bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6306Hyperlipidemia inhibits the protective effect of lisinopril after myocardial infarction via activation of dendritic cells
Authors: Ma Y , Ma L , Ge J , Zou Y 
Published: October 2019

Abstract

Background
In clinical situation, patients with myocardial infarction (MI) usually suffered from hyperlipidemia, hypertension, renal dysfunction or diabetes as well and the interaction of those risk factors may affect the effectiveness of ACEI. Dendritic cell (DC) is a potent central immunoregulator that orchestrates various types of inflammatory cells in innate and adoptive immunity. The role of DCs in the inflammation of cardiovascular disease is a hotspot of international research.

Purpose
To investigate the improvement of cardiac remodeling and inflammatory immune response after MI via ACEI regulating DCs and explore that whether the protective effect of ACEI is under the circumstance of hyperlipidemia.

Methods
In vivo, MI mice models were created via coronary artery ligation. We detected the survival and left ventricular function on day 7 after MI. Tissue samples of the myocardium, spleen, bone marrow and peripheral blood were obtained and assessed for Ang2 concentration, inflammatory cytokines and DCs expression via immunohistochemistry, ELISA, flow cytometry and western blot. In vitro, we treated DCs with ox-LDL+AngIIfor 48 hours simulating the internal environment of MI in ApoE−/− mice to explore the mechanism involved in the DCs maturation and inflammation.

Results
Under the circumstance of hyperlipidemia, the cardioprotective effect of ACEI is attenuated through regulating DCs maturation and inflammation after MI, including survival rate (Figure 1) and left ventricular function. The number of DCs in cardiac tissue were increased in MI mice with hyperlipidemia (Figure 2), when compared with the WT group. The expression of the maturity phenotype related molecules, such as CD83, on the DCs in spleen were also increased in the ApoE−/− mice. Then, the expressions of inflammatory cytokines, such as IL-6 and TNF-α. In vitro, it was found that the immune maturation and inflammation of DCs could be further induced by ox-LDL on the basis of AngIItreatment, as indicated by the upregulation of CD83 and CD86, the expressions of cytokines and chemokines. Furthermore, ox-LDL could activate the toll-like receptor 4 (TLR4)-myeloid differentiation factor 88 (MyD88) signaling pathway, promoting the phosphorylation of interleukin-1 receptor associated kinase (IRAK)-4 and the nuclear transferring of nuclear factor-kappaB (NF-κB).

Conclusion
We proved ACEI reduces the recruitment of DCs to the infarct, leading to a higher survival rate and improved function and remodeling through decreased inflammation resulting from immune response after MI. However, this effect was inhibited under the circumstance of hyperlipidemia. TLR4-MyD88 signaling pathway might be the possible molecular mechanism involved in the immune maturation and inflammation of DCs induced by ox-LDL on the basis of AngII.

Acknowledgement/Funding
the Youth fund of the National Natural Science Foundation of China, Grant 81600280
P6311Is the new PH classification useful to assess the need for heart transplantation? Looking for harder markers for hard patients
Authors: Moretta A , Masetti M , Russo A , Dardi F , Palazzini M , Martin Suarez S , Galie' N , Potena L 
Published: October 2019

Abstract

Background
Pulmonary hypertension (PH) is an important prognostic marker among patients (pts) with heart failure. Recent ESC guidelines have introduced the concept of diastolic transpulmonary gradient (DPG) to differentiate combined (CpC) and isolated (IpC) post-capillary PH. However, its validation in a setting of patients evaluated for heart transplantation (HT) has been poorly explored; moreover, it doesn't incorporate right ventricular (RV) function.

Purpose
To analyze the prognostic role of current classification of PH and its interplay with RV function and diuretic therapy in pts with advanced heart failure referred for HT.

Methods
We included all pts evaluated for HT in our Center (2002–16) undergoing to a right heart cath (RHC), collecting data at first evaluation. Patients were divided into three groups: no PH (mPAP<25 mmHg), IpC-PH (mean PAP >25 mmHg, PVR<3 WU), CpC-PH (mean PAP>25 mmHg, PVR ≥3 WU and/or DPG ≥7 mmHg). Pulmonary artery pulsatility index (PAPi) was analyzed as a marker of RV function; oral furosemide>125 mg/day (median value) or i.v. diuretics/dialysis were considered as high-dose diuretics (HDD). The study endpoint was the combined incidence of death or need for high urgent HT, expressed as 2-yrs survival rate.

