bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3366Increased left ventricular remodelling index in paradoxical low-flow severe aortic stenosis with preserved left ventricular ejection fraction compared to normal-flow
Authors: Ngiam N , Chew N , Sim H W , Tan Y Q B , Sia C H , Kong W K F , Yeo T C , Poh K K 
Published: October 2019

Abstract

Background
Left Ventricular Remodelling Index (LVRI) has been demonstrated to be able to reliably discriminate between an athlete's heart and pathological LV remodelling. Patients with paradoxical low-flow severe aortic stenosis (LF AS) despite preserved left ventricular ejection fraction (LVEF) are a distinct group from normal-flow (NF) with poorer prognosis, more concentric hypertrophy and smaller LV cavities.

Purpose
We compared LVRI in LF compared to NF AS and examined clinical outcomes.

Methods
We studied consecutive patients with index echocardiographic diagnosis of severe AS (aortic valve area<1cm2) with preserved LVEF (>50%). LVRI was determined by the ratio of LV mass to the end-diastolic volume.

Results
Of the 450 patients studied, 149 (33.1%) were LF. There were no significant differences in baseline clinical profile of patients between LF and NF. LVRI was significantly higher in patients with LF compared to NF (2.27±0.68 vs 1.85±0.53 g/ml, p<0.001). Patients with high LVRI (>1.56 g/ml) had poorer clinical outcomes in terms of mortality (log-rank 9.18, p=0.002) and admissions for cardiac failure (log-rank 7.61, p=0.006).
Low-flow (n=149) Normal-flow (n=301) Mean difference/Odds Ratio (95% CI) p-value Age (years) 73.5 (±12.8) 71.0 (±13.1) 2.5 (−0.1 to 5.1) 0.053 Body Mass Index (g/m2) 24.6 (±5.6) 24.7 (±5.3) −0.1 (−1.2 to 1.1) 0.877 Gender (male) 49 (32.9%) 125 (41.5%) 0.7 (0.5 to 1.1) 0.076 Hypertension 100 (67.1%) 195 (64.8%) 1.1 (0.7 to 1.7) 0.624 Diabetes 57 (38.3%) 100 (33.2%) 1.2 (0.8 to 1.9) 0.295 Hyperlipidaemia 79 (53.0%) 147 (49.0%) 1.2 (0.8 to 1.7) 0.425 End-diastolic volume (ml) 72.3 (±18.9) 112.6 (±26.3) −40.2 (−44.9 to −35.5) <0.001 Left ventricular ejection fraction (%) 66.0 (±7.9) 67.4 (±7.1) −1.4 (−2.9 to 0.2) 0.077 Left ventricular mass index (g/m2) 99.7 (±33.0) 126.8 (±37.4) −27.2 (−34.8 to −19.6) <0.001 Transaortic mean pressure gradient (mmHg) 32.2 (±17.4) 37.1 (±19.9) −4.9 (−8.6 to −1.1) 0.011 Aortic valve area (cm2) 0.78 (±0.16) 0.79 (±0.17) 0.1 (−0.2 to 0.1) 0.635 Stroke volume index (ml/m2) 28.6 (±5.6) 46.9 (±9.8) −18.3 (−20.0 to −16.6) <0.001 Left ventricular remodelling index (LVRI, g/ml) 2.27 (±0.68) 1.85 (±0.53) 0.42 (0.31 to 0.54) <0.001
LVRI in LF versus NF AS

Conclusion
Pathological LV remodelling as evidenced by increased LVRI was more common in LF compared to NF AS. Patients with increased LVRI also had worse clinical outcomes.

Acknowledgement/Funding
None
P3370Prevalence of right ventricular dysfunction according to different parameters: basal and one year after transcatheter aortic valve implantation
Authors: Pardo Sanz A , Santoro C , Hinojar R , Rajjoub E , Pascual M , Salido L , Gonzalez A , Garcia A , Jimenez J J , Casas E , Abellas M , Hernandez S , Hernandez R , Zamorano J L , Fernandez-Golfin C 
Published: October 2019

Abstract

Background
Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use.
The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters.

Methods
Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) <17 mm, fractional area change <35%, systolic movement of the RV lateral wall by tissue Doppler imaging (RV-S'TDI) <9.5 cm/s, global longitudinal (RV-GLS) and free wall strain (RV-FWS) using as cutting point [20]. Pre procedure echo, immediate post procedure and 1 year echo were analyzed. Statistical analysis was performed using SSPS version 22.

