bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4625On women with ST-elevation myocardial infarction: raised concentrations of pro-C-type natriuretic peptide predict increased one-year mortality
Authors: Mark P , Frydland M , Moeller-Helgested O K , Holmvang L , Moeller J E , Johansson P I , Ostrowski S R , Prickett T C R , Hassager C , Goetze J P 
Published: October 2019

Abstract

Introduction
Endothelial C-type natriuretic peptide (CNP) contributes to the local regulation of vascular homeostasis including a vasodilatory function in the microcirculation when studied in animal models. Clinical investigations have shown that high concentrations of C-type natriuretic peptides in plasma are associated with adverse clinical outcome in subgroups of patients with cardiac disease.

Purpose
To determine the prognostic potential of pro-C-type natriuretic peptide (proCNP) measurement in plasma sampled on admission of patients with ST-elevation myocardial infarction (STEMI).

Methods
In 1760 patients (470 women, 1290 men) with confirmed STEMI, we measured proCNP concentration in plasma obtained on hospital admission before coronary angiography. We divided patients into groups of low, normal or raised proCNP concentrations based on lower and upper cut-off values of sex- and age-specific 95% reference intervals from a reference population (688 individuals). We estimated differences in baseline characteristics including medical history and determined the prognostic value of proCNP measurement by Kaplan-Meier plots including log-rank tests and Cox regression survival analyses (expressed as hazard ratio (HR) and 95% confidence interval).

Results
Raised proCNP concentrations in plasma were associated with a higher prevalence of hypertension (P<0.001), diabetes mellitus (P=0.009), and peripheral artery disease (P=0.023), and a higher one-year all-cause mortality rate compared with normal proCNP concentrations (Plog-rank = 0.009, HR: 1.6 (1.1–2.4)). However, when adjusted for sex, an interaction between sex and groups of normal vs. raised proCNP was found (P=0.030). In sex-stratified analyses only women with raised proCNP concentrations showed an increased one-year all-cause mortality rate (women: Plog-rank <0.001, HR: 2.6 (1.5–4.6), men: Plog-rank= 0.66, HR: 1.1 (0.6–1.9)). Furthermore, in women, stepwise increases of proCNP concentration in the upper range (proCNP concentration > median) were independently associated with increased risk of death within one year after adjusting for age, plasma concentrations of creatinine and proANP, and quartiles of plasma troponins (HR: 1.02 (1.00–1.05) per 1 pmol/L increase of proCNP, P=0.047).
One-year all-cause mortality rates

Conclusion
In patients with STEMI, a raised concentration of proCNP from plasma sampled on admission was associated with a higher risk of death within one year. However, only women displayed this difference of mortality rate in sex-specific estimates. Moreover, stepwise increases of proCNP concentration in the upper range independently predicted a higher risk of one-year death in women following STEMI after adjusting for potential confounders.
P4632Impact of intracardiac thrombosis in patients with acute myocardial infarction: insights from nationwide inpatient sample in the United States
Authors: Dayanand S , Amanullah A , Martinez Castellanos J , Goyal A , Jeannette C , George J , Rangaswami J 
Published: October 2019

Abstract

Background
Intracardiac thrombosis (ICT) is a complication of Acute myocardial infarction (AMI).

Hypothesis
Our aim was to evaluate the impact of ICT on mortality, thromboembolism, length of stay in patients with AMI.

Methods
Data was collected from the Nationwide Inpatient Sample (NIS) for the year 2016, where patients with a primary diagnosis of ICT as a complication of AMI (ICD10-CM code I23.6) were included. Comparisons were made between patients with ICT post-AMI (ICD10-CM code I23.6) vs those with AMI (ICD10-CM I21.0).

