bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5513Relation of thyroid hormones level to the extent of myocardial injury in patients with acute coronary syndrome
Authors: Badran H , Soltan G , Belal A 
Published: October 2019

Abstract

Objective
Previous studies have identified that abnormal thyroid hormonal status is associated with worse prognosis especially in coronary artery disease (CAD). The present study further explores whether thyroid hormones associated with size of myocardial injury and extent of CAD in patients with acute coronary syndrome (ACS).

Methods
In this study, we enrolled 120 consecutive patients (52% male, mean age 54.2±6.4 years) who were admitted to ICU with ACS and having coronary angiography.
All patients underwent testing for thyroid function status [thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4)], cardiac troponin I (cTnI), cardiac enzymes, C-reactive protein (CRP). Risk profile, clinical characteristics and angiographic results (Gensini score) were also analyzed.

Results
43.3% of patients presented with STEMI, 33.3% with NSTEMI and 23.3% unstable angina. CK-MB, troponin and CRP were significantly higher in STEMI compared with NSTEMI group (P<0.0001). Abnormal thyroid status was prevalent in 13.4% of total population; Low FT3 syndrome in 6.7%, subclinical hypothyroidism in 5% and clinical hypothyroidism in 1.7%. Lower thyroid hormone levels showed significantly lower HDL (P<0.02), higher triglyceride level& CRP and cTnI (P<0.007), higher rate of in hospital complications including recurrent angina, CHF and cardiogenic shock (P<0.001) and more severe CAD using Gensini score (P<0.0001). However, there was no significant difference in abnormal thyroid status between STEMI and NSTEMI. After adjusting for conventional risk factors, FT3 showed direct correlation to LV EF% (r=0.62, P<0.000) and inverse correlation to LV internal dimension (r=−0.57, P<0.0001), troponin (r=−0.27, P<0.03), CRP (r=−0.39, P<0.003), Gensini score (r=−0.48, P<0.0001) and number of in hospital complications (r=−0.62, P<0.0001). From a linear stepwise regression analysis low EF% (β: 0.032, 95% CI: 0.009–0.055, P<0.007) and presence of complications (β: 0.625, 95% CI: 1.194–0.056, P<0.03) are independent predictors of low FT3.

Conclusions
In ACS, the lower thyroid hormones levels are associated with larger myocardial injury, more severe CAD and higher rate of complications especially during their hospital course.
P5514Impact of pro-inflammatory conditions on myocardial infarction with non-obstructive coronary arteries
Authors: Lopez Pais J , Espinosa Pascual M J , Izquierdo Coronel B , Galan Gil D , Alcon Duran B , Moreno Vinues C , Awamleh Garcia P , Martinez Peredo C G , Alvarez Rodriguez L , Nunez Rodriguez A , Gorriz Magana J , Mata Caballero R , Oteo Dominguez J F , Gonzalez Juanatey J R , Alonso Martin J J 
Published: October 2019

Abstract

Background
Despite all the recent publications, including new guidelines, myocardial infarction with non-obstructive coronary arteries (MINOCA) is still a controversy “working diagnosis”. MINOCA patients have a characteristic risk profile, with a lower prevalence of classical risk factors (CVRF). The aim of this study is to analyze the relationship between known proinflammatory conditions and MINOCA.

Methods
Analytical and observational study developed in a University Hospital, which covers 220.000 individuals. We analyzed data of 109 consecutive MINOCA patients admitted to our center during a 3 years period (2016–2018). We used the definitions and the clinical management of the 2016 European Society of Cardiology Working Group Position Paper on MINOCA.
The composite of proinflammatory conditions (PIC) includes vasculitis and other autoimmune pathologies; connective tissue diseases, the presence of active cancer and the fact of presenting the myocardial infarction as a complication during admission for a non-cardiovascular pathology. Follow up analysis included death from any cause and major adverse cardiovascular events (MACE). Survival analysis is based on Cox regression and represented by Kaplan Meier curves. Median follow up was 17 months.

