bluuebunny/crossref_metadata_2025_split huggingface dataset:
465Benefit of modern P2Y12-inhibitors on long-term prognosis in patients with ST-elevation myocardial infarction with and without advanced chronic kidney disease
Authors: Schmucker J , Fach A , Osteresch R , Retzlaff T , Michel S , Garstka D , Wienbergen H , Hambrecht R 
Published: October 2019

Abstract

Background
Current guidelines on the management of patients with ST-elevation myocardial infarction (STEMI) recommend the preferred use of the modern P2Y12-inhibitors ticagrelor or prasugrel regardless of the presence of chronic kidney disease (CKD), although patients with advanced stages of CKD were excluded from randomized trials. Aim of the present study was therefore to evaluate the potential benefit of modern P2Y12-inhibitors in patients with and without advanced renal disease at admission.

Methods
All patients admitted with STEMI between 2006–2017 from a large german heart center treated with primary percutaneous coronary intervention (PCI) entered analysis. Initial CKD was estimated with the initial glomerular filtration rate (GFR), calculated with the CKD-EPI-equation, assigning them to the groups G1-G5.

Results
Of 7227 patients with STEMI and primary PCI 2669 (37%) showed no relevant reduction in GFR at admission (≥90 ml/min/1.73 m2, G1), 2976 pts. (41%), a slight reduction (GFR 60–89 ml/min/1.73 m2, G2), 880 pts. (12%) a moderate reduction (GFR 45–59 ml/min/1.73 m2, G3a) and 702 pts. (10%) a moderate to severe reduction (GFR<45 ml/min 1.73 m2, G3b-G5). Pts. with more advanced stages of CKD were on average older (G1: 55±11 years, G2: 66±12 years, G3a: 72±12 years, G3b-G5: 75±11 years, p<0.01) and more likely to be female (G1: 19%, G2: 26%, G3a: 40%, G3b-G5: 48%, p<0.01). Prasugrel/ticagrelor were less often given instead of clopidogrel in patients with advanced CKD (G1: 70%, G2: 45%, G3a: 31%, G3b-G5: 32%, p<0.01). The use of ticagrelor/prasugrel was associated with a reduction in 1-year-MACCE (major adverse cardio- and cerebrovascular events)-rates in patients with no/low-grade-CKD (G1-G2), while no significant reduction in MACCE could be observed for patients with moderate to severe CKD (table). Furthermore, CKD was associated with an elevation in severe bleeding events within 1 year (G1: 1%, G2: 3%, G3a: 5%, G3b-G5: 6%, p<0.01).
Impact of CKD-stage on outcome CKD-stage G1 CKD-stage G2 CKD-stage G3a CKD-stage G3b-G5 1-year-MACCE-rate (%) Ticagrelor/prasugrel 4.5 11.0 27.4 47.3 Clopidogrel 9.9 15.6 26.6 50.4 Significance <0.01 <0.01 0.6 0.7

Conclusions
These data from a large STEMI-registry demonstrate, that modern P2Y12-inhibitors were less often used in patients with CKD and their benefit regarding MACCE disappeared in advanced stages of CKD while bleeding rates increased. These results underline the special role of patients with advanced stage-CKD in STEMI and the necessity of specialized randomized trials for these patients.
484Impact of AF type on the outcome of atrial fibrillation ablation: insights from the CABANA trial
Authors: Monahan K H , Bunch T J , Poole J E , Bahnson T D , Al-Khalidi H R , Silverstein A P , Mark D B , Lee K L , Packer D L 
Published: October 2019

Abstract

Background
Prior studies suggest that catheter ablation (ABL) for atrial fibrillation (AF) is a treatment option for patients (pts) with paroxysmal AF (PAF). Pts with persistent (Per) or long-standing persistent (LSP) were routinely excluded from most ABL based clinical trials. The effectiveness of ABL compared to drug therapy (MED) in relation to underlying AF type has not been evaluated in a large randomized clinical trial.

