bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3125Five-year impact of immediate invasive strategy on clinical outcomes in patients with non-ST-segment elevation myocardial infarction: RIDDLE-NSTEMI study
Authors: Milosevic A , Milasinovic D , Vasiljevic Z , Vukcevic V , Dikic M , Matic D , Stefanovic B , Asanin M , Stankovic G 
Published: October 2019

Abstract

Background
Most of the previous studies evaluated the impact of early versus delayed invasive intervention on clinical outcomes in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) in one-year period.

Purpose
The aim of this study was to assess whether the immediate invasive intervention influences the occurrence of death and new myocardial infarction (MI), specifically in patients with non-ST segment MI (NSTEMI) in long-term follow-up.

Methods
In The Randomized Study of Immediate Versus Delayed Invasive Intervention in Patients With Non ST-segment Elevation Myocardial Infarction (RIDDLE-NSTEMI) 323 patients with NSTEMI were randomized to either immediate (median time to intervention was 1.4 hours) or delayed invasive strategy (61.0 hours). The incidence of primary outcome -death or new MI at 30 days was lower in patients assigned to the immediate (n=162) than in patients assigned to the delayed (n=161) invasive intervention group (4.3% vs. 13%, respectively; p=0.008). Long-term follow-up of 5 years was available for 96.90% of the patients.

Results
At 5 years, the immediate invasive intervention was associated with lower rate of death or new MI, compared with delayed invasive strategy (15.8% vs 32.9%, respectively; p=0.00). The observed benefit of the immediate intervention was mainly due to an increased early reinfarction risk with the delayed strategy (2.5% vs 9.9%, p=0.001) with similar new MI rates beyond 30 days (5.9% in the immediate and 10.7% in the delayed group, p=0.130). Five-year mortality was 12.0% in the immediate invasive intervention strategy group, and 18.1% in the delayed strategy group (p=0.135).

Conclusion
Immediate invasive intervention in the patients with NSTEMI significantly reduces the early risk of new MI. However, the timing of invasive intervention appears not to have significant impact on the clinical outcome beyond 30 days.
P3132Methylenetetrahydrofolate reductase A1298C as a risk factor for rheumatic heart disease in indonesian population
Authors: Nauphar D , Pratamawati T M , Sanif M E 
Published: October 2019

Abstract

Introduction
Rheumatic heart disease (RHD) is a chronic condition causing damage in cardiac valvular tissues due to acute rheumatic fever (ARF) post Streptococcus pyogenes or Group A β hemolytic Streptococcus (GABHS) infection. The damage to the valve tissue within the heart can lead to congestive heart failure, strokes, endocarditis, and death. However, only 3–6% of post-streptococcal infection individuals develop ARF, suggesting host susceptibility in the pathogenesis of ARF. Polymorphisms of methylenetetrahydrofolate reductase (MTHFR) may be linked to the genetic susceptibility of the host that results in abnormal autoimmune response to the infection.

Purpose
This study aims to look at MTHFR A1298C polymorphism as a risk factor for rheumatic heart disease in Indonesian population.

Methods
This was an observational analytical study with case control approach. Blood samples were obtained from 36 Indonesian RHD patients with confirmed diagnosis of RHD using echocardiography and 36 healthy controls. Patients DNA were isolated and then amplified using polymerase chain reaction followed by restriction fragment length polymorphism analysis using MboII restriction enzyme.

Results
We observed a significant difference between genotypic distribution between cases and controls (OR = 4.6, 95% CI = 1.697–12.469, p=0.002). The genotype frequency of MTHFR A1298C AA (wild type) was 36.1%, heterozygous AC was 47.2%, and 16.7% of CC in the cases group. In the control group, the genotype frequency of the wild type AA was 72.2%, AC was 27.8%, and homozygous CC was 2.8%.

