bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2266The predictor of mortality and neurological outcome in out-of-hospital cardiac arrest patients with non-ST-segment elevation
Authors: Matsuda J , Nitta G , Kato S , Kono T , Ikenouchi T , Murata K , Kanoh M , Takamiya T , Inamura Y , Negi K , Inaba S , Sato A , Yamato T , Matsumura Y 
Published: October 2019

Abstract

Background
The prognosis of patients with out-of-hospital cardiac arrest (OHCA) remains poor. Coronary artery disease (CAD) is the most frequent cause of OHCA. The prompt evaluation and revascularization for coronary artery in OHCA patients with ST-segment elevation are recommended because they often have CAD. However, OHCA patients without ST-segment elevation also have any coronary stenosis in the non-negligible proportion. The predictor of mortality and neurological outcome in OHCA patients with no ST-segment elevation has not been sufficiently elucidated.

Purpose
We sought to investigate the predictor of mortality and neurological outcome at 30 days in OHCA patients without ST-segment elevation.

Methods
A total of 1382 out-of-hospital cardiac arrest patients were transferred to our critical care center, of which 252 cardiovascular arrest patients achieving the return of spontaneous circulation (ROSC) were extracted from the institutional consecutive database between January 2015 and December 2018. Among those patients, 183 patients' electrocardiogram after ROSC were without ST-segment elevation. We performed coronary angiography (CAG) for 103 patients, who were eligible for final analysis. To predict mortality in hospital and neurological outcome at 30 days, we investigated basic patients' characteristics, pre-hospital information, post-hospital care.

Results
Any coronary stenosis was founded in 50 patients (48.5%). Male (P=0.007), older age (P<0.001), past history of coronary artery disease (CAD) (P=0.037) and diabetes mellitus (P=0.087) were associated with coronary artery stenosis on CAG findings. Age (OR 1.05; 95% confidence interval (CI) 1.02–1.08; P<0.001), male (OR 5.33; 95% CI 1.37–20.7; P<0.001) were independent predictors of coronary artery stenosis. Among those who had stenosis, 34 patients (68.0%) survived and 27 patients (54.0%) achieved good neurological outcome (cerebral-performance-category (CPC) =1 or 2) at 30 days. Successful revascularization by percutaneous coronary intervention (PCI) was not associated with low mortality (P=0.77). Past history of CAD (P=0.014) and high Syntax score (P=0.030) were associated with mortality. Bystander cardiopulmonary resuscitation (CPR) (P-0.021), pre-hospital ROSC (P<0.001) was more frequent in patients with good neurological outcome. Pre-hospital ROSC (OR 14.7; 95% CI 3.1–69.3; P<0.001) was independently predictive for good neurological outcome.

Conclusions
Successful PCI for OHCA patients with no ST-segment elevation was not a predictor of mortality. CAD past history and complex CAD was associated with mortality. Pre-hospital information such as pre-hospital ROSC was important to achieve good neurological outcome.
P2267CTEPH patients long term follow-up: results from a single center
Authors: Mladoniczky S , Szegedi M , Piroth Z S , Nemeth J , Ablonczy L , Andreka P , Temesvari A , Balint O H 
Published: October 2019

Abstract

Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is a thrombotic pulmonary disease associated with pulmonary vasculopathy. Pulmonary endarterectomy (opus, PEA) is the first treatment choice in CTEPH, and specific PAH medication when there is a contraindication for surgery or residual pulmonary arterial hypertension (rPAH) occurs. In the presence of PAH balloon pulmonary angioplasty (BPA) might be also recommended if available.

Objective
We investigated the long term outcome of our CTEPH patients.

Methods
CTEPH from our institution retrospectively analyzed (data between 2003 and 2018). Baseline, treatment and outcome data were documented. We compared the outcome, together with mortality in those with and without surgery (PEA vs. non PEA group). NYHA class, 6 minutes walking distance (6MWD) and NT-proBNP were also reported during follow-up.

