bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4800Estimated effect of NOACs compared to Vitamin K Antagonists in real-world atrial fibrillation patients: Data from FANTASIA Registry
Authors: Esteve Pastor M A , Rivera-Caravaca J M , Roldan V , Roldan Rabadan I , Muniz J , Cequier A , Bertomeu-Martinez V , Badimon L , Rana-Miguez P , Ruiz-Ortiz M , Anguita M , Lip G Y H , Marin F 
Published: October 2019

Abstract

Background
Despite of the effectiveness and safety profile of Non-vitamin K Antagonists Oral Anticoagulants (NOACs) even in real-world (RW) Atrial Fibrillation (AF) patients, Vitamin K Antagonists (VKAs) have remained widely used in clinical practice worldwide but the comparison with acenocoumarol therapy in RW is unknown.

Purpose
To estimate the potential absolute benefit in clinical adverse events if the AF patients anticoagulated with VKA therapy had been treated with NOACs.

Methods
We analyzed anticoagulated AF patients who were prospectively recruited into the multicentre FANTASIIA registry. Patients were treated with VKAs for at least 6 months prior to inclusion. The estimation of clinical adverse events avoided was calculated applying absolute risk reductions, relative risk reductions and hazard ratios from the meta-analysis of RW use of NOACs relative to VKAs.

Results
We analyzed 1,470 patients under VKA therapy (mean age 74.1±9.5 years; 56.4% male). Stroke rate with acenocoumarol treatment was 0.88%/year. The estimated rates for stroke using NOACs would be 0.80%/year for Dabigatran 150 mg; 0.76%/year for Rivaroxaban and 0.74%/year for Apixaban instead of VKA. No significant differences were observed between the different NOACs and VKA in stroke rate. Major bleeding with acenocoumarol was 3.40%/year. The estimated rates for major bleeding using NOACs would be 2.75%/year for Dabigatran 150 mg; 3.37%/year for Rivaroxaban and 2.18%/year for Apixaban instead of VKA. Apixaban was the only NOAC that showed a significant estimated reduction rates (p=0.046). Finally, the all-cause mortality rate with acenocoumarol was 4.69%/year. The estimated rates of all-cause mortality using NOACs would be 3.28%/year for Dabigatran 150mg; 4.88%/year for Rivaroxaban and 2.67%/year for Apixaban. Dabigatran and Apixaban showed significant estimated reduction rates with the highest reduction with Apixaban (Table).
Annual Rate reduction of adverse events

Conclusion
The absolute estimated effect of NOACs in the AF patients anticoagulated with VKA showed a significant reduction in adverse clinical events. Apixaban performed the highest estimated reduction in major bleeding and all-cause mortality in comparison with acenocoumarol.
4938Left ventricular global longitudinal strain recovery predicts scar size reduction and systolic remodelling post ST-elevation myocardial infarction
Authors: Vo T , Nguyen T , Chen A , French J , Otton J , Mussap C , Richards D , Dimitri H , Thomas L 
Published: October 2019

Abstract

Background
Left ventricular (LV) strain has prognostic utility following ST-elevation myocardial infarction (STEMI); however, serial changes in LV strain has not been evaluated post-infarct. We sought to determine the relationship between post-STEMI transthoracic echocardiographic (TTE) LV global longitudinal strain (GLS) and cardiac magnetic resonance (CMR) imaging derived scar size and LV systolic remodelling.

Methods
Following revascularisation, 172 first STEMI patients (85% male, 56.9±10.7 years) had paired TTE for GLS, and CMR to evaluate scar size and LV systolic function at baseline (2–7 days) and follow-up (8–10 weeks). Patients were divided into 3 groups according to absolute baseline GLS: group 1 (GLS ≥16%), group 2 (12%< GLS <16%), group 3 (GLS ≤12%). GLS recovery was defined as ≥10% increase in GLS at follow-up, excluding patients with normal baseline GLS. LV systolic adverse remodelling was defined as ≥15% increase in LVESV. LV systolic reverse remodelling was defined as ≥15% decrease in LVESV. Scar reduction was defined as ≥30% decrease in scar size.

