bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1508The Coronary Arteriogenesis with combined Heparin and Exercise therapy in chronic refractory Angina (CARHEXA) trial: a double-blind randomized placebo-controlled stress echocardiographic study
Authors: Petrovic M T , Djordjevic-Dikic A , Stepanovic J , Giga V , Boskovic N , Vukcevic V , Cvetic V , Mladenovic A , Radmili O , Markovic Z , Kalimanovska-Ostric D , Aleksadric S , Ostojic M C , Beleslin B , Picano E 
Published: October 2019

Abstract

Background
Coronary collateral circulation exerts protective effects on myocardial ischemia due to coronary artery disease (CAD) and can be promoted by exercise (E) with heparin (H) co-administration. Whether this arteriogenetic effects is accompanied by functional improvement of left ventricle (LV) during stress remains unknown.

Purpose
To establish the stress-induced functional effects on LV regional and global function of 2-week cycle of H+E in patients with “no-option” CAD.

Methods
In a prospective, single-center, double-blind, randomized, parallel-group study we recruited 32 “no-option” patients (27 males; mean age of 61±8 years), with stable angina and CTO, refractory to OMT, not suitable for revascularization and with E-induced ischemia. All underwent 2-week cycle of E (2 E test per day, 5 days a week) and were pre-treated with i.v. 0.9% saline or unfractionated H (100 IU/kg up to maximum of 5.000IU, 10 min prior to E). Canadian Class Score (CCS) and 12-lead E-ECG for time-to-1 mm ST-segment depression were assessed at entry and after treatment. LV function was evaluated during treadmill exercise with conventional and advanced imaging indices: Wall Motion Score Index (WMSI); Ejection Fraction (EF); Force (systolic blood pressure/end-systolic volume); Global Longitudinal Strain (GLS).

Results
Post-treatment exercise-time and CCS improved in both groups. In H+E patients exercise-time improved from 369.8±107.8 sec to 475.3±114.6 sec (p=0.001) while in E patients improved from 384±152.7 sec to 464.8±134.1 sec (p=0.019). CCS score changed in H+E from 2.6±0.7 to 1.9±0.7 (p=0.000), and in E group from 2.4±0.7 to 2.1±0.9 (p=0.046). At peak exercise, H+E was different from E group for EF and GLS (see Table).
Effects of H+E on SE parameters H+E p P+E p *H+E vs P+E STRESS Time 0 vs Time 1 Time 0 vs Time 1 Time 0 Time 1 WMSI 1.377 vs 1.279 0.005 1.404 vs 1.376 0.290 0.626 0.255 EF (%) 60.9 vs 64.8 0.016 61.2 vs 57.8 0.284 0.943 0.016 Force (mmHg/mL) 6.36 vs 6.5 0.158 5.82 vs 4.68 0.209 0.760 0.098 GLS (%) −16.96 vs −18.50 0.001 −15.79 vs −15.60 0.380 0.325 0.027 SE = stress echocardiography; H+E = heparin+exercise; P+E = placebo+exercise; Time 0 = before randomization; Time 1 = after 2-week therapy cycle. *p values.

Conclusion
A 2-week, H+E cycle is associated with improvement in regional and global LV function during exercise, concordantly shown by conventional (WMSI, EF) and advanced (GLS) echocardiographic indices of LV function. This integrates and supplements the classical objective index based on ST-segment depression, unable to localize and quantify the functional consequences of therapy on myocardial ischemia.
P1512The selected stress testing protocol is independently associated with mortality irrespective of exercise capacity and comorbidities
Authors: Harb S , Menon V M , Wu Y W , Cremer P C , Cho L C , Gulati M G , Jaber W A J 
Published: October 2019

Abstract

Background
A variety of exercise stress testing protocols with various workloads are available. The test protocol is typically selected according to patient's expected exercise performance.