Results
Around one-third of the MINOCA patients had PIC (34.8%). They tended to be older (67.9±14 vs 62.8±15, p 0.08), with no differences in rate of female sex (55.3 vs 49.3%, p 0.55) neither in traditional CVRF: Tobacco (40.5 vs 42.6%), diabetes (18.4 vs 26.8%), dyslipidaemia (39.5 vs 48.6%) or hypertension (55.3 vs 64.8%). Patients with PIC had a higher proportion of ischemic ECG at presentation (75.7 vs 53.5%, p 0.03), a tendency to worse ejection fraction (45.9 vs 28.2%, p 0.07) and higher in-hospital mortality (2.6 vs 0.0%, p 0.17). Levels of troponin were similar (4.0±6.0 vs 6.6±10.4, p 0.2)
During follow-up (Figure 1), PIC was related to a higher all-cause-mortality (16.2 vs 1.5%, Hazard Ratio (HR) 10.7 (95% Confidence Interval [CI]: 1.3–89.0, p 0.03). Patients with PIC also showed a non-significant higher cardiovascular mortality (5.3 vs 1.4%, HR 3.5 [CI: 0.3–38.5], p 0.3) and higher rate of MACE (13.5 vs 9.2%, HR 1.6 [CI: 0.5–5.1], p 0.4).

Conclusion
In this study, MINOCA patients had a high prevalence of PIC, being present in more than one-third of them. They are linked to worse prognosis, with higher all-cause mortality and a non-significant increase in cardiovascular mortality and MACE, which could be significant with the appropriate number of patients.
P5519Effects of crowding in the emergency department on time dependent processes and outcomes using fast diagnostic protocols in patients with suspected acute coronary syndrome
Authors: Giannitsis E , Biener M , Hund H , Mueller-Hennessen M , Vafaie M , Katus H A , Stoyanov K M 
Published: October 2019

Abstract

Background
Accelerated diagnostic algorithms using high-sensitivity troponin (hsTn) assays in suspected acute coronary syndrome (ACS) are regarded as particularly beneficial to expedite diagnosis and safe discharge of low risk patients in crowded emergency departments (ED). However, little is known about potential negative effects of crowding on implementation and efficacy of fast diagnostic protocols. We studied the effects of crowding on outcomes and process times in patients admitted with suspected ACS using fast diagnostic protocols.

Methods
A total of 2,525 consecutive patients were evaluated during 12 months using 2015 ESC guideline recommended fast protocols. Crowding was defined as mismatch between patient visits and monitoring capacities as well as effective physician time per case. Electronic time-stamps were available for length of ED stay, timing of hsTnT measurements, time intervals between measurements, and laboratory turn-around-times (TAT). Patients were followed up for all-cause mortality at 30 days and 1 year.

Results
Crowding was associated with increasing intervals between blood samples from 98 to 107 minutes (p=0.008), increasing median TAT from 53 to 57 minutes (p<0.001), significantly higher numbers of additional hsTnT measurements after diagnosis (p<0.001 for trend), and a trend for more frequent hospital discharge (58.9 vs. 62.8%, p=0.08) across crowding levels. There were indirect findings for additional negative effects on time dependent care processes. However, there was no significant effect of crowding on 30-day (1.8 vs. 1.9%) or 1-year all-cause mortality (5.4 vs. 5.9%).

Conclusion
Time-dependent processes are prolonged in a crowded ED diminishing some positive effects of fast diagnostic protocols for evaluation of suspected ACS.

