bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3760Temporal trends in stroke prevalence and its associations with changing patterns of antithrombotic regimens in patients with atrial fibrillation and a wide spectrum of coronary artery disease
Authors: Hudzik B , Desperak A , Freedman B , Nielsen P B , Larsen T B , Desperak P , Trzeciak P , Gasior M 
Published: October 2019

Abstract

Introduction
Much of the morbidity and mortality associated with atrial fibrillation (AF) is due to cerebrovascular thrombo-embolic complications such as ischemic stroke. Antithrombotic therapy is the fundamental treatment for many cardiovascular conditions, e.g. coronary artery disease (CAD), AF, and stroke to prevent thrombotic complications and death, but many patients have both CAD and AF. Dual antiplatelet therapy (DAPT) with acetylsalicylic acid (ASA) and a P2Y12 inhibitor has proven most effective in patients with recent myocardial infarction (MI) or after percutaneous coronary intervention (PCI), whereas for AF, oral anticoagulation (OAC) is most effective, with lesser efficacy but similar bleeding using DAPT. We investigated temporal trends in stroke prevalence and its associations with changing patterns of antithrombotic regimens in patients with non-valvular AF and a wide spectrum of co-incident CAD.

Methods
The Silesian TRiplE Antithrombotic Therapy (TREAT) Registry enrolled 14,873 patients with CAD from 2006 to 2014: 9,379 with stable CAD (SCAD), 1,460 with unstable angina (UA), 1,760 with NSTEMI and 2,328 with STEMI. We compared temporal trends in clinical features, an incidence of clinical events and patterns of antithrombotic regimens.

Results
2,194 of 14,873 patients (14.6%) had AF, including 74.1% with SCAD, 7.7% with UA, 10.1% with NSTEMI and 8.1% with STEMI. The AF prevalence increased from 11.2% in 2006 to 17.2% in 2014 which may be attributed to increasing age from 62.7 in 2006 to 67.8 in 2014. Overall, there was an increasing use of OAC therapy alone or with SAPT or DAPT from 46–50% in 2006–7 to 77–86%% in 2013–14. There was a steady increase in utilization of TREAT, and OAC ± SAPT throughout the study period (Panel A): after PCI there was a substantial increase in TREAT with a steady decline in DAPT (Panel B). The stroke rates declined throughout the study period from 3.3% in 2004 through a peak of 4.9% in 2011 to 1.1% in 2014. Conversely, bleeding rates increased from 6.0% to 10.5%.

Conclusions
There has been an increase followed by a progressive decline in stroke rate despite increasing age and AF prevalence in patients with both CAD and AF. This phenomenon is associated with a significant increase in the proportion of AF patients receiving guideline-recommended OAC therapy, driven by a steady increase in the utilization of triple antithrombotic therapy in patients following ACS or stent implantation and increase in OAC monotherapy in patients without ACS or stent implantation. This positive effect on stroke incidence is offset by increased bleeding risk, necessitating a closer look at the duration of triple therapy for ACS or PCI, and the long-term requirement for additional antiplatelet treatment in uncomplicated CAD.
P3765Low vascular endothelial growth factor-C was a predictor for cardiovascular events in patients with atrial fibrillation and suspected or known coronary artery disease: a subanalysis of the ANOX study
Authors: Iguchi M , Suzuki M , Matsuda M , Ajiro Y , Shinozaki T , Sakagami S , Yonezawa K , Shimizu M , Funada J , Takenaka T , Morita Y , Abe M , Akao M , Hasegawa K , Wada H 
Published: October 2019

Abstract

Background
Lymphatic system has been considered to play an important role in cardiovascular disease. We recently reported that vascular endothelial growth factor-C (VEGF-C), a central player in lymphangiogenesis, predicted all-cause mortality in patients with suspected or known coronary artery disease (CAD). However, relationship between VEGF-C and atrial fibrillation (AF) remains unclear.

