bluuebunny/crossref_metadata_2025_split huggingface dataset:
6116Thromboembolic risk in infection-related atrial fibrillation: is infection or atrial fibrillation the sinner?
Authors: Gundlund A , Olesen J B , Butt J H , Christensen M A , Gislason G H , Torp-Pedersen C , Koeber L , Kumler T , Fosboel E L 
Published: October 2019

Abstract

Introduction
Infection-related atrial fibrillation (AF) has been associated with similar risk of thromboembolic events as AF without a concurrent infection. However, it is unknown whether the increased thromboembolic risk in this patient group is primarily associated with AF or with the infection.

Purpose
We compared type of infection and 1-year outcomes in patients with AF during an infection and in patients with infection without AF.

Methods
By crosslinking data from Danish nationwide registries, AF naïve patients admitted with an infection from 1996–2016 were identified. Patients with infection-related AF (defined as patients who developed AF during their hospital admission with infection) were matched 1:3 on age, calendar year, sex, and type of infection (gastrointestinal infection, pneumonia, urinary tract infection, sepsis, and other infections) with those who had infection without AF. Cumulative incidences of thromboembolic events were calculated using the Aalen Johansen estimator and adjusted hazard ratios (HR) of thromboembolic events and hospital contacts with AF were assessed by multivariable Cox regression analysis comparing those with infection-related AF with those with infection without AF.

Results
The study population comprised 30,711 patients with infection-related AF and 92,133 patients with infection without AF (median age 79 years [interquartile range 71–86] and 47.6% males in both groups). In general, patients with infection-related AF had more concurrent diseases than patients with infection without AF. During the first week after the hospital admission, 9.8% of the patients with infection-related AF and 0.1% of the patients with infection without AF initiated oral anticoagulation therapy.
During the first year after the infection, 7.6% of patients with infection-related AF and 4.4% of patients with infection without AF had a thromboembolic event, while 36.1% and 1.8% had a new hospital-contact with AF. Cumulative incidences of thromboembolic events are depicted in the Figure. In the multivariable models, infection-related AF was associated with an increased 1-year risk of thromboembolic events and new hospital contacts with AF compared with infection without AF (HR 2.05, 95% confidence interval (CI) 1.94–2.17 for thromboembolic events and HR 26.06, 95% CI 24.72–27.48 for new AF episodes, respectively).

Conclusion
More than one third of patients with infection-related AF had a new hospital contact with AF during the first year after their infection. Further, infection-related AF was associated with a significantly increased 1-year risk of thromboembolic events compared with infection without AF. Consequently, this study suggests that AF begets AF, even if it presents during an infection.

Acknowledgement/Funding
None
6124Aorta and sports. the silent threat
Authors: Diaz Babio G , Vera Janavel G , Carrero C , Garcia Botta T , Masson Juarez G , Mezzadra M , Constantin I , Viguie S , Stutzbach P 
Published: October 2019

Abstract

Background
Thoracic aorta is the less known component of the athlete's heart and current publications shown that may be larger in athletes. It is known that high static training and body collision sports could increase the risk of sudden death, especially in patients with aortic disease (AD). Large scale traditional screening detects underlying cardiovascular diseases which may cause sudden cardiac death (SCD), however AD might be subdiagnosed.
OBJECTIVE
To describe AD burden on preparticipation screening and to assess diagnostic precision of traditional screening for AD detection in trained athletes.

Methods
Different sports athletes were recruited to follow current European guidelines (clinical history and cardiac examination, including resting 12-lead ECG) for preparticipation screening program (PSP). Bidimensional transthoracic echocardiography (TTE) was performed in all patients to detect AD: bicuspid aortic valve (BAV), thoracic aorta dilatation by Z score (TAD) and BAV plus TAD (BAD). Athletes were excluded from competition following international criteria. Sensitivity (Sn) and specificity (Sp) were calculated with 95% Clopper-Pearson confidence intervals and results are expressed as percentajes. McNemar paired chi-square test for one sample of individuals was used to compare diagnostic precision (Sn, Sp) of PSP vs gold standard: complete assessment (for sport exclusion, SpE) or TTE (for AD or BAD detection). Significance was set at p<0.05

Results
Included population (n=1123) was 22.3±6.2 y-o and 222 (19.8%) female. Five athletes (0.44% of total) were excluded from competition due to different causes. AD was found on 11 athletes (0.98%) and 4 of them had BAD (0.36%), a high risk condition with poor prognosis. Three patients with BAD were competitive cyclists and close follow up was indicated. The remaining patient with BAD was a rugby player and was excluded from competition (one out of 5 excluded patients, 20%). Diagnostic precision of PSP was better for SpE than for AD or BAD diagnosis. PSP tended to have less Sn for AD [36.4 (10.9–69.2)] and BAD [25 (0.6–80.6)] detection, than for SpE [80 (28.4–99.5); p=NS]. PSP had significant less Sp for AD [91.1 (89.3–92.7)] and BAD [90.9 (89–92.5)] diagnosis, than for SpE [97.2 (96.1–98.1); p<0.05].

