bluuebunny/crossref_metadata_2025_split huggingface dataset:
3331Impact of baseline hemoglobin level and white blood cell count in real-world patients undergoing contemporary percutaneous coronary intervention: insights from the GLOBAL LEADER study
Authors: Chichareon P , Modolo R , Tomaniak M , Kogame N , Fontos G , Lantelme P , Barraud P , Hamm C , Steg G , Juni P , Vranckx P , Valgimigli M , Windecker S , Onuma Y , Serruys P W 
Published: October 2019

Abstract

Introduction
The impact of hemoglobin (Hb) level and white blood cell count (WBC) on the outcomes in all-comers PCI patients is unknown.

Purpose
We sought to assess the association between baseline Hb level, WBC count on 2-year outcomes after PCI in all-comers patients in the GLOBAL LEADERS study. We compared the outcomes between anemic and non-anemic patients according to WHO definition.

Methods
GLOBAL LEADERS study assessed the efficacy and safety of two antiplatelet strategies in 15,991 patients undergoing PCI. The primary endpoint was all-cause mortality or new Q wave myocardial infarction (MI) at 2 years. Secondary safety endpoint was BARC 3 or 5 bleeding at 2 years.
The association between WBC count, Hb level and outcomes at 2 years were assessed in the multivariable Cox model adjusted for age, diabetes, ejection fraction and renal impairment. For Hb level, patients were categorized according to the WHO definition of anemia (Hb <12 g/dL in women, Hb <13 g/dL in men).

Results
Of 15991 patients randomized in the GLOBAL LEADER study, baseline WBC count and Hb levels were available in 14960 (93.7%) patients and 15215 (95.3%) patients, respectively.
Hb level had an inverse association with adverse events after PCI. In the multivariable Cox model, Hb level was an independent predictor for ischemic and bleeding outcomes at 2 years while the WBC count was not (see table).
Compared with non-anemic patients, anemic patients had significantly higher risk of primary endpoint (adjusted HR 2.07, 95% CI 1.72–2.49), BARC 3 or 5 bleeding (adjusted HR 1.49 95% CI 1.14–1.96), all-cause mortality (adjusted HR 2.33, 95% CI 1.89–2.86), any MI (adjusted HR 1.41, 95% CI 1.11–1.80), and any revascularization (adjusted HR 1.20, 95% CI 1.03–1.39).
Hb level, WBC count and 2-year outcomes Outcomes at 2 years Hemoglobin level (mg/dL) WBC count (109/L) HR (95% CI) P value HR (95% CI) P value All-cause mortality or new Q wave MI 0.87 (0.82–0.91) <0.0001 1.00 (0.999–1.002) 0.33 All-cause mortality 0.82 (0.78–0.87) <0.0001 1.00 (0.999–1.002) 0.37 Any myocardial infarction 0.93 (0.87–0.99) 0.0165 1.00 (0.996–1.001) 0.23 Any revascularization 0.96 (0.93–1.00) 0.0302 1.00 (1.00–1.001) 0.25 BARC 3 or 5 bleeding 0.85 (0.79–0.91) <0.0001 1.00 (0.997–1.002) 0.76

Conclusion
In the all-comers patients undergoing PCI, the baseline Hb level was significantly associated with the ischemic and bleeding outcomes at 2 years whereas baseline WBC count was not. Baseline WBC count may not be useful as a prognostic factor after PCI.
4033A way forward for cardiac rehabilitation - Nurse clinics with active holistic patient management
Authors: Gasparini C G , Marshall W M , Reed S R , Johansen Y V , Benatar J R B 
Published: October 2019

Abstract

Background
Early cardiac rehabilitation (CR) nurse follow up clinics 2- 3 weeks post hospital discharge have been instituted at our Hospital for all patients with established coronary artery disease to improve patient engagement and adherence. In the last 2 years these clinics have increased in attendance rates and patient complexity. These now have medical supervision, allowing for active management of patients. Patients are seen multiple times to maximize evidence based treatments by the same nurse. Risk factors are addressed in these clinics and patients are invited into cardiac rehabilitation education classes and individualized prescribed exercise programmes.

Purpose
To assess rates of adherence and intervention in CR nurse clinics.

Methods
The CR team at our Hospital has prospectively recorded rates of adherence and interventions at Nurse Specialist clinics over a 12 month period.