Results
Among the overall cohort of 458 pts (53.1±10.9 yrs, 82,6% males, 40.3% CAD, 9.3% on IABP), 57.9% had PH: 30.8% IpC-PH, 27.1% CpC-PH. Only 8 pts (0.2%) had DPG≥7, one with PVR<3. The use of HDD differed significantly according to PH classes (44.6% vs 56.3% vs 68.3%, no PH vs IpC vs CpC-PH respectively, p<0.01) and was associated with a worse outcome (p<0.01). The incidence of the primary endpoint in the overall cohort was 74.1±2.5%. While pts with CpC-PH had the worst prognosis, DPG≥7 did not predict the primary endpoint. At multivariate analysis, PVR ≥3 WU (HR: 16.7), PAPi <3.8 (median value, HR: 4.1), HDD (HR: 5.6) were independent predictors of the primary endpoint, (p<0.04 for all) as well as need for IABP (HR: 19.0, p<0.01), even adjusting for clinical variables. Lower PAPi values carried an higher risk at 2 years both in IpC and CpC PH groups, thus allowing to better stratify the need for urgent HT (81.6±6.6% vs 78.6±5.7% vs 67.3±6.7% vs 49.1±7.9% respectively, p<0.001) (Fig.1).
Figure 1

Conclusion
Our results suggest that, even if current definition of type 2 PH predicts the need of urgent HT, the incorporation of DPG ≥7 is epidemiologically irrelevant and doesn't increase accuracy, whereas combining an indirect marker of RV function (PAPi) with PVR assessment, even correcting for diuretic therapy, could help to better stratify the need of a rare resource like HT in patients with advanced heart failure and pulmonary hypertension.
P6315Effects of chronic heart failure unconventional therapies on endothelial function
Authors: Maloberti A , Piccinelli E , Zannoni J , Castelnuovo S , Vallerio P , Bassi I , Pansera G , Occhi L , Varrenti M , Masciocco G , Perna E , Cipriani M , Frigerio M , Giannattasio C 
Published: October 2019

Abstract

Introduction
Endothelial Dysfunction (ED) of peripheral arteries in Chronic Heart Failure (CHF) subjects has been demonstrated.

Purpose
We assessed endothelial function in subjects undergoing unconventional treatments for CHF, namely Heart Transplantation (HTX), continuous-flow Left Ventricular Assist Device implantation (LVAD), and repeated levosimendan infusions (r-LEVO).

Methods
Twenty HTX recipients (median time from HTX 21 months), 20 patients supported with LVAD (median time from implant 39 months), and 20 patients receiving monthly Levosimendan infusions (median time on treatment 28 months) were enrolled and compared to a group of 20 healthy subjects. ED was evaluated with ultrasound assessment of the diameter before and after ischemic stress at the brachial artery level. The difference between the two diameters normalized for the baseline value (Flow Mediated Dilation – FMD) has been used for the analysis. All the patients were stable at the time of FMD assessment, with those on r-LEVO being evaluated prior to infusion.

Results
FMD was significantly lower in HTX and LVAD groups with respect to controls (9.8±7.4, 9.3±5.7, and 15.6±6.4% respectively, p=0.01), but not in r-LEVO group (12.5±6.9%).
When patients were analyzed according to time from the operation or on treatment, (< versus > of the median value), no differences were seen in HTX and r-LEVO group, while in LVAD group FMD was borderline significantly higher in patients with longer follow-up (8.4±6.4% versus 10.2±5.2%, p=0.05).

Conclusions
Based on this preliminary data we can inference the following: 1- FMD is abnormal in HTX recipients, despite their good functional status, probably due to factors unrelated to CHF (e.g. hypertension, renal insufficiency, denervation, and drug effects); 2- LVAD patients also show ED, with possible better adaptation in very long-term survivors; 3- Near-normal FMD values in CHF patients who remain stable with r-LEVO suggest that pulsed treatment may obtain favorable effects at peripheral level, persisting after clearance of the drug and its metabolites.

Acknowledgement/Funding
None
P6331Influence of dynapenia and obesity on prognoses of elderly heart failure patients
Authors: Uchida S , Kamiya K , Hamazaki N , Matsuzawa R , Nozaki K , Ichikawa T , Nakamura T , Yamashita M , Kootaka Y , Maekawa E , Yamaoka-Tojo M , Matsunaga A , Masuda T , Ako J 
Published: October 2019

Abstract

Background
In elderly people, a decline in activities of daily living is more closely associated with low muscle strength (dynapenia) than with low muscle mass. Moreover, the combination of low muscle strength and obesity (dynapenic obesity) is associated with a higher risk of mortality than dynapenia or obesity alone, but its influence on prognosis is still unknown in elderly heart failure (HF) patients. To clarify these relationships may contribute to the development of rehabilitation programs for elderly HF patients and the improvement their prognoses in the future.

