bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1707Non-business hours and cold exposure independently worsen neurological outcome after out-of-hospital cardiac arrest
Authors: Uechi T , Shibata S , Suda T , Hata N , Hirabuki K , Tsukada T , Hirasawa A , Matsuda T 
Published: October 2019

Abstract

Background
It has been known that survival rates after out-of-hospital cardiac arrest (OHCA) are lower at night than during the day. It may be explained by diurnal temperature changes.

Purpose
The purpose of the present study was to test our hypothesis that diurnal variation of the prognosis after OHCA would be independent from the ambient temperature changes.

Methods
We used the All-Japan Utstein Registry (2005–2010) combined with atmospheric temperature from the Automated Meteorological Data Acquisition System, and enrolled adult OHCA patients who had suffered from a witnessed cardiac arrest and who had been resuscitated.
The primary outcome was a favorable neurological outcome one month after OHCA and the secondary outcome was the presence of return of spontaneous circulation (ROSC) before hospital admission. Effects of business vs. non-business hours and ambient temperature on the primary and secondary outcomes were assessed with adjustment for factors that are known to potentially affect OHCA outcomes. Sub-group analysis based on the initial cardiac rhythm (VT/Vf, PEA and Asystole) was also performed.

Results
Among the 263,750 witnessed OHCA patients, neurological survival and ROSC rates were significantly increased with an adjusted odds ratio (OR) of 1.13 (95% CI 1.08–1.18) and hazard ratio (HR) of 1.06 (95% CI 1.04–1.09) for non-business hours, and OR of 1.11 (95% CI 1.05–1.17) and HR of 1.05 (95% CI 1.02–1.08) for each 20°C increase in temperature. The effects were different between business vs. non-business hours and ambient temperature dependent on the initial cardiac rhythm.

Conclusions
These findings suggest that both the outdoor temperature and business hours are independent factors for predicting neurological outcomes after OHCA with different characteristics based on the initial cardiac rhythms. Diurnal variability of prognosis after OHCA is likely to be attributable to diurnal variation of medical resources.
P1726A gender perspective on incidence, management, short- and long term outcome of cardiogenic shock complicating ST-elevation myocardial infarction - A report from the SWEDEHEART register
Authors: Sederholm Lawesson S , Venetsanos D , Fredriksson M , Jernberg T , Johnston N , Ravn-Fischer A , Alfredsson J 
Published: October 2019

Abstract

Background
Cardiogenic shock [CS] is a severe complication of ST-elevation myocardial infarction [STEMI]. An increased use of primary percutaneous coronary intervention [PPCI] has been associated with a decline in CS incidence, and a better prognosis. Female gender has been associated with a worse prognosis in STEMI, but whether there is a gender difference in incidence and outcome of CS complicating STEMI is not known.

Purpose
The objectives of this study were to compare the genders regarding incidence, management, and prognosis of CS complicating STEMI.

Methods
Patients with STEMI and CS were identified in SWEDEHEART 2005–2014. Cardiogenic shock was defined as any of; 1) systolic blood pressure [BP] <90 mm Hg ≥30 min, 2) signs of tissue hypoperfusion, 3) cardiac index <1,8 l/min/m2, 4) ionotropic drugs and/or need of intra-aortic balloon pump. Multiple logistic and cox regression analyses were done with reperfusion therapy, in-hospital and 1-year mortality as dependent variables.

Results
Among 56072 STEMI patients 3134 CS cases were identified. Women more often than men developed CS (6.3 vs 5.2%, p<0.001). The age-adjusted incidence of CS did not change in women, whereas in men the incidence increased by 2.7% yearly. Women had a less chance of receiving reperfusion therapy, OR 0.77 (95% CI 0.65–0.92), but had neither higher in-hospital mortality (OR 1.01, 95% CI 0.85–1.19), nor higher 1-year mortality (OR 0.97, 95% CI 0.70–1.33). Upon age stratification the gender difference in reperfusion was only evident among the oldest (>80 years).

Conclusion
Women had higher risk of CS than men when stricken by STEMI, but whereas CS incidence increased in men it was stable in women. Although women had less likelihood of receiving reperfusion therapy, adjusted in-hospital, and 1-year mortality was without any gender difference. The rate of reperfusion was especially low in elderly women, where there seems to be room for improvement.
P1743Assessment of quality of care of patients with ST-segment elevation myocardial infarction in Poland
Authors: Hudzik B , Budaj A , Gierlotka M , Witkowski A , Wojakowski W , Zdrojewski T , Gil R , Legutko J , Bartus S , Buszman P , Dudek D , Gasior M 
Published: October 2019

Abstract

Introduction
2017 ESC Guidelines for the management of ST-elevation myocardial infarction (STEMI) patients have called for the assessment of the quality of care to establish measurable quality indicators in order to ensure that every patient with STEMI receives the best possible care. We investigated the quality indicators of health care services in Poland provided to STEMI patients.

