bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6328Relationship between exercise capacity and muscle function in adult patients with heart failure
Authors: Chiala O , Klompstra L , Vellone E , Stromberg A , Jaarsma T 
Published: October 2019

Abstract

Introduction
Physical fitness is a multidimensional concept and is of great importance to assess in heart failure (HF) patients, due to that HF is associated with exercise intolerance, dyspnea and fatigue. Some measures of physical fitness have been associated to HF severity, rehospitalization and mortality risk.

Purpose
The aim of this study was to explore the relationship between two different measures of physical fitness in patients with HF: exercise capacity and muscle function.

Methods
This is a secondary analysis performed on the baseline data of a multi-centre RCT study aimed at exploring the effect of exergame access to improving exercise capacity in HF patients. Physical fitness was assessed by two different measures: exercise capacity assessed by the 6-minute walk test (6MWT), and muscle function assessed by 3 different isometric tests of upper and lower limbs. Descriptive statistics, Spearman correlation and principal component analysis were used to analyse the data.

Results
In total, 605 HF patients were included in this analysis (mean age 67±12, 29% women, 90% NYHA II/III). Exercise capacity (6MWT) was correlated with all of the muscle function tests, with correlation-coefficients ranging from r=0.23 to r=0.50 (p<0.001). Principal component analysis showed a bi-dimensional nature of physical fitness, with the first dimension including the lower body strength and the second dimension including the upper body strength and exercise capacity. These two dimensions explained 71% of the total variance of the measured variables.
Correlation matrix (n=605) 6MWT Right Heel-Lift Left Heel-Lift Shoulder abduction Right Shoulder Flexion Left Shoulder Flexion 6MWT 1 Right Heel-Lift 0.23** 1 Left Heel-Lift 0.26** 0.86** 1 Shoulder abduction 0.40** 0.30** 0.34** 1 Right Shoulder Flexion 0.47** 0.51** 0.48** 0.52** 1 Left Shoulder Flexion 0.50** 0.49** 0.48** 0.52** 0.83** 1 **p<0.001.
Principal Component Analysis

Conclusions
Although strong correlations between exercise capacity and muscle function tests, the measures loaded on two different factors. The results suggest that upper body strength and exercise capacity had a stronger relationship than with lower body strength. This may imply that muscle function tests for upper and lower limbs and exercise capacity represent different aspects of physical fitness and to attain a more complete assessment of physical fitness all three tests are important.

Acknowledgement/Funding
Swedish National Science Council, The Swedish Heart and Lung Association, The Swedish Heart and Lung Association, Swedish Heart-Lung Foundation
P6332Prevalence and prognostic impact of sarcopenia identified according to Asia Working Group for Sarcopenia definition in non-dependent elderly patients with heart failure
Authors: Iwatsu K , Ikeda T , Matsumura K , Ashikawa H , Sakamoto M , Sakata T , Haratani K , Fujita R , Takabayashi K , Kitaguchi S , Nohara R 
Published: October 2019

Abstract

Background
Sarcopenia is a geriatric syndrome characterized by loss of muscle mass and muscle function. As the population ages, there is a growing worldwide interest in the intersection of sarcopenia and heart failure (HF). However, estimates of the prevalence of sarcopenia in HF vary widely because of difference in diagnostic criteria. Although the Asian Working Group of Sarcopenia (AWGS) has announced a consensus on the diagnostic criteria of sarcopenia in Asian people, the prevalence and prognostic impact of sarcopenia based on AWGS criteria in patients with HF remains unclear.

Purpose
The aim of this study was to investigate the prevalence and predictive value of sarcopenia identified according to AWGS definition in non-dependent elderly patients with HF.

Methods
This study was a prospective, single-center cohort study in Japan. We consecutively enrolled 274 patients, aged 65 years or older, hospitalized due to acute HF or acute exacerbation of chronic HF and who were able to walk at least 20 m at discharge. Patients with severe cognitive or psychiatric disorders were excluded. Patients with implantable cardiac pacemaker or cardioverter defibrillator were also excluded because skeletal muscle mass was estimated by using bioimpedance analysis. At hospital discharge, we collected data on age, gender, left ventricular ejection fraction, brain natriuretic peptide, estimate glomerular filtration rate, body mass index and sarcopenia. Sarcopenia was diagnosed according to the AWGS criteria: low skeletal muscle index (<7.0 kg/m2 in men, <5.7 kg/m2 in women) and either slow usual walking speed (<0.8 m/s) or low handgrip strength (<26 kg in men, <17 kg in women). Study outcome was rehospitalization for worsening HF within 180 days after discharge. We assessed the independent association between sarcopenia and HF rehospitalization by using multivariate Cox proportional hazards regression analysis.

