bluuebunny/crossref_metadata_2025_split huggingface dataset:
224 Malignancy associated pericardial effusion- do we need to drain them all?
Authors: Ho C , Lee P H , So T C , Chiang M C S , Wong M H , Fong Y H , Tsang C F , Cheng Y W , Luk N H , Chui S F , Chan K C , Wong C Y , Fu C L , Lee K Y , Chan K T 
Published: January 2020

Abstract

On Behalf
Cardiac Team, Department of Medicine, Queen Elizabeth Hospital

Background
Management of significant pericardial effusion in cancer patients is controversial. These patients have poor prognosis, and avoiding unnecessary intervention is important. Close monitoring of symptoms and echocardiogram is often a reasonable option, but inherits risk of cardiac tamponade. Whether pericardial drainage by means of percutaneous pericardiocentesis or surgical pericardiotomy could prevent future deterioration or affect survival is unknown.

Purpose
To evaluate the benefit of elective pericardial drainage in malignancy associated pericardial effusion without echocardiographic or clinical evidence of tamponade effect.

Methods
From 1st Jul 2014 to 31st Dec 2017, all patients with new onset malignancy-associated pericardial effusion with size more than 1cm were retrospectively analyzed. Patients with clinical or echocardiographic evidence of cardiac tamponade were excluded. We compared pericardial drainage versus monitoring for short-term (30-day), mid-term (90-day) and long term (1 year) survival without need for drainage.

Results
101 patients were retrospectively analyzed. 40 (39.6%) patients underwent drainage. Overall median survival free from drainage was 4 months. There were no significant difference in short-term (30-day), mid-term (90-day) and long term (1-year) survival free from drainage or mortality between treatment and monitoring group. Size of pericardial effusion did not predict mortality or future need of drainage. Chemotherapy was associated with improved 30-day mortality (RR 0.53 CI 0.32-0.87 p = 0.025) but not survival free from drainage or longer term mortality.

Conclusion
Close monitoring could be a feasible strategy in cancer patients with significant pericardial effusion without tamponade effect.
Baseline characteristics Factor Drainage (n = 40) monitoring (n = 61) p-value method of drainage pericardiocentesis alone 17 NA pericardiotomy alone 13 both 10 Male 19 (47.5%) 27 (44.3%) 0.749 mean size (cm) 1.93 2.77 &lt;0.001 mean age 60.9 63.1 0.357 on chemotherapy 27 (67.5%) 38 (62.3%) 0.593
Abstract 224 Figure. Survival free from drainage
P24 Association between plasma PCSK9 and major cardio-cerebrovascular events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Santoso A , Nofanda Putra A , Arifa Yuzar D A F S A H 
Published: January 2020

Abstract

Background
Some STEMI patients still suffers adverse outcomes though they undergo optimal management, including primary PCI. Plasma PCSK9 is deemed to have a role in that residual risk. Our knowledge on the association between plasma PCSK9 level and MACCE in STEMI is still limited.

Purpose
The aim of this study is to evaluate the association between plasma PCSK9 level during admission with MACCE in STEMI who undergo primary PCI.

Methods
This was a prospective observational study, recruited 239 patients with STEMI who were treated with primary PCI and assayed for PCSK9 level using ELISA technique. MACCE and other supportive data were taken from the medical records and telephone follow-up.

Results
There were 28 study participants who experienced MACCE in 30 days. However, survival analysis did not show a significant association between plasma PCSK9 level and MACCE in 30 days. The hazard ratio for MACCE between the third tertile and the second tertile of plasma PCSK9 level was 1.466 (95%CI 0.579-3.714) and between the first tertile and the second tertile was 1.257 (95%CI 0.496-3.185).

Conclusion
Plasma PCSK9 levels was not associated with MACCE in STEMI patients treated with primary PCI.
P42 Role of statins for the prevention of anthracycline-induced cardiomyopathy: a meta-analysis
Authors: Reymatias J , Villanueva D L , Ramiro V , Magno J D 
Published: January 2020

Abstract

Background
Anthracyclines are key components of many chemotherapeutic regimens, having demonstrated efficacy in lymphomas and many solid tumors. However, a major factor limiting their use is a cumulative, dose-related cardiotoxicity which ultimately leads to asymptomatic and symptomatic heart failure. Oxidative stress is considered as a major mechanism in anthracycline-induced cardiomyopathy. Statins have been shown to possess anti-oxidative, pleiotropic effects besides their anti-inflammatory and lipid-lowering effects.

