bluuebunny/crossref_metadata_2025_split huggingface dataset:
P605Correlation of left atrial phasic transport function and arrhythmogenic substrate in patients with atrial fibrillation: cardiac magnetic resonance feature tracking and bipolar voltage mapping
Authors: Schoenbauer R , Tomala J , Kirstein B , Huo Y , Gaspar T , Richter U , Piorkowski J , Schoenbauer M S , Fiedler L , Roithinger F X , Hengstenberg C , Mascherbauer J , Ulbrich S , Piorkowski C 
Published: October 2019

Abstract

Background
Bipolar voltage mapping is a widely accepted approach to identify areas of arrhythmogenic substrate in patients presenting for atrial fibrillation (AF) ablation.
However, until now little is known about the correlation of left atrial (LA) bipolar voltage distribution and LA transport function.

Purpose
To study the impact of LA low voltage zones (LVZ) on LA transport function.

Methods
107 consecutive patients presenting for ablation of symptomatic AF (34 paroxysmal AF, 73 persistent AF) were prospectively enrolled. Each patient underwent cardiac magnetic resonance imaging (CMR) within 24 hours prior to the ablation procedure. 59 patients were in sinus rhythm (SR) and 48 in AF. LA phasic indexed volumes (LAVi) and ejection fractions were calculated using biplane area length formula. In addition LA phasic strains and strain rates were analyzed using dedicated software (Figure 1A & B).
LA bipolar voltage mapping was performed prior to beginning of ablation in sinus rhythm using a 3-dimensional mapping system and LVZ were defined as areas of bipolar voltage <0.5mV.

Results
LVZ were present in 47 patients (23 in SR). The area of LVZ was 14.6cm2 (5.3–34.0). For patients in AF at the time of CMR only elevated minimal and maximal LAVi (p=0.001 and p=0.002 respectively) but no LA functional parameter was predictive for the occurrence of LVZ. In contrast for patients in SR all LA phasic volumes (endsystolic, pre atrial contraction and enddiastolic LAVi) and LA function parameters (passive, active and total ejection fraction (EF), reservoir, conduit and booster pump strains and strain rates) were predictive for the occurrence of LVZ. After clustered and pooled multivariate logistic regression only impaired booster pump strain rate was still predictive for occurrence of LVZ (OR 0.974, 95% CI 0.950–0.998, p=0.036).
In addition Pearson correlation analysis revealed a strong link between LA booster pump functional parameters and cm2 expansion of LVZ areas: LA active EF, LA booster pump strain and SR (r=−0.42, p=0.044; r=−0.47, p=0.024; r=−0.65, p=0.001 [Figure 1C] respectively).

Conclusion
For patients in SR LA transport function is closely linked to the occurrence of LA LVZ and outperforms LA volumetric measurements for the prediction of LA LVZ.
Furthermore LA booster pump function parameters show robust correlation to the extension of LA LVZ.
P611Relation of exercise intolerance and left ventricular diastolic function to myocardial fibrosis in the patients with hypertrophic cardiomyopathy
Authors: Hwang J W , Kim S.U.N.G.M , Park S.U.N.G.-J , Kim E U N K , Chang S.U.N.G.-A , Lee S.A.N.G.-C , Choe Y.E.O.N.H , Park S W O O , Kim D.A.R.A.E , Choi J.I.N.-O.H , Kim H A J , Ok S.E.O.N.H 
Published: October 2019