Conclusion
Compared with the CC frequency in the control population, the frequency of MTHFR CC was 5 times higher in individuals with rheumatic heart disease (p=0.002), suggesting that MTHFR A1298C gene variant may contribute to the pathogenesis of RHD. Individuals with MTHFR 1298C have a risk of 4.6 times higher to develop ARF post streptococcal infection.
P3139Transvenous lead extraction: lead age threshold to predict the success of the procedure
Authors: Giannotti Santoro M , Segreti L , Fiorentini F , Bernini G , Barletta V , Della Tommasina V , Cellamaro T , Soldati E , Di Cori A , Zucchelli G , De Lucia R , Viani S , Paperini L , Pedrinelli R , Bongiorni M G 
Published: October 2019

Abstract

Introduction
Transvenous lead extraction is a safe and effective procedure. The dwell time of the leads, with other factors, is associated with poor outcome of the procedure. However, a precise estimation of the success of the procedure is not available.

Purpose
The aim of this study is to identify a lead's age threshold able to predict the success of the transvenous lead extraction (TLE) procedure.

Methods
All patients who underwent TLE in our center from January 2009 to December 2017 were retrospectively analyzed. The primary endpoint was the clinical success of the procedure. The optimal cut-off threshold was determined by the analysis of Receiver-Operating Characteristics (ROC) curves, using the Youden index.

Results
We analyzed 1210 consecutive patients that required transvenous removal of 2343 leads (686 ICD leads, 1657 pacemaker leads, 322 coronary sinus leads). Clinical success was achieved in 1168 patients (96.5%). Dwelling time median of the oldest lead for a patient was 66 months (interquartile range 27.0–115.0). The oldest lead completely removed was 32 years old. ROC curve analysis showed a dwell time threshold of 107 months – 8,92 years - for clinical success (Positive Predictive Value: 99.5%; Negative Predictive Value: 7.8%) and the area under the curve (AUC) was 0.879. Comparison of ROC for dwelling time and the 0.5 curve was assessed as statistically significative (p<0.0001).

Conclusions
Transvenous lead extraction is an effective procedure. The best cut-off threshold to predict a very high clinical success is 107 months.
P3341Micro and macrovascular damage across the glycemic spectrum among women and men from general population
Authors: Roos M , Aribas E , Chaker L , Klaver C , Ahmadizar F , Kavousi M 
Published: October 2019

Abstract

Background
Type 2 diabetes mellitus (T2DM) is a global epidemic that is strongly associated with micro- and macrovascular complications. Head to head comparisons of micro- and macrovascular dysfunction across the glycaemic spectrum among women and men from large population-based cohorts are sparse.

Purpose
To investigate associations of impaired serum fasting glucose (IFG) and T2DM with markers of micro- and macrovascular damage among women and men from general population.

Methods
We included 10,920 women and men (>45 years) from a large prospective population-based study. We applied linear and logistic regression analyses to examine the cross-sectional associations between IFG and T2DM with markers of micro- and macrovascular damage including estimated glomerular filtration rate (eGFR), retinopathy, carotid intima-media thickness (cIMT), carotid plaque (CP), carotid-femoral pulse-wave velocity (PWV), and ankle-brachial index (ABI), adjusted for cardiovascular risk factors.

Results
Mean age was 65.09±10.0 years, 11.8% had IFG and 12.2% were T2DM patients. The majority of population were women (57.2%). In the fully adjusted models, compared to individuals with normal glucose levels (<6.1 mmol/l), IFG was independently associated with PWV (β; 95% CI: 0.011; 0.002–0.021) among men. T2DM was independently associated with larger burden of CP (Odds ratio (OR); 95% CI: 1.57; 1.13–2.17), and higher eGFR (β; 95% CI: 2.17; 0.62–3.72) among women and with larger burden of retinopathy (OR; 95% CI: 1.92; 1.30–2.85), higher cIMT (β; 95% CI: 0.010; 0.01–0.02), and PWV (β; 95% CI: 0.03; 0.01–0.04) among men.