Results
Of a total of 200930 cases of AMI, 488 (0.5%) had ICT. The patients with ICT had an increased length of stay (LOS) (8.5±9.8 vs 5.7±7.4 days; p<0.001), increased ischemic stroke (10.6% vs 2.9%; p<0.001), and cardiogenic shock (15% vs 7%; p<0.001). There was no difference in mortality between the groups.
Table 1. Patient characteristics AMI% (n=200,930) ICT post AMI% (n=488) p-values Demographic variables   a. Males 59 73   b. Females 41 27 <0.001 Race   a. Caucasian 71 68 0.10   b. African American 11 15 0.01   c. Hispanic 7.5 6.1 0.23   d. Other races 5.6 6.2 0.80   e. Race not specified 4.4 4.9 0.59 Comorbidities   Drug abuse 23.9 31.1 <0.001   Atrial Arrhythmias 33.1 41.6 <0.001   Ventricular Arrhythmias 5.6 9.2 <0.001   Chronic pulmonary disease 27.7 21.1 <0.001   Diabetes Mellitus 38.9 31.1 <0.001   Hypertension 81.2 70.2 <0.001   Peripheral Vascular disease 10.5 3.52 <0.001   Current or past smoker 20.5 26.1 <0.001   Chronic kidney disease 28.1 20.4 <0.001   History of coronary artery bypass surgery 10.6 5.9 <0.001   HFrEF 23.3 50 <0.001 HFrEF = Heart failure with reduced ejection fraction; pVAD = Percutaneous ventricular assist device.

Conclusion
ICT as a complication of AMI is associated with increased hospital LOS and adverse events.
P4634Acute-phase high platelet reactivity with prasugrel loading is correlated with clinical outcomes during hospitalization in acute coronary syndrome
Authors: Kuroda K , Gentaro S , Kawamura K , Ono T , Tokioka K , Kawai Y , Tohru O 
Published: October 2019

Abstract

Background/Introduction
Although high platelet reactivity (HPR) seems to be associated with adverse cardiovascular events after percutaneous coronary intervention (PCI), the relationship between post-procedure HPR with prasugrel loading and clinical outcomes in acute coronary syndrome (ACS) is still unclear. Moreover, factors contributing to HPR in ACS with prasugrel loading are also unknown.

Purpose
This study aimed to assess the impact of post-procedure HPR with prasugrel loading on clinical outcomes in ACS during hospitalization, as well as to define appropriate cut-off values and identify factors contributing to HPR.

Methods
We performed a single-centre, retrospective observational study that enrolled 132 patients who underwent emergent PCI for ACS with prasugrel loading. The P2Y12 reaction unit (PRU) value was measured immediately after PCI with the VerifyNowR System. The primary endpoint was major adverse cardiac events (MACE, defined as the composite of death, myocardial infarction, stroke, heart failure, ventricular arrhythmia needing defibrillation).

Results
Mean patient age (standard deviation) was 70.7 (±12.5) years, 76% were male, and average time from prasugrel intake to PRU calculation was 101 (±48.8) min. During a mean hospital stay of 15.4 (±8.0) days, there were 22 (16%) MACE events and 6 (4%) deaths. The post-procedure PRU value was 241±66. HPR was significantly higher in MACE group than non-MACE group [287 (±55) vs 232 (±64), p<0.001]. The ROC curve analysis of PRU for discriminating significant in-hospital MACE showed a cut off value of 293 (sensitivity: 64%, specificity: 84% [AUC=0.764, p<0.0001]). Thus, 33 patients (25%) were found to have HPR (PRU>293) immediately after emergent PCI. Kaplan-Meier curve analysis showed MACE events occurred more frequently in the HPR group than in the non-HPR group (42% vs 8%, log rank p<0.001). Multiple Cox regression analysis showed that peak creatine phosphokinase >3,000 U/L and HPR were independent predictors of MACE in patients with ACS who underwent PCI (OR 4.96, 95% CI 1.86–13.26, p=0.001, and OR 7.52, 95% CI 2.73–20.7, p<0.0001, respectively). HPR was significantly correlated with age, female sex, and reference lumen short diameter (pre-dilation) used in PCI.