Results
718 (94%) patients attended CR nurse clinics following discharge. Of these 413 (57%) patients had an intervention in clinic: up titration was 38% for RAAS/beta blocker, 11% for statin and 18% for antianginal and BP medication. A further 21% were referred for further investigations or treatments including admission to hospital. 48% (Standard deviation 11%) attended a cardiac rehabilitation programme in addition to these 1 hour clinics.
Interventions in clinic

Conclusion
Nurse Specialist clinics with medical supervision that are scheduled early post discharge provide a safety net for patients who are discharged following short hospital stays. They also lead to increased prescription of secondary prevention medication and ensure patients have appropriate investigations and referrals. These clinics have resulted in change in practice with routine doctor follow up clinics now cancelled. Long term follow-up for patients is now rationalized and has freed up doctor clinics for more complex patients. Early and intensive engagement with patients is also associated with higher uptake of cardiac rehabilitation programs.

Acknowledgement/Funding
None
4079The future of recurring restenosis prediction - Urinary cysteinyl leukotriene e4
Authors: Maga M , Wachsmann A , Maga P 
Published: October 2019

Abstract

Background
Peripheral artery disease (PAD) is one of the common atherosclerosis manifestations. However endovascular treatment (percutaneous transluminal angioplasty - PTA) remains the most frequently applied treatment method, it is less successful in patients with recurrent restenosis. Even though the influence of cysteinyl eicosanoids on atherosclerosis progression is well-known, their role in restenosis after endovascular treatment has not been studied yet.

Purpose
The aim of this study was to establish prognostic features of urinary leukotrienes E4 (uLtE4) in occurrence of restenosis.

Methods
180 patients admitted for PTA with lower limbs ischemia on 3 or 4 stage of Rutherford scale were recruited in this prospective innovative study. Urine samples were collected before intervention as well as 2 hours after and day after it. During control visits were performed 1,3,6 and 12 months after PTA including uLtE4 level measurement, evaluation of treatment success and complex assessment of restenosis basing on ankle-brachial index, Doppler ultrasound and general condition of patient. To perform the analysis all of patients were divided into 2 groups basing on presence of complications on each follow-up meeting: A-without restenosis; B-with restenosis.

Results
Significant differences in level of uLtE4 were observed between group A and B on 3-month (85.57 vs 157.64, p<0.002) 6-month (83.17 vs 158.28, p<0.001) and 12-month (76.81 vs 150.25, p<0.001) follow-up visits (Fig1). Patients with increased uLtE4 level in 1month had higher risk of restenosis in 3-month observation (OR=3.57, p=0.002) and elevated uLtE4 in 3-month follow-up increased the risk of restenosis in 6 months (OR=2.38, p=0.016). The same trend was observed in 6 months uLtE4 levels regarding 12-months restenosis however it wasn't statistically significant (OR=1.82, p=0.1). However post-operative uLtE4 were significantly higher compared to the pre-operative ones, they did not correlated with future restenosis in none of the follow-ups.
Figure 1

Conclusions
Our study shows that, elevated level of uLtE4 correlates with increased risk of restenosis occurrence in PAD patients after EVT. Leukotrienes rise can also predict the restenosis in the following months. These results confirms the role of inflammatory mediators in atherosclerosis and let us believe, that one day uLtE4 level may become the significant biomarker of complications after lower limbs endovascular treatment.

Acknowledgement/Funding
Grant of Polish Ministry of Science and Higher Education - “Best of the best 2.0” (S/FS0/0267)
4095Exercise and vascular ageing: a cross-sectional and randomized controlled trial
Authors: Streese L , Deiseroth A , Hanssen H 
Published: October 2019

Abstract

Background
Vascular ageing can be quantified at subclinical stages by use of sensitive vascular biomarkers of the macro- and microcirculation. Detection of vascular impairments enables initiation of timely treatment strategies to counteract development of CV disease and improve CV outcome.

Purpose
To (a) compare large artery stiffness and retinal microvascular diameters in healthy life-long active and healthy sedentary older adults with CV risk patients, and (b) to assess the effects of short-term high-intensity exercise training on vascular health in these patients.

Methods
Seven hundred and eighty-three participants were screened for their CV risk and physical activity profile. We included 38 healthy active (HA, mean age 60±7 years) and 36 healthy sedentary (HS, mean age 60±7 years) as well as 84 sedentary patients with ≥2 CV risk factors (SR, mean age 59±6 years) in the cross-sectional approach. SR were randomized to a 12-week high-intensity interval training (HIIT) or physical activity recommendations after the baseline assessment. Carotid-femoral PWV (cfPWV) was measured as a marker of large artery stiffness and the central retinal arteriolar (CRAE) and venular (CRVE) diameters as well as the retinal arteriolar-to-venular diameter ratio (AVR) were measured as a marker of the microcirculation. Standard procedures of anthropometric measurements were implemented.