Conclusions
IFG and T2DM were associated with micro- and macrovascular damage. Compared to non-diabetics, diabetic men had larger burden for markers of microvascular damage including retinopathy while diabetic women had larger burden of macrovascular damage including CP. Both IGF and T2DM were also associated with age-related macrovascular markers such as cIMT and PWV. Proper screening of macrovascular changes at earlier stages of dysglycemia and before the overt T2DM is crucial for prevention and early treatment of end-organ damage
P3353Safety and performance of stress testing: results from 78220 nuclear cardiology studies performed over 15 years in Brazil
Authors: Vitola J V , Stier Jr A L , Kormann O J , Franca O , Silva J A , Bettini L A F , Maruiti R , Dippe Jr T , Kinzel T V R , Farias F R , Zapparoli M M , Cunha C , Prado P , Silva M M F , Cerci R J 
Published: October 2019

Abstract

Background
Stress testing for nuclear cardiology (NC) is safe for evaluating suspected or known coronary heart disease (CHD). Rates of serious adverse events (SAE) are low, roughly 1 death/myocardial infarction: 10,000 studies. However, this may vary depending on patient characteristics using different stress modalities.

Purpose
To describe the rates of SAE using different stress modalities in patients referred to NC.

Methods
We included all patients undergoing NC at Quanta in Curitiba, Brazil from 2003 to 2018. Stress modalities were categorized as: exercise (Ex), dipyridamole (Dip), a hybrid protocol of dypiridamole and low workload exercise (DipEx), and dobutamine (Dob). SAE during/after stress were recorded: cardiac arrest or ST segment elevation myocardial acute infarction (STEMI). Development of second or third degree atrial ventricular block (AVB) during stress and recovery were also recorded.

Results
From 78220 studies in 61984 patients (47% women, mean age 63 years-old), Ex was the most frequent stress modality (67%), followed by Dip (24%), DipEx (7%) and Dob (1,7%). Patients undergoing Ex were the youngest (mean age 60 vs 70 vs 65 vs 71 years old), the least likely of having hypertension (62 vs 78 vs 76 vs 75%) and diabetes (22 vs 35 vs 32 vs 32%) and had the lowest prevalence of known CHD (26 vs 35 vs 41 vs 30%, for Ex vs Dip vs DipEx vs Dob respectively, p<0.001 for all comparisons). Six patients had cardiac arrest and one STEMI, results in SAE rate of 1:11.144 studies. There was important differences among stress modalities, being higher for pharmacological stress, particularly DipEx (Table). This group had the highest prevalence of known CHD and higher baseline risk. AVB rates were higher when dipyridamole was used. All patients who arrested in the laboratory recovered with treatment.
Serious adverse events and stress in NC Adverse event Ex Dip DipEx Dob N=52,237 N=18,848 N=5,824 N=1,311 Cardiac Arrest or MI 1 : 17,412 1 : 9,424 1 : 2,912 None 2nd or 3rd Degree AVb 1 : 4,353 1 : 1,885 1 : 1,941 None Observe how adverse event rates different importantly in patients undergoing different stress modalities in NC.

Conclusion
In this large 15-year registry, rates of SAE related to stress testing in NC were low, albeit the SAE were much higher with pharmacological stress modalities, particularly with DipEx, which had the highest rate of patients with known CHD. Our findings suggest that the well-known 1:10,000 event rate does not necessarily apply to all stress modalities in NC. Physicians should take patient's baseline risk into account, particularly those requiring pharmacologic stress.
P3355Stress-induced left ventricular dyssynchrony predicts future cardiac events in patients with known or suspected coronary artery disease
Authors: Katoh S , Watanabe T , Arimoto T , Narumi T , Aono T , Goto J , Sugai T , Takahashi T , Tamura H , Nishiyama S , Takahashi H , Shishido T , Watanabe M 
Published: October 2019

Abstract

Background
Prognostic value of stress induced left ventricular (LV) dyssynchrony has not been fully understood.
The aim of this study was to evaluate the possible impact between cardiovascular events and stress induced worsening LV dyssynchrony.

