bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1455Atrial fibrillation detection by integrated trans-telephonic ECG monitoring after cryptogenic stroke in the years 2016–2018 in the Czech and Slovak Republics
Authors: Bulkova V , Sanak D , Tomek A , Brozman M , Gandalovicova J , Kovarikova D , Pelikanova V , Mikulik R , Nevsimalova M , Monhart Z , Palanova A , Taborsky M , Linhart A , Fiala M 
Published: October 2019

Abstract

Background
Cryptogenic strokes can be estimated to ∼3500 patients in the Czech (CZ) and 2000 patients in Slovak (SK) republics. Systematic screening in these patients and methods of ECG monitoring are generally uneven across different hospitals and districts.

Purpose
Assessment of integrated screening for atrial fibrillation (AF) after cryptogenic stroke was launched in collaboration with Czech Society of Cardiology and stroke centers in the year 2016.

Methods
Patients with stroke of unknown source within the last 3 weeks, and without AF/atrial tachycardia (AT) detected during in-hospital ECG monitoring, were referred by stroke centers into integrated database of the MDT center, who subsequently contacted the patients and shipped the loop/continuous ECG recorder (Vitaphone, Faros, ECGPocket) with automatic data transmission over cell phone to them directly home or into aftercare unit. ECG monitoring was scheduled for 3 weeks, and the data were regularly edited and evaluated to inform the referring stroke centers in case of AF detection. Upon termination of ECG monitoring, the device was returned to the MDT center, and the final report was sent to the referring physician for eventual treatment decision.

Results
The project involved 36 stroke centers in the CZ and 11 centers in SK. A total of 3.120 patients (65±17 years, 46% females) were monitored for 21.6±5.3 days. AF was detected in 308 (9.9%) patients. Additional findings included: AV block II-III in 62 (2%), NSVT over 5 QRS complexes in 249 (8%), sinus pauses over 4 seconds in 17 (0.5%), and regular SVT over 5 minutes in 69 (2.2%) patients. Total monitoring costs amounted to 374 400 € (120 €/patient). In CZ, the counts of monitored patients in 2016, 2017, 2018 were 302, 754, and 1148, which accounted for ∼10%, 21%, and 32%, respectively, of eligible patients.

Conclusion
Systematic screening of patients after cryptogenic stroke with integrated ECG monitoring has become adopted within 3 years to cover 39% of eligible patients in CZ. Besides approximately 10% AF/AT detection, clinically significant arrhythmias were identified in another 13% of patients.
P1461Assessment of remote heart rhythm and arterial blood pressure sampling in professional drivers of public transport
Authors: Bykova A , Chashkina M I , Kopylov P H Y U , Syrkin A L 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) and arterial hypertension are two main causes of stroke. Therefore, screening for these diseases is essential in population and especially in people which professions is related to public safety.

Purpose
The aim of this study was to estimate the prevalence of newly cases of AF and hypertension in professional drivers of public transport working in Moscow.

Methods
From August to September 2018 480 professional drivers of public transport were enrolled in the study. All of them were screened with CardioQVARK monitor attached to iPhone to obtain 1-channel ECGs and photoplethysmograms. Blood pressure was calculated by using waveform and spectral analysis of photoplethysmograms. All ECGs were analyzed automatically and checked by experienced cardiologist. Outpatient counseling was provided to drivers with detected atrial fibrillation or hypertension. During this visit ECG and blood pressure were measured to confirm the remote monitoring results.

Results
Among 480 professional drivers 97,9% (n=470) were male and 2,1% (n=10) female, mean age was 47 years (min – 20, max – 67). 44,6% (n=214) were active smokers and 29,8% (n=143) were obese.
We diagnosed 5 new cases of atrial fibrillation (1%) and 187 (39%) new cases of hypertension. Patients with newly diagnosed AF were male, three of them had newly diagnosed hypertension and CHA2DS2-VASc score – 1. So, in three cases oral anticoagulants therapy was started. The prevalence of hypertension in patients with newly AF was higher (p<0,0001).
In patients with newly diagnosed hypertension 29,2% (n=140) were in grade 1, 8,3% (n=40) – in grade 2 and 1,5% (n=7) – in grade 3 respectively. These patients were significantly older (p<0,0001) and obese (p<0,0001). Antihypertensive therapy was started in all cases.