Methods
The Polish Registry of Acute Coronary Syndromes (PL-ACS) is an ongoing, nationwide, multicenter, prospective, observational study of consecutively hospitalized patients with the whole spectrum of ACS in Poland. For the purpose of assessing quality indicators, we included 8,279 patients from the PL-ACS Registry hospitalized with STEMI between January 1 and December 31, 2018.

Results
All emergency medical services (EMS) are equipped with ECG/defibrillators. 408 of 8,279 patients (4.9%) arrived at PCI center by self-transport, 4,791 patients (57.9%) patients arrived at PCI center by direct EMS transport, and 2,900 patients (37.2%) were transferred from non-PCI facilities. Whilst 95.1% of STEMI patients arriving in the first 12 hours received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various STEMI pathways). 7,807 patients (94.3%) underwent PCI as a mode of primary reperfusion strategy. The median left ventricular ejection fraction (LVEF) was 46% and was assessed before discharge in 86.0% of patients. 489 of 8,279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50–85% of patients depending on various clinical settings. Only one in two STEMI patient is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the PL-ACS Registry.
Figure 1

Conclusions
The results of this study identified areas of healthcare systems that require solid improvement. These include prehospital ECG decision strategy, direct transport to PCI center, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. More importantly, we recognized an urgent need for the initiation of recording quality indicators associated with patient-reported outcomes.
P1757GLP-1 levels predict cardiovascular risk in patients with acute myocardial infarction
Authors: Kahles F , Rueckbeil M V , Mertens R W , Foldenauer A C , Arrivas M C , Moellmann J , Lebherz C , Biener M C , Giannitsis E , Katus H , Marx N , Lehrke M 
Published: October 2019

Abstract

Background
Glucagon-like peptide 1 (GLP-1) is a gut incretin hormone, which induces post-prandial glucose-dependent insulin secretion. GLP-1 receptor agonists improve cardiovascular outcomes in patients with diabetes at high cardiovascular risk. We recently found GLP-1 levels to be increased in patients with acute myocardial infarction.

Purpose
The aim of this study was to assess the predictive capacity of GLP-1 for cardiovascular outcome in patients with myocardial infarction.

Methods
Total GLP-1 levels, NT-proBNP concentrations and the Global Registry of Acute Coronary Events (GRACE) score were assessed at time of admission in 918 patients with myocardial infarction presenting with acute chest pain. Among these 597 patients presented with NSTEMI and 321 with STEMI. The primary composite outcome of the study was the first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke with a median follow-up of 311 days.

Results
Kaplan-Meier survival plots (separated by tertiles with cut-off values 35.44 and 53.45) and univariate cox regression analyses found GLP-1 values to be associated with adverse outcome (combined endpoint and all-cause mortality) (logarithmized GLP-1 values HR: 5.459; p<0.0001). Further adjustment for age, sex, previous cardiovascular disease, diabetes, hypertension, hypercholesterinemia, kreatinin, CRP, troponin T and NT-proBNP levels did not affect the association of GLP-1 with adverse outcomes (p=0.0341). Receiver operating characteristic curve analyses illustrated that GLP-1 is a strong indicator for early events (area under the curve of the combined endpoint at 7 days: 0.79; 14 days: 0.81; 30 days: 0.80 and 183 days: 0.64), which proved to be superior to Troponin T, serum creatinin, NT-proBNP and CRP within the first 100 days. Adjustment of the GRACE risk estimate by GLP-1 increased the area under the receiver-operating characteristic curve (AUC) after 1 month from 0.86 to 0.89 in NSTEMI patients. Addition of GLP-1 to a model containing GRACE and NT-proBNP led to a further improvement in model performance (increase in AUC from 0.88 for GRACE + NT-proBNP to 0.90 for GRACE + NT-proBNP + GLP-1).

Conclusion
GLP-1 is a new biomarker of cardiovascular risk and adverse outcomes in patients with acute myocardial infarction and improves the predictive value of the GRACE score in patients with NSTEMI.
P1766Clinical impact of atrial fibrillation and heart failure in a cohort of patients with hypertrophic cardiomyopathy
Authors: Esteve Ruiz I , Llamas Gomez H , Esteve Ruiz I M , Romero Reyes M J , Pavon Jimenez R , Molano Casimiro F J 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) and heart failure (HF) are common complications in Hypertrophic Cardiomyopathy (HCM) patients, leading to a worsening of their quality of life, need of hospitalization and prognosis.