Conclusion
HPR was significantly associated with adverse event during hospitalization in ACS patients. Female patients with large culprit lesion diameter were more likely to have HPR. Appropriate cut-off value of HPR in this study was 293. HPR in early-phase of ACS with prasugrel loading is a useful predictor of adverse events during hospitalization.
P4640Validation of the PRECISE-DAPT Score in a real-world cohort of patients undergoing coronary stent implantation
Authors: Witberg G , Zusman O Z , Bental T , Plakht I , Gabbay H , Gerber Y , Kornowski R 
Published: October 2019

Abstract

Background
The optimal duration of dual antiplatelet treatment (DAPT) following percutaneous coronary interventions (PCI) should be tailored to patient characteristics. The DAPT score is one of two risk scores recommended for use by the European practice guidelines to aid in decision making on DAPT duration. To date, it's decision rule has not undergone external validation

Methods
A retrospective cohort study using a prospective all comers PCI registry.

Results
The PRECISE-DAPT score could be calculated for 6413/12,162 patients (52.7%). Of whom, 1,072 received DAPT for 3–6 months and 5,341 received DAPT for 12–24 months post PCI. The distribution of the score was similar to that in the original PRECISE-DAPT cohort.
During 24 months follow up, there were 254 (4.0% 95 CI 3.6–4.4%) actionable bleeding events. Higher PRECISE-DAPT quartiles were associated with higher risk for bleeding: 2.5% (95% CI 1.7–3.3%), 3.1% (95% CI 2.3–3.9%), 4.2% (95% CI 3.2–5.2%), and 6.7% (95% CI 5.5–7.9%), for Q1 through 4, respectively (p<0.001). however, within each quartile the risk for bleeding was similar in patients treated with long vs. short DAPT: 10.7 vs. 8.7%, (p=0.292); 10.6 vs. 8.5%, (p=0.282); 11.0 vs. 9.6%, p=(0.549) and 11.0 vs. 9.6%, (p=0.498) for PRECISE-DAPT quartiles 1 through 4, respectively. The PRECISE-DAPT score was not associated with the risk for myocardial infarction (MI)/Cerebrovascular accident (CVA)/Target vessel revascularization (TVR). The Absolute risk difference (ARD) for overall benefit (bleeding+ischaemic events) was not statistically significant for long vs. short DAPT in any of the quartiles: 1.4% (95% CI −1.0 to 3.8%); 1.4% (95% CI −0.6 to 4.6%); 0.9% (95% CI −2.3 to 5.3%) and 0.4% (95% CI −2.2 to 3.0%) for PRECISE-DAPT quartiles 1 through 4, respectively

Conclusions
In a large cohort of real world PCI patients, higher PRECISE-DAPT score were associated with increased risk for bleeding. However, the PRECISE-DAPT decision rule was not able to identify patients more/less likely to benefit from extended vs. standard DAPT duration. The findings indicate that the PRECISE-DAPT score and its decision rule for DAPT duration may not be generalizable to real-world population, stress the need forphysicians makng decisions regarding DAPT duration be aware of the score's limitations and use sound clinical judgement, when making decisions regarding DAPT duration. Our results also highlight the yet unmetneed for a simple, reproducible and valid tool to aid in choosing optimal DAPT duration for patients undergoing PCI.
P4642Prevalence and clinical significancy of bicuspid aortic valve diagnosed in the first year of life: a long term follow up in the paediatric age
Authors: Cresti A , Sparla S , Stefanelli S , Navarri R , Baratta P , Solari M , Limbruno U 
Published: October 2019

Abstract

Introduction and objectives
Bicuspid aortic valve (BAV) is the most common congenital malformation, with an estimated prevalence ranging from 0,48 to 2%. Most of the studies describe complications associated with BAV, including aortic stenosis and regurgitation, infective endocarditis and aortic dilation and dissection. Very few studies have been performed in the neonatal and paediatric age, most lacking in long-term follow up. The aim of our study was to explore the prevalence of BAV and the progression of aortic valve disease and aortic dilation in paediatric patients followed from January 1996 to August 2018.