Methods
The ANOX study is a multicenter, prospective cohort study of 2,418 patients with suspected CAD, to determine the predictive value of possible novel biomarkers related to angiogenesis or oxidative stress for major adverse cardiovascular events (MACE) among patients undergoing elective angiography. Blood samples were collected from the arterial catheter sheath at the beginning of coronary angiography. Serum levels of VEGF-C, as well as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin-I (cTnI), and high-sensitivity C-reactive protein (hsCRP), were measured. The outcome was a MACE defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.

Results
Of a total of 2,418 patients, 261 patients had AF at baseline. AF group were older, and had more chronic kidney disease, history of heart failure, and history of stroke, but less diabetes, dyslipidemia, and CAD. The median level of NT-proBNP, cTnI, and hsCRP were higher in AF group [AF vs non-AF: NT-proBNP, 1048 pg/ml vs 162 pg/ml (p<0.0001); cTnI, 0.0003 ng/ml, vs 0.0 ng/ml (p<0.0001); hsCRP, 1.43 ug/ml vs 0.88 ug/ml (p=0.0005)], whereas median level of VEGF-C was lower in AF group [3107 pg/ml vs 3590 pg/ml (p<0.0001)]. AF was associated with lower VEGF-C and higher hsCRP after adjustment for potential confounders. During the 3-year follow-up, 29 (11.1%) patients in AF group and 136 (6.3%) patients in non-AF group developed MACE (p=0.007). Incidence of stroke was higher in AF group (17 (6.5%) vs 52 (2.4%); p<0.0009), despite that the incidence of cardiovascular death and myocardial infarction were similar between the groups. We divided the entire cohort into two groups based on the lowest quartile of VEGF-C or highest quartile of other biomarkers, lowest quartile of VEGF-C (log rank p=0.0004), as well as highest quartile of cTnI (log rank p=0.0009), were significantly associated with MACE in AF group. After adjustment for established risk factors and these biomarkers, both lowest quartile of VEGF-C (HR, 2.73; 95% CI, 1.27–6.06) and highest quartile of cTnI (HR, 2.54; 95% CI, 1.08–6.09) were significantly associated with MACE in AF group.

Conclusions
AF was associated with lower level of VEGF-C, and low VEGF-C as well as high cTnI might serve as an independent predictor of MACE in patients with AF and suspected or known CAD.
P3771Validation of risk scoring system predicting for progression of atrial fibrillation: the Fushimi AF Registry
Authors: Ogawa H , An Y , Ishigami K , Aono Y , Ikeda S , Doi K , Ishii M , Iguchi M , Masunaga N , Esato M , Wada H , Hasegawa K , Abe M , Akao M 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) increases the risks of thromboembolism and death. Progression from paroxysmal to sustained types (persistent or permanent) of AF is sometimes seen in clinical practice. We recently reported that progression of AF was associated with increased risk of clinical adverse events in Japanese AF patients. However, risk stratification schemes of predicting the progression of AF has not been fully established.

Methods
The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, Kyoto, which is a typical urban district of Japan with a population of 283,000. Follow-up data were available for 4,454 patients. We investigated the risk factors of AF progression and validated the performance of various risk scoring systems predicting for progression of AF, such as APPLE, BASE-AF2, HATCH, and MB-LATER score, using data from 995 paroxysmal AF patients (mean age; 72.6±11.4 years, female; 42.2%, mean CHA2DS2-VASc score; 3.26±1.67) whose echocardiogram data were obtained at baseline.

Results
Of 995 AF patients, during the median follow-up of 1,477 days, progression from paroxysmal to sustained AF occurred in 160 patients (16.1%; 4.0 per 100 person-years). On a multivariate model, we indicated that history of AF ≥2 years (odds ratio [OR] 1.83; 95% confidence interval [CI] 1.28–2.61), left atrial diameter ≥40 mm (OR 1.45; 95% CI 1.02–2.08), daily drinker (OR 1.56; 95% CI 1.24–2.81), and cardiomyopathy (OR 2.58; 95% CI 1.17–5.69) were significantly associated with higher incidence of AF progression. Our model had better predictive potential for AF progression (area under curve [AUC] 0.612; 95% CI 0.566–0.658) than the APPLE (AUC 0.553; 95% CI 0.508–0.598; p=0.06), BASE-AF2 (AUC 0.571; 95% CI 0.526–0.617; p=0.04), CHADS2 (AUC 0.508; 95% CI 0.462–0.554; p<0.01), CHA2DS2-VASc (AUC 0.501; 95% CI 0.453–0.548; p<0.01), HATCH (AUC 0.502; 95% CI 0.456–0.548; p<0.01), and MB-LATER (AUC 0.528; 95% CI 0.483–0.572; p<0.01) score.

