bluuebunny/crossref_metadata_2025_split huggingface dataset:
1205Zero-fluoroscopy catheter ablation of right- and left-sided supraventricular tachycardias
Authors: Prolic Kalinsek T , Zizek D , Kuhelj D , Antolic B , Stublar J , Jan M 
Published: October 2019

Abstract

Background
Catheter ablation (CA) of supraventricular tachycardias (SVTs) is traditionally performed with the aid of fluoroscopy. However, ionizing radiation is associated with potentially harmful deterministic and stochastic effects to the patient and operator. Many methods have been suggested to reduce the radiation exposure, one of the methods, which completely eliminates ionizing radiation exposure, is zero-fluoroscopy catheter ablation.

Purpose
Our aim was to assess feasibility, success rate and safety of zero-fluoroscopy CA for treatment of various right and left-sided SVTs with the use of three-dimensional (3D) electroanatomical mapping system (EAM) and intracardiac echocardiography (ICE).

Methods
Consecutive 274 patients (140 male, mean age 33.5±21.8 years) with documented SVTs underwent CA in our center from April 2014 to May 2018. All procedures were performed with the 3D EAM without any use of fluoroscopic guidance. ICE was used as primary visual modality when left-sided approach was required. The procedural endpoint for atrioventricular nodal reentrant tachycardia (AVNRT) was nodal rhythm during radiofrequency (RF) energy delivery and non-inducibility. The procedural endpoint for focal atrial tachycardia (AT) was termination and non-inducibility. The procedural endpoint for accessory pathway (AP) mediated tachycardia was absence of bidirectional conduction over the AP. The procedural endpoint for typical atrial flutter (AFL) was bidirectional block over the cavo-tricuspid isthmus.

Results
One hundred thirty two patients had AVNRT, 79 had AP mediated tachycardia (47 left-sided, 25 septal and 7 right-sided), 31 patients had AT (8 left-sided), 32 patients had AFL. Cryo-ablation was used in 14 (14/132, 10.6%) patients with AVNRT and 5 patients with septal AP (5/25, 20%), RF was used in the rest. The procedural endpoint was achieved in all procedures (100%). During the mean follow-up of 343±253 days the recurrence rate for AVNRT, AP mediated tachycardia, focal AT, AFL was 7.5%, 16.4%, 32.3% and 9.4%, respectively. No procedural complications were observed.

Conclusions
Zero-fluoroscopy CA of right and left-sided SVTs with the use of the 3DEAM and ICE is feasible, safe and results in promising long-term success rates after single CA procedure.

Acknowledgement/Funding
None
1207Pulsed Field Ablation: Acute and Chronic Safety and Lesion Efficacy
Authors: Verma A , Haines D , Kirchhof N , Onal B , Martien M , Grassl E , Barka N , Howard B , Stewart M 
Published: October 2019

Abstract

Introduction
Thermal ablation methods are the cornerstone of treatment for atrial fibrillation. However, they pose a risk to extra-cardiac structures and may result in inadequate efficacy. Nonthermal, pulsed-field ablation (PFA) delivery to cardiac tissues may create durable, efficacious lesions while avoiding collateral damage.

Purpose
The purpose of this preclinical GLP study was to assess acute and chronic electrical isolation combined with a pathology assessment of chronic lesion extent in response to PFA delivery to cardiac tissue, and to document any collateral damage.

Methods
Six pigs were treated with biphasic, bipolar PFA doses through a circular multi-electrode catheter. PFA was delivered at four locations at specified voltages: superior vena cava (SVC at 700V), right atrial appendage (RAA at 1500V), left atrial appendage (LAA at 1200V), and right pulmonary vein (RPV at 1500V). Phrenic nerve pacing thresholds and electrical block at SVC, RPV, and RAA sites were investigated acutely, and electrical block at the SVC sites chronically. Pigs were survived for 4 weeks. After euthanasia, necropsies and histopathological assessments documented the findings at the lesion sites and collateral tissues.

