors: Reinstadler S , Reindl M , Tiller C , Holzknecht M , Mayr A , Klug G , Metzler B 
Published: October 2019

Abstract

Objectives
To evaluate the independent and incremental value of left ventricular (LV) strain assessed by cardiac magnetic resonance feature tracking (CMR-FT) for prediction of adverse LV remodeling following ST-elevation myocardial infarction (STEMI).

Background
The role of LV myocardial strain by CMR-FT for prediction of adverse remodeling after STEMI in comparison to LV ejection fraction and infarct severity is unclear.

Methods
STEMI patients treated with primary percutaneous coronary intervention within 24 hours after symptom onset were enrolled. CMR core laboratory analysis was performed to assess LV ejection fraction, infarct pathology and LV myocardial strain. The primary endpoint was adverse remodeling defined as ≥20% increase in LV end-diastolic volume from baseline to 4 months.

Results
From the 232 patients included, 38 (16.4%) reached the primary endpoint. Global longitudinal strain (GLS), global radial strain, and global circumferential strain were all predictive of adverse remodeling (p<0.01 for all), but among strain values only GLS was an independent predictor of adverse remodeling (hazard ratio: 1.36 [1.03–1.78]; p=0.028) after adjustment for strain parameters, ejection fraction and CMR markers of infarct severity. A GLS >-14% was associated with a 4-fold increase in risk for LV remodeling (hazard ratio: 4.16 [1.56–11.13]; p=0.005). Addition of GLS to a baseline model comprising ejection fraction, infarct size and microvascular obstruction resulted in net reclassification improvement of 0.26 ([0.13–0.38]; p<0.001) and integrated discrimination improvement of 0.02 ([0.01–0.03]; p=0.006).

Conclusions
In STEMI survivors, determination of GLS using CMR-FT provides important prognostic information for the development of adverse remodeling that is incremental to LV ejection fraction and CMR markers of infarct severity.
4939Clinical significance of global strain estimated by 3D speckle tracking acutely after onset of ST-elevation myocardial infarction on prediction of long term prognosis
Authors: Iwahashi N , Kirigaya J K , Horii M H , Akiyama E A , Okada K O , Matsuzawa Y M , Konishi M K , Maejima N M , Hibi K H , Kosuge M K , Ebina T E , Tamura K T , Kimura K K 
Published: October 2019

Abstract

Background
Three-dimensional (3D) speckle tracking echocardiography (STE) is a novel method for assessing cardiac function because of free form out-of-plane motion effects.

Aim
To explore the role of 3D-STE for prediction of the long term prognosis in patients with a first-time ST elevation acute myocardial infarction (STEMI).

Methods
A total of 238 patients (mean age 64.6 years) with a first-time STEMI treated with reperfusion therapy were enrolled in our study. Twenty four hours after admission, standard 2D echocardiography and 3D full volume imaging were obtained and strain parameters (GLS: global longitudinal strain, GCS: global circumferential strain) were calculated using 4D LV analysis. Infarct size was measured with single-photon emission computed tomography imaging 7 to 14 days after onset. We followed them for median 94 months (inter quartile range: 69–109 months). The primary end point was the major adverse cardiac and cerebrovascular events (MACE: cardiac death, non-fatal MI, heart failure requiring intravenous diuretics administration and stroke). The patients with persistent chronic atrial fibrillation, poor image quality, emergency bypass surgery were excluded.

Results
During follow up periods, 78 patients experienced MACE (26 cardiac death, 48 heart failure, 29 non-fatal MI, 5 stroke) and 48 patients died (22 non-cardiac death). In multivariate analysis, 3D-GLS was the strongest predictor for MACE. Kaplan-Meier Curve demonstrated that 3D-GLS >−11.4 was the independent predictor for MACE (Log-rank χ2=73.818, p<0.0001). When combined with 3D-GCS >−19.2, the patients with higher value both of 3D-GLS and 3D-GCS were extremely high risk.
The figure shows the Kaplan-Meier curve according to the 4 groups based on the cut-off values determinded by ROC curves.