Results
Of 29 CTEPH patients (mean age was 62±19 years, 52% male) 16 (55%) were accepted for PEA, and further 12 of them had a long term follow-up post surgery (n=3 periop exit, n=1 waiting for surgery). Half of the PEA patients were cured (n=6) and the other half (n=6) required specific PAH treatment (n=1, in combination with BPA) for rPAH. All patients from the non-PEA group (n=13) were started on specific PAH treatment (n=1 in combination with BPA). Patients with or without PEA did not differ hemodynamically. At the late follow-up there was a significant improvement in PEA group for NYHA class and NT-proBNP (p<0,001, and p=0,046), and in non PEA group for NYHA class and the 6MWD (p=0,012, and 0,006). We found significant difference in mortality at 1,3,5 year (Kaplan-Meier survival analysis) follow-up, for PEA group 100%-100%-100% and non PEA group 100%-85%-78% (p=0,013), respectively.

Conclusions
55% of CTEPH patients were suitable for PEA, and those who survived the surgery 50% were cured. Non PEA patients improved functionally on the long term, but had worse survival.
P2269IABP-SHOCK II risk score validation for cardiogenic shock after myocardial infarction in a cohort treated with pharmaco-invasive therapy
Authors: Moraes P I M , Alves C M R , Souza M T , Kawakami S E , Galhardo A , Kanhouche G , Cardoso J P , Santos L P M , Arero J R B , Ramon C H , Goncalves Jr I , Moreno A C , Barbosa A H P , Caixeta A , Carvalho A C C 
Published: October 2019

Abstract

Background
Risk stratification using scores is a valuable tool in cardiogenic shock after ST elevation myocardial infarction (STEMI). During pharmacoinvasive therapy (PIT) their use is unexplored in the literature. Objective: To validate the IABP-SHOCK II (Intra-aortic Balloon Pump in Cardiogenic Shock) score in patients treated with PIT and to analyze the influence of ischemia time on the different risk strata.

Methods and results
Of 2,143 STEMI patients seen between May 2010 and April 2017, 212 (9.9%) developed cardiogenic shock. Thirty-one patients (14.6%) with incomplete data were excluded from the analysis and the validation cohort included the remaining 181. Mortality rates were similar between the analyzed and excluded patients (42.5% and 45.1% respectively, p=0.77). The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62), and 76% for high-risk (n=25) (p<0.001). The validation of the score showed good discrimination for death, with an area under the curve of 0.73 (95% confidence interval 0.66 to 0.81 p<0.001). Although pain-to-needle time was significantly longer in patients who died within 30 days (251 min, interquartile range 140–528 vs. 210 min, interquartile range 130–343, p=0.032), the median intervals of pain-to-needle and fibrinolytic-catheterization showed no association with the group stratification (220 vs 251 vs 200 min; p=0.22 and 390 vs 435 vs 315 min; p=0.18, respectively). This finding may be explained by the potential of these variables to be more closely associated with the development of cardiogenic shock in STEMI patients treated with PIT, and to be less associated with progression to death when the patient is already in shock.
30-day mortality in scored strata

Conclusion
In patients with cardiogenic shock after STEMI treated with PIT, risk stratification using the IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterization times on the ability to the score model stratification.
P2277Utility of cardiovascular implantable electronic device (CIED)-derived patient activity, a novel digital biomarker, to predict inappropriate therapy
Authors: Rosero S , Jones P , Goldenberg I , Zareba W , Stein K , McNitt S , Brown M , Polonsky B , Kutyifa V 
Published: October 2019

Abstract

Background
The role of cardiovascular implantable electronic device (CIED)-derived activity to predict inappropriate implantable cardioverter-defibrillator (ICD) therapy is not known. The Multicenter Automatic Defibrillator Implantation Trial – Reduce Inappropriate Therapy (MADIT-RIT) enrolled 1500 patients with contemporary indication for an ICD or a CRT-D. We aimed to identify whether activity, as a digital biomarker, predicted inappropriate therapy.

Methods
In 1500 patients enrolled in MADIT-RIT, CIED-derived patient activity was acquired daily. CIED-derived activity was averaged for the first 30 days following randomization and utilized in this study to predict inappropriate therapy post- 30-day. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression models were used to evaluate first inappropriate therapy by 30-day CIED-derived patient activity quintiles, and by 30-day device derived patient activity as a continuous measurement.