Results
The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1.
Prevalence of RV dysfunction

Conclusions
The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.
P3381Quantification of hypo-attenuated leaflet thickening after transcatheter aortic valve implantation - clinical relevance of HALT volume
Authors: Karady J , Apor A , Nagy A I , Kolossvary M , Szilveszter B , Simon J , Molnar L , Bartykowszki A , Jermendy A L , Panajotu A L , Suhai F I , Varga A L , Rajani R , Maurovich-Horvat P , Merkely B 
Published: October 2019

Abstract

Background
Hypo-attenuated leaflet thickening (HALT) is a recently recognized phenomenon following transcatheter aortic valve implantation (TAVI) and there is no consensus over the standardized assessment of HALT and its clinical relevance is poorly understood. We sought to determine the predictors and clinical significance of HALT volume.

Methods
Patients, who previously underwent TAVI between 2011 and 2016 were prospectively enrolled in the RETORIC (Rule out Transcatheter Aortic Valve Thrombosis with Post Implantation Computed Tomography) study, a single-center observational study. At inclusion cardiac computed tomography angiography (CTA), transthoracic echocardiography (TTE) and brain magnetic resonance imaging (MRI) was performed. HALT was volumetrically quantified on cardiac CTA images by segmenting the inner volume of the TAVI frame at the level of the leaflets and applying a threshold of −200 to 200 Hounsfield units. We evaluated the clinical predictors of HALT volume, and its association with ischemic brain MRI lesions (recent and chronic large vessel ischemic focuses, microbleed/microembolization, white matter or small vessel disease) and all-cause mortality.

Results
In total, we analyzed 111 patients with CoreValve bioprosthesis (56.7% female, mean age 80.3±7.4 years). A median of 19 [IQR: 11–29] months passed between TAVI procedure and enrollment. The mean HALT volume was 111.0±163.4 mm3. Current malignant disease, prosthesis implantation depth measured on CTA images acquired at inclusion, and aortic mean gradient and aortic valve area evaluated on TTE images at inclusion predicted HALT volume by univariate analysis (all p<0.05). After multivariate adjustment, aortic mean gradient remained a significant predictor of HALT volume (beta-coefficient: 11.5, 95% CI: 5.0–18.0; p<0.001). HALT volume was not associated with ischemic brain MRI lesions (all p>0.05) and did not predict all-cause mortality (median follow-up: 20 months [IQR: 18–23]; HR: 1.0; 95% CI: 1.0–1.0; p=0.15).
Volumetric quantification of HALT.

Conclusion
Aortic mean gradient was the only predictor independently associated with HALT volume. Our results suggest that TAVI valve function is negatively affected by HALT volume, however, we found no association of HALT volume with cerebrovascular ischemic lesions or increased risk for all-cause mortality.
P3400Definition of extremely high cardiovascular risk in patients after acute myocardial infarction - Data from the TERCET Registry
Authors: Dyrbus K , Gasior M , Desperak P , Osadnik T , Banach M 
Published: October 2019

Abstract

Background
The latest guidelines from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) introduced a new “ultra-high risk” category of patients, for whom a low-density lipoprotein cholesterol (LDL-C) level <55 mg/dL (1.4 mmol/L) is advised.

Purpose
Therefore we aimed at identification of the risk factors in patients after acute myocardial infarction (MI), which increased the risk most, and might help to define the group of individuals at extremely high cardiovascular (CV) risk.

Methods
We analyzed consecutive patients included in the TERCET Registry admitted to the Polish tertiary cardiovascular centre due to MI between 2006 and 2018. According to the guidelines of the European Society of Cardiology (ESC), all patients included in the analysis are considered as of very high CV risk. All patients included in the registry underwent coronary angiography during the hospital stay. On the basis of multivariate analysis, we determined the subgroup of patients with the most unfavourable 12-month outcome (all-cause mortality).

Results
Finally, 4,562 patients admitted due to STEMI or NSTEMI and discharged from our centre were included in the analysis. According to the results of multivariate analysis performed with stepwise backward regression model, the following risk factors in patients after MI: LVEF<35% (odds ratio [OR]=3.83, 95% confidence interval [CI]: 3.14–4.67), age>75 years (OR=1.91, 95% CI: 1.55–2.35), lack of PCI of culprit vessel (OR=1.66, 95% CI: 1.26–2.20), multivessel CAD (OR=1.60, 95% CI: 1.30–1.99), atrial fibrillation (OR=1.53, 95% CI: 1.21–1.94), diabetes mellitus (OR=1.34, 95% CI: 1.11–1.64), increased LDL-C level (OR=1.09 per 1 mmol/L, 95% CI: 1.01–1.19) and increased creatinine level (OR=1.04 per 10 μmol/L, 95% CI: 1.04–1.05), might help to define the group of patients at extremely-high cardiovascular risk (all p<0.05). The aggregate summary of risk factors associated with extremely high risk is presented in the attached Figure.
Next, the effect of the combination of the aforementioned risk factors will be investigated, and SCORE applied for patients in secondary prevention after MI will be prepared.
Multivariate analysis results