Abstract

Myocardial fibrosis happened to increased left ventricular (LV) stiffness and higher LV filling pressure likewise diastolic dysfunction, as associated with clinical outcomes in patients with hypertrophic cardiomyopathy (HCMP). Additionally, reduced exercise capacity affected patients along a broad spectrum of clinical severity. The aim of study was to determine the relation between exercise intolerance and LV diastolic parameters to myocardial fibrosis in the patients with HCMP.
We enrolled 289 patients with HCMP and normal LV systolic function (ejection fraction >50%). Study populations underwent both cardiopulmonary exercise test (CPET) as estimating peak oxygen consumption (peak VO2) and cardiac magnetic resonance (CMR) as myocardial fibrosis by late gadolinium delayed enhancement (LGE). NT-proBNP levels were determined at baseline. Basic echocardiography was used to measure the diastolic parameters.
The study population was included with 248 males (85.8%), and the median age of population was 53 years [interquartile range (IQR) 46–60]. Median follow-up was 6.5 years (IQR 3.2–8.6). The median value of Peak VO2 as a representation of exercise tolerance was 29.0 ml/kg/min (IQR 25.0–34.0) in study population. The amount of LGE on CMR was 14.27 mL (IQR 6.30–27.76). The median value of diastolic parameters as left atrium volume index (LAVI) and E/e' ratio, respectively, were 39.10 mL/m2 (IQR 31.30–47.25) and 10.88 (IQR 8.58–13.31). The median NT-proBNP level was 295.40pg/mL (IQR 139.10–687.70). After adjusting for age and gender, peak VO2 was inversely correlated with NT-proBNP (r=−0.274, p<0.001). A linear regression analysis with adjusting age and gender showed that LAVI and E/e' as diastolic parameters could predict the peak VO2 (LAVI: β=−0.082, p<0.001, E/e': β=−0.373, p<0.001) and NT-proBNP (LAVI: β=11.454, p<0.001, E/e': β=55.533, p<0.001), as well as the LGE also could associate the peak VO2 (LGE: β=−0.075, p<0.001) and NT-proBNP (LGE: β=16.194, p<0.001).
In conclusion, through the correlation among exercise tolerance, parameters of diastolic dysfunction, and myocardial fibrosis, we demonstrated that exercise intolerance and parameters of diastolic dysfunction could predict the myocardial fibrosis in patients with HCMP. We inferred the adverse effects of myocardial fibrosis, as assessed by LGE, lead to diastolic dysfunction and reduced the exercise tolerance.

Acknowledgement/Funding
None
P612Multimodal cardiac imaging in patients with suspected ST-elevation myocardial infarction and no obstructive coronary arteries
Authors: Andersson H , Christensen T E , Ahtarovski K , Rasmussen T , Ghotbi A , Thomsen J H , Soeholm H , Nepper-Christensen L , Engstroem T , Vejlstrup N , Grande P , Bang L E , Clemmensen P , Hasbak P , Holmvang L 
Published: October 2019

Abstract

Background
Patients with suspected ST-elevation myocardial infarction (STEMI) and normal coronary arteries comprise a heterogeneous group with various underlying causes of disease.

Purpose
To study pathophysiology and underlying diagnoses in patients with suspected STEMI and normal coronary arteries using multimodal cardiac imaging.

Methods
We consecutively included patients with suspected STEMI, normal coronary arteries on acute coronary angiography, and elevated troponin T levels at a tertiary heart center (2012–14). Patients were examined with echocardiography, cardiac magnetic resonance imaging, and 13NH3/82Rb and 18F-FDG positron emission tomography within one week from symptom onset.

Results
We included 42 patients (60% male, median age 58 (IQR 50–65) years. Median troponin T levels were 783 (IQR 566–1208) ng/l. Multimodal cardiac imaging findings are presented in Table 1. Multimodal cardiac imaging showed signs of cardiac involvement in all but one patient (98%). Underlying diagnoses were acute myocardial infarction (36%), Takotsubo cardiomyopathy (29%), perimyocarditis (10%), and cardiomyopathy (7%). The diagnosis was unclear in 19% of patients.
Echocardiography   Left ventricular ejection fraction <40%, n (%) 12 (29)   Moderate to severe left ventricular hypertrophy, n (%) 3 (7)   Moderate to severe valvular disease, n (%) 3 (7)   Pericardial effusion, n (%) 5 (12)   Apical thrombus, n (%) 1 (2) Magnetic resonance imaging   Left ventricular end diastolic volume, ml (IQR) 157 (125–185)   Left ventricular end systolic volume, ml (IQR) 75 (63–88)   Left ventricular stroke volume, ml (IQR) 73 (57–93)   Edema, n (%) 38 (91)   Late gadolinium enhancement, n (%) 22 (52) 13NH3/82Rb and 18F-FDG positron emission computer tomography   Myocardial perfusion defect, n (%) 29 (69)   Myocardial perfusion-metabolism mismatch, n (%) 12/30 (40)   Reduced myocardial viability, n (%) 6/30 (20)

Conclusion
The majority of patients with suspected STEMI and normal coronary arteries had signs of cardiac involvement by multimodal cardiac imaging and were diagnosed with cardiac disease.