Purpose
We sought to assess whether the choice of the protocol is by itself independently associated with mortality even after adjusting for clinical variables and estimated workload achieved in metabolic equivalents of task (METS).

Methods
In a 25-year stress testing registry spanning from 1991 to 2015, we identified 120,705 patients who underwent 7 different standardized exercise protocols: Bruce, Modified Bruce, Cornell 0%, 5%, and 10%, Naughton, and modified Naughton. The choice of the protocol was dependent on the supervising exercise physiologist, mainly according to patient's expected exercise performance. 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 protocols. A total of 8426 death occurred over 8.7 years of mean follow-up duration. Table 1 presents the baseline characteristics by protocol. After adjusting for the number of METs, age, gender, hypertension, diabetes, coronary disease, end-stage renal disease, smoking, and statin use, the protocol selected remained predictive of mortality. Figure 1 shows the adjusted HR for death by protocol selected when compared to Bruce.
Baseline characteristics by protocol Variable Bruce (n=74953) Modified Bruce (n=8368) Cornell 0% (n=2648) Cornell 5% (n=9972) Cornell 10% (n=20425) Naughton (n=1226) Modified Naughton (n=3113) Age, mean ± SD 49.4±11.3 61.3±10.3 66.4±11.7 62.5±11.8 57.2±11.5 67.5±9.8 55.5±11.9 Male, % 64.6 51.8 37.8 42.3 51.7 49 66.7 Coronary disease, % 8.7 32.5 31.7 26.7 21.1 49.7 45.6 Diabetes mellitus, % 7.6 16.5 25.3 20 14.2 27.2 26.2 Hypertension, % 41.7 64 85.4 77.9 67.1 82.5 97.5 Smoker, % 40.9 55 50.7 50.9 50.8 56.9 60.6 ESRD, % 0.7 1 3.7 2.4 1.6 2.7 8.1 Mets, mean ± SD 10.3±2.4 7.2±1.7 5.2±1.6 6.7±1.5 8.3±1.9 4.8±1.5 4.6±1.5 Statin use, % 22.4 15.2 41.8 38.3 35.1 19 40.1 ESRD = end-stage renal disease; METS = metabolic equivalents of task.
Adjusted HR by protocol selected

Conclusion
The choice of the stress testing protocol, which is in large part dependent on patient's expected exercise performance is in itself independently associated with mortality even after adjustment for METs achieved and patients' demographics and comorbidities. The choice of the modified-Naughton is associated with the greatest risk of mortality, likely chosen based on limited functional capacity
P1517Risk of acute kidney injury in transcatheter aortic valve implantation procedures and impact on 30-day outcome
Authors: Sgura F A , Arrotti S , Magnavacchi P , Tondi S , Gabbieri D , Vitolo M , Pennacchioni A , Autieri A , Boriani G 
Published: October 2019

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is a safe and effective procedure for patients with symptomatic aortic stenosis who do not qualify for surgery. Nevertheless, post-procedure acute kidney injury (AKI) is a frequent complication and it is associated with worse outcomes.

Aim
To assess the impact of acute kidney injury (AKI) occurring immediately after the TAVI procedure on patients' outcome.

Methods
We conducted a multicenter retrospective study on patients treated with TAVI from 2010 to 2018. The assigned treatment, the selection of the device (self-expandable/balloon-expandable valve) and the type of approach used were determined by each individual Center on the basis of the patient's characteristics and the choice of the operator. All patients had an intermediate or high Society of Thoracic Surgeons (STS) score. Basal creatinine and glomerular filtrate (using the body mass index, sex and age) were evaluated for each patient. According to the KDIGO criteria, AKI is defined as an increase in serum creatinine (SCr) ≥0,3mg/dl within 48 hours or an increase in SCr ≥1.5 times baseline or urine volume <0,5ml/kg/h for 6 hours. The incidence of post procedural AKI and its correlation with the short-term mortality and outcomes was evaluated as primary end point (stroke/TIA/RIND, cardiac tamponade, bleeding, vascular complications, cardiocirculatory arrest with subsequent ROSC, definitive pacemaker implantation, postoperative atrial fibrillation, left bundle branch block de novo).Postoperative outcomes were defined according to the updated Valve Academic Research Consortium 2 definitions