Acknowledgement/Funding
Roche Diagnostics International Ltd.
P5531A systematic follow-up strategy after percutaneous coronary intervention based on patient risk profile: the prospective POST-PCI registry
Authors: Ferlini M , Rossini R , Musumeci G , Grieco N , Trabattoni D , Cornara S , Cardile A , Calchera I , Russo F , Ielasi A , Faggiano P , Castiglioni B , Lettieri C , Klersy C , Oltrona Visconti L 
Published: October 2019

Abstract

Background
Redundant clinical and non-invasive examinations after percutaneous coronary intervention (PCI) increase the cost of medical care with no outcome improve. A multidisciplinary consensus document (MCD) providing a follow-up (FU) strategy based on 3 clinical and angiographic risk profile (A high, B intermediate, and C low) has been recently proposed.

Aim
To evaluate the potential reduction of cardiologic consults (CC), stress tests (ST), and echocardiograms (EC) with the application of the MCD after PCI.

Methods
The Post-PCI registry is a multicenter, observational, prospective data collection carried out during a four-week period that included consecutive patients undergoing PCI at 31 Italian Hospitals both for acute coronary syndromes (ACS) or stable coronary artery disease (SCAD). FU strategies were left at investigator's discretion. A comparison between the CC, ST and EC performed in the first 12-months with the potential suggested by the MCD was evaluated.

Results
A total of 1113 patients were included; 12-months follow up was available in 90% of the cases (mean age 68±11 years old, 58% ACS). Based on MCD risk profile 17% were in A, 74% in B and 9% in C strategy. On average observed CC and ST were significantly lower compared to the expected based on MCD (respectively 1.63±1.07 vs 1.91±0.28, and 0.41±0.59 vs 0.61±0.84; on the contrary EC were significantly higher (0.64±0.73 vs 0.34±0.75, all: p<0.001). The excess rate for CC, ST and EC as compared to MCD was respectively 25%, 14% and 8% for the strategy A, 14%, 25% and 50% for the strategy B and 26%, 54% and 40% for the strategy C. At multivariable logistic analysis the MCD strategy was an independent predictor (in a model with age, sex, consulting physician, public or private hospital) of an increased number of cardiac examination in patients at intermediated and low risk [B group OR 2.56 (95% CI 1.38–4.75), C group 27.00 (95% CI 8.13–89.62)]. The other independent predictor was age, with a reduced number of examination for elderly (>75 years old) patients [OR 0.59 (CI 95% 0.43–0.80)].

Conclusion
Our data suggest that in a real word population of patients undergoing PCI, a follow-up strategy based on clinical and anatomical risk profile would allow to a reduction of cardiac tests and consultations, particularly in patients at intermediated and low risk leading to an increase of appropriateness of prescription and to a cost reduction of medical care.

Acknowledgement/Funding
The Post-PCI registry was supported by the Italian Society of Interventional Cardiology (SICI-GISE) receiving an unrestricted grant from Astra Zeneca
P5538Safety and efficacy of acetylcholine provocation test for diagnosis of vasospastic angina in young patients
Authors: Tateishi K , Kitahara H , Nakayama T , Fujimoto Y , Kobayashi Y 
Published: October 2019

Abstract

Background
Vasospastic angina (VSA) is considered as a cause of myocardial infarction with nonobstructive coronary arteries. Given the previous reports of higher incidence of cardiovascular events in young VSA patients, early diagnosis and optimal treatment are important for these patients. While acetylcholine provocation test (ACh test) for VSA diagnosis is well reported, ACh test among young patients is not as commonly performed, therefore its safety and usefulness for this patient subset have not been fully evaluated.

Purpose
The purpose of this study was to evaluate the safety and the proportion of positive results of ACh test for young patients.

Methods
Data from patients who underwent ACh test in our institution from May 2012 to September 2018 were retrospectively analyzed. A total of 669 patients were enrolled and divided into 2 groups according to age: Young group (Age≤50, n=106); and Senior group (Age>50, n=563).