Methods and results
One hundred and eighty consecutive subjects with known or suspected coronary artery disease (CAD) (142 men, mean age 68±12 years) underwent both gated myocardial single photon emission computed tomography (SPECT) with 99mTc-sestamibi or tetrofosmin according to a standard same day stress-rest protocol and coronary angiography or coronary computed tomography. The summed difference score (SDS) was calculated in every subjects. LV ejection fraction (EF) and phase Entropy at after stress and rest were determined by cardioREPO software. We determined %ΔEntropy = (stress Entropy - rest Entropy)/rest Entropy x100, as an indicator of stress-induced LV dyssynchrony. In the study population, the mean SDS was 2.7±3.9 and LVEF was 58±16%, stress and rest Entropy were 0.62±0.15 and 0.57±0.13, respectively.
%ΔEntropy was higher in patients with CAD than in those without CAD (3.3±11.5 vs. 10.2±15.0, respectively). Moreover, there was a strict correlation between the presence of CAD and %ΔEntropy, indicator of stress induced LV dyssynchrony (non-CAD vs. CAD and/or 1 vessel disease vs. multivessel disease: 4.3±12.5 vs. 8.8±15.6 vs. 12.7±14.3, respectively. p<0.05)
We examined all study subjects and they were divided into 2 groups by cut off value of the %ΔEntropy constructed with receiver operating characteristic curve (=15.4). Kaplan-Meier analysis revealed that future cardiovascular event rate was significantly higher in %ΔEntropy >15.4 group (20/57) than in %ΔEntropy <15.4 group (24/123) (Log-rank p<0.01). On the other hand, summed stress score and SDS were no significant differences between 2 groups.
However, SDS was higher in patients with future cardiovascular event than in those without cardiovascular event (4.4±5.4 vs. 2.2±3.2, respectively. p=0.001).

Conclusion
In patients with known or suspected CAD, stress-induced worsening LV dyssynchrony may predict the presence of CAD and future cardiac events.

Acknowledgement/Funding
None
P3358Cardiovascular risk, aortic valve microcalcification and vascular microcalcification: is there a link?
Authors: Domingues C , Oliveira-Santos M , Castelo-Branco M , Silva R , Gomes A , Chichorro N , Abrunhosa A , Donato P , Pedroso De Lima J , Goncalves L , Vidigal Ferreira M J 
Published: October 2019

Abstract
18F-sodium fluoride (18F-NaF) has been used to evaluate aortic stenosis. It is know that its uptake is related with microcalcification. The purpose of this study is to assess the relationship between 18F-NaF uptake by the aortic valve and by the main arterial vessels and cardiovascular risk.
Twenty-five hypertensive patients without known cardiovascular disease or aortic stenosis underwent PET-CT with 18F-NaF. Cardiovascular risk was assessed through the ASCVD risk calculator. The patients had a mean age of 64.0±8.6 years and 56% were males. The mean ASCVD risk was of 28.8±19.0 (IQR: 10–48.5). The uptake of 18F-NaF assessed through the corrected uptake per lesion (CUL = max SUV – mean blood-pool SUV) was of 0.49±0.14 (IQR: 0.44–0.57) and the mean uptake in the aortic, coronary and carotid territories was of 0.66±0.21 (IQR: 0.53 - 0.76).The patients were classified according to the ASCVD: Group A: patients with a risk above the 50thpercentile of the ASCVD risk distribution (50thpercentile=25), 12 patients) and Group B: patients with a risk under or equal to the 50thpercentile of the ASCVD risk distribution, 13 patients.
The uptake of 18F-NaF in the aortic valve (AoV)and in the main vascular territories (VT) were evaluated in both groups: A vs B: AoV CUL = 0.57±0.09 vs 0. 42±0.14, p=0.005; VT= 0.78±0.16 vs 0.54±0.20, p=0.003. We also evaluate the relation between AoV uptake and VT uptake and they were significantly related (r=0.69, p=0.0001).
In conclusion on this study microcalcification of the aortic valve and in the main vessels, evaluated through 18F-NaF uptake, were related between them and with cardiovascular risk reinforcing the importance of cardiovascular risk prevention in aortic valve degeneration and vascular atherosclerosis.
P3360Quantitative assessment of tricuspid regurgitation using right and left ventricular stroke volumes obtained from tomographic equilibrium radionuclide ventriculography
Authors: Eyharts D , Lavie-Badie Y , Cazalbou S , Fournier P , Cariou E , Pascal P , Campelo F , Marcheix B , Galinier M , Berry I , Carrie D , Lairez O 
Published: October 2019