Results
Post PFA, entrance block was achieved in all SVC, RPV, and RAA sites. Histopathology showed characteristic replacement fibrosis of the myocardium at all ablation sites. The PFA lesions in the SVC and RPV were all continuously circumferential and histopathology did not detect any remaining myofiber conduits across the post-ablation fibrosis (consistent with the electrical assessments). PFA of the appendages caused wide-ranging fibrosis in the RAA, and limited fibrosis in the LAA. Histologically, the atrial fibrosis was almost exclusively transmural in both, with the RAA lesions overall diagnosed as circumferentially complete in all but one case. The right phrenic nerve (RPN) pacing thresholds were unchanged from baseline to the end of the procedure and were all <1.0V. The examined juxtaposed RPN segments exposed to PFA at the SVC and RPV sites were normal. None of the ablated targets was associated with stenosis, aneurysms, luminal thrombus or collateral damage on the abluminal side.
Continuous lesion sites

Conclusions
This limited preclinical study evaluated the acute and chronic safety and efficacy of PFA in multiple cardiac and vascular treatment sites. In this porcine model, PFA results in acute and chronic electrical isolation, confirmed by pathology data, for all of the RPV and SVC targets. Pathology findings of the RAA revealed the ability to achieve chronic transmural lesions in highly trabeculated cardiac tissue. No collateral damage was seen to the adjacent RPN.

Acknowledgement/Funding
Medtronic
1349Effect of bariatric surgery on long-term cardiovascular outcomes in patients with obesity: a nation-wide nested cohort study
Authors: Ardissino M , Moussa O M , Tang A R , Heaton T , Ziprin P , Khan O , Darzi A , Purkayastha S , Collins P 
Published: October 2019

Abstract

Background
Obesity is a cardinal risk factor for the development of atherosclerotic cardiovascular disease. Bariatric surgery is an effective method of achieving weight reduction and improving control of cardiovascular risk factors in patients with obesity. However, the effect of bariatric surgery on long-term cardiovascular outcomes has yet to be defined.

Purpose
The aim of this study is to evaluate the effect of bariatric surgery on long-term risk of major adverse cardiovascular events in a large population of patients with obesity.

Methods
A nested cohort study was carried out; including the 3,701 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and 3,701 age, gender and BMI matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction; and fatal or non-fatal acute ischaemic stroke. Secondary endpoints included all-cause mortality, new diagnosis of heart failure, fatal or non-fatal myocardial infarction, and fatal or non-fatal acute ischaemic stroke. Data was analysed using a Cox proportional hazards model to account for multiple covariates.

Results
Patients were followed up for a median of 11.2 years; 20.3% of the population were female, the median age was 36 years and median BMI was 40.4 kg/m2. Patients who had undergone bariatric surgery had a significantly lower occurrence of the primary composite outcome (HR 0.450; 95% CI 0.312–0.671, p<0.001, NNT=62); this was driven by a reduction in myocardial infarction (HR 0.444; 95% CI 0.302–0.654, p<0.001, NNT=64) and not in acute ischaemic stroke (HR 0.528; 95% CI 0.159–1.751, p=0.296). A significant reduction was observed in rates all-cause mortality (HR 0.254; 95% CI 0.183–0.353; p<0.001, NNT=27) and of new diagnosis of heart failure (HR 0.519; 95% CI 0.311–0.864, p=0.012, NNT=153).
Table 1. Primary and secondary endpoints during follow-up Events No Bariatric Surgery Bariatric Surgery HR 95% CI p (n=3,701) (n=3,701) Primary endpoint 93 37 0.458 0.312–0.671 <0.001 Secondary endpoints   All-cause mortality 182 45 0.254 0.183–0.353 <0.001   Heart failure 46 22 0.519 0.311–0.864 0.012   Fatal or non-fatal myocardial infarction 93 36 0.444 0.302–0.654 <0.001   Fatal or non-fatal ischaemic stroke 9 4 0.528 0.159–1.751 0.296
Adjusted primary endpoint rates

Conclusion
The results of this large, nation-wide nested cohort study support the role of bariatric surgery in reducing the risk of major cardiovascular events, all-cause mortality and new onset of heart failure in patients with obesity.
1350Outcome after diagnosis with hypertrophic cardiomyopathy: a nationwide study
Authors: Jacobsen M , Modin D , Koeber L , Fosboel E L , Axelsson A 
Published: October 2019

Abstract

Background
Patients with hypertrophic cardiomyopathy (HCM) are generally considered to have an increased morbidity and mortality due to symptomatic heart failure, atrial fibrillation, stroke and sudden cardiac death. Data reporting the mortality compared with background populations are however conflicting and primarily based on small cohorts from tertiary centers.

Purpose
We aimed to investigate whether a nationwide cohort of patients with HCM had an increased risk of death compared with a matched cohort derived from the general Danish population.

Methods
Using nationwide registries, we identified all patients with a first-time HCM diagnosis in Denmark between 2007 and 2016. Patients were matched 1:5 on age, sex and HCM diagnosis date to controls using risk set sampling. The study population was followed until death, emigration, or end of study period Jan. 1, 2017–whichever came first. Mortality was compared using Kaplan Meier plots and multivariable adjusted Cox proportional hazard analysis.