Conclusion
We identified 4 risk factors which may be useful to predict for progression of AF in Japanese patients. External validation of our model in other cohorts is needed.

Acknowledgement/Funding
Boehringer, Bayer, Pfizer, Bristol-Myers, Astellas, AstraZeneca, Daiichi Sankyo, Novartis, MSD, Sanofi and Takeda. Japan Agency for Medical Research
P3776Blood pressure variability and incidence of new-onset atrial fibrillation
Authors: Choi E.-K , Lee S R , Han K D , Oh S 
Published: October 2019

Abstract

Background
Visit-to-visit blood pressure (BP) variability is a known risk factor for stroke, but the association between BP variability and atrial fibrillation (AF) incidence is uncertain. We sought to evaluate the association between BP variability and incident AF.

Methods
We identified 8,063,922 subjects (mean age 48 years; 59% men) who had ≥3 health checkups provided by the Korean National Health Insurance Corporation between 2004 and 2010. Systolic and diastolic BP variability was defined as variability independence of the mean (VIM). VIM was divided into four groups and high variability of BP was defined as the highest quartile values. The primary end point was new-onset atrial fibrillation.

Results
During a mean 7 years of follow-up, 140,086 subjects were newly diagnosed with AF (2.53 per 1000 person-years). High variation in BP was associated with an increase in the risk of AF (SBP: hazard ratio [HR], 1.060; 95% confidence interval [CI], 1.044–1.075, DBP: HR, 1.066; 95% CI, 1.050–1.082) compared with subjects with lowest quartile of BP. Among subjects with high variation both in SBP and DBP, the risk of AF was 7.6% higher than subjects without high variation in SBP and DBP. The risk of high BP variation on new-onset AF was more obvious in high-risk patients. The association of high BP variability with AF was being stronger for high-risk subjects who were older (≥65 years), with diabetes, or with CKD compared with subjects who were younger, without diabetes, or without CKD.

Conclusions
Fluctuation in SBP and DBP was associated with higher incidence of AF, especially in high-risk subjects, independent of traditional AF risk factors.
P3795Should we also screen for obstructive sleep apnea in patients presenting with excessive supraventricular ectopic activity?
Authors: Marinheiro R , Parreira L , Amador P , Mesquita D , Farinha J , Fonseca M , Esteves A , Pinheiro A , Sousa S , Silva M , Lopes C , Chambel D , Santos B , Carradas C , Caria R 
Published: October 2019

Abstract

Background
It is recommended to consider obstructive sleep apnoea (OSA) screening in atrial fibrillation (AF) patients with risk factors, due to the strong evidence of an association between these two entities. Excessive supraventricular ectopic activity (ESVEA) has been proposed to be a risk factor for AF. However, strong evidence between ESVEA and OSA has not been established.

Objective
We aimed to determine if ESVEA is associated with moderate to severe OSA since its treatment may prevent AF.

Methods
We studied patients who performed polysomnography and 24-hour Holter monitoring. Patients with atrial fibrillation were excluded. ESVEA was defined as more than 30 PACs per hour (frequent PACs) or runs of >4 consecutive PACs. The circadian pattern of PACs was also evaluated. Sleeping hours were used to define “nocturnal”. Moderate to severe OSA was defined when polyssonography demonstrated a apnoea/hypopnoea index (AHI) >15. We examined the association between ESVEA and moderate to severe OSA during wakefulness and sleep.

