bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6572Sinus arrest post-cardioversion
Authors: Ahmed M , Sharma E , Sheikh W , Parulkar A , Chu A 
Published: October 2019

Abstract

Introduction
Sinus arrest remains a recognized but likely underreported complication of cardioversion, with incidence ranging widely in the literature, from virtually 0% to 1.5%. After a case of elective cardioversion resulting in the need for ECMO support, we investigated possible risk factors that could help predict adverse outcomes after cardioversion.

Hypothesis
Cardioversion, while generally benign, is not without risks, and further study may help elucidate predictors of morbidity and mortality.

Methods
We retrospectively reviewed data of all patients who underwent cardioversion at three hospitals within the Lifespan health system, Rhode Island Hospital, Newport Hospital, and the Miriam Hospital, between 2000 and 2015. 23 patients who experienced sinus arrest after cardioversion, and characteristics of these patients were compared with those of 3:1 age-and-gender matched controls using binomial logistic regression analysis on Stata.

Results
Of 12,156 patients who underwent cardioversion, 23 patients (57% male, mean age 78±14), or 0.18%, experienced immediate post-cardioversion sinus arrest, defined as absence of sinus activity for greater than five seconds. Compared with 3:1 age-and-gender-matched controls who underwent cardioversion without incident, binomial logistic regression revealed that paroxysmal atrial fibrillation (OR 11.8; 95% CI 1.85–75.72; p=0.009), beta-blocker use (OR 58.0; 95% CI 2.4–1404.48; p=0.013), Amiodarone use (OR 19.9; 95% CI 2.0–198.32; p=0.011), and elevated ventricular rate (CV 0.028; 95% CI 0.0031–0.053; p=0.027) were statistically significant predictors of sinus arrest after cardioversion. Calcium-channel blocker use, Digoxin use, age, gender, PR interval, QRS duration, and corrected QT interval were not significant associations.

Conclusions
Sparse data exists regarding characteristics predisposing patients to adverse outcomes following cardioversion, and further risk stratification is warranted, given the potential for significant morbidity and mortality. Our findings raise questions that demand elucidation, such as whether beta-blockers or Amiodarone should be held prior to cardioversion.
P6588Impact of age and sex on the long-term prognosis associated with early repolarization in the general population
Authors: Holkeri A K , Eranti A , Haukilahti M A , Kerola T , Kentta T V , Tikkanen J T , Noponen K , Seppanen T , Rissanen H , Heliovaara M , Knekt P , Junttila M J , Aro A L , Huikuri H V 
Published: October 2019

Abstract

Background
Early repolarization (ER) in the electrocardiogram (ECG) has been associated with increased sudden cardiac death (SCD) risk in the general population. However, controversy remains about the risk associated with ER in different population subgroups.

Purpose
We evaluated whether age and sex affect the prognostic significance of ER in general population subjects.

Methods
The study population consisted of Finnish general population subjects aged over 30 years participating in the Mini-Finland Health Survey in 1978–80. Subjects underwent extensive baseline health examinations including a resting 12-lead ECG and were followed for 24±10 years. After excluding ECGs with QRS duration >110ms, the presence of ER (J-point elevation ≥0.1 mV in ≥2 inferior/lateral leads) was assessed from the remaining 6,631 subjects. The association between ER and SCD risk was analysed in subgroups according to age (<50 years or ≥50 years) and sex by using the Cox proportional hazards model. Effect modification of ER by age group and by sex was tested using the Wald test.

Results
ER was present in 250 (15.7%) of the 1,592 male subjects aged <50 years, 117 (6.8%) of the 1,713 female subjects aged <50 years, 182 (13.4%) of the 1,362 male subjects aged ≥50 years, and 244 (12.4%) of the 1,964 female subjects aged ≥50 years. There was a significant interaction between age group and ER (p=0.011). Among subjects aged <50 years, ER was associated with SCD risk after adjusting for age, sex, blood pressure, body mass index, serum cholesterol, coronary artery disease, diabetes, and active smoking (hazard ratio [HR] 1.79; 95% confidence interval [CI] 1.09–2.92; p=0.021), whereas in subjects aged ≥50 years ER was not associated with increased risk of SCD. Particularly female subjects aged <50 years with ER had a high risk of SCD (HR 4.85; 95% CI 1.65–14.29; p=0.004) in the multivariate analysis, whereas among <50-year-old male subjects ER was not associated with SCD (p=0.024 for interaction between sex and ER).