Purpose
To analyze clinical variables associated with the presence of AF and HF in HCM patients.

Methods
HCM patients followed-up in cardiological visits from 2005 to 2017 were included and a descriptive analysis of those with AF and HF was performed.

Results
Out of 168 patients, 28% had reported AF. They were older than those without arrhythmia (68±15 years (yrs) vs 56±20 yrs, p<0.001) and had more comorbidities such as diabetes (27.7% vs 12.4%, p=0.02) and chronic renal disease (21.3% vs 6.6%, p=0.006). Echocardiographic findings are summarized in Table 1.
In our cohort, 27.4% of the patients had HF with a functional class according to the New York Heart Association criteria ≥2. They were older than those without HF (69.3±11.6 yrs vs 55.9±20.6 yrs, p<0.001) and had higher rate of cardiovascular (CV) risk factors such as hypertension (65.2% vs 44.3%, p=0.015). The presence of HF was directly associated with the presence of AF: 52.2% of the patients with HF and 18.9% of the patients without HF developed this arrhythmia (p<0.001). HF patients associated larger left atrial diameter (48±8.1 vs 41.6±7.2mm, p<0.001), myocardial thickness (21.7±3.9 vs 19.2±5.8mm, p=0.002) and higher left ventricular outflow obstruction (LVOO) (55±32 vs 34.3±31.3mmHg, p=0.021), without any differences in the left ventricular ejection fraction. HF patients had a worse prognosis (Picture 1). Multivariate analysis showed that the presence of AF (OR 2.6, CI 95% 1.1–6.3) and LVOO (OR 4.8, CI 95% 1.5–14.8) were independent risk factors of developing HF.
Table 1. Echocardiographic findings AF (n=47) Non AF (n=121) p LVOO 27.7 19 0.22 Aortic regurgitation 12.8 3.3 0.02 Mitral regurgitation 27.7 12.4 0.02 Left atrial diameter (mm) 48.8±7.2 40.7±7 <0.001 Myocardial thickness (mm) 20±5.4 19±5.2 0.02 Qualitative variables are expressed as percentages (%) and quantitative variables as mean and standard deviation (M ± SD).
Picture 1. Main outcomes of HF patients

Conclusions
AF and HF were directly associated in our cohort, especially in elderly patients with higher comorbidities, leading to a worse prognosis with a higher hospitalization rate and CV death. This emphasizes the importance of a thorough search of both complications in order to initiate early treatment and improve the prognosis of HCM patients.
P1776Identifying the ideal MitraClip candidate - a COAPT-derived, retrospective subgroup stratification of a large real-life cohort
Authors: Tigges E , Kalbacher D K , Gossling A G , Ludwig S L , Schofer N S , Conradi L C , Schirmer J S , Girdauskas E G , Reichenspurner H R , Blankenberg S B , Lubos E L 
Published: October 2019

Abstract

Background/Introduction
Recently published, diverging data of the COAPT and Mitra.fr trials yielded discussion on the impact of the magnitude of mitral valve insufficiency and of left ventricular end-diastolic volume index (LVEDVI) in patients with functional mitral regurgitation (FMR) prior to MitraClip intervention on outcome measures.

Purpose
We sought to evaluate the leverage of the effective orifice area (EROA) and LVEDVI on long-term outcome in a real-life cohort.

Methods
We stratified 394 patients (74.4±8.6 years, 60.9% male) that had been treated by MitraClip from 09/2008 to 01/2018 into four subgroups: I (FMR, EROA ≤30mm2 [n=76]), II (FMR, EROA 30–40mm2 [n=87]), III (FMR, EROA >40mm2 [n=105]) and IV (degenerative MR [DMR], n=126). Follow-up was conducted at on-site visits 6 months and annually after MC procedure up to 60 months.