Objective
To assess the impact of AF type on clinical outcomes of ABL vs. MED in pts with AF.

Methods
The CABANA trial randomized 2204 pts with AF at 126 sites worldwide to ABL vs. MED with rate or rhythm control drugs. The primary endpoint was a composite of death, disabling stroke, severe bleeding, or cardiac arrest. Key secondary endpoints included mortality and recurrence of AF. Outcomes of ABL vs. MED were compared within subgroups defined by AF type using Intention-to-Treat (ITT) analyses.

Results
Of the 2204 pts, 946 had PAF, 1042 had Per and 215 presented with LSP. There were baseline differences among AF types in age, gender, HTN, LVH, CHF and NYHA Class. For the primary endpoint, there were no significant differences between ABL and MED in pts with PAF (hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.51, 1.31), Per (HR 0.87; 95% CI 0.59, 1.28), or LSP (HR 1.01, 95% CI 0.39, 2.61). Likewise, there were no significant treatment differences in mortality; PAF (HR 0.84; 95% CI 0.46, 1.52), Per (HR 0.90; 95% CI 0.56, 1.46) and LSP (HR 0.67, 95% CI 0.23, 1.94). Post-blanking AF (time to first recurrence) was significantly reduced by ABL compared to MED across all AF types (PAF by 51%), (Per by 47%) and (LSP by 36%).
Clinical Characteristics and Outcomes Clinical Outcomes Comparing ABL vs. MED (HR and 95% CI) Interaction p-value Primary Endpoint 0.82 (0.51, 1.31) 0.87 (0.59, 1.28) 1.01 (0.39, 2.61) 0.925 Mortality 0.84 (0.46, 1.52) 0.90 (0.56, 1.46) 0.67 (0.23, 1.94) 0.881 Recurrent AF 0.49 (0.38, 0.62) 0.53 (0.43, 0.65) 0.64 (0.41, 1.01) 0.564

Conclusion
Pts with LSP have a lower proportion of women, and a higher proportion with manifestations of heart failure despite lower CHA2DS2VASc scores. By ITT analysis, there is no significant effect of ABL compared to MED in the primary endpoint or mortality in any AF group. However, ABL is more effective than MED for reducing recurrences of AF regardless of AF type, but with a greater effect in PAF vs Per vs LSP.

Acknowledgement/Funding
NIH, St Jude Medical Foundation and Corporation, Biosense Webster Inc., Medtronic Corporation, and Boston Scientific Corporation
486Are the results of the CASTLE-AF trial reproducible in the real life? Clinical outcomes after catheter ablation for atrial fibrillation with heart failure in a nationwide cohort study
Authors: Bisson A , Mondout F , Herbert J , Clementy N , Pierre B , Gaborit C , Guillon Grammatico L , Babuty D , Fauchier L 
Published: October 2019

Abstract

Background
Catheter ablation for atrial fibrillation (AF) is a validated therapy for patients with symptomatic AF to prevent recurrences. The CASTLE AF trial indicated that ablation for AF in patients with heart failure (HF) was associated with a lower rate of death from any cause or hospitalization for worsening HF than was medical therapy. The purpose of our study was to compare the incidence of these events in AF patients with HF after AF catheter ablation versus those not treated with AF ablation at a nationwide level in centers possibly less well experienced.

Methods
This French longitudinal cohort study was based on the national hospitalization PMSI (Programme de Médicalisation des Systèmes d'Information) database covering hospital care from the entire population. We included all patients, over 18 years old, with AF and HF from January 2010 to December 2015. Crude event rates were ascertained and hazard ratios (HR) were estimated using Cox proportional hazards risk model. Propensity-matched Cox regression was also used to compare event rates according to AF ablation usage status.