Results
In this study, a total of 199 patents (43.4%) fulfilled sarcopenia criteria at discharge. During follow-up, 57 patients (20.8%) readmitted for HF. Kaplan-Meier survival curves showed that patients with sarcopenia had significantly lower event-free survival than those without sarcopenia (Figure). After adjusting for other prognostic factors, sarcopenia was independently associated with HF rehospitalization (hazard ratio: 2.31, 95% confidence interval: 1.20–4.53).

Conclusion
Based on AWGS criteria, sarcopenia is highly prevalent even among non-dependent elderly HF patients, and is an independent strong predictor of rehospitalization for worsening HF. AWGS criteria for sarcopenia may be useful for risk prediction in HF.
P6350Impact of diabetes on serum biomarkers in heart failure with preserved ejection fraction: insights from the spironolactone for heart failure with preserved ejection fraction (TOPCAT) trial
Authors: De Marco C , Claggett B , De Denus S , Huynh T , Desai A S , Sirois M G , Jarolim P , Solomon S D , Pitt B , Rouleau J L , Pfeffer M A , O'meara E 
Published: October 2019

Abstract

Background and purpose
Diabetes mellitus (DM) is common in heart failure with preserved ejection fraction (HFpEF). Patients with DM and HF with reduced ejection fraction have higher levels of prognostic biomarkers relative to non-diabetics. We sought to examine differences in biomarkers at baseline and over time in patients with HFpEF with and without DM (non-DM).

Methods
The Americas cohort of the TOPCAT trial included 248 subjects with baseline measurements of serum biomarkers and follow-up measures 12 months later. Subjects were identified as non-DM or DM at baseline. Baseline values were compared using non-parametric tests and 12-month changes were compared via linear regression after log-transformation and adjustment for baseline biomarker value, age, gender, randomization strata, and randomized treatment.

Results
At baseline, DM patients had significantly lower eGFR and higher hsCRP, PIIINP, TIMP1, and Gal-3 levels versus non-DM patients (Table). In addition, there was a significantly larger increase over time in levels of hs-TnT, a marker of myocyte death, in DM vs. non-DM patients (p=0.016).
Baseline and 12-Month Biomarkers Baseline % Change at 12 Months Non-DM (n=132) DM (n=116) p Non-DM (n=110) DM (n=94) p eGFR (mL/min/1.73m2) 67 [57, 77] 57 [46, 73] 0.003 −14% (−17, −10) −14% (−18, −10) 0.34 hsCRP (mg/L) 2.4 [1.1, 5.6] 3.1 [1.6, 7.5] 0.046 1% (−5, 3) −11% (−27, 7) 0.54 NT-proBNP (pg/mL) 624 [338, 1235] 629 [278, 1429] 0.80 −2% (−12, 10) −5% (−21, 13) 0.48 hs-TNT (ng/mL) 5.7 [3.1, 12.4] 7.1 [3.7, 14.2] 0.17 −1% (−14, 13) 11% (−3, 27) 0.016 Soluble ST2 (ng/mL) 28 [22, 32] 28 [21, 35] 0.36 −1% (−7, 5) −4% (−9, 2) 0.60 Aldosterone (ng/L) 149 [120, 202] 142 [113, 174] 0.09 17% (9, 26) 23% (14, 33) 0.76 PICP (ng/mL) 137 [101, 169] 127 [102, 155] 0.29 5% (−5, 17) 1% (−9, 12) 0.07 CITP (ng/mL) 1.6 [1.0, 2.8] 1.6 [0.9, 3.0] 0.93 −25% (−37, 10) −23% (−36, −8) 0.87 PIIINP (ng/mL) 23 [16, 30] 28 [21, 36] <0.001 5% (−4, 15) 5% (−3, 14) 0.12 TIMP-1 (ng/mL) 188 [170, 212] 212 [183, 245] <0.001 −1% (−4, 2) −2% (−5, 2) 0.59 Galectin-3 (ng/mL) 20 [16, 23] 22 [18, 28] <0.001 6% (3, 10) 9% (4, 14) 0.52 eGFR, estimated glomerular filtration rate; hsCRP, high-sensitivity CRP; NT-proBNP, N-terminal pro-B-type natriuretic peptide; hs-TnT, high-sensitivity troponin T; PICP, pro-collagen type I carboxy-terminal peptide; CITP, collage type I; PIIINP=pro-collagen type III amino-terminal peptide; TIMP-1=tissue inhibitor of MMP-1.