Results
There were a total of 1463 patients with activity data available (90%), 135 patients received at least one inappropriate therapy during the post-30 day follow-up period. Patients in the highest quintile (Q5) of CIED-derived activity (more active) were younger, more often males and more likely to have had a prior ablation of an atrial arrhythmia. Patients in the highest quintile of 30-day CIED-derived median activity had the highest risk of receiving inappropriate therapy, 21% at 2 years as compared 7–11% in the other four quintiles (Figure, p<0.001 for the overall duration). Patients with the highest level of 30-day median patient activity (Q5) had 1.75 times higher risk of any inappropriate therapy as compared with lower levels of activity, Q1-Q4 (HR=1.75, 95% CI: 1.23–2.50, p<0.002). Each 10% increase in CIED-derived 30-day median patient activity was associated with a significant, 73% increase in risk of receiving inappropriate therapy (HR=1.73, 95% CI: 1.17–2.54, p=0.005). Patients in the highest quintile for activity had a 68% increase in the risk of SVT excluding atrial fibrillation, atrial flutter or atrial tachycardia (HR=1.69, 95% CI: 1.26–2.25, p=0.004), despite 96% receiving beta-blocker medications.
Inappropriate ICD Therapies by Activity

Conclusions
CIED-derived 30-day median patient activity predicted subsequent inappropriate therapy in ICD and CRT-D patients enrolled in MADIT-RIT. Patients with high levels of 30-day CIED-derived median patient activity were at a significantly higher risk of receiving inappropriate therapy. Activity, as a digital biomarker, may have utility in predicting and managing the risk of inappropriate therapy in this population.

Acknowledgement/Funding
Boston Scientific
P2278Risk of life-threatening ventricular tachyarrhythmia events in diabetes patients with higher ejection fraction in MADIT-CRT
Authors: Kutyifa V , Solomon S , McNitt S , Zareba W , Goldenberg I 
Published: October 2019

Abstract

Background
Data on the risk of life-threatening ventricular tachyarrhythmia events in diabetes patients with mild heart failure (HF) and higher ejection fraction (LVEF) are not currently known.

Objective
We aimed to assess the risk of life-threatening ventricular tachyarrhythmia events in mild HF patients with diabetes in patients with baseline LVEF ≤30% or >30%.

Methods
We evaluated the risk of life-threatening VT/VF treated with shock in mild HF patients with diabetes, by those with LVEF ≤30% or >30%, enrolled in MADIT-CRT. Kaplan-Meier analysis and multivariate adjusted Cox regression models were utilized.

Results
Out of 542 mild HF patients with diabetes and VT/VF data, 206 (38%) had LVEF >30% and 336 (62%) had LVEF ≤30%. The 5-year cumulative probability of VT/VF treated with shock was 15% in patients with diabetes LVEF >30% as compared to the 15% probability in patients with diabetes and LVEF ≤30% (p=0.342 for the overall difference in event rates during follow-up) (Figure). In Cox models, the risk of VT/VF treated with shock was similar in diabetes patients with LVEF>30% and LVEF ≤30% (HR=0.88, 95% CI= 0.51–1.53, p=0.647) after adjustment for age, ischemic etiology, prior ventricular or atrial arrhythmia, and CRT-D-LBBB interaction. The risk of VT/VF treated with shock was similar regardless of LVEF in both CRT-D patients (HR=1.09, p=0.830) and ICD only patients (HR=0.67, p=0.345).

Conclusion
Diabetes patients with an LVEF >30% are at similarly high risk of life-threatening ventricular tachyarrhythmias to patients with LVEF≤30%. Our findings highlight the need for further investigation and treatment of this uniquely high-risk patient cohort with a higher ejection fraction.

Acknowledgement/Funding
MADIT-CRT was funded by an unrestricted research grant from Boston Scientific to the University of Rochester.
P2281Inadequate heart rate control begets sustained ventricular arrhythmias in a large cohort of women
Authors: Erath J W , Kutyifa V , Assmus B , Burch A , Bondermann D , Russo A 
Published: October 2019

Abstract

Background
The Wearable Cardioverter Defibrillator (WCD) is an effective therapy for treating ventricular arrhythmias (VT/VF) in at-risk patients, while providing continuous heart rate (HR) monitoring. Because women are under-represented in defibrillator trials, we chose to specifically focus on HR control in women prior to VT/VF events.