Results
We studied 290 patients [median age 65 (55–72) years, 62% males, body mass index (BMI) 30 (27–34)]. 112 (38%) had moderate to severe OSA. Median AHI was 11 (5–24) and mean oxygen saturation was 94% (92–95). Median PACs was 35 (9–117) and 29 patients (10%) had frequent PACs. Runs of >4PACs occurred in 114 patients (39%). Forty-three patients (15%) had predominant nocturnal PACs and 42 (14%) had nocturnal runs of PACs. Multivariate logistic regression analysis demonstrated only nocturnal PACs were associated with moderate to severe OSA (p=0.027) (table 1).
Multivariate logistic regression Odds Ratio 95% Confidence Interval p-value Male gender 4.49 2.48–8.17 <0.001 Body mass index (kg/m2) 1.09 1.03–1.15 0.002 Nocturnal PACs 4.12 1.17–14.46 0.027 Variables not included in the model: age, number of PACs/h, frequent PACs (>30 PAcs/hour), runs of PACs (>4 consecutive PACs), nocturnal frequent PACs and nocturnal runs of PACs.

Conclusion
OSA screening in patients presenting with nocturnal PACs should be routinely considered, especially in male and obese. Treating moderate to severe OSA patients with CPAP has a potential benefit in preventing ESVEA and consequently AF.
P3798High levels of C-reactive protein after coronary artery bypass graft surgery is associated with postoperative atrial fibrillation
Authors: Olesen O J , Vinding N E , Oestergaard L , Butt J H , Gislason G H , Torp-Pedersen C , Koeber L , Fosboel E L 
Published: October 2019

Abstract

Background
Postoperative atrial fibrillation (POAF), a common complication following coronary artery bypass graft (CABG) surgery, is associated with increased morbidity and mortality. Inflammation seems to be an important pathogenic factor and elevated preoperative levels of C-reactive protein (CRP) are associated with POAF. However, the association between postoperative CRP and POAF is less established.

Purpose
To examine the association between postoperative levels of CRP and POAF after CABG.

Methods
Patients undergoing first-time isolated CABG (Jan 01, 2000 to Dec 31, 2016) were identified using Danish nationwide administrative registries. Patients with CRP measurements from the fourth postoperative day and no history of atrial fibrillation were included. POAF was defined as a postoperative atrial fibrillation rhythm that required medical therapy or cardioversion, with patients being followed for POAF until discharge. The study population was divided into quartiles based on CRP levels. A Cochran-Armitage trend test was used to examine the trend of increased levels of CRP and the associated risk of POAF. The association between CRP levels and POAF was investigated using a multivariable logistic regression analysis adjusted for other patient characteristics.

Results
The study included 6,711 patients with mean CRP values from the lowest to the highest CRP groups being 66, 109, 150 and 228 mg/L, respectively. Patients in the highest CRP group were older and more likely to be male compared with the lowest CRP group (median age 67 years [P25-P75: 61–73] and 84.7% men vs. median age 64 years [P25-P75: 56–70] and 77.9% men). In the highest CRP group, 35% of patients developed POAF vs. 25% in the lowest CRP group. A dose-response relationship was seen between increasing levels of CRP and the associated risk of POAF (p<0.0001 for trend). An adjusted analysis showed a statistically significant association between the highest CPR group and POAF (OR: 1.44; 95% CI: 1.24–1.69) compared with the lowest CRP group (figure 1).

Conclusion
High postoperative CRP levels after CABG were associated with POAF development. Future studies may examine whether CRP also predicts worse outcomes and whether these factors could be modified in the development of POAF.

Acknowledgement/Funding
Internal grant from Copenhagen University Hospital
P3801The impact of the type of response to cardiac resynchronization therapy in the survival of patients with advanced heart failure
Authors: Camanho L , Slater C , Oliveira Jr L A , Carvalho Dias L , Saad E B , Mourilhe-Rocha R 
Published: October 2019

Abstract

Fundamental
Cardiac resynchronization therapy (CRT) reduces total mortality in patients (pt) with advanced heart failure (HF). However, the impact of this reduction is unknown in the different types of response.