Conclusions
In comparison to patients without DM, those with DM had poorer renal function and higher baseline levels of markers of myocardial stretch, myocyte death, and pro-fibrotic biomarkers. Further, hs-TnT increased over 12 months only in patients with DM.
P6354Decreased beneficial effects of oral heart failure medications in patients with acute decompensated heart failure and hyperglycemia: results from an international observational cohort
Authors: Akiyama E , Cinotti R , Arrigo M , Lassus J , Miro O , Celutkiene J , Cohen-Solal A , Maggioni A P , Mueller C , Parenica J , Spinar J , Sato N , Tamura K , Kimura K , Mebazaa A 
Published: October 2019

Abstract

Background
Hyperglycemia is common, regardless of diabetes mellitus (DM), and is associated with increased mortality in patients with acute heart failure (AHF). Current oral heart failure (HF) medications improve the outcome in patients with AHF. However, the relationships between HF medications, admission glucose levels, and prognosis in AHF patients remained unknown.

Purpose
This study sought to investigate the effect of oral HF medications on relationships between hyperglycemia at admission and 1-year all-cause mortality in patients with AHF.

Methods
From the GREAT (Global Research on Acute Conditions Team) registry, 13840 patients presenting with AHF whose admission glucose levels were available were included and followed up for 1-year all-cause mortality. Hyperglycemia was defined as a glucose levels of ≥7 mmol/L for patients without history of DM and ≥10 mmol/L for those with history of DM. Patients with hypoglycemia (defined as a glucose levels of ≤4 mmol/L, n=193, 1.4%) were excluded in this analysis.

Results
There were 6418 (%) patients with hyperglycemia and 7229 (%) patients with normoglycemia. One-year mortality was higher in patients with hyperglycemia than those with normoglycemia (1911 [30%] and 1821 [25%], respectively). Even after adjustment, the risk for 1-year mortality was significantly higher in hyperglycemia (HR 1.14, 95%-CI 1.04–1.26, P=0.008) compared with normoglycemia. Detrimental effects of hyperglycemia on 1-year mortality were more severe in de novo AHF patients than in patients with history of HF (p for interaction 0.004). Oral HF medications (beta blockers and/or angiotensin converting enzyme inhibitors/angiotensin receptor blockers) at discharge were effective in AHF patients with normoglycemia regardless of history of HF. Oral HF medications at discharge are very effective in de novo AHF patients with hyperglycemia and less effective in acute decompensated HF patients with hyperglycemia (Figure).
HF medications and 1-year mortality

Conclusions
Hyperglycemia at admission is associated with increased risk for 1-year mortality. Current oral HF medications are effective in most of subgroups, though they were less effective in patients with acute decompensated HF and hyperglycemia. These patients might need more aggressive therapies to improve outcomes.

Acknowledgement/Funding
This work was supported by a research fellowship from Japan Heart Foundation (E.A.)
P6376The role of circulating lymphocytes on hypertensive heart disease
Authors: Schluter K.-D , Schreckenberg R , Wolf A , Kutsche H , Troidl C , Simsekyilmaz S , Niemann B 
Published: October 2019

Abstract

Aims and background
Hypertension is a disease accompanied by moderate inflammation. Physical activity and pharmacological intervention protect the organisms against hypertension-dependent end-organ damage. They should therefore interfere with the mobilization of lymphocytes. Different subsets of lymphocytes should specifically interfere with vascular and cardiac remodeling. In this study we correlated the amount of circulating lymphocytes with the expression of vascular and cardiac specific genes in the aorta and left ventricle to identify the tissue-specific effects of these cells.

Methods
50 female spontaneously hypertensive rats (SHR) and 6 female normotensive Wistar rats (Wis) were analyzed. They were grouped in 7 subgroups exposed to different treatment regimes (modification of activity, type of activity, aldosterone blockade, and a combination thereof. Indicator genes of mal-adaptive vascular and cardiac remodeling were quantified by qRT-PCR.

