bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3545Association between diastolic dysfunction and two-year survival in heart failure patients with mid-range or reduced left ventricular ejection fraction
Authors: Nordbeck P , Liu D , Hu K , Lau K , Kiwitz T , Robitzkat K , Hammel C , Ertl G , Frantz S 
Published: October 2019

Abstract

Background
Extensive studies have demonstrated prognostic impact of echocardiographic defined diastolic dysfunction (DD) in patients with preserved as well as reduced left ventricular ejection fraction (LVEF). Nevertheless, it remains controversial whether evaluation of DD could provide additional prognostic information in heart failure (HF) patients with impaired systolic function. The purpose of present study, therefore, is to investigate the prognostic impact of echocardiography-defined DD on survival in HF patients hospitalized in our centre from 2009 to 2017 with mid-range LVEF (HFmrEF, LVEF 41–49%) and reduced LVEF (HFrEF, LVEF<40%).

Methods
A total of 2018 patients with echocardiography-evidenced LVEF<50% and hospitalized in our centre between July 2009 to December 2017 were included. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 24 (IQR 13–36) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Patients were divided into mild, moderate and severe DD according to recent guidelines.

Results
The mean age was 69±13 years in the HFmrEF group and 68±13 years in the HFrEF group. All-cause mortality/HTx rate was significantly higher in the HFrEF (all-cause death n=318 and HTx n=11, 30.9%) group than in patients with HFmrEF (all-cause death n=235 and HTx n=2, 24.9%, P=0.003). All-cause mortality/HTx rate increased in proportion to DD severity in HFmrEF patients: 17.1% (54/315) in the mild DD group, 25.4% (115/452) in the moderate DD group, and 37.0% (68/184) in the severe DD group (P<0.001) and in HFrEF patients: 18.9% (43/228) in the mild DD group, 30.3% (146/482) in the moderate DD group, and 39.2% (140/357) in the severe DD group (P<0.001). Multivariable Cox regression analysis showed that Doppler parameter early-diastolic mitral inflow velocity to septal mitral annular velocity ratio (E/E') >14 (HR 1.41, 95% CI 1.06–1.89, P=0.020) and peak tricuspid regurgitation velocity (TRVmax) >2.8m/s (HR 1.75, 95% CI 1.33–2.29, P<0.001) were independent determinants of all-cause mortality/HTx in patients with HFmrEF; while E/E'>14 (HR 1.48, 95% CI 1.08–2.04, P=0.015) remained as an independent determinant of all-cause mortality/HTx in patients with HFrEF after adjustment for clinical and other echocardiographic confounders. Besides DD-related parameters, after adjustment with age and sex, lower tricuspid and mitral annular plane systolic excursions (TAPSE and MAPSE) were also closely related to higher mortality/HTx rate in both HFmrEF and HFrEF patients.
Figure 1. Kaplan-Meier curves

Conclusion
Our results indicate that all-cause mortality/HTx rate increases in proportion to DD severity in both HFmrEF and HFrEF patients.
P3563The influence of circadian patterand obstructive sleep apnean of blood pressure in nocturnal arrhythmias in hypertensive patients
Authors: Marinheiro R , Parreira L , Amador P , Mesquita D , Farinha J , Fonseca M , Esteves A , Pinheiro A , Sousa S , Silva M , Lopes C , Fernandes A , Guerreiro A , Chambel D , Caria R 
Published: October 2019

Abstract

Introduction
There is growing evidence suggesting hypertension is related to the occurrence of arrhythmias. When occurring predominantly during the night, two potential entities commonly present in hypertensive patients could be related with increased arrhythmogenesis: (1) the lack of normal nocturnal dipping of blood pressure (BP) (non-dipping pattern of hypertension) or (2) obstructive sleep apnea (OSA). Thus, nocturnal arrhythmias (NAs) can identify hypertensive patients with OSA and/or non-dipping pattern, both related with adverse outcomes.

Aims
To determine if NAs are related with non-dipping hypertension, OSA or both.