Objective
To describe the survival of responders and super responders pt to CRT in a retrospective cohort.

Methods
250 pt who underwent a CRT were retrospectively evaluated. All presented in functional class (FC) III/ IV (NYHA). The criteria of response to CRT were: improvement of FC (>1); increase in ejection fraction (EF) >10% and decrease in left ventricular end-systolic diameter (LVESD) – >15%. They were divided into three groups: Group I – 73/250 pt (33%): responder only by the criterion of FC improvement. Group II - 57/250 pt (24%): responder was defined by three criteria (clinical and echocardiographic). Grupo III - super responder – 48/250 pt (20%): decrease >30% in LVESD and/or EF >45%. The survival and clinical outcomes were analyzed in the 3 groups.

Results
In group I, the mean age was 68.7 years; 75% were male; left bundle branch block (LBBB) was observed in 93% and average QRS duration was 164 ms; EF: 26%; average LVESD and left ventricular end-diastolic diameter (LVEDD): 46 and 57.7 mm, respectively. BIV-ICD was observed in 72% of pt. The mean post-implant survival was 30.8 months (CI95%: 25.06–36.54). In group II, the mean age was 70 years; 82% were male; left bundle branch block (LBBB) was observed in 98% and average QRS duration was 166 ms; EF: 27.5%; average LVESD and LVEDD: 52 and 67 mm, respectively. BIV-ICD was observed in 75% of pt. The mean post-implant survival was 45.4 months (CI95%: 38.96–51.84). In group III, the mean age was 71 years; 65% were male; left bundle branch block (LBBB) was observed in all pt (100%) and average QRS duration was 176 ms; EF: 29.2%; average LVESD and LVEDD: 54 and 68 mm, respectively. BIV-ICD was observed in 70% of pt. The mean post-implant survival was 53 months (CI95%: 45.96–60.04). The total mortality observed was 11%, 17% and 6.25%, respectively (48%: neoplasia; 24%: stroke; 19%: terminal HF; 9%: sepsis).

Conclusion
In the present study, the survival of responders pt to CRT varied according to the type of response, being significantly higher in the super responders and in those who presented echocardiographic criteria of response to CRT. These findings present significant clinical relevance and should be evaluated in future studies.
P3803New predictive score for clinical prognosis in non-ischemic cardiomyopathy patients with cardiac resynchronization therapy
Authors: Yang S , Hua W 
Published: October 2019

Abstract

Objective
To derive and validate a prediction score for clinical prognosis in non-ischemic cardiomyopathy (NICM) patients receiving cardiac resynchronization therapy (CRT).

Methods
A cohort of 422 consecutive NICM patients with CRT were retrospectively enrolled from January 2010 to December 2017, randomly categorized into the derivation group (n=338) and the validation group (n=84). Primary endpoint defined as all-cause death and heart transplantation. A new score was established based on the β coefficients of each risk factor.

Results
High sensitive C-response protein [hazard ratio (HR):1.081, 95% confidence interval (CI): 1.029–1.134 P=0.002], left atrial diameter (HR: 1.056, 95% CI: 1.020–1.093, P=0.002), non-LBBB (HR: 1.793, 95% CI: 1.131–2.844, P=0.013), N-terminal pro-B-type natriuretic peptide per 100 pg/ml (HR: 1.018, 95% CI: 1.007–1.030, P=0.002), were independent predictors for primary endpoint. A new prediction score, HALP score, showed significant difference of primary endpoint among different risk groups (log-rank test, all P<0.01) by Kaplan-Meier curve; Compared with three prior models, HALP scores had adequate discrimination [AUC: 0.738 (95% CI: 0.680–0.794)] and good calibration for all caused death and heart transplantation.
Table 1. Predictors of all-cause mortality and heart transplantation risk by uni- and multivariate Cox proportional hazards models in deviation datasets Variables Univariate Multivariate HR (95% CI) P-value HR (95% CI) P-value Age 0.992 (0.972–1.012) 0.423 Sex (male) 1.821 (1.091–3.041) 0.022 Non-LBBB 2.260 (1.438–3.552) <0.001 1.793 (1.131–2.844 0.013 Type of device (CRT-D) 1.592 (1.009–2.512) 0.046 Atrial Fibrillation 1.797 (1.055–3.062) 0.031 NYHA function class IV 1.878 (1.105–3.191) 0.020 AST 1.014 (1.000–1.027) 0.045 HS-CRP 1.106 (1.055–1.160) <0.001 1.081 (1.029–1.134) 0.002 NT-proBNP per100 1.029 (1.020–1.039) <0.001 1.018 (1.007–1.030) 0.002 Big Endothelin-1 1.973 (1.350–2.882) <0.001 Creatinine 1.007 (1.001–1.013) 0.015 Uric acid 1.001 (1.000–1.003) 0.144 LA 1.084 (1.051–1.117) <0.001 1.056 (1.020–1.093) 0.002 LVFE 0.975 (0.950–1.000) 0.054 LVEDD 1.032 (1.011–1.053) 0.003
Figure 1. Comparison of different scores