Acknowledgement/Funding
The Danish Heart Foundation, the A.P. Møller Foundation, the Foundation of Reinholdt W. Jorck and Wife, Rigshospitalet's Research Foundation
P615Role of three-dimensional (3D) speckle-tracking echocardiography (STE) system, using comparison with cardiac magnetic resonance imaging (CMR) and to assess the contribution of regional RV function to
Authors: Sen N , Tanwar S , Jain A , Kalra B , Chandra N 
Published: October 2019

Abstract

Background
Chronic obstructive pulmonary disease may alter right and left ventricular function by changing intrathoracic pressure. Pulmonary hyperinflation may increase right atrial pressure, leading to reduced venous return and subsequent reductions in RV pre-load. In COPD patients, hyperinflation has been directly correlated with reduced atrial chamber size, global RV dysfunction, and reduced LV filling. Accurate assessment of global and regional right ventricular (RV) systolic function is challenging.

Purpose
The aims of this study were to confirm the reliability and feasibility of a three-dimensional (3D) speckle-tracking echocardiography (STE) system, using comparison with cardiac magnetic resonance imaging (CMR), and to assess the contribution of regional RV function to global function.

Methods
In a retrospective, cross-sectional study setting, RV volumetric data were studied in 302 patients who were referred for both CMR and 3D echocardiography within 1 month. Three-dimensional STE-derived area strain, longitudinal strain, and circumferential strain were assessed as global, inlet, outflow, apical, and septal segments.

Results
208 patients (69%) had adequate 3D echocardiographic data. RV measurements derived from 3D STE and CMR were closely related (RV end-diastolic volume, R2=0.88; RV end-systolic volume, R2=0.81; RV ejection fraction [RVEF], R2=0.69; P<0.004 for all). RVEF and RV end-diastolic volume from 3D STE were slightly but significantly smaller than CMR values (mean differences, −2.8% and −7.8 mL for RVEF and RV end-diastolic volume, respectively). Among conventional echocardiographic parameters for RV function (tricuspid annular plane systolic excursion, fractional area change, S' of the tricuspid annulus, RV free wall two-dimensional longitudinal strain), only fractional area change was significantly related to RVEF (r=0.29, P=0.003). Among segmental 3D strain variables, inlet area strain (r=−0.48, P<0.002) and outflow circumferential strain (r=−0.37, P<0.003) were independent factors associated with CMR-derived RVEF.

Conclusions
Regional RV wall motion showed that heterogeneous segmental deformations affect global RV function differently; specifically, inlet area strain and outflow circumferential strain.RV volume and RVEF determined by STE were comparable with CMR measurements. Severity of COPD influences RV systolic dysfunction, which is reflected in speckle tracking 3D echocardiographic parameters.
P617Early global longitudinal strain predicts late infarct size in patients with anterior ST-segment elevation myocardial infarction treated with a primary percutaneous coronary intervention
Authors: Bendary A , Afifi M , Tawfik W , Mahros M , Ramzy A , Salem M 
Published: October 2019

Abstract

Background
Late infarct size (IS) after STEMI is a determinant of subsequent mortality. Late Gadolinium enhancement in cardiac magnetic resonance imaging (LGE-CMRI) is the gold standard for IS measurement, however, it is not readily accessible in many areas.

Aims
To evaluate the value of early baseline 2D-echocardiographic global longitudinal strain (GLS) for prediction of late IS after STEMI.

Methods
From October 2017 to July 2018, we studied 100 patients with their 1st anterior STEMI treated with a PPCI. Baseline GLS calculation was performed within 48 hours of admission. The average value of the 9 segments supplied by the LAD was assessed separately (anterior GLS). Infarct size was assessed 3 months later using LGE-CMRI, and large infarcts were defined as ≥20% LV myocardium covered by scar.

Results
Based on CMRI, patients were divided into 2 groups; 57 patients with large infarcts (group I) and 43 patients with small infarcts (group II). Both groups were matched in all baseline demographics and risk factors. There was a good and significant correlation between GLS and the degree of myocardium affected by scar (r=−0.840, P<0.001). This correlation was even higher for anterior GLS (r=−0.867, P<0.001). ROC analysis showed a cut-off point of GLS (−13%) that identified large late IS with a sensitivity and specificity of 66.7% and 88.4% respectively (AUC= 0.85). For anterior GLS, the cut-off point was −9.6% (Sensitivity 94%, specificity 86%, AUC= 0.9).
Baseline 2D-GLS & Late LGE-CMRI

Conclusion
Baseline GLS significantly predicts and correlates well with late IS after anterior STEMI.
P626Higher fitness is associated with improved survival among cancer patients
Authors: Fardman A , Banschick G D , Rabia R , Segev S , Klempfner R , Fourey D , Percik R , Grossman E , Maor E 
Published: October 2019

Abstract

Background
Cardio-respiratory fitness (CRF) is a known predictor of cardiovascular morbidity and mortality. However, data on the association of CRF with survival following a diagnosis of cancer is limited.

