bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2638Preeclampsia is preceded by changes in the cardiovascular function
Authors: Paez O , Majul C R , Puleio P , Visser M , Cragnolino R 
Published: October 2019

Abstract

The changes in the cardiovascular function (CVF) during preeclampsia are known. Whether they begin prior clinical manifestation or persist after delivery remains unclear.

Objective
We hypothesized that preeclampsia is preceded by early CVF changes. We evaluated the eventual difference between patients who develop preeclampsia and those who stayed normotensives. Secondly we searched for a link between CVF changes and development of preeclampsia.

Methods
This prospective study, included 260 normotensive primiparous women, referred for routinely control to the Cardiology section. At week 22 of gestation and 1 year after delivery were performed: Office blood pressure (OBP), blood and urine lab test. Cardiac index (CI) and systemic vascular resistance index (SVRI) through impedance cardiography. Wave pulse velocity (PWV) through pressure signals. According to the evolution during pregnancy patients were assigned to one of 3 groups: G1 preeclampsia:. G2 Gestational hypertension G3 Normotensive. Statistic tests: one-way analysis of variance and the Bonferroni post-hoc test.

Results
12 patients evolved to preeclamsia, 18 to gestational hypertension and 230 remained normotensive. G1 had significantly lower value of CI in both measurements and higher values of OBP, SVRPI and WPV comparing to G3. G2 always showed intermediate values between G1 and G2. The median age of the population was 25 ≠ 4 years old. By logistic regression analysis WPV and SVRI at 22 week of gestation were predictors of preeclampsia. (p<0.05)
Patient Characteristics Characteristics G1 G2 G3 p<0.05 Systolic, mmHg OBP* 128±10 120±9 107±10 0.001 Diastolic, mmHg OBP* 84±6 75±7 66±6 0.001 Systolic mmHg OBP** 128±11 117±10 114±8 0.01 Diastolic, mmHg OBP** 77±7 71±6 70±6 0.09 WPV, m/sec* 10±4 7±0.8 5.6±1 0.02 WPV, m/sec** 9±1.3 6.4±1 4.7±1.5 0.01 CI, l/m2* 2.7±0.4 3.1±0.4 3.4±0.6 0.01 IC, l/m2** 2.4±0.6 2.6±0.3 3.2±0.6 0.01 SVRPI, dyn sec·cm* 1894±151 1783±454 1431±252 0.01 SVRPI, dyn sec·sec** 1900±436 1657±436 1385±248 0.01 Data are given as median and SD. *Measurements at week 22 of gestation. **Measurements at 1 year after delivery.

Conclusion
Preeclampsia showed different CVF compare with normotensive, before diagnosis and after delivery. The early endothelial dysfunction could be responsible of these changes.
P2643Antiproteinuric efficacy of ACE inhibitors, selective MRAs and ACE inhibitor/selective MRA combination therapy in diabetic hypertensives with microalbuminuria
Authors: El Mokadem M , Abd El Hady Y , Aziz A 
Published: October 2019

Abstract

Background
There is increasing evidence suggesting use of Mineralocorticoid Receptor Antagonists (MRA) in combination with Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARB) to have a protective effect on chronic kidney disease patients.

Purpose
The aim of our study was to compare the antiproteinuric efficacy of ACEI monotherapy, Selective MRA monotherapy and their combination in mildly hypertensive patients with type 2 diabetes mellitus (DM) and microalbuminuria.

Methods
Seventy five patients with established diagnosis of type 2 DM, mild hypertension (systolic BP 140–159 mmHg and/or diastolic BP 90–99 mmHg) and microalbuminuria (30–299mg/g) were randomly assigned to one of three groups of therapy; ramipril 10 mg monotherapy (25 patients), eplerenone 50 mg monotherapy (25 patients) and eplerenone/ramipril 50/10 mg combination therapy (25 patients).The duration of the study was 24 weeks. All patients had measurement of blood pressure, urinary albumin/creatinine ratio, renal function tests and serum K level at baseline and at the end of the study after 24 weeks. All patients were followed up monthly till the end of the study for detection of side effects and/or treatment failure.

