bluuebunny/crossref_metadata_2025_split huggingface dataset:
6132Trends in mortality from heart failure between 1980 and 2016
Authors: Santos S C , Villela P B , Klein C H , Queiroga D , Oliveira G M M 
Published: October 2019

Abstract

Background
Heart failure (HF) is a highly prevalent disease with high mortality rates worldwide, representing the final stage of a large set of cardiovascular diseases.

Purpose
To evaluate the trend of mortality rates fromHF, by sex and Brazilian geoeconomic region, between 1980 and 2016.

Methods
Time series analysis of the underlying causes of death from HF between 1980 and 2016. Population and death-related data were obtained from the Information Technology Department of the Brazilian Unified Health System (DATASUS/MS). Annual crude mortality rates per 100,000 inhabitants were calculated. Standardized rates were estimated according to the age structure of the Brazilian population in the year 2000. Mortality rates were evaluated in all federal units (FedUs) that comprise the Braziliangeoeconomicregions (Northern, Northeastern, Southeastern, Southern and West-Central).

Results
In Brazil, of the 35,348,374 deaths recorded between 1980 and 2016, 3.2% had HF as the underlying cause. The crude mortality rates from HF in both sexes showed a similar reduction trend over the period. In men, those rates ranged from 13.77 in 1980 to 6.69 per 100,000 inhabitants in 2016, while in women, those rates ranged from 13.15 in 1980 to 7.27 per 100,000 inhabitants in 2016 (Figure 1). Despite the relative stability in the last decade, the standardized rates (Figure 1 - Std) showed a similar trend, but with lower values at the end of the study period. Of all FedUs, only Maranhão (Northeastern region) showed a mortality rate similar to that observed in 1980 (10.44 per 100,000 inhabitants in 1980 and 10.65 per 100,000 inhabitants in 2016). All the other FedUs showed a reduction over the period. The FedUs of the Southeastern, Southern and West-Central regions had the highest reductions, especially Espírito Santo (Southeastern region), Rio Grande do Sul (Southern region) and the Federal District, which decreased from 38.98, 53.34 and 28.56 in 1980 to 3.43, 8.49 and 4.33 per 100,000 inhabitants in 2016, respectively.
Figure 1

Conclusions
The crude and standardized mortality rates from HF decreased in the last 37 years, probably because of the better control of risk factors and the advances in HF treatment. The most important reductions occurred in the richest regions of the country, which may be related to the improvement of socioeconomic factors.
P4987Long term follow up after comparison of two strategies in a chest pain unit: exercise echocardiography and multidetector computed tomography
Authors: Pineiro-Portela M , Peteiro-Vazquez J , Bouzas-Mosquera A , Martinez-Ruiz D , Yanez-Wronenburger J C , Pombo F , Vazquez-Rodriguez J M 
Published: October 2019

Abstract

Introduction and objectives
Up to 5% patients with acute chest pain present an acute coronary syndrome (ACS). This study aimed to compare peak exercise echocardiography (ExE) and multidetector computed tomography (MCT) in patients referred to a chest pain unit.

Methods
203 patients with ≥1 cardiovascular risk factors, no ischemic ECG changes and negative biomarkers were randomized to ExE (n=103) or MCT (n=100). The endpoints were hard events (cardiovascular death and non-fatal myocardial infarction), combined events (hard events and revascularizations), and combined events plus readmissions during follow-up. Cost of either strategy was also investigated.

Results
Mean age was 64±11 years and 131 patients were male. Hypertension was seen in 71%, hypercholesterolemia in 74%, diabetes mellitus in 28%, and smoking in 21%. Most of the patients had a low TIMI risk score (68% TIMI I and 32% TIMI II). Mean follow-up was 4,7±2,7 years. Invasive angiography due to positive/nonconclusive results was performed in 34 of the patients, 103 submitted to SE and in 27 of the 100 submitted to MCT (33% vs. 27%, p=0.15). A final diagnosis of acute coronary syndrome was achieved in 53 patients (30 [88%] in the ExE group and 23 [85%] in the MCT group, p=0.12). There were no significant differences between groups in hard events (5 [5%] patients in the ExE group and 7 [7%] in the MCT group, p=0,42), combined events (35 patients [34%] in the ExE group and 29 [29%] in the MCT group), and combined events plus readmissions (43 [42%] patients in the ExE group and 41 [41%] in the MCT). The median stay in hospital was 7 (5–10) days in the ExE group and 8 (5–10,25) in the MCT group (p=NS). For patients with negative results by either technique the mean stay was less than 8 hours. There were no differences in the global cost, although it was lower for patients with negative ExE (557 € vs. 706 €, p<0,02) as compared to those with negative TCM.