Results
A total of 371 pts were analysed. Mean age was 82.3±5.9 and the majority of the pts had an STS score>10 (97.6%). Incidence of Acute kidney Injury (AKI) stage 3 post TAVI, according to VARC-2 criteria, was 16,2%. In patient with AKI, the hospitalization time was longer 18,7±6,1 days vs 8,4±6,1 days without AKI (p<0,01). Patients with AKI had an increased risk of in hospital mortality (OR 50,0; 95% CI 5,2–390,16; p<0,01) and 30 day mortality (OR: 5,88; 95% CI 2,08–16,60; p<0,01). Acute Kidney Injury instead was more common in patients treated with transapical access (OD 3,9-CI 95% 2,16–7,07; p<0,01) or with PAD (OR 1,87 - CI 95% 1,03–3,41; p=0,03)
AKI and short term mortality

Conclusion
Acute kidney injury is a frequent complication after TAVI. AKI seems to be the strongest predictor for 30 day mortality and increases the hospitalization time. AKI was more common in patients treated with a transapical approach or if they presented a PAD. In contrast, pre-procedural chronic kidney disease did not seem to correlate directly with an increased risk of AKI.
P1524Women are from venus and face barriers for AMI treatment
Authors: Mehta S , Botelho R , Niklitschek S , Fernandez F , Cade J , Prudente M , Cavalcanti R , Dusilek C , Hamdan N , Hurtado E , Lacativa M , Frauenfelder A , Vieira D , Torres M A , Pinto G 
Published: October 2019

Abstract

Background
The Latin American Telemedicine Infarct Network (LATIN), a program for managing population-based AMI care, has utilized an innovative hub-spoke strategy and remote guidance to expand medical access in remote parts of Brazil, Colombia, Mexico, and Argentina. Based on the Global Lumen Organization for Women (GLOW) project, that has previously demonstrated gender inequalities and worse outcomes for women who undergo Primary PCI, our research explored the management of female patients in our network.

Purpose
To demonstrate gender disparities in a telemedicine-guided, population based AMI program.

Methods
Meta-analysis of >750,000 patients within LATIN. Telemedicine was employed as a screening tool to accurately diagnose AMI. According to the duration of chest pain and transfer time, AMI patients were triaged into guidelines-based pathways of thrombolysis, pharmaco-invasive management or Primary PCI. Resource allocation was identical for men and women.

Results
Data from 784,395 screened patients reveals broad gender disparities. The critical results yielded that female patients have a lower prevalence of STEMI diagnosis and treatment regardless of the technique – PCI, pharmaco-invasive or CABG (p<0.01). These findings assume more significance given the fact that more women than men, were screened through the Telemedicine pathway.

Conclusions
LATIN gender data signals the urgency to demand better AMI care for women.
P1525Impact of renal function on silent myocardial ischemia and long-term outcomes in asymptomatic patients with diabetes mellitus
Authors: Wakabayashi K , Toshiaki T S , Shibata K S , Furuya T F , Sato C S , Nishikura T N , Fukuoka H F , Ikeda N I , Honda Y H , Kikuchi M K , Miyoshi F M , Tanno K T 
Published: October 2019

Abstract

Introduction
Coronary artery disease (CAD) is a major cause of the morbidity and mortality in diabetic patients, however aggressive screening for CAD in asymptomatic patients is not recommended in guidelines. Chronic kidney disease (CKD) is one of serious co-morbidity and such patients especially tends to be observed without angiography to avoid contrast induced nephropathy. It is well known that systemic atherosclerosis worsens renal function. Thus, chronic kidney disease (CKD) may be associated with potential myocardial ischemia and worse clinical outcomes in asymptomatic DM patients.

