bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5028Shanghai score system into practice
Authors: Carvalho P , Gravinese C , Varalda G P , Previti A , Mandrile G , Giachino D F , Pozzi R 
Published: October 2019

Abstract

Background
The 2016 J Wave Syndrome Consensus Report proposed the Shanghai Brugada Syndrome (BS) Score, a diagnostic score based on ECG features, genetic results, family and clinical history.

Purpose
The aim of our study was to reclassify our institution's BS cohort using the Shanghai BS Score.

Methods
We collected 170 patients with BS diagnosis (according to guidelines) who attended our outpatient clinic between 1996 and 2019. Patients were followed on an yearly basis. During follow up (FU) we looked for the appearance of a spontaneous Type 1 ECG (either with a 12 lead ECG or a 12 lead Holter monitoring) and arrhythmic events (defined as unexplained cardiac arrest or documented VF/polymorphic VT, nocturnal agonal respirations, syncope, atrial flutter/fibrillation). Genetic analysis, limited to SCN5A and SCN1B variants, was performed. We examined each item of the Shanghai BS Score at the first and the last visit at our hospital.

Results
At baseline all patients presented a type 1 ECG: 26 (15%) spontaneously, 2 (1%) during a febrile illness and 142 (84%) after ajmaline pharmacological challenge. 158 (93%) patients were asymptomatic while 12 (7%) presented symptoms: 1 unexplained cardiac arrest, 1 nocturnal agonal respirations, 9 syncopes, 1 atrial flutter/fibrillation under the age of 30 years. Genetic testing was performed in 73 (43%) patients; an SCN5A mutation was detected in 11 patients while a SCN1B was detected in 1 patient.
According to the score we divided the patients as follows: group A 2 to 3 points 107 (63%) patients; group B 3.5 points 13 (8%) patients; group C 4 to 5 points 39 (23%) patients; group D ≥5.5 points 11 (6%) patients.
During FU (medium 59 months) there were 3 (2.8%) arrhythmic events in group A (2 unexplained cardiac arrests and 1 syncope; 0 in group B; 1 (2.6%) in group C (syncope); 3 (27%) in group D (1 FV and 2 syncopes).
19 patients (11%) modified their Shanghai score during FU: 16 because of the appearance of a spontaneous type 1 ECG, 3 for their clinical history.

Conclusions
Although the Shanghai Score has been proposed as a diagnostic tool, data from literature show that patients with a higher score are at a progressively higher risk for VT/VF. Unexpectedly, we observed 2 unexplained cardiac arrests in the group of patients with a score 2 to 3. This may suggest the need to the use other risk criteria such as fractionated potentials or other ECG markers. Additionaly, we have shown that this Score is prone to changes over time, stressing the importance of a regular FU with continuous risk assessment.
P5235A technological approach to improving efficiency of primary to secondary care referrals
Authors: Graby J , MacConnell T 
Published: October 2019

Abstract

Introduction
Recognised in the 2019 NHS Long-term plan was the need to streamline services, with less face-to-face outpatient (OP) care by utilising digital technology and creating “virtual clinics” (VC). A team of Cardiologists and General Practitioners (GP) collaborated to create a VC via a web-based video link, enabling discussion of patients being considered by primary care for referral to the Cardiology clinic with members of the GP team present to: identify appropriate patients for OP review, enable early selection of investigations, identify patients not requiring further assessment. We aimed to assess the safety and efficacy of this approach.

Methods
VC's were established between a Consultant Cardiologist and two primary care practices. All referrals required an ECG. Each patient was presented by the referring GP, with all others present in the room to enable an educational experience. Consultant Cardiologist issued correspondence and co-ordinated any required tests and follow-up. A 13 month period of this practice was reviewed with 135 patient events screened via a cross-matched record of patients. Data was recorded for: indication for discussion; outcome; likelihood patient would have had test or referral made without this service (as assessed by Cardiology), and whether patients discussed had unplanned admissions or assessments.

Results
8/135 were excluded (duplication; admitted prior to VC; not discussed; re-discussed for learning). Efficacy: The overall number of patients a GP “would” have referred were 113 (89%), and the number “would” have had tests booked 98 (77%), across the two practises. This left an overall OPA post VC of 11% vs potential 89% “would” have been referred (100 potential appointments avoided), and an overall test rate post SAC 48% vs 77% “would” have had tests (37 potential tests avoided).