Purpose
To evaluate the association between CRF in a large cohort of asymptomatic adults and a probability of survival after subsequent cancer diagnosis.

Methods
We evaluated asymptomatic self-referred adults aged 40–79 years who were screened annually at a tertiary medical center. All subjects were free of cardiovascular disease and cancer at baseline and completed maximal exercise stress test according to the Bruce protocol. Fitness was categorized into age- and sex-specific quintiles (Q) according to Bruce protocol treadmill time with Q1-Q2 defined as low fitness and Q3-Q5 as higher fitness. Cancer data was available from a national cancer registry. The primary end point was all-cause mortality.

Results
Final study population in included 15,800 subjects. Mean age was 51±8 years and 72% were men. During median follow up of 13 years (IQR 7–16) 1,312 (8%) subjects developed cancer and 486 (3%) died. Most common cancer types were prostate in 302 (23%) and breast cancer in 189 (14%) patients. No difference was found in distribution of major cancer types between different fitness categories. Univariate Cox regression with cancer as a time dependent covariate showed that subjects who developed cancer during follow up were 19 times more likely to die (95% CI 15.5–22.5, p<0.001). Kaplan Meier analysis showed that the cumulative probability of death from the time of cancer diagnosis was significantly lower among high fitness patients (34% ± 4% vs. 25% ± 3%, p Log rank = 0.008; Figure 1). Multivariate interaction analysis with cancer as a time dependent covariate showed that cancer-related risk of death was fitness-dependent, such that in the lower fitness group cancer was associated with 18 folds increased risk of death (95% CI: 13.5–23) whereas among high fitness group the risk of death was lower (HR=13; 95% CI: 10–17; p for interaction = 0.048).

Conclusions
Low CRF is associated with worse survival among subjects diagnosed as having cancer during follow up. These findings support the effectiveness of fitness assessment in preventive health care settings.
P628Association of outpatient cardiac rehabilitation with mortality and morbidities in patients with acute myocardial infarction
Authors: Seki T , Takeuchi M , Kawasoe S , Takeuchi K , Miki R , Ueshima K , Kawakami K 
Published: October 2019

Abstract

Background/Introduction
Outpatient cardiac rehabilitation (CR) is commonly recommended for patients with acute myocardial infarction (AMI). However, the survival benefit has recently been contested, especially with no survival benefit having been found in non-Western countries.

Purpose
To investigate whether outpatient CR, under current real-world clinical practice, is associated with lower mortality and morbidity risks in patients with AMI.

Methods
The retrospective cohort study was conducted from January 2011 to June 2016 (final date of follow-up: July 31, 2016) with a nation-wide administrative database for acute-care hospitals in Japan. Data for 7,411 patients were analyzed, with 5,654 fulfilling the inclusion criteria of being admitted for AMI and receiving both percutaneous coronary intervention and inpatient CR between January 2011 and December 2014. We compared patients who participated in outpatient CR at least once within 180 days of discharge and who did not. To account for measured baseline imbalances between outpatient CR participants and non-participants, 1:1 propensity-score matching was performed. The primary outcome was a composite of all-cause death and recurrence of AMI after the landmark time-point of day 180 after discharge. Secondary outcomes included all-cause death, recurrence of AMI, and heart failure.

Results
Among 5,654 patients (mean [SD] age, 66.8 [12.4] years; 21.2% female; median follow-up period [IQR] 1.44 [0.87 to 2.27] years), 730 (12.9%) received outpatient CR. Of 1,458 propensity-score matched patients, outpatient CR participants did not show a significantly lower risk of the primary outcome than non-participants (1.38 vs. 2.12 per 100 patient-years; hazard ratio [HR], 0.71 [95% CI, 0.32 to 1.61]). Similarly, outpatient CR participation was not associated with lower risks of all-cause death (0.68 vs. 1.31 per 100 patient-years; HR, 0.83 [95% CI, 0.25 to 2.73]), recurrence of AMI (0.69 vs. 0.88 per 100 patient-years; HR, 0.56 [95% CI, 0.19 to 1.66]) or heart failure (2.01 vs. 2.06 per 100 patient-years; HR, 0.89 [95% CI, 0.47 to 1.72]), respectively.

