bluuebunny/crossref_metadata_2025_split huggingface dataset:
P901Association between arrhythmias and myocardial mass with the presence of fibrosis in a cohort of patients with Fabry disease
Authors: Ruiz Cueto M , De Frutos Seminario F , Alcoberro Torres L , Codina Verdaguer P , Manito Lorite N , Gonzalez Costello J , Torras Ambros J , Gascon Bayarri J , Diez Lopez C , Cequier Fillat A 
Published: October 2019

Abstract

The presence of myocardial fibrosis is a marker of advanced disease in Fabry disease.
A retrospective, transversal analysis was performed from a unicentric cohort. Clinical, electrical and imaging parameters were tested for their association with fibrosis.
The study population consisted of fifteen patients (mean age 44.8). We found a statistically significant association between fibrosis, indexed myocardial mass and interventricular septum (IVS) thickness. Although not statistically significant, a tendency of association between the fibrosis and age, NT-proBNP, QRS duration, ventricular extrasystolia, supraventricular tachycardia and atrial fibrillation was observed. Ventricular arrhythmias or syncope happened only in patients with fibrosis. T wave depth and QTc duration were not associated with fibrosis.
Myocardial fibrosis in fabry disease Absence of fibrosis (N=6) Fibrosis (N=9) P Age (Years) 51.3 (16.4) 55.8 (12.9) 0.64 Females (%) 3 (50%) 5 (55%) 1 NT-proBNP (ng/L) 294 (374) 1334 (1663) 0.14 IVS thickness (MRI, mm) 13.5 (4.3) 22.8 (10) 0.02 Indexed myocardial mass (echocardiography, g/m2) 108 (39.7) 206 (85.3) 0.03 PR segment duration (mseg) 145 (25.1) 171 (41.8) 0.21 Presence of negative T wave (yes/no) 5 (83%) 8 (89%) 1 Maximum depth of T wave (mV) 6.5 (6.8) 4.2 (3.2) 0.86 QTc duration (mseg) 426 (24) 423 (28) 0.72 QRS duration (mseg) 94.7 (15.3) 113.3 (26.5) 0.11 Supraventricular extrasistolia (number/day) 833 (1413) 769 (871) 0.88 Ventricular extrasistolia (number/day) 280 (605) 1247 (3079) 0.16 Supraventricular tachycardia (yes/no) 0 (0%) 3 (37.5%) 0.23 Atrial fibrillation (yes/no) 1 (17%) 4 (44%) 0.58 Ventricular tachycardia (yes/no) 0 (0%) 2 (22%) 0.49 Sincope (yes/no) 0 (0%) 1 (11%) 1 Results are presented as average and standard deviation for quantitative variables (comparisons with Wilcoxon test) and as a number of patients and proportion for qualitative variables (comparison with Fisher test).

Conclusions
Reduction of fibrosis formation could be a target to prevent the development of arrhythmias in FD. Increased myocardial mass and hypertrophy, derived from glycosphingolipids accumulation, is associated with fibrosis generation; treatments targeting myocardial mass could affect the presence of fibrosis.
P929Predictors of renal function improvement in patients with chronic kidney disease undergoing TAVR
Authors: Lemes M V S , Bacelar A C , Rosa V E E , Caixeta A M , Lemos P A , Ribeiro H B , Almeida B O , Mariani J , Campos C A H M , Tarasoutchi F , Franken M , Brito F S 
Published: October 2019

Abstract

Background
Chronic kidney disease (CKD) is common among patients undergoing transcatheter aortic valve replacement (TAVR). The prognosis of CKD on TAVR outcomes has been previously documented. However, there is a paucity of data about predictors of renal function improvement and its clinical relevance.

Purpose
To determine predictors of renal function improvement after TAVR among patients with CKD.