Purpose
To evaluate HR profiles preceding sustained VT/VF in women fitted with a WCD.

Methods
Data from women fitted with WCD (≥30 days use) from 2015 to 2018 were obtained from the manufacturer's database. HR is expressed as a weekly resting nighttime median (midnight to 7 am). Men (random sample) with the same inclusion criteria served as a control.

Results
A total of 21,440 women, age 67±15 years, were included for analysis. Over a median WCD use of 90 days (59–116 days), 118 women (0.6%) and 133 men (0.8%) received shocks for VT/VF (p=0.01). Resting HR one-week preceding VT/VF was above the target of 70bpm in 55% of shocked women (65 of 118) versus 44% of non-shocked women (9,272 of 21,322, p=0.01) (figure). HR one week before WCD shock was similar in women and men (71 bpm vs. 72 bpm; p=0.60). Younger women (≤50 years) had higher HR prior to shock than older women (HR 80 bpm vs. 70 bpm p=0.003). Among shocked patients, 24-hour-survival was 89% in women and 88% in men. During three-month follow-up, the same percentage of men and women died after receiving adequate WCD shock therapy (18%).
Heart rate profiles

Conclusions
Women with adequate heart rate control experienced significantly less spontaneous VT/VF than those with higher heart rates. The WCD can be utilized as a diagnostic tool to monitor HR in at-risk women in addition to treating sustained VT/VF.
P2426Validating the diagnostic value of a machine learning algorithm for STEMI detection
Authors: Mehta S , Botelho R , Fernandez F , Villagran C , Frauenfelder A , Matheus C , Vieira D , Torres M A , Pinto G , Mazzini J , Pisana L , Jacobucci R , Marin M A , Funatsu C , Vallenilla I 
Published: October 2019

Abstract

Background
We have previously reported the use of Artificial Intelligence (AI) guided EKG analysis for detection of ST-Elevation Myocardial Infarction (STEMI). To demonstrate the diagnostic value of our algorithm, we compared AI predictions with reports that were confirmed as STEMI.

Purpose
To demonstrate the absolute proficiency of AI for detecting STEMI in a standard12-lead EKG.

Methods
An observational, retrospective, case-control study. Sample: 5,087 EKG records, including 2,543 confirmed STEMI cases obtained via feedback from health centers following appropriate patient management (thrombolysis, primary Percutaneous Coronary Intervention (PCI), pharmacoinvasive therapy or coronary artery bypass surgery). Records excluded patient and medical information. The sample was derived from the International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (53,667 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVIDIA GTX 1070 GPU, 8GB RAM.

Results
The model yielded an accuracy of 97.2%, a sensitivity of 95.8%, and a specificity of 98.5%.

Conclusion(s)
Our AI-based algorithm can reliably diagnose STEMI and will preclude the role of a cardiologist for screening and diagnosis, especially in the pre-hospital setting.
P2429More precise assessment of flow-mediated dilation by measuring individually determined maximum dilatory peak time in healthy middle-aged subjects and patients with diabetes mellitus type 2
Authors: Herbrand T , Coester H V , De Vries H , Heiss C , Heise T , Kelm M , Sansone R 
Published: October 2019