Conclusion
Our results suggest that among adults <50 years old, and especially among <50-year-old women, ER is associated with increased SCD risk, whereas among older subjects ER is not associated with SCD. Future research should focus on identifying the factors accounting for the difference between the age groups and to improve the risk stratification in the younger female patient populations with ER.

Acknowledgement/Funding
Aarne Koskelo foundation and Paavo Ilmari Ahvenainen Foundation
P6593Comparison of the termination effects between multi-segment continuous illumination and anti-tachycardia pacing on myocardial infarction ventricular arrhythmia
Authors: Long W A N G , Kang W E N , Cheng Y U E , Wang X I 
Published: October 2019

Abstract

Introduction
Anti-tachycardia pacing (ATP) therapy is an important treatment for current ICD termination of ventricular arrhythmia (VA). But there was concern about excessive frequency and voltage can cause arrhythmia, pain and damage. Optogenetic allowed modulation of electrical excitation with light in myocardium over-expressing light-sensitive protein, and optical illumination developed a non-contact and pain-free approach to research and treatment of cardiac disorder.

Purpose
Explore the effects of optogenetic termination and electric termination of myocardial infarction VA in vivo.

Methods
Rats (N=10) accepted jugular vein injection with 1×1012 vector genomes of (AAV-CAG-hChR2(H134R)-mcherry) to achieve cardiac transgenic expression of light sensitive protein Channelrhodopsin-2 (ChR2). After thoracotomy, myocardial infarction was induced by ligation of the left anterior descending coronary artery, and then VA was induced by electrical burst stimulation (10 v, 50 Hz, 2 s). Before the myocardial infarction operation, every heart was illuminated by 473 nm laser or electrical stimulated on the right ventricle in a train of 30 pulses at 8 HZ to test the threshold of light intensity or electrical pacing voltage. The VA termination process during 20 s after burst stimulation was investigated in different performance: optical termination, 1 s constant illumination repeated in 4 episodes with 1 s interval (470 nm, 20 times threshold intensity); electrical termination, ATP in 8 pulses of 8hz with 2ms duration in 4 times pacing threshold; natural recovery from VA, without optical or electrical intervention. Recovery time was defined as the time from the end of the burst stimulation to the recovery of sinus rhythm, and the termination rate was the percentage of sinus rhythm recovery among 11s after the end of burst stimulation with or without any intervention.

Results
We analyzed the recovery time and the termination rate (N=10, n=127 episodes per mode). The sequence of recovery time was optical termination (7.328±0.3623 s) < electric termination (10.31±0.4482 s) < natural recovery (12.97±0.3834 s) (figure D). We confirmed that the termination rate of optical illumination (86.14±4.145%) was higher than those of ATP (63.5±6.371%) and natural recovery (47.71±5.476%) (figure E), and there was no significant difference between the last two process (one-way of ANOVA; p=0.124).
Comparison of three modes

Conclusions
Optogenetic manipulation shortened the recovery time and increased the termination rate in myocardial infarction ventricular arrhythmia, which may provide a potential approach for translational arrhythmia therapy.

Acknowledgement/Funding
The national natural science foundation of China (81772044)
P6604Role of macrophage migration inhibitory factor and early after infarction remodeling in patients with ST-segment elevation myocardial infarction
Authors: Storozhenko T E , Kopytsya M P , Vyshnevska I R , Petyunina O V 
Published: October 2019

Abstract

A heart failure formation in patients with ST-segment elevation myocardial infarction (STEMI) is the most often adverse outcome and determined by early cardiac remodeling. One of the promising biomarkers for the early diagnosis of cardiac remodeling is proinflammatory cytokine macrophage migration inhibitory factor (MIF).

Purpose
estimate the role of MIF in the prediction of early cardiac remodeling in patients with STEMI.

Methods
The study involved 73 STEMI patients (72.6% male and 27.4% female) with an average age of 58.25±10.45 years. Control group of 12 healthy volunteers included. All patients were made to undergo a baseline investigation. In addition, the level of MIF determined during the first 12 hours of STEMI and before the percutaneous coronary intervention.

Results
64% of STEMI patients had elevated MIF levels above the highest value in healthy controls (2778±217 ng/ml; 225±6,7 ng/ml; p=0,0003). Using the linear regression analysis, the dependences of the biomarker MIF on the parameters of the left ventricle end-diastolic volume and the left ventricle end-systolic volume obtained (dependent variables, standardized coefficients beta −1.1; p=0.001 and 0.6; p=0.02, respectively).