Purpose
This study evaluated the potential role of statin for the prevention of anthracycline-induced cardiomyopathy.

Methods
Using MEDLINE, EMBASE, ScienceDirect, Scopus, Google Scholar, ClinicalKey, Cochrane Database of Systematic Reviews, clinicaltrials.gov, and Cochrane Central Register of Controlled Trials databases, a search for eligible studies was conducted until December 2018. Included studies were evaluated based on the Cochrane Collaboration"s tool for assessing risk of bias. Our primary outcome of interest was the development of anthracycline-induced cardiomyopathy. We also investigated the mean change in LVEF pre- and post-chemotherapy with anthracycline. Review Manager (RevMan) 5.3 was utilized to compute for relative risk and mean change in LVEF. A random effects model was applied for all meta-analyses.

Results
We identified 3 studies involving 332 cancer patients, showing that in cancer patients undergoing anthracycline-based chemotherapy, pre-treatment with statins was associated with a lower risk of developing anthracycline-induced cardiomyopathy (RR 0.33, 95% CI 0.14-0.79, p &lt; 0.05). There was a significant decrease in LVEF among patients who were not treated with statins [Mean difference -6.25, 95% CI -11.68 - (-) 0.82, p= 0.02]

Conclusions
Pre-treatment with statins on cancer patients undergoing anthracycline chemotherapy may prevent the development of anthracycline-induced cardiomyopathy and reduction in LVEF. This will expand the utility of statin as a medication for the prevention and treatment of cardiovascular diseases.
P104 Prognostic value of Circulating Amino Acids (AAs) in Patients with Idiopathic Dilated Cardiomyopathy (DCM)
Authors: Wakasa M , Kawai Y , Kajinami K 
Published: January 2020

Abstract

Backgrounds Circulating levels of some amino acids are significantly decreased in heart failure patients. However, relationship between their levels and cardiac function remains unclear. We therefore examined association between amino acid levels and cardiac function as prognostic predictor in DCM patients.

Methods
Consecutive 59 patients with DCM (M/F: 46/13, mean age: 59 years) were enrolled. We measured 25 kinds of plasma AA concentration, derivative of reactive oxygen metabolites (d-ROMs) as marker of oxidative stress, and washout rate of Tc-99m Sestamibi (WOR) as function of mitochondria and LVEF as LV function parameters. The occurrence of rehospitalization for cardiac events or cardiac death were followed during mean 1101 days (13-2626).

Results
Histidine, arginine and Fischer ratio (FR) showed a significant positive association with LVEF (p &lt; 0.05). Threonine and asparagine showed a significant negative association with WOR (P &lt; 0.05). Histidine and arginine showed a significant negative association with levels of d-ROMs (p &lt; 0.05).Rehospitalization for cardiac events and cardiac death were recorded in 16 patients (27%) and 6 patients (10%), respectively. Kaplan-Meier curves analysis showed similar trend of rehospitalization in subjects with lower FR and those with higher values. However, cardiac death in subjects with lower FR was observed more frequently as compared to those with higher values (22.2% vs 5.3% p &lt; 0.05).
ConclusionsThe plasma FR could be a novel prognostic biomarker in DCM patients.
P119 The impact of minimal alcohol price policy on premature CVD mortality in Kazakhstan
Authors: Davletov K , Mereke A , Tussupbekova S , Tolegenova A 
Published: January 2020

Abstract

Background
In Kazakhstan, premature cardiovascular (CVD) mortality is one of the highest in the world despite the dramatic decline of CVD mortality since 2006. Our previous research found that alcohol consumption was the main determinant of premature CVD mortality in Kazakhstan and the decrease of alcohol use was the main factor influencing the CVD mortality decline.

Purpose
With the aim of examining the impact of minimal price changes for strong spirits (vodka) and alcohol sales on premature CVD mortality in 2006-2014, we compared age-specific CVD mortality for the age group 19-49 with changes in the minimal price of strong spirit (vodka) and alcohol sales.

Methods
Age-specific CVD mortality rates in age group 19-49 in Kazakhstan were obtained from the Global Burden of Disease database and explored with regard to changes in minimal prices of vodka and alcohol sales in Kazakhstan over this period.

Results
Age-standardized CVD mortality rates in age group 19-49 declined by 47% from 2006 to 2014, for both men and women. However, we observed the plateauing effect in CVD mortality trend in 2015-2017. These mortality trends coincided with the sharp increase in minimal vodka prices and decrease or flatten in alcohol sales in 2006-2014 period and consequent minimal price decrease and plateauing in 2015-2017 that was accompanied by increase of alcohol sales in this period.