Conclusions
AD is subdiagnosed by current PSP and its burden may be overlooked. Despite BAD is less frequent, its finding is determinant in a significant proportion of cases to decide exclusion from competitive (high static or body collision) sports. Although PSP has good sensitivity to detect potential pathologies of SCD, AD cannot be ruled out only by normal ECG and clinical examination. Diagnostic precision of PSP for AD and BAD detection could be enhanced by TTE screening, new studies with a larger number of athletes may answer the question.
P4986Quadruple imaging exercise stress echocardiography in unexplained dyspnoea
Authors: Zagatina A , Ciampi Q , Zhuravskaya N , Carpeggiani C , Picano E 
Published: October 2019

Abstract

Background
Current guidelines recommend the use of exercise stress echocardiography (ESE) in patients with unexplained dyspnoea. The methodological standard of ESE was recently reshaped with the quadruple imaging protocol, mainly tested in patients with chest pain. Aim of this study was to define the ESE pattern of response in patients with dyspnoea as the main symptom

Methods
From the initial population on a 1-year cohort of 604 patients referred in a single center for clinically-driven semi-supine ESE, we selected a subset of 93 consecutive patients (age 63±9 years, 52 females, resting Ejection fraction = 64±7%) with exertional dyspnea (shortness of breath, exertional fatigue or poor exercise capacity). All underwent quadruple imaging ESE: 1- Regional wall motion abnormalities (RWMA, step A) assessment (with wall motion score index, WMSI); 2- B-lines (step B) with simplified 4-site scan, each space scored from 0 = black, to 10= white (positivity criterion: stress score > rest for at least 2 points); 3- Left ventricle contractile reserve (LVCR, step C) assessment with stress/rest ratio of LV force measured as systolic blood pressure/end-systolic volume (positivity criterion:<2.0); 4- Pulsed-wave Doppler coronary flow velocity reserve (CFVR, step D) assessment in mid-distal LAD (positivity criterion: stress/rest diastolic peak flow velocity <2.0). Readers were accredited for each parameter upstream to recruitment via a web-based system.

Results
Feasibility was 100% for steps A, B and C, and 82% for step D. RWMA were present in 56 patients (60%). Of them, 27 underwent coronary angiography verification, showing significant coronary artery disease in 81%. B-lines positivity occurred in 35 patients (38%), an abnormal LVCR in 63 patients (68%), and a reduced CFVR in 44 pts (55%). At least one positivity criterion was observed in 80 patients (86%).

Conclusions
Patients with unexplained dyspnea are a reason of referral to ESE, accounting for 15% of contemporary testing. Quadruple imaging is useful to document the origin of dyspnoea as an ischemic equivalent (A positivity) and/or its cardiogenic origin for acute backward failure with pulmonary congestion (B positivity), myocardial function abnormalities (C positivity), and reduction of CFVR of microvascular-epicardial-myocardial origin (D positivity). Dyspnoea of unexplained origin is a multifactorial problem, and a more comprehensive assessment of these patients during ESE expands the clinical potential of the method.
P4993Tissue sodium concentration emerged as a determinant of hypertrophic vascular remodeling in type 2 diabetes
Authors: Schmieder R , Jung S , Kannenkeril D , Harazny J M , Striepe K , Ott C , Linz P , Nagel A M , Uder M 
Published: October 2019

Abstract

Background
Studies describe a linkage between greater sodium intake and higher incidence of organ damage and cardiovascular end points. Sodium intake is usually assessed by measuring 24-hour urinary sodium excretion, which is prone to high fluctuation. For the assessment of tissue sodium a new technique (23Na-MRI) has been developed. We analyzed whether tissue sodium is linked to vascular remodeling of small resistance vessels in patients with type-2 diabetes.

Methods
In patients with type 2 diabetes we assessed tissue sodium content and vascular structural parameters of the retinal arterioles, since structural changes of resistance vessels (150–300 μm) can be non-invasively and reliably assessed in the retinal circulation by Scanning Laser Doppler Flowmetry (SLDF). Patients with antidiabetic medication were off the therapy (antihypertensives were kept constant) for 4 weeks. The structural parameters of retinal arterioles assessed were outer- and inner diameter (OD & ID), wall thickness (WT), wall-to-lumen ratio (WLR) and wall cross sectional area (WCSA). Tissue sodium content was assessed non-invasively with a 3.0 T clinical MRI system in each patient. Subject placed their lower legs in the center of a 23Na knee coil and sodium content in skin and muscle (musculus triceps surae) were measured.