Methods
Prospective study, analyzing 819 patients from 22 centers with symptomatic severe aortic stenosis included in the Brazilian TAVR Registry between 2008 and 2015. CKD was defined as estimated glomerular filtration rate (eGFR) <60mg/dL, and patients without CKD were excluded. Groups were divided according to variation of eGFR between baseline and 7 days after TAVR: improvement (increase >10% in eGFR) in 197 (34.1%) patients, worsening (decrease >10% in eGFR) in 203 (35.2%), and stable (neither criteria) in 177 (30.7%). Logistic regression analysis was used to identify predictors of renal function improvement. One-year outcomes were determined as Kaplan-Meier survival curves.

Results
CKD was present in 577 (70%) patients. The mean age was 81.9±6.8 years, 56.2% were male, 31.7% had diabetes and 74.5% had hypertension. The mean STS score was 10.6±7.9%, the mean EuroSCORE II were 21.8±15.2% and the preferable access site was transfemoral (93.4%). The mean eGFR was 37.3±12.5 ml/min in the improvement group (IG), 39.6±11.7 ml/min in the stable group (SG) and 40.2±12.3 ml/min in the worsening group (WG), with significant statistical difference between IG and WG (p=0.044). There was no difference related to contrast midia volume between the 3 groups. In the multivariate analysis, coronary artery disease (OR: 0.69; 95% CI 0.48–0.98; p=0.039) and baseline eGFR (OR: 0.98; 95% CI 0.97–1.00; p=0.039) were associated with improvement in renal function. There was no significant difference in 1-year all-cause mortality between IG and SG (15.4 vs 9.5%, log rank p=0.141) (Figure 1A). However, the WG had higher mortality compared with the IG (29.3 vs 15.4%, log rank p<0,001) (Figure 1B).
Figure 1

Conclusion
Improvement in renal function after TAVR was frequently found among patients with CKD. The absence of coronary artery disease and lower baseline eGFR were independent predictors of improvement in renal function. Although the IG had lower 1-year all-cause mortality compared to WG, no difference were observed related to SG.

Acknowledgement/Funding
SBHCI
P938Extensive formation of atherosclerotic cardiovascular disease in subjects with severe familial hypercholesterolemia defined by the international atherosclerosis society criteria
Authors: Funabashi S , Kataoka Y , Harada-Shiba M , Hori M , Doi T , Ogura M , Hirayama A , Nishikawa R , Tsuda K , Noguchi T , Yasuda S 
Published: October 2019

Abstract

Introduction
The International Atherosclerosis Society (IAS) has proposed “severe familial hypercholesterolemia (FH)” as a FH phenotype with the highest cardiovascular risk. Coronary artery disease (CAD) represents a major atherosclerotic change in FH patients. Given their higher LDL-C level and atherogenic clinical features, more extensive formation of atherosclerosis cardiovascular disease including not only CAD but stroke/peripheral artery disease (PAD) may more frequently occur in severe FH.

Methods
481 clinically-diagnosed heterozygous FH subjects were analyzed. Severe FH was defined as untreated LDL-C>10.3 mmol/l, LDL-C>8.0 mmol/l+ 1 high-risk feature, LDL-C>4.9 mmol/l + 2 high-risk features or presence of clinical ASCVD according to IAS proposed statement. Cardiac (cardiac death and ACS) and non-cardiac (stroke and peripheral artery disease) events were compared in severe and non-severe FH subjects.

Results
Severe FH was identified in 50.1% of study subjects. They exhibit increased levels of LDL-C and Lipoprotein (a) with a higher frequency of LDLR mutation. Furthermore, a proportion of %LDL-C reduction>50% was greater in severe FH under more lipid-lowering therapy (Table). However, during the observational period (median=6.3 years), severe FH was associated with a 5.9-fold (95% CI, 2.05–25.2; p=0.004) and 5.8-fold (95% CI, 2.02–24.7; p=0.004) greater likelihood of experiencing cardiac-death/ACS and stroke/PAD, respectively (picture). Multivariate analysis demonstrated severe FH as an independent predictor of both cardiac-death/ACS (hazard ratio=3.39, 95% CI=1.12–14.7, p=0.02) and stroke/PAD (hazard ratio=3.38, 95% CI=1.16–14.3, p=0.02) events.
Clinical characteristics of severe FH Non-severe FH Severe FH P-value Baseline LDL-C (mmol/l) 5.3±1.5 6.6±2.0 <0.0001 Lp(a) (mg/dl) 15 [8–28] 21 [10–49] <0.0001 LDLR mutation (%) 49.6% 58.9% 0.00398 On-treatment LDL-C (mmol) 133 [106–165] 135 [103–169] 0.9856 %LDL-C reduction>50% 21.3% 49.8% <0.0001 High-intensity statin (%) 13.3% 42.3% <0.0001 PCSK9 inhibitor (%) 6.3% 21.2% <0.0001
Clinical outcome