Results
The senior group had a higher incidence of hypertension, dyslipidemia, diabetes mellitus, and coronary artery disease. On the other hand, the young group had a significantly higher incidence of current smoker and tendency of daily alcohol. The rate of positive ACh test was similar, and there were no significant differences in major or minor complications between the 2 groups.
Patient characteristics and outcome Young group Senior group p (n=106) (n=563) Age (years) 42.8±7.3 68.0±9.0 <0.001 Male (%) 56.6 52.2 0.407 Current smoker (%) 34.9 15.4 <0.001 Daily alcohol (%) 31.1 22.9 0.070 Hypertension (%) 33.0 66.6 <0.001 Dyslipidemia (%) 50.0 68.4 <0.001 Diabetes (%) 12.3 20.8 0.047 ACh positive (%) 52.8 49.9 0.581 Minor adverse event (%) 4.7 5.9 0.820 Major adverse event (%) 0.9 1.4 1.000 Major adverse event: composite of death, ventricular fibrillation, sustained ventricular tachycardia (VT), myocardial infarction and stroke. Minor adverse event: non-sustained VT and paroxysmal atrial fibrillation.

Conclusion
ACh provocation test for young patients can be safely performed, and the rate of positive results was similar to that of senior patients. In young patients suspected of having VSA, ACh test should be actively performed to identify optimal medical therapy for prevention of cardiovascular events.

Acknowledgement/Funding
None
P5544Antiplatelet effects of intraoperative administration of ticagrelor versus clopidogrel in patients undergoing one-stop hybrid coronary revascularization: a single-center randomized controlled trial
Authors: Zhang Q , Xu H Y , Wu Y J 
Published: October 2019

Abstract

Background
“One-stop” hybrid coronary revascularization (HCR) has emerged to be a reliable and attractive alternative for selected patients with multivessel coronary artery disease. However, the optimal antiplatelet regimen of this procedure still remains controversial. Therefore, we conducted a randomized controlled trial to compare antiplatelet effect between ticagrelor and clopidogrel during this hybrid procedure.

Purpose
The study objective was to evaluate the onset of platelet inhibition between ticagrelor and clopidogrel in patients during “one-stop” HCR.

Methods
In a single-center, randomized, open-label study, 60 patients receiving one-stop HCR were randomized equally to received either clopidogrel (300 mg loading dose, 75 mg once per day), or ticagrelor (90 mg loading dose, 90 mg twice daily) after confirmation of LIMA-LAD graft patency. All patients treated with aspirin 100mg once daily during the treatment period. Platelet reaction units (PRU) was assessed by Verify Now™ P2Y12 assay before surgery; after confirmation of LIMA-LAD graft patency before administration study drugs; and at 30 minutes, 1 hour, 2 hours, 6 hours, 12 hours, 24 hours after loading dose. Major adverse cardiac events and bleeding events within a year follow-up were recorded.

Results
Ticagrelor produced further suppression of platelet aggregation in patients undergoing “one-stop” HCR from 2 hours after loading dose (PRU 271.0±51.6 vs 313.2±61.2, P=0.008). The average PRU value was still better at 24 hours after loading dose in the ticagrelor group than in the clopidogrel group (121.1±75.5 vs 284.3±67.0, P<0.001). There were no differences of bleeding or major adverse cardiac events between two groups.
PRU value at various time points T C T vs C, P BS 272.7±48.5 275.5±60.4 0.842 BA 321.4±50.0 324.6±60.2 0.823 0.5 h 335.5±50.7 334.47±58.9 0.940 1 h 309.9±45.3 319.6±64.6 0.503 2 h 271.2±57.6 313.2±61.2 0.008 6 h 215.9±57.5 291.5±56.2 <0.001 12 h 196.9±80.1 295.4±62.8 <0.001 24 h 121.1±75.5 284.3±67.0 <0.001 PRU = platelet reation units; T = ticagrelor; C = clopidogrel; BS = before surgery; BA = before administration (after confrimation of left internal mammal artery graft patency).
The trial flow diagram

Conclusions
In patients receiving “one-stop” HCR, the onset of action was fater and higher with ticagrelor than with clopidogrel.