Safety
Unplanned Cardiology input post-VC included 1 subsequent chest pain clinic (different issue to VC), and 1 admission with syncope (discussed in SAC), with nil found.
Table 1 No Further Input Blood Test Cardiac Test OPA Primary Care 1 21 (40%) 3 (6%) 25 (47%) 4 (7%) Primary Care 2 32 (43%) 0 (0%) 32 (43%) 10 (14%) Overall 53 (42%) 3 (2%) 57 (45%) 14 (11%) Distribution of plan made in VC including: no further input required; blood test in Primary Care; Cardiac test in hospital only; outpatient Cardiology clinic (OPA).

Conclusion
The reduction in OPA and tests demonstrates improvement resource untilsation, and safety data was encouraging. This service demonstrates a novel approach to technology-enabled streamlining of primary to secondary care services in a safe and efficient manner.
P5239Cost-effectiveness of direct oral anticoagulants for cancer-associated venous thromboembolism
Authors: King J , Bhat S , Heath L J , Derington C G , Yu Z , Clark N P , Witt D M , Reynolds K , Lang D T , Xu S , Bellows B K 
Published: October 2019

Abstract

Background
Direct oral anticoagulants (DOACs) are at least as effective as low-molecular weight heparins (LMWH) at preventing recurrence after cancer-associated venous thromboembolism (CA-VTE). DOACs are also oral and far less costly, but they may confer a higher bleeding risk than LMWH.

Purpose
To estimate the cost-effectiveness of DOACs and LMWHs for CA-VTE.

Methods
We developed a health state transition model to estimate recurrent VTE, bleeding events, quality-adjusted life years (QALY), and direct healthcare costs (2018 United States dollars) associated with DOACs vs. LMWH use. The model had four states: (1) long-term anticoagulation (first 3 months after VTE), (2) extended anticoagulation (more than 3 months after VTE), (3) off anticoagulants, and (4) death. We used a United States healthcare sector perspective, 3-month cycle length, and 1-year time horizon. Event probabilities were derived from the Hokusai Cancer VTE trial and other literature. Event and medication costs were obtained from national sources. We used a threshold of less than $50,000 per QALY gained to define cost-effectiveness.

Results
Compared to LMWH, DOACs were less costly (mean costs: $8,477 vs. $33,917 per year) and similarly effective (mean QALY: 0.616 vs. 0.622). The incremental cost-effectiveness ratio was $4,479,374 per QALY gained with LMWH, indicating that DOACs are cost-effective (Table 1). In threshold analyses, LMWH therapy only became cost-effective when DOAC recurrent VTE risk increased to at least 72% (relative risk vs. LMWH, 6.19) or DOAC clinically relevant bleeding increased to at least 39% (relative risk vs. LMWH, 10.09).
Scenarios Recurrent VTE, % Major bleed, % Mean difference DOAC − LMW ICER DOAC LMWH Relative Risk DOAC LMWH Relative Risk Cost QALY Base case 8.1 11.6 0.71 6.8 4.0 1.75 −$25,440 (−26,496, −24,274) −0.006 (−0.019, 0.008) $4,479,374 DOAC outcome rate threshold at which LMWH becomes cost-effective*   Recurrent VTE 71.5 11.7 6.19 – – – −$6,064 (−7,534, −4,627) −0.121 (−0.136, −0.108) $49,886   Major Bleed – – – 38.9 4.0 10.09 −$2,192 (−3,400, −704) −0.044 (−0.056, −0.030) $49,878 DOAC = direct oral anticoagulant, ICER = incremental cost-effectiveness ratio, LMWH = low-molecular-weight heparin, VTE = venous thromboembolism. Values are mean (95% Uncertainty Interval). Uncertainty was derived from 1,000 stochastic model iterations. *Represents the minimum increased risk with DOAC that would result in LMWH achieving an ICER <$50K per QALY gained.

Conclusion
In this simulation study, DOACs were a cost-effective oral alternative to LMWH for the treatment of CA-VTE. For LMWH to be cost-effective, DOAC event rates needed to be far higher than what is likely to be observed in clinical practice.

Acknowledgement/Funding
Agency for Health Research and Quality R18HS026156
P5247In-hospital healthcare utilization, outcomes and costs in pre-hospital adjudicated low-risk chest pain patients
Authors: Van Dongen D N , Ottervanger J P , Tolsma R , Fokkert M , Badings E , Sluis A , Van 'T Hof A , Slingerland R 
Published: October 2019

Abstract

Background
There is increasing evidence that in patients presenting with acute chest pain, pre-hospital triage can accurately identify low-risk patients. It is, however, yet unclear which diagnostics are performed in pre-hospital adjudicated low-risk patients and what the contribution is of those diagnostic results in the healthcare process.