Results
Anthropometric parameters differed between the groups according to the inclusion criteria. cfPWV was highest in SR (8.2±1.4m/s) compared to HS (7.5±1.6m/s) and HA (7.0±1.1 m/s). HA had a lower cfPWV compared to HS (p<0.05) and SR (p<0.001). HA had wider CRAE (179±14μm) and narrower CRVE (204±17μm) compared to HS (CRAE: 172±11 μm; CRVE: 209±11 μm) resulting in a higher AVR in HA (0.88±0.05) compared to HS (0.83±0.04, p<0.001). By contrast, SR showed narrower CRAE (171±14 μm) and wider CRVE (218±16μm, p<0.05) compared to HS resulting in a lower AVR (0.79±0.05, p<0.001) compared to HS and HA. HIIT in SR improved most classic CV risk factors. Additionally, CRAE increased (pre: 175±14μm vs post: 181±13μm, p=0.001) and CRVE decreased (pre: 222±14μm vs post: 220±14μm, p=0.007) in the HIIT group without changes in the cfPWV. PWV was significantly but moderately associated with AVR (r=−0.2, p=0.01).

Conclusions
Life-long physical activity and fitness were associated with lower arterial stiffness and favourable retinal vessel diameters in healthy individuals. CV patients had higher arterial stiffness and lower AVR. Short-term HIIT improved retinal microvascular phenotype without changes in large artery stiffness. Retinal vessel diameters are sensitive diagnostic tool for CV risk stratification and subclinical vascular disease monitoring in CV patients. Short-term HIIT may postpone development of small vessel disease in older patients.

Acknowledgement/Funding
Swiss National Science Foundation, Nora van Meeuwen-Häfliger Stiftung
4097Validation of seven different exercise treadmill stress testing protocols in a large 25-year stress testing registry
Authors: Harb S , Menon V M , Wu W U , Cremer P C , Cho L C , Gulati M G , Jaber W A J 
Published: October 2019

Abstract

Background
While the Bruce protocol has been extensively validated, other modified exercise protocols with less workload burden are commonly used, though their prognostic value is not well established.

Purpose
We sought to assess whether exercise capacity (or workload achieved in metabolic equivalents of task [METs]) remains predictive of mortality across various exercise stress testing protocols.

Methods
In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent 7 different standardized symptom-limited exercise stress testing protocols: Bruce, Modified Bruce, Cornell 0%, Cornell 5%, Cornell 10%, Naughton, and modified Naughton. The choice of the protocol was dependent on the supervising exercise physiologist according to purpose of the test and the individual patient. The primary outcome was all-cause mortality.

Results
Mean age was 53.3±12.5 years and 59% were male. There were 74953 Bruce, 8368 modified Bruce, 2648 Cornell 0%, 9972 Cornell 5%, 20425 Cornell 10% 1226 Naughton, and 3113 modified Naughton individual protocols. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Figure 1 shows that there was an inverse relationship between peak METs achieved and mortality across all 7 protocols. On multivariable analysis, increasing METs remained protective against death [adjusted HR of 0.46; 95% CI (0.44 - 0.48); p<0.001] even after adjusting for the protocol chosen, age, gender, hypertension, diabetes, coronary disease, end-stage renal disease, smoking, and statin use.
METS vs. mortality by protocol

Conclusion
Across 7 different exercise protocols with various workloads, the predicted exercise capacity remained predictive of mortality irrespective of the protocol chosen, patients' demographics and comorbidities. Different testing choices likely represent different estimated functional capacity.
4102QT interval duration, long QT pattern and changes over time in children practicing sport
Authors: D'Ascenzi F , Anselmi F , Graziano F , Berti B , Franchini A , Bacci E , Ceccon C , Capitani M , Bonifazi M , Mondillo S 
Published: October 2019

Abstract

Background
Twelve-lead electrocardiogram (ECG) is an established tool in the evaluation of adult athletes, providing information about life-threatening cardiovascular diseases such as long-QT syndrome. However, changes induced by development challenge the interpretation of ECG in the paediatric population, particularly for the repolarisation phase. The aim of this prospective, longitudinal study was to determinate the distribution of QT interval in children practicing sport and to evaluate changes in QT duration during preadolescence.

Methods
A final population of 1473 children practising sport (mean age: 12.0±1.8 years, interval 7–15 years) was analysed. Each athlete was evaluated at baseline, mid-term and end of the study with a mean follow-up of 3±1 years. QT interval was corrected with Bazett (B) and Fridericia (F) formulae.

