bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4546Acute heart failure: speckle tracking echocardiography, a new ally in intensive care unit
Authors: Cameli M , Falciani F , Mandoli G E , Parisella M L , Incampo E , Rizzo C , D'Ascenzi F , Focardi M , Valente S , Mondillo S 
Published: October 2019

Abstract

Background
Acute Heart Failure (AHF) is a life-threatening condition with high mortality rate.

Purpose
The aim of our study was to identify the best predictors of in-hospital mortality and stay, among laboratory blood tests, clinic and echocardiographic (standard and by Speckle Tracking Echocardiography, STE) parameters in patients admitted to our Intensive Care Unit (ICU) for AHF.

Methods
We enrolled 57 patients (age 70±13 y, 70% man) admitted to our ICU with de novo AHF or acute decompensation of Chronic Heart Failure (CHF). Exclusion criteria were: active malignancies, chronic liver disease, absent acoustic echocardiographic window and patient refusal. At ICU admission, all patients were assessed with vital signs (heart rate, HR; systolic blood pressure, SBP), blood laboratory tests, standard echo and STE of left ventricle (LV), right ventricle (RV) and left atrium (LA). These indexes were then related to the length of stay and mortality.

Results
The population was finally composed of 52 patients, due to 5 in-hospital deaths. 56% had an ischemic aetiology, 26% idiopathic dilated cardiomyopathy, 11% valvular diseases, 7% other causes of HF. At admission, average HR was 78±16 bpm, SBP 119±24 mmHg and EF 33±13%. Among all the parameters, the ones that showed significant statistical correlation with the length of hospitalization (15,34±7.03 days) were plasmatic creatinine, SBP, Systolic Pulmonary Artery Pressure, high LV filling pressure (E/E' >12) and Peak Atrial Longitudinal Strain (PALS). The maximal dose of intravenous loop diuretics and inotropic drugs also showed a good correlation. Analysing the two sub-populations with mortality data, we observed that patients who died, had a significantly lower EF (19±9.62% vs 35±12.55%; p=0,01), but not a higher left atrial volume indexed (31.04±14.87 vs 26.36±12.03 ml/m2; p= ns) compared to the survivors; instead PALS was significant worse (10.08±4.62 vs 20.64±13,35%; p<001). Free wall RV Longitudinal Strain (fw-RVLS) values for the patients who died (−9.41±4.66%) were significantly lower than in survivors (−13.67±6.02%; p<0.01). LVGLS (Left Ventricular Global Longitudinal Strain) did not show statistical significant differences between the two populations. Based on the results of ROC analysis (Figure 1), we created a score to predict in-hospital mortality, composed of: EF, PALS and RVLS-free wall. The ideal cut point to predict mortality was >1.5.
Figure 1

Conclusions
AHF represents one of the major challenges in ICU. The use of a combined echocardiographic score, assessed at admission, could help to better predict mortality risk, in addition to commonly used indexes.
P4567Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income sub-Saharan countries
Authors: Kramoh K E , Macquart De Terline D , Damourou J M F , Kouam Kouam C , Ali Toure I , Mipinda J B , Diop B I , Ferreira B , Houenassi M D , Mfeukeu Kuate L , Limbole E , Jouven X , Azizi M , Antignac M , Kingue S 
Published: October 2019

Abstract

Background
Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa.

Purpose
We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries.

Methods
We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries.

Results
There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95% CI [1.79–2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95% CI [1.35–2.56] and middle vs. high wealth: OR: 1.42, 95% CI [1.11–1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p=0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001).

Conclusion
This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.
Figure 1. Percentage of patients according to their adherence level by patient wealth index stratified by country-level income.
P4570Prognostic interest of HbA1c and plasma glucose assessment on one-year mortality in non-diabetic patients after acute myocardial infarction
Authors: Gueniat-Ratheau E , Mouhat B , Verges B , Chague F , Beer J.-C , Maza M , Zeller M , Cottin Y 
Published: October 2019

Abstract

Background
The usefulness of the combined assessment of HbA1c and plasma glucose (PG) in acute myocardial infarction (AMI) in nondiabetic patients remains unclear.

Purpose
In a large observational study, we aimed to identify the prognostic values of these biomarkers regarding one-year all-cause mortality in nondiabetic patients after AMI.