Conclusions
STEMI patients with higher MIF concentration associated with more pronounced changes in heart geometry during the acute period. Further investigations of the MIF biological effects are the perspective direction in the development of prevention and treatment of STEMI.
64Risk of dementia in patients treated with non-vitamin k antagonist oral anticoagulant or warfarin for nonvalvular atrial fibrillation
Authors: Kim D , Yang P S , Jang E , Yu H T , Kim T H , Uhm J S , Kim J Y , Sung J H , Pak H N , Lee M H , Lip G Y H , Joung B 
Published: October 2019

Abstract

Background
Evidence is accumulating that use of oral anticoagulants (OACs) decreases the risk of dementia in patients with atrial fibrillation (AF), but it is unclear if there is a difference between non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in protecting against dementia.

Purpose
To compare the risk of dementia between patients taking either NOAC or warfarin using a nationwide cohort data covering the entire Korean population.

Methods
Using the Korean national health insurance service database, 68,984 new OAC users with non-valvular AF aged ≥50 years and no prior diagnosis of dementia were identified during the period of 2013–2016 (39,687 NOAC users and 29,297 warfarin users). Starting from OAC initiation, participants were followed up until the date of dementia, death, or December 31, 2016. We compared the rates of dementia in 1:1 propensity score-matched cohorts of NOAC (n=18,925) and warfarin users (n=18,925).

Results
During the 52,259 person-years of follow-up, there were 2,750 dementia events. Use of NOAC was associated with significant lower risk of dementia [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.69–0.81], compared with warfarin. The risk reduction was prominent for vascular dementia (HR 0.60, 95% CI 0.52–0.71), whereas there was no significant difference in the risk of Alzheimer dementia (HR 0.92, 95% CI 0.83–1.02). Restricting the analyses to patients with no stroke diagnosis prior to OAC initiation (primary prevention) showed no significant difference between NOAC and warfarin in any types of dementia, but in the subgroup with prior stroke (secondary prevention), NOAC significantly reduced the risk of overall (HR 0.70, 95% CI 0.63–0.78) and vascular dementia (HR 0.59, 95% CI 0.49–0.69).
Subgroup analysis according to stroke Hx Patient N Overall dementia Alzheimer dementia Vascular dementia HR (95% CI) P for interaction HR (95% CI) P for interaction HR (95% CI) P for interaction Total 37,850 0.75 (0.69–0.81) 0.92 (0.83–1.02) 0.60 (0.52–0.71) Without prior stroke 24,773 0.90 (0.78–1.05) 0.948 0.98 (0.83–1.15) 0.235 0.85 (0.56–1.28) 0.863 With prior stroke 13,077 0.70 (0.63–0.78) 0.90 (0.79–1.03) 0.59 (0.49–0.69) CI, confidence interval; HR, hazard ratio.
KM curves of dementia incidence

Conclusion
In this propensity-weighted nationwide cohort of non-valvular AF patients, NOAC was associated with reduced risk of dementia, compared with warfarin. This association was the most pronounced for vascular dementia in patients with prior stroke.

Acknowledgement/Funding
The Korean Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and the Korean Ministry of Health & Welfare (HI16C0058, HI15C1200)
77Infective endocarditis in patients with congenital heart disease: Results of a nationwide study including 1494 endocarditis cases
Authors: Diller G P , Freisinger E , Bronstein L , Koeppe J , Gerss J , Reinecke H , Baumgartner H 
Published: October 2019

Abstract

Background
Infective endocarditis (IE) represents a major complication in patients with congenital heart disease (CHD) and is associated with high morbidity and mortality. The aim of this study was to analyse the frequency and outcome of IE in contemporary CHD patients based on all IE hospital admissions in Germany between 2011 and 2016.

Methods
Based on the German diagnosis related groups data of patients treated between 2011 and 2016, we identified all CHD patients with a diagnosis of IE. The data contains information on patient demographics, primary and secondary diagnoses, interventional or surgical procedures, duration of stay and outcome including mortality. The primary endpoint of the study was endocarditis-associated mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis, resuscitation or intubation).