Results
At baseline, patients of subgroup IV were oldest (p=0.0011), while subgroups I to III demonstrated significantly higher rates of any cardiomyopathy (I: 78.4%, II: 93.1%, III: 86.7%, IV: 47.6%, p<0.001). The left ventricular ejection fraction (LVEF) differed significantly (I: 38±13%, II: 35±14%, III: 34±14%, IV: 54±12%, p<0.001), as did EuroSCORE values (median, I: 20.4%, II: 24%, III: 23%, IV: 18.4%, p<0.001). Procedural success (placement of ≥1 Clip, residual MR ≤2+) differed significantly (I: 96.1%, II: 96.6%, III: 89.5%, IV: 87.3%, p=0.039).
Up to 60 month follow-up lasting success was noted in 87.5% (I), 81.8% (II), 87.5% (III) and 77.8% (IV) and all subgroups demonstrated a significant improvement in New York Heart Failure Association classification.
In further stratification according to LVEDVI (A: ≤96ml/m2 and B: >96ml/m2), no differences were noted in Kaplan-Meier estimates for death (A: p=0.36 and B: p=53) or in post-hoc comparison of each group (I-IV). Likewise, the combined endpoint of death and cardiac rehospitalization (A: p=0.18, B: p=0.94), MACE (A: p=0.37, B: p=0.54) and MACCE (A: p=0.16, B: p=0.49) and post-hoc comparisons of each group (I-IV) yielded no significant differences in outcome measures.

Conclusions
Despite distinct differences in baseline characteristics of each subgroup, we observed high procedural success rates, long-lasting reductions of MR and beneficial clinical outcome in all patients. In this retrospective analysis of a real-life cohort, EROA and LVEDVI did not influence long-term outcome measures. These results indicate no limitation for MitraClip treatment based on advanced stages of FMR and its underlying pathology, yet mark the necessity for further pre-procedural stratification.
P1779Quantitation of severe degenerative mitral regurgitation by echocardiography and CMR with acetate PET for external reference for left ventricular volumes
Authors: Baron T , Holm Orndahl L , Kero T , Sorensen J , Bjerner T , Hedin E.-M , Harms H J , Stahle E , Astudillo R , Flachskampf F A 
Published: October 2019

Abstract

Background
Quantitative echocardiographic assessment of severity of primary mitral regurgitation (MR) is challenging. CMR is recommended if MR severity cannot be clearly determined, since quantitation of regurgitation as well as of left ventricular (LV) volumes and function is crucial for the indication for surgery especially in asymptomatic patients.

Purpose
We aimed to compare volumetric measurements obtained from transthoracic echo (TTE) and cardiovascular magnetic resonance (CMR) using ECG-gated [(11)C]acetate PET as reference for assessment of LV volumes.

Methods
A total of 51 asymptomatic patients with severe primary mitral regurgitation underwent TTE, CMR and PET on the same day. Mitral regurgitant volumes (RVol) were measured by TTE using proximal convergence (PISA) method and by CMR, subtracting aortic forward flow volume from LV stroke volume. LV volumes were measured by TTE, CMR and PET.

Results
Despite a fair correlation between regurgitant volumes measured by TTE and CMR (r=0.53, p<0.001), PISA method heavily overestimated regurgitant volumes on TTE as compared to CMR (103±60ml vs. 78±35ml, p<0.001). TTE systematically underestimated LV volumes as compared to CMR (see table) despite a good correlation (r=0.81, 0.67 and 0.76 respective for LV EDV, ESV and SV, p<0.001 for all). There was no difference in LV EF between the methods. LV volumes obtained by CMR and PET showed a strong correlation (r=0.92, 0.79 and 0.89 respective for LV EDV, ESV and SV, p<0.001 for all) and agreement (see table).
Comparison of TTE, CMR and PET TTE CMR PET PET TTEvs.CMR PET CMRvs.PET F-test LV EDV, ml 145±34 241±57 234±51 <0.001 0.004 <0.001 LV ESV, ml 47±11 76±22 81±23 <0.001 0.067 <0.001L LV SV, ml 99±26 164±38 152±34 <0.001 <0.001 <0.001 LV EF, % 68±5 69±5 65±6 0.236 <0.001 <0.001

Conclusions
As compared to CMR, PISA method used by TTE substantially overestimates regurgitant volumes in patients with asymptomatic primary mitral regurgitation. Conversely, LV volumes in spite of good correlation are heavily underestimated by TTE in comparison with CMR. A strong correlation and agreement between LV volumes measured by CMR and PET confirms the accuracy of the former method which is considered as a golden standard for assessment of ventricular function and volumes. Thus, even so-called quantitative echo measures should be understoas essentially semi-quantitative indicators of severity.
P1810May early myocardial involvement detection in chagas disease have a prognosis impact?
Authors: Fernandez Valledor A , Jorda P , Pajuelo C , Vinas D , Hernandez J , Culotta V , Pinazo M J , Posada E , Aldasoro E , Gascon J , Sitges M , Garcia Alvarez A N A 
Published: October 2019

Abstract

Background
Brain natriuretic peptide (BNP) and novel echocardiographic techniques such as speckle-tracking and a comprehensive evaluation of diastolic function can detect early myocardial involvement in patients with Chagas disease. However, there is lack of longitudinal studies that can confirm whether this early myocardial involvement translates into a worse prognosis.