Methods
A prospective collection of Congenital Heart Disease (CHD) diagnosed in the first year of life was performed in our institution from January 1996 to August 2018. Patients affected by BAV were then followed yearly. BAV morphology, aortic valve dysfunction and aortic dimensions were measured. Comparisons were performed between right-left cusp fusion (R-L) and right-non coronary cusp fusion (R-N), according to Shaefer's classification. Rate of change of the ascending aorta size over time was analyzed, and aortic size values were normalized as the number of standard deviations above or below the mean size expected for body surface area (z scores).

Results
A total of 35,310 live births were screened. Incidence rate of total CHD, including small ventricular septal defects and BAV was19,57%. Sixty had BAV (8,73% of CHD), with an incidence of 17/1,000 live births. Male/Female ratio was 1.4. A positive family history was present in 5 (8.3%). In 12 patients (24%) BAV was associated to other CHD (9 Aortic Coarctation, 1 Atrio-Ventricular Septal Defect, and in two cases a critical neonatal aortic stenosis). BAV was isolated in 48 cases (80%), with an incidence of 13.6/1.000 live births. According to Shaefer's classification the most common was type 1 (R-L), with Right to Left cusps fusion (R-L 76%, R-N 21% and L-N 3%). Among patients with isolated BAV, after a median follow up of 11 [1–21] years an aortic stenosis was observed in 5 patients (10.4%, none severe), an aortic insufficiency in 13 (27%, in one case severe). A dilated ascending aorta (z-score>2) was found in 11 patients (23%). An indication cardiac surgery due to severe aortic insufficiency was present in one case. No patient had indication for aortic aneurysm surgery.

Conclusions
Paediatric patients with isolated BAV warrant medical follow-up but progression towards severe valve dysfunction and/or dilation of the ascending aorta warranting cardiac surgery is very low.
P4643Pulmonary hypertension incidence is higher than systemic arterial hypertension in children after aortic coarctation repair
Authors: Ferreira A F , Moura C , Rodrigues P G , Saraiva F A , Barros A S , Areias J C , Leite-Moreira A F , Falcao-Pires I 
Published: October 2019

Abstract

Introduction
Coarctation of the aorta (CoA) is characterized by diffuse arteriopathy which can persist to upward of the aortic isthmus, even after successful surgical correction. This arteriopathy can also occur in the pulmonary vasculature, leading to pulmonary hypertension (PH), a strong risk factor of poor prognosis in CoA population.

Purpose
The purpose of this study was to determine the incidence of systemic and pulmonary hypertension in a CoA paediatric population after surgical repair, as well as the impact of PH in right ventricular function.

Methods
This cross-sectional study included children after successful surgical repair of the CoA in a tertiary centre [1996, 2009] up to the first year of age. Children with other cardiac structural lesions or recoarctation were excluded. Systemic arterial hypertension was defined as blood pressure in the 95th percentile or higher. PH was considered if the estimated pulmonary systolic arterial pressure (PSAP) was higher than 30mmHg. Pulse wave velocity, ambulatory 24 hours blood pressure monitoring, echocardiographic assessment of right ventricle (RV) and blood tests were performed 11±4 years after surgical procedure. Echocardiographic variables were normalized and evaluated by z-scores. One sample t test or sign test was used to estimate the deviation of measured/observed values from the normality/expected values (defined by z-score=0).