Results
We identified 3010 patients diagnosed with HCM (53.8% male) per registry codes. Men were on average 8.5 years younger at diagnosis than women (62.6 years [p25-p75: 49.8–73.9] vs. 71.1 years [p25-p75: 59.7–80.6]). Patients with HCM had more comorbidities than matched controls. The median time of follow-up was 4.4 years (p25-p75: 2.3, 6.7). For HCM patients and matched controls, 1-year, 5-year and 10-year probabilities of death were 10% (95% CI 9–12%), 28% (95% CI 26–30%) and 47% (95% CI 42–51%) and 2% (95% CI 1–3%), 13% (95% CI 12–14%) and 24% (95% CI 23–25%) respectively (Figure 1). After adjusting for comorbidities and medications a diagnosis of HCM was associated to a 107% increased risk of death (hazard ratio 2.07 [95% confidence interval 1.60, 2.68], p<0.0001).
Figure 1

Conclusion
In a Danish nationwide cohort, HCM was associated with a significantly higher risk of death compared with the background population. This study emphasizes the importance of continued, life-long follow-up of patients with HCM with the aim to anticipate and treat preventable adverse events. Furthermore, the findings stress the need to develop effective disease-modifying treatment strategies.
1386Reduction of mitral regurgitation in patients with heart failure and secondary mitral regurgitation: relationship between changes in brain natriuretic peptide and outcomes from the COAPT trial
Authors: Abraham W , Lindenfeld J , Mack M , Ellis J , Morishetti D , Weissman N , Stone G 
Published: October 2019

Abstract

Background
Brain natriuretic peptide (BNP) is a well-established predictor of hospitalization and death in patients with heart failure (HF). In the COAPT trial, treatment of patients with HF and secondary mitral regurgitation (SMR) with transcatheter mitral valve repair (TMVr) reduced the 2-year rates of all-cause mortality and HF hospitalization compared with maximally-tolerated guideline-directed medical therapy (GDMT) alone. Whether these improvements in outcomes were reflected in serial changes in BNP levels has not been reported.

Purpose
Herein, we report the first results of serial changes in BNP levels by treatment group in patients from the COAPT trial.

Methods
614 patients with HF and 3+ or 4+ SMR were randomized 1:1 to TMVr + GDMT or GDMT alone. Key inclusion criteria included NYHA functional class II-IVa (ambulatory), ischemic or non-ischemic cardiomyopathy with LVEF 20%-50% and LVESD ≤70 mm. Baseline BNP or NT-proBNP levels were drawn at baseline and at 6 and 12 months. For the present analysis NT-proBNP (pg/ml) values were converted to BNP values (pg/ml) using a ratio of 7 to 1.

Results
At baseline, mean values of BNP were not significantly different between treatment groups (945 pg/ml vs. 964 pg/ml in the TMVr + GDMT and GDMT groups respectively, p=0.84). At 6 months, mean values of BNP in the TMVr + GDMT group were significantly lower than in the GDMT alone group (690 pg/ml vs 893 pg/ml, p=0.02) but not at 12 months (584 pg/ml vs. 728 pg/ml, p=0.22). By analysis of covariance, BNP decreased to a greater degree after TMVr + GDMT compared with GDMT only at both 6 and 12 months (least squares mean differences of −121 pg/ml and −166 pg/ml respectively, both p<0.05) (Figure).
Change in BNP level from baseline

Conclusions
In patients with HF and 3+ or 4+ SMR enrolled in the COAPT trial, reduction of SMR with TMVr reduced BNP compared with maximally-tolerated GDMT only, a change which paralleled the reductions noted in all-cause mortality and HF hospitalizations with TMVr.

Acknowledgement/Funding
Abbott
1416Combined therapy of empagliflozin and linagliptin is superior to metformin and insulin glargine in improving blood pressure and vascular function in type 2 diabetes
Authors: Jung S , Bosch A , Kannenkeril D , Karg M , Striepe K , Bramlage P , Ott C , Schmieder R E 
Published: October 2019

Abstract

Background and purpose
The optimal choice of antidiabetic medication in patients that need combined therapy is under debate. The aim of this study was to analyze whether beyond glucose control the combination of empagliflozin (E) and linagliptin (L) improves blood pressure (BP) and vascular function in patients with type 2 diabetes (T2DM) as opposed to the combination of metformin (M) and insulin glargine (I).