Results
In patients with type 2 diabetes (N=52) we observed a significant correlation between tissue sodium content (muscle and skin) and OD, WT and WCSA and a trend has been noticed between muscle sodium content and ID and WLR. Multiple linear regression analysis demonstrated that tissue sodium content is a significant determinant of hypertrophic vascular remodeling as indicated by increased WT and WCSA, independent of age, gender and 24-hour ambulatory diastolic blood pressure.
Correlation coefficients Muscle sodium content (mmol/l) Skin sodium content (mmol/l) OD (μmol) r=0.402, p=0.003 r=0.299, p=0.033 ID (μmol) r=0.265, p=0.058 r=0.202, p=0.154 WT (μm) r=0.402, p=0.003 r=0.313, p=0.026 WLR r=0.247, p=0.078 r=0.171, p=0.230 WCSA (μm2) r=0.417, p=0.002 r=0.322, p=0.021

Conclusion
With the novel 23Na-MRI technology, we could demonstrate that high tissue sodium concentration is linked to with hypertrophic vascular remodeling of retinal arterioles. Thus, the reduction of tissue sodium content may emerge as a therapeutic target.
P5002The impact of diabetes mellitus on global longitudinal strain of patients with acute heart failure
Authors: Kwak S , Hwang I.-C , Park J.-J , Park J.-H , Cho G.-Y , Park J.-B 
Published: October 2019

Abstract

Introduction
Diabetes mellitus (DM) aggravates the clinical features and the prognosis of heart failure (HF) patients. However, the impact of DM on the ventricular systolic function of HF patients is not well delineated.

Purpose
The present study aimed to investigate the impact of DM on HF, regarding the systolic function presented by the global longitudinal strain (GLS).

Methods
In 4312 patients with acute HF, left ventricle (LV) and right ventricle (RV) GLS were acquired by speckle-tracking echocardiography. HF patients with DM were compared to those without DM from the entire cohort (n=4312), as well as the propensity-score matched cohort (n=3034).

Results
Our cohort consisted of 1750 DM patients (40.6%). Both LV-GLS and LVEF were significantly lower within the patients with DM (10.1±4.8% vs. 11.3±5.1%, p<0.001 for LV-GLS; 39.1±15.5% vs. 41.7±15.6%, p<0.001 for LVEF) in the entire cohort. In the propensity-score matched cohort, LV-GLS was significantly reduced in the patients with DM compared to those without DM (10.2±4.9% vs. 10.9±5.0%, p<0.001), even with the matched LVEF (Table 1). Decreased LV-GLS in the DM patients was consistently identified in both subgroups of preserved EF and reduced EF (Table 1). Although RV-GLS was slightly lower in the patients with DM from the matched cohort, it was not significant in neither the preserved EF nor the reduced EF subgroup. When comparing the adverse outcome in the propensity-score matched cohort, the survival of patients with DM was significantly lower (Figure 1-A, 1-B), except for the preserved EF group (Figure 1-C).
Comparison between heart failure patients with and without diabetes in the matched cohort Matched cohort p-value HFrEF (matched) p-value HFpEF (matched) p-value No-DM (n=1517) DM (n=1517) No-DM (n=823) DM (n=801) No-DM (n=652) DM (n=669) Age, years 71±14 71±11 0.962 69±14 70±11 0.305 75±11 74±10 0.061 Ischemic heart disease, n (%) 545 (35) 575 (37) 0.275 375 (36) 402 (39) 0.238 150 (34) 147 (34) 0.945 GFR, mL/min/1.73m2 56±27 55±27 0.282 58±28 56±27 0.253 54±27 54±26 1.000 HbA1C, % 5.7±0.4 7.3±1.4 <0.001 5.7±0.4 7.3±1.4 <0.001 5.7±0.4 7.2±1.4 <0.001 LV ejection fraction, % 39±15 39±15 0.871 31±9 31±10 0.99 59±5 59±6 0.279 LV-GLS, % 10.9±5.0 10.2±4.9 <0.001 9.1±3.8 8.3±3.6 <0.001 15.5±4.5 14.9±4.5 0.036 RV-GLS, % 13.1±6.5 12.7±6.2 0.045 12.1±6.2 11.8±5.9 0.188 15.6±6.5 15.0±6.4 0.157
Figure 1. Outcome by DM status