Conclusions
To our knowledge, the presented study is the first such an analysis conducted on the population of patients after myocardial infarction gathered in the registry of secondary cardiovascular prevention. In patients after MI, potential risk factors were identified that might help to define the group of patients at ultra-high/extremely-high risk, what might contribute to significantly higher 12-month mortality.

Acknowledgement/Funding
None
P3407Genetic predisposition and QRISK3 algorithm are promising cardiovascular risk scoring tools in young patients with axial spondyloarthritis (Bechterew's disease)
Authors: Vasilenko E , Dadalova A , Nikolaeva O , Korolev M , Mazurov V , Gaydukova I 
Published: October 2019

Abstract

Introduction
Major cardiovascular events (CVE) are frequently registered in patients with axial spondyloarthritis (axSpA) at age 35–55 years old. However, assessment of cardiovascular risk (CVR) in these age is complicated, as in pts <40 years conventional CVR scales (SCORE, ets.) are not recommended.

Aim of the study
To show capability of QRISK3 in assessment of CVR in young pts with axSpA and its association with gene polymorphisms, responsible for the inflammation and neoangiogenesis.

Materials and methods
The study included 46 pts 25–40 years old with axSpA (ASAS criteria 2009), achieved inactive disease on TNF-α inhibitors. AxSpA activity was assessed with ASDAS and BASDAI, CVR with QRISK3 (https://qrisk.org/three/). Gene polymorphisms to cytokines, responsible for inflammation and neoangiogenesis were measured (IL17A-197, IL17F7 His/Arg, IL17F-11139 c/g, TNF-863, TNF-308, TNF-238, IL1B-31, IL4–590, IL6–174, IL10–1082, IL10–592, VEGF-2578, VEGF936, MMP2–1306, MMP3–5A6A, and MMP9–1562).

Results
Mean age of axSpA pts was 32.5±3.87 years, 36 (78.3%) pts were male, axSpA duration 8.71±4.72 years, duration of the treatment 3.1±2.4 years, ASDAS 1.95±1.23, BASDAI 1.4±0.8, QRISK3 score 1.18±1.64%. 34 (75.6%) of the pts had a low CVR and 11 (23.9%) had increased CVR. All the patients with increased CVR had strong associations with some alleles of TNFα, IL17F and IL6, p<0.ehz745.0282 for all the correlations (table 1).
Interrelations of CVR with another gene polymorphisms were not significant (R<0.25, p≥0.05, data are not present).
Coefficient of correlation of QRISK3 and Gene polymorphisms (results of exploratory factor analysis with “varimax” rotation) QRISK3 IL17F-11139 CC IL17F-11139 CG IL17F7 His/His IL17F7 His/Arg IL6–174 CC IL6–174 CG TNF-308 GA TNF-308 GG 0.486 0.830 −0.830 −0.824 0.809 −0.564 0.545 0.935 −0.935

Conclusion
A quarter of axSpA pts in age <40 years have an increased CVR. Similar gene polymorphisms in IL-6, IL17F, and TNF-α are strongly associated with increased CVR. QRISK3 and gene polymorphisms could be promising tools in CVR assessment in axSpA, acceptable in any age.

Conflict of interests
Not declared.
P3415Will less developed countries be capable of giving high-quality universal coverage to cardiovascular disease survivors? Results from a national health survey, Chile ENS 2016–2017
Authors: Margozzini P , Passi A , Kruk M , Danaei G 
Published: October 2019

Abstract

Background
Chilean Health System has fully implemented Universal Health Coverage (UHC) for acute cardiovascular events since 2005. Age-adjusted cardiovascular mortality has decreased, but there is limited information about coverage and quality of chronic health care given to cardiovascular disease (CVD) survivors at the national level.

Purpose
To assess the prevalence and quality of care in Chilean adult CVD survivors.