Conclusions
Both MCT and ExE are equally effective for the stratification of patients with low to moderate probability of ACS admitted to a chest pain unit. The cost was similar with both strategies, although significant lower in ExE when negative studies were compared.
P4988Beta-blockers in diabetes with stable coronary heart disease - a cause for concern?
Authors: Malik A H , Shetty S , Kar K , El Accaoui R 
Published: October 2019

Abstract

Background
Beta-blocker (BB) therapy is a cornerstone for the treatment of coronary heart disease (CHD). The evidence of the benefit from long-term BB therapy in diabetic patients with stable CHD is scarce. This meta-analysis summarises the evidence relating to the BB therapy in diabetic patients with stable CHD.

Methods
A meta-analysis was performed according to PRISMA and MOOSE guidelines for reporting of systematic reviews of observational studies. PubMed, Embase, and Cochrane central were searched and two authors independently screened studies for eligibility. The quality of studies was assessed with the Newcastle Ottawa scale. The primary outcome of interest was all-cause mortality, cardiovascular (CV) mortality and major adverse cardiovascular events (MACE) in diabetic patients with and without BB therapy. A generic inverse variance model was used to pool the odds ratio or hazards ratio from included studies to calculate the overall effect estimate. The significance threshold was set at p-value <0.05. Heterogeneity was assessed by I2.

Results
Four non-randomized studies with 9,515 participants were selected for the analyses. Four studies were post-hoc analyses of randomised controlled trials, and 1 article was an analysis of a nationally representative survey. In a fixed effects model, BB therapy in diabetic patients with stable CHD was found to be associated with increased risk of CV mortality, and MACE (27%, and 32% respectively; p-value <0.05) and was not associated with a reduction in all-cause mortality (HR 1.12; 95% CI 0.94–1.33; p-value =0.22).

Conclusion
BB therapy in diabetic patients with stable CHD appears to be linked to higher mortality. Large randomised trials are needed in this population to confirm these findings.

Acknowledgement/Funding
None
P4996The adult heart requires baseline expression of the transcription factor Hand2 to withstand right ventricular pressure overload
Authors: Koop A M C , Videira R F , Ottaviani L , Poels E M , Van De Kolk K W , Lourenco A , Nascimento D S , De Windt L J , Falcao-Pires I , Berger R M F , Da Costa Martins P A 
Published: October 2019

Abstract

Introduction
Heart and neural crest derivatives expressed-2 (Hand2) has been identified as an important embryonic basic helix-loop-helix-transcription factor, with different functions in the development of the first and second heart field, from which the left and right ventricle originate, respectively. Our previous work revealed that Hand2, under conditions of left ventricular (LV) pressure overload, is re-expressed in the adult heart and activates a “fetal gene” program contributing to pathological cardiac remodeling. Ablation of cardiac expression of Hand2 resulted in protection to cardiac stress and attenuated maladaptive remodeling.

Purpose
In this study, we aimed at unraveling the role of Hand2 during cardiac remodeling in response to right ventricular (RV) pressure overload induced by pulmonary artery banding (PAB).

Methods
Hand2F/F and MCM− Hand2F/F mice were treated with tamoxifen (control and knockout, respectively) and subjected to six weeks of RV pressure overload induced by PAB. Echocardiographic and MRI derived hemodynamic parameters, and molecular remodelling were assessed for experimental groups and compared to sham-operated controls (Fig. 1a). RNA sequencing and gene ontology enrichment analysis were performed to compare the dysregulated genes between the pressure overloaded RV of the control and Hand2 knockout mice.