Results
Both ramipril and eplerenone monotherapy significantly reduced microalbuminuria after 24 weeks nearly to the same extent (37% and 38% respectively) without significant difference between both groups (P=0.95). There was more significant reduction of microalbuminuria in the eplerenone/ramipril combination group (60%) compared with ramipril and eplerenone monotherapy groups (P=0.0001).All groups showed significant reduction of both systolic and diastolic BP with more significant reduction of systolic BP in combination group compared with monotherapy groups (P<0.0001).There was insignificant elevation of serum potassium level among the three groups with slightly higher non significant incidence of sustained hyperkalemia in combination group (P=0.5). All groups showed insignificant changes in serum creatinine and estimated glomerular filtration rate.

Conclusion
Addition of eplerenone (selective MRA) to an ACE inhibitor may confer further antiproteinuric benefit with low risk of hyperkalemia compared with MRA or ACEI monotherapy.

Acknowledgement/Funding
None
P2652Seasonal influences on clinical features, comorbidities, and outcome in patients with ST-elevation myocardial infarction managed invasively
Authors: Vintila V , Cotoban A , Udroiu C , Stuparu C , Lungeanu Juravle L , Vinereanu D 
Published: October 2019

Abstract

Background
Outcome of STEMI patients has improved in the last years, with better survival due to an improved onset of symptoms to balloon time, and better pharmacological and nonpharmacological treatment. However, influences of seasonal differences are not studied yet.

Purpose
To identify differences in clinical features, associated comorbidities, and outcome of ST-elevation myocardial infarction (STEMI) patients, related to seasonal differences, in a temperate continental climate.

Methods
We examined data from the electronic STEMI registry from a high-volume PPCI center. We analyzed retrospectively data from 518 STEMI patients, managed invasively, admitted in the last year. We compared clinical features, comorbidities, and outcome, between winter months (December, January, and February) and summer months (June, July, and August).

Results
269 (52%) patients (74% men, median age 61 years) were admitted during winter months, while 249 (48%) patients (80% men, median age 59 years) were admitted during summer months. Killip class at admission was higher during winter (χ2=10.2; p=0.017), with significant differences for all Killip classes (Killip I: 83% winter vs. 92% summer; Killip II: 8.6% winter vs. 4.4% summer; Killip III: 3.7% winter vs. 1.2% summer; Killip IV: 4.5% winter vs. 2.0% summer, p=0.04). Meanwhile, maximal Killip class anytime during hospitalization was higher during winter (χ2=9.7; p=0.021). In terms of comorbidities, a trend toward more frequent atrial fibrillation (AF) was recorded during winter (5.2% vs. 2,0%; χ2=3.7; p=0.053). Severe left ventricular dysfunction (LVEF<30%) was more frequent among patients admitted in winter (9.7% vs. 4.4%; χ2=5.4, p=0.020). In-hospital mortality was higher during winter (9.7% vs. 4.4%; χ2=5.4; p=0,020). We computed a predictive model for in-hospital death for STEMI patients, using stepwise logistic regression analysis. Independent significant predictors were seasonal months, blood glycemia, and creatinine (χ2=53.3, p<0.005). Patients with STEMI admitted during winter months had a 2.8-fold increase in probability of death during index hospitalization compared with summer months.

Conclusions
Winter months are associated with worse clinical features, more frequent AF, worse LV function, and higher risk of death of STEMI patients managed invasively than summer months. We consider temperature differences, changes in air pressure, decrease in physical activity, and increase in food intake as possible explanations for worse evolution of winter patients. A prospective dedicated research is necessary to provide detailed explanations.
P2666Association of out-of-hospital cardiac arrest occurrence time and the survival in all-Japan utstein registry: difference between international resuscitation guidelines 2005 and 2010
Authors: Kato K , Otsuka T , Seino Y , Tahara Y , Yonemoto N , Nonogi H , Nagao K , Ikeda T , Sato N , Tsutsui H 
Published: October 2019

Abstract

Background/Introduction
Previous studies have shown that out-of-hospital cardiac arrest (OHCA) occurring at night have poor outcomes compared with OHCA occurring during daytime. On the other hand, nationwide OHCA outcomes have gradually improved in Japan.

Purpose
We sought to examine whether one-month survival of OHCA differed between daytime and nighttime occurrences, and they differed between the periods of International Resuscitation Guidelines 2005 and 2010.