Results
We included 38 children with a mean age of 12±4 years (63% male). Late arterial hypertension was diagnosed in 29% of the children and PH incidence was 68% with a mean PSAP of 37±5mmHg. The mean of A' wave (z-score: 0.34±0.93, p=0.030) and median of E/E' ratio (z-score: 0.46 [−1.32; 3.68], p=0.004) z-scores were increased comparing with expected normal values in paediatric population. Moreover, E' wave (z-score: −0.35±0.98, p=0.034) and RV index of myocardial performance (z-score: −0.20±0.41, p=0.006) were decreased. Regarding RV systolic function, TAPSE z-score was significantly increased (z-score: 2.06±2.33, p<0.001), being outside the z-score normal range.

Conclusion
Children submitted to CoA surgical repair before the first year of life showed a higher PH incidence than late systemic hypertension occurrence. Also, they already present with significant RV functional abnormalities when compared to the normal paediatric population. These abnormalities can underlie pulmonary vascular remodelling after left ventricular pressure overload in CoA population that seems irreversible after pressure overload relief.

Acknowledgement/Funding
AFF are supported by FCT (SFRH/BD/138925/2018)
P4651Biopsy-proven myocarditis: independent predictors of dismal prognosis, relapse and role of immunosuppressive therapy
Authors: Caforio A , Marcolongo R , Cheng C Y , Gianstefani S , Baritussio A , Seguso M , Gallo N , Leoni L , Rizzo S , Perazzolo Marra M , Tarantini G P , Plebani M , Basso C Y , Iliceto S 
Published: October 2019

Abstract

Background
Biopsy-proven myocarditis may be infectious or autoimmune. Risk stratification in biopsy-proven myocarditis and the role of immunosuppressive therapy in autoimmune forms have not been completely defined.

Purpose
To identify clinical, instrumental and immunological predictors of death, cardiac transplantation and relapse in a prospective cohort of 314 biopsy-proven myocarditis patients, and describe the effect of immunosuppressive treatment on secondary outcome measures, e.g. left ventricular ejection fraction (LVEF), in a subgroup of 45 consecutive patients with biopsy-proven autoimmune myocarditis diagnosed in our Cardiology Clinic.

Methods
Univariate and multivariate Cox regression analysis were used to identify predictors of death, heart transplant, and relapse in a cohort of 314 patients with biopsy-proven myocarditis (male 75%, median age 37). Actuarial survival free from death or transplant was calculated by the Kaplan-Meier method.

Results
Actuarial survival free from death or heart transplantation was 83% at 5 years. Among the clinical, instrumental and immunological features at diagnosis, independent predictors of death or heart transplantation by multivariable analysis were a lower transthoracic echocardiographic biplane LVEF% (p=0.001) and high serum titre for anti-nucler (ANA) and anti-cardiac endothelial cell autoantibodies (AECA). The only independent predictor of relapse was previous history of myocarditis. Immunosuppressive therapy was associated with a significantly favorable effect on LVEF (LVEF pre-therapy 37% (26; 50 interquartile range) vs. LVEF post-therapy 59% (48; 65 interquartile range), respectively, p=0.000).

Conclusions
In biopsy-proven myocarditis left ventricular dysfunction at diagnosis and autoimmune pathogenesis are associated with dismal prognosis, immunosuppressive therapy with improved LVEF in autoimmune patients.
P4653A natural history of carcinoid heart disease in the modern management era
Authors: Baron E , Szymanski C , Lepere C , Mustafic H , Dubourg O , Mansencal N 
Published: October 2019

Abstract

Background
The development of carcinoid heart disease (CaHD) is still relatively unknown at present. It is difficult to define an optimal follow-up for patients initially free from cardiac involvement. The aim of this study was to assess the prevalence and the evolution of CaHD using annual echocardiographic follow-up.

Methods
We reviewed from our database 137 patients (61±12 years, 53% men) with histologically proven neuroendocrine tumor between 1997 and 2017. All patients underwent serial conventional transthoracic echocardiographic studies. Right-sided and left-sided CaHD were systematically assessed. We used a previous validated echocardiographic scoring system of severity for the assessment of CHD. An increase of 25% of the score was considered as significant.