Conclusion
Among patients with AMI who received percutaneous coronary intervention and inpatient CR, outpatient CR was not associated with lower risks of mortality and morbidities. The survival benefit of outpatient CR should be reaffirmed under current real-world clinical practice, especially in non-Western countries.
P635The addition of yoga to aerobic exercise programs reduces global cardiovascular risk
Authors: Pandey A , Huq N , Chapman M , Fongang A , Poirer P 
Published: October 2019

Abstract

Introduction
Regular physical activity may modulate the inflammatory process and be cardio-protective. Yoga is a form of exercise that may have cardiovascular benefits. The effects of yoga on global cardiovascular risk have not been adequately described. The purpose of this study is to determine whether the addition of yoga to a regular exercise regimen reduces global cardiovascular risk.

Methods
Sixty consecutive individuals with essential hypertension were recruited in a lifestyle intervention program. All individuals with known hypertensive end organ damage, known cardiovascular diseases, as well as those taking medications/supplements that affected blood pressure, blood sugar, cholesterol or vascular inflammation were excluded. Participants were randomized to either a yoga group or similar duration stretching control group. Participants, over the 3-month intervention regimen, performed 15 minutes of either yoga or stretching in addition to 30 minutes of aerobic exercises thrice weekly. Blood pressure, cholesterol levels and hs-CRP were measured, and Reynold's Global Cardiovascular Risk Score was calculated at baseline and at the end of the 3-month intervention program.

Results
At screening, there were no statistically significant differences between the groups in any measured parameters or the 10-year risk of a cardiovascular event as measured by the Reynolds Risk Score. (8.2 vs. 9.0%; yoga vs. control group) After the 3-month intervention period, there was a statistically significantly greater decrease in the Reynold's Risk Score in the yoga vs. the control group. (7.0 vs. 8.4%, p=0.003, relative reduction 13.2 vs. 6.5%, p<0.0001)
Baseline and 3 Month Outcomes

Conclusions
In patients with essential hypertension on no medications and with no known end organ damage, the practice of yoga incorporated into a 3-month exercise intervention program was associated with significant greater improvement in the Reynold's Risk of a 10-year cardiovascular event, when compared to the control stretching group. If these results are validated in more diverse populations over a longer duration of follow up, yoga may represent an important addition to traditional cardiovascular disease prevention programs.
P645Low levels of low density lipoprotein cholesterol and cardiovascular, cancer and all-cause mortality outcomes
Authors: Sung K , Lee J Y , Lee S J 
Published: October 2019

Abstract

Aims
The effect of low concentrations of low density lipoprotein-cholesterol (LDL-C) on cardiovascular disease (CVD) cancer and all-cause mortality is still controversial. In a large, young, well characterized, relatively healthy occupational cohort (Kangbuk Samsung health study, KSHS), we tested associations between low levels of LDL-C concentration, and CVD, cancer and all- cause mortality. To validate these associations, we analyzed data from another cohort (Korean genome and epidemiology study, KoGES).

Methods and results
347,971 subjects in KSHS (mean age 39.6 years, 57.4% men) were studied over a mean follow up of 5.64±3.27 years. All subjects treated with any lipid lowering therapy were excluded. After excluding the data from subjects who died during the first 3 years of follow up, five groups were defined according to baseline LDL-C concentration (<70, 70–99, 100–129, 130–159, ≥160 mg/dL). Hazard ratios (HR and 95% CIs) for all-cause mortality, CVD and cancer mortality were estimated using Cox proportional hazards models. In the KoGES validation cohort, 182,943 subjects (mean age 53.1 years, 34.6% men) were studied over a mean follow up of 8.57±2.59 years with same methods. 2,028 deaths (897 from cancer and 282 from CVD) occurred during follow-up in KSHS. The lowest LDL-C group (LDL<70 mg/dL) had a higher risk of all-cause mortality (HR 1.95, 1.55–2.47), CVD mortality (HR 2.02, 1.11–3.64) and cancer mortality (HR 2.06, 1.46–2.90) compared to the reference group (LDL 120–139 mg/dL). This association was more prominent in men than in women. In the validation cohort, 2,338 deaths (1,823 from cancer and 199 from CVD) occurred during follow-up. The lowest LDL-C group (LDL<70 mg/dL) had a higher risk of all-cause mortality (HR 1.81, 1.44–2.28). Men in the lowest LDL-C group had a higher risk of CVD mortality (HR 3.15, 1.21–8.21) and cancer mortality (1.34, 0.99–1.82) in the KoGES cohort.

Conclusions
Low levels of LDL-C concentration are strongly and independently associated with increased risk of cancer, CVD and all-cause mortality especially in men.