Conclusions
Severe FH subjects exhibit substantial atherosclerotic risks for coronary, carotid and peripheral arteries despite lipid lowering therapy. Our finding underscore the screening of systemic arteries and the adoption of further stringent lipid management in severe FH patients.
P948Rapid and automated risk stratification by determination of aortic stiffness in healthy and cardiovascular diseased
Authors: Rammos C , Halfmann L , Lortz J , Steinmetz M , Janosi A , Rassaf T 
Published: October 2019

Abstract

Background and aims
Aortic stiffness is an independent predictor of cardiovascular morbidity and mortality and thus simple, rapid and preferably automated techniques are indispensableto persue a global approach in risk statification. A novel oscillometric based carotido-femoral pulse-wave velocity (cfPWV) was investigated, regarding diagnostic accuracy, sensitivity and specificity and with emphasis on costs, training curves and procedural time effort.

Methods
In a single-center crossover study, we evaluated subjects free of known cardiovascular disease (CVD) and CVD subjects and a subgroup with peripheral artery disease (PAD) undergoing ankle-brachial index (ABI) and PWV measurements using oscillometry (BoSo, Bosch + Sohn, Germany) compared to tonometry (SphymoCor, Atcor Australia). Pearson's correlation analysis was used to assess the relationship of PWV measurements for both methods. Moreover, examination times and costs were compared.

Results
A total of 174 study subjects underwent assessment of oscillometric and tonometric PWV measurements. CVD-free subjects (n=57) were younger (60.4±15.6 vs. 67±12.9 years, p=0.003) compared to CVD subjects (n=117). PWV measurements showed significant correlations in CVD-free subjects (r=0.797, p<0.001), in CVD subjects (r=0.817, p<0.001) and the subgroup of PAD subjects (r=0.807, p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value of the oscillometric measurement for detecting arterial stiffness reached 93%, 84%, 86%, and 92%. The examination time of the oscillometric method was shorter compared to tonometry (4.4±0.5 vs. 9.2±0.8 min, p<0.001) in line with reduced costs.

Conclusion
Using a simple and rapid automated oscillometric method, we provide good diagnostic accuracy for the determination of aortic stiffness through PWV, both in CVD-free and in CVD subjects. This might help in terms of cost-effectiveness and simplification in daily practice to screen for cardiovascular morbidity and for vascular damage in atherosclerosis.
P954Value of a single bolus erythopoetin in STEMI patients treated with the Genous endothelial progenitor cell capture stent
Authors: Camaro C , Suryapranata H , Ottervanger J P , Dambrink J H E , Gosselink M , Zijlstra F , De Boer M J 
Published: October 2019

Abstract

Background
The Endothelial Progenitor Cell (EPC) stent was designed to capture circulating EPCs and promote early stent re-endothelization. Erythropoietin (EPO) stimulates mobilization of EPC from the bone marrow. Combination of EPO and the EPC stent in the setting of ST-segment elevation myocardial infarction (STEMI) has never been investigated.

Methods
STEMI patients enrolled in the HEBE-III trial were randomized to a single bolus of EPO or No-EPO after implantation of the EPC capture stent. Late lumen loss (LLL) was determined at 9-month angiographic follow-up. Clinical data was collected at 30 days and 12 months.