Methods
From the “obseRvatoire des Infarctus de Côte d'Or” (RICO) survey database, we included all consecutive nondiabetic patients with AMI (n=6617) from May 2001 to December 2016. Exclusion criteria were: admission known or unknown diabetes, in-hospital death. The primary endpoint was all-cause one-year mortality. The secondary endpoints were: MACE, infarct size, LVEF<40% and GRACE risk score. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of one-year death (HbA1c 5.9% and PG 7.3mmol/L) to set up 4 groups: low HbA1c/low glucose (n=3158), low HbA1c/high glucose (n=1264), high HbA1c/low glucose (n=1378) and high HbA1c/high glucose (n=817).

Results
Elevation of PG was associated with elevated rate of LVEF<40%, STEMI, anterior wall location, DFG<60mL/min/m2 and higher troponin Ic pic (all p<0.001); HbA1c>5.9% was associated with elevated rate of CRP>3mg/L (p<0.001); High HbA1C and high PG together were associated with higher rate of MACE (p<0.001). By multivariate logistic regression analysis, elevated admission PG remained a strong predictor of one-year all-cause (OR (95% CI): 1.64 (1.31–2.05)) mortality and cardiovascular mortality (OR (95% CI): 1.75 (1.33–2.31)), beyond GRACE score (OR (95% CI): 1.03 (1.03–1.04)), as well as elevated HbA1c (OR (95% CI): 1.43 (1.15–1.78) and OR (95% CI): 1.83 (1.39–2.41) respectively).

Conclusions
Admission PG and HbA1c had strong independent predictive value regarding one-year all-cause mortality in our nondiabetic patients with AMI. These biomarkers could be useful to identify the most-at-risk patients after AMI in order to reduce residual risk in this target population.

Acknowledgement/Funding
University Hospital Center Dijon Bourgogne, France
P4572Lipoprotein(a) is not associated with survival after acute coronary syndromes
Authors: Roth C , Dalos D , Gangl C , Krychtiuk K , Schrutka L , Distelmaier K , Wojta J , Hengstenberg C , Berger R , Speidl W 
Published: October 2019

Abstract

Aims
Lipoprotein(a) [Lp(a)] is associated with coronary artery disease in population studies, however studies on its predictive value in patients with established cardiovascular disease, in particular after acute coronary syndromes (ACS), are conflicting. The aim of this study was to investigate whether Lp(a) is associated with survival after ACS.

Methods and results
We analyzed 4469 consecutive patients that underwent coronary angiography for ACS. Lp(a) measurement at time of ACS was available in 1245 patients and median follow-up for cardiovascular and total mortality was 5.0 (IQR 3.2–8.0) years. 655 (52.6%) presented with ST-segment elevation myocardial infarction (STEMI), 424 (34.1%) with Non-ST-segment elevation myocardial infarction (NSTEMI) and 166 (13.3%) underwent coronary angiography for unstable angina. Cardiovascular mortality was 9.1% and total mortality was 15.7%. Patients were stratified into four groups to their Lp(a) levels. (≤15 mg/dL, >15–30 mg/dL, >30–60 mg/dL, and >60 mg/dL). Multivessel disease was significantly more common in patients with Lp(a) >60 mg/dL (p<0.05). Increased levels of Lp(a) were not associated with cardiovascular mortality (HR compared with Lp(a) ≤15 mg/dL were 1.2, 1.2, and 1.0, respectively; p=0.69) and not with total mortality (HR compared with Lp(a) ≤15 mg/dL were 1.2, 1.2, and 1.2, respectively; p=0.46).
Central Figure

Conclusion
Lp(a) levels at time of ACS were neither associated with cardiovascular nor with total mortality. Although Lp(a) has been shown to be associated with incidence of coronary artery disease, this study does not support any role of Lp(a) as a risk factor after ACS. This should be taken into account for development of outcome studies for agents targeting Lp(a) plasma levels.
P4583Effect of permanent right internal mammary artery occlusion on right coronary artery collateral function. a randomized controlled trial
Authors: Bigler M R , Stoller M , Tschannen C , Grossenbacher R , Seiler C 
Published: October 2019

Abstract

Background
Extracardiac coronary artery supply via the pericardiophrenic branch of the internal mammary arteries (IMA) has been well documented anatomically. Recently, a proof-of-concept study has found functional relevance of these anastomoses in patients with coronary artery disease (CAD) during a brief right coronary artery (RCA) occlusion.