Purpose
To determine the impact of CKD on the incidence of silent myocardial ischemia (SMI) and the long-term outcomes in asymptomatic patients with DM.

Methods
A total of 461 consecutive patients with DM were prospectively studied from July 2011 to August 2017. All patients were asymptomatic and self-sufficient in daily life. They underwent the ergometer exercise test. Coronary angiography was performed when the stress test was positive, or the patients did not achieve 90% of target heart rate. Primary end point was major adverse cardiac and cerebrovascular events (MACCE) including death, non-fatal myocardial infarction and stroke.

Results
SMI was diagnosed in 81 patients. The incidence of SMI increased with higher stage of CKD as shown in Figure. The median follow-up duration from diagnosis was 35 (15–57) months in the overall cohort of 461 diabetic patients. SMI patients had worse clinical outcomes (Figure). Among 81 patients with SMI, severe CKD group (≥ stage 3a) had worse long-term outcomes. After adjustment of age, gender and coronary risk factors, eGFR was independently associated with MACCE in diabetic patients with SMI [HR0.96, 95% CI (0.923–0.996), p=0.028].
Incidence of SMI and Kaplan-Meier curves

Conclusions
The incidence of potential CAD was high in CKD and the long-term outcomes of those patients were poor in asymptomatic DM. CKD patients should be aggressively screened for CAD and more intensively treated in our daily practice of DM.
P1534Short time and short term of high-intensity intermittent exercise training reduces arterial stiffness via upregulation of endothelial nitric oxide signalling
Authors: Hasegawa N , Fujie S , Horii N , Uchida M , Iemitsu M 
Published: October 2019

Abstract

Introduction
Conventionally, as an exercise mode which leads to reduction of arterial stiffness, it is well used that moderate-intensity continuous exercise training (MICT). High-intensity interval training (HIIT), such as HIIT program with a total exercise time of 15–30 min is highly time-effective as an exercise mode for which reduces risks of cardiovascular disease. Recent study showed that even shorter HIIT leads to an effective reduction in arterial stiffness. Therefore, HIIT is an effectively exercise therapy which can use in patients with cardiovascular diseases. Although MICT induces vasodilation by acceleration of nitric oxide (NO) production via upregulating arterial endothelial NO synthase (eNOS)/protein kinase B (Akt) signalling pathway, an underlying mechanism of HIIT effects remains unclear.

Purpose
This study aimed to clarify the effects of short HIIT on arterial stiffness and arterial NO production in rats.

Methods
Forty 10-week-old male Sprague-Dawley rats were randomly divided into four groups; CON: 8-week sedentary control, MICT: treadmill running for 60 min at 30m/min, 5 days/wk for 8weeks, HIIT: fourteen 20 sec swimming sessions with a weight equivalent to 14–16% of each body weight and 10 sec pause was allowed between exercise sessions, 4 days/wk for 6 weeks from 12-week-old, and RT: ladder climbing, 8–10sets/day, 3 days/wk for 8 weeks groups (n=10 each group). After training session, we measured aortic pulse wave velocity (aortic PWV) as an index of arterial stiffness and plasma nitrite/nitrate (NOx) concentrations and phosphorylation of eNOS and Akt in the aorta.

Results
Aortic PWV was significantly reduced in both MICT and HIIT groups as compared to CON and RT groups (P<0.05), whereas there was no difference between RT and CON groups. Additionally, arterial phosphorylations of eNOS and Akt and plasma NOx levels were significantly elevated in both MICT and HIIT groups as compared to CON and RT groups (P<0.05), whereas there was no difference between RT and CON groups. Moreover, HIIT-induced reduction of aortic PWV and increase in eNOS and Akt phosphorylations and plasma NOx levels were equal to these MICT effects. Arterial eNOS phosphorylation was negatively correlated with aortic PWV in all groups (r=−0.38, P<0.05). Further study was conducted whether a single-bout high-intensity intermittent exercise accelerates NO production. After acute high-intensity intermittent exercise, plasma NOx levels were significantly elevated (P<0.05).