Methods
Using the All-Japan Utstein Registry between 2005 and 2015, adult OHCA patients whose collapse was witnessed by a bystander and the call-to-hospital admission interval was shorter than 120 min were included in this study. OHCA patients were divided by period of the International Resuscitation Guideline 2005 and 2010. Guideline 2005 included years from 2006 to 2010, while Guideline 2010 included years from 2011 to 2015. The primary outcome was one-month survival with favorable neurological outcome, defined as Cerebral Performance Category scale of 1 or 2. Daytime, evening, and night were defined as 0700 to 1459 h, 1500 to 2259 h, and 2300 to 0659 h, respectively.

Results
Among 479,046 cases, 20.3% revealed OHCA occurring at night. OHCA patients occurring at night had lower rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator use than those occurring at both daytime and evening. In addition, of those who received bystander CPR, higher rate of patients received CPR by family members. OHCA patients occurring at night in both guideline periods had significantly worse one-month survival than those occurring during daytime (reference) (adjusted odds ratio, 0.69, 0.64; 95% confidence interval 0.65–0.72, 0.61–0.67; P<0.001, P<0.001, Guideline 2005 and 2010 respectively). OHCA patients occurring during daytime in Guideline 2010 had better one-month survival than those in Guideline 2005 (adjusted odds ratio, 1.29; 95% confidence interval 1.24–1.34; P<0.001).

Conclusions
One-month survival with favorable neurological outcome in OHCA patients occurring at night remains to be significantly worse than those occurring during daytime, even improved by the periods during daytime. CPR training for the family members should be more expanded and strengthened against the night time imperfection.
P2671The addition of admission lactate to the CREST risk score to determine prognosis in out of hospital cardiac arrest: the C-AREST score
Authors: Kelham M , Jones T N , Rathod K S , Guttmann O , Proudfoot A , Wragg A , Baumbach A , Jain A , Weerackody R , Mathur A , Jones D A 
Published: October 2019

Abstract

Introduction
There has been an increasing focus on the development of scoring systems for patients admitted following resuscitation from out-of-hospital cardiac arrest (OHCA) to determine both prognosis and short-term management. One such system, the CREST score, has been shown to predict circulatory aetiology death in patients without ST-elevation myocardial infarction, however with an increasing number of OHCAs seen, general scoring systems to predict outcome in OHCA would be helpful.

Aims
We sought to determine whether the addition of an admission lactate ≥8 mmol/l to the existing CREST score was able to better predict in-hospital mortality in patients admitted with OHCA.

Methods and results
We retrospectively analysed the data of 500 patients admitted with an OHCA of presumed cardiac origin to our tertiary cardiac centre between June 2014 and Oct 2018. Mean age was 62.6y (±14.7), 379 (76%) were male and 250 (50%) were Caucasian. 313 (62.6%) were admitted with ST elevation myocardial infarction or equivalent. 48.6% (243/500) of patients died in hospital and of those that survived, 20.2% (52/257) were left with hypoxic brain injury (CPC score 3–4).
When analysed independently, all individual factors other than history of Coronary artery disease (OR 1.47, p=0.084) significantly predicted in-hospital mortality: Admission lactate ≥8 mmol/l (OR 6.78, p<0.0001), non-shockable Rhythm (OR 10.9, p<0.0001), Ejection fraction <30% (OR 5.84, p<0.0001), Shock at presentation (OR 5.49, p<0.0001) and ischaemic Time >25 minutes (OR 12.8, p<0.0001).
When each factor was assigned one point and totalled, both increasing CREST and C-AREST scores were associated with increasing in-hospital mortality: CREST (0–5 points): 4.3%, 30.5%, 41.5%, 85.6%, 95.2%, 100% vs C-AREST (0–6 points): 9.1%, 28.3%, 41.9%, 62.8%, 97.6%, 96.4%, 100%. When analysed with stepwise logistic regression, the addition of admission lactate ≥8 mmol/l to the model improved the prediction of in-hospital mortality: CREST (40.8% of variance explained) vs C-AREST (43.3%), with admission lactate remaining an independently significant predictor (OR 3.67, p=0.002).