Results
Among the 261,449 patients identified with AF and HF, 1,270 patients were treated with AF ablation (24% female, mean age 63±10 yo) and 260,179 did not have AF ablation (45% female, mean age 79±11 yo). During follow-up (417±502 days), there were 56,981 hospitalizations with a primary diagnosis of HF and 81,393 deaths were recorded. Incidence of hospitalization for HF was significantly lower in patients with AF ablation than in those with no ablation (13.74% vs 51.11% person per year respectively, p<0.0001). Incidence of death was also significantly lower in patients with AF ablation than in those with no ablation (6.07% vs 27.42% person per year respectively, p<0.0001). These associations were confirmed in a multivariable analysis after adjustment on age and other comorbidities (HR 0.33, 95% CI 0.28–0.39, p<0.0001 for HF and HR 0.38, 95% CI 0.31–0.48, p<0.0001 for all-cause death). After 1:1 propensity score matching, AF ablation was also associated with a lower risk of hospitalization for HF (HR 0.38, 95% CI 0.31–0.47, p<0.0001) and a lower risk of death (HR 0.54, 95% CI 0.42–0.70, p<0.0001).

Conclusion
In the nationwide analysis of unselected AF patients with HF seen in hospitals, AF ablation was independently associated with a lower risk of hospitalization for HF and death. This provides “real world” data consistent with those observed in recent trials with lower numbers of highly selected patients
P302Prediction of long-term success with global longitudinal strain in patients treated with transcatheter mitral repair
Authors: Fukui M , Bae R , Niikura H , Garcia S , Gossl M , Sorajja P , Cavalcante J L 
Published: October 2019

Abstract

Background
Transcatheter mitral valve repair with MitraClip is effective for patients with mitral regurgitation (MR) and high or prohibitive surgical risk. Global longitudinal strain (GLS) allows evaluation of subclinical myocardial dysfunction, but its incremental clinical utility is unknown in patients treated with MitraClip.

Purpose
To evaluate the relation of baseline GLS and 1-year combined endpoint of all-cause death and heart failure hospitalization in patients treated with MitraClip.

Methods
We analyzed all patients who underwent MitraClip in our hospital between 2012 and 2018. Baseline LV GLS was obtained by 2D speckle tracking echocardiography, averaging the 18-segments from 3 apical views. Receiver operating characteristic (ROC) analyses were used to assess GLS cut-point associated with mortality. Multivariate models with Cox regression tested its relationship after adjustment of baseline characteristics.

Results
We examined 155 patients (mean age 83±7 years, 52% men; mean LVEF 56±10%, the Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) for repair 6.62±5.22%). At one-year, there were 30 deaths and 9 of heart failure hospitalizations, totalizing a composite outcome rate of 25.2%. Baseline GLS (per 1% increase) was associated with 1-year combined endpoint before (HR 1.10, 95% CI 1.02–1.19, p=0.02) and after (HR 1.10, 95% CI 1.01–1.20, p=0.04, respectively) adjustment for baseline characteristics. The optimal value of GLS for discriminating mortality at 1-year was −14.5% (AUC, 0.60; sensitivity 40%, specificity 76%). After accounting for baseline characteristics, patients with reduced GLS (>−14.5%) had worse 1-year combined endpoint than those with preserved GLS (≤−14.5%) (p<0.001; Figure).

Conclusions
Baseline GLS is independently associated with 1-year combined endpoint of all-cause mortality and/or heart failure hospitalization in patients who received transcatheter mitral valve repair. Detection of subclinical myocardial dysfunction by GLS may improve risk stratification and long-term success in these patients.

Acknowledgement/Funding
Valve Science Center, Minneapolis Heart Institute Foundation
P304Prognostic significance of transvalvular flow rate during exercise in asymptomatic patients with aortic stenosis
Authors: Hirasawa K , Izumo M , Umemoto T , Suzuki K , Harada T , Akashi Y J 
Published: October 2019

Abstract

Background
The optimal management of asymptomatic aortic stenosis (AS) remains controversial. The aim of this study is to investigate the prognostic value of exercise stress echocardiography (ESE) in asymptomatic patients with AS.