Results
Overall, 181,924 CHD patients were included in the analysis (55% male; 73% children, mean age 2.3 years; 27% adults, mean age 58.4 years; underlying heart defect of simple complexity 55%, moderate complexity 23% and complex heart defect 22%, respectively). During the study period 1494 cases were treated for IE corresponding to 0.82% of all inpatient treatment cases in CHD patients. Mortality rate was 6.6% (95% CI: 5.0–7.6%) with a major adverse events rate of 44.6% (95% CI: 41.3–48.2%). In total, 682 IE patients (45.7% CI: 42.3%-49–2%) required a surgical intervention. The relative risk of dying due to endocarditis in CHD patients was significantly lower compared to older IE patients without CHD (relative risk 0.39; 95% CI: 0.32–0.47).

Conclusions
Infective endocarditis accounts for a minority of CHD related hospitalizations but remains a deadly disease with a high proportion of patients requiring surgical intervention. In addition, major adverse events are common in this setting, with almost half of the IE population presenting with a major adverse event. Due to different demographic and comorbidity spectrum encountered in CHD patients, these younger patients tend to have significantly better survival prospects compared to non-CHD IE patients in the current era.
94Course of contained annulus ruptures after TAVI: the ENCORE (European contained rupture)-registry
Authors: Breitbart P , Minners J , Pache G , Hansson N C , Norgaard B L , De Backer O , Sondergaard L , Alsanjari O , Hildick-Smith D , Reinoehl J , Abdel-Wahab M , Loebig S , Neumann F.-J , Ruile P 
Published: October 2019

Abstract

Background
An asymptomatic contained rupture (CR) of the aortic annulus is a rare complication of transcatheter aortic valve implantation (TAVI). Their clinical implication is unclear so far.

Purpose
To determine the long-term outcomes in patients with CR.

Methods
The ENCORE-registry is a multicenter registry (6 centers across Europe) of patients with CR diagnosed on post-TAVI computed tomography angiography (CTA) or transesophageal echocardiography (TEE).

Results
A total of 21 patients (mean age 81.9±4.1 years, 81% balloon-expandable TAVI-prostheses) were diagnosed with CR (62% located adjacent to the left coronary cusp, mean size of lesions was 15.3±6.9 x 8.5±3.3 x 8.5±2.3 mm). Seventeen were diagnosed among a total of 1602 consecutive routine post-TAVI CTA (incidence 1.1%), two in TEE and two in post-TAVI CTA (each conducted due to suspicion of periinterventional complications). During a mean follow-up of 2.3±1.7 years nine patients (43%) died from non-cardiac causes. None of the patients exhibited symptoms or underwent interventional treatment related to the CR, no sudden cardiac death occurred. A follow-up CTA, performed in eleven patients 240±176 days post-TAVI, revealed stable CR findings in seven, regression in one, and remission in three patients.

Conclusion
The results of our ENCORE-registry demonstrate a benign course of initially asymptomatic contained ruptures of the aortic annulus after TAVI supporting a watch-and-wait approach in these patients. Thus, no specific treatment seems to be necessary.
102Diagnosis of coronary plaque rupture, plaque erosion, and calcified nodule by using near-infrared spectroscopy intravascular ultrasound
Authors: Terada K , Kubo T , Matsuo Y , Ino Y , Kitabata H , Emori H , Katayama Y , Khalifa A , Shimamura K , Shiono Y , Tanaka A , Hozumi T , Akasaka T 
Published: October 2019

Abstract

Objectives
This study sought to investigate the ability of near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) to differentiate among plaque rupture (PR), plaque erosion (PE), and calcified nodule (CN) in acute myocardial infarction (AMI) using an optical coherence tomography (OCT) diagnosis as a reference standard.

Background
In vivo, precise differentiation among PR, PE and CN is a major challenge for intravascular imaging.

Methods
The study enrolled 156 AMI patients who had a de novo culprit lesion in a native coronary artery. The culprit lesions were assessed by both NIRS-IVUS and OCT.

Results
OCT identified 112 PR, 29 PE, and 15 CN. IVUS-detected plaque ulceration showed a high specificity (100%) to identify OCT-PR although the sensitivity (62%) was intermediate. IVUS-detected convex calcium showed a high sensitivity (93%) and specificity (100%) to identify OCT-CN. In NIRS, the maximum lipid core burden index in 4 mm (maxLCBI4mm) was greatest in OCT-PR (values are median [interquartile range]) (671 [530 to 853]), followed by OCT-CN (355 [303 to 432]) and OCT-PE (283 [89 to 357]) (p<0.001). MaxLCBI4mm of <422 was the best cut-off to discriminate OCT-PE from OCT-PR and OCT-CN. The NIRS-IVUS classification algorithm using plaque ulceration, convex calcium, and maxLCBI4mm <422 showed a sensitivity and specificity of 96% and 95% for identifying OCT-PR, 93% and 95% for OCT-PE, and 93% and 100% for OCT-CN, respectively.
NIRS-IVUS classification algorism

Conclusion
Lipid component assessed by NIRS-IVUS was different among OCT-PR, OCT-PE and OCT-CN. The NIRS-IVUS classification algorism was highly sensitive and specific for differentiating these unstable lesion types in AMI.