Conclusions
DM is associated with the impaired LV systolic function presented by GLS in HF patients, even with the adjustment of LVEF. The result indicates that GLS is a more sensitive marker of systolic function than LVEF, in terms of the DM status among the HF patients.
P5007Acute natriuretic activity of sodium-glucose cotransporter 2 inhibitor in heart failure patients with type 2 diabetes mellitus
Authors: Fukuoka S , Dohi K , Ishiyama M , Takeuchi T , Fujimoto N , Ito M 
Published: October 2019

Abstract

Background
Sodium-glucose cotransporter 2 (SGLT2) inhibitor promotes diuresis and reduces the risk of hospitalization for heart failure (HF). However, the mechanisms of diuretic effects of SGLT2 inhibitor in HF patients with type 2 diabetes mellitus (T2DM) remain under investigation.

Purpose
The purpose of this study was to investigate the mechanisms of acute diuretic effects of SGLT2 inhibitor and to identify its predictor in HF patients with T2DM.

Methods
We prospectively enrolled 40 hospitalized HF patients with T2DM (68±13 years, 63% male, and hemoglobin A1c 7.1±0.9%) between July 2014 and June 2018. All patients received ipragliflozin at a dose of 50 mg once daily after breakfast. They underwent 24-hour urine test and first-morning blood and urine tests before and after ipragliflozin therapy.

Results
Urine volume significantly increased from 1,365±511 ml/day on day 0 to 1,698±595 ml/day on day 3 (p<0.001). Multivariate linear regression analyses showed that the increase of 24-hour urine sodium but not urine sugarwas significantlyand independently associated with the increase of 24-hour urine volume (β-Coefficient=0.80; P<0.001). Univariate and multivariate logistic regression analyses showed that higher dosage of furosemide-equivalent loop diuretics and lower level of first-morning urine sodium concentration (per 1 mEq/L) at baseline were significantly associated with the diuretic effect of ipragliflozin therapy, and the latter independently predicted increase of 24-hour urine volume (Table).
Predictors for increase of urine volume Univariate Multivariate Odds ratio (95% CI) P value Odds ratio (95% CI) P value Dosage of furosemide, mg 1.09 (1.01–1.18) 0.04 – – HbA1c, % 1.45 (0.56–3.78) 0.44 Fasting blood glucose, mg/dL 1.02 (0.99–1.04) 0.24 eGFR, mL/min/1.73m2 1.01 (0.97–1.05) 0.65 Plasma BNP, pg/mL 1.00 (0.99–1.01) 0.12 Left ventricular ejection fraction, % 0.98 (0.94–1.02) 0.24 First-morning urine sugar, mg/dL 1.20 (0.96–1.50) 0.12 First-morning urine sodium, mEq/L 0.96 (0.93–0.99) 0.02 0.96 (0.93–0.99) 0.02 24-hour urine sugar, g/day 3.49 (0.13–93.40) 0.46 24-hour urine sodium, mEq/day 0.98 (0.96–1.01) 0.20 eGFR, estimated glomerular filtration rate; BNP, brain natriuretic peptide.

Conclusion
SGLT2 inhibitor has acute natriuretic activity and may restore loop-diuretic resistance in HF patients with T2DM.

Acknowledgement/Funding
None
P5021Hypoperfusion markers identify patients with acute pulmonary embolism at highest risk for an adverse outcome
Authors: Ebner M , Sentler C , Harjola V P , Bueno H , Keller K , Lerchbaumer M , Hobohm L , Hasenfuss G , Eckardt K U , Konstantinides S , Lankeit M 
Published: October 2019

Abstract

Background/Introduction
According to the European Society of Cardiology (ESC) 2014 guideline, systemic hypotension (HT) is the critical variable defining high-risk in patients with pulmonary embolism (PE). However, signs of organ hypoperfusion might more adequately identify PE patients with cardiogenic shock due to right ventricular (RV) failure.

Purpose
We investigated whether hypoperfusion markers provide superior prognostic information for identifying PE patients at highest risk of early adverse outcomes.

Methods
Consecutive PE patients enrolled in a prospective single-centre registry between 09/2008 and 03/2018 were included. We analysed the predictive value of symptoms and findings suggesting hypoperfusion for in-hospital adverse outcome (catecholamine treatment, resuscitation or PE-related death) and in-hospital all-cause mortality.