Purpose
To investigate the additive value of ESE in asymptomatic patients with AS.

Methods and results
We retrospectively enrolled 109 consecutive patients (mean age 73±13 years, 55 men) with AS (aortic valve area ≤1.5cm2) who underwent ESE. Of these, 10 patients referred for aortic valve replacement without symptoms were excluded; finally, 99 conservatively managed patients were enrolled. During the mean follow-up period of 14±11 months, 23 patients (23%) suffered from AS related events. Although no differences in mean pressure gradient at rest and during exercise were found between the patients with and without adverse events, transvalvular flow rate during exercise (Ex-FR) was lower in patients with adverse events than those without adverse events (236±55 ml/sec vs 274±64 ml/sec, P=0.01). Using multivariate Cox regression analysis, low Ex-FR (<270 ml/sec) was an independent predictor for adverse events in patients with asymptomatic AS (hazard ratio: 3.53, P<0.01). The Kaplan–Meier analysis showed that Ex-FR was clearly stratified the event-free survival (Figure, log-rank P<0.01).
K-M curve according to Ex-FR

Conclusion
These results suggested that Ex-FR measured by ESE should play crucial roles in risk stratification in asymptomatic patients with AS.
P310Differentiation between arrhythmogenic right ventricular cardiomyopathy and athlete's heart using cardiac magnetic resonance based derived parameters and strain analysis
Authors: Czimbalmos C , Csecs I , Dohy Z , Toth A , Suhai F I , Szabo L , Kiss O , Sydo N , Kovacs A , Lakatos B , Merkely B , Vago H 
Published: October 2019

Abstract

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a major cause of sudden cardiac death in young athletes. However diagnosing ARVC in highly trained athletes may be complicated because of overlapping features such as elevated right ventricular (RV) end-diastolic volume index or T-wave inversion in precordial leads. The revised Task Force criteria contain no specific cut-off value for professional athletes. Additional CMR parameters and CMR deformation imaging may have an added diagnostic value in this special patient population.
Our goal was to determine novel CMR parameters which can help to distinguish between ARVC and athlete's heart. CMR examination of ARVC patients with definite diagnosis based on the revised Task Force criteria (n=34; 41±13 y, 22 male) and healthy professional athletes (members of the Hungarian national water polo, canoing or rowing team performing minimum of 15 hours of training per week, n=34, 32±6 y, 22 male) was performed. We evaluated left and right ventricular end-systolic, end-diastolic (EDVi) and stroke volume index, ejection fraction (EF) and mass. We established derived parameters such as ejection fraction ratio (LVEF/RVEF) and end-diastolic volume ratio (LVEDV/RVEDV). Global and regional strain analysis for the right ventricle was performed using feature tracking technique. Area under the ROC curves (AUC) of conventional and derived CMR parameters and CMR based strain values were analysed.
There was no significant difference between RVEDVi of ARVC patients and athletes (124±17 vs 142±47), RVEF was lower in ARVC patients compared to athletes (56±5 vs 41±14%; p<0.001). Significant differences were found between athletes and ARVC patients in LVEDV/RVEDV (0.96±0.08 vs 0.82±0.23), LVEF/RVEF (1.04±0.06 vs 1.41±0.56), global circumferential strain (−34.8±5.9 vs −25.2±12.2) and regional strain values such as midventricular RV strain (−31.5±10.2 vs −20.0±13.4) or midventricular RV strain rate (−1.37±0.56 vs −1.04±0.68), respectively.
RVEF and LVEF/RVEF showed excellent (AUC of 0.9–1.0), RV global strain and RV midventricular strain values showed good diagnostic accuracy (AUC of 0.8–0.9), while RVEDVi showed poor diagnostic accuracy (AUC of 0.59).
Consequently, in highly trained healthy athletes RVEDVi is in the range of major Task Force criteria, while CMR based derived parameters such as LVEDV/RVEDV or LVEF/RVEF and both global and regional RV strain parameters can be useful parameters in the differential diagnosis.