Acknowledgement/Funding
This study was funded by AstraZeneca (China) Co, Ltd.
P5550The prognostic and therapeutic characteristics of heart failure among elderly patients with hypertrophic cardiomyopathy
Authors: Ghersin I , Bahouth F , Farah J , Azzam Z S 
Published: October 2019

Abstract

Introduction
Symptomatic heart failure is frequent among patients with hypertrophic cardiomyopathy. Once regarded a disease of mostly young adults, recently, hypertrophic cardiomyopathy has been increasingly diagnosed in older patients. There is scarce medical literature specifically dedicated to hypertrophic cardiomyopathy in elderly patients. As a result, their natural history with respect to risk of adverse events such as heart failure, stroke, and sudden cardiac death remains relatively unknown.

Purpose
We aimed to determine the prognostic and therapeutic implications of heart failure in hypertrophic cardiomyopathy patients older than 65 years old.

Methods
In this retrospective observational study, we searched our hospital's database for hypertrophic cardiomyopathy patients who were admitted due to acute decompensated heart failure between 1/1/2000 and 31/12/2016. Patients were stratified into two age groups: over 65 years old and under 65 years old (our control group).
Our primary outcomes were overall mortality and re-admissions due to acute decompensated heart failure.

Results
Our cohort included 86 patients. 54 patients were older than 65 years and 32 were younger than 65. There were significantly more women in the over 65 group. In the elderly group, significantly less patients had a history of smoking (26% vs. 47%, p=0.047), whereas more patients had known coronary artery disease (48% vs. 19%, p=0.006). The echocardiographic features of the two groups were similar.
The survival rate was not significantly different between the two age groups (10 year survival rate 41% under 65, 37% over 65, p=0.68). There were also no significant differences in the risk of re-admission due to acute decompensated heart failure between the two age groups.

Conclusion
No differences were seen in overall mortality or in re-admission due to acute decompensated heart failure between older (over 65) and younger (under 65) patients. Hence, it appears prudent to adhere to ESC guidelines for hypertrophic cardiomyopathy management in older hypertrophic cardiomyopathy patients.
P5556Impact of viral genome detection in endo-myocardial biopsy of arrhythmogenic cardiomyopathy substrate
Authors: Gasperetti A , Dello Russo A , Casella M , Basso C , Della Rocca D , Catto V , Zanchi S , Fassini G , Moltrasio M , Vettor G , Andreini D , Natale A , Tondo C 
Published: October 2019

Abstract

Background
Arrhythmogenic cardiomyopathy (ACM) is a genetically inherited cardiomyopathy characterized by myocardial fibro-fatty replacement. A pathogenetic role of viral myocardial infections in ACM natural history has been proposed over the years, although no definitive conclusion has been reached yet.

Purpose
To describe viral genome presence into a cohort of ACM biopsy proven patients (pts) and its impact on clinical features and outcome.

Methods
A cohort of all ACM pts undergoing an invasive third level evaluation at our institution was enrolled. All pts underwent a cardiac magnetic resonance (MR), an invasive electrophysiological study (EPS) with endo-cavitary electro-anatomical mapping (EAM), and a EAM guided endo-myocardial biopsy (EMB). Viral genome research through molecular biology techniques was performed on all biopsied samples.
According to arrhythmic risk evaluation, a trans-catheter ablation (TCA) and/or an internal cardioverter device (ICD) implant was performed. Clinical arrhythmic presentation, MR data, arrhythmia inducibility at EPS, EAM and EMB characteristic, and arrhythmic events at a 12-month follow up visit were retrieved in all pts and compared between the viral genome positive (v+ACM) and negative group (v-ACM).

