bluuebunny/crossref_metadata_2025_split huggingface dataset:
P606High intermodality variability in ejection fraction measured by echocardiography, cardiac magnetic resonance and single photon emission computed tomography in chronic coronary artery disease patients
Authors: Stokke T M , Sarvari S I , Bjerring A W , Haugaa K H , Elahi M T , Hoedemakers S I , Rademakers F , Monaghan M , Sicari R , Engvall J , Nagel E , Zamorano J L , Ukkonen H , D'hooge J , Edvardsen T 
Published: October 2019

Abstract

Background
Clinical treatment strategies are often based on measurement of left ventricular ejection fraction (LVEF). There is limited evidence about variations in LVEF when measured by different imaging modalities.

Purpose
To investigate the intermodality variability of LVEF measured by two-dimensional echocardiography (2DE), three-dimensional echocardiography (3DE), cardiac magnetic resonance (CMR), and single photon emission computed tomography (SPECT) in patients with chronic coronary artery disease (CAD).

Methods
Patients from a multicenter study (DOPPLER-CIP – Determining optimal noninvasive parameters for the prediction of left ventricular remodeling in chronic ischemic patients) with chronic CAD were included. LVEF was measured by CMR and at least one additional modality. In each modality, LVEF was measured by a core laboratory independently of the other modalities. Measurements of LVEF by CMR were compared to 2DE, 3DE and SPECT using correlation and Bland-Altman plots.

Results
A total of 343 patients were included. Mean age was 63.9±8.3 years and 253 (74%) were males. Mean LVEF by CMR was 61.8±11.6%. Correlations between CMR LVEF and other modalities were moderate for 2DE and 3DE, and good for SPECT (Figure A-C). CMR had significantly greater correlation to SPECT, compared to 2DE and 3DE. Bland-Altman plots indicated relatively wide limits of agreement between all modalities, ranging from 31% to 42% (Figure, D-F). Mean absolute difference of LVEF between CMR and other modalities were 8.5% for 2DE, 9.0% for 3DE, and 8.3% for SPECT. The percentage of measurements that fell within a range of 5% difference compared to CMR LVEF was 41% for 2DE, 34% for 3DE and 37% for SPECT (all p>0.05).

Conclusions
In a multicenter study with chronic CAD patients, LVEF assessed by CMR had better correlation to SPECT, compared to 2DE and 3DE. However, there was considerable variability among all three modalities that were compared to CMR. Awareness of these variations are important in clinical management.
P608Exercise testing and multi-parametric CMR assessment in patients with Ebstein anomaly
Authors: Radke R M , Bietenbeck M , Meier C , Orwat S , Baumgartner H , Yilmaz A 
Published: October 2019

Abstract

Background
Ebstein anomaly (EA) is a rare congenital heart disease characterized by an apically displaced tricuspid valve. It is associated with tricuspid valve regurgitation and right heart dilatation leading to significant morbidity. While echocardiography remains the mainstay of routine outpatient cardiac imaging, assessment of right ventricular (RV) anatomy and function is still challenging. Cardiovascular magnetic resonance imaging (CMR) has been shown to be of advantage in these patients being free from acoustic window limitations and offering superior volume quantification. In the present study, parameters obtained from cardiopulmonary exercise testing (CPET) were compared to conventional and novel CMR parameters in patients with EA.

Methods
In this prospective single centre study, N=17 patients with EA (mean age = 33.8±12.7yrs; N=10 females) underwent clinical assessment, CPET and multi-parametric CMR. Maximal work load (maxWL) and peak oxygen uptake (maxO2) were derived from CPET. CMR studies were performed on a 1.5-T Philips scanner and respective CMR parameters comprised a) anatomical, b) functional and c) myocardial deformation values of both ventricles.