Acknowledgement/Funding
None
103Maximum calcium thickness is a useful predictor for under expansion after post dilatation in calcified lesions: optical coherence tomographic study
Authors: Matsuhiro Y , Nishino M , Nakamura H , Yasumoto K , Tanaka A , Nakamura D , Matsunaga Y , Yano M , Yamato M , Egami Y , Shutta R , Tanouti J 
Published: October 2019

Abstract

Background
Several reports have revealed that stent under expansion is associated with target lesion failure and calcified lesions usually induced inadequate stent expansion. Contemporary debulking devices such as rotational/orbital atherectomy can modify severe calcified lesions before stenting. However, it is uclear which calcium parameter is most useful predictor for stent expansion in the calcified lesions. Thus, we investigated useful calcium parameters correlating with stent expansion in the calcified lesions.

Methods
We enrolled 43 consecutive calcified lesions (43 patients) who underwent optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) between September 2016 and January 2019. We evaluated the lesions treated with post dilatation by non-compliant balloon due to stent under expansion after stenting. Exclusion criteria included acute coronary syndrome, in-stent restenosis and lesions without any calcium or treated with rotational atherectomy. If there were several calcium lesions in one patient, we selected maximum calcium angle lesion. Stent expansion defined as post-PCI lumen area divided by the values predicted by the manufactures compliance charts. We compared mean reference area, pre lesion area stenosis, calcium parameters including calcium arc, maximum thickness, area and longitudinal length in pre-PCI OCT evaluations with post-PCI stent expansion at that site.

Results
Maximum calcium thickness showed significant correlation with stent expansion, while the others did not show a significant correlation with stent expansion (table). The optimal thresholds of maximum calcium thickness for the prediction of acceptable stent expansion defined by 80% of the values predicted by the manufactures compliance charts was 870mm (area under curve (AUC): 0.65) (figure).
Results of OCT parameters Univariate analysis P value Mean reference area 0.41 Pre % area stenosis 0.16 Calcium parameters   Calcium arc 0.37   Calcium maximum thickness 0.04   Calcium area 0.20   Calcium longitudinal length 0.43

Conclusion
A maximum calcium thickness<870mm is a useful predictor for acceptable stent expansion after post dilatation in calcified lesions.
123Effects of scoring or cutting balloon use on severely calcified lesions treated by percutaneous coronary intervention
Authors: Ikuta A , Kuwayama A , Tada T , Kadota K 
Published: October 2019

Abstract

Background
Whether preparation techniques during percutaneous coronary intervention (PCI) are associated with restenosis in severely calcified lesions is not well studied.

Purpose
We aimed to clarify the effects of the preparation techniques during PCI on mid-term outcomes of severely calcified lesions.

Methods
We examined 2688 consecutive severely calcified lesions (1854 patients) treated by PCI between January 2008 and December 2017, and identified 1789 lesions (66.6%) undergoing routine follow-up angiography within one year postprocedure. The angiographic outcome measure was defined as in-stent restenosis (ISR); ISR was defined as stenosis of ≥50%. We divided the 1789 lesions into two groups on the basis of the presence or absence of ISR: ISR and non-ISR groups.

Result
ISR was detected in 337 of the 1789 lesions (18.8%). The ISR group, in comparison with the non-ISR group, had more chronic total occlusion lesions (17.9% vs. 12%, p<0.01), less bifurcation lesions (41.9% vs. 48.5%, p=0.03), less reference diameter (2.85±0.64 mm2 vs. 2.96±0.54 mm2, p<0.01), lower use rate of scoring or cutting balloon (13.9% vs. 23.1%, p<0.01), and lower postprocedural percent stenosis (25.9±20.7% vs. 16.9±9.3%, p<0.01). After adjusting chronic total occlusion lesions, target lesions, and other factors in multiple logistic regression models, the use of scoring or cutting balloon was independently associated with ISR (hazard ratio, 0.62; 95% confidence interval, 0.44 to 0.89; p<0.01).

Conclusion
Using scoring or cutting balloon is associated with good midterm results of severely calcified lesions treated by PCI.