Results
Forty-five pts were enrolled in our study (48±13 years; 66% male); the EMB samples of 7 (15%) pts presented a lymphocytic infiltrate and tested positive for viral genome (n=3 B19 Parvovirus; n=2 for Citomegalovirus; n=2 for Ebstein-Bar Virus) [Figure1].
At arrhythmic presentation, complex ventricular arrhythmias (NSVT, SVT and FV) were more frequent in the v+ACM group (86% vs 50%; p=0.039). Both left and right ventricular ejection fraction at MR resulted more depressed in the v+ACM group (44±7 vs 52±2 and 47±2 vs 52±2; p=0.047 and p=0.041). Complex ventricular arrhythmia inducibility at EPS was more frequent in v+ACM (72% vs 34%; p=0.032), while no differences in pathological potentials rate and extension at unipolar and bipolar EAM were found. TCA was performed in 55% and 57% and an ICD was implanted in 29% and 42% in the v+ACM and v-ACM group respectively. No differences in 12-months arrhythmic event rates (39% vs 42%) between the two groups were described.
EBM at different magnifications/stains

Conclusion
In our cohort a viral infection super-imposed to the fibrofatty infiltration was found in 15% of the patients. ACM pts testing positive for viral genome at the EMB had a more severe arrhythmic disease presentation, a more impaired heart function, and a higher rate of complex ventricular arrhythmias at disease presentation, but seemed to respond as well as viral genome negative ACM to ablative and pharmacological treatment
P5558Conditions associated with eosinophilic myocarditis: a national population-based cross sectional study
Authors: Li W , Wu L 
Published: October 2019

Abstract

Background
Eosinophilic Myocarditis (EM) is a rare but potentially fatal form of myocardial inflammation, characterized by eosinophilic infiltration of the myocardium. Due to its rare occurrence, there has been no descriptive study of EM on the population level.

Purpose
Our study aims to use a large national database to describe the prevalence, associated clinical conditions and hospital outcomes of EM.

Methods
We analyzed the 2016 National Inpatient Sample Database (NIS) for all hospitalizations with a diagnosis of EM. Prevalence and baseline characteristics of EM were described and compared with non-EM admissions, as well as associated clinical conditions.

Results
In 2016, there were 170 admissions with a diagnosis of EM. Among those, White represented the major ethnic group, followed by African American, Asian/Pacific Islander/Native American, and Hispanic (Fig. 1). There was no significant gender predisposition to EM, but EM patients presented at an older age compared with the general population. The prevalence of Systemic Lupus Erythematosus, Myeloproliferative disorders, Acute Coronary Syndrome, Heart Failure, Arrhythmia, Heart Transplant, Eosinophilic Granulomatosis with Polyangiitis, Eosinophilia was significantly higher in EM patients. Also, EM patients had higher mortality. (Table 1)
Table 1. A comparison of EM and Non-EM EM (n=170) Non-EM (n=35,675,421) P-value Demographic   Age, years 61.53±2.93 49.00±0.19 P=0.007   Female, % 50.00±7.80 56.72±0.10 P=0.38 Clinical Conditions   Systemic Lupus Erythematosus, % 2.94±2.74 0.50±0.01 P=0.03   Myeloproliferative Disorder, % 8.82±4.33 0.52±0.01 P<0.001   Acute Coronary Syndrome, % 20.59±6.07 6.55±0.06 P<0.001   Heart Failure, % 61.76±9.42 13.29±0.10 P<0.001   Arrhythmia, % 14.71±7.25 2.44±0.03 P<0.001   Heart Transplant, % 2.94±2.84 0.06±0.005 P<0.001   EGPA, % 2.94±2.92 0.00±0.00 P<0.001   Eosinophilia, % 5.88±3.95 0.07±0.002 P<0.001 Outcome   Mortality, % 8.82±4.83 1.91±0.02 P=0.003 Data is presented in the format of the mean ± standard error.
Figure 1. Racial distribution of EM patients

Conclusion(s)
Eosinophilic Myocarditis is rare, and it's associated with autoimmune diseases, cardiac complications, and worse hospital outcomes.