Objectives
The aim of this study is to quantify health care utilization, costs and outcomes in pre-hospital adjudicated low-risk chest pain patients, and to extrapolate to costs on a national level.

Methods
This is a prospective cohort study including 700 patients with suspected NSTE-ACS in which pre-hospital risk stratification using the HEART score was performed by paramedics. Low risk was defined as a pre-hospital HEART score ≤3. Data on (results of) hospital diagnostics, costs and discharge diagnosis were collected.

Results
A total of 172 (25%) patients were considered as low risk. Of these low-risk patients, mean age was 54 years, 52% were male, 84% of patients were discharged within 12 hours. Repeated electrocardiography and routine laboratory measurements, including cardiac markers were performed in all patients. Chest X-ray was performed in 61%, echocardiography in 11% of patients. After additional diagnostics, 2 patients (%) were diagnosed as non-STEMI, 2 patients (%) as unstable angina. Other diagnoses were atrial fibrillation (n=1) and acute pancreatitis/cholecystitis (n=2), all other patients had non-specific/non-acute discharge diagnoses. Mean in-hospital costs per patient were €1.580,-. The estimated yearly acute healthcare costs in low-risk chest pain patients in the Netherlands are € 30.438.700,-

Conclusion
In low-risk chest pain patients according to pre-hospital risk assessment, acute healthcare utilization and costs are high, with limited added value. Possibly, if a complete risk assessment can be performed by ambulance paramedics, acute hospitalization of the majority of low-risk patients is not necessary which can lead to substantial cost reduction.
P5249Comprehensive invasive and non-invasive assessment of coronary artery lesions with and without hemodynamic significance
Authors: Engel L C , Landmesser U , Abdelwahed Y , Gigengack K , Manes C , Wurster T.-H , Skurk C , Leistner D.-M , Lauten A , Schuster A , Noutsias M , Hamm B , Botnar R M , Makowski M , Bigalke B 
Published: October 2019

Abstract

Background
There is limited knowledge about specific morphological parameters beyond the degree of stenosis to further characterize hemodynamically relevant coronary lesions.

Objective
The goal of this study was to identify certain morphological or molecular characteristics that distinguish hemodynamically significant from non-significant coronary lesions using various invasive and non-invasive measures.

Methods
This clinical study included patients with symptoms suggestive of CAD who underwent native T1-weighted CMR and gadofosveset-enhanced CMR as well as invasive coronary angiography between 2015 and 2016. OCT of the culprit vessel to determine the plaque type was performed in a subset of patients. Functional relevance of all lesions was examined using quantitative flow reserve (QFR-Angio). Hemodynamically significant lesions were defined as lesions with a QFR <0.8. Signal intensity (contrast-to-noise ratios; CNRs) on native T1-weighted CMR and gadofosveset-enhanced CMR was defined as a measure for intraplaque hemorrhage and endothelial permeability respectively.

Results
Overall 13 patients (n=28 coronary segments) were included, whose invasive coronary angiograms projections were eligible for QFR analysis. Segments containing lesions with a QFR <0.8 (n=9) were associated with significantly higher signal enhancement on Gadofosveset-enhanced CMR as compared to segments containing a hemodynamically non-relevant lesions (lesion-QFR>0.8; n=19) (7.0±4.9 vs. 3.0±2.6; p=0.02). No differences in signal enhancement were seen on native T1-weighted CMR (2.1±4.3 vs. 3.3±4.1; p=0.24). 66,7% (4 out of 6) of all vulnerable plaque and 33.3% (2 out of 6) of all non-vulnerable plaque (fibroatheroma) as assessed by OCT were hemodynamically significant lesions.

Conclusion
The findings of this small feasibility study suggest that hemodynamically significant lesions are more advanced and associated with a higher grade of endothelial permeability while the presence of intraplaque hemorrhage may not be associated with hemodynamically relevant coronary lesions.
P5254Prognostic value and clinical predictors of Intramyocardial Hemorrhage measured by CMR T2* weighted sequences
Authors: Igual Munoz B , Ferre M F V , Sanchez E S L C , Diez J L , Plaza Lopez D , Paya R P S , Berenguer A B J , Sepulveda Sanchez P , Miro Palau V , Montero A M A , Morell S M C , Martinez Dolz L 
Published: October 2019

Abstract

In the setting of STEMI, microvascular injury consists of microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH). We aimed to investigate prognostic value and clinical predictors of MR T2* w analysis of IMH in this setting.