Purpose
The aim of the present randomized controlled, single-blind trial was to investigate the effect of permanent right IMA (RIMA) occlusion on RCA collateral flow index (CFI) and on the occurrence of angina pectoris. We hypothesized that the change in RCA CFI from baseline to follow-up examination is higher in the group of patients with than without permanent RIMA occlusion.

Methods
One hundred patients with CAD were randomly allocated (1:1) to permanent RIMA device occlusion at baseline or to no RIMA occlusion (sham control group). The primary study endpoint was CFI change in the RCA from baseline to the 6-week follow-up examination. CFI is the ratio between mean coronary occlusive and aortic pressure both subtracted by central venous pressure as obtained during a 1-minute proximal RCA balloon occlusion. RCA CFI was measured at baseline before RIMA occlusion or the sham procedure and at the follow-up invasive exam. At the end of the same occlusion, occurrence of angina pectoris was assessed. Percutaneous coronary intervention (PCI) of the RCA was deferred until after follow-up RCA CFI measurement.

Results
There were 51 patients in the RIMA occlusion (verum) group and 49 patients in the sham control group. PCI in the left coronary territory was performed at baseline for clinical reasons in 27 patients of the verum group and in 25 patients of the sham control group. There were no differences in clinical characteristics at baseline between the groups (age 68±12 years, 88 men). RCA CFI change during the 6 weeks of follow-up was equal to +0.028±0.077 in the verum group and −0.026±0.079 in the sham control group (p=0.0017). Angina pectoris during CFI measurement had disappeared at follow-up exam in 30% of the verum group and in 2% of the sham control group (p=0.0013).

Conclusions
Right coronary collateral function is augmented 6 weeks after permanent RIMA occlusion when compared to sham treatment. This manifests as less frequent angina pectoris during myocardial ischemia among patients with RIMA occlusion.

Acknowledgement/Funding
This study was supported by a grant from the Swiss National Science Foundation for Research (grant #32003B_163256/1 to CS).
P4586Bilateral internal thoracic artery grafting neutralizes detrimental effect of diabetes on survival in patients with ischemic cardiomyopathy
Authors: Kainuma S , Taniguchi K T , Toda K T , Miyagawa S M , Yoshikawa Y Y , Hata H H , Yoshioka D Y , Ueno T U , Kuratani T K , Sakaguchi T S , Funatsu T F , Kondoh H K , Masai T M , Daimon T D , Sawa Y S 
Published: October 2019

Abstract

Background
In ischemic cardiomyopathy patients requiring coronary artery bypass grafting (CABG), the association of diabetic status with outcomes after surgery as well as survival benefit with bilateral internal thoracic artery (ITA) grafting remain largely unknown.

Purpose
We evaluated the associations of diabetic status with postoperative LV reverse remodeling, change in renal function, and late outcome following surgical revascularization, with focus on cases with severely impaired LV function. We also attempted to determine the survival benefit of bilateral ITA grafting over single ITA grafting according to diabetic status.

Methods
We classified 188 patients (mean age 67±9 years) with left ventricular (LV) ejection fraction ≤40% who underwent isolated initial CABG into non-diabetic (n=64), non-insulin-dependent DM (NIDM, n=74), and insulin-dependent DM (IDM, n=50) groups.

Results
At baseline, there were no differences between the diabetic and non-diabetic patients in terms of age, LV function parameters and degree of coronary artery disease, while the diabetic patients were more likely to present chronic kidney disease and peripheral vascular disease. During follow-up (68±47 months), the 5-year survival rate was 84% and 65% in the non-diabetic and diabetic patients respectively (p=0.034). After adjusting for all covariates, both NIDM and IDM were independently associated with increased mortality (NIDM: adjusted hazard ratio 1.9, 95% confident interval 1.0–3.7, p=0.049; IDM: adjusted hazard ratio 2.4, 95% confident interval 1.2–4.8, p=0.016) and composite adverse events defined as mortality and/or heart failure readmission (NIDM: hazard ratio 1.7, 95% confident interval 1.0–2.8, p=0.038; IDM: hazard ratio 3.0, 95% confident interval 1.7–5.1, p<0.001). Diabetic patients showed less improvements in LV dimensions and ejection fraction (interaction effect p<0.05 for all), and steady decrease in the estimated glomerular filtration rate over time after surgery (group effect p<0.05). Among non-diabetic patients, there was no difference in survival rate between single ITA and bilateral ITA grafting (5-year: 86% vs. 80%, p=0.95), whereas among diabetic patients, survival of those who received the latter was better (57% vs. 81%, p=0.004). Multivariate analysis revealed that use of bilateral ITA was significantly associated with decreased risk of mortality (hazard ratio 0.3, 95% confident interval 0.1–0.8, p=0.024).