Results
Group 1 and 2 had smaller follow-up scar size and higher LVEF compared to group 3 (p<0.0001 for both, see table). There was no difference in scar size reduction or systolic reverse remodeling among the baseline GLS groups (p>0.05 for both). Importantly, no patients from group 1 demonstrated systolic adverse remodelling. Relative change in GLS is significantly correlated with changes in LVEF (r=0.354, p<0.0001) and scar size (r=−0.262, p<0.0001), see figure. On multivariate binary logistic analysis, patients who demonstrated GLS recovery had greater reduction in scar size (OR=2.77 (1.09–7.01), p=0.032) and LV systolic reverse remodelling (OR=9.63 (1.21–76.41), p=0.032).
Follow-up parameters within GLS groups All patients (n=172) Group 1 (n=47) Group 2 (n=72) Group 3 (n=53) Follow-up GLS, % 16.02±3.44 19.38±1.90 16.36±2.09 12.57±2.69 GLS recovery, n 110 (64%) 19 (40%) 53 (74%) 38 (72%) Follow-up scar size, % 7.67±5.40 5.01±3.38 6.27±3.73 12.02±6.24 Follow-up LVEF, % 51.80±10.20 57.83±6.95 54.14±8.02 43.26±9.83 Data presented as mean ± SD or n (%).
Correlation graphs for change in GLS

Conclusion
Stratification of STEMI patients by baseline GLS was a determinant of CMR scar size as well as LV systolic function. However, the evaluation of GLS recovery could provide additional insights into reduction in scar size and LV systolic remodelling, both important prognostic markers. Thus, echocardiographic serial GLS evaluation may be a relevant non-invasive parameter, that is cheaper and more widely available for monitoring STEMI patients and guiding therapy.
4942Automated recognition of regional wall motion abnormalities by deep neural network interpretation of echocardiography
Authors: Huang M S , Tsai M R 
Published: October 2019

Abstract

Background
The deep neural network assisted in automated echocardiography interpretation joint to cardiologist final confirmation has now been gradually emerging. There were applications applied in echocardiography views classification, chamber size and myocardium mass evaluation, and certain disease detections already published. Our aim, instead of frame-by-frame “image-level” interpretation in previous studies, is to apply deep neural network in echocardiography temporal relationship analysis – “video-level” – and applied in automated left ventricle myocardium regional wall motion abnormalities recognition.

Methods
We collected all echocardiography performed in 2017, and preprocessed them into numeric arrays for matrix computations. Regional wall motion abnormalities were approved by authorized cardiologists, and processed into labels whether regional wall motion abnormalities presented in anterior, inferior, septal, or lateral walls of the left ventricle, as the ground truth. We then first developed a convolutional neural network (CNN) model to do view selection, and gathered parasternal long/short views, and apical four/two chamber views from each exam, as well as developing view prediction confidence for strict image quality control. Within these images, we annotated part of images to develop the second CNN model, known as U-net, for image segmentation and mark each regional wall. Finally, we developed the major three-dimensional CNN model with the inputs composed of four views of echocardiography videos and then output the final label for motion abnormalities in each wall.

Results
In total we collected 13,984 series of echocardiography, and gathered four main views with quality confidence level above 90%, which resulted in 9,323 series for training. Within these images, we annotated 2,736 frames for U-net model and resulted in dice score of segmentation 73%. With the join of segmentation model, the final three-dimensional CNN model predict regional wall motion with accuracy of 83%.

Conclusions
Deep neural network application in regional wall motion recognition is feasible and should mandate further investigation for promoting performance.