Acknowledgement/Funding
National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277), ÚNKP-18-3-IV New National Excellence Program of Human Capacities.
P326Characteristic of sympathetic nerve activity in two subgroups of patients with heart failure (HFrEF and HFmrEF)
Authors: Urbancsek R , Barta J , Forgacs I , Boczan J , Edes I , Csanadi Z , Rudas L 
Published: October 2019

Abstract

Introduction
Sympathetic overactivity is a well documented in severe heart failure (HF) with reduced ejection fraction (HFrEF). The European Society of Cardiology has recently introduced a new HF category, i.e. HF with mid-range ejection fraction (HFmrEF), characterized by left ventricular EF of 40–49%. The sympathetic regulation in this new category has not been thoroughly described.

Aims
Characterization of the sympathetic regulation in patients with HFmrEF compared with data obtained from HFrEF patients and healthy volunteers.

Method
14 HFrEF patients, 22 HFmrEF patients and 10 control subjects were enrolled (Table 1). Muscle sympathetic nerve activity, (MSNA) was recorded in the superficial peroneal nerve by microneurography, and processed by the Nerve Traffic Analyzer System (Model 662C-3, Iowa). Continuous ECG and non-invasive blood pressure (Finapres 2300) were digitized online (500 Hz/channel). Sympathetic burst frequency (bursts/minute) and burst incidence (bursts/100 heartbeats) were determined. The 6 min walking distances (6MWD) and NT proBNP levels in the HF subgroups were also assessed.

Results
Both burst frequency and incidence were significantly elevated in the HF subgroups compared to controls, and significant differences were also seen between the HFrEF and HFmrEF groups. The sympathetic burst activity in the HF populations significantly correlated with the NT proBNP level (R=0.53, p=0.003) and inversely correlated with the ejection fraction (R=−0.38, p=0.03).
Table 1. Results EF <40% EF: 40–49% Healthy control group (HC) p p p (n=14) (n=22) (n=10) EF <40% vs. EF: 40–49% EF <40% vs. HC EF: 40–49% vs. HC NYHA   I–II 8 21 − − − −   III–IV 6 1 − − − − Age 58.36±12.31 62.23±9.74 52.44±10.41 0.302 0.247 0.019 BMI 29.65±3.77 29.84±4.19 − 0.895 − − NT proBNP [ng/L] 1574.75±1415.06 300.20±247.35 − 0.002 − − 6MWT [m] 476.88±63.53 496.53±76.59 − 0.503 − − EF [%] 44.47±3.34 26.78±8.58 − − − − Baseline   burst/min 59.29±14.18 39.55±9.48 25.78±8.47 <0.001 <0.001 0.001   burst/100 84.64±12.63 65.68±15.48 35.78±11.27 0.001 <0.001 <0.001

Conclusion
Sympathetic activity is elevated in heart failure as compared to healthy controls. In patients with HFrEF both parameters of sympathetic activity were significantly higher as compared to patients with HFmrEF.

Acknowledgement/Funding
The work is supported by the GINOP-2.3.2-15-2016-00043 project. The project is co-financed by the EU and the European Regional Development Fund
P333Late mortality after pharmaco-invasive PCI for STEMI
Authors: Idris H , Yang W , Burgess S , Faour A , McLean A , Sidney Lo S , Mussap C J , Juergens C P , French J K 
Published: October 2019

Abstract

Background
Worldwide, and in Australia, a large proportion of patients with ST-segment elevation myocardial infarction (STEMI) are unable to undergo timely primary percutaneous coronary intervention (PCI), and so are transferred for PCI after receiving fibrinolytic therapy (so-called pharmaco-invasive PCI).