Methods
We studied hypertensive patients who performed ambulatory blood pressure monitoring (ABPM) and also polysomnography and 24-hour Holter monitoring. Non-dipping pattern was considered when nocturnal BP reduction was inferior to 10%. Based on Holter monitoring, NAs were present when atrial fibrillation, frequent premature atrial contractions (PACs) (>30 PACs/hour), runs of >4 consecutive PACs, frequent premature ventricular contractions (PVCs) (>30PVCs/hour) or runs of >4 consecutive PVCs were present predominantly during sleeping hours. During polyssonography, apnoea/hypopnoea index (AHI) and oxygen saturation (SaO2) were analysed. Moderate to severe OSA was considered when AHI >15.

Results
We studied 104 patients [median age 62 (54–70) years, 65% male): 42 (40%) had moderate to severe OSA (median AHI=11 (6–26), mean SaO2=94% (92–95)] and 64 (61%) were non-dippers. NAs occurred in 18 patients (17%) and they were independently associated with AHI (Odds Ratio (OR) for a one unit increase 1.04, 95% confidence interval (CI) 1.01–1.07, p=0.03) but not with SaO2 (OR 0.96, CI 0.78–1.19, p=0.73) nor non-dipping pattern (OR 1.23, CI 0.38–3.98, p=0.72). No interaction was found between OSA and non-dipping hypertension (p=0.35). In patients with dipping pattern (n=40), AHI was higher in NAs patients comparing with no NAs patients (median AHI 29 versus 10, p=0.04), while in those with non-dipping pattern (n=64), AHI was not statistically different between patients with and without NAs (21 versus 11, p=0.12) (figure).
Figure 1

Conclusion
In this population of hypertensive patients, the presence of NAs was associated with OSA severity (i.e AHI), but not with the non-dipping pattern of hypertension. The importance of obstructive events in arrhythmogenesis seemed to be more pronounced in dipping patients, suggesting the abnormal high blood pressure during the night may also have some impact on NAs in non-dipping patients. Overall, our results suggest that OSA screening should be considered when nocturnal arrhythmias are detected in hypertensive patients, but ABPM should not be forgotten since multiple mechanisms can be involved in nocturnal arrhythmogenesis.
P3566Ambulatory blood pressure response to riboflavin supplementation in adults with the C677T polymorphism in the folate metabolising enzyme methylenetetrahydrofolate reductase (MTHFR)
Authors: Ward M , Hughes C F , Mc Mahon A , Rooney M , Strain J J , Plumb R , Troesch B , Bendik I , Mc Nulty H 
Published: October 2019

Abstract

Background
Epidemiological evidence suggests that the C677T polymorphism in the folate metabolising enzyme MTHFR is associated with a 24–87% increased risk of hypertension. Riboflavin (a cofactor for MTHFR) can modify this phenotype, as demonstrated in a series of RCTs, at this centre. ABPM measures BP over 24hrs and provides a more reliable assessment of an individual's BP compared to clinic BP.

Aim
To investigate the effect of riboflavin supplementation on BP (by ABPM) in adults with the MTHFR 677TT genotype.

Methods
Adults (n=3462) were recruited and screened for the MTHFRTT genotype and those eligible (n=81), were stratified by baseline SBP and randomised to receive riboflavin (10mg/day/16weeks) or placebo. Riboflavin status was measured using the erythrocyte glutathione reductase activation coefficient (EGRac) assay and clinic and ABPM were measured in accordance with clinical guidelines.

Results
Mean 24hr, daytime and night-time SBP was 6mmHg higher (p<0.05) in adults with the TT v CC genotype. BP response to riboflavin was strongly dependent on baseline BP. In participants with a baseline SBP≥125mmHg, riboflavin resulted in a significant BP lowering in daytime SBP (Table).
Day-time SBP response to riboflavin Treatment Placebo P-value Age 48.6 (11.3) 47.8 (12.0) 0.823 Male n (%) 17 (73.9) 12 (46.2) 0.093 BMI 28.8 (3.8) 27.2 (3.1) 0.131 Riboflavin status (EGRac)†   Pre 1.33 (1.28–1.38) 1.29 (1.24–1.34)   Post 1.20 (1.14–1.25) 1.31 (1.25–1.36) <0.001   Change −0.12 0.02 Daytime BP (mmHg)‡   Pre 137.1 (132.7–141.3) 134.7 (130.3–139.1)   Post 133.0 (128.9–138.1) 134.8 (130.6–139.1) 0.036   Change −3.8 −0.2 ANCOVA, adjusting for sex. †Higher EGRac values indicate lower riboflavin status; ‡mean of participant daytime/awake hrs personalised for each participant.