Acknowledgement/Funding
None
4946The effects of climate and air pollutants on heart failure hospitalizations and mortality (CLIMATE-HF Study)
Authors: Ngampongpan W , Yingchonchareon T , Aekplakorn W , Boonhat H , Pattanaprateep O , Sritara P , Yamwong S , Vathesatogkit P , Janwanishstaporn S 
Published: October 2019

Abstract

Background
The data on the effects of air pollution on acute heart failure (HF) in tropical countries is limited. Particulate matter air pollution in Thailand is comparably higher than in other countries in Southeast Asia. The existence of climate and air pollution seasonal variation in our country has never been studied before.

Purposes
We sought to explore the effects of air pollution on HF hospitalizations and in-hospital mortality, including the effects of seasonal variation on HF negative outcomes and the association between air pollutants and hospitalizations of acute heart failure across geographical areas.

Methods
We undertook a retrospective analysis of longitudinal collected clinical data. The Data from 258,539 patients with primary HF admissions and daily pollutant parameters between 2011 and 2015 were collected. Data in daily pollutant parameters including respirable suspended particulates with diameter ≤10 μm (PM10), total suspended particles, ozone, carbon monoxide, nitric oxide, sulfur dioxide, air quality index were obtained. Generalized additive regression models and non-linear distributed lag functions were performed.

Results
440,988 hospital admissions occurred with strong seasonal variation and peaked in winter. Particulate matter ≤10 μm (PM10) 2 days prior to admission date was associated with relative risk (RR) (95% confidence interval (CI)) of 1.02 (1.00–1.04, p-value <0.001) for HF hospitalizations after adjusting with age, sex, respiratory tract infection, acute coronary syndrome and other HF comorbidities (diabetes, hypertension, chronic kidney disease). The association of HF hospitalizations and seasonal PM10 variations was strongest in the Northeastern part of Thailand with RR (95% CI) of 1.04 (1.01–1.05), p-value = 0.005.

Conclusion
HF hospitalizations were associated with preceding PM10 exposure, especially in the area with greater seasonal PM10 variations. Reducing exposure to particulate matter air pollution among those at risk for HF may be the potential prevention of HF hospitalizations.

Acknowledgement/Funding
Research grant from Heart Failure Foundation, Ramathibodi Hospital
4948Irregular eating behavior and incidence of cardiovascular disease: results from a Swedish 60-year-old cohort of men and women
Authors: Laguzzi F , Salleber S , Gigante B , De Faire U , Hellenius M L , Leander K 
Published: October 2019

Abstract

Background
Irregular meals may increase the risk of cardiovascular disease (CVD) but knowledge is limited. We aimed to investigate this association in men and in women, respectively, in a Swedish cohort followed-up for 11 years for incident CVD.

Methods
4,232 participants (54% women) aged 60, randomly selected from Stockholm County in 1997–1998 were followed regarding incident CVD (coronary heart disease or ischemic stroke) up to 2009. Using national registers, 375 incident CVD cases (135 in women) were identified in subjects free from prior CVD events. Self-reported habit of seldom or sometimes having regular meals was compared to reports of often or always having regular meals. Cox proportional models were employed to estimate hazard ratios (HR) with 95% confidence interval (CI).

Results
The habit of having irregular meals was associated with increased risk of CVD in men (HR: 1.70 95% CI: 1.19; 2.43) but not in women (HR: 0.64 95% CI: 0.33; 1.22) in a model adjusted for civil status. Adjustments for smoking, physical activity, obesity and occasional intake of fruits and vegetables did not affect these relationships.

Conclusions
Our results show a clear association between irregular meal patterns and increased risk of CVD in men but not in women. Further studies are needed to confirm these gender specific results and elucidate the underlying biological mechanisms.