Purpose
To assess if early myocardial involvement detected by BNP or a comprehensive echocardiographic evaluation was associated with future events in Chagas disease.

Methods
182 consecutive individuals from endemic areas who underwent T. cruzi screening where prospectively included from 2007 to 2014. ECG, BNP and a comprehensive echocardiography including diastolic function and longitudinal myocardial strain were performed. Four different groups were defined: healthy controls (N=77); Chagas indeterminate form (positive serology, normal ECG and left ventricle (LV) diameter (<55 mm), LV ejection fraction (>50%) and no segmental abnormalities, N=88); Chagas patients with abnormal ECG but normal LV dimensions and motility (N=7); and Chagas patients with LV diameter>55 mm or LV ejection fraction<50% or segmental abnormalities (N=13). The primary outcome included advanced atrioventricular block, sustained ventricular tachycardia, heart failure, heart transplant or death. Kaplan Meier with Long rank test and Cox regression analysis was used.

Results
Mean age was 37±9 and 34% were male. Median follow-up was 63 months (range 1 to 137). The primary endpoint occurred in a total of 11 (10%) individuals: 2 (2.4%) in the Indeterminate group; 3 (43%) in the abnormal ECG group; and 6 (46%) in the group with abnormal LV dimension or motility, with no events among controls (long-rank test<0.01, Figure). In the global population, age, BNP, diastolic dysfunction parameters and longitudinal strain at the inferior and lateral walls were significant predictors. In the cohort of Chagas patients with normal standard echocardiography (N=92), ECG abnormalities (HR=49, p=0.001), Em (HR=0.68, p=0.03), deceleration time (HR=0.01, p=0.01), left atrial diameter (HR=1.24, p<0.01) and longitudinal strain at the midventricular lateral wall (HR=0.75, p=0.028) remained significantly associated with outcome.
Cumulative survival without events

Conclusions
Outcome was significantly more frequent in Chagas patients with abnormalities in ECG or standard echocardiography. In early forms of the disease, myocardial involvement detected by BNP or a comprehensive echocardiography was associated with prognosis, and may help to individualize treatment and follow-up.
P1814A novel method of transradial approach for left ventricular endomyocardial biopsy
Authors: Lan M I N G , He Q I N G 
Published: October 2019

Abstract

Background
Left ventricular endomyocardial biopsy (LV-EMB) may offer a superior diagnostic yield compared with right ventricular endomyocardial biopsy (RV-EMB) in conditions predominantly affecting the LV. Recently, transradial way is used for LV-EMB, and it has lower complication rates and has an advantage of immediate post-procedural ambulation compared with transfemoral technique. Previous reports of transradial LV-EMB need relatively complicated sheathless guiding catheter exchanging.

Purpose
We aimed at finding a novel and easier transradial method with a 6F sheath and a 6F guiding catheter.

Methods and results
In this manuscript, we described a method that allowed interventional cardiologists to obtain LV-EMB via transradial access with a 6F sheath and a 6F guiding catheter. This technique was successfully conducted in 25 consecutive patients at our institution. The transradial success rate was 100% (25 of 25). Mild or moderate radial artery spasm occurred in only 1 (4%) patient, but no severe radial spasm was observed. All the patients were performed coronary angiography and left ventricular angiogram according to the indication, and they were performed EMB through the same radial sheaths without sheathless guiding catheter exchanging. Heparin was administered to 100% of patients at a dose of 5000IU. Median fluoroscopy time was 13.45min. Median total skin dose was 1478mGy. Median area product was 15486 cGy·cm2. All biopsy samples were graded as excellent quality. Immediate patient mobilization could be achieved in all patients. Radial artery patency was confirmed by doppler ultrasonography 24 hours after the sheath removal. There were no major complications (pericardial tamponade, life-threatening arrhythmia, cerebrovascular accident or death).
Transradial LV-EMB with a 6F sheath

Conclusions
The present article demonstrates a result of feasibility, safety and efficacy of a novel transradial access for LV-EMB using a 6F sheath and a 6F guiding catheter. This is of clinical importance since this new technique may overcome the currently existing methods, and may be regarded as an interventional “one stop shop” technique.