Purpose
We aimed to investigate the influence of dynapenia and obesity on prognoses of elderly HF patients.

Methods
We evaluated 1006 elderly HF patients aged ≥65 years (76.5±6.9 years, 579 males) who were admitted to our hospital and participated in an inpatient cardiac rehabilitation program. We assessed patients' characteristics, including body mass index (BMI) and handgrip strength during hospitalization. Patients with low handgrip strength (<26 kg and <18 kg in males and females, respectively) and high BMI (≥25 kg/m2) were considered to have dynapenia and obesity, respectively. Moreover, patients fulfilling the above two criteria (dynapenia, obesity) were considered to have dynapenic obesity. Patients were divided into four groups: normal, dynapenia only, obesity only, and dynapenic obesity. We compared survival rates among the four groups using the Kaplan-Meier method and log-rank test. To identify predictors for all-cause mortality, we performed Cox regression analysis.

Results
During the 8-year follow-up period, 228 patients (21.2%) died. Eight-year cumulative incidences of mortality were 35.4%, 26.0%, 62.6%, and 33.1% in the normal, obesity only, dynapenia only, and dynapenic obesity groups, respectively. Significantly lower survival rates were observed in the dynapenia only group than in the other 3 groups (log-rank: 28.893, P<0.001). Cox regression analysis, after adjusting for age and sex, showed significantly poor prognosis in the dyanapenia only group than in the other 3 groups (normal group, hazard ratio [HR] = 0.684, 95% confidence interval [CI] = 0.488–0.959, P=0.028; obesity only group, HR = 0.330, 95% CI = 0.182–0.598, P<0.001; dynapenic obesity group, HR = 0.390, 95% CI = 0.206–0.739, P=0.004).

Conclusion
Elderly HF patients with dynapenia alone had poor prognoses. Obesity may have protective effects on the survival of dynapenia patients with HF.
P6335The impact of patient's adherence to maintenance of euvolaemia on all-cause mortality and heart failure re-hospitalization: insights from the Optimize Heart Failure Care Program
Authors: Lopatin Y , Grebennikova A , Pagava Z , Berkinbayev S , Glezer M , Rakisheva A , Abdullaev A , Kurlyanskaya A , Dadashova G , Voronkov L , Chesnikova A , Tarlovskaya E , Sisakian H , Koziolova N , Hayrapetyan H 
Published: October 2019

Abstract

Background
Four recommended self-care behaviors (low salt diet, avoidance of excessive fluid intake, weight control, and flexible diuretic regimen) play an important role in the management of heart failure (HF) patients. However, little is known about the impact of patients' adherence to these self-care behaviors on prognosis and rate of HF re-hospitalizations. The aim of our study was to analyze the impact of HF patients' adherence to maintenance of euvolaemia on all-cause mortality and HF re-hospitalizations.

Methods
The analysis included data from the international prospective multicenter Optimize Heart Failure Care Program which was collected over 12 months from 628 patients (mean age 62.6±12.3 years, 70% male) hospitalized with decompensated HF, NYHA II-IV (mean 2.7±0.6), mean left ventricular ejection fraction 33.8±9.4%. The underlying etiology of HF was ischemic in 64% of cases. Before discharge from the hospital all HF patients were educated in self-care skills to maintain the euvolaemia. To assess patients' adherence to low salt diet, avoidance of excessive fluid intake, weight control and flexible diuretic regimen, an indirect method (patient-reported compliance, which was measured using a special questionnaire) was used. Three types of adherence were determined: good (patients always maintained euvolaemia), moderate (patients sometimes maintained euvolaemia) and poor adherence (patients did not maintain euvolaemia).

Results
After discharge from the hospital the overall adherence rates were 66.4% for low sodium diet, 58% for fluid intake, 69.9% for weight control, and 87.2% for the flexible diuretic regimen. However, the adherence to diet and the flexible diuretic regimen significantly decreased (p<0.01) by the 12 months of follow-up. Good, moderate and poor adherence to maintain euvolaemia were noted in 40%, 31.5% and 28.5% patients, respectively. After 12 months of follow-up all-cause mortality and rate of HF re-hospitalizations and were significantly lower in the group of good patients' adherence in comparison with moderate and poor patients' adherence (HR 0.72, 95% CI 0.61–0.84, p<0.0001) (Figure).

