bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3818Association between e-cigarette use and myocardial infarction: analysis of two large population-representative studies in USA
Authors: Farsalinos K , Voudris V , Niaura R 
Published: October 2019

Abstract

Background
Smoking is a major risk factor for cardiovascular disease. E-cigarettes are an emerging and controversial public health issue. It is unknown how e-cigarette use affects cardiovascular disease.

Purpose
In this study, we examine the association between e-cigarette use and myocardial infarction (MI) in two large population-representative studies in USA.

Methods
The study analyzed the 2016 and 2017 (pooled) National Health Interview Survey (NHIS, N=59,770) and the 2017 Behavioral Risk Factor Surveillance System survey (BRFSS, N=450,016). Proportions (95% CI) were calculated and logistic regression analyses were performed to identify the association between e-cigarette use and MI. Independent variables in the models were demographics, e-cigarette use (daily, some days, former, never), smoking status (daily, some days, former, never) and risk factors for MI (hyperlipidemia, hypertension, diabetes, BMI). Exercise was also introduced as an independent variable, where available (BRFSS only).

Results
In NHIS, 90.9% (88.8–93.0%) of daily e-cigarette users were current or former smokers. The respective proportion in BRFSS was 86.3% (85.3–87.3%). The majority of some days and former e-cigarette users (≥70%) were also current or former smokers in both surveys. MI was reported by 4.2% (2.7–5.7%) of daily vs. 3.2% (3.0–3.4%) of never e-cigarette users in NHIS (P=NS), and 4.2% (3.5–6.1%) vs. 4.4% (4.2–4.5%) in BRFSS (P=NS), respectively.
In NHIS, daily e-cigarette use was not associated with MI (OR: 1.59, 95% CI: 0.97–2.61, P=0.067). Some days and former e-cigarette use were also not associated with MI. In the BRFSS, daily e-cigarette use was not associated with MI (OR: 1.40, 95% CI: 0.96–2.04, P=0.077), but some days (OR: 1.51, 95% CI: 1.09–2.11, P=0.014) and former e-cigarette use (OR: 1.14, 95% CI: 1.02–1.28, P=0.021) were associated with MI. In both surveys, all patterns of smoking (daily, some days and former smoking) and established risk factors (hypertension, hyperlipidemia, diabetes) were consistently and strongly associated with MI.
ORs for MI

Conclusion
E-cigarettes are predominantly used by current and former smokers. Daily e-cigarette use was not associated with having had an MI, while inconsistent and seemingly paradoxical associations are observed for some days and former e-cigarette use. Long-term epidemiological studies are needed to examine how e-cigarette use affects the risk of MI, considering the complex interactions between smoking and e-cigarette use.

Acknowledgement/Funding
None
P3825Long-term prognostic value of growth differentiation factor-15 in acute coronary syndrome
Authors: Peiro Ibanez O M , Ordonez J , Garcia A , Bonet G , Quintern V , Rojas S , Bardaji A 
Published: October 2019

Abstract

Introduction
Biomarkers plays a critical role in diagnostic, prognostication, and decision-making in cardiovascular medicine. Growth differentiation factor-15 (GDF-15) has been reported as a potential biomarker in acute coronary syndrome (ACS). However, there is limited data on the long-term prognostic value after an ACS.

Purpose
To study the long-term prognostic value of GDF-15 in ACS.

Methods
We included patients with ACS who underwent coronary angiography. During angiography an arterial blood sample was collected. Plasma GDF-15 were measured and clinical data and long-term events were obtained. As previously reported, risk categories were defined as low risk (<1200ng/L), intermediate (1200–1800ng/L) and high risk (>1800ng/L). Incremental prognostic value of GDF-15 for all-cause death was assessed on top of a clinical model (GRACE score, LVEF<40% and age).