Results
SHRs had an increased number of circulating NK cells and monocytes, but lower numbers of T cells. T cells inversely correlated with the vascular expression of p22phox, a member of the NADPH oxidase complex. Thus, lower number of T-cells favors the vascular expression of p22phox and thereby oxidative stress. In the left ventricle, T cells are inversely correlated with the expression of arginase-1 and UCP-2 but positively correlated with Glut-4 expression. The lower number of T cells in SHR therefore favors the expression of proteins often associated with oxidative stress and glucose metabolism. Monocytes are positively correlated with key markers of left ventricular hypertrophy (such as ANP, collagen-1, and β-MHC). Thus, the increased number of monocytes in SHRs supports cardiac hypertrophy. NK cells are inversely correlated with the expression of anti-inflammatory cytokines in the aorta (IL-10, IL-15). Thus, high number of circulating NK cells seems to favor a pro-inflammatory phenotype in the vasculature.

Conclusion
In a standard model of essential hypertension the profile of circulating lymphocytes differs from that in normotensive rats. The different subsets of lymphocytes specifically interfere with specific processes in the ventricle and vessel. Collectively, the difference between hypertensive and normotensive rats (less T cells, more NK cells and monocytes) supports a mal-adaptive role under hypertensive conditions.
P6377Cardiopulmonary effects of nitric oxide supplementation in a model of chronic hypoxia pulmonary hypertension
Authors: Reinero M , Beghetti M , Samaja M , Milano G 
Published: October 2019

Abstract

Objective
We previously demonstrated that the inhibition of phosphodiesterase type-5, an enzyme that degrades cGMP into inactive 5'-GMP, attenuates pulmonary remodeling and right ventricular (RV) hypertrophy (RVH) during exposure to chronic hypoxia (CH). The nitric oxide (NO) pathway is thought to play a major role in these changes. In this study, we investigate whether L-Arginine (L-ARG), a substrate of endothelial NO synthase (eNOS) and molsidomine (MOL), a NO donor, might alleviate the cardiovascular and pulmonary dysfunction led by CH.

Methods
Male rats (n=80; 10/group) were maintained in normoxic (21% O2) or hypoxic chambers (10% O2) for 14 days. Hypoxic rats were subdivided in four groups: untreated control, treated with L-ARG (45 mg/kg), eNOS inhibitor N-nitro-L-arginine methyl ester (L-NAME, 45 mg/kg) or MOL (15 mg/kg). Drugs were given daily in the drinking water. After sacrifice, we measured RV systolic pressure (RVSP), RV contractility (dP/dt), RVH, the lung/body weight ratio, the pulmonary vessels medial wall thickness, and the cardiac and pulmonary eNOS phosphorylation.

Results
Although CH increased RVSP, RV contractility and RVH, these increases were attenuated by L-ARG and MOL. Whereas L-ARG attenuated the RVH increase, MOL and L-NAME were ineffective. No treatment prevented the increase in lung/body weight ratio. Under all conditions, the lung tissue water content was unchanged, indicating no edema development. By contrast, CH rats developed a marked increase in medial wall thickness of small (0–100 mm) pulmonary arteries, while larger arteries were not affected. This increase was attenuated by L-ARG or MOL. Although CH decreased cardiac and pulmonary phosphorylated eNOS, L-ARG and MOL restored the normoxic level.

Conclusions
NO supplementation during CH attenuates RVSP, RVH and pulmonary remodeling, probably due to increased phosphorylation of eNOS. Despite normalizing RVSP, MOL does not influence RVH development.
P6379The impact of coronary artery evaluation and intervention to predict mortality and neurological outcome in out-of-hospital cardiac arrest patients with extra corporeal cardiopulmonary resuscitation
Authors: Kato S , Matsuda J 
Published: October 2019

Abstract

Background
Refractory cardiac arrest (CA), as defined by the absence of a return of spontaneous circulation (ROSC) is associated with poor prognosis. Current guidelines advocate the use of extracorporeal cardiopulmonary resuscitation (ECPR) for selected patients with CA. Although previous studies have reported the association of survival with some prognostic factors such as age, bystander CPR attempt, low-flow duration or lactate serum level, the impact of the evaluation of coronary artery by coronary angiography (CAG) and the revascularization of coronary artery stenosis have not been sufficiently elucidated.