Conclusion
Although the professional drivers of public transport in Moscow had annually and every day medical check-up, it had been possible to evaluate new cases of AF and hypertension by using remote heart rate and photoplethysmogram monitoring. Remote monitoring of ECG and blood pressure (BP) is useful tool for screening AF and hypertension especially in people which work activities is concerned with public safety. The remote monitoring of ECG and BP in this category had great social and economic outcomes.
P1470Myocardial dysfunction index: a novel myocardial strain parameter for diagnosing myocardial ischemia
Authors: Tanekda S , Asanuma T , Masuda K , Kozuma A , Minami S , Nakayama T , Nakatani S 
Published: October 2019

Abstract

Background and purpose
Peak systolic strain (ε-sys) derived from speckle tracking echocardiography (STE) is a useful parameter for assessing regional contractile dysfunction during acute ischemia. However, low ε-sys does not always indicate myocardial ischemia because of its relatively large variation in segmental normal ranges and intervendor differences. Therefore, comparison of strain before and after an ischemic event and demonstration of a decrease in ε-sys should be necessary to confirm myocardial ischemia, which is not always possible in clinical situations. It is well known that early systolic lengthening (ESL) and post-systolic shortening (PSS) occur during acute ischemia. We hypothesized that ESL and PSS would correlate with the decrease in ε-sys and integrated analysis of ESL and PSS could be useful to diagnose the presence of myocardial ischemia.

Methods
2D short-axis or 3D full-volume images were acquired by Artida at baseline, during flow-limiting stenosis (mean 50±20% flow reduction), and during complete occlusion of the left circumflex coronary artery in 22 dogs (2D-STE = 12, 3D-STE = 10).Circumferential strain was analyzed in the center of risk area, and the absolute value of peak systolic strain (ε-sys), post-systolic strain index (PSI) as a parameter of PSS, and early systolic strain index (ESI) as a parameter of ESL were measured. A new parameter, myocardial dysfunction index (MDI), which was calculated as follows: (ESL amplitude + PSS amplitude)/maximal strain amplitude during the cardiac cycle, was also calculated. The difference in ε-sys between at baseline and during ischemia (Δε-sys) was measured and the diagnostic accuracy for estimating Δε-sys < −3% was assessed by the receiver operating characteristics (ROC) curve analysis.

Results
During ischemia, ε-sys decreased from 19±3 to 12±6% and MDI increased from 2±4 to 27±30%. MDI was significantly correlated with Δε-sys (2D-STE: r=−0.80, 3D-STE: r=−0.83, p<0.01, respectively) (Figure). The area under the curve (AUC) of MDI for estimating Δε-sys < −3% tended to be larger than those of ESI and PSI (MDI: 0.9, ESI: 0.73, PSI: 0.85).
Figure 1

Conclusions
The novel parameter, MDI was correlated with the decrease in ε-sys during acute ischemia. Integrated analysis of ESL and PSS may be useful for diagnosing the presence of myocardial ischemia.
P1490Exercise lung ultrasound in patients with exertional dyspnea: pilot study
Authors: Malek J , Vecera J , Kubrycht M , Matejka J , Vojtisek P 
Published: October 2019

Abstract

Purpose
The aim of the present study was to test the correlation of the exercise lung ultrasound (LUS) and B-lines count with clinical, laboratory and echocardiographic parameters among patients with preserved left ventricle ejection fraction and without signs of congestion reffered for cardiopulmonary exercise test (CPET) for exertional dyspnea.

Methods
The study population consisted of 39 patients (age 63.0±9.3 years; 62% females) with preserved ejection fraction (≥50%) and without signs of congestion reffered for exercise testing. Pulmonary disease and coronary artery disease was ruled out. CPET, rest and stress echocardiography and B-lines count assessed by 8 zone LUS were performed.