Results
The majority of patients presented in NYHA class I or II (mean NYHA = 1.6±0.7) and with normal or mildly elevated NT-proBNP values (mean NT-proBNP = 189±158pg/ml). CPET-based maxWL was 147.14±55 watts and maxO2 19.32±5 ml/kg/min. CMR-based mean LVEF was 57.1±6.4% and RVEF was 46.5±11.1%, respectively. Deformation imaging revealed (amongst others) a LV global longitudinal strain (LV-gLS) of −13.7±3.0 and a RV global longitudinal strain (RV-gLS) of −14.7±5.0. Non-ischemic presence of late-gadolinium-enhancement was documented in 36% of our patients. Comprehensive correlation analysis revealed a substantial correlation a) between LV-gLS and NYHA class (r=0.64, p=0.01), but not between RV-gLS and NYHA class (r=0.19, p=0.46), b) between serum NT-proBNP levels and maxO2 (r=−0.53, p=0.03) as well as maxWL (r=−0.63, p=0.02), and c) between LV-EF and LV-gLS (r=−0.64, p=0.01).

Conclusion
Our preliminary data suggest that serum markers such as NT-proBNP and novel CMR parameters such as LV-gLS – but not RV-gLS - correlate with CPET-derived exercise parameters in patients with EA. The predictive value of these parameters regarding cardiac disease progression in EA has to be evaluated in future follow-up studies.
P614Comparison of echo parameters with cardiac MRI in the assessment of right ventricular function
Authors: Agasthi P , Venepally N R , Mookadam F , Jokerst C E , Marcotte F , Brown L , Semkiv O I , Wang P , Konduru S , Fath A R , Arsanjani R 
Published: October 2019

Abstract

Introduction
Systolic right ventricular (RV) function has prognostic significance both in acquired and congenital heart diseases. However accurate assessment of RV ejection fraction (EF) with transthoracic echocardiography (TTE) remains challenging due to the complex geometric shape of the RV. Magnetic resonance imaging (MRI) remains the gold standard modality for assessment of RV function; however the cost and availability limits the regular use of MRI in clinical practice. The RV strain measured by speckle tracking (RVS) is a novel method of assessing RV EF.

Purpose
The purpose of the study was to assess the accuracy of RVS compared RV fractional area change (FAC%), tricuspid annular peak systolic excursion (TAPSE) and Doppler tissue imaging-derived isovolumic acceleration and peak systolic velocity (S') at the lateral tricuspid annulus in the assessment of impaired RV EF.

Methods
We retrospectively identified patients who had a cardiac MRI between 2012- 2017 and only included patients with a TTE within 1 month of the MRI for our final analysis. Baseline characteristics, TTE and MRI parameters were extracted from chart review. RV strain was measured retrospectively using ECHOINSIGHT software. Four TTE parameters including RVS, TAPSE, S' and FAC% were tested for accuracy to identify impaired RV EF (defined as EF<45%) using receiver operator curves.

Results
The study cohort included 500 patients with mean age 55 yr ± 18 and right ventricular systolic pressure 33.7±13.6 mmHg. The proportion of female gender, diabetes, hypertension and obstructive sleep apnea were 38%, 15.6%, 43% & 19.8% respectively. The area under ROC for TAPSE, S', FAC% and RVS were 0.58 (95% confidence interval [CI] 0.51–0.65, p=0.03), 0.59 (95% CI 0.52–0.66, p=0.03), 0.67 (95% CI 0.61–0.73, p=0.03) and 0.70 (0.64–0.76, p=0.03) for assessing RV EF <45%.

Conclusion
Right ventricular strain most accurately detected impaired right ventricular ejection fraction as obtained by MRI.

Acknowledgement/Funding
None
P638High intensity interval exercise training improves endothelial function in patients with heart failure with preserved ejection fraction
Authors: Deljanin Ilic M , Kocic G , Simonovic D , Pavlovic R , Ilic S , Petrovic D , Ilic B 
Published: October 2019

Abstract

Background
Cardiac rehabilitation has traditionally invoved low-to moderate intensity continuous exercise training (MICT). There is growing evidence that high intensity interval exercise training (HIIT) shows similar or greater efficacy compared with MICT. However, the relationship between the training modality and its effects on endothelial function still remains to be elucidated.

Purpose
To evaluate the impact of high intensity interval exercise training versus low-to moderate intensity continuous exercise training on circulating blood markers of endothelial function: the stable end product of nitric oxide (NOx), S–nitrosothiols (RSNO–reservoir for bioavailable nitric oxide), dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in patients (pts) with heart failure with preserved ejection fraction (HFpEF).