Results
After six weeks of increased pressure load (Fig. 1b), levels of Hand2 increased in the control banded animals but, as expected, remained absent in the knockout hearts (Fig. 1c). In contrast to the what was previously observed for the pressure overloaded LV, in the pressure loaded RV, Hand2 depletion resulted in more severe remodelling and dysfunction as reflected by increased hypertrophic growth, increased RV end-diastolic and end-systolic volumes as well as decreased RV ejection fraction (Fig. 1d–g). In addition, RNA sequencing revealed a distinct set of genes that are dysregulated in the pressure-overloaded RV, compared to the previously described pressure-overloaded LV. These include components of the extracellular matrix structure, collagen assembly and organization and several types of collagens. Genes associated with inflammation response, adhesion and muscle organization were also affected in the RV of the Hand2 KO mice (Fig. 1h).
Figure 1

Conclusion
Cardiac-specific depletion of Hand2 is associated with severe cardiac dysfunction in conditions of RV pressure overload. While inhibiting Hand2 expression can prevent cardiac dysfunction in conditions of LV pressure overload, the same does not hold true for conditions of RV pressure overload. This study highlights the need to better understand the molecular mechanisms driving pathological remodelling of the RV, in contrast to the LV, in order to better diagnose and treat patients with RV or LV failure.
P5008Empagliflozin in a real-world chronic heart failure population
Authors: Rocha M L , Cunha G C , Gomes R M , Morais R , Campos L , Araujo I , Fonseca M C 
Published: October 2019

Abstract

Introduction
Heart Failure (HF) is a burdensome syndrome with significant mortality, morbidity and costs. Its prognosis is further aggravated by diabetes mellitus (DM). The EMPA-REG OUTCOME trial suggested that empagliflozin significantly reduced HF hospitalizations compared to placebo in patients with DM.

Purpose
We aimed to investigate which patients with chronic HF and DM in the outpatient setting could have been enrolled in the main empagliflozin trial.

Methods
This analysis is based on a retrospective cohort enrolling chronic HF patients who consecutively attended the HF appointment between January and July 2018. Of these, those with concomitant DM were selected and further analysed. The key EMPA-REG OUTCOME trial inclusion criteria [(i.e., hemoglobin A1c 7–10%, high cardiovascular (CV) risk and glomerular filtration rate [GFR] ≥30mL/min/1,73m2) were considered. Further, the European Medicine Agency (EMA) restriction (GFR>60mL/min/1,73m2) was also considered in an additional analysis.

Results
Of 316 patients with HF, 114 (36%) concomitantly had DM. Mean age was 74±10 years, 63% were male and most (54%) had preserved left ventricular ejection fraction. Ischemic (51%) and hypertensive (27%) HF were the most often observed etiologies. According to the inclusion criteria, 21 (18.4%) (or 5.3% when further considering the EMA restriction) HF patients could have been potentially enrolled in the main trial and derive a HF hospitalization reduction benefit from starting empagliflozin. The remainder would be excluded due to GFR<30mL/min/1.73m2 (2.6%), absence of “high CV risk” as per trial's definition (7%), HbA1c off target (18,4%) or a combination of the above criteria (53.6%). In light of the new Standards of Medical Care in Diabetes 2019, controlled patients with HbA1c off target (i.e., <7% or >10%) could be switched to a SGLT2 inhibitors, hence possibly expanding the indication to start empagliflozin to 36.8% of our HF cohort.
Figure 1

Conclusions
Roughly 1 in every 5 patients with HF and DM could have been enrolled in the main empagliflozin trial, as per key inclusion criteria, and potentially derive CV benefit from it. Thus, only a minority of our cohort shared the features for EMPA-REG OUTCOME trial inclusion, limiting the extrapolation of the trial's observed CV benefits to our HF cohort. Indeed, whether these benefits also expand to overall HF cohort is eagerly awaited by ongoing trials.

Acknowledgement/Funding
None
P5011Impact of guideline-recommended medical therapy at discharge on long-term mortality in patients with or without left ventricular dysfunction after primary PCI for STEMI
Authors: Radomirovic M , Milasinovic D , Mehmedbegovic Z , Jelic D , Zobenica V , Zaharijev S , Zivkovic I , Pavlovic A , Dudic J , Obreski A , Dolicanin A , Vukcevic V , Asanin M , Stankovic G 
Published: October 2019

Abstract

Background
Clinical practice guidelines provide class I recommendation for the use of angiotensin-converting enzyme inhibitors (ACE-I) and beta-blockers in patients with prior myocardial infarction and left ventricular (LV) dysfunction, whereas their use in patients without LV dysfunction is considered to be a class IIa recommendation.