Results
We analysed 814 patients, including 83 (10.2%) ESC 2014 high-risk patients. Patients presenting with cardiac arrest (CA, 4.5%) were a priori defined as high risk. Markers suggesting hypoperfusion of the brain (altered metal status, odds ratio [OR] 8.2 [95% CI, 4.2–16.0]), lung (respiratory insufficiency, 25.0 [9.4–66.7]) and tissue (venous lactate ≥2.2 mmol/l, 6.4 [3.2–12.9]) as well as HT (13.5 [6.7–27.2]) predicted an adverse outcome. The risk for an adverse outcome increased with the number of positive markers (AUC 0.86 [0.80–0.93]). Patients with ≥3 positive hypoperfusion markers had an OR of 42.9 (11.0–167.3) and patients defined as high-risk by the ESC 2014 an OR of 17.2 (8.8–33.3) with regard to an adverse outcome (Figure 1; Table 1).
A new definition of high-risk (CA or ≥3 hypoperfusion markers) was associated with an OR of 73.2 (31.3–171.1) for an in-hospital adverse outcome and 26.2 (12.1–56.7) for in-hospital mortality.
Table 1. Prognostic performance of hypoperfusion markers Adverse outcome (if negative) Adverse outcome (if positive) Sensitivity Specificity LR+ OR (95% CI) ≥1 hypoperfusion marker 1.1% 21.0% 91.9% 68.2% 2.9 24.4 (7.3–80.8) ≥2 hypoperfusion markers 4.7% 50.0% 48.6% 95.5% 10.9 20.3 (9.1–45.1) ≥3 hypoperfusion markers 6.5% 75.0% 24.3% 99.3% 32.7 42.9 (11.0–167.3) ESC 2014 high-risk 5.7% 51.1% 35.0% 96.9% 11.4 17.2 (8.8–33.3) Cardiac arrest 8.4% 86.5% 33.0% 99.3% 47.3 70.1 (26.4–186.1) Abbreviations: LR+, positive likelihood ratio; OR, odds ratio; CI, confidence interval.
Figure 1. Frequency of adverse outcome

Conclusions
Markers of organ hypoperfusion have high predictive value for early adverse outcomes in acute PE. Risk increases with the number of positive markers and is critically elevated in patients presenting with CA or ≥3 markers.

Acknowledgement/Funding
This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).
P5029Inducibility of ventricular tachyarrhythmias by up to two extrastimuli does not predict future cardiac events in asymptomatic Brugada patients: results from long-term follow-up
Authors: Takagi M , Kamakura T , Shinohara T , Sekiguchi Y , Yokoyama Y , Aihara N , Hiraoka M , Aonuma K 
Published: October 2019

Abstract

Background
Most recent consensus conference report recommends Implantable Cardioverter Defibrillator (ICD) implantation for asymptomatic Brugada patients with spontaneous or fever-induced type-1 ECG (A-BrS) and inducible ventricular tachyarrhythmias (VTs) by up to two extrastimuli as class IIb indication. However, the validity of the inducible VTs by up to two extrastimuli in A-BrS is still unknown.

Purpose
To evaluate the validity of the inducibility by up to two extrastimuli in A-BrS in a large Japanese cohort of BrS (The Japan Idiopathic Ventricular Fibrillation Study [J-IVFS]).

Methods
A total of 193 consecutive A-BrS patients performed programmed electrical stimulation (PES) with non-aggressive uniform protocol (mean age 50±13 years, 180 males) were enrolled. PES protocol was using 2 basic pacing cycles and the order of introduction of up to 2 ventricular extra-stimuli from right ventricular apex [RVA] first, then right ventricular outflow tract [RVOT], 3 ventricular extra-stimuli from RVA then RVOT down to the minimum of 200ms. Clinical outcomes during the follow-up period were compared between A-BrS patients with and without inducible VTs by up to two extrastimuli.

Results
Thirty-five A-BrS (18%) had inducible VTs by up to two extrastimuli. During a mean follow-up period of 101±48 months, 7 A-BrS experienced cardiac events (sudden cardiac death [SCD] or VTs, 0.4%/yr). None of the 7 A-BrS had inducible VTs by up to two extrastimuli. The incidences of cardiac events tended to be higher in A-BrS without inducible VTs by up to two extrastimuli than in those with inducible VTs (p=0.10), as determined by the Kaplan-Meier method. In the A-BrS, the annual incidences of cardiac events in A-BrS with family history of SCD, inferolateral J wave, wide QRS duration >90msec in lead V2, or inducible VT/VF by 3 extrastimuli were 0.7, 0.7, 0.6, and 0.3%/yr, respectively.

Conclusions
Our large-scaled multicentre study with long-term follow-up revealed the inducibility of ventricular tachyarrhythmias by up to two extrastimuli does not predict future cardiac events in A-BrS, even using non-aggressive uniform protocol. Rather, other parameters such as family history of SCD or inferolateral J wave might be helpful for risk assessment in A-BrS.