Conclusion
HALP score system may be an effective model for clinical prognostics in NICM patients with CRT.

Acknowledgement/Funding
None
P3806Very long-term and late response to CRT: is left ventricular ejection fraction a powerful indicator of sustained and late response?
Authors: Kahr P C , Kaufmann P , Kuster J , Tonko J , Breitenstein A , Flammer A , Ruschitzka F , Steffel J , Winnik S 
Published: October 2019

Abstract

Background
Cardiac-resynchronization therapy (CRT) reduces morbidity and mortality in selected symptomatic patients with reduced left ventricular ejection fraction (LVEF) and wide QRS complex. While many patients demonstrate a response to CRT within the first year of follow-up, sustained or late response to CRT is highly relevant but poorly characterized.

Purpose
To characterize the patient population that demonstrates improvements of LVEF late after CRT implantation, irrespective of the primary response, and to identify factors associated with beneficial long-term outcome.

Methods
All patients undergoing CRT implantation at our institution between Nov 2000 and Jan 2015 with at least two follow-up echocardiographic studies were included. Primary follow-up (FU1) was performed within one year after CRT implantation (median 6.1 months [IQR: 3.5–10.7]). The most recent echocardiography at a median follow-up time of 3.9 years [27.3–70.4] was considered as long-term follow-up (FU2). LVEF-based response to CRT was stratified into 4 categories: non-response (ΔLVEF <−5%), non-progression (−5% to +5%), response (+6 to +15%) and super-response (>+15%). Primary study endpoint was the composite of all-cause death, heart transplantation or implantation of a ventricular assist device.

Results
Out of 362 patients (median age 65.9 years, 23% female, 41% with ischemic cardiomyopathy), 99 (27.3%) demonstrated LVEF improvements beyond their primary response to CRT (blue bars in figure). At baseline, late responders demonstrated lower LVEF (23.4% [19.0–30.0] vs. 27.0 [22.0–32.0], p=0.005) and an increased prevalence of non-ischemic cardiomyopathy (67.8% vs. 55.9%, p=0.042) compared to the remaining patients. Reduction in LVEDV(I) at FU1 correlated positively with late response (ΔLVEDV −28.5 ml [−71.8; −3.25] vs. 18.0 [−46.0; 3.0], p=0.033). Importantly, late responders were seen amongst all types of primary response, including patients demonstrating a negative response with substantially worsened LVEF at first follow-up after CRT implantation. Finally, patients with late response demonstrated significantly better survival compared to patients with late progression of heart failure or continued non-progression (median survival 7.8 [7.1–8.5] vs. 7.0 [6.6–7.5] years, aHR 0.54 [0.33–0.88] p=0.013 on multivariate cox regression analysis).

Conclusions
A significant proportion of patients achieves LVEF improvements beyond the initial phase after CRT implantation indicating a substantial limitation in categorizing patients into “responders” and “non-responders” based on the initial response to CRT. Further prospective studies are required to validate these findings and optimize treatment strategies for CRT patients.