Methods
A total of 43 pts with HFpEF (mean age 57.5±6.8y) admitted at residential rehabilitation center were enrolled in the study. Patients were randomized to HIIT, (HIIT group, n=20) and MICT, (MICTgroup, n=23). At baseline and 3 weeks later, in all pts values of NOx, RSNO, ADMA and SDMA were determined and exercise test was performed.

Results
After 3 weeks NOx increased significantly in both groups: in HIITgroup (from 34.7±7.5 to 48.5±8.3 μmol/l, P<0.0001), in MICTgroup (from 35.0±9.5 to 42.5±10.0 μmol/l, P<0.05), and value of NOx after 3 weeks was higher in HIIT than in MICT group (P<0.05). Value of ADMA as well of SDMA decreased in both groups after 3 weeks, and this decrease was significant in HIIT group: ADMA in HIIT group (from 0.305±0.055 to 0.250±0.077 μmol/l, P<0.005) and in MICT group (from 0.325±0.069 to 0.280±0.140 μmol/l, ns); SDMA in HIIT group (from 0.285±0.050 to 0.240±0.060 μmol/l, P<0,005) and in MICT group (from 0.270±0.080 to 0.247±0.063 μmol/l, ns). Value of RSNO significantly increased in both groups, with higher increase in HIIT group: in HIIT group (from 3.0±1.5 to 5.1±1.7 μmol/l, P<0.001), in MICTgroup (from 3.2±1.7 to 4.5±2.3 μmol/l, P<0.05). Compared to the baseline, at the end of the study, exercise capacity (METs) was significantly higher in both groups (P<0.0001). Higher increase in METs in HIIT group during exercise training (by 39.8%), compared to increase in MICT group (by 27.2%), resulted in significantly higher exercise tolerance in HIIT than in MICT group at the end of the study (P<0.02). In both groups, adverse events during or after exercise training, were not occurred.

Conclusions
In pts with HFpEF high intensity interval exercise training as well as low-to moderate intensity continuous exercise training induced favorable modification of endothelial function, expressed through increase of NOx and RSNO, and decrease of ADMA and SDMA. More significant increase of NOx and RSNO, and significant decrease of ADMA and SDMA gives an advantage to HIIT over MICT exercise training in patients with HFpEF.
P651Prevalence of hypertriglyceridemia in statin treated high risk patients who might benefit from treatment with icosapent ethyl for secondary prevention in clinical practice - Results of DYSIS
Authors: Gitt A K , Horack M , Lautsch D , Ferrieres J 
Published: October 2019

Abstract

Background
Patients with elevated triglyceride (TG) levels are at increased risk for ischemic events. In the recently published REDUCE-IT-Study among patients with elevated triglyceride levels who were receiving statin therapy, the risk of major ischemic events, including cardiovascular death, was significantly lower with 2 g of icosapent ethyl twice daily than with placebo. Little is known about how many patients in clinical practice might benefit from this additional treatment.

Methods
The cross sectional, observational Dyslipidemia International Study (DYSIS) examined lipid goal attainment among statin-treated very high cardiovascular risk patients (defined as per 2011 EAS/ESC guidelines, including patients suffering from coronary heart disease, diabetes, chronic kidney disease or peripheral atherosclerotic disease) in Canada, Europe, Middle East countries and China. Data were collected under real life conditions in physicians' offices and hospital outpatient wards between 2008–2012. We examined the prevalence of mixed dyslipidemia with TG >135 mg/dl in high statin treated high risk patients in clinical practice.