Conclusion
These results suggest that HIIT increases NO production via the upregulation of arterial Akt/eNOS signalling pathway, resulting in the reduction of arterial stiffness, despite a reduction in total exercise volume as compared with MICT.

Acknowledgement/Funding
JSPS KAKENHI (#17H02182 and #16K13059 for M. Iemitsu; #18H06423 for N. Hasegawa)
P1535Clinical impact of carotid plaque score rather than carotid intima-media thickness on atherosclerotic cardiovascular disease
Authors: Tada H , Nakagawa T , Okada H , Nakahashi T , Mori M , Sakata K , Kawashiri M , Takamura M 
Published: October 2019

Abstract

Background
Carotid intima-media thickness (cIMT) assessed by ultrasound has been widely accepted as a surrogate marker of atherosclerotic cardiovascular disease. On the other hand, carotid plaque score (cPS) reflecting throughout the carotid artery plaque burden may be better marker.

Methods
We retrospectively examined 2,035 patients who underwent carotid ultrasonography between January 2006 and December 2015 at our University Hospital. Median follow-up period was 4 years. We used Cox models that adjusted for established risk factors of ASCVD, including age, gender, hypertension, diabetes, smoking, and serum lipids to assess the association of cIMT as well as cPS with major adverse cardiac events (MACE). MACE was defined as all-cause mortality or rehospitalization for a cardiovascular-related illness

Results
During follow-up, 243 participants experienced MACE. After adjustment for established risk factors, cPS was associated with MACE (hazard ratio [HR] = 3.38 for top quintile vs. bottom quintile of cPS; 95% confidence interval [CI] 1.82 to 6.27; P-trend = 1.4×10–8), while cIMT was not (HR = 0.88, P=0.57). Addition of the cPS to established risk factors significantly improved risk discrimination (C-index 0.726 vs. 0.746; P=0.017)

Conclusion
As a marker, cPS, rather than cIMT can identify 20% of individuals who are at more than three-fold increased risk for MACE. Targeting diagnostic or therapeutic interventions to this subset may prove clinically useful.
P1538Low energy intake predicts readmission of elderly heart failure patients independently of nutritional status
Authors: Shimomura K , Katano S , Yano T , Ohori K , Honma S , Watanabe A , Ishigo T , Fujito T , Nagano N , Koyama M , Kouzu H , Hashimoto A , Miura T 
Published: October 2019

Abstract

Background
Malnutrition is frequently present and closely associated with poor clinical outcomes in elderly heart failure (HF) patients. Our previous study showed that low energy intake (EI) is associated with worse functional status in elderly HF inpatients after cardiac rehabilitation, but significance of EI in prediction of hospital readmission has not been elucidated fully.

Purpose
We examined whether low EI is a predictor of readmission for cardiac events in elderly HF patients.

Methods
We retrospectively retrieved data for 298 HF patients aged ≥65 years (median age of 77 years, interquartile range [IQR]: 71 - 82, female: 53%) who admitted to our institute for diagnosis and treatment of HF. Medical records were reviewed with regard to demography, medical history, comorbidities, medications, laboratory data, echocardiograms, functional status, nutritional status and total energy intake. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and total EI per day were calculated at discharge by a registered dietitian and a trained physical therapist. The primary endpoint was readmission due to cardiovascular events including worsening HF, arrhythmia, angina pectoris and myocardial infarction during a 1-year follow-up period.