Results
A total of 358 patients were included; 157 as a low risk, 85 as an intermediate and 116 as a high risk. The median (IQR) age was 65 (56–74) years and 27.4% were female. Of all patients, 61.5% were admitted with non-ST-elevation myocardial infarction, 24.0% with ST-elevation myocardial infarction and 14.5% with unstable angina. Higher values of GDF-15 were consistently associated with an increased prevalence of cardiovascular risk factors. During 6 years of follow-up 54 patients died. Of those patients, 7 (4.5%) had values of GDF-15 below 1200ng/L, 6 (7.1%) between 1200–1800ng/L and 41 (35.3%) above 1800ng/L. After adjustment for a multivariate Cox regression model, GDF-15 >1800ng/L were independently associated with all-cause death (HR 4.5; 95% CI 1.8–11.6; p=0.002) and the composite of major adverse cardiovascular events (MACE) which were identified as all-cause death, nonfatal MI and heart failure (HR 2.5; 95% CI 1.4–4.4; p=0.001). For long-term all-cause death a significant increase of the c-statistic was seen after addition of GDF-15 to the clinical model 0.871 (95% CI 0.817–0.924; p=0.019) as well as net reclassification improvement (0.769; 95% CI 0.487–1.051; p<0.001) and integrated discrimination improvement (0.117; 95% CI 0.062–0.172; p<0.001). Of 18 events of heart failure, 17 occurred in patients with GDF>1800ng/L. A multivariate competing risk model showed a significant association between GDF-15>1800ng/L and incidence of heart failure (adjusted HR 30.8; 95% CI 4.1–231.5; p=0.001) but non-significant association were found for myocardial infarction.
KM figures and all-cause death ROC curve

Conclusions
In the setting of ACS GDF-15 can predict long-term all-cause death, MACE and heart failure and provides incremental prognostic value beyond traditional risks factors in the long-term all-cause death.
P3856Timing and associated predictors of onset of new conduction disturbances requiring permanent pacemaker implantation after transcatheter aortic valve implantation
Authors: Kooistra N H M , Van Mourik M S , Rodriguez-Olivares R , Maass A H , Nijenhuis V J , Van De Werf H , Ten Berg J M , Kraaijeveld A O , Baan Jr J , Voskuil M , Vis M M , Stella P R 
Published: October 2019

Abstract

Objectives
This study aimed to investigate the onset and the associated predictors of new conduction disturbances (CDs) requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation (TAVI).

Background
The onset and associated predictors of onset of new CDs leading to PPI are still unknown. However, these are essential for safe and early discharge. Currently, these CDs lead to prolonged post-procedural monitoring after TAVI, limiting early discharge possibilities.

Methods
We retrospectively analyzed data from five centers in Europe. Post-TAVI electrocardiograms and telemetry data were evaluated to identify the onset of new CD in all patients who required a PPI within 30 days after TAVI. Early onset CDs were defined as within 48 hours after procedure, and late onset CDs as after 48 hours.

Results
A total of 2,804 patients were included for analysis. The PPI rate was 11%, of which 18% was due to late onset (>48h) CDs. Independent predictors for late onset CDs requiring PPI were pre-existing non-specific intraventricular conduction delay (IVCD), pre-existing right bundle branch block (RBBB), self-expandable valves, and predilation (Figure). Patients with a balloon-expandable valve without predilation did not develop CDs requiring PPI after 48 hours.
Figure 1

Conclusions
Associated predictors of late onset conduction disturbances leading to PPI after TAVI were pre-existing IVCD, pre-existing RBBB, the use of self-expandable valves, and predilation. Patients without CDs in the first 48 hours after TAVI and without risk factors for late onset CDs requiring PPI are possible candidates for early discharge after 48 hours.
P4128The right heart in patients undergoing transcatheter aortic valve replacement: insights from cardiac magnetic resonance imaging
Authors: Koschutnik M , Nitsche C , Kammerlander A A , Aschauer S , Goliasch G , Siller-Matula J , Winter M P , Andreas M , Loewe C , Hengstenberg C , Mascherbauer J 
Published: October 2019

Abstract

Background
Cardiac magnetic resonance (CMR) provides the gold standard for the assessment of ventricular volumes and mass. However, data on right ventricular systolic dysfunction (RVSD) and its prognostic significance on outcome in patients undergoing transcatheter aortic valve replacement (TAVR) are lacking.

Methods
We consecutively enrolled patients with severe aortic stenosis scheduled for TAVR who underwent preprocedural CMR. Kaplan-Meier estimates and multivariate Cox-regression analysis were used to identify factors associated with outcome, including RVSD. A composite of heart failure hospitalization and/or cardiovascular death was selected as primary study endpoint.