Results
Exercise B-lines count was significantly higher than rest B-lines count (3.1±0.5 vs. 1.1±0.2; p<0.001). No correlation was found between B-lines count and peakVO2, workload, NT-proBNP. Among echocardiographic parameters only left atrium diameter correlated weakly (r=0.35; p=0.027) with exercise B-lines count. Difference between rest and exercise B-lines count correlated weakly with VE/VCO2 (r=0.41; p=0.015).
Characteristics of study population <3 B-lines (n=22) ≥3 B-lines (n=17) p Age (years) 62.2±6.2 64.1±12.1 NS Females (n; %) 16 (72.7%) 8 (47.1%) NS DM (n; %) 3 (14%) 1 (6%) NS Arterial hypertension (n; %) 15 (68%) 14 (82%) NS BMI (kg/m2) 29.4±5.7 31.3±3.3 NS NYHA class 1.9±0.5 2.0±0.4 NS HFpEF (n; %) 8 (57.1%) 8 (42.1%) NS NT-proBNP (pg/ml) 240.0±472.8 275.4±323.1 NS E/e' 9.8±2.7 10.4±2.2 NS Left atrial diameter (mm) 36.4±4.7 39.4±4.6 p=0.039 LVEF (%) 62.9±5.6 60.6±4.7 NS PeakVO2 (ml/kg/min) 20.2±5.7 19.5±3.6 NS VE/VCO2 32.3±5.7 35.9±6.2 NS WR (W/kg) 1.7±0.5 1.5±0.3 NS DM = diabetes mellitus; LVEF = left ventricle ejection fraction; WR = workload.
Rest and peak exercise B-lines count

Conclusion
We observed weak but significant correlation between exercise B-lines count and left atrium diameter. However we didn't observe significant difference between HFpEF patients and rest of study population in B-lines count. Limitation of our observation is small study population.
P1514Evaluation of endothelial progenitor cells as cardiovascular prognostic biomarkers in hemodialysis patients
Authors: Infante T , Bruzzese G , Schiano C , Lucchese R , Alfano R , Faenza M , Nicoletti G F , Napoli C 
Published: October 2019

Abstract

Background
Endothelial cells arise from endothelial progenitor cells (EPCs), which reside in bone marrow vascular niches, and are classified according to specific functional differences. Oxidative stress and inflammation lead to endothelial dysfunction that is a critical event in the initiation and progression of atherosclerotic plaques. Patients with chronic renal failure frequently show endothelial dysfunction and are at a greatly increased risk of developing atherosclerosis. Owing to their ability to partially restore vascular damage, both the number and functional changes in EPCs may be considered as useful prognostic biomarkers of cardiovascular events in hemodialysis (HD) patients.

Purpose
This study investigated EPC features and several biomarkers of systemic vascular inflammation and carotid atherogenesis in hemodialysis (HD) patients.

Methods
We studied 104 HD patients (males=55 and females 49, mean age: 51±12 years) and 40 healthy controls (males=20/females=20; mean age: 52±11 years). Isolated EPCs were cultured in the fibronectin-covered culture dishes and counted. EPC markers were studied by flow cytometry (FACS) by using anti-CD34, anti-CD133 and anti-vascular endothelial growth factor receptor 2 (VEGFR-2) antibodies. Serum levels of intercellular cell adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), IL-6, TNF-α, and asymmetric dimethyl-arginine (ADMA) were measured by ELISA method. Carotid intima-media thickness (CIMT) and ratio (CIMR) were also evaluated.

Results
In our experimental conditions, EPC number was decreased in HD patients when compared to controls (p<0.01). Expression of CD34 was significantly lower in the HD group (p<0.01). Interestingly, EPCs were significantly inversely correlated with serum TNF-α levels in HD patients (r=−0.388, p<0.01) but not in the control group (r=−0.133, p=NS). Furthermore, there was an inverse association between VEGFR-2 positive cells and serum TNF α levels (r=−0.401, p=0.002) in HD patients. In HD patients, there was a positive correlation between ICAM levels with CIMT (r=0.405, p=0.03) and CIMR was positively correlated with VCAM levels (r=0.377, p=0.01) and ADMA (r=0.233, p<0.05).

Conclusions
Our study shows that EPC number was decreased in HD patients and it was associated with systemic inflammation. TNF-α could activate inhibitory actions on EPC in HD patients. A significant relationship was present between ICAM/VCAM and carotid atherosclerosis, while this was not evident with EPC number. These pathogenic mechanisms can contribute to the high incidence of cardiovascular diseases in HD patients. However, further larger studies should investigate this working hypothesis.
P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015)
Authors: Anguita M , Sambola Ayala A , Elola J , Bernal J L , Fernandez C , Ferreiro J L , Bueno H , Marin F , Bonilla J L , Nunez-Villota J , Sanmartin M , Raposeiras S , Jimenez-Navarro M F , Filgueiras D , Ruiz-Ortiz M 
Published: October 2019

Abstract

Background
Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial.