Results
The median period of follow-up was 235 days (IQR: 78–365 days). The 1-year readmission rate for cardiovascular events was 54.4%. The cutoff values of MNA-SF score and EI, calculated by ROC curve analysis to predict the primary endpoint, were 7 points (area under the curve [AUC]: 0.59, sensitivity: 0.65, specificity: 0.50) and 31.8 kcal/kg/day (AUC: 0.59, sensitivity: 0.83, specificity: 0.35), respectively. Patients with low MNF-SF score (≤7) or low EI (≤31.8 kcal/kg/day) had significantly higher readmission rate during a 1-year follow-up period than did the patients with high MNF-SF score or EI (MNA-SF: 60.7% vs. 45.6%, p<0.01, EI: 60.4% vs. 36.8%, p<0.01), respectively. When patients were classified into four groups using cutoff values of MNA-SF score and EI, 1-year readmission rate was significantly higher in patients with low EI than in those with high EI regardless of MNF-SF scores. In multivariate Cox proportional hazard analyses adjusted for known prognostic factors in addition to age and gender, hazard ratios (HR) were significantly higher in patients with high MNA-SF score and low EI (adjusted HR: 2.81, 95% confidential interval [CI]: 1.15 - 9.32, p=0.02) and low MNA-SF score (≤7) and low EI (adjusted HR: 4.16, 95% CI: 1.72 - 13.72, p<0.01) than those with high MNA-SF score and high EI.
Kaplan-Meier curves of readmission rates

Conclusions
Low energy intake is a nutritional status-independent predictor of 1-year readmission rate in elderly HF patients.
P1556Cardiovascular risk in white-coat hypertension individuals stratified by their nocturnal blood pressure dipping status
Authors: Liakos C , Karpanou E , Grassos C , Markou M , Vyssoulis G , Tousoulis D 
Published: October 2019

Abstract

Background/Introduction
Nocturnal blood pressure (BP) dipping status, defined by the night-to-day BP ratio, has been correlated with the cardiovascular (CV) risk in patients with arterial hypertension. The risk is higher in those with less than normal or no drop in nocturnal BP while data in extreme dippers are inconsistent. On the other hand, white-coat hypertension (WCHT), defined as an elevated office BP despite a normal out-of-office BP, is characterized by a lower CV risk than that of sustained hypertension and rather comparable with that of true normotension.

Purpose
The present study assessed the possible relation between the nocturnal BP dipping status and the underlying CV risk in WCHT individuals.

Methods
Among all individuals examined in our outpatient anti-hypertensive units over the past 15 years, 2310 (42% men, 52.2±13.1 years of age) were diagnosed with WCHT (increased office BP: 156.4±10.0/99.6±6.2 mmHg and normal 24-hour ambulatory BP: 122.4±6.3/75.3±5.4 mmHg) and were enrolled in the study. A night-to-day BP ratio (from the 24-hour ambulatory BP monitoring) 0.8–0.9 defined Normal nocturnal BP Dipping, <0.8 Extreme Dipping, 0.9–1 Mild Dipping and >1 Absence of Dipping. The underlying 10-year CV risk of death in the studied population was calculated with the Hellenic version of the HeartScore (Hellenic Score), as proposed by the current 2018 European Society of Hypertension guidelines, based on age, gender, smoking status, systolic BP and total cholesterol levels.

Results
From 2310 individuals studied, 1208 (52.3%) were found with Normal Dipping, 386 (16.7%) with Extreme Dipping, 622 (26.9%) with Mild Dipping and 94 (4.1%) with Absence of Dipping. Hellenic Score was 3.21±4.67% in subjects with Normal Dipping, 3.49±4.97% in those with Extreme Dipping, 3.66±5.04% in those with Mild Dipping, 6.21±7.29%, in those with Absence of Dipping (p for trend<0.05) and 3.50±4.99% in the whole cohort of the studied population.

Conclusions
Nocturnal BP dipping status is closely associated with the underlying CV risk of WCHT individuals. Extreme Dipping, Mild Dipping and especially Absence of Dipping increase CV risk thus necessitating closer follow-up of these individuals and possibly faster initiation of BP-lowering drug treatment.