Acknowledgement/Funding
The Stockholm County Council, The Swedish Heart-Lung Foundation, The Swedish Research Council for Longitudinal Research, The Swedish Research Council
5163Predictors of adverse cardiovascular events in patients with truncating variants in the filamin c (flnc) gene
Authors: Akhtar M , Rangel-Sousa D , Palomino-Doza J , Arana Achaga X , Bilinska Z , Zamarreno Golvano E , Climent V , Navarro Penalver M , Barriales-Villa R , Charron P , Yotti R , Zorio E , Jimenez-Jaimez J , Garcia-Pavia P , Elliott P M 
Published: October 2019

Abstract

Background
Truncating variants in Filamin C (FLNCtv) are associated with arrhythmogenic (AC) and dilated cardiomyopathies (DCM). Affected patients are reported to demonstrate a high incidence of arrhythmic and heart-failure related cardiovascular events. The aim of this study was to determine factors that predict adverse events in mutation carriers.

Methods
The study cohort comprised 168 FLNCtv carriers followed at 19 European centres. Baseline and longitudinal follow-up clinical data were collected. The primary endpoint was a composite of sudden cardiac death (SCD), aborted SCD, appropriate implantable cardioverter-defibrillator (ICD) shock, cardiac transplantation (HTx) and mortality from end-stage heart failure (ESHF).

Results
47 different pathogenic or likely-pathogenic FLNCtv were identified in 60 unrelated probands. In those with baseline and longitudinal data (160 patients; 57 probands), 114 (71.3%) patients exhibited evidence of cardiac disease at initial evaluation. Gene penetrance was 85% by the age of 40 years. During a median follow-up of 1.5 years (IQR 4.1), 24 individuals (15%) reached the primary endpoint – 16 arrhythmic (SCD/aborted SCD/ICD shock) and 8 heart failure (ESHF/HTx) related-events. Univariable predictors at baseline evaluation of the composite primary endpoint included proband status (HR 4.0, 95% CI: 1.5–10.9, p=0.01), symptoms of dyspnoea (HR 2.8, 95% CI: 1.2–6.4, p=0.02), LV systolic dysfunction (LVSD) (HR 12.4, 95% CI: 2.9–53.2, p=0.001), frequent ventricular ectopy (VE>500) on 24-hour Holter (HR 9.3, 95% CI: 1.2–74.7, p=0.04) and the presence of late gadolinium enhancement on CMR (HR 8.9, 95% CI: 1.2–68.5, p=0.04).
Multivariable analysis identified LVSD (LVEF <50%) at baseline as an independent predictor of the primary endpoint with a hazard ratio of 8.6 (95% CI: 1.8–41.5, p=0.007). ROC analysis using LV systolic dysfunction to predict the primary endpoint demonstrated an area under the curve of 0.84 (95% CI: 0.76–0.91, p<0.001) and identified an optimal LVEF “cut-off” of 47% for predicting adverse events with a Youden's index of 0.61 (sensitivity 0.91; specificity 0.70).
Kaplan-Meier plot to demonstrate freedom

Conclusions
LVSD is associated with an over 8-fold increase in the hazard of a primary endpoint event in FLNCtv gene carriers indicating that these patients should be considered for implantable cardioverter-defibrillator (ICD) implantation, optimal heart failure medical therapy and close clinical follow-up.

Acknowledgement/Funding
NIHR Biomedical Research Centre; Instituto de Salud Carlos III; DETECTIN-HF project; Wellcome Trust;CIBERCV; EU Regional Development Fund; FEDER.
5191Recurrent coronary heart disease in the year following myocardial infarction among US men and women between 2008 and 2015
Authors: Peters S A E , Colantonio L D , Zhao H , Bittner V , Farkouh M E , Dluzniewski P J , Poudel B , Muntner P , Woodward M 
Published: October 2019

Abstract

Background
Although the risk of recurrent events among adults with coronary heart disease (CHD) has declined considerably from the 1970's in the US and many Western countries, studies from the 2000's show that rates remain high. Women have lower rates of incident CHD but little is known about sex differences in recurrent events in adults with CHD.

