bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4539Android to gynoid fat ratio and its association with functional capacity in male patients with heart failure
Authors: Dos Santos M R , Fonseca G W P , Sherveninas L , Souza F R , Battaglia Filho A C , Pereira R M R , Negrao C E , Alves M J N N , Barretto A C P 
Published: October 2019

Abstract

Background
Obesity may have a protective role in patients with heart failure with reduced ejection fraction (HFrEF), a phenomenon known as obesity paradox. However, some patients can also present sarcopenic obesity with similar exercise intolerance as lean patients with muscle wasting. However, the impact of body fat distribution on exercise intolerance in HFrEF is unknown.

Purpose
To study the association between android to gynoid fat ratio and functional capacity (VO2 peak) in male patients with HFrEF.

Methods
We enrolled 118 male with HFrEF with left ventricular ejection fraction (LVEF) <40%, mean age of 56±7 years old. Body composition was measured with dual x-ray absorptiometry. Android and gynoid fat were measured and the ratio between them was calculated (A/G ratio). Appendicular lean mass (ALM) was calculated as the lean muscle mass of both arms and legs divided by the height squared. Sarcopenic obesity was defined according to Foundation for the National Institutes of Health criteria (ALM adjusted for body mass index <0.789 for men). Muscle strength was assessed using the handgrip dynamometer (cutoff point for sarcopenia was defined as proposed by European Working Group on Sarcopenia in Older People). Blood sample was used to measure metabolic and hormonal parameters.

Results
Of those 118 patients, 15 (12.7%) showed sarcopenic obesity. In our cohort, the median A/G ratio was 0.55. A/G ratio >0.55 was detected in 60 patients. Weight and BMI were higher in patients with A/G ratio >0.55 (P<0.001). Absolute peak VO2 was similar between patients with A/G ratio lower or higher than 0.55 (1.48±0.40 vs. 1.43±0.40 L/min, P=0.559), while relative peak VO2 was lower in patients with A/G ratio >0.55 (18.7±5.3 vs. 22.5±6.1 mL/kg/min, P<0.001). LVEF, total cholesterol, LDL, haemoglobin, and IGF-1 were similar between patients with A/G ratio lower or higher than 0.55 (P>0.05). On the other hand, HDL, total testosterone, free testosterone, and DHEA were lower in patients with A/G ratio >0.55 (P<0.05). Logistic regression analysis showed A/G Ratio >0.55 to be independently associated with reduced peak VO2 (L/min) adjusted for age, BMI, LVEF, presence of sarcopenia, anabolic hormones, and haemoglobin (odds ratio 3.895, 95% CI 1.030–14.730, p=0.045).

Conclusion
Our data suggest that body fat distribution, particularly android and gynoid fat composition, might have an important adverse role on functional capacity in male patients with HFrEF.

Acknowledgement/Funding
FAPESP #2016/24306-0 and 2016/24833-0
P4547Serum biochemical determinants of peripheral congestion assessed by bioimpedance vector analysis in acute heart failure
Authors: Scicchitano P , Massari F , Iacoviello M , Valle R , Sanasi M , Piscopo A , Sasanelli P , De Palo M , Guida P , Mastropasqua F , Caldarola P , Ciccone M M 
Published: October 2019

Abstract

Background
The pathophysiology of peripheral congestion is poorly investigated in patients with acute heart failure (AHF).

Purpose
This study evaluated the relative contribution of serum colloid osmotic pressure (COP), relative plasma volume status (PVS), biomarkers of renal function, electrolytes, haemoglobin, and brain natriuretic peptide (BNP) in peripheral fluid overload using bioimpedance vector analysis (BIVA).

Methods
We retrospectively analysed data from 485 patients with AHF. Hydration status was evaluated by semiquantitative and quantitative approach using BIVA (R/Xc graph) and Hydration Index (HI), respectively. COP was calculated from albumin and total protein concentration, while relative PVS was calculated from validated equations.

Results
Congestion assessed by BIVA was observed in 304 (63%) patients and classified as mild (30%), moderate (42%), and severe (28%). On univariate analysis, HI was inversely correlated with COP (P<0.01), glomerular filtration rate (P<0.01), and haemoglobin (P<0.01), while positive correlations were found for relative PVS (P<0.05), BNP (P<0.01), and blood urea nitrogen (BUN; P<0.01). On stepwise multivariate analysis, COP explained 12% of the total variability, while BUN, PVS, haemoglobin, and BNP added a further 6%, 4%, 2%, and 1%, respectively, to the final explanatory model.