Results
Of a total of 44,593 patients on very high cardiovascular risk, all on chronic statin treatment, 21,312 (47.8%) had mixed dyslipidemia with TG values >135mg/dl. Patients with elevated TG also had higher levels of total and LDL-cholesterol. The overall use of additional fibrates on top of statins was low (4.0%), but more frequent in patients with TG >135 mg/dl.
CVD patients with TG>135 mg/dl Pts with TG >135 mg/dl Pts with TG ≤135 mg/dl p-value OR (95% CI) n=21,312 (47.8%) n=23,281 (52.2%) Age (years) 65.4±10.1, 68.1±10.2 <0.0001 Females 42.2% 38.6% <0.0001 1.16 (1.12–1.21) Sedentary lifestyle 43.0% 37.6% <0.0001 1.25 (1.20–1.30) Risk factors/CV-disease   Hypertension 79.0% 74.9% <0.0001 1.26 (1.21–1.32)   Diabetes mellitus 56.3% 45.3% <0.0001 1.55 (1.50–1.61)   Ischemic heart disease 50.6% 54.4% <0.0001 0.86 (0.83–0.89)   Cerebrovascular disease 16.1% 17.7% <0.0001 0.90 (0.85–0.94)   Peripheral artery disease 8.1% 6.9% <0.0001 1.18 (1.10–1.27) Lipid lowering therapy   Rosuvastatin 11.3% 11.8% 0.13 0.95 (0.90–1.01)   Atorvastatin 38.2% 40.9% <0.0001 0.89 (0.86–0.93)   Simvastatin 41.9% 38.9% <0.0001 1.13 (1.09–1.18)   Other statins 8.6% 8.4% 0.12 0.96 (0.88–1.05)   Fibrates 5.5% 1.5% <0.0001 3.86 (3.40–4.37) Lipid Profile   Total Cholesterol (mg/dl) 185.6 159.0 <0.0001   LDL-Cholesterol (mg/dl) 102.1 88.9 <0.0001   Triglyderides (mg/dl) 189.5 95.7 <0.0001

Conclusion
Almost half of consecutive patients with cardiovascular disease treated with statins for secondary prevention in clinical practice suffer from TG levels >135 mg/dl and might benefit from additional treatment with icosapent ethyl with further reduction in subsequent major ischemic events, including cardiovascular death.

Acknowledgement/Funding
MSD
P667Aspirin in primary prevention. Risks and benefits. Up date 2019. A meta-analysis
Authors: Lobo L M , Masson G , Molinero G , Masson W , Giorgi M A , Siniawski D 
Published: October 2019

Abstract

The usefulness of aspirin in patients without a cardiovascular history continues to be a subject of controversy.

Objectives
1. Perform an updated meta-analysis on the use of aspirin in primary cardiovascular prevention. 2. Analyze the results by risk.

Methods
This meta-analysis was performed according to the PRISMA guidelines. The primary endpoint was cardiovascular death, AMI, and ischemic stroke. The measures of effect size are expressed as odds ratios. The level of statistical significance was established at 0.05.
Characteristics of the studies Trials Year N Follow-up Risk RTPDABMD 1988 5,139 5.5 Middle PHS 1989 22,071 5 Low HOT 1998 18,790 3.8 Middle TPT 1998 5,085 6.7 Middle PPP 2001 44,95 3.6 Low WHS 2005 39,876 10.1 Low JPAD 2008 2,539 4.4 Low POPADAD 2008 1276 6.7 High AAA 2010 3,350 8.2 Low JPPP 2014 14,464 5 Low ASCEND 2018 15,480 7.4 Middle ARRIVE 2018 12,546 5 Low ASPREE 2018 19,114 4.7 Low RTPDABMD, Randomised trial of prophylactic daily aspirin in British male doctors; PHS, Physicians' Health Study; HOT, Hypertension Optimal Treatment; TPT, Thrombosis Prevention Trial; PPP, Primary Prevention Project; WHS, Women's Health Study; JPAD, Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes; POPADAD, Prevention of Progression of Arterial Disease and Diabetes; AAA, Aspirin for Asymptomatic Atherosclerosis; JPPP, Japanese Primary Prevention Project; ASCEND, A Study of Cardiovascular Events in Diabetes; ARRIVE, Aspirin to Reduce Risk of Initial Vascular Events; ASPREE, Aspirin in Reducing Events in the Elderly.
Figure 1

Results
Thirteen works were considered for the analysis (Table 1). A total of 164,225 patients were included, 82,900 in the aspirin arm and 81,325 in the control group. A reduction of the primary endpoint was observed in the AAS group (OR 0.90, 95% CI 0.85–0.94). No differences by risk group (Figure 1). Risk of severe bleeding was significantly higher in patients treated with ASA (OR 1.45, 95% CI 1.34–1.56), this difference was maintained by risk (Figure 1).