Results
145 consecutive patients (80.5±7.6 years; 51.7% female) were prospectively included, 25 (17.2%) of which had RVSD defined as RV ejection fraction (RVEF) <40%. RVSD was significantly associated with male sex, atrial fibrillation, reduced left ventricular (LV) EF (<50%) and RV endsystolic volume on CMR (all p<0.05). Serum NT-proBNP (14065±12042 vs. 3203±4615 ng/ml; p<0.001) and creatinine levels (1.59±0.96 vs. 1.29±1.03 mg/dl; p=0.201) were elevated in patients with RVSD. A total of 27 events occurred during follow-up (29±13 weeks). While LVSD was not significantly associated with outcome (p=0.654), RVSD showed a strong and independent association with event-free survival in the multivariate Cox-regression analysis [hazard ratio 3.836 (95% confidence interval 1.670–8.810); p=0.002], which included all relevant CMR parameters, cardiovascular risk factors and routine biomarkers.

Conclusions
RVSD rather than LVSD, as determined by CMR, is an important predictor of outcome in patients undergoing TAVR. RV function might thus add useful prognostic information on top of established risk factors.
P4136Neurogenic stunned myoacardium in multiple sclerosis patients
Authors: Gialafos E , Tsougos E , Andreadou E , Tzanetakos D , Tzartos I , Vakrakou A , Evangelopoulos E M , Koutsis G , Dimitrakopoulos A , Anagnostouli M , Stefanis L , Kilidireas K 
Published: October 2019

Abstract

A wide spectrum of topics regarding Multiple Sclerosis (MS) have been thoroughly studied, like immunology, nature of demyelinating lesions (DL's), therapeutics, etc. However, little is known about the influence of MS DL's on the cardiovascular system and especially in the coronary vasculature although few reports mention coronary vasospasm due to autonomic nervous system (ANS) abnormalities. Aim of this study was the detection the presence of Neurogenic Stunned Myocardium (NSM) through perfusion test.

Method
We enrolled 50 asymptomatic fulfilling the criteria MS patients, aged 45±7 years old and disease in our study duration of 6±13 years with EDSS= 2,5. After echocardiography and clinical examination as primary screening, pharmacologic stress thallium 201 scintigraphy and/or coronary angiography were performed to identify the incidence of NSM. Clinical characteristics of MS, type of disease, treatments as well as localization of demyelinating plaques (DP) were noted.

Results
13 patients (26%) had abnormal scintigraphy test although clinical profile was not indicative. Cardiac ultrasound showed that 2 patients from this group had a critical ejection fraction (around 50%). All positive patients that underwent for coronary angiogram were negative implying coronary artery spasm as a potential mechanism for the stress positive result. A common finding of all positive patients was the localization of DP which was in the lateral horn of the lower cervical part (C5–7) and upper thoracic part (Th1–4). No correlation seems to have the presence of CAD with disease duration, EDSS and treatment approaches.

Discussion
Our study shows a high incidence of NSM. This finding due to the location of the DP seems to correlate with ANS disturbance and might help to distinguish patients at higher risk.
P4167Non-shockable rhythm related sudden cardiac arrest in the community
Authors: Sharifzadehgan A , Rischard J , Bougouin W , Dumas F , Waldmann V , Beganton F , Aissaoui N , Geri G , Jost D , Lamhaut L , Cariou A , Jouven X , Marijon E 
Published: October 2019

Abstract

Introduction
A significant increase in the prevalence of sudden cardiac arrest (SCA) with non-shockable rhythm has been reported, related to asystole and pulseless electrical activity (PEA). Factors associated with non-shockable rhythm and the mode to the return of spontaneous circulation (ROSC) may help for a better understanding.

Purpose
We aimed to describe the frequency, characteristics and outcome of SCA related to non-shockable versus shockable rhythm in the community.

Methods
In this prospective ongoing, multicentre population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed. Initial rhythm was obtained from the EMS report and the initial recorded rhythm strip when available. Medical records for each SCA were reviewed by cardiologists to identify underlying aetiology and associated conditions.

Results
Among the 3,028 SCAs admitted alive out of a total of 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 2,904 patients had available information regarding initial rhythm at the time of EMS arrival. Among them, 1,314 patients (45.3%) presented with non-shockable rhythm: 1,109 (38.2%) cases with asystole, 197 (6.8%) with PEA and 8 (0.3%) with high degree atrioventricular block.
Cases with non-shockable rhythm were older (60.6 vs. 57.4 years, P<0.001), with greater proportion of females (34.9 vs. 19.2%, P<0.001) and less proportion of family history of coronary artery disease or SCA. Proportion of warning symptoms prior to the SCA was higher among patients with non-shockable rhythm (74.3 vs. 64.9%, P<0.001) but the proportion of chest pain was lower (24.0 vs. 43.3%, P<0.001). Survival rate was much lower in non-shockable rhythm cases (7.2 vs. 42.3%, P<0.001).
Among the 1,314 non-shockable cases eventually admitted alive to hospital, 1,022 (77.8%) did not require external defibrillation prior to ROSC, and a majority (91.7%) received adrenaline during resuscitation. In this subgroup, the main identified cardiac cause was acute coronary syndrome (45.3%), followed by chronic CAD (27.1%), structural non-ischemic heart disease (22.4%), and non-structural heart disease (5.2%).

Conclusions
Initial non-shockable rhythm is encountered in almost half of SCA cases admitted alive; mostly occurs in older patients with higher proportion of females. Over three quarters of these cases did not require external defibrillation prior to ROSC.
P4339Reference values for cardiorespiratory fitness in healthy Koreans: compared to western nations and nomogram
Authors: Jang W Y , Kim W , Kang D O , Park Y , Park E J , Na J O , Choi C U , Rha S W , Park C G , Seo H S , Park S , Kim E J 
Published: October 2019

Abstract

Introduction
Cardiorespiratory Fitness (CRF), defined as the integrated ability to properly oxygenate skeletal muscles during physical activity, is associated with a high risk of cardiovascular disease and all-cause mortality. The reference range for CRF may differ among nations, with Asians under-represented in previous data.

Purpose
In this study, we sought to establish reference values of CRF for Asians using a recent Korean cohort.

Methods
We analyzed 2646 healthy Korean adults recently enrolled in the Korea Institute of Sports Science Fitness Standards (KISS FitS) project with estimated maximal oxygen uptake (VO2max) values during treadmill test. Patients with cardiovascular or renal disease, systemic infection, pregnant women and those with orthopedic injuries unable to measure physical fitness were excluded. Age-specific mean VO2max values were compared with those from recent American, Norwegian, Danish cohorts and old Korean data.

Results
Age-specific reference values for healthy Korean adults in this cohort were as shown (Table). We were able to draw a nomogram to predict exercise capacity for a given age and MET value (Figure). When compared to other countries, less CRF reduction by aging was seen in Asians than in other Westerners. When compared to old Korean data from the 1980s, values were similar after adjustment for difference in methods, except for those under 30 years old which were decreased.
Exercise capacity of healthy Korean Men Women Age VO2max (ml/kg/min) N P-value for trend Age VO2max (ml/kg/min) N P-value for trend 19–29 42.3±6.3± 209 <0.01 19–29 34.3±4.3± 110 <0.01 30–39 42.0±5.0± 170 39–39 32.2±4.5± 211 40–49 41.4±5.6± 238 40–49 30.8±4.6± 284 50–59 38.0±5.7± 274 50–59 28.3±4.6± 367 60–69 32.4±6.2± 134 60–69 26.0±5.7± 336 70–79 27.2±5.6± 83 70–79 23.9±4.4± 195 >80 24.1±4.0± 11 >80 21.0±3.7± 24 Total 38.6±7.4± 1119 Total 28.5±5.8 1527 Data are presented as mean ± standard deviation. VO2max, maximal oxygen uptake; N, number.
Nomogram of exercise capacity in Koreans

Conclusions
While there was no significant change in CRF over time in the same ethnic group, there was a clear inter-ethnic difference. CRF should be assessed according to ethnic or national standards, and it is necessary to establish a reference for each nation or ethnicity with periodic updates.

Acknowledgement/Funding
National Sports Promotion Fund of the Korea Sports Promotion Foundation in 2015
P4349Simple and rapid estimation of left ventricular longitudinal deformation by tissue-tracking mitral annular displacement in single apical view
Authors: Nishi T , Hozumi T , Takemoto K , Wada T , Maniwa N , Kashiwagi M , Shimamura K , Shiono Y , Kuroi A , Matsuo Y , Kitabata H , Ino Y , Kubo T , Tanaka A , Akasaka T 
Published: October 2019

Abstract

Background
Noninvasive assessment of left ventricular (LV) deformation using global longitudinal strain (GLS) has prognostic value in patients with and without preserved ejection fraction (EF). Application of speckle-tracking technology to the mitral annulus provides rapid and easy assessment of displacement of septal and lateral mitral annulus and mid-point of mitral annular line in single apical view (TMAD) even in poor echo-image quality. TMAD may be used as a simple index of LV longitudinal deformation in patients with and without preserved EF (Figure).

Purpose
The purpose of this study was to examine whether TMAD can be used as a simple index of LV longitudinal deformation in patients with and without preserved EF.

Methods
The study population consists of 95 patients without segmental wall motion abnormality, significant valvular diseases, and atrial fibrillation in whom both TMAD and GLS measurements were applied by QLAB software (Philips). We estimated GLS from apical 4- and 2-chamber views and apical longitudinal views, and TMAD from apical 4-chamber view. TMAD was automatically and quickly evaluated as the base-to-apex displacement of septal (TMADsep), lateral (TMADlat), and mid-point of annular line (TMADmid) (Figure). The percentage of M-TMAD to LV length from the mid-point of mitral annuls to the apex at end-diastole (%TMADmid) was also calculated. We compared each TMAD values with GLS values by linear regression analysis, and evluated TMAD values by a receiver operating characteristic (ROC) analysis to detect impaired LV longitudinal deformation (|GLS|<12.0%).

Results
TMAD was successfully assessed in 94 of 95 patients (99%) while GLS was measured in 84 of 95 patients (87%, p=0.0082 vs TMAD). There were good correlations between each TMAD index and |GLS| (TMADsep:r=0.77, TMADlat:r=0.81, TMADmid:r=0.82, %TMADmid:r=0.87). According to ROC curve, the best cut-off values for TMADsep, TMADlat, TMADmid, and %TMADmid in determining LV longitudinal deformation were 6.8mm, 8.0mm, 7.8mm, and 9.5% respectively (Table).

Conclusions
The present results suggest that rapid and easy assessment of TMAD in single apical view may be used as a simple index of LV longitudinal deformation.
P4352Usefulness of speckle tracking echocardiography in the detection of ventricular mechanics changes after percutaneous intervention of coronary chronic total occlusions
Authors: Mahia P , Salinas P , Gonzalo N , Islas F , Escaned J , Perez De Isla L , Macaya C 
Published: October 2019

Abstract

Background
Previous studies show contradictory results of the effect of chronic total occlusions (CTO) revascularization on LVEF. Deformation parameters based on speckle tracking (2D-ST) echo allows the evaluation of the systolic regional function.

Purpose
To examine the usefulness of 2D-ST to detect changes in regional ventricular mechanics in a consecutive cohort of patients with successful CTO percutaneous revascularization.

Methods
Prospective study that included 13 consecutive patients (72±8 y, 85% men). Revascularization was justified based on the evidence of viability of the underlying territory. 2D-ST was performed before, one and three months after of the procedure. Based on 16 segments model (n: 208), these were classified in two groups (dependent/non-dependent) according to their relationship with the treated CTO. Strain rate (Sr) and Strain (S) of the three myocardial layers were measured.

Results
208 segments analyzed. 62 (30%) perfusion dependent, (mean 5 segments/patient), non-dependent: 146 (70%). During follow-up (median: 3.3 m), there were no significant differences with respect to LVEF (56±6 vs. 59±6, p: 0.2). Although non-dependent segments showed no significant changes of deformation parameters after the procedure, dependent segments showed an increase (Δ) of both the S and Sr, being statistically significant the Δ of the three layers S at 3 months vs. non-dependent.
Table 1 PRE POST p Δ Non-Dependent segments (N: 146)   S-epicardial −16.6±4.9 −16.0±4.0 0.06 0.6±4.0   S-mesocardiac −17.4±4.8 −16.8±4.2 0.08 0.6±3.9   S-endocardial −18.1±5.1 −17.7±4.9 0.337 0.4±4.5   Sr −1.15±0.4 −1.09±0.4 0.080 0.07±0.47 Dependent segments (N: 62)   S-epicardial −13.7±5.8 −16.3±4.5 <0.001 −2.6±5.2*   S-mesocardiac −14.7±6.1 −17.0±4.5 <0.05 −2.3±5.2*   S-endocardial −15.8±6.7 −17.9±4.9 <0.05 −2.1±5.6*   Sr −0.98±0.4 −1.03±0.4 0.353 −0.05±0.42 *p<0.05 ΔNon-dependents vs. ΔDependents.
S (%) improvement post RCA CTO treatment

Conclusions
This study shows that CTO treatment improves regional myocardial function in LV segments dependent on CTO at three months of follow-up, without changes in LVEF. 2D-ST allows to examine the effect of flow restoration, providing new information on the potential short-term benefits of this strategy