Conclusions
Our findings indicate that public health measures such as tax increases for strong spirits can be a very effective CVD prevention strategy in Kazakhstan and other former USSR countries, where similar mortality trends can be observed. Unfortunately, this mortality decline was not sustained over time. We believe it happened due to a weakened policy in regard to the minimal alcohol prices. Therefore, there is much scope for further policy action in this area.
Abstract P119 Figure. CVD and Alcohol price
P176 Left ventricular diastolic function by gated myocardial perfusion SPECT strongly reflects NT-ProBNP
Authors: Hata S , Sakai K , Otsuka K , Kusumoto S , Sonoda K , Muroya T , Shinboku H , Ikeda S , Maemura K 
Published: January 2020

Abstract

Background
The importance of left ventricle diastolic dysfunction (LVDD) has been recognized widely, as it is well established that heart failure with preserved ejection fraction has a poor prognosis. Furthermore, N-terminal pro–B-type natriuretic peptide (NT-ProBNP) is used as a marker of heart failure. However, the association between LVDD and NT-proBNP is unclear.

Purpose
The aim of this study was to clarify the association between LVDD and NT-ProBNP.

Methods
In this study, an index based on gated myocardial perfusion SPECT using CardioREPO software for the diagnosis of LVDD was used. Out of the 171 patients who underwent myocardial perfusion imaging (MPI) between January 2015 and December 2018, 163 individuals (116 men and 47 women) completed MPI and NT-ProBNP. Patients were classified into 4 groups: NT-ProBNP levels below 125 pg/ml (n = 52), NT-ProBNP levels 125 to 400 pg/ml (n = 33), NT-ProBNP levels 400 to 900 pg/ml (n = 23), and NT-ProBNP levels over 900 pg/ml (n = 37). CardioREPO parameters (peak filling rate　(PFR), 1/3 mean filling rate (MFR), and time to peak filling rate/R-R (TTPFR)) were compared between the 4 NT-ProBNP groups.

Results
Of the 163 patients, 55 had LVDD. The PFR and 1/3MFR were associated with LVDD. There was a statistically significant difference in PFR and 1/3 MFR between the NT-ProBNP levels below 125 pg/ml group and the NT-ProBNP levels 400 to 900 pg/ml group (PFR = 2.51+/-1.11 vs. 1.80+/-0.65, p = 0.001; 1/3 MFR = 1.41+/-0.55 vs. 1.06+/-0.47, p = 0.006, Table).

Conclusions
The MPI indices obtained by CardioREPO software were useful in the diagnosis of LVDD. The evaluation of LVDD by MPI correlated with NT-Pro BNP level is thought to have a clinical utility in the diagnosis and management of LVDD.
Variable: NT-ProBNP 　 0-125 (n = 52) 125-400 (n = 33) 400-900 (n = 23) 900- (n = 37) p Age 66 ± 11 72 ± 11 68 ± 17 70 ± 12 0.133 Male 40 (77%) 22 (12%) 18 (78%) 23 (62%) 0.36 Left ventricular diastolic dysfunction 8 (15%) 4 (12%) 10 (43%) 27 (73%) &lt;0.001 E/A 0.9 ± 0.3 0.8 ± 0.2 1.1 ± 0.7 1.4 ± 0.9 (35) &lt;0.001 E/e" 10.27 ± 3.69 (20) 8.83 ± 3.56 (10) 12.46 ± 3.75 (12) 20.25 ± 8.30 (25) &lt;0.001 rest-PFR /s 2.51 ± 1.11 2.06 ± 0.58 2.16 ± 0.65 1.80 ± 0.65 0.001 rest-1/3 MFR /s 1.41 ± 0.55 1.19 ± 0.41 1.16 ± 0.50 1.06 ±0.47 0.008 rest-TTPFR ms 177 ± 53 181 ± 69 198 ± 80 166 ± 85 0.38 rest-TTPFR / R-R 　 0.19 ± 0.06 0.20 ± 0.11 0.21 ±0.09 0.21 ± 0.15 0.92
P194 Trimetazidine preserves right ventricular function on pulmonary arterial hypertension patients in national cardiovascular center harapan kita hospital indonesia
Authors: Sakti Muliawan H , Widyantoro B , Soerarso R , Hersunarti N , Sahara E , Atmadikoesoemah C A , Kasim M , Adiarto S , Raharjo S B , Sukmawan R , Siswanto B B 
Published: January 2020

Abstract

Funding Acknowledgements
National Cardiovascular Center Harapan Kita Hospital

Background
Right ventricular dysfunction is the worst mortality predictor in pulmonary arterial hypertension (PAH). Recent animal PAH studies have demonstrated the benefit of partial fatty acid inhibitor such as trimetazidine in improving right ventricular function. Therefore, we hypothesize that trimetazidine can improve right ventricular ejection fraction (RVEF) in PAH patients.