Purpose
To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years.

Methods
We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015.

Results
A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006).
Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval.

Conclusions
Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.
P1519IL6 trans-signalling affects risk of cardiovascular events pre-eminently in men
Authors: Ziegler L , Frumento P , Wallen H , De Faire U , Gigante B 
Published: October 2019

Abstract

Background
Interleukin 6 (IL6) is a known cardiovascular risk marker. The pro-atherogenic effects of IL6 are mediated by the IL6 trans-signalling pathway via a binary complex of IL6 and the soluble IL6 receptor (IL6:sIL6R). The binary complex is however neutralised by the natural inhibitor, sgp130 when forming the ternary complex (IL6:sIL6R:sgp130). To assess the risk of cardiovascular events (CVE) with IL6 trans-signalling, a ratio between the active binary complex and the neutralised ternary complex was calculated. We recently demonstrated that high levels of the binary/ternary complex ratio (b/t ratio > the median) representing an excess of the active binary complex, was independently associated with a 44% increased risk of future CVE in subjects free of prevalent cardiovascular disease.

Purpose
In this study we aimed to analyse the risk of CVE and time to event associated with the b/t ratio in men and women separately.

Methods
In a cohort of 60 year old men and women from Stockholm, the molar concentrations of the binary and ternary IL6 complex were estimated at baseline. Subjects free of prevalent cardiovascular disease were followed through national registers to assess future CVE (myocardial infarction, hospitalised angina pectoris and ischemic stroke). During a 16 year follow-up, 525 first time CVEs were registered. The risk for CVE and time to CVE was calculated for men and women, separately. To evaluate the risk associated with IL6 trans-signalling, the b/t ratio dichotomised at the median was modelled in a Cox regression model and risk was expressed as hazard ratios (HR) with 95% confidence intervals (CI). In addition, analysis was performed using censored quantile regression that allows measuring the effect of covariates on different quantiles of the time to CVE.

Results
Approximately half of the population were men and 64% of the CVE occurred in men. The risk of CVE during follow-up was significantly higher in men with b/t ratio > median (HR 1.70; 95% CI 1.35–2.15), while no significant difference was found in women (HR 1.12; 95% CI 0.84–1.50). Consistently, quantile regression showed that, men with a b/t ratio > median suffered their CVEs at an earlier time point. The time at which 15% of the male population was observed to have experienced CVE was 5.6 years shorter (95% CI: 4.0–7.2) in the high b/t ratio group. In women there was no significant difference in time to CVE.

Conclusion
The risk of CVE and early events associated with IL6 trans-signalling estimated by a b/t ratio >median is significantly increased in men.

Acknowledgement/Funding
The Stockholm County Council ALF project, Strategic research in Epidemiology
P1520Management and outcome of women with NSTEMI. Have there been any changes in recent years?
Authors: Cacho C , Gonzalez Ferrero T , Torrelles Fortuny A , Perez Dominguez M , Abbou Johk C , Antunez Muinos P J , Alvarez Alvarez B , Agra Bermejo R , Rigueiro Veloso P , Garcia Acuna J M , Gonzalez Juanatey J R 
Published: October 2019

Abstract

Introduction
Women have been less represented in every NSTEMI clinical trial. Moreover, it has been observed that this group of patients have usually received less revascularization and evidence based treatment, therefore presenting with a greater long and short-term mortality.

Purpose
The purpose of our study is to analyze the presence of differences in baseline characteristics, management and outcome of women with NSTEMI during the last decade.