Conclusions
Global strain estimated by 3D-STE immediately onset of STEMI was useful tool for the prediction of long term prognosis.

Acknowledgement/Funding
None
4940Early reverse remodelling assessed by myocardial work after sacubitril-valsartan therapy
Authors: Valentim Goncalves A , Galrinho A , Pereira-Da-Silva T , Ilhao Moreira R , Soares R , Moura Branco L , Rio P , Feliciano J , Abreu J , Timoteo A T , Mendonca T , Reis J , Mano T , Cruz Coutinho M , Cruz Ferreira R 
Published: October 2019

Abstract

Introduction
Sacubitril/Valsartan (LCZ696) had prognosis benefit demonstrated in PARADIGM-HF trial, however less is known about his effects in cardiac dimensions and function.
Myocardial work (MW) is a new transthoracic echocardiographic (TTE) parameter. None is known about the effects of LCZ696 therapy in MW parameters.

Purpose
The aim of this study was to prospectively compare several TTE parameters, including MW, before and after LCZ696 therapy.

Methods
Prospective evaluation of chronic HF patients with optimized standard of care therapy and LVEF≤40%, in which LCZ696 therapy was started.
TTE study was performed before and 6 months after LCZ696 therapy. A semiautomated analysis of GLS was performed and MW were estimated using custom software of GE Vivid E95 ultrasound system.

Results
Of the 42 patients, 35 (83.3%) completed the 6 months follow-up, since 2 patients (4.8%) died and 5 patients (11.9%) discontinued treatment for adverse events. Mean age was 58.6±11.1 years with 82.9% of male patients.
LV dimensions and atrial volumes were significantly lower at 6 months of treatment. LVEF had a mean absolute raise of 8.9% and GLS a relative decrease of 27.8%. MW had a significant increase in constructive work (720.2mmHg VS 900.6mmHg, p=0.016) and work efficiency (78.6% VS 86.6%, p=0.027), with a non-significant decrease in the wasted work (150.2mmHg VS 136.8mmHg, p=0.441).
TTE data before and after 6 months of LCZ696 treatment Time 0 6 months p LV end-diastolic diameter (mm) 71.3±8.4 66.9±7.6 0.001 LV end-systolic diameter (mm) 57.8±9.4 53.1±9.3 0.002 Interventricular septum (mm) 9.6±1.7 9.9±1.9 0.280 LVEF (%) 29.3±6.4 38.2±8.9 <0.001 GLS (%) −7.0±2.9 −8.9±2.8 0.001 MW – Constructive (mmHg) 720.2±230.5 900.6±343.2 0.016 MW – Wasted (mmHg) 150.2±83.3 136.8±54.2 0.441 MW – Efficiency (%) 78.6±10.8 86.6±12.0 0.027 E/e' 13.7±4.5 12.8±4.9 0.449 Pulmonary artery systolic pressure (mmHg) 38.3±12.2 30.9±10.6 <0.001 Left atrium volume (ml/m2) 51.5±22.6 43.7±15.8 0.004 Right atrium volume (ml/m2) 33.1±4.4 28.5±13.5 0.036 TAPSE (mm) 19.2±4.4 20.0±4.9 0.404

Conclusion
LCZ696 therapy is associated with signs of reverse remodelling in TTE, including an increase in constructive work and work efficiency.
4943Remnant cholesterol increases the risk for recurrent vascular events independent of LDL-cholesterol in patients with clinical manifest vascular disease
Authors: Heidemann B E , Koopal C , Bots M L , Asselbergs F W , Westerink J , Visseren F L J 
Published: October 2019

Abstract

Background
For many years, low density lipoprotein cholesterol (LDL-C) is recognized as an important risk factor for the development of atherosclerosis and cardiovascular disease. However, even with normal LDL-C levels there is a residual risk for cardiovascular disease and mortality. Previous research in patients with ischemic heart disease, diabetes mellitus type 2 (T2DM) and in the general population has shown that this residual risk could be explained by elevated plasma levels of very low density lipoprotein- (VLDL) and chylomicron-remnant cholesterol.

Purpose
We evaluated the relation between plasma levels of VLDL- and chylomicron-remnant cholesterol and recurrent vascular disease and all-cause mortality in a cohort of patients with clinical manifest arterial disease.

Methods
Prospective cohort study in 8057 patients with manifest arterial disease from the UCC-SMART study. Patients with triglyceride levels >9 mmol/L or known homozygote Apo E2 genotype were excluded. Cox proportional hazard models were used to evaluate the effect of fasting VLDL- and chylomicron-remnant cholesterol (calculated by total cholesterol - high density lipoprotein cholesterol (HDL-C) - LDL-C) on occurence of myocardial infarction (MI), stroke, vascular death, a composite endpoint (i.e. MI, stroke, vascular death) and all-cause mortality. Models were adjusted for LDL-C, current smoking, waist circumference, creatinine and systolic blood pressure. Effect modification of HDL-C and T2DM on the relation between remnant cholesterol and vascular endpoints was evaluated.

Results
Patients mean age was 60.0±10.3 years, 74% were male, 4894 (61%) had a prior history of coronary artery disease (CAD), 2445 (30%) of stroke and 1990 (25%) patients had peripheral arterial disease (PAD) or aneurysm abdominal aorta (AAA). There were 1544 vascular events and 1792 deaths during a median follow up of 8.2 (interquartile range (IQR) 4.5–12.2) years and a total follow up of 68699 person-years. For every 1 mmol/L increase in remnant cholesterol, risk for recurrent vascular events was increased in patients with manifest vascular disease (HR 1.17; 95% CI 1.05–1.31 for the composite endpoint (figure 1)). There was no effect for all-cause mortality in this population. Furthermore, there was no significant effect modification of HDL-C and the presence of T2DM on the relation between remnant cholesterol and vascular endpoints.
Figure 1

Conclusion
In patients with clinically manifest arterial disease plasma remnant cholesterol confers an increased risk for recurrent vascular events, independent of traditional risk factors such as LDL-C levels.
4947Association between secondhand smoke exposure and diabetes mellitus in 131,724 Korean never smokers using self-reported questionnaire and cotinine: gender differences
Authors: Kim B J , Kim J H , Seo D C , Kim B S , Kang J H 
Published: October 2019

Abstract

Background
No study has reported the relationship between secondhand smoke (SHS) exposure and diabetes mellitus in self-reported never-smokers verified by nicotine metabolite.

Purpose
The aim of this study is to determine the relationship between SHS exposure and diabetes mellitus in self-reported and cotinine-verified never-smokers.

Methods
A total of 131,724 self-reported and cotinine-verified never-smokers (42,681 men; age 35.0±7.1 years) enrolled in Kangbuk Samsung Health Study (KSHS) and Kangbuk Samsung Cohort study (KSCS) between 2011 and 2016 were included. Cotinine-verified never-smoker was defined as individuals having urinary cotinine <50 ng/mL. SHS exposure was defined as having experienced passive smoking indoors at home or the workplace. Diabetes mellitus was defined as having a fasting blood glucose level of ≥7.0mmol/L, hemoglobin A1C ≥6.5% or taking anti-diabetic medication(s).

Results
The frequency of diabetes mellitus in the overall population was 1.6%; the frequency in males was higher than that in females (2.2% versus 1.3%, p<0.001). The overall frequency of SHS exposure was 22.9%, with rates of 27.6% for males and 20.7% for females (p<0.001). The frequency of diabetes mellitus in group with SHS exposure was higher than that in group without SHS exposure only in females (1.8% versus 1.2%, p<0.001 for females; 2.2% versus 2.2%, p=0.956 for males). There was significant gender interaction for the relationships between SHS exposure and diabetes mellitus (p for interaction <0.001). A multivariate regression model was adjusted for the baseline variables including age, waist circumference, body mass index, frequency of alcohol drinking and vigorous exercise, systolic blood pressure, blood urea nitrogen, creatinine, uric acid, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, and hsCRP. Only in females, SHS exposure was significantly associated with diabetes mellitus (odds ratio [95% confidence interval], 1.40 [1.20, 1.65] for females; 1.00 [0.85, 1.19] for males). Higher frequency and longer duration of SHS exposure were also significantly associated with diabetes mellitus (p<0.001) for all trends). In particular, females with SHS exposure of ≥1 hours/day, ≥3 times/week, and ≥10 years increased the risk of diabetes mellitus 51–64% above that for those without SHS exposure (1.64 [1.25, 2.13], 1.51 [1.21, 1.87], and 1.59 [1.30, 1.95], respectively.