Purpose
Investigating the effect of trimetazidine on right ventricle function in PAH patients.

Methods
We conducted 3 months randomized double blind placebo controlled trial on PAH patients at outpatient clinic in National Cardiovascular Center Harapan Kita Hospital Indonesia. Those who fulfilled the inclusion criteria will be randomized into trimetazidine or placebo group for 3 months on top of their standard PAH regime. Clinical and cardiovascular magnetic resonance imaging (CMR) parameters will be evaluated before and after 3 months therapy. The primary outcome of this study is the differences of RVEF from CMR.

Results
We randomly enrolled 26 PAH patients equally to receive placebo or trimetazidine for 3 months on top of their standard PAH regime. Total of 10 patients in each group was able to finish the study. There was significant improvement of RVEF in trimetazidine group 3.78 + 1.5% compared to placebo 2.76 + 1.6% (p 0.008, CI 1.96 to 10.96). Furthermore, we also observed improvement of functional capacity in trimetazidine group 0.24 + 0.09 compared to placebo -0.44 + 0.16 (p 0.002, CI 0.28 s/d 1.08).

Conclusions
Trimetazidine therapy for 3 months on top of standard PAH regime significantly improve RVEF and functional capacity in PAH patients.
Abstract P194 Figure. Effect of trimetazidine on RV function
P203 Unsupervised one-class classification and anomaly detection of stress echocardiograms with deep denoising spatio-temporal autoencoders
Authors: Loh B C S , Fong A Y Y , Ong T K , Then P H H 
Published: January 2020

Abstract

Introduction
The combination of medical knowledge, experience and AI algorithms have supported the advancement of patient care and the lowering of healthcare costs. Machine and deep learning methods enable the extraction of meaningful patterns that remain beyond human perception. Numerous computer-aided diagnosis and detection systems have been developed to assist in the assessment of stress echocardiograms. However, issues are encountered when facing imbalanced, limited, and unannotated datasets. Learning from imbalanced medical datasets impairs diagnostic accuracy due to classifier bias and overfitting. Furthermore, datasets comprising of all existing abnormal classes are impossible to obtain, hence supervised algorithms would fail to generate predictions for classes devoid of training samples. Moreover, reliance on prior knowledge in the form of expert annotation and anatomical region extraction impairs scalability, as these procedures are time-consuming, computationally expensive, and limited to specific tasks.

Purpose
We aimed to perform one-class classification and anomaly detection of stress echocardiograms using unsupervised deep learning techniques to discriminate between normal and abnormal videos as well as to localise wall motion abnormalities within individual frames.

Methods
Deep denoising spatio-temporal autoencoder networks were employed to learn visual and motion representations from multiple echocardiographic cross-sections and stress stages. Extracted middle layer features were modelled by one-class support vector machines to discriminate between regular and irregular echocardiograms despite the absence of abnormal training samples. Reconstruction errors allowed for direct visualisation and localisation of anomalous cardiac regions, without the need for annotated training data or segmentation of structures.

Results
2D B-mode stress echocardiograms acquired from 36 patients were classified as normal or abnormal based on patient reports and served as the ground truth. Results revealed that learnt features extracted from spatio-temporal autoencoders trained solely on normal data can be utilised to classify abnormal echocardiograms with a high level of accuracy, sensitivity and specificity. In addition to that, as validated by an expert reader, spatio-temporal autoencoder reconstruction errors were capable of detecting and localising wall motion abnormalities in specific cardiac regions without prior knowledge of abnormal segments.