Purpose
To examine trends in rates of recurrent myocardial infarction (MI), recurrent CHD, and all-cause mortality following a MI hospitalization between 2008 and 2015 among US men and women. Also, we compared sex differences in event rates among individuals with a MI hospitalization versus their counterparts without a history of CHD.

Methods
Data were used from 1,232,024 (53% women) US adults <65 years of age with commercial health insurance in the MarketScan database and US adults ≥66 years of age with government health insurance through Medicare who had a MI hospitalization between January 1, 2008 and December 31, 2015. For each calendar year, age-standardized sex-specific rates of recurrent MI, recurrent CHD (i.e., recurrent MI or coronary revascularization), and all-cause mortality (in Medicare only) were calculated through 365 days following the hospital discharge date for MI. In a secondary analyses, we assessed the rate of recurrent MI, CHD events and all-cause mortality among women versus men with a history of MI (n=324,283) and without a history of CHD (n=1,297,132) in 2014–2015. For these analyses, adjusted hazard ratios (95% confidence intervals) were calculated using follow-up through December 31, 2016.

Results
From 2008 to 2015, age-standardized rates over 365 days of follow-up for recurrent MI declined by 15%, from 94 to 80 per 1000 person-years, in men and by 14%, from 89 to 77 per 1000 person-years, in women. Age-standardized recurrent CHD rates decreased by 16%, from 163 to 138 per 1000 person-years, in men and by 17%, from 142 to 118 per 1000 person-years, in women. In the Medicare population, age-standardized all-cause mortality rates following MI decreased by 6%, from 446 to 421 per 1000 person-years, in men and by 3%, from 412 to 398 per 1000 person-years, in women. In the secondary analyses, the women-to-men hazard ratios for those with a history of MI and those without prior CHD were 0.97 (0.94–0.99) and 0.67 (0.65–0.69), respectively, for MI, 0.89 (0.87–0.91) and 0.52 (0.51–0.54), respectively, for CHD, and 0.84 (0.83–0.85) and 0.74 (0.73–0.75) respectively, for all-cause mortality.

Conclusion
Reductions in rates of recurrent MI, recurrent CHD, and all-cause mortality within 365 days after hospitalization for MI have been similar for US women and men. The lower risk for events comparing women versus men without prior CHD is attenuated after a MI.

Acknowledgement/Funding
The design and conduct of the study was supported through a research grant from Amgen, Inc.
5196Coronary artery calcification predicts MACE and all-cause mortality in individuals undergoing non-cardiac computed tomography for non-cardiovascular indications
Authors: Banerji D , Alvi R M , Ivanov A , Sootodeh R , Olalere D , Will E , Aluru J S , Bogdan S , Osborne M T , Lu M T , Hoffmann U 
Published: October 2019

Abstract

Introduction
Coronary artery calcification (CAC) measured on ECG-gated cardiac CT is a strong predictor of cardiovascular (CV) risk in asymptomatic individuals in a primary prevention setting. However, the prognostic value of CAC in an unselected population referred for non-gated non-cardiac chest CT (NCCT) is unknown.

Purpose
To determine whether CAC predicts major adverse cardiovascular events (MACE) and all-cause mortality in patients referred for NCCT for non-CV indications.

Methods
A random sample of 741 individuals, without prior known history of coronary artery disease (CAD) who underwent NCCT for non-CV indications at a tertiary care hospital in 2008 were included in this study. NCCT was assessed qualitatively for the presence and extent of CAC by two experienced physicians. Data abstraction was performed by electronic medical record (EMR) review. Our primary endpoint of MACE, defined as CV mortality, MI, PCI, CABG, heart failure and stroke as well as secondary endpoint of all-cause mortality, over a median follow up of 8 (IQR 4–10) years, was adjudicated per independent review.