Purpose
Our aim was to comparatively assess the impact of ACE-I and/or beta-blockers on 3-year mortality in patients with or without impaired left ventricular (LV) function undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).

Methods
The analysis included 4425 patients admitted for primary PCI during 2009–2015 from a prospective, electronic registry of a high-volume tertiary center, who survived initial hospitalization, and for whom information on LV function and discharge medication were available. Patients were stratified according to LV systolic dysfunction, defined as LVEF <40%. Unadjusted and adjusted Cox regression models were created to investigate the impact of beta-blocker and/or ACE-I therapy on 3-year mortality.

Results
22.9% (n=1013) had LV dysfunction, 23.0% (n=1017) received either an ACE-I or a beta-blocker and 72.2% received both medications at discharge (n=3197). The concurrent use of both ACE-I and beta-blockers was not different in LVEF≥40% vs. LVEF<40% (72.4% vs. 71.7%, p=0.43). The use of at least one of the guideline-recommended medications was associated with a significantly lower 3-year mortality in both patients with LVEF≥40% (18.7% if neither was used, 11.2% if either a beta-blocker or an ACE-I were used and 9.4% if both were used, p=0.001), and LVEF<40% (55.4% if neither was used, 32.5% if either a beta-blocker or an ACE-I were used and 22.9% if both were used, p<0.001) (Figure). After adjusting for significant mortality predictors including older age, diabetes, hypertension, renal failure, previous stroke, Killip class ≥2 and non-culprit chronic total occlusion (CTO), the concurrent use of both a beta-blocker and an ACE-I remained independently associated with lower 3-year mortality in both patients with LVEF<40% (HR 0.30, p<0.001) and LVEF≥40% (HR=0.41, p=0.001). The use of a single agent was independently associated with lower mortality in patients with LVEF<40% (HR 0.45, p=0.002), but not in patients with LVEF≥40% (HR 0.61, p=0.07).

Conclusions
Guideline-recommended use of both a beta-blocker and an ACE-I in post-MI patients was associated with a lower 3-year mortality regardless of the LV function, whereas using only one of the two agents was associated with improved prognosis only in patients with LV dysfunction, but not in patients without LV impairment.
P5016Usefulness of different electrocardiographic patterns as predictors of in-hospital mortality in acute pulmonary embolism
Authors: Alarcon P , Bilbao J A , Melchiori R , Cigalini I M , Scatularo C E , Jauregui J C , Bernal M I , Aboy J M , Ortego J , Schmidt P , Figueroa A V , Garcia Zamora S , Thierer J , Zaidel E J , Bonorino J 
Published: October 2019

Abstract

Background
Many electrocardiographic (ECG) patterns may be present in acute pulmonary embolism (PE), but their prevalence and association with in hospital mortality (IHM) are less well established.

Objective
Assess the correlation between different ECG patterns and IHM in patients (Pts) with PE using a whole country dataset.

Methods
Prospective multicenter registry which included Pts with acute PE hospitalized in 75 academic centers from October 2016 to November 2017. We considered the following ECG patterns: sinus tachycardia, pulmonary P waves, Q waves in DII-aVF leads, negative T waves in V1-V4, ST segment elevation in aVR and V1, atrial fibrillation or atrial flutter (AF/AF), right bundle branch block (RBBB), ST segment depression, S1Q3T3 pattern or Qr in V1. Statistical analysis was carried out using de STATA version 13.1. A value of p<0.0.5 was considered statistically significant.

Results
We included 684 Pts; mean age 63.8±16.7 years (43% male). Global IHM was 12%. The most prevalent ECG patterns were sinus tachycardia (51.7%), S1Q3T3 (24.5%), negative T waves in V1- V4 (16%), RBBB (9.9%), AF/AF (8.6%). Four ECG patterns remained statistically significant predictors of IHM on multivariate analysis: AF/AF (OR: 3.81; CI 95% 1.82–7.95, p<0.01), pulmonary P waves (OR: 3.81; CI 95% 1.2–12, p<0.04), RBBB (OR: 2.71; CI 95% 1.39–5.30, p<0.01) and sinus tachycardia (OR: 2.05; CI 95% 1.18–3.54, p<0.04).
ECG pattern and in-hospital mortality.Multivariate analysis Electrocardiographic pattern OR CI 95% p value AF/AF 3.81 1.82–7.95 <0.01 Pulmonary P waves 3.81 1.20–12.00 <0.04 RBBB 2.71 1.39–5.30 <0.01 Sinus tachycardia 2.05 1.18–3.54 <0.04 Q waves in DII-aVF 0.93 0.32–2.64 0.89 ST segment depression 1.07 0.39–2.96 0.80 Negative T waves in V1-V4 0.93 0.47–1.81 0.83 S1Q3T3 pattern 0.75 0.39–1.41 0.37 Qr in V1 2.07 0.63–6.73 0.22 ST segment elevation in aVR 2.38 0.79–7.15 0.12