Purpose
We sought to investigate impact of the CAG and the revascularization of coronary artery stenosis to predict mortality and neurological outcome at 30 days in out-of-hospital CA (OHCA) patients resuscitated by ECPR.

Methods
1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 899 patients with refractory CA at the emergency department were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, we performed ECPR for 85 patients, who were successfully resuscitated. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, and post-hospital care including CAG and coronary revascularization.

Results
Among those who had first resuscitated by ECPR, 20 patients (23.5%) survived and 10 patients (11.8%) achieved good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. We performed CAG for 40 patients (47.1%) and revascularization by percutaneous coronary intervention for 25 patients (29.4%). Younger age (P=0.037), CAG (P=0.001), PCI (P=0.001), and hypothermia therapy (P<0.001) were associated with low mortality. In the multivariate analysis, age (Odds ratio (OR) 0.95; 95% confidence interval (CI) 0.91–0.99; P=0.0025), PCI (OR 4.5; 95% CI 1.15–17.6; P=0.031), and hypothermia therapy (OR 13.7; 95% CI 1.52–124; P=0.020) were independent predictors of 30-days survival. Without diabetes mellitus (P=0.024), CAG (P<0.001), PCI (P=0.006), and hypothermia therapy (P=0.038) were associated with good neurological outcome. PCI (OR 7.39; 95% CI 1.73–31.6; P<0.001) was independently predictive for good neurological outcome.

Conclusions
Successful PCI was an independent predictor of 30-days survival and good neurological outcome in OHCA patients who were resuscitated by ECPR.
P6382The use of a mobile GPS-tracking system to activate volunteer first responders increases survival among patients with out-of-hospital cardiac arrest in residential areas
Authors: Jangaard L , Mickley H , Joergensen G , Schakow H , Gerke O , Henriksen F L 
Published: October 2019

Abstract

Background
In residential areas, survival in patients with out-of-hospital cardiac arrest (OHCA) is less than one third compared with the survival in patients with OHCA in public areas. New strategies are needed to improve outcomes in residential areas.

Purpose
To evaluate the effect on survival in OHCA patients in residential vs. public areas, when using a mobile GPS-tracking system to activate volunteer first responders (VFRs).

Methods
In 2012 a mobile GPS-tracking system was brought into use by a first aid volunteer corps on a rural island with a population of about 12,000 inhabitants. In all cases of emergency calls where an emergency medical service (EMS) was requested, the system was activated. Three VFRs were recruited and successively provided with distinct VFR roles. One of the VFRs was guided to the nearest automatic external defibrillator before approaching the patient.
We retrospectively screened all emergency ambulance journals in the years 2012–2017 to identify patients with OHCA. Additional information was collected from hospital records. Location was categorized as residential or public place. OHCAs witnessed by EMS, occurring at nursing homes or at uncertain locations were excluded. Clinical outcome was 30-day survival.

Results
During the 6-year period, there was a total of 114 OHCAs. Of these, 66 (57.9%) took place in residential areas, 16 (14.0%) in public areas and 32 (28.1%) were excluded. The 30-day survival in OHCA patients in residential vs. public areas was 15.2% and 12.5%, respectively (p=0.79).
Demographic and survival results Residential area (n=66) Public area (n=16) P value Age, mean (SD) 71 (13) 69 (13) 0.14 Male sex, no. (%) 47 (71) 13 (87) 0.22 Volunteer first responder activated, no. (%) 55 (83) 15 (94) 0.30 AED arrives before EMS, no. (%) 36 (55) 9 (56) 0.34 Shock given before EMS, no. (%) 8/63 (13) 3/15 (20) 0.88 First rhythm shockable by EMS, no. (%) 11/64 (17) 3 (19) 0.63 30-day survival, no. (%) 10 (15) 2 (13) 0.79 The table shows the differences in OHCA located at residential areas versus public areas. AED: Automated external defibrillator; EMS: Emergency medical service; OHCA: Out-of-hospital cardiac arrest; SD: Standard deviation.

Conclusion
The use of a mobile GPS-tracking system to activate VFRs increases the 30-day survival among patients with OHCA in residential areas to a level comparable with the survival observed in public areas.

Acknowledgement/Funding
One year grant from Odense University Hospital's PhD Fund. One year grant from University of Southern Denmark. A 500,000 DKKR grant from TV2 Funen and OUH