Methods
This was a prospective, randomized, controlled, single center study including 101 patients with T2DM, who were randomized 1:1 to E 10–25mg combined with L 5mg once daily or M 850 or 1000mg twice daily combined with I once daily. All patients underwent BP measurement and vascular function analysis by validated systems at baseline and after 12 weeks of treatment.

Results
In comparison to baseline, office, 24-hour ambulatory BP as well as central blood and pulse pressure (PP) values decreased significantly after 12 weeks of treatment with E+L, whereas there was no change in the M+I group (see table). Twenty-four-hour peripheral systolic (mean difference: −5.2±1.5mmHg, p=0.004) and diastolic BP (−1.9±1.0mmHg, p=0.036), central clinical systolic BP (−5.56±1.9mmHg, p=0.009), forward pressure pulse height (−2.0±0.9mmHg, p=0.028), 24-h central systolic BP (−3.6±1.4mmHg, p=0.045) and 24-h pulse wave velocity (−0.14±0.05m/s, p=0.043) were reduced to a greater extent in the E+L than in the M+I group.
Empagliflozin+Linagliptin Metformin+Insulin Baseline 12 weeks p value Baseline 12 weeks p value Peripheral ambulatory BP values   24-h SBP [mmHg] 131.0±10.9 127.0±8.8 <0.001 131.0±9.7 131.0±8.6 0.438   24-h DBP [mmHg] 81.5±7.1 79.7±7.0 0.013 81.0±7.1 81.0±7.5 0.976 Clinical (laboratory) central vascular parameters   Central SBP [mmHg] 123.0±9.6 117.0±10.4 <0.001 121.0±9.9 121.0±8.3 0.944   Central PP [mmHg] 44.4±8.0 41.4±6.6 0.004 43.5±8.6 42.8±7.5 0.471   Forward pressure pulse height [mmHg] 33.0±5.7 30.2±4.6 <0.001 32.5±5.6 31.8±4.5 0.216   Central office PWV [m/s] 8.2±1.6 8.0±1.5 0.039 8.4±1.3 8.3±1.2 0.400 24-h ambulatory central vascular parameters   Central 24-h SBP [mmHg] 120.5±9.3 117.3±7.9 0.007 121.0±9.1 121.0±8.0 0.608   Central 24-h DBP [mmHg] 83.2±7.3 81.1±6.9 0.016 82.4±7.1 82.4±7.7 0.928   Central 24-h PWV [m/s] 8.9±1.3 8.8±1.3 0.010 9.0±1.4 9.0±1.3 0.349 SBP, systolic blood pressure; DBP, diastolic blood pressure; PP, pulse pressure; PWV, pulse wave velocity.

Conclusion
The combination of E+L significantly improves BP and vascular function in contrast to the combination of M+I.

Acknowledgement/Funding
This IIS was supported by a research grant from Boehringer Ingelheim International GmBH
1417Effect of sodium glucose cotransporter 2 inhibitor on sympathetic nerve activity in type 2 diabetes mellitus patients
Authors: Hamaoka T , Murai H , Sugimoto H , Mukai Y , Okabe Y , Tokuhisa H , Inoue O , Takashima S , Kato T , Usui S , Furusho H , Takamura M 
Published: October 2019

Abstract

Background
Diabetes mellitus (DM) is a well-known risk factor for cardiovascular diseases. Augmented sympathetic nerve activity plays an important role in the progressive worsening disease severity. Most of anti-diabetic drugs were demonstrated to not only decrease blood glucose, but also increase sympathetic nerve activity. Recently, it has been reported that sodium glucose cotransporter 2 (SGLT2) inhibitor has beneficial effects on cardiovascular events in spite of the decrease in blood glucose in type 2 DM patients. The underlying mechanisms remain speculative; however, it is assumed that SGLT2 inhibitor would improve sympathetic nerve activity in type 2 DM patients.

Purpose
The purpose of this study was to evaluate the effect of SGLT2 inhibitor on sympathetic nerve activity in type 2 DM patients.

Methods
This study was designed as the prospective single-arm study. Type2 DM patients whose HbA1c >7.0% with at least one atherosclerotic risk factors (Hypertension, obesity, smoking history, aging ...) were included. Patients who had renal failure (eGFR<45ml/min/1.73m2) or high age patients (>80 years old) were excluded. We measured blood glucose, HbA1c and blood insulin concentration at baseline and 12 weeks after treatment of dapagliflozin (5mg/day). Muscle sympathetic nerve activity (MSNA) was applied to scrutinize accurate sympathetic nerve activity in type 2 DM patients. Also, baroreflex sensitivity was calculated by examining the relationship between MSNA and beat to beat diastolic blood pressure.