Results
196 patients were randomized to EPO (n=100) or No-EPO (n=96). No significant difference in baseline characteristics was observed between the two groups. A significant reduction in angiographic LLL was observed with EPO (0.43±0.57mm) as compared to No-EPO (0.74±0.63mm) (p=0.011). At 12 months follow up, no difference with regard to death or re- infarction was observed in both groups, whereas significant reduction in the need for target vessel revacularization for the EPO versus No-EPO was observed with rates of 7.1% and 19.1% respectively (p=0.013).
Angiographic and clinical results EPO (n=39) No-EPO (n=45) P-value Angiography   Lume late loss 0.43±0.57 0.74±0.63 0.011 12 months clinical   Death 0 0 ns   Re infarction 0 1 (2.2%) ns   Additional PCI 4 (10.3%) 17 (37.8%) 0.004   CABG 2 (5.1%) 2 (4.4%) ns   CVA 0 0 ns   Bleeding 3 (7.7%) 4 (8.9%) ns ns = not significant; CVA = cerebrovascular accident; CABG = coronary bypass graft; PCI = percutaneous coronary intervention.

Conclusion
In STEMI patients treated with EPC capture stent, additional EPO can further improve angiographic LLL
P960Association of peri-procedural intravenous morphine use on clinical outcomes in ST-elevation myocardial infarction treated by percutaneous coronary intervention: systematic review and meta-analysis
Authors: Batchelor R , Liu D , Bloom J , Noaman S , Chan W 
Published: October 2019

Abstract

Background
Morphine analgesia may affect absorption of co-prescribed P2Y12 antagonists attenuating platelet inhibition. The impact of peri-procedural intravenous (IV) morphine administration on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is not well defined.

Purpose
To conduct a systematic review and meta-analysis exploring clinical outcomes with peri-procedural IV morphine in patients undergoing PPCI for STEMI.

Methods
Analysis of the electronic databases MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science and ClinicalTrials.gov for association of peri-PCI IV morphine use with myocardial infarction (MI) and mortality. Primary and secondary outcomes were in-hospital or 30-day MI and all-cause mortality respectively.

Results
Eleven studies (1 randomised controlled trial; 10 cohort studies) were included for systematic review. Five studies, including 3,748 patients were included in meta-analysis of the primary outcome. Of 3,748 patients, 2,239 were treated concurrently with ticagrelor, 1,256 treated with clopidogrel and 253 with prasugrel. As shown in the Figure, there was a trend towards increased risk of myocardial infarction with IV morphine (odds ratio 1.88; 95% CI 0.87–4.09, I2 0%). Across seven studies and 6585 patients, no increased risk of mortality at the same composite time endpoint was evident (odds ratio 0.70, 95% CI 0.40–1.23, I2 19%).
Figure 1. MI in hospital or at 30 days

Conclusion
Based on current literature, evidence of an association between IV morphine and myocardial infarction in patients undergoing PPCI for STEMI is limited by observational methodology and conflicting results. There is no evidence of an association between intravenous peri-procedural morphine and mortality. Clinical trial evidence with strong documentation of adverse events data is required to demonstrate association or causality.

Acknowledgement/Funding
None
P970DK-crush is the best treatment strategy to reduce stent oriented clinical outcome, results from a network meta-analysis of twenty-six randomized clinical trials comparing different stent techniques
Authors: Mandurino Mirizzi A , Crimi G , Gritti V , Scotti V , Strozzi C , Silvestri A , Montalto C , D'Ascenzo F , Repetto A , Ferlini M , Marinoni B , De Servi S , Ferrario M , Klersy C , Oltrona Visconti L 
Published: October 2019

Abstract

Background
Coronary bifurcation disease (CBD) accounts for approximately 20% of all and is associated with worse short- and long- term clinical outcomes. Provisional stenting (PS) is the preferred choice, however, this approach may not be suitable in all CBD anatomies, therefore several elective two-stents techniques have been described, however there is lack of randomized evidence to guide interventionalist across different stent techniques. Objectives. To identify the best percutaneous coronary interventions (PCI) technique for CBD.