Methods
A single center observational cohort study was performed in patients with reperfused STEMI with CMR examination after percutaneous revascularization. Infarct related CMR characteristics were analyzed in whole LV short-axis late gadolinium enhancement sequences (LGE) for infarct size and MVO and whole volume T2*w sequences for IMH. Extent of MVO and IMH were derived as percentage of LV mass. Kaplan-Meier was used to analyze the incidence of major adverse cardiovascular events, defined as a composite of cardiac death, myocardial re-infarction, and new congestive heart failure.

Results
94 reperfused STEMI patients were included in the study. T2*w IMH was present in 26 (28%) patients and the median size of IMH was 1.1% (IQR: 0.5 to 2.9%). MVO was identified in 49 (52%) patients and the median size of MVO was 3% mass (IQR: 1.5 to 5.4%). T2*w IMH extension was independently associated with anterior myocardial infarction (p=0.022) and thrombectomy (p=0.049). IMH was correlated with MVO (R=0.62, p<0.001), necrosis (R=0.58, p<0.001) and LVEF (R=-0.21, p=0.04). Patients with IMH presented higher incidence of MACE, independently of LVEF (p=0.022).
Typical CMR sequences

Conclusions
Whole LV T2*w proves useful to asses IMH. IMH extension was associated with anterior infarction and thrombectomy. T2*w IMH was associated with higher incidence of MACE regardless preserved or reduced LVEF
P5264There is no significant effect of ischemic time and elapse time since cardiac allograft transplant on myocardial T1 relaxation time
Authors: Vietheer J , Unbehaun C , Classen K , Richter M , Rieth A , Rademann M , Keller T , Hamm C W , Rolf A 
Published: October 2019

Abstract

Background
Graft failure caused by allograft rejection and vasculopathy is the most common cause of mortality after heart transplantation. To detect an early allograft rejection, endomyocardial biopsy is still needed. Tissue characterization by T1-mapping and Late gadolinium enhancement is well established in acute and chronic myocardial tissue alterations. Therefore several studies investigated T1-mapping as a potential noninvasive parameter to monitor cardiac allograft vasculopathy and allograft rejection. However it is unclear if T1 is also influenced by pretransplant ischemic time and elapsed time since transplantation.

Purpose
It was the aim of our study to examine the influence of ischemic and elapsed time since transplantation to the cardiac allograft tissue characteristics measured by CMR T1 relaxation times.

Methods
Allograft transplant patients underwent stress CMR on a yearly routine. T1-maps were acquired using a modified look locker sequence (MOLLI 3(2)3(2)5) in the midventricular septum. Uni- and multi linear regression analysis was used to predict T1 by ischemic time, time since transplantation, troponin and NT-Pro-BNP.

Results
49 cardiac allograft transplanted patients underwent stress CMR (mean age 58.6±11.7 years, left ventricular ejection fraction 62.1±6.8%; indexed enddiastolic volume 68.4±14.7 ml/m2; native T1 1120±51 ms, extracellular volume 0.27±0.04). A significant correlation was found between T1 and NT-Pro-BNP (1519±3639 pg/ml, p=0.003) and a trend for troponin (17.0±12.8 ng/dl, p=0.051). We saw no correlation between T1 and the ischemic time (198.4±44.9 minutes, p=0.1172) and elapse time since transplantation (47±7 month, p=0.9868). In the multivariate regression analysis none of the four parameters were independently associated with the T1 time (p=0.1017).
Table 1 Characteristics Mean ± SD p Ischemic time (minutes) 198.4±44.9 0.1172 Time since transplant (month) 47±7 0.9868 NT-Pro-BNP (pg/ml) 1519±3639 0.003 Troponine (ng/dl) 17.0±12.8 0.051

Conclusion
There was no significant effect of pretransplant ischemic time and elapse time since transplantation on native T1 times, whereas native T1 was significantly correlated with troponine and NT-Pro-BNP-Levels. T1 is excellently suited to detect acute changes in allograft transplant patients without being influenced by aging of the transplanted heart and the heart's pretransplant condition.
P52714D-flow cardiac magnetic resonance analysis of left ventricular blood flow dynamics in mid-ventricular obstructive hypertrophic cardiomyopathy
Authors: Miyajima K , Shirai Y , Kin F , Watanabe T , Tatsuguchi M , Kawaguchi Y , Wakabayashi Y 
Published: October 2019

Abstract

Background
Mid-ventricular obstructive hypertrophic cardiomyopathy (MVO-HCM) has different blood flow dynamics from other phenotypes, but there are few detailed data on blood flow dynamics in the left ventricle.