Acknowledgement/Funding
None
P671Impacts of echocardiography-defined pulmonary hypertension on clinical outcome in patients with multiple myeloma
Authors: Bae S A , Yoon H J , Kim K H , Kim H Y , Park H J , Cho J Y , Jeong M H , Park J C 
Published: October 2019

Abstract

Background
Pulmonary hypertension (PH) is a rarely reported complication of multiple myeloma (MM). PH of MM is usually mild to moderate and can be secondary to a variety of conditions, including left ventricular dysfunction, diastolic dysfunction, chronic heart failure, treatment-related toxicity, thrombophilic condition and precapillary involvement. However, only few reports regarding PH in MM incidence and prognosis exist up to now.

Purpose
The purpose of this study was to investigate the risk factors of transthoracic echocardiography-defined PH and its impact on clinical outcome in patients with MM.

Methods
A total of 277 MM patients was included and divided into 2 groups–those non-pulmonary hypertension (PH) or those with PH, based on the results of the transthoracic echocardiography (TTE); PH group (n=143, 60.9±9.2 years, 68 males) versus non-PH group (n=134, 55.9±11.5 years, 72 males). We analyzed propensity score matching and multiple imputation method were used to deal with the missing data in echocardiographic characteristics.

Results
During the follow-up period (median 618 days), all-cause death occurred in 79 (28.5%) patients and 41 patients (14.8%) died from cardiovascular causes (including acute decompensated heart failure, fatal MI, sudden cardiac arrest). In the Kaplan-Meier survival analysis of crude population and propensity-matched population, cumulative overall survival and cardiovascular death (CVD)-free survival were significantly lower in the PH group than in the non-PH group (p<0.001). In propensity-matched population, estimated pulmonary artery pressure >35mmHg in TTE, congestive heart failure, and DM were significant independent predictors of all-cause death.
KM curves in MM stratified by PH

Conclusion
This study demonstrates that the presence of PH, congestive heart failure, and DM is an independent prognostic factor for all-cause death in MM patients with MM. These results highlight the risk associated cardiovascular disease in MM patients and emphasize that management strategies that prevent deterioration of cardiac function are essential.
P676Percutaneous coronary intervention and clinical outcomes in patients with lymphoma: a 10-year period United States nationwide inpatient sample (NIS) analysis
Authors: Borovac J A , Kwok C S , Konopleva M , Kim P Y , Palaskas N L , Zaman A , Butler R , Lopez-Mattei J C , Mamas M A 
Published: October 2019

Abstract

Background
Clinical outcomes and characteristics of patients with lymphoma undergoing percutaneous coronary intervention (PCI) are unknown.

Purpose
To describe clinical characteristics and procedural outcomes in patients that underwent PCI and had a concurrent diagnosis of Hodgkin (HL) or non-Hodgkin (NHL) lymphoma and compare risks of complications and in-hospital mortality in lymphoma subtypes to patients without lymphoma.

Methods
A total of 6,413,175 PCI procedures undertaken in the United States between 2004 and 2014 in the Nationwide Inpatient Sample were included in the analysis. Multivariable regression analysis was performed in order to examine the association between lymphoma diagnosis and clinical outcomes post-PCI including complications and in-hospital mortality.