Results
Eleven type2 DM patients were included in this study. Body mass index, blood pressure, HbA1c and blood insulin concentration tended to decrease at 12weeks after dapagliflozin (body mass index: 27.2±6.3 vs. 24.9±3.2 kg/m2. systolic blood pressure: 121±12.3 vs. 118±13.6 mmHg. diastolic blood pressure: 74.3±6.3 vs. 72.5±7.6 mmHg. HbA1c: 7.6±0.3 vs. 7.2±0.7%. insulin: 9.7±7.2 vs. 8.8±5.1 μU/ml). Dapagliflozin significantly decrease MSNA and heart rate compared to baseline (46.7±7.5 vs. 38.6±6.9 bursts/minute, P<0.05. Heart rate: 80.6±8.5 vs. 72.8±7.4 beats per minute, P<0.05). However, there is no interaction between the reduction in MSNA and baroreflex sensitivity or insulin resistance.
12 weeks administration decreased MSNA

Conclusion
Our data demonstrated that dapagliflozin significantly decreased MSNA and HR beyond the lowering effect of blood glucose in type2 DM patients. These results indicate the favorable effect of SGLT2 inhibitor might be, in part, attributed to the improvement in sympathetic nerve activity.
1421Dyskalemias in hypertensive patients treated with combination of antihypertensive drugs: a nested case-control study using Danish national registries
Authors: Krogager M L , Mortensen R N , Lund P E , Boeggild H , Hansen S M , Kragholm K , Aasbjerg K , Soegaard P , Torp-Pedersen C 
Published: October 2019

Abstract

Aims
Little is known about the occurrence of potassium disturbances in relation to combination therapy in hypertension. Using data from Danish electronic registries, we investigated the association between different combinations of antihypertensive therapy and potassium imbalances, in 22,060 individuals, between 1995–2012.

Methods
Using incidence density matching, two comparison patients without hypokalemia were matched to each corresponding patient with hypokalemia on age, gender, renal function, time from HTN date to date of potassium measurement. The same approach was applied to identify matches for patients with hyperkalemia. The ten most common antihypertensive drug combinations in our population were: (1) Beta-blockers + Angiotensin converting enzyme inhibitors, (2) Angiotensin converting enzyme inhibitors + Thiazides, (3) Angiotensin converting enzyme inhibitors + Thiazides + Potassium supplement, (4) Angiotensin receptor blockers + Other diuretics, (5) Beta-blockers + Angiotensin converting enzyme inhibitors + Potassium supplement (ATC: A12B), (6) Beta-blockers + Calcium channel blockers, (7) Beta-blockers + Thiazides + Potassium supplement, (8) Calcium channel blockers + Angiotensin converting enzyme inhibitors, (9) Calcium channel blockers + Thiazides + Potassium supplement, (10) Other antihypertensive drug combinations. We used conditional logistic regression analysis to examine the risk of developing hypo- and hyperkalemia in relation to different combinations of antihypertensive drugs within one year. The multivariable model was adjusted for serum sodium, malignancy, inflammatory bowel disease, diabetes, alcoholism and beta2-agonists.

Results
The multivariable analysis showed 10.5 times increased odds for developing hypokalemia if administered Calcium channel blockers + Thiazides + Potassium supplement (95% CI 4.97–22.06) compared to Angiotensin converting enzyme inhibitors + Beta blockers. Other drug combinations significantly associated with increased hypokalemia risk were: Angiotensin converting enzyme inhibitors + Thiazides (OR 5.01, 95% CI 2.32–10.79), Angiotensin converting enzyme inhibitors + Loop + Potassium supplement (A12B) (OR 4.03, 95% CI 1.69–9.62), Angiotensin converting enzyme inhibitors + Thiazides + Potassium supplement (OR 4.16, 95% CI 2.01–8.64) and Calcium channel blockers + Angiotensin converting enzyme inhibitors (OR 4.04, 95% CI 1.72–9.50). None of the ten groups were associated with increased odds for developing hyperkalemia in the multivariable analysis.
Cumulative incidence curves for hypokale

Conclusion
Thiazide diuretics in combination with angiotensin converting enzyme inhibitors or calcium channel blockers were strongly associated with hypokalemia risk within one year from treatment initiation.

Acknowledgement/Funding
None