Conclusions
The trained model enables the classification and detection of spatio-temporal abnormalities in stress echocardiograms. Therefore, the proposed networks have the potential of assisting in the global and regional assessment of stress echocardiograms.
P258 Pharmacometabolomics analysis of plasma and urine to identify clopidogrel exposure metabolic biomarkers
Authors: Mohamed Amin Mostafa A , Mostafa H , Sk Abdul Kader M A , Kah Hay Y 
Published: January 2020

Abstract

Funding Acknowledgements
This research was funded by Universiti Sains Malaysia

Introduction
Clopidogrel is a widely used P2Y12 antiplatelet drug. Patient"s compliance to clopidogrel is crucial to achieve therapeutic outcome and prevent thromboembolic events. While measuring serum level of clopidogrel and/or its active metabolite may indicate compliance, many confounding factors interfere, however, often compromising the reliability of the results. Identifying drug exposure metabolic biomarkers is reliable and fast tool to evaluate patient"s compliance, as well as getting in-depth information on the metabolic perturbation associated with drug exposure. We hypothesized that Nuclear magnetic resonance (1HNMR) pharmacometabolomics analysis of plasma and urine can phenotype clopidogrel loading dose (LD) in coronary artery disease (CAD) patients.

Purpose
We aimed to phenotype clopidogrel exposure in plasma and urine of CAD patients using 1HNMR pharmacometabolomics.

Methods
We analysed pre-dose and post-dose plasma and urine samples from 79 CAD patients who had clopidogrel 600 mg LD using 1HNMR pharmacometabolomics technique. Data analysis of 1HNMR spectra was performed by developing preliminary orthogonal partial least square discriminant analysis models (OPLS-DA). This was followed by univariate logistic regression (ULR), factor analysis (FA) and multivariate logistic regression (MVLR) for the 1HNMR spectral regions with variable influence on projection (VIP) &gt; 1 in the OPLS-DA preliminary models to indicate the best discriminating models (metabotypes). Area under receiver operating characteristic (AUROC) was used to evaluate the OPLS-DA and MVLR models.

Results
OPLS-DA models discriminated between pre-dose and post-dose in plasma and urine with accuracy of 91.77% and 100%, respectively. MVLR indicated final plasma and urine metabotypes with accuracy of 84.2% and 82.2%, respectively. From the final exposure metabotypes, 27 and 20 metabolites were found perturbed in plasma and urine upon exposure to clopidogrel LD, respectively.

Conclusion
1HNMR pharmacometabolomics analysis of plasma and urine was efficient in phenotyping clopidogrel exposure with good accuracy. The study is ongoing to indicate metabolic pathways associated with clopidogrel exposure.
Models Accuracy Metabotype OPLS-DA Model MVLR Model Specificity Sensitivity Accuracy AUROC Specificity Sensitivity Accuracy AUROC Plasma 96.20% 87.34% 91.77% 0.99 97.5% 70.9% 84.2% 0.88 Urine 100% 100% 100% 1.0 93.2% 71.2% 82.2% 0.924 OPLS-DA: orthogonal partial least square discriminant analysis, MVLR: multivariate logistic regression, AUROC: Area under receiver operating characteristic
P276 A meta-analysis on the association of febuxostat compared to allopurinol on blood pressure and major adverse cardiac events (MACE) among adult patients with hyperuricemia
Authors: Barrientos M , Macabeo R A , Ragasa R A 
Published: January 2020

Abstract

Background
Increased uric acid levels have been known to be associated with different cardiovascular and renal diseases. Over the last few years, several studies have examined the role of urate-lowering therapy (ULT) in hypertension and Major Adverse Cardiac Events (MACE) and results are pointing to a potential role of elevated serum uric acid as an emerging independent cardiovascular risk factor.

Objective
To determine if urate-lowering therapy (Febuxostat vs Allopurinol) has an association on blood pressure and MACE among adult patients with hyperuricemia.

Methodology
Randomized controlled trials with outcomes of blood pressure, all-cause mortality, myocardial infarction, and stroke were searched through PubMed and Cochrane database.

Results
Pooled analysis of studies on hyperuricemic patients showed that Febuxostat 40 mg has no significant difference compared with Allopurinol 100/300mg with respect to lowering diastolic (MD -0.56 with 95% CI of -4.28 to 3.15) and systolic blood pressure (MD -0.72 with 95% CI of -4.87 to 6.31). No significant differences were also noted on all-cause mortality (OR 1.21 with 95% CI of 0.35 to 4.12) and myocardial infarction (MI) (OR 1.38 with 95% CI of 0.19 to 9.94). Outcomes on non-fatal stroke were only reported by Becker, et. al (2010) with only 2 events reported in the Febuxostat 80 mg group (0.26%) and no event in the Allopurinol group (CI= 0.082 to 1.155).

Conclusion
The results of this meta-analysis showed that urate-lowering therapy (Febuxostat vs Allopurinol) has no significant association on blood pressure among adult patients with hyperuricemia. No significant association was also found with respect to all-cause mortality and MI. Outcomes on stroke were inconclusive since only one study reported on its events.