Abstract

Background
Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations.

Aims
To investigate the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the quantification of tricuspid regurgitation (TR).

Methods and results
Sixty-one patients (44 men; mean age 59±12 years) who underwent both t-ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. A sub-group of 22 patients underwent both t-ERV and CMR. Patients with mitral/aortic regurgitation by TTE were excluded of the study. TR regurgitant volume (RVol) was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from t-ERV. RVol tended to be higher using the ERV volumetric method as compared to PISA method (43±35 and 35±33 ml, respectively; P<0.0001). There was a significant correlation between RVol as assess by ERV and by TTE (R=0.95, P<0.0001). Intraclass correlation coefficient between TTE and ERV for TR quantification was 0.95 (P<0.0001). Among patients who underwent CMR, the correlation between RVol obtained by TTE and by t-ERV and CMR were R=0.81 and R=0.75, respectively (all P<0.0001), without difference between the two correlations (P=0.263).
Linear regression (left) and Bland-Altma

Conclusion
TR assessment using the t-ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.
P3363Severity of lymphoma is associated with aortic FDG uptake assessed by FDG PET/CT imaging
Authors: Solomou E , Koutagiar I , Vlachopoulos C , Georgakopoulos A , Sioni A , Giannouli S , Hontropoulos S , Stergiou I , Kafouris P , Karakitsios I , Gaitanis A , Terentes-Printzios D , Pianou N , Pouli A , Tousoulis D 
Published: October 2019

Abstract

Introduction
There is increasing evidence that metabolic disease burden in lymphoma modifies patients' outcome. However, the impact of disease severity on cardiovascular system remains unknown.

Purpose
To investigate whether lymphoma is associated with arterial inflammation by examining the relationship between disease burden and arterial F-18 Fluorodeoxyglucose (FDG) uptake assessed by positron emission tomography/computed tomography (PET/CT) in Hodgkin and non-Hodgkin sub-types.

Methods
Sixty-two patients (43 male, mean age 58±18 years) with Hodgkin (n=29) or non-Hodgkin lymphoma (n=33) underwent FDG PET/CT imaging before chemotherapy. Disease severity was quantified by total metabolic tumor volume (TMTV) that represents the volume exhibiting standard uptake values (SUV) ≥41% or ≥2.5 of maximum SUV within lymphoma regions, while aortic FDG uptake assessment was based on target-to-background ratio (TBR). Serum high sensitivity-C-reactive protein (hs-CRP), white blood count (WBC), ratio of neutrophils to lymphocytes (N/L), albumin and lactic acid dehydrogenase (LDH) values were recorded in all the patients.

Results
TMTV measurements correlated significantly with hs-CRP, WBC, N/L ratio, albumin and LDH. (Table) Patients with advanced stage disease (III-IV) had higher aortic TBR values compared to those with stage I-II disease (median 2.19 interquartile range (1.96–2.54) vs. 2.04 (1.83–2.15) p=0.046 respectively). Aortic TBR was related with N/L ratio (R=0.370, p=0.009), while no significant correlation was observed with either WBC or hs-CRP values (p=0.930 and p=0.296, respectively). There were significant associations between aortic TBR uptake and TMTV values even after adjustment for age, sex, LDH, albumin, N/L ratio, as well as for the number of cardiovascular risk factors of each patient (β=0.353, p=0.001, adjusted R2=0.318 for TMTV41%, β=0.442, p=0.001, adjusted R2=0.269 for TMTV2.5).
Table 1. Pearson correlation between indices of lymphomas' severity and serum biomarkers PET derived measurements Hs-CRP P-value Neutrophils to lymphocytes ratio P-value MTV41% 0.306 0.016 0.317 0.026 MTV2.5 0.312 0.013 0.389 0.006 Albumin LDH MTV41% −0.281 0.044 0.465 <0.001 MTV2.5 −0.419 0.002 0.616 <0.001