Conclusion
This is the first study to show, using ABPM, that riboflavin supplementation, targeted at adults with the MTHFR 677TT genotype, results in significant lowering of mean, day and night BP. Given the frequency of this genotype worldwide (approximately 10%, but as high as 30% in some populations) these findings could offer a personalised approach for BP management in at-risk sub-populations.

Acknowledgement/Funding
This work was supported by DSM Nutritional Products, Ltd and Wellcome Trust-Wolfston Northern Ireland Clinical Research Facility are acknowledged
P3580Impact of glucose-6-phosphate dehydrogenase deficiency on the extent and severity of coronary atherosclerosis in patients with acute coronary syndrome
Authors: Montereggi F , Sanna G D , Corda G , Ponti E , Murgia A , Talanas G , Saba P S , Parodi G 
Published: October 2019

Abstract

Background
Studies in animal models and humans suggested that glucose-6-phosphate dehydrogenase (G6PD) deficiency, a genetically inherited condition causing haemolytic anemia, may be considered a risk factor for cardiovascular disease. It is currently unknown whether enzymatic activity may impact the extent and severity of coronary atherosclerosis in patients with acute myocardial infarction. This hypothesis was tested in a cohort of acute coronary syndrome (ACS) patients undergoing invasive management from Northern Sardinia, where the population prevalence of G6PD deficiency is the highest in the Mediterranean area.

Methods
The study was based on a prospective single-centre registry of consecutive ACS patients undergoing coronary angiography and subsequent percutaneous revascularization between January 2017 and December 2018, in which G6PD activity has been measured quantitatively using a biochemical assay based on G6PD/6GPD ratio in erythrocytes. Subjects were defined as deficient when the ratio was <0.80. The primary endpoint of the study was the severity of coronary artery disease as assessed by the SYNTAX I score at baseline angiography.

Results
Among the 466 enrolled patients, 41 (9%) showed G6PD deficiency. Patients with G6PD deficiency were less likely to have a history of dyslipidemia (27% vs 50%; p=0.005) or diabetes (12% vs 21%; p=0.105). As expected, at admission patients with deficiency had lower hemoglobin level (12.1 vs 13.7 g/dL; p=0.005) as compared with those without. By angiography, SYNTAX score resulted as 19±9 and 16±9 (p=0.039) in patients with and without G6PD deficiency; while the number of diseased (with >50% stenosis) vessels was 1.9 vs 1.6 (p=0.089) in the 2 study groups. Left main disease was detected in 15% and 7% (p=0.06) patients, respectively. G6PD deficiency emerged as an independent predictor of high SYNTAX score (OR=2.16, 95% CI 1.1–4.5; p=0.037). Angioplasty with coronary stenting of the culprit vessel was performed in all patients, while GP IIb/IIIa inhibitors were used in 30% and 14% (p=0.009) of patients with and without G6PD deficiency. Finally, in-hospital events were similar between the 2 study groups.

Conclusions
An increased extent and severity of coronary artery disease was observed in ACS patients with G6PD deficiency as compared with those without, despite the lower prevalence of “classic” cardiovascular risk factors.
P3597Occurence of type 2 myocardial infarction in patients with coronary artery disease
Authors: Jeanmichel M , Putot A , Maza M , Bichat F , Pommier T , Zeller M , Cottin Y 
Published: October 2019

Abstract

Background
Type 2 myocardial infarction (T2MI) is an emerging entity defined by a myocardial oxygen supply and demand mismatch, in the absence of coronary thrombosis. The prevalence of T2MI is high in patients admitted for an acute MI, but is unknown in patients with coronary artery disease (CAD).

Purpose
We aimed to address the comparative prevalence and characteristics of T2 and Type 1 MI in CAD patients.

Patients
We conducted a single-center retrospective study among 33 669 consecutive patients admitted from January 2014 to December 2016 in a university hospital emergency or intensive care unit (ICU). Patients admitted for acute MI, diagnosed by troponin elevation associated with symptoms or signs of myocardial ischemia (typical chest pain and/or ECG changes) and with history of CAD were included. They were systematically adjudicated as T1MI or T2MI according to 4th MI universal definition.