Conclusion
Less than half of HF patients demonstrated good adherence to the guideline-recommended control of euvolaemia. The rates of all-cause mortality and HF re-hospitalizations in the group of good patient's adherence were significantly lower compared with the groups of moderate and poor adherence to maintenance of euvolaemia. Constant efforts to promote the maintenance of euvolaemia in HF patients are needed.
P6336Plasma proteomic profile predicts survival in heart failure with reduced ejection fraction
Authors: Gui H , She R C , Li J , Sabbah H , Williams L K , Lanfear D 
Published: October 2019

Abstract

Background
Whether the plasma proteome can predict the course of heart failure (HF) and has incremental value to established predictors is uncertain.

Methods
Patients meeting Framingham HF criteria with history of reduced ejection fraction (n=1017) were prospectively enrolled in a registry and donated fasting blood samples. Plasma underwent analysis on the SOMAscan proteomic discovery platform, quantifying 4789 proteins using standard assay and quality controls. Patients were randomly divided into derivation (n=681) and validation (n=336) cohorts. We derived a proteomic risk score (PRS) in the derivation cohort using Lasso-penalized Cox regression and then tested it in the validation cohort. Both models were adjusted for an establish HF clinical risk score (MAGGIC) and NTproBNP. We assessed risk stratification improvement in the validation cohort by comparing models with and without PRS using the model C statistic, continuous net reclassification index (NRI), integrated discrimination index (IDI), and the median improvement in risk score (MIRS).

Results
Overall 47.5% of patients were African American, 35.2% were female, mean ejection fraction was 34.8%, and average age was 67.9 years. After median follow-up of 3.6 years, there were 296 deaths (194 in derivation and 102 in validation). Optimized modeling defined a 32 protein PRS (hazard ratio [HR] 2.33, p<2.00E-16) which was also statistically significant when tested in the validation cohort (PRS HR=1.19, p=4.87E-02) and showed some improvement in risk stratification (Table).
Methods Variables Estimate 95% CI P Validation Testing MAGGIC 1.06 1.027, 1.092 2.84E-04 NTproBNP 1.84 1.430, 2.359 1.88E-06 PRS 1.19 1.001, 1.408 4.87E-02 Risk Stratification Assessment C-statistic improvement 0.012 −0.076, 0.101 8.30E-01 IDI 0.034 0.007, 0.095 <2.00E-16 Continuous-NRI 0.286 −0.062, 0.475 9.00E-02 Median Improvement in Risk Score 0.015 0.001, 0.078 2.00E-02

Conclusion
A plasma multi-protein predictive score can improve risk stratification in HF patients on top of a validated clinical score and NTproBNP. Additional investigation is warranted to define mechanisms underlying individual proteins and explore proteomic clinical applications.
P6340Mortality and prognostic factors in dilated cardiomyopathy versus ischaemic heart disease in patients with heart failure with reduced ejection fraction - a Swedish population-based study
Authors: Silverdal J , Bollano E , Sjoland H , Pivodic A , Dahlstrom U , Fu M 
Published: October 2019

Abstract

Background
In heart failure with left ventricular ejection fraction reduction <40% (HFrEF) the increased mortality in patients with underlying ischaemic heart disease (IHD) compared to multi-aetiological non-ischaemic HFrEF is established. The prognostic difference over time in comparison with dilated cardiomyopathy (DCM) is less clear.

Purpose
To evaluate the difference in mortality between IHD and DCM in HFrEF, overall, in specific subgroups and over time.

Methods
By applying multivariable Cox regression analyses on Swedish Heart Failure Registry data from the years 2000 to 2012 (including 51,060 patients), the incidence of mortality in 8,982 patients with non-valvular clinical IHD-HFrEF was compared to 2,220 patients with DCM-HFrEF overall and for subgrouping variables of age category, sex and EF group (<30% and 30–39%), adjusted for additional 23 baseline variables.