Conclusions
Aortic wall FDG uptake is related with disease severity and subtype of lymphoma indicating a vascular effect of lymphoma, as well as a new potential role of molecular imaging in cardio-oncology by evaluation of disease severity and its consequences to vascular beds with a single examination.
P3364Cardiac damage in a real-world severe aortic stenosis population
Authors: Ventura Gomes R , Pais J , Pereira A R , Sebaiti D , Cruz I , Almeida A R , Joao I , Pereira H 
Published: October 2019

Abstract

Introduction
The cardiac consequences of aortic stenosis, besides left ventricular ejection fraction and systolic pulmonary artery pressure, aren't considered in the recommendations for surgical intervention in patients (pts) with severe aortic stenosis (SAS). In 2017, a new staging echo classification was presented to accurately describe them.

Purpose
To evaluate this new echo classification in risk stratification of pts with SAS with or without AVR, in a real–world setting.

Methods
Retrospective cohort study of pts with SAS (mean transvalvular pressure gradient (MG) ≥40 mmHg or a peak transvalvular velocity (PTV) ≥4.0 m/s), examined between January 2014 and December 2016. Pts were classified according to the new staging echo classification (no extravalvular cardiac damage - Stage 0, left ventricular damage - Stage 1, left atrial or mitral valve damage - Stage 2, pulmonary vasculature or tricuspid valve damage - Stage 3, or right ventricular damage - Stage 4). Follow-up (FU) was 2.6±1.0 years. The primary outcome was a composite of cardiovascular death or heart failure hospitalization.

Results
212 pts with SAS were included (age 76.1±9.1 years, 31.6% men; aortic valve area 0.69±0.21cm2; PTV 4.5±0.4m/s; MG 48.5±11.6mmHg; LVEF 58.8±12.2%).
19 (9.0%) pts were classified as Stage 0, 29 (13.7%) as Stage 1, 129 (60.8%) as Stage 2, 12 (5.7%) as Stage 3 and 23 (10.8%) as Stage 4.
Pts with more advanced stages had more events (stage 0: 5.3%; stage 1: 10.3%; stage 2: 17.1%; stage 3: 50.0%; stage 4: 52.2%; p<0.0001). In the multivariate analysis, the classification system was also a predictor of the outcome, even when including the AVR in the model (table 1).
Similar findings in the uni and multivariate analysis were identified when analyzing only the pts with SAS and no aortic intervention (events in stage 0: 16.7%; stage 1: 18.2%; stage 2: 29.3%; stage 3: 75.0%; stage 4: 64.7%, p<0.005; Figure 1).
Table 1. Predictors of the outcome Variables Adjusted HR (95% CI) p-value Sex* 1.86 (1.01–3.44) 0.047 eGFR* 0.99 (0.98–1.01) 0.201 AVR* 8.97 (3.85–20.90) 0.0001 Classification* – 0.031   Stage 0 0.19 (0.02–1.537) 0.120   Stage 1 0.28 (0.08–1.01) 0.052   Stage 2 0.36 (0.17–0.74) 0,006   Stage 3 0.81 (0.30–2.19) 0.675   Stage 4 1 – *Variables with p<0.05 in univariate analysis.
Figure 1. Survival of SAS pts with no AVR

Conclusion
In a real-world experience, the new staging echo classification showed a significant relationship between the extent of cardiac damage at baseline and the primary outcome in pts with SAS, even after controlling for AVR. This classification was also able to identify the SAS pts who did not perform AVR and had a significant risk of adverse events.