Results
At baseline QTcB was 412±25ms and QTcF 387±21ms, with no changes during follow-up. Ten children (0.68%) had an abnormal QTc. In children with QTc ≥480ms confirmed both by Bazett and Fridericia formulae, QT duration persisted abnormal during the follow-up and children were disqualified. Conversely, children with borderline QTc intervals (>460 and <480ms) were not disqualified and we found a normalization of QT interval during the development. Mean difference in the calculation of QT between the two formulae was 25±11ms, p<0.0001. For HR values higher than 80 bpm, the QTcF resulted with low fluctuations around the mean was independent from HR values. Conversely, the QTcB revealed significant growing trend as the HR increased and showed higher variability than Fridericia correction.
Dynamic changes in QT interval duration Baseline Mid-term FU Long-term FU p value Intervallo QT 343±25 345±24* 346±25* <0.0001 RR (ms) 599±111 711±111* 721±119*^ <0.0001 QTc Bazett (ms) 412±25 (371–449) 411±25 (367–449) 409±25 (367–446) 0.10 QTc Fredericia (ms) 387±21 (355–418) 387±20 (353–419) 387±20 (353–418) 0.59 FU, follow up; *p<0.0001 vs. baseline; §p<0.0001 vs. mid-term FU; ^p<0.05 vs. mid-term FU.

Conclusions
QT duration does not change over time in children with normal duration. A minority of children has a QT ≥480ms; in these subjects QT interval remains prolonged during the follow-up. Conversely, in children with borderline QT, mid-term follow-up is useful to identify a normalization during the growth. Clinicians should take into account that the use of Bazett and Fridericia correction formulae is not interchangeable and that Fridericia formula should be preferred when resting HR is higher than 80 bpm.
4224Conflict-driven risk factors faced by displaced populations and deterioration of health: Review of Syrian conflict as an example
Authors: Shimony E , Shekhar A C , Narula J 
Published: October 2019

Abstract

Purpose
Conflict yields adverse health effects for those living in afflicted regions. It dramatically exacerbates poverty and creates large numbers of vulnerable refugees. In addition to food scarcity, healthcare disparity, and overwhelming inequality, refugees face extreme emotional trauma and cumulative stress. This could lead to lifestyle modifications – including unhealthy diets, low activity levels, and smoking – that contribute to cardiovascular disease (CVD). The issue of refugees and displaced persons has never been more apparent than in the last decade. There are currently 68.5 million refugees worldwide, including those due to violent conflict in Syria. [i]

Methods
To conceptualize the magnitude of cardiovascular risk refugees face during periods of conflict and resettlement, we reviewed the published literature for the prevalence of behavioral modification in Syrian refugees, including altered diets, smoking, stress, and overall mental health.

Results
Literature review suggests refugees are 10 times more likely to experience post-traumatic stress disorder (PTSD), with lifetime incidence as high as 38.5% as seen in a study of Syrian Kurdish refugees in Iraq.[ii] Syrian refugees in Sweden were found to experience high levels of both depression and anxiety, 40% and 32%, respectively. [iii] The INTERHEART study showed a causal link between elevated levels of stress and CVD. [iv]
In addition to serving as a risk factor for CVD, stress cultivates unhealthy lifestyles. A study of Syrian refugees found an increase of 7.6 cigarettes per day following the war; this data also followed a trend of increasing levels of PTSD, suggesting that the stress of migration and the conflict led to increased cigarette use.[v] In Syrian resettlement areas, Palestinian refugees were found to consume almost twice as many cigarettes as the local population, a trend also true in Lebanon.[vi] Heart-healthy nutrition and diets are often not available to refugees, and a study of Syrian refugees in Lebanon found diets that consisted almost exclusively of carbohydrates with little to no vegetables, fruits, or proteins. Stress, poor diets, and smoking in displaced people may translate into a higher incidence of noncommunicable diseases. In the Lebanese study, hypertension, diabetes, and CVD were reported in refugees at 60%, 47%, and 30%, respectively. [vii]

Conclusions
Improving the health of war-affected displaced subjects is an issue worthy of concern. Conflict results in unhealthy lifestyles and behaviors and must end to restore emotional health and physical well-being.
4252Additional value of stress testing for evaluation of ventricular arrhythmias in athletes undergoing preparticipation screening
Authors: Vessella T , Zorzi A , De Lazzari M , Menegon V , Spagnol R , Merlo L , Pegoraro C , Giorgiano F , Cardillo R , Perazzolo Marra M , Basso C , Corrado D , Sarto P 
Published: October 2019

Abstract

Introduction
The optimal protocol of athletes pre-participation screening is a matter of debate. The aim of this study is to test the additional value of exercise testing (ET) for evaluation of ventricular arrhythmias (VA) in athletes with otherwise normal findings.