Results
The overall mortality was higher in IHD-HFrEF with the crude mortality of 42.1% and the event rate 15.4 (95% confidence interval [CI]: 14.9 - 15.9) per 100 person years compared with 19.4% and 5.5 (95% CI: 5.0–6.1) in DCM-HFrEF. The probability of survival in IHD-HFrEF was lower than in DCM-HFrEF (Figure). After multivariable adjustment the risk for mortality in IHD-HFrEF remained increased with a hazard ratio (HR) of 1.34 (95% CI: 1.18–1.50). The adjusted HR was higher in all groups of age <80 years and in both sexes, with a significantly higher risk in women than in men (HR 1.85 vs 1.22, p for interaction = 0.002). Overall, HR was increased regardless of EF group but analyses by both age group and EF group revealed significantly increased mortality in EF <30% only for age groups <80 years. No significant temporal trend was seen between IHD-HFrEF and DCM-HFrEF.
Probability of survival

Conclusions
In patients with heart failure and reduced ejection fraction, ischaemic heart disease compared to dilated cardiomyopathy was associated with increased mortality in all age groups below 80 years of age, throughout the 13-year study period.

Acknowledgement/Funding
The Swedish Heart-Lung Foundation. The regional ALF agreement between Västra Götalandsregionen and University of Gothenburg (ALFGBG-72196, prof.Fu)
P6365Contrasting the impact of the European (ESC/ESH 2018) versus American (ACC/AHA 2017) high blood pressure clinical practice guidelines in Poland
Authors: Wyszomirski A , Pencina M J , Whelton P K , Wojtyniak B , Gaciong Z , Bandosz P , Zieleniewicz P , Zdrojewski T 
Published: October 2019

Abstract

Background
The 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for the management of arterial hypertension and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline for the prevention, detection, evaluation, and management of high blood pressure in adults differ in approach to defining stages of hypertension and recommendations for treatment of high blood pressure.

Purpose
To contrast the implications of the ESC/ESH versus ACC/AHA hypertension guidelines among the general population in Poland – a country representing a high CVD risk region in Europe.

Methods
We used data from a representative random sample of 1439 Polish adults aged 40 to 79 from the research program NATPOL 2011. The analysis was weighted in order to reflect the structure of the population in Poland and was stratified by age and gender. We applied the ESC/ESH 10-year SCORE (Systematic COronary Risk Evaluation) and the ACC/AHA ASCVD (atherosclerotic CV disease) risk assessment tools and followed guideline-specific algorithms to detect hypertension and follow recommendations for treatment.

Results
The overall prevalence of hypertension among Polish adults according to the ACC/AHA guideline was 76.9% (95% CI, 74.7–79.0%) versus 51.8% (95% CI, 49.2–54.4%) according to the ESC/ESH guidelines. Application of the ACC/AHA guideline recommendations would result in antihypertensive drug treatment for 63.0% (95% CI, 60.5–65.5%) of Polish adults compared with 46.2% (95% CI, 43.6–48.7%) based on application of the ESC/ESH guidelines (difference 16.8% (95% CI, 14.9–18.8%), table 1).
Table 1 2017 ACC/AHA guideline 2018 ESC/ESH guideline Δ (difference) Hypertension Recommended treatment Hypertension Recommended treatment Hypertension Recommended treatment % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) Age   40–49 (n=391) 63.2 (58.4–68.0) 37.3 (32.6–42.1) 32.0 (27.4–36.6) 21.2 (17.2–25.3) 31.2 (26.6–35.8) 16.1 (12.5–19.8)   50–59 (n=452) 77.7 (73.8–81.5) 61.7 (57.2–66.2) 49.1 (44.5–53.7) 40.0 (35.5–44.6) 28.5 (24.4–32.7) 21.7 (17.9–25.5)   60–69 (n=356) 82.3 (78.3–86.3) 75.3 (70.8–79.8) 62.4 (57.3–67.4) 61.5 (56.5–66.6) 19.9 (15.8–24.1) 13.8 (10.2–17.3)   70–79 (n=231) 90.0 (86.2–93.9) 90.0 (86.2–93.9) 74.5 (68.8–80.1) 76.6 (71.2–82.1) 15.6 (10.9–20.3) 13.4 (9.0–17.8) Gender   Male (n=689) 80.4 (77.4–83.4) 67.5 (64.0–71.0) 52.5 (48.8–56.3) 47.2 (43.4–50.9) 27.9 (24.5–31.2) 20.3 (17.3–23.3)   Female (n=741) 73.6 (70.4–76.7) 58.8 (55.3–62.4) 51.2 (47.6–54.8) 45.2 (41.6–48.8) 22.4 (19.4–25.4) 13.6 (11.2–16.1)

Conclusions
Application of the ACC/AHA guideline would result in a considerable increase in the prevalence and antihypertensive drug treatment of hypertension in Polish adults compared with application of the ESC/ESH guidelines.