Conclusions
We corroborate the usefulness of the ECG as a prognostic tool in acute PE. Four simple ECG patterns (AF/AF, Pulmonary P waves, RBBB and sinus tachycardia) were associated with a higher IHM and therefore should be considered for PE risk stratification.
P5269The impact of sarcomeric mutations on myocardial fibrosis and ventricular diastolic function in hypertrophic cardiomyopathy (SADS-TW HCM registry study)
Authors: Chen C.-Y , Lin L.-Y , Lin Y.-H , Wang Y.-C , Lee J.-K , Wu C.-K , Lin L.-C , Chen W.-J , Lin P.-C , Ho L.-T , Liu Y.-B , Lai L.-P , Hwang J.-J , Juang J.-M 
Published: October 2019

Abstract

Background
Hypertrophic cardiomyopathy (HCM) may manifest as diastolic dysfunction. The degree of myocardial fibrosis quantified by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) imaging is positively correlated with the risk of sudden cardiac death, whereas the impact of sarcomeric mutations on the ventricular diastolic function and myocardial fibrosis is unclear.

Purpose
We aimed to investigate the difference of the ventricular diastolic function and the degree of myocardial fibrosis between the HCM patients with and without sarcomeric mutation.

Methods
From 2014 to 2018, we prospectively enrolled 55 unrelated patients with HCM as defined by the 2014 European Society of Cardiology guideline. All enrolled patients underwent next-generation sequencing screening of 20 sarcomeric genes and CMR examination for the evaluation of left ventricular (LV) function, mass and LGE.

Results
After comparing the results with several public databases (Taiwan Biobank, gnomAD, HGMD, ClinVar) and performing in silico analyses (SIFT, Polyphen-2, PROVEAN, REVEL, CADD), 24 pathogenic variants were identified in 22 HCM patients. Although there were no differences in demographic data and clinical presentations between the mutation-positive and mutation-negative groups, the degree of LGE (14.2±14.3 vs 6.2±8.9%, p=0.015) and left atrial diameter (4.54±0.63 vs 4.00±0.49 cm, p<0.001) were significantly higher in the mutation-positive group, whereas the LV ejection fraction, mass, strain rates, peak ejection and filling rates, peak intra-LV and tricuspid regurgitation pressure gradient were similar in both groups.
Table 1. Comparisons of the CMR parameters of HCM patients with and without sarcomeric mutation Sarcomeric mutation (+, M+), Sarcomeric mutation (−, M−), Control (C), M+ vs M− M+ vs C M− vs C n=21 n=34 n=36 P-value P-value P-value PER/LVEDV, L/s −4.73±1.18 −5.03±1.19 −3.49±0.78 0.361 <0.001* <0.001* PFR/LVEDV, L/s 4.05±1.00 3.74±1.25 5.52±1.20 0.341 <0.001* <0.001* Global radial diastolic strain rate, /s −2.49±0.99 −2.74±1.51 −2.68±0.88 0.527 0.210 0.846 Global circumferential diastolic strain rate, /s 0.89±0.19 0.92±0.30 1.49±0.32 0.684 <0.001* <0.001* Global longitudinal diastolic strain rate, /s 0.64±0.19 0.62±0.24 0.95±0.27 0.744 <0.001* <0.001* C: control; LVEDV: left ventricular end-diastolic volume; M+: sarcomeric mutation (+); M−: sarcomeric mutation (−); PER: peak ejection rate; PFR: peak filling rate. *p<0.05.

Conclusions
The HCM patients with sarcomeric mutations had a higher degree of LV myocardial fibrosis than patients without mutations, which may imply that these mutations accelerate myocardial fibrosis in HCM. Nonetheless, there was no difference in diastolic function between the patients with and without sarcomeric mutation.

Acknowledgement/Funding
None