Result
Among the 619 patients included, 254 (41%) had T2MI and 365 (59%) had T1MI. T2MI patients were characterized by an older age (median age [IQR]: 82 [71–87] vs 72 [62–81] y, respectively, p<0.001) and more frequent comorbidities than T1MI patients. In contrast, T2MI patients had similar rates of cardioprotective chronic treatments than T1MI. Only 41% of T2MI patients admitted in ICU underwent a coronary angiography, of whom most (56%) had three-vessels disease. Percutaneous coronary intervention was much less performed in T2MI than in T1MI (28% vs 67%, respectively p<0.001). Median (IQR) time from first CAD diagnosis to index MI was similar for both groups (83 [27–151] months vs 94 [30–179] for T1MI, respectively p=0.22). In-hospital mortality were 2 fold higher in T2MI than in T1MI (15.0% vs 6.6%, respectively, p<0.001). Moreover, in the first year following CAD diagnosis, T2MI had similar rate of occurrence than T1MI (17% vs 14%, respectively p=0.389).

Conclusion
This large real-life study in CAD patients with a recurrence of MI highlights the high frequency of T2MI. Furthermore, almost 1 out of 5 patients had an acute MI, either T1 or T2MI, within the first year after CAD diagnosis. These findings may have implications for prevention and management strategies of T2MI.

Acknowledgement/Funding
University Hospital Center Dijon Bourgogne, Agence Régionale de Santé Bourgogne Franche Comté, France
P3612Validation of Charlson Comorbidity Index to predict adverse events in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: an analysis from LONGEVO-SCA Registry
Authors: Esteve Pastor M A , Marin E , Alegre O , Castillo Dominguez J C , Formiga F , Martinez-Selles M , Diez-Villanueva P , Sanchis J , Ariza-Sole A , Marin F 
Published: October 2019

Abstract

Background
Aging is frequently characterized by the coexistence of several comorbid conditions that increase the adverse prognosis during hospitalization. There are few scores to analyze the impact of comorbidities in prognosis. Charlson Comorbidity Index (CCI). This score evaluates the burden of comorbidity in general population but the influence within cardiac diseases is unknown.

Purpose
The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients with atrial fibrillation (AF) admitted after an acute coronary syndrome (ACS).

Methods
The prospective multicenter LONGEVO-SCA included unselected elderly patients hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities in elderly AF patients, comparing high quartiles of CCI (Q3-Q4: high burden of comorbidities) to low quartiles (Q1-Q2) and the predictive performance of adverse events at 6 months follow-up of CCI.

Results
We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis. 91 (71.1%) patients were classified into Q1-Q2 and 37 (28.9%) patients into Q3-Q4. We analyzed the association of clinical factors and adverse events and, after Cox multivariate regression analysis, CCI was independently associated with readmissions [HR 1.19, 95% CI (1.02–1.39); p=0.020) and all-cause mortality [HR 1.32, 95% CI (1.09–1.59); p=0.003]. Patients into Q3-Q4 had higher risk of mortality than patients into Q1-Q2 [HR 5.52, 95% CI (1.01–30.3); p=0.049]. Kaplan Meier analysis showed that AF patients into Q3-Q4 had significantly worse prognosis during the follow-up with high risk of all-cause mortality (p=0.034) and readmissions due to ACS (p=0.027). We observed good predictive performance of CCI for mortality (c-statistic 0.705; p<0.001) and modest predictive performance for readmissions (c-statistic 0.627; p<0.001).
Event Free Survival according Charlson

Conclusions
Patients into high quartiles of CCI had higher risk of adverse events during the follow-up. CCI was an independent predictor of all-cause mortality and readmissions in elderly patients. Indeed, this is the first time to validate CCI to predict adverse events in AF patients with ACS.
P3624Prevalence and severity of coronary artery disease linked to prognosis in psoriasis patients referred for coronary computed tomography angiography: A multicentre cohort study
Authors: Tinggaard A B , Hjuler K F , Andersen I T , Winther S , Iversen L , Boettcher M 
Published: October 2019

Abstract

Background
Psoriasis (Pso) is a disease characterized by systemic inflammation and is associated with an increased risk of cardiovascular disease. However, the degree of coronary artery calcification in Pso and its relation to prognosis is largely unknown.