Conclusions
This study showed that the SHS exposure in females was significantly associated with diabetes mellitus in self-reported never-smokers verified by urinary cotinine and this association was proportional to the frequency and duration of SHS exposure. These findings suggest the importance of banning smoking in the home and public to reduce the risk of diabetes mellitus.

Acknowledgement/Funding
None
4950Adiposity gain from 17 to 25 years has a substantial effect on cardiac structure, independent of haemodynamics
Authors: Park C M , Taylor H , Jones S , Rapala A , Williams S , Howe L , Fraser A , Chaturvedi N , Hughes A D 
Published: October 2019

Abstract

Introduction
Body mass index (BMI) is independently associated with increased left ventricle mass (LVM) and remodeling in children. However associations from adolescence to emerging adulthood are unknown.

Purpose
To investigate associations between the change (Δ) in BMI to Δ in cardiac structure from 17 to 25 yrs using a large population-based sample of echocardiography in youth, and to explore the role of possible haemodynamic mediators.

Methods
901 participants (61% female) underwent echocardiography, anthropometry and sitting blood pressure (BP) measurements aged 17 yrs and had repeated measures aged 25 yrs. BMI, LVM, concentricity0.67 (LVM/end-diastolic volume0.67), total arterial compliance (TACI), peripheral resistance (TPR) and effective arterial elastance (Ea) were calculated. Regression analysis was used to investigate associations between ΔBMI and ΔLVM indexed to height2.7 (ΔLVMI) and Δconcentricity0.67.

Results
From 17 to 25 yrs BMI increased by 2.05±2.1 g/m2 in males and 1.80±3.1 kg/m2 in females, LVMI increased by 3.10±6.2g/m2.7 and 2.01±6.0g/m2.7 and concentricity0.67 increased by 0.91±1.2g/ml0.67 and 0.03±1.1g/ml0.67. ΔBMI was associated with ΔLVMI and Δconcentricity0.67 independently of age, socioeconomic status (SES) and smoking status. Haemodynamic measures did not substantially mediate these associations.
Table 1 ΔLVMI (g/m2.7) ΔConcentricity0.67 (g/m0.67) Males Females Males Females Model 1: Age, SES and smoking @25 0.78±0.15** 0.53±0.08** 0.12±0.03** 0.083±0.02** + ΔSystolic BP (mmHg) 0.68±0.16** 0.46±0.09** 0.10±0.03* 0.069±0.016** + ΔDiastolic BP (mmHg) 0.83±0.16** 0.47±0.08** 0.12±0.03** 0.074±0.015** + ΔMean Arterial Pressure (mmHg) 0.77±0.17** 0.46±0.08** 0.11±0.03** 0.069±0.015** + ΔPulse Pressure (mmHg) 0.72±0.15** 0.54±0.08** 0.11±0.03** 0.083±0.015** + ΔTACI (ml/m2/mmHg) 0.68±0.16** 0.53±0.08 0.12±0.03** 0.091±0.015** + ΔTPR (mmHg/min/L) 0.76±0.17** 0.65±0.08** 0.10±0.03* 0.072±0.016** + ΔEa (mmHg/ml) 0.73±0.17** 0.54±0.08** 0.11±0.03** 0.083±0.015** Data are β±SE. *p<0.01, **p<0.0001.

Discussion
BMI gain from adolescence to emerging adulthood has a substantial effect on cardiac structure, independent of haemodynamics. These findings highlight the importance of weight control in early adulthood for good cardiovascular health.

Acknowledgement/Funding
BHF