Conclusion
Non-insulin- and insulin-dependent diabetes was significantly associated with worse long-term clinical outcome after CABG for ischemic cardiomyopathy. Bilateral ITA grafting has potential to improve survival in diabetic patients with ischemic cardiomyopathy.
P4589The prognostic impact of the Medina classification in bifurcation lesion percutaneous coronary intervention
Authors: Perl L , Witberg G , Vaknin-Assa H , Kornowski R , Assali A 
Published: October 2019

Abstract

Background/Introduction
The Medina classification is the most widespread method to describe bifurcation lesions. However, little is known regarding the prognostic impact of the classification.

Purpose
To assess the prognostic significance of the Medina classification following percutaneous coronary intervention (PCI).

Methods
The study included 738 consecutive patients from a prospective bifurcation registry. There were 609 patients (82.5%) with “true bifurcation” (TB) lesions (Medina class 1.0.1, 1.1.1, 0.1.1) and 129 (17.5%) in all other categories (“non-true bifurcation” = NTB). We compared rates of death and major adverse cardiac events (MACE: cardiac death, myocardial infarction, or target vessel revascularization) at 12 months and 3 years.

Results
Patients with TB had lower rates of previous bypass surgery (9.4% vs. 12.2%, p=0.03) and hyperlipidemia (75.2% vs. 79.0%, p=0.04). TB lesions were more likely to be calcified (33.8% vs. 28.2%, p=0.03) and ulcerated (8.9% vs. 3.4%, p<0.01). At 12 months, mortality was numerically higher for TB PCI (4.1% vs. 2.0%m p=0.052) and MACE rates were higher (13.2% vs. 5.2%, p<0.001). At 3 years, both all cause death (10.1% vs. 4.9%, p=0.002), as well as rates of MACE (27.2% vs. 11.6%, p<0.001) were higher for TB PCI (Figure 1). After performing regression analysis, TB remained an independent predictor for poor outcomes (OR- 3.93 at 12 months, CI 1.45–10.66, p=0.007, OR-3.26 at 3 years, CI 1.47–7.25, p=0.004 for MACE).

Conclusions
TB lesions, according to the Medina classification, portend worse prognosis for patients undergoing bifurcation PCI. This may guide prognostication and decision making in treatment.
P4590Temporal trends of the characteristics, management, and clinical outcomes of patients with acute coronary syndrome and multi-vessel disease - the ACSIS registry
Authors: Shiyovich A , Shlomo N , Iakobishvili Z , Kornowski R , Eisen A 
Published: October 2019

Abstract

Introduction
Multi-vessel coronary artery disease (MVD) is common among patients with acute coronary syndrome (ACS) and is associated with worse outcomes compared with single-vessel disease. Multiple studies focused particularly on patients with ACS and MVD and their results were incorporated into guidelines' recommendations.

Objectives
To examine temporal trends in clinical characteristics, treatment and outcomes of patients presenting with ACS and MVD.

Methods
Time- dependent analysis of patients enrolled in the biennial ACS Israeli Surveys (ACSIS) between 2000 and 2016 according to three time periods: early (2004–2006; n=2,111), mid (2008–2010; n=2,049), and late (2013–2016; n=2,010). MVD was defined as >50% stenosis in ≥2 separate major coronary territories at the index ACS. Clinical outcomes were 30-day MACE (death, unstable angina, myocardial infarction, stroke, stent thrombosis, urgent revascularization) and 30-days and 1-year mortality.