Results
Among 741 individuals (mean age 61.1±15.5 years, 60% female, 91% Caucasian), 57% were hypertensive, 30% had hyperlipidemia, 14% were diabetic and the mean ASCVD score was 12.2±11.6. CAC was present in 425/741 (57.4%) individuals. Among those with CAC, it was mild in 172/425 (40%), moderate in 143/425 (34%) and severe in 110/425 (26%) individuals. Overall, MACE occurred in 115/741 (15.5%) patients. Compared to those without MACE, CAC was more prevalent (83% vs. 53%, p<0.001) and extensive (at least moderate: 67% vs. 28%, p<0.001) in those with MACE. Over a median follow up of 8 (IQR 3–10) years, the presence of any CAC was associated with a 4-fold higher risk of MACE (HR 4.22, 95% CI (1.4–8.9), p<0.001), after adjustment for age and gender. On stratification, severe CAC had a near 9-fold increased risk of MACE (HR 8.8, 95% CI (5.1–15.2), p<0.001), followed by moderate CAC with a near 6-fold increased risk of MACE (HR 5.7, 95% CI (2.8–9.8), p<0.001), and a near doubling of MACE risk with mild CAC (HR 1.99, 95% CI (1.1–4.3), p=0.034). Similar results were observed with all-cause mortality (Figure 1).

Conclusions
CAC is an independent predictor of MACE and all-cause mortality in an unselected patient population referred for NCCT for non-CV indications, which may provide an opportunity to improve population health without the need for additional imaging.

Acknowledgement/Funding
Dr. Banerji and Dr. Alvi were supported by NIH/NHLBI 5T32HL076136.
5203Ablation of scar-related ventricular tachycardia: paced electrogram feature analysis (PEFA) is a novel and effective substrate based strategy
Authors: Crinion D , Hassan Shariat M H S , Gupta D G , Gul E E G , Glover B G , Hashemi J H , Abdollah H A , Simpson C S , Michael K A M , Baranchuk A B , Redfearn D R 
Published: October 2019

Abstract

Background
Ablation of scar related ventricular tachycardia (VT) has been shown to be superior to escalation of drug therapy. However, the incremental benefit remains modest, with 42% experiencing recurrent shocks and 64% appropriate anti-tachycardia pacing (ATP) in the VANISH study. Improved ablation strategies are needed. Paced electrogram feature analysis (PEFA) is a novel substrate based ablation technique.

Purpose
To investigate the effectiveness of the PEFA based VT ablation technique.

Methods
A single centre, prospective study. Consecutive cases of scar related VT that had an implantable cardiac defibrillator (ICD) and no prior ablations were recruited. Close coupled pacing was performed at the right ventricular apex and the VT isthmus(es) identified on high density mapping catheters by increased electrogram (EGM) duration and latency. A algorithm was developed to identify the latest EGM component after the S2 pacing artefact,. This millisecond value was displayed on the geometry as a colour (PEFA map) (St Jude Ensite Precision Electroanatomic Mapping). PEFA identified VT isthmus sites were targeted for ablation (Figure 1). Follow up ICD interrogation data was utilized to assess for VT recurrence.

Results
A total of 20 patients were recruited. These comprised ischaemic cardiomyopathy (CM) (17/20), dilated CM (2/20), and arrhythmogenic CM (1/20), male (18/20), and endocardial only approach (19/20). Mean age was 64.3±11.3 years, ejection fraction 24.4% ± 14.4, and ablation time was 1989.9±1078.1 seconds. Non-inducibility was demonstrated at the end of the case in 18/20. A class I or III anti-arrhythmic drug was continued in 50%. VT recurred in three cases (Day 28,30,55). One death occurred following a stroke on day 181. Mean follow up was 437.5±231.7 days.
Figure 1

Conclusion
This is the largest study to date on PEFA based VT ablation, the first to include non-ischaemic aetiologies, and reports a longer mean follow up. A high proportion of cases were non-inducible, and low VT recurrence rates were observed. PEFA appears to be a promising tool to guide VT ablation targets.

Acknowledgement/Funding
This research was funded in part by the Canadian Institute for Health Research (139080) and a grant from St. Jude Medical.