Methods
Chilean National Health Survey 2016–2017 (ENS 2016–2017) is a random stratified multistage sample of non-institutionalized population over 14 years (n=6240). Age, education, gender, rural/urban and geographical area weighted prevalence of CVD survivors (self-reported medical diagnosis of myocardial infarction or cerebrovascular attack) were calculated. High quality of care was defined as meeting six criteria simultaneously: under 70mg% LDL- C level, statin use, aspirin use, blood pressure under 130/80 mmHg, HgA1C<7 or 8 (>74-year-old) and non-smoking. Quality of care was explored using multivariate linear and logistic regression adjusting by age, gender, education and year of diagnosis (before or after UHC).

Results
Weighted national prevalence of CVD survivors in over 20-year-old population was 6.1%. The sample size for the CVD survivor analyses was n=455. 28.7% of CVS had their first event before the year 2005 (n=141). Overall 27.9% had LDL-C under 70mg%, 37.8% used statins, 41.4% used aspirin, 37.8% had controlled blood pressure, 78.3% were non-smokers and 84.3% had good glycemic control. National “high quality of care” prevalence in CVD survivors was 0.3%, 0.4% and 0.1% for men and women respectively. LDL and Blood pressure control prevalence (meet both criteria simultaneously) was 4,4%. In the adjusted multivariate model age was associated to a higher number of quality criteria achievement.

Conclusion
The number of CVD survivors in Chile is a huge challenge for the health care system. Universal coverage does not guarantee the quality of chronic life long care. Specific surveillance in high-risk population is needed to assess the system's effectiveness and accountability.

Acknowledgement/Funding
ENS 2016-2017 was funded by the chilean Ministry of Health (MINSAL)
P3426Machine learning for medical decision support in a first attendance ambulatory of a tertiary care cardiologic hospital
Authors: Hortegal R , Babolin B , Hsu G J , Polivanov R , Salvador P , Brito S , Santos I , Regis C D , Fragata A , Szewierenko P 
Published: October 2019

Abstract

Introduction
Cardiovascular disease is an expensive public health problem. Establish the right level of healthcare attention for each patient in a high-demand system is a complex task, and in this scenario, the development of computational methods to support medical decisions has shown to be quite promising.

Purpose
Define Machine Learning (ML) algorithms to support medical decisions in a first attendance ambulatory of a tertiary cardiology hospital.

Methods
A prospective observational study was performed in 336 patients (58±13 years and 49.4% male), obtaining clinical and ECG/VCG data. A follow up of 15 months was performed in order to access MACE, PCI, Cardiac Surgery and evidence of Severe Cardiac Disease. From twenty-five initial features, running the ML K-means Clustering algorithm, we identify which ones to use and the optimal number of Clusters. Once defined the Clusters the data were labeled, and then the clusters compared with field data (outcomes) and by Kaplan Meyer curves. The labeled data were also run by a Gradient Boosting algorithm in order to define a Predictor for future use in medical decision support.

Results
The best result, with well-defined Clusters, was obtained with the combination 5 Clusters and 8 specific Features, and the follow-up data has matched the Cluster classification as shown in the Table. Kaplan Meyer curves corroborated these finding with statistically significant differences between the Clusters: Log-rank test (p<0.001). Predictor algorithm, trained by the labeled data, presented an average precision of 95% (CI 95%; 91–100%).
Clustering Outcomes vs Follow-up results Cluster Patients Features Follow-up 15 months results Age BMI Previous Cardiac Previous Previous Diabetes** SM QRS_T QRS_T_loop Severe Heart Outcome (year)* (kg/m2)* Surgery** MI** PCI** angle* index* Disease* (%) 1 96 46±12 28.3±5.4 0 0.03 0.02 0 60±34 0.31±0.61 0.26 4.2% 2 60 61±12 29.6±5.5 0 0.25 0 1 97±45 0.41±1.32 0.57 20.0% 3 34 64±11 27.6±3.8 1 0.59 0.35 0.5 118±43 -0.11±1.22 0.72 35.3% 4 114 64±9 25.4±4.0 0 0.21 0 0 101±41 0.48±0.98 0.38 12.3% 5 32 50±10 28.7±5.1 0 0.88 1 0.47 82±34 0.52±0.69 0.81 50.0% *Mean ± sd; **yes = 1; no = 0.