Conclusion
We describe a novel modification to the previously described CREST scoring system for OHCA: the C-AREST score. The addition of admission lactate ≥8 mmol/l may have a role in differentiating those in intermediate risk categories (score between 2 and 3) where the predicted in hospital mortality would otherwise vary greatly. Given the relative ease of obtaining admission lactate, this scoring system may further improve stratification of patients who may or may not benefit from invasive management.
P2672Coronary artery calcification on the whole body computed tomography predicts coronary artery disease and mortality in patients with out-of-hospital cardiac arrest
Authors: Kato S , Matsuda J 
Published: October 2019

Abstract

Introduction
Coronary artery disease (CAD) is the most frequent cause of out-of-hospital cardiac arrest (OHCA). Although the prompt evaluation of coronary artery in OHCA patients is recommended, it is not easy to identify the CAD by coronary artery angiography (CAG) because OHCA patients often exhibit unstable systemic condition after the return of spontaneous circulation (ROSC). The Agatston score, which is a popular calcium scoring of coronary artery calcification by computed tomography (CT), is useful for the risk stratification in patients suspected CAD. The impact of coronary artery calcification to predict the existence of CAD in OHCA patients has not been sufficiently elucidated. The usefulness of coronary artery calcification to predict mortality has also been unclear.

Purpose
We sought to assess the impact of evaluating the Agatston score to predict the existence of coronary artery stenosis and patients' mortality at 30 days in OHCA.

Method
A total of 748 OHCA patients were transferred to our critical care center, of which 126 cardiovascular arrest patients achieving the ROSC were extracted from the institutional database from January 2017 to December 2018. Among those patients, we performed the whole-body CT scanning in Emergency Department (ED) for 101 patients and evaluated coronary artery by CAG for 82 patients. We assessed their coronary artery calcifications on CT findings, calculating the Agatston score. We investigated the usefulness of the Agatston score to predict the existence of coronary artery stenosis on CAG findings, and patients' mortality at 30 days.

Result
Both the whole-body CT scanning and CAG were performed in 70 patients. Among those patients, 31 (44.3%) patients had any coronary artery stenosis on CAG findings. The Agatston score was significantly higher in those who had any coronary artery stenosis (p<0.01). The optimal cut off value of the Agatston score to predict the existence of coronary artery stenosis was 9.9 ((Area under the curve (AUC) 0.75; 95% Confidence interval (CI) 0.63 - 0.87). The positive predictive value to predict coronary artery stenosis was 72.5%. In the present study, 101 patients were eligible to be calculated the Agatston score. The Agatston score was significantly higher in those who was dead at 30 days (p=0.04). The optimal cut off value of the Agatston score to predict the 30-days mortality was 15.1 ((Area under the curve (AUC) 0.62; 95% Confidence interval (CI) 0.51 - 0.73). Among the patients who had lower Agatston score (<15.1), 22 (50%) patients survived at 30 days.

Conclusion
The Agatston score calculated by the whole-body CT scanning in ED is helpful to predict the existence of coronary artery stenosis in OHCA patients. And evaluating the Agatston score is useful to predict mortality in OHCA patients.
P2673Challenging time limits: Using a single high-sensitive troponin I to rule-out acute myocardial infarction in early presenters
Authors: Hansen C , Bang C , Lauridsen K G , Frederiksen C A , Schmidt M , Jensen T , Hornung N , Loefgren B 
Published: October 2019

Abstract

Introduction
According to ESC guidelines, an acute myocardial infarction (MI) can be excluded without serial troponin measurements in patients presenting with a single high-sensitive troponin below the 99th percentile and chest pain starting >6 hours prior to admission. However, it is unclear if single-testing of high-sensitive troponin can rule-out MI in early presenters.

Purpose
To investigate the diagnostic performance of a single value of high-sensitive cardiac troponin I (hs-cTnI) at presentation for ruling-out MI in patients presenting with chest pain to the Emergency Department irrespective of chest pain onset.