Methods
We systematically review randomized clinical (RCTs) of patients receiving CBD PCI with either PS or six type of elective two-stent techniques (DK-crush, TAP, culotte, dedicated bifurcation stents, crushing, T-stenting) and compare device oriented clinical events (DOCE) in a network meta-analysis. DOCE was defined as composite of cardiac death, target-vessel myocardial infarction, stent thrombosis, target lesion revascularization OR target vessel revascularisation.

Results
We included 26 RCTs leading to a pooled population of 10339 patients-years with 1229 DOCE. Compared to PS, the DK-crush technique had a lower DOCE with RR=0.62, [0.42–0.92]. Figure. DK-crush had the highest likelihood (model likelihood=90.2%, SUCRA=98.0%) of being the best treatment to reduce DOCE.
Figure 1

Conclusions
In the management CBD, when a two-stent technique is required as upfront strategy, the DK- Crush technique should be privileged as it showed to reduce stent-related clinical outcomes (DOCE) when compared to other bifurcation techniques.
P987Dilated cardiomyopathy - a group that does not benefit from ICD?
Authors: Silverio Antonio P , Nunes-Ferreira A , Aguiar-Ricardo I , Rigueira J , Santos R , Rodrigues T , Cunha N , S Morais P , Couto Pereira S , J Pinto F , De Sousa J , Marques P 
Published: October 2019

Abstract

Introduction
The prevalence of sudden death in patients with heart failure with reduced ejection fraction has been declining in the last decade, not only due to better optimization of pharmacological therapy, but also due to the high rate of cardiac resynchronization responders. Overall, based on recent studies demonstrating a lack of improvement in mortality in some patients with dilated cardiomyopathy, the CRT-P/CRT-D implantation ratio has been increasing across Europe.

Objective
To evaluate the evolution of the CRT-P/CRT-D implantation ratio and to evaluate the impact on mortality of dilated cardiomyopathy (DCM) patients who underwent resynchronization therapy.

Methods
A single-center prospective study of non-randomized patients who underwent CRT implantation since 2015. Demographic and clinical data from patients with dilated cardiomyopathy were assessed. The mortality of these patients and the predictors of mortality by the Cox and Kaplan-Meier regression method were evaluated.

Results
486 CRTs were implanted since 2015 (male 73.9%, age 72.06±9.9 years, median follow-up time of 487 days IIQ [175, 749].) During the last 3 years, occurred an increased in CRT-P/CRT-D ratio with the CRT-P implant rate increasing from 36% of the total devices in 2015 to 47% in 2018. Of the patients submitted to CRT implantation, 256 (55%) had dilated cardiomyopathy as the etiology of heart failure. In this population, by multivariate Cox analysis, age (HR 1.1, 95% CI 1.0–1.1, p=0.003) and GFR <60ml/min/1.73m2 (HR 1.8 IC 95% 1, 2–2.6, p=0.01) were independent predictors of mortality. In addition, CRT-D implantation in these patients was associated with a significant reduction in all-cause mortality (HR 0.33 95% CI 0.15–0.73, p<0.01) with a required number to treat only 10 patients. Similar results were obtained in the subgroup of patients aged ≥59 years.
Mortality in DMC – CRT-P vs CRT-D

Conclusion
The CRT-P implant rate has been increasing at the expense of the CRT-D implant after some studies suggest no benefit in the population aged ≥59 years. However, in our population of patients with DCM, CRT-D implantation demonstrated a 67% mortality reduction. These results may demonstrate a good selection of patients for this therapy, but should also motivate further studies in the evaluation of mortality in this subgroup of patients.
P989Incidence of appropriate implantable cardioverter defibrillator therapy and sudden cardiac death in cardiac sarcoidosis - a systematic review and meta-analysis
Authors: Franke K , Marshall H , Kennewell P , Pham H D , Rattanakosit T , Aboustate N , Tully P , Mahajan R 
Published: October 2019

Abstract

Background
Implantation of implantable cardioverter defibrillator (ICD) is a Class IIb indication in patients with Cardiac Sarcoid and with LVEF 36%-49% despite immunosuppression and optimal heart failure therapy.