Methods
The study included 10,975 competitive athletes who underwent preparticipation screening including ECG and stress testing. Athletes with ≥3 isolated premature ventricular beats or ≥1 repetitive VA underwent second-line investigations (echocardiography and 24-hour ambulatory ECG monitoring with a training session) and, in case of frequent, complex or exercise-induced VA or echocardiographic abnormalities, also cardiac magnetic resonance (CMR).

Results
451 (4,1%) athletes were excluded for abnormalities at history, physical examination and baseline ECG. Among the remaining 10524 athletes, 524 (5%)showed VA at ET, 87 of whom underwent CMR.Echocardiography identified major cardiac abnormalities in 5 athletes and regional ventricular systolic dysfunction in 7, which were confirmed by CMR in 6. Other 12 patients with normal echocardiography had a positive CMR. In particular, in 16 subjects the CMR showed left ventricular late gadolinium enhancement suggesting myocardial fibrosis with a non-ischemic distribution. At multivariate analysis, VA observed at high work load at ET, the presence of complex VA at ET and the presence of a morphology other than infundibular or fascicular predicted an underlying pathological myocardial substrate while the presence of frequent (>500/24-hour) premature ventricular beats did not.
Predictors of underlying pathological myocardial substrate Substrate Univariate Multivariable YES (n=23) NO (n=501) OR (95% IC) P OR (95% IC) P Age 17 [13–43] 15 [14–17] 1.03 [0.98 -1.06] 0.18 – Male gender 15 (65%) 184 (37%) 3.2 [1.3–7.7] <0.001 1.6 [0.7–4.8] 0.28 >500 PVBs/24-hour 7 (30%) 98 (20%) 1.8 [0.7–4.5] 0.21 – VA at high work-load 10 (44%) 78 (16%) 4.2 [1.8–9.8] <0.001 1.6 [1.1–4.7] 0.02 Couplets/NSVT at ET 14 (61%) 117 (23%) 6.2 [2.5–15] <0.001 8.5 [2.5–29] 0.01 PVBs other than infundibular/fascicular 17 (74%) 118 (24%) 6.1 [2.4–16] <0.001 3.9 [1.4–11] 0.008

Conclusions
VA at ET may represent the only sign of a pathological myocardial abnormalities, such as the “isolated nonischemic left ventricular scar”, that could be the substrate for life-threatening ventricular arrhythmias. Addition of ET to baseline ECG may increase the sensitivity of PPE of competitive athletes.
4301Diastolic dysfunction is an independent predictor of adverse events in patients with systolic dysfunction. Insights from the MADIT-CRT trial
Authors: Gori M , Claggett B , Shah A M , Senni M , Goldenberg I , Kutyifa V , Solomon S D 
Published: October 2019

Abstract

Background
Diastolic dysfunction (DD) is common in patients with heart failure with reduced ejection fraction (HFrEF). However, its prognostic relevance in HFrEF, on top of conventional risk factors including natriuretic peptides, is unknown

Purpose
To show the prognostic contribution of DD in HFrEF

Methods
We analyzed 1155 baseline echocardiograms (63% of all available exams) in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study, comprising HFrEF patients with LVEF≤30%, QRS duration ≥130 ms, and NYHA class I/II. We classified DD according to ASE 2016 classification, based on transmitral Doppler velocities, mitral annular Tissue Doppler velocities, pulmonary venous flow velocities, and left atrial volumes. Using Cox regression and C-statistics we assessed the independent prognostic value of DD for nonfatal HF or death. We also evaluated CART (Classification And Regression Tree) analysis

Results
Patients were 64±11 years-old, 24% females, and mean LVEF was 24±5%. While 45% had impaired relaxation, 33% had pseudo-normal filling, 12% restrictive patter, 6% had indeterminate diastolic function, and 4% were not classifiable due to missing data. During a mean follow-up of 2.1±1.0 years, there were 233 adverse events. After multiple adjustment, compared to patients with impaired relaxation, those with pseudo-normal and restrictive filling had greater risk of HF/death (respectively HR 1.76, 95% CI 1.16–2.66, p=0.007; HR 2.70, 95% CI 1.58–4.60, p<0.001), independently of assigned treatment (p-interaction 0.34). Adding DD to conventional markers of risk improved prediction (C-statistic 0.733, 95% CI 0.689–0.776 versus 0.708, 95% CI 0.663–0.753, p=0.024). Finally, at CART analysis DD was the first parameter to be considered to risk stratify patients (Figure)
Risk stratification tree

Conclusions
DD is a strong independent predictor of death or heart failure in HFrEF patients with mild symptoms and should be considered in assessment of risk in this population