Results
Mean follow-up was 2.6±3.5 years [0; 16]. Prevalence of CaHD was 27% (37 pts) at baseline and 36% (49 pts) at the end of follow-up. Among patients with initial CaHD followed for more than one year, disease progression was observed in 28% of cases. Among the patients free from initial cardiac involvement, an onset of the disease was observed during follow-up in 21% of cases. The onset of CHD could be very late, more than 5 years from the initial echocardiographic examination in 42% of our cases (Figure). This late occurrence of CaHD was only observed in patients presenting with new resumption of neuroendocrine tumor (symptoms, increased of 5-HIAA, occurrence of new metastasis).

Conclusion
Our study demonstrated that in patients without initial CaHD, cardiac involvement may occur tardily after a normal initial assessment. Our data suggest the need for prolonged echocardiographic follow-up in patients presenting with a resumption of tumor process.
P4659Left ventricular thrombus and arterial embolism in patients with noncompaction cardiomyopathy - Prognostic value of cardiac magnetic resonance imaging
Authors: Schneider B , Huemme T H , Schwab J , Gerecke B , Desch U , Vorbringer H 
Published: October 2019

Abstract

Background
Left ventricular noncompaction cardiomyopathy (LVNC) is characterized by an increased number of LV trabeculations with deep intertrabecular recesses. This abnormality is associated with heart failure, arrhythmias and arterial embolic events (AE). At present, it is unknown if AE is mainly due to blood stasis within the intertrabecular recesses, reduced LV ejection fraction or concomitant atrial fibrillation. LVNC is usually diagnosed by echocardiography but cardiac magnetic resonance imaging (CMRI) has evolved as an alternative method.
This study assessed the prognostic value of CMRI for arterial embolic events in patients (pts) with LVNC.

Methods
34 consecutive pts (19m, 15f, age 53±16) with LVNC underwent cine and contrast-enhanced CMRI with a 1.5 T scanner. LV diameter, volume, ejection fraction, and ratio of noncompacted to compacted myocardium (NC/C) were determined, and in 32 pts presence and localization of late gadolinium enhancement (LGE) was assessed. Clinical and CMRI findings were compared in pts with and without LV thrombus and/or AE.

Results
Overall, 20 pts (59%) were in heart failure NYHA III or IV, 14 (41%) had left bundle branch block (LBBB), 7 (21%) paroxysmal atrial fibrillation and 6 (19%) ventricular tachycardia (VT). By CMRI, LV diameter in end-diastole (66±8 mm), end-systole (53±10 mm), end-diastolic (229±69 ml) and end-systolic volume (150±68 ml) were enlarged and ejection fraction (36±14%) was reduced. The NC/C ratio was 3.2±1.4 in end-diastole and 2.6±1.4 in end-systole. One pt had right ventricular involvement with a thrombus. LGE was seen in 9/32 pts (28%) in the compacted myocardial layer (n=6), in the noncompacted trabecular layer (n=6) and within the papillary muscles (n=3). LGE was present in 3 areas in 1 and in 2 areas in 4 pts.
In 3 pts (9%) a thrombus was seen within the trabecular layer which resolved under anticoagulation, and 6 additional pts (18%) without detectable thrombus experienced AE (transient ischemic attack n=1, stroke n=5). Thrombus and/or AE were not associated with age, sex, NYHA class, larger left atrial or LV diameter, LV volume, LBBB or documented VT. Atrial fibrillation (2/9 vs 5/25 pts, p=ns), LV ejection fraction (33±13% vs 38±15%, p=ns) and the NC/C ratio in end-diastole (median 3.2 vs 3) or end-systole (both median 2.6, p=ns) were similar. Thrombus and/or AE occurred mainly in pts with LGE (6/9 vs 2/23 pts, p=0.002).

Conclusion
In LVNC, evaluation by CMRI and demonstration of LGE in the compacted or noncompacted myocardium identifies patients at high risk for thrombus formation and/or arterial embolic events, warranting anticoagulation.