Purpose
This systematic review and meta-analysis aimed to provide an estimate on the incidence of ventricular arrhythmias and risk of sudden cardiac death (SCD) in patients with CS.

Methods
The terms “Cardiac Sarcoidosis*” AND “Implantable Cardioverter Defibrillator” AND “Sudden Cardiac Death” were searched on PubMed, EMBASE, and Scopus on 21st of September 2018 yielding 759 articles. After exclusions, 12 studies met inclusion criteria.

Results
The 12 studies consisted of 612 patients with CS of which 534 had ICD implanted for primary or secondary prevention. Assuming appropriate device therapy as a surrogate for SCD, the annual incidence of appropriate ICD therapies and SCD combined was 6.3% (95% CI; 3.5%-9.1%) in primary prevention cohorts, 11.6% (95% CI; 7.8%-15.3%) in secondary prevention cohorts, and 8.7% (95% CI; 6.0%-11.5%) in both cohorts. The mean left ventricular ejection fraction (LVEF) was pooled as 59±7 (n=155) in primary prevention cohorts and 48±15 (n=48) in secondary prevention cohorts. However, the LVEF was 35±13 (n=28) in those with appropriate ICD therapy, and 49±16 (n=47) in those with ICDs without therapy.
Incidence of SCD in Combined Cohorts

Conclusion
The incidence of ventricular arrhythmias and SCD is high not only secondary but also in primary prevention cohorts of CS. This data supports the role of implanting ICDs for primary prevention in patients with CS with mild to moderate reduction in LVEF.

Acknowledgement/Funding
None
P993Diagnostic accuracy of cardiac magnetic resonance and endomyocardial biopsy for arrhythmogenic right ventricular dysplasia/cardiomyopathy and myocarditis
Authors: Della Rocca D G , Casella M , Dello Russo A , Gasperetti A , Fassini G , Catto V , Tundo F , Riva S , Ribatti V , Dessanai M A , Pizzamiglio F , Moltrasio M , Carbucicchio C , Natale A , Tondo C 
Published: October 2019

Abstract

Introduction
Patients with myocarditis may fulfill the cardiac magnetic resonance (CMR) criteria set forth by the 2010 Task Force for arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), thereby increasing the risk of misdiagnosis.

Purpose
We sought to evaluate the role of CMR and endomyocardial biopsy (EMB) in the differential diagnosis between myocarditis and ARVD/C.

Methods
Consecutive patients presenting with ventricular arrhythmias, underwent a complete diagnostic work-out, which included CMR and EMB. The final diagnosis served as the gold standard to assess the diagnostic accuracy of CMR and EMB.

Results
Overall, 74 consecutive patients presenting with VAs underwent a complete diagnostic workout at our institution. The cohort was 70.3% male, with a mean age of 38.9±12.1 years. A final diagnosis of ARVD/C was made in 30 (40.5%) patients, whereas 19 (25.7%) had a diagnosis of myocarditis.
The McNemar's test showed significant differences in the diagnostic performance of EMB and cardiac MRI (p=0.003 for ARVD/C, p=0.04 for myocarditis).
At receiver operating characteristic (ROC) analyses, the area under the curve (AUC) to discriminate between controls and ARVD/C patients was 0.711 (95% CI: 0.59–0.83) for MRI and 0.944 (95% CI: 0.88–1.00) for biopsy (p<0.001). The AUC to discriminate between controls and patients with myocarditis was 0.656 (95% CI: 0.51–0.80) for MRI and 0.893 (95% CI: 0.80–0.99) for biopsy (p=0.006).
Diagnostic performance of CMR and EMB

Conclusion
Even though CMR has good diagnostic performances as single technique, a complete diagnostic work-out including EMB may frequently reduce the risk of misdiagnoses.