Results
Overall 6,170/15,000 patients (41.1%) had MVD (age 64.5±12.1, males 80%). Patients admitted in the later periods were older with a higher prevalence of cardiovascular risk factors and their treatment (i.e. statins, and hypoglycemic drugs) prior to admission. The rate of CABG has decreased and of MV percutaneous coronary intervention and guideline recommended medical treatment has increased with time. At 30 days, the rates of mortality, MACE and re-infarction have decreased (Figure). A trend of reduction in 1-year mortality was observed with time, yet it did not reach statistical significance (early=9.3%, mid=7.8%, late=7.7%, P=0.13). A multivariate adjusted analysis demonstrated that the mid and late periods were associated with significantly reduced risk for 30-day MACE (OR=0.65 [0.54–0.77] and 0.54 [0.45–0.65], respectively).
Figure 1. Temporal trends in 30-day outcomes of patients with ACS and MVD

Conclusions
During the last decade, the burden of cardiovascular risk factors among ACS patients with MVD has increased, more extensive invasive and medical treatments were provided and significant improvements in 30-day outcomes were observed.

Acknowledgement/Funding
None
P4606Comparing biomarker profiles in patients with stable atherosclerosis treated with anacetrapib versus placebo: a nested proteomic study from HPS3/TIMI 55-REVEAL
Authors: Berg D , Morrow D , Braunwald E 
Published: October 2019

Abstract

Background
The cholesteryl ester transfer protein (CETP) inhibitor anacetrapib improves cardiovascular outcomes in patients with stable atherosclerosis; however, the potential interaction of HDL-C-, LDL-C-, and non-lipid-mediated effects remains incompletely understood.

Purpose
The aim of this study was to identify biological pathways that are influenced by treatment with anacetrapib.

Methods
HPS3/TIMI 55-REVEAL was a randomized, double-blind, placebo-controlled trial of anacetrapib in patients with stable atherosclerotic cardiovascular disease. We performed a nested prospective biomarker study in 500 patients, analyzing 274 candidate biomarkers. We compared changes in biomarker levels between randomization and mid-study (∼2 years) in patients treated with anacetrapib vs. placebo using a stringent threshold for statistical significance. We evaluated associations between changes in selected biomarkers and changes in HDL-C and LDL-C from baseline to mid-study in each treatment group.

Results
Eleven biomarkers were significantly modified by anacetrapib vs. placebo (Figure). These proteins represent pathways implicated in inflammation, lipid metabolism, and hematopoiesis. Among anacetrapib-treated patients, changes in 5/11 biomarkers were not significantly correlated with changes in either serum HDL-C or serum LDL-C.

Conclusion(s)
In patients with stable atherosclerosis, treatment with anacetrapib results in changes in protein expression extending beyond lipid metabolism. Some of these changes appear to be independent of anacetrapib-mediated effects on HDL-C and LDL-C.

Acknowledgement/Funding
HPS3/TIMI 55-REVEAL was sponsored by Merck.
P4609The use of stellate ganglion block in the management of electrical storm reduces VA burden by 92% and completely excludes the need for general anesthesia
Authors: Jiravsky O , Spacek R , Chovancik J , Szmek B , Neuwirth R , Hrosova M , Palowski M , Sknouril L 
Published: October 2019

Abstract

Background
The electrical ventricular storm (ES) is a life-threatening condition. The treatment is based on addressing the triggering cause, influencing reversible factors, patient sedation, and antiarrhythmics. Suppressing the massive sympathetic surge is a keystone in the emergent management. Stellate ganglion block (SGB) might serve this purpose.

Purpose
To show the efficacy of ultrasound-guided SGB in the management of ES.

Methods
Retrospective analysis of case series. All ES patients in whom SGB was used. SGB was performed after the initial failure of reversible factors modification + sedation + antiarrhythmics. We compared the mean VA burden 2 days before vs. 7 days after SGB (to show the long effect of SGB).
31 patients (5 females). Procedure date between 01.03.2017 and 21.11.2018. Mean LVEF 27±9%. Etiology: 74% ischemic vs. 26% non-ischemic cardiomyopathy. Antiarrhythmic treatment: amiodarone 27 pt. (87%), trimecaine 3pt (10%), digoxin 2 pt. (6%), beta-blocker 28 pt. (90%).

Results
The ES management including SGB resulted in a significant decrease (92%) in VA burden (mean 26,0 episodes/day vs. 0,6 episodes/day; p<0.001). Separately, ATP episodes were reduced by 99%, external or ICD shocks by 76%. There was no need for general anesthesia as a last resort in refractory ES. 30-days mortality 12,9%. No significant adverse events have been noticed, 10 pt. (32,3%) have developed Horner syndrome, which always disappeared in 24 hours.

Conclusion
Ultrasound-guided SGB in the management of ES is safe and very effective. Randomized prospective studies are required to precisely determine the effect of SGB.