Purpose
The aim of this study was 1) to estimate the prevalence and severity of coronary artery disease (CAD) in this patient group and 2) to asses the risk of major adverse cardiovascular events (MACE) including revascularization and all-cause mortality after initial diagnosis and treatment in a large-scale cohort of patients who underwent coronary computed tomography angiography (CCTA) due to angina symptoms.

Methods
This study consists of two parts using data from the Western Denmark Heart Registry; a cross-sectional study included 40,125 patients and a follow-up study included 42,861 patients. Pso patients were identified by the National Patient Registry and verified by nationwide prescription and treatment code registers. Primary outcome in the cross-sectional study was a coronary artery calcium score (CACS) >0, with a secondary outcome defined as a CACS ≥400. In the follow-up study, the primary outcome was a combined outcome including myocardial infarction, revascularization, ischemic or unspecified stroke and all-cause mortality. Events within the first 90 days after CCTA were attributed to initial treatment and consequently excluded. All outcomes were adjusted for common cardiovascular risk factors and comorbidities.

Results
In the cross-sectional study 1,407 (3.5%) Pso patients were identified. OR was 1.31 (95% CI; 1.15–1.49) for CACS >0 and 1.33 (95% CI; 1.10–1.62) for CACS ≥400 in Pso patients compared to non-Pso patients. In the follow-up study 1,591 (3.7%) Pso patients were identified. The mean duration of follow-up after CCTA was 4.0 years (min/max 0.0/10.2). Crude HR for the combined outcome was 1.52 (95% CI; 1.24–1.87), while adjusted HR was 1.16 (95% CI; 0.95–1.43).

Conclusion
In this clinically relevant cohort of patients referred to CCTA for CAD rule out, coronary artery calcification was more frequent and more severe in Pso patients even compared to the control patients with several risk factors and angina symptoms, but without inflammatory diseases. An increased risk of the combined outcome of MACE including revascularization and all-cause mortality after initial treatment in Pso patients was found in the crude analysis. The increased risk seemed predominantly carried by an increase in traditional risk factors.
P3641Matrix Metalloproteinase-2 polymorphisms are associated with prognosis of patients with symptomatic coronary artery disease
Authors: Groga-Bada P , Heller F , Lente N , Hack L , Schaeffeler E , Winter S , Mueller K , Droppa M , Stimpfle F , Schwab M , Gawaz M , Geisler T , Rath D 
Published: October 2019

Abstract

Background
Matrix Metalloproteinase-2 (MMP-2) is involved in regulation and proliferation of vascular and endothelial cells and is therefore an important component of atherosclerotic vessels. Inhibition of MMP-2 activity is associated with improvement of cardiac function in animal models after myocardial infarction. MMP-2 single nucleotide polymorphisms (SNPs) might alter MMP-2 expression and therefore influence prognosis in patients with symptomatic coronary artery disease (CAD).

Methods and results
Genotyping for selected MMP-2 SNPs variants (rs2241145, rs2285053, rs2287076, rs243865, rs7201) was performed in 943 consecutive patients with symptomatic CAD. All patients were followed-up for all-cause death (ACD), myocardial infarction (MI) and ischemic stroke (IS) for 360 days. The primary combined endpoint (CE) consisted of either first occurrence of ACD, and/or MI, and/or IS. Secondary endpoints were defined as the single events of ACD or MI. Homozygous carriers of major allele (rs2241145, rs2287076) showed significantly better event-free survival than carriers of the minor allele for CE (Log rank = 0.022 and Log rank= 0.015, respectively). Furthermore, homozygous carriers of major allele (rs2241145, rs2285053, rs2287076) showed significantly better event-free survival for ACD (Log rank= 0.047, Log rank= 0.006 and Log rank= 0.023, respectively). In multivariate analysis, MMP-2 rs2241145, rs2287076 and rs2285053 were significantly and independently associated with CE and ACD.
Figure 1

Conclusions
MMP-2 rs2241145, rs2287076 and rs2285053 are associated with prognosis and might be valuable for further risk stratification in CAD patients.

Acknowledgement/Funding
DFG, KFO 274, CRC TR 240