Methods
4D-Flow MRI were performed at 1.5 T or 3 T with 9 MVO-HCM patients and 22 control patients (LVEF>50%, no wall motion abnormality). Myocardial infarction, severe valvular disease, HCM cases other than MVO were excluded. We calculated the cardiac function parameters and observed blood flow dynamics in the left ventricle using 4D-Flow MRI.

Results
LV mass was significantly higher in MVO-HCM group than in Control group (Control group; 73.3g vs MVO-HCM group; 109.5g, P=0.019). LVEF was higher in MVO-HCM group (Control group; 61.6% vs MVO-HCM group; 70.6%, P=0.026), but Stroke volume did not differ between the two groups (Control group; 68.8ml vs MVO-HCM group; 64.4ml, P=0.43).One or two vortices were observed in the left ventricle after opening the mitral valve. Two vortices were observed in 16 cases (72.7%) in the control group and 9 cases (100%) in the MVO-HCM group. Two vortices were formed on the anterior side and the posterior side. Blood flow pattern in which the vortex on the posterior side was formed to be the same size or larger than the vortex on the anterior side was observed only in the MVO-HCM group (Control group; 0% vs MVO-HCM group; 66.7%, P<0.001).
Streamline of MVO-HCM & Control

Conclusion
Characteristic blood flow patterns in the left ventricle of the MVO-HCM were revealed by using 4D-MRI. We thought that blood flow collides with the left ventricle wall due to the marked hypertrophy in the mid-ventricle, and normal vortex ring can not be formed in the MVO-HCM cases.
P5273Trabecular complexity as a subclinical structural alteration in Fabry cardiomyopathy: a cardiac magnetic resonance study
Authors: Lazzeroni D , Camporeale A , Moroni F , Garibaldi S , Pica S , Chow K , Camici P , Lombardi M 
Published: October 2019

Abstract

Background
Heart involvement represents the main cause of death in Fabry Disease (FD), thus its early detection is important to define the optimal therapeutic strategy. Recently, a disproportionate increase in myocardial trabeculation has been described in FD by cardiac magnetic resonance (CMR), even in early (prehypertrophic) stage of the disease. In addition, CMR with T1 mapping can identity the presence of myocardial sphingolipid storage (causing lowering of native T1 values) in more than 50% of FD patients with no LVH. However, it is not clear whether a relationship exists between trabecular complexity and sphingolipid storage in FD.

Aim
To explore the association between myocardial trabecular complexity, quantified by endocardial border fractal analysis, and sphingolipid storage, described by CMR T1 mapping, in different stages of Fabry cardiomyopathy.

Methods
Study population included 60 subjects: 15 FD patients with no detectable signs of cardiac involvement (no LVH, normal T1; 2 M, age 30.6±14; Group 1); 15 FD patients with early sphingolipid storage (no LVH, low T1; 9 M, age 33±9.6; Group 2); 15 FD patients with LVH (11 M, age 53.5±9.6; Group 3); 15 healthy controls (9 M, age 34±10). Patients and controls underwent CMR with T1 mapping; disease severity was quantified using Mainz Severity Score Index (MSSI). Myocardial trabecular fractal dimension was evaluated, blinded to patients'characteristics, on short axis cine images using the Image J dedicated plug-in FracLac, deriving the following parameters: total, basal, mid-ventricular and apical fractal dimensions.

Results
Total fractal dimension was higher in all Fabry groups compared to controls. Indeed, a gradient of total fractal dimension was observed, with this parameter gradually increasing from healthy controls to Groups 3 (1.27±0.02 in controls vs 1.29±0.02 in Group 1 vs 1.30±0.02 in Group 2 vs 1.34±0.02 in Group 3; p<0.001) (Figure 1A). Interestingly, both total and basal fractal dimensions were significantly higher in Group 1 compared to controls (1.27±0.02 vs 1.29±0.02, p=0.044 and 1.26±0.04 vs 1.30±0.03; p=0.007, respectively). Moreover, considering the total population, fractal dimension showed significant correlations with: i) T1 values (r=−0.567; p<0.001 - Figure 1B); ii) LV mass (r=0.674, p<0.001); iii) trabecular mass expressed as percentage of global LV mass (r=0.611; p<0.001); iv) MSSI (r=0.535; p<0.001).

Conclusion
Cardiac involvement in FD is characterized by a progressive increase in fractal dimension of endocardial trabeculae (Figure 1C). Both total and basal myocardial trabeculation are increased in Fabry patients even before the presence of detectable sphingolipid storage, thus representing a very early sign of cardiac involvement.