Conclusion
The defined Predictor, using eight simple, quick and easy to get Features (clinical and ECG/VCG), shows excellent performance to classify patients who require tertiary cardiovascular healthcare attention.
P3446Left-ventricular assist device as a destination therapy in Duchenne cardiomyopathy: are we ready to change the natural history?
Authors: Adorisio R , D'Amario D , Cantarutti N , Cicenia M , D'Amico A , Baban A , Bertini E , Catteruccia M , Perri G , Filippelli S , Drago F , Amodeo A 
Published: October 2019

Abstract

Background
Heart failure is becoming the most prominent cause of death among patients with Duchenne Muscular Dystrophy (DMD) and end-stage cardiomyopathy (CMP). Implantation of left ventricular assist devices (LVAD) as destination therapy (DT) in this group of patients is still matter of debate. No current data are available on long-term follow- up of young patients.

Purpose
The aim of this study was to evaluate the long-term outcome of LVAD in DMD end stage heart failure (HF) compared to a group treated optimal medical treatment (OMT) with inotropes

Methods
All patients affected by DMD patients presenting with end-stage HF receiving OMT or LVAD have been reviewed. All data about characteristics of HF at presentation including assessment of nutritional status and respiratory function, left ventricular ejection fraction, brain natriuretic peptide, serum sodium, in-hospital treatment and long term follow up have been collected. OMT group was constituted by 4 patients matching implantation VAD criteria but not eligible or refusing treatment. Survival was represented by Kaplan Meier analysis.

Results
A total of 12 DMD patients with end-stage CMP were considered for this analysis. 8 have been implanted with LVAD during the period from 2011 until mid-2017 and compared with 4 treated with OMT. Mean systolic pressure was 103 versus 91 mmHg in those not receiving LVAD (p=0.2), and left ventricular ejection fraction at the time of presentation was 16‰ for LVAD group and 22‰ for the second group (p=0.1). LVADs improved survival throughout follow-up for patients undergoing baseline inotropic infusions (P=0.0014); for the LVAD group versus the OMT group, 1-month survival was 100‰ and 67‰ respectively and 2-month survival was 100‰ versus 0‰. For LVAD group survival was 86‰ at one year, 71‰ at 2 years and 48‰ at 5 years from implantation. Analysis on short and long-term follow-up showed significant improvement of survival in DMD patients treated with LVAD (log rank<0.001), with a 5-year increase in life expectancy.

Conclusions
LVAD improved outcomes in patients with LVAD when compared to those without. Long-term follow-up was similar to DT LVAD adult population. Further studies are necessary to confirm these data.
P3475Dabigatran inhibits the activation of endothelial progenitor cells induced by thrombin
Authors: Papadaki S , Sidiropoulou S , Moschonas I , Tselepis A 
Published: October 2019

Abstract

Introduction
Thrombin is a coagulation serine protease, which also activates various cell types, including endothelial cells. Late-outgrowth endothelial cells (OECs) are a type of endothelial progenitor cells that contribute to endothelial regeneration and angiogenesis. Dabigatran is a direct oral anticoagulant that inhibits thrombin's action and is widely used in everyday clinical practice.

Purpose
We investigated the effect of dabigatran on thrombin-induced activation of OECs, using the membrane expression of adhesion molecule ICAM-1 as activation marker. Control experiments were conducted in mature human umbilical vein endothelial cells (HUVECs).

Methods
CD34+ cells were isolated from cord blood mononuclear cells, using human CD34 Microbead Kit and appropriately cultured for OEC formation. HUVECs were purchased from Lonza. Confluent OECs and HUVECs were incubated with 10 or 20 μM dabigatran for 10 min, before activation with 8 U/mL thrombin, for 24 h. The effect of dabigatran on ICAM-1 expression (anti-CD54-PE) was evaluated in both cell types as % gated CD31+/CD54+ cells, using flow cytometry.

Results
Thrombin induced ICAM-1 membrane expression by 33±15% on OECs and by 123±22% on HUVECs, compared with respective untreated cells (p<0.05 for both comparisons, from 6 different experiments). Dabigatran at 10 μM significantly inhibited ICAM-1 expression by 36±7% on OECs and 57±8% on HUVECs, as well as at 20 μM by 51±8% on OECs and 79±7% on HUVECs (p<0.05 for all comparisons, from 4 different experiments).

Conclusions
We show for the first time that dabigatran at concentrations relevant to those existing in vivo after oral administration, inhibits the thrombin-induced membrane expression of the adhesion molecule ICAM-1 on OECs, a phenomenon that is also observed on mature endothelial cells. The significance of this effect regarding the pathophysiological role of OECs and mature endothelial cells at the clinical level remains to be established.

Acknowledgement/Funding
Operational Program “Human Resources Development, Education and Lifelong Learning”. Co-financed by the European Union and Greek national funds