Methods and results
Retrospective study including 861 women admitted for NSTEMI between 2003 and 2015 in our center. We divided 2 groups according to hospitalization period (2003–2008 and 2009–2015) with a medium follow up of 4.5±2.9 years. Baseline characteristics and treatment at discharge are described on table 1. We noticed a greater use of statins and ACEI/ARB on the second period as well as a greater percentage of patients receiving early revascularization. It is remarkable on women a non-significant reduction of heart failure hospitalization at follow up (6.8% vs 4.5%; p=0.091), neither differences on 30-day mortality (1.3% vs 0,4%) or 1-year mortality (7.1% vs 5.8%). However, long-term mortality for the second group is reduced (HR 0.69; CI 95% 0.52–0.89), even after performing a multivariate analysis (HR 0.64; CI 95% 0.48–0.85).
Characteristic Population (n=861) 2003–2008 (n=395) 2009–2015 (n=466) p-value Age (years) 73±12 73±12 72±12 0.316 Hypertension 629 (73.1%) 285 (72.2%) 344 (73.8%) 0.318 Hypercholesterolemia 414 (48.1%) 190 (48.1%) 224 (48.1%) 0.523 Killip class 0.292   I 664 (77.1%) 299 (75.7%) 365 (78.3%)   II 143 (16.6%) 74 (18.7%) 69 (14.8%)   III 47 (5.5%) 20 (5.1%) 27 (5.8%)   IV 4 (0.5%) 2 (0.5%) 2 (0.4) GRACE score 129±32 130±37 128±33 0.897 Early PCI 249 (29.3%) 76 (19.2%) 173 (38.0%) <0.005 Treatment at discharge   AAS 698 (81.1%) 313 (79.2%) 385 (82.6%) 0.120   Clopidogrel 465 (54.0%) 221 (55.9%) 244 (52.4%) 0.162   ACEI/ARB 466 (54.1%) 191 (48.4%) 275 (59.0%) 0.001   Beta-blocker 509 (59.1%) 238 (60.3%) 271 (58.2%) 0.290   Statins 643 (74.7%) 275 (69.6%) 368 (79.0%) 0.001

Conclusions
In recent years, early interventionist management and greater use of evidence-based therapies have been observed in women with NSTEMI. This has been associated with a lesser long-term mortality, although short-term events have remained the same.
P1528The added value of cardiac magnetic resonance to the diagnosis of patients after aborted sudden cardiac death
Authors: Szabo L , Czimbalmos C S , Dohy Z , Csecs I , Toth A , Suhai F , Becker D , Geller L , Merkely B , Vago H 
Published: October 2019

Abstract

Introduction
An estimated 25% of all cardiovascular deaths are due to sudden cardiac death (SCD). The primary cause of SCD is coronary artery disease, however cardiac diseases accounted for SCD differ in young vs. older individuals. In patients with normal coronary angiography (NCA) the differential diagnosis is still challenging, due to the broad spectrum of underlying cardiovascular abnormalities. Cardiac magnetic resonance (CMR) provides accurate tissue specific and functional information of the heart.

Purpose
We aimed to investigate patients after aborted sudden cardiac death but NCA using cardiac magnetic resonance imaging (CMR). Our goal was to evaluate left and right ventricular parameters, presence of late gadolinium enhancement (LGE) and to assess the diagnostic value of CMR.

Methods
We enrolled 84 consecutive patients (39±13 y; 51% male) after aborted SCD with NCA and without CMR contraindication. CMR examination including long- and short-axis cine, T2-weighted and LGE images were performed. Left and right ventricular parameters were evaluated. Presence and pattern of the oedema and LGE were also assessed.

Results
Structural myocardial abnormality was present in 57% of pts: dilated (n=13), arrhythmogenic right ventricular (n=6) and hypertrophic (n=4) cardiomyopathy (CMP), moreover acute (n=2) and chronic (n=3) myocardial infarction, acute (n=2) and chronic (n=2) myocarditis, Tako-Tsubo CMP (n=1), noncompaction CMP (n=1), endomyocardial fibrosis (n=1). In 13 cases aspecific structural alterations were detected with (n=7) and without (n=6) LGE. Only 13% of the patients showed ejection fraction lower than 35% (LVEF=52±9%), 54% showed LV dilation (LVEDVi>100 ml/m2 in males and >90 ml/m2 in females; LVEDVi=104±22 ml/m2). LGE was present in 36%, showing ischemic pattern in five cases and nonischaemic pattern in 25 cases. Eleven patients were elite athletes (28±10y, 91% male, training hours: >10 hours/week). Three of them showed ARVC based on the current Task Force criteria, another three athletes showed aspecific structural alteration with nonischaemic LGE.
The CMR examination confirmed the referral diagnosis in 22%, excluded the presence of structural myocardial alteration in 43% and changed the clinical diagnosis in 35% of the patients.

Conclusion
CMR has an important diagnostic value in patients after reanimation but NCA. More than half of these patients showed structural alteration and CMR provided a diagnosis in 42%.

Acknowledgement/Funding
Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary