bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1249Prognostic impact of sarcopenia on major adverse cardiovascular outcomes in coronary artery disease patients undergoing successful percutaneous coronary intervention
Authors: Kang D O , Park S Y , Park Y , Jang W Y , Kim W , Choi B G , Na J O , Choi C U , Kim E J , Rha S.-W , Park C G , Hong S.-J , Seo H S 
Published: October 2019

Abstract

Background
Sarcopenia is an emerging marker of frailty. Its prognostic impact on atherosclerotic cardiovascular disease (ASCVD) requires further investigation.

Purpose
We investigated the long-term prognostic impact of computed tomography (CT)-determined sarcopenia in patients with coronary artery disease (CAD).

Methods
Total 475 CAD patients those who underwent successful percutaneous coronary intervention (PCI) and performed CT scan within 30 days of PCI were enrolled. The cross-sectional area of skeletal muscle at the first lumbar vertebra (L1) level was measured. Sarcopenia was defined as L1 skeletal muscle index of less than 34.60 cm2/m2 for men and of less than 25.90 cm2/m2 for women. Primary outcome was 3-year all-cause mortality and secondary outcome was 3-year major adverse cardiovascular event (MACE), a composite of all-cause mortality, any myocardial infarction, and repeat revascularization.

Results
Sarcopenia was present in 214 (45.1%) of 475 patients. The incidence of 3-year all-cause mortality and MACE was significantly higher in patients with sarcopenia than in those without sarcopenia (17.7% vs. 5.7%, p<0.001; and 35.0% vs. 11.2%, p<0.001, respectively). In the fully adjusted multivariable analysis, sarcopenia was an independent predictor of higher risk of 3-year all-cause mortality (odds ratio [OR]: 2.98; 95% confidence interval [CI]: 1.35 to 6.58, p=0.007) and MACE (OR: 4.39; 95% CI: 2.49 to 7.73, p<0.001). The results were consistent after propensity-score matched analysis with 100 pairs of study population (C-statistics = 0.868).
Kaplan–Meier analysis of 3-year outcomes Overall population PSM population Sarcopenia (n=214) No sarcopenia (n=261) Log-rank p-value Sarcopenia (n=100) No sarcopenia (n=100) Log-rank p-value All-cause mortality 36 (17.7) 14 (5.7) <0.001 19 (20.0) 7 (7.7) 0.013 Non-fatal MI 12 (6.6) 5 (2.0) 0.021 6 (7.0) 2 (2.3) 0.134 Repeat revascularization 32 (20.3) 14 (6.2) <0.001 17 (23.3) 8 (8.0) 0.027 Total MACEs 68 (35.0) 27 (11.2) <0.001 36 (39.3) 14 (15.4) 0.001 Data are expressed as n (%). MACE = major adverse cardiovascular event; MI = myocardial infarction; PSM = propensity-score matched.
Clinical impact of sarcopenia on CAD

Conclusion
Sarcopenia is a useful predictor of adverse clinical outcomes in patients with CAD undergoing PCI. CT-determined sarcopenia may further aid in risk stratification and decision-making for patients with established ASCVD.

Acknowledgement/Funding
National Research Foundation of Korea (NRF-2016R1A2B3013825), Ministry of Future Creation and Science of Korea (2018K000255)
P1252Diagnostic performance of quantitative flow ratio from coronary angiography versus fractional flow reserve from computed tomography
Authors: Emori H , Kubo T , Tanigaki T , Kawase Y , Shiono Y , Shimamura K , Sobue Y , Matsuo Y , Hirata T , Kitabata H , Ota H , Ino Y , Okubo M , Matsuo H , Akasaka T 
Published: October 2019

Abstract

Background
QFR and FFRCT are recently developed, less-invasive techniques for functional assessment of coronary artery disease.

Objectives
We compared the diagnostic performance between fractional flow reserve derived from computed tomography (FFRCT) and quantitative flow ratio (QFR) derived from coronary angiography, using FFR as the standard reference.

Methods
We measured FFRCT, QFR and FFR in 152 patients (233 vessels) with stable coronary artery disease.

Results
QFR was highly correlated with FFR (r=0.78, p<0.001), while FFRCT was moderately correlated with FFR (r=0.63, p<0.001). Both QFR and FFRCT showed good agreements with FFR, presenting small values of mean difference and root-mean-squared deviation (FFR -QFR: 0.02±0.09 and FFR -FFRCT: 0.03±0.11). The AUC of QFR was significantly greater than that of 3D-QCA-derived %DS (0.93 vs. 0.78; difference: 0.15; 95% CI: 0.09 to 0.20; p<0.001). The AUC of FFRCTwas significantly greater than that of CCTA-derived %DS (0.82 vs. 0.70; difference: 0.12; 95% CI: 0.05 to 0.19; p<0.001). The AUC of QFR was significantly greater than that of FFRCT (0.93 vs. 0.82; difference: 0.11; 95% CI: 0.05 to 0.16; p<0.001). The sensitivity, specificity, positive predictive value, and negative predictive valueof QFR ≤0.80 for predicting FFR ≤0.80 were 90%, 82%, 81%, and 90%, respectively. Those of FFRCT ≤0.80 for predicting FFR ≤0.80 were 82%, 70%, 70%, and 82%, respectively. The diagnostic accuracy of QFR ≤0.80 for predicting FFR ≤0.80 was 85% [95% confidence interval: 81% to 89%], while that of FFRCT≤0.80 for predicting FFR ≤0.80was 76% [95% confidence interval: 70% to 80%].
Figure 1. Comparison of FFR ≤0.80 predictors

Conclusions
Both QFR and FFRCTpossessed the ability to accurately evaluate the functional severity of coronary stenosis.
P1257ETNA-AF Europe: First 1-year follow-up snapshot analysis of more than 7,500 AF patients treated with edoxaban in routine clinical practice
Authors: De Caterina R , Kelly P , Monteiro P , Deharo J C , De Asmundis C , Lopez-De-Sa E , Weiss T , Waltenberger J , Steffel J , De Groot J R , Levy P , Bakhai A , Kirchhof P 
Published: October 2019

Abstract

Introduction
Edoxaban has been approved for stroke prevention in patients with atrial fibrillation based on its comparable efficacy and superior safety compared to warfarin in the pivotal ENGAGE AF-TIMI 48 trial. ETNA-AF Europe (NCT02944019) was initiated in agreement with the EMA to evaluate benefits and risks of edoxaban treatment in unselected patients in routine clinical practice.

Methods
13,980 patients from across 825 hospital and office-based physicians from 10 European countries (Austria, Belgium, Germany, Ireland, Italy, The Netherlands, Portugal, Spain, Switzerland and United Kingdom) were enrolled, and will be followed-up for 4 years. This snapshot analysis includes baseline and first outcome data of 7,672 patients (56.3% of all enrolled patients) that have completed their first 1-year follow-up visit (mean follow-up: 343.5 days).

Results
The average age of patients was 73.4 years, the mean weight was 81.9 kg (Table 1). Frequent comorbidities include hypertension (77.2%), valvular heart disease (17.4%), congestive heart failure (5.8%) and history of myocardial infarction (4.2%). Patients receiving the 30 mg dose (22.9%) were older, had a lower creatinine clearance and had a higher risk for both stroke and bleeding as compared to those on the 60 mg dose (77.1%). Overall, the incidence of clinical events was low: all-cause mortality: 3.56%/y, major bleeding 0.95%/y, intracranial haemorrhage 0.28%/y, any stroke or systemic embolic events 0.88%/y.
Patient characteristics at Year 1 Patient characteristics All patients Edoxaban 60 mg Edoxaban 30 mg [7,672] [5,916 (77.1%)] [1,756 (22.9%)] Age [years] mean (SD) 73.4 (9.26) 71.8 (8.98) 79.1 (7.81) Body weight [kg] mean (SD) 81.9 (17.33) 84.1 (16.80) 74.3 (16.93) CrCl (CG) [mL/min] mean (SD) 75.0 (30.29) 82.5 (29.14) 51.2 (19.75) CHA2DS2-VASc mean (SD) 3.1 (1.38) 2.9 (1.34) 3.8 (1.28) HAS-BLED mean (SD) 2.5 (1.10) 2.4 (1.07) 2.9 (1.08) First occurrence of all-cause mortality (n, %/year) 257 (3.56%) 129 (2.31%) 128 (7.90%) First occurrence of intracranial haemorrhage (n, %/year) 20 (0.28%) 16 (0.29%) 4 (0.25%) First occurrence of major bleeding (n, %/year) 68 (0.95%) 49 (0.88%) 19 (1.18%) First occurrence of stroke/SEE (n, %/year) 63 (0.88%) 45 (0.81%) 18 (1.11%) CG, Cockcroft-Gault; CrCl, creatinine clearance; SD, standard deviation; SEE, systemic embolic events.

Conclusions
We found low bleeding and stroke rates in 7,672 unselected, mainly elderly AF patients treated with edoxaban in routine clinical practice. These findings were consistent across edoxaban doses and reinforce the effectiveness and safety of NOACs such as edoxaban in routine clinical care in Europe.

Acknowledgement/Funding
Daiichi Sankyo Europe GmbH, Munich, Germany
P1258Left atrial dimension and risk of cardiovascular outcomes in patients with and without atrial fibrillation: a systematic review and meta-analysis
Authors: Meyre P , Froehlich L , Aeschbacher S , Blum S , Djokic D , Kuehne M , Osswald S , Kaufmann B , Conen D 
Published: October 2019

Abstract

Background
The prognostic value of left atrial (LA) dimensions measured by transthoracic echocardiogram among patients with versus without atrial fibrillation (AF) is uncertain. We aimed to investigate the association of LA echocardiographic parameters with the risk of cardiovascular events in AF patients compared to non-AF patients.

Methods
MEDLINE and EMBASE were searched from inception to July 2018. Records were retained if they studied the association between LA echocardiographic parameters and cardiovascular outcomes in AF patients, and in populations with no or less than 10% of AF patients. Left atrial dimensions had to be measured by transthoracic echocardiography, and parameters of interest were the following: LA diameter (LAD), LA diameter indexed to body surface (LADI), LA volume (LAV) and LA volume indexed to body surface (LAVI). Data were independently abstracted by 2 reviewers and pooled using inverse variance random-effects meta-analysis. The primary outcome was incident stroke and thromboembolic events. Secondary outcomes were heart failure, all-cause mortality and major adverse cardiac events (MACE).

Results
Twenty-three studies of AF patients (14'939 patients) and 69 studies of non-AF patients (52'654 patients) were included. Summary of the meta-analyses for the associations of LA parameters with cardiovascular outcomes is presented in the Figure. Increasing LAD was significantly associated with the risk of stroke and thromboembolic events in non-AF patients (P=0.03), but not among AF patients (P=0.27), and the association did not differ between population (P for difference=0.05) (Figure, A). Greater LADI was associated with risk of stroke and thromboembolic events in AF patients (P<0.001) and in non-AF patients (P=0.04), but the association did not differ between populations (P for difference=0.49). For MACE, increasing LADI was significantly associated with the outcome in AF patients (P<0.001) and in non-AF patients (P<0.001), but the association was stronger in non-AF populations (P for difference<0.001). Increasing LAVI was associated with high risk of MACE in AF patients (P=0.03) and in non-AF populations (P<0.001). Again, the correlation was stronger among non-AF patients (P for difference<0.001). Other associations did not differ between populations, and meta-analysis of LAV was not conducted by the limited number of studies.
Summary of meta-analysis

Conclusions
Left atrial echocardiographic parameters are powerful predictors of adverse cardiovascular events, mainly among individuals without AF.
P1259Right atrial low voltage zone as a novel predictor of sinus node dysfunction in patients with non-paroxysmal atrial fibrillation
Authors: Kondo T , Kimura M , Nakayama M , Matsuda O 
Published: October 2019

Abstract

Background
Although sinus node dysfunction (SND) coexists with atrial fibrillation (AF) in some cases, SND in patients with Non-paroxysmal AF (Non-PAF) could not be estimated in conventional electrophysiological study.
Atrial low voltage zone (LVZ), which may be surrogate for atrial fibrosis, is although reported to present in patients with Non-PAF, the association between SND and right atrial LVZ (RA-LVZ) has not been fully evaluated. The aim of the present study was to assess the relationship between SND and RA-LVZ in patients with Non-PAF.

Method
Eighty-six Non-PAF patients underwent high density voltage mapping of right atrium (RA) during AF before ablation procedure. We defined LVZ as that with electrogram amplitude <0.1 mV in order to delineate strongly damaged area in RA. We evaluated the surface are of the RA-LVZ in Non-PAF patients with and without SND.

Results
Twenty-seven of 86 patients (31.4%) presented with SND after AF termination. There were no significant differences between patients with and without SND in variables such as age, sex, AF duration, left atrial diameter, and left ventricular ejection fraction. The mean value of RA-LVZ of all the patients was 12.1±11.4%, and RA-LVZ was significantly larger in patients with SND than in those without SND (22.8±14.6 vs 7.2±4.2%; P<0.001). In multivariate logistic regression analysis for the incidence of subsequent pacemaker implantation (PMI), only RA-LVZ was a significant predictor of subsequent PMI (odd ratio 1.306; 95% confidence interval 1.159 - 1.473; P<0.001). Receiving-operating characteristic curve for PMI following ablation procedure indicated cut-off value 10.5% for RA-LVZ with 85.2% sensitivity and 88.1% specificity (area under curve = 0.924, P<0.001). Kaplan-Meier analysis of the incidence of PMI after AF termination showed that freedom from pacemaker implantation was significantly better in patients with RA-LVA <10.5% than in those with RA-LVZ ≥10.5% (log-rank test; P<0.001).

Conclusions
Broad RA-LVZ measured during AF was strongly associated with SND and PMI after AF termination in patients with Non-PAF. Evaluation of RA-LVZ during AF could be a potential target in predicting SND requiring PMI in patients with Non-PAF.
P1454A telemonitoring service approved by the ministry of health for a large-scale screening of silent and symptomatic atrial fibrillation
Authors: Lupi L , Glisenti F , Papa I , Piazzani M , Arabia G , Castiello A , Bonelli A , Gensini G , Gabbrielli F , Nodari S 
Published: October 2019

Abstract

Introduction
despite good progress in the management of patients with atrial fibrillation (AF), this disease remains one of the major cause of stroke, heart failure, sudden death and cardiovascular morbidity. Screening for silent AF is recommended in high risk population, especially in elderly, but often it is not applied for the absence of medical prescriptions or long waiting times

Purpose
to evaluate the effectiveness of a remote monitoring through ECG Holter and 12-lead ECG provided by a network of pharmacies across the Country for the screening of AF

Methods
according to a Ministerial Decree, from 2010 authorized pharmacies may provide specialist outpatient care services. Health Telematic Network, in collaboration with our Cardiology University Department and Federfarma (National Association of Pharmacists), has installed in 4,008 authorized pharmacies across the Country a telematic network connected to a single Telemedicine platform where cardiologists were available for tele-consulting. In order to identify silent or symptomatic AF, 12-lead ECG and ECG Holter monitoring were performed in patients with episodes of palpitation, syncope or pre-syncope or with a history of AF. Informations regarding lenght of AF episodes, mean heart rate and anticoagulant therapy were collected

Results
From Jan 2017 to Dec 2018 a total of 31,156 ECG Holter monitoring were performed (46% male, mean age 61 years). Among these records, 2390 (8%) showed paroxysmal or persistent AF (53% male, mean age 77±10 years). The lenght of AF episodes was greater of 6 minutes in 14% cases and mean heart rate was greater of 90 bpm in 406 patients (17%). History of AF was not previously known in 669 patients (28%). None of this subgroup of patients and only 18% of patients with known paroxysmal AF were taking anticoagulant therapy. In the same period 196,349 ECG were performed (mean age 78 years) and 17,088 have been carried out in patients aged 65 years or older. Among these group of patients, 831 records showed unknown AF (5%): 356 (43%) high ventricular rate AF, 385 (46%) medium ventricular rate AF and 90 (11%) low ventricular rate AF. All the patients with unknown AF episodes or with frequent high ventricular rate AF episodes were referred to their General Practitioner or Cardiologist for urgent evaluation and therapeutic management.

Conclusion
our data confirm the important role of a single telematic network in which health care services can be provided timely by authorized pharmacies across all the Country to promote early diagnosis and treatment of AF, then resulting in a likely positive impact on related cardiovascular events
P1459Evaluation of remote monitoring in patients with leadless pacemakers
Authors: Mendez Zurita F , Ramirez De Diego I , Espinosa Viamonte H , Rodriguez Font E , Campos Garcia B , Alonso Martin C , Guerra Ramos J , Elamrani Rami A , Maldonado Chavez J , Paz Jaen E , Velasco Nieves A , Grande Osorio M , Bote Collazo M , Vinolas Prat X 
Published: October 2019

Abstract

Introduction
Remote monitoring (RM) of cardiac devices is a technology established in clinical practice. The early activation of RM is associated with greater survival. The RM of leadless pacemakers consists of a non-automatic remote interrogation (RI), however factors such as age, the monitoring center and the type of device delivered can condition the adequate adherence to the system.

Purpose
Describe the results of RM in patients with leadless pacemakers in the clinical practice of a tertiary referral hospital.

Methods
All patients with leadless pacemakers were included. Since October 2017, RM was offered to all new patients and to previously implanted patients who had an elevated threshold. Clinical and demographic characteristics were analyzed. The following variables were evaluated: Activation (first RI), early activation (activation occurring before 90 days from the implant or from the medical order), premature activation (activation before 15 days), and adherence to follow-up (patients with almost one RI after 12 months from activation).

Results
A total of 142 patients have been implanted with a leadless pacemaker, of which 56 patients were offered RM, being accepted in 96% of the cases (54 patients, 88±6 years old, 54% males). A 54% patients received a RM using App based technology. During a mean follow-up of 200 days, 7 deaths occurred (13%). 100% of the patients have performed the activation, being in all cases an early activation, and in 50% (26 patients) it has been premature activation. 32 patients have follow-up longer than 12 months and all are adherent to RM. There are no differences in the percentage of activation or adherence depending on the type of monitor.

Conclusions
The implementation of RM program in old patients with a leadless pacemaker has a high acceptance rate, achieving an early activation in all patients. The adherence to this technology remains high despite the limitation of a non automatic transmission. RM using App based technology is possible in spite of the age.
P1460Seismocardiographic measurement of systolic time intervals in left ventricular dysfunction: validation with transthoracic echo
Authors: Padmanabhan D , Bhushan M , Amba R , Joseph P , Sibal S , Vangal R , Venu A , Rao S , Manjunath C N , Vidyasagar K , Reddy S 
Published: October 2019

Abstract

Background
Systolic time intervals (STI) measured using Transthoracic Echo (TTE) have been shown to be sensitive indicators of contractile performance, but TTE is limited to a hospital setting. Recent advances in technology have enabled the simultaneous measurement of Electrocardiograms (ECG) and Seismocardiograms (SCG) using wearable devices. However, the use SCG to measure STIs has not been validated in a mobile setting, or on pathological subjects.

Purpose
To test the validity of an automated algorithm for measuring STIs using a wearable device recording ECG and SCG, in subjects with varying degrees of left ventricular dysfunction.

Methods
179 Patients with suspected left ventricular dysfunction were assessed using TTE performed by a Cardiologist. Patients were simultaneously fitted with a novel wearable device worn on a chest strap, recording SCG and single-lead ECG data, while the cardiologist measured the pre-ejection period (PEP) and left ventricular ejection time (LVET) with the patient in a supine position. Of these subjects 29 (16.2%) were diagnosed with Dilated cardiomyopathy (DCM), and 109 (60.8%) had Ischemic Heart disease.
The SCG and ECG data recorded on the wearable device was then analysed using a peak-detection algorithm, which detected the Q,R,S points on the ECG, and then determined the 4 most prominent peaks in the SCG signal corresponding to each R-peak. Heart rate, patient's age, gender and SCG time intervals were then used in a DecisionTree algorithm to determine the values of PEP and LVET, which were were then compared against those determined by the cardiologist using TTE.

Results
The correlation coefficient (r2) between PEP calculated using TTE, and the values obtained from the algorithm analyzing SCG data was 0.92 while the mean error was 7.47%. The r2 between the LVET calculated using the TTE and the algorithm was 0.75, while the mean error was 8.53% (p-value<0.001 for all cases).
Results All Subjects With IHD Without IHD With DCM Without DCM Number of Subjects 178 109 69 29 149 PEP (r2) 0.92 0.89 0.94 0.88 0.91 PEP (% age error) 7.47 7.50 7.42 6.99 7.56 LVET (r2) 0.75 0.81 0.66 0.55 0.83 LVET (% age error) 8.53 6.69 11.4 20.42 6.16 DCM, Dilate Cardiomyopathy; IHD, Ischemic Heart Disease.
ECG + SCG signals for a DCM patient

Conclusion
The algorithm-derived STIs measured by SCG correlate well with those measured by TTE across most patient groups, including those with Dilated Cardiomyopathy and Ischemic Heart Disease, opening prospects for continuous remote monitoring of STIs in a mobile setting.

Acknowledgement/Funding
Fourth Frontier Technologies
P1466Can physicians trust a machine learning algorithm to diagnose ST elevation myocardial infarction?
Authors: Mehta S , Fernandez F , Villagran C , Frauenfelder A , Matheus C , Vieira D , Torres M A , Mazzini J , Pisana L , Quintero S , Cecilio E , Aboushi H , Acosta M I , Lopez C , Sunkaraneni S 
Published: October 2019

Abstract

Background
For the past years, the medical field has been taking advantage of the endless possibilities that Artificial Intelligence (AI) provides. Using computer-aided devices that can perform and interpret electrocardiograms (EKG) accurately pushes current healthcare boundaries. We present the LUMENGT-AI, this model can handle large datasets, multiclass diagnoses, complex EKG morphology, and still detect ST Elevation MI (STEMI) accurately.

Purpose
To develop an innovative AI-based system for automated STEMI specific EKG analysis.

Methods
An observational, retrospective, case-control study. Sample: 8,511 EKG records, previously diagnosed as “normal”, “abnormal” (over 200 conditions) or “STEMI” (4,255 cases). Records excluded patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (90,592 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.

Results
Ground Truth Score – Accuracy (94.1%), Sensitivity (87.8%), Specificity (98.1%) – see the comparison to published data in Table.

Conclusions
A statistical analysis allowed us to compare STEMI recognition efficiency between physicians and our model. The LUMENGT algorithm results secured its place as a reliable tool to diagnose STEMI faster and more accurately than physicians.