Methods
We conducted a substudy of preliminary data from the RACING-MI trial. We included patients presenting with chest pain suggestive of MI to the Emergency Department of a Regional Hospital. We used the Siemens hs-cTnI (Siemens Healthcare, TNIH, Limit of detection: 2.21 ng/L) and a diagnostic cut-off value <3 ng/L to rule-out MI at presentation. Two physicians independently adjudicated the final diagnosis based on all clinical information. Patients were stratified based on time from chest pain onset to hospital admission as very early (0–3 hours), early (3–6 hours) and late presenters (>6 hours).

Results
We included 989 patients with available hs-cTnI results at admission. MI was confirmed in 82 (8.3%) patients. Using hs-cTnI <3 ng/L as diagnostic cut-off value at presentation, 302 (30.5%) patients without MI were classified as rule-out. Overall, the negative predictive value (NPV) for MI was 100% (95% CI 98.7–100).
Based on chest pain onset, 33.8% of patients were classified as very early, 12.8% as early, and 42.7% as late presenters, with 10.7% patients with unreported/unknown onset. NPV was 100% (95% CI 96.5–100) for very early, 100% (95% CI 88.3–100) for early and 100% (95% CI 97.3–100) for late presenters.

Conclusions
Using a single hs-cTnI value <3ng/L as diagnostic cut-off to rule-out MI seems to be safe and to allow rapid rule-out of MI in patients presenting with chest pain to the emergency department, even in very early presenters.
ClinicalTrials.gov Identifier: NCT03634384.

Acknowledgement/Funding
Randers Regional Hospital, A.P Møller Foundation, Boserup Foundation, Korning Foundation, Højmosegård Grant, Siemens Healthcare (TNIH assays), etc.
P2676Prospective validation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T in Asian countries
Authors: Shiozaki M , Inoue K , Suwa S , Lee C C , Chiang S J , Shimizu M , Fukuda K , Hiki M , Kubota N , Tamura H , Fujiwara Y , Sumiyoshi M , Daida H 
Published: October 2019

Abstract

Background/Introduction
Implementation of the 2015 ESC 0-hour/1-hour algorithm using high-sensitivity troponin (hs-cTn) T in Asian countries presents a challenge for clinical practice.

Purpose
We aimed to prospectively validate the 0-hour/1-hour algorithm in Asian countries.

Methods
We conducted a prospective, multi-center, international cohort already utilizing 0-hour/1-hour algorithm using hs-cTnT for evaluation of patients with suspected of non-ST elevation acute coronary syndrome (NSTE-ACS). All patients underwent a clinical assessment the included medical history, physical examination, 12-lead ECG, continuous ECG monitoring, pulse oximetry, standard blood test, chest radiography, cardiac and abdominal ultrasonography. Patients presenting with congestive heart failure, terminal kidney disease on hemodialysis state, arrhythmia, or infection disease (which cause to increase troponin level) were excluded. Patients were divided into three groups according to the algorithm: hs-cTnT below 12 ng/L and delta 1 hour below 3 ng/L were the “rule out” group; hs-cTnT at least 52 ng/L or delta 1 hour at least 5 ng/L were in the “rule in” group; the remaining patients were classified as the “observational” group. The final diagnosis was then adjudicated by 2 independent cardiologists using all available information, including coronary angiography, coronary computed tomography, stress electrocardiography and follow-up data. The presence of acute myocardial infarction (AMI) was defined according to the Fourth Universal Definition of Myocardial Infarction.

Results
Of the 1,332 patients enrolled in 2014 to 2018, 933 patients were analyzed after exclusion. AMI was the final diagnosis for 122 (13.1%) patients. The algorithm ruled out AMI in 401 patients with a negative predictive value and sensitivity of 100% (95% confidential interval [CI], 98.6%-100%) and 100% (95% CI, 94.0%-100%), respectively, in the rule-out group. None of the patients were diagnosed with AMI. Among the 211 patients classified into the rule-in group, 90 were diagnosed as having AMI. The positive predictive value and specificity were 43.1% (95% CI, 36.2%-50.2%) and 78.3% (95% CI, 74.5%-81.7%), respectively. The median length of hospital stay was 159 min (142–180) in rule out group.

Conclusion(s)
Our findings suggest that the 0-hour/1-hour algorithm using hs-cTnT provides very high safety and efficacy for the triage toward rapid rule-out to rule-in of AMI.

Acknowledgement/Funding
JSPS KAKENHI Grant Number JP18K09554