Methods
Our Hospital, the primary PCI centre for Southwest Sydney, Australia receives patients for both primary PCI and transferred post- fibrinolytic therapy for rescue or prognostic PCI. Associations were determined between late outcomes (bleeding according to Bleeding Academic Research Consortium (BARC) criteria and mortality) and reperfusion strategy, either primary PCI, or pharmaco-invasive PCI, in patients undergoing PCI for STEMI during hospitalization.

Results
Among 2083 consecutive patients (80% male) with STEMI who underwent PCI (1076 [52%] primary PCI and 1007 [48%] pharmaco-invasive PCI), mortality at 3 years was 8.7%,11.1% after primary PCI and 6.2% after pharmaco-invasive PCI (9.4% after rescue PCI and 4.6% after prognostic PCI); p<0.001 (Figure). Rates of type 2–5 BARC bleeding post-PCI were 35% after primary PCI and 24% after pharmaco-invasive PCI (42% after rescue PCI and 15% after prognostic PCI); p<0.001. while the rate of major bleeding type 3b-5 were 5% after primary PCI and 3% after pharmaco-invasive PCI (8% after rescue PCI and 1% after prognostic PCI); p=0.112.The independent predictors of 3 year mortality were, pre-PCI cardiogenic shock HR=0.25 [95% CI: 0.16–0.39], p<0.001), age (HR=1.05 [95% CI: 1.03–1.06], p<0.001), TIMI 3 flow post-PCI (HR=5.25 [95% CI: 2.51–11.00], p≤0.001), eGFR<60mL/min/1.73m2 (HR=2.90 [95% CI: 1.93–4.34], p≤0.001), post PCI bleeding (HR=2.17 [95% CI: 1.53–3.08], p≤0.001), anterior infarction (HR=1.76 [95% CI: 1.23–2.51], p=0.002), and female gender (HR=1.56 [95% CI: 1.07–2.27], p=0.022); and primary PCI (HR=1.6 [95% CI: 1.18–2.19; p=0.003]. On multi-variable analysis, age, cardiogenic shock presentation, rescue PCI, intra-aortic balloon pump, Pre-procedural anaemia, (all p<0.001) and eGFR<60mL/min/1.73m2 (p=0.006) were associated with bleeding.
Figure 1. Late survival after primary & PI PCI

Conclusion
Among patients with STEMI who underwent pharmaco-invasive PCI had lower mortality rates than to those who had primary PCI, though procedural selection criteria may have been different; bleeding rates were similar. Among suitable patients pharmaco-invasive PCI should be evaluated in large clinical trials.
P338Combined assessment using clinical and imaging parameters to predict response to pharmacotherapy in patients with dilated cardiomyopathy
Authors: Ikeda Y , Inomata T , Maemura K , Yazaki M , Oki T , Fujita T , Nabeta T , Maekawa E , Koitabashi T , Ako J 
Published: October 2019

Abstract

Background
Normalization of left ventricular (LV) contraction is a strong surrogate marker of favorable prognosis in patients with dilated cardiomyopathy (DCM). Although several studies have reported the individual predictive significance of clinical and imaging parameters for LV recovery in patients with DCM, there have been no reports on the scoring systems that combine these multifactorial parameters.

Methods and results
In 406 idiopathic patients with DCM, there were 185 (46%) with LV recovery at 1-year follow-up after pharmacotherapy, which was defined as improvements in LV ejection fraction of ≥+10% together with absolute values of ≥50%. Multivariate analysis demonstrated that eight baseline clinical factors and the absence of late gadolinium enhancement (negative LGE) on magnetic resonance imaging were independently associated with LV recovery. The highest odds ratio for the prediction of LV recovery was negative LGE (odds ratio: 5.62, 95% confidence interval: 2.97–10.6; p<0.0001). Response score for the prediction of LV recovery that included these nine parameters had a predictive accuracy of 0.76 for LV recovery (Figure).

Conclusion
Combined assessment using clinical and imaging parameters has a high prognostic value for predicting response to pharmacotherapy in patients with DCM.