Abstract
The assessment of flow-mediated dilation (FMD) is widely used in clinical research to quantify endothelial function. FMD is calculated by subtracting the artery's baseline diameter from the peak diameter during hyperemia. However, there is no consensus on how to determine peak diameter. Many authors report FMD results based on values assessed at predefined time points. This may limit the accuracy and reproducibility of FMD. We hypothesised that FMD values using maximum dilatory peak time (MDP) would differ from those using predefined time points. Using individually determined MDP may lead to a lower number of subjects needed to show significance for a given difference in FMD.
FMD was measured in middle-aged subjects with and without diabetes mellitus type 2 (T2DM) by ultrasound (12-MHz transducer). In a subset of subjects, FMD was measured again 30 days later. All measurements were performed by certified research physicians and evaluated using appropriate software. FMD values were compared at 60 s and 90 s after start of hyperaemia and at MDP during hyperaemia.
FMD was measured in 100 healthy subjects and 72 subjects with T2DM (mean ± SD age 57±6 years, healthy: body mass index 26.2±3 kg/m2, blood pressure 127±10 /80±7 mmHg, DMT2: body mass index 29±3 kg/m2, blood pressure 135±11 / 86±5 mmHg, HbA1c 7.1±0.7%). FMD in healthy subjects was lower at predefined time points compared to MDP (least square mean difference (95% CI)) 60 s vs. MDP −1.14% (−1.72 to −0.56; p<0.0001) and 90 s vs. MDP −1.87% (−2.48 to −1.26; p<0.0001). Also in subjects with DMT2, FMD at predefined time points was lower compared to MDP (least square mean difference (95% CI)) 60 s vs. MDP −1.08% (−1.71 to −0.44; p<0.001) and 90 s vs. MDP −1.73% (−2.38 to −1.06; p<0.001). The intra-subject variability was lowest for MDP compared to 60 s and 90 s (15% vs. 36% and 51%, respectively). Assuming 80% power and alpha at 0.05, the individually determined peak requires 15 people to detect a 1% difference in FMD versus 26 subjects if determined at 60 s and 31 subjects if determined at 90 s.
This study demonstrated significantly higher FMD values and superior reproducibility of the individually determined maximum dilatory peak compared to peaks at predefined time points in healthy middle-aged people and patients with type 2 diabetes. This roughly halves the number of study participants needed to detect a 1% difference in FMD.
P2441The prognostic value of left atrial dyssynchrony in the general population
Authors: Hoeegholm Karsum E , Andersen D M , Modin D , Biering-Soerensen S R , Moegelvang R , Jensen G , Schnohr P , Gislason G , Biering-Soerensen T 
Published: October 2019

Abstract

Introduction
Parameters derived from left atrial (LA) speckle tracking such as LA peak reservoir strain and LA dyssynchrony are potent predictors of cardiovascular morbidity and mortality in various patient populations. However, whether LA dyssynchrony as evaluated by speckle tracking is associated with long-term outcome in the general population is currently unknown.

Methods
In a cohort study with participants from the general population 385 participants without atrial fibrillation (AF), ischemic heart disease (IHD), heart failure (HF) or previous ischemic stroke (IS) had a health examination and an echocardiogram, including LA speckle tracking, performed. LA dyssynchrony was defined as the standard deviation of the time to peak regional atrial reservoir strain values. The endpoints were all-cause mortality, a combined endpoint of AF and IS, and a combined endpoint of major adverse cardiovascular events (MACE) comprised of acute myocardial infarction (AMI), HF or cardiovascular death (CVD).

Results
Median LA dyssynchrony was 42 ms (IQR: 22–58 ms), 60% percent of included participants were women, mean age was 55 years (SD 16 years), 34% had hypertension and 7% had diabetes mellitus. During a median follow up of 16.1 years (IQR 15.0–16.3 years), 83 (22%) participants died, 60 (15%) reached the composite endpoint of AF and IS, and 38 (10%) reached the composite MACE endpoint.
Increasing LA dyssynchrony was associated with increasing age, lower estimated glomerular filtration rate, lower E/A ratio, lower e' and higher E/e'. In a univariable Cox regression, LA dyssynchrony was a significant predictor of all-cause mortality (HR 1.07, 95% CI 1.02–1.11, p=0.001, per 10 ms increase) but was not significantly associated with the combined endpoint of AF and IS (HR 1.05, 95% CI 1.00–1.10, p=0.064, per 10 ms increase) nor MACE (HR 1.04, 95% CI 0.98–1.12, p=0.22, per 10 ms increase). However, when adjusted for age, LA dyssynchrony did not predict all-cause mortality (HR 1.03, p=0.28), the combined endpoint of AF and IS (HR 1.01, p=0.83), or MACE (HR 0.99, p=0.88,). Similarly, after further adjustment for age, sex, smoking status, systolic blood pressure and cholesterol, LA dyssynchrony did not predict any of the study outcomes (All-cause mortality: HR 1.01, p=0.72) (AF and IS: HR 0.98, p=0.88) (MACE: HR 1.00, p=0.93).

Conclusion
In this general population study, LA dyssynchrony was not an independent predictor of all-cause mortality and did not predict MACE nor a composite outcome consisting of AF and IS.