Results
Patients with lymphoma generally had a significantly higher incidence of post-PCI complications and in-hospital mortality compared to patients without lymphoma (Figure 1). Patients with lymphoma were more likely to experience in-hospital mortality (OR 1.34, 95% CI 1.20–1.49), stroke or transient ischemic attack (TIA) (OR 1.59, 95% CI 1.47–1.73), and any in-hospital complication (OR 1.19, 95% CI 1.14–1.25), following PCI. In the lymphoma subtype-analysis, diagnosis of HL was associated with an increased likelihood of in-hospital death (OR 1.31, 95% CI 1.17–1.48), any in-hospital complication (OR 1.20, 95% CI 1.14–1,26), bleeding complications (OR 1.12 95% CI 1.05–1.19) and vascular complications (OR 1.10 95% CI 1.03–1.17) while these risks were not significantly associated with NHL diagnosis. Finally, both types of lymphoma were associated with an increased likelihood of stroke/TIA following PCI, with this effect being twice greater for HL than NHL diagnosis (OR 1.66, 95% CI 1.52–1.81 and OR 1.33, 95% CI 1.06–1.66, respectively) (Table 1).
Table 1. ORs for clinical outcomes Variable HL vs. No Lymphoma NHL vs. No Lymphoma Bleeding complications 1.12 (1.05–1.19) 1.07 (0.89–1.27) Vascular complications 1.10 (1.03–1.17) 1.13 (0.92–1.27) Cardiac complications 0.94 (0.85–1.03) 0.86 (0.68–1.11) Post-procedural stroke/TIA 1.66 (1.52–1.81) 1.33 (1.06–1.66) Any complication 1.20 (1.14–1.26) 1.04 (0.91–1.18) In-hospital mortality 1.31 (1.17–1.48) 0.89 (0.65–1.21) HL, Hodgkin's Lymphoma; NHL, non-Hodgkin's Lymphoma; TIA, Transient Ischemic Attack.
Figure 1. Type of lymphoma and outcomes

Conclusions
While the incidence of lymphoma in the observed PCI cohort was low, a diagnosis of lymphoma was associated with an adverse prognosis following PCI, primarily in patients with a diagnosis of HL.
P683Cardiovascular adverse events associated with BRAF and MEK inhibitors
Authors: Mincu R I , Mahabadi A A , Michel L , Mrotzek S M , Schadendorf D , Rassaf T , Totzeck M 
Published: October 2019

Abstract

Background
Cardiovascular adverse events (CVAE) following treatment with B-Raf proto-oncogene serine/threonine kinase inhibitors and mitogen-activated protein kinase (BRAF/MEK) inhibitors in patients with melanoma remain incompletely characterized. We conducted the first detailed meta-analysis focused on BRAF/MEK inhibitor-associated CVAE.

Purpose
To determine the type and risk of BRAF/MEK inhibitor-associated CVAE.

Methods
We systematically searched Pubmed, Cochrane, and Web of Science for keywords “vemurafenib”, “dabrafenib”, “encorafenib”, “trametinib”, “binimetinib”, “cobinimetinib” through November 30, 2018. We selected randomized controlled trails (RCT) reporting on CVAE in melanoma patients under BRAF/MEK inhibitors. The selected endpoints were: decrease in left ventricular ejection fraction (LVEF), pulmonary embolism, atrial fibrillation, arterial hypertension, myocardial infarction, heart failure, pericarditis, and QTc interval prolongation. All-grade and high-grade (grade 3 or higher) CVAE were recorded.

Results
9 RCTs including 4,616 patients with melanoma were selected. The treatment with BRAF/MEK inhibitors was associated with an increased risk in a decrease in LVEF, pulmonary embolism, atrial fibrillation, and arterial hypertension. The relative risks (RR) of myocardial infarction, heart failure, pericarditis, and QTc prolongation were similar between the BRAF/MEK inhibitors group and control group (Figure). These results were consistent for high-grade CVAE. The subgroup analysis showed that the combination therapy with BRAF/MEK inhibitors resulted in a higher risk of a decrease in LVEF, pulmonary embolism, and arterial hypertension, while the risk for atrial fibrillation was increased in BRAF inhibitors monotherapy group compared to controls. There was no significant difference between melanoma patients with mean age below and above 55 years old, except for the increased risk of atrial fibrillation in the older population group. The endpoints were similar between studies with mean follow-up times under and over 24 months.
RR of cardiovascular adverse events

Conclusions
The therapy with BRAF and MEK inhibitors is associated with a higher risk of CVAE. This study increases the awareness on CVAE under these therapies and help to balance between beneficial melanoma treatment options and increased cardiovascular morbidity and mortality.