Conclusions
COP was the major determinant of the presence and entity of peripheral congestion assessed by BIVA. BUN, PVS, haemoglobin, and BNP revealed reduced influence on congestion as compared with COP. Routine laboratory testing could be useful in peripheral fluid accumulation. Future studies should evaluate the relationship between COP and pharmacological target therapies for the fluid management of AHF patients.

Acknowledgement/Funding
None
P4548Early drop in systolic blood pressure and worsening renal function in the elderly acute heart failure: how does heart rate interact?
Authors: Takeuchi M , Nagai M , Dote K , Kato M , Oda N , Kunita E , Kagawa E , Yamane A , Higashihara T , Kobayashi Y , Shiota H 
Published: October 2019

Abstract

Background
Renal dysfunction is a frequent finding in patients hospitalized for acute heart failure (AHF). Worsening renal function (WRF) during hospitalization was found to be related with a poor outcome independently of baseline renal function. Early drop in systolic blood pressure (SBP) has shown to predict WRF in AHF. However, there have been few studies that reported the impact of on-admission heart rate (HR) on the relationship between early SBP drop and WRF in the elderly AHF.

Purpose
We assessed the hypothesis that early SBP drop predict WRF in the elderly patients with AHF, and investigated that on-admission HR might have an interaction with that relationship.

Methods
SBP and HR were measured on admission and 6 times during 48 hours in the 245 elderly AHF inpatients (82.9±6.0 years old, male 49.4%). WRF was defined as a serum creatinine increase of ≥0.3 mg/dL by Day 5. Early drop in SBP was calculated as the difference between admission and the lowest value measured during the first 48 hour of hospitalization.

Results
Early SBP drop (51.3 vs 32.5mmHg, p<0.01) and on-admission HR (79.3 vs 89.6bpm, p<0.05) were significantly different between the group with WRF (n=36) and the group without WRF (n=209). In the multiple logistic regression analysis adjusted for the confounders including age, gender, hypertension, left ventricular ejection fraction, total cholesterol, BNP, baseline creatinine, beta-blockade use, intravenous loop diuretic, isosorbide dinitrate and carperitide use, early SBP drop (OR: 1.003, 95% CI: 1.003–1.03, p<0.04) and on-admission HR (OR: 0.98, 95% CI: 0.96–0.99, p<0.01) were significantly associated with WRF. The interaction term of early SBP drop by on-admission HR did not have a significant association with WRF (p=0.3).

Conclusions
In the elderly AHF patients, exaggerated early SBP drop and lower on-admission HR were shown as significant independent predictors of WRF. These two factors were additively associated with WRF. Too much reduction in SBP and that in HR might be harmful to renal circulation in AHF.
P4556Thrombin generation and platelet function in patients on RAAS inhibitors
Authors: Helten C , Dannenberg L , Mourikis P , Naguib D , Poehl M , M'pembele R , Ayhan A , Zako S , Knoop B , Hohlfeld T , Kelm M , Zeus T , Polzin A 
Published: October 2019

Abstract

Background
ACE inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are beneficial for patients with cardiovascular disease. However, little is known about whether one of these drugs is superior. First analyses show that the inhibition of the renin-angiotensin-aldosterone system (RAAS) affects platelet reactivity. Therefore we evaluated the effects of ACEI and ARB on platelet reactivity and thrombin generation.

Methods
In a time series analysis, samples of 24 patients before, 4h and 24h after initial intake of ACEI were analysed. Also we included 10 patients with permanent ACEI treatment and 4h, 24h and 3 months after switching to ARB. Platelet reactivity was measured via light transmission aggregometry (LTA). Thrombin generation was measured as endogenous thrombin potential (ETP) by calibrated automated thrombogram. Protease-activated receptor (PAR) expression was analysed by flow cytometry. Thrombin-antithrombin (TAT) complexes were measured with an enzyme-linked immunosorbent assay.

Results
TRAP-6 induced platelet reactivity increased during ACEI treatment (prior vs. 4h post ACEI: 41.9±16.2% vs. 55.2±16.7%; p=0.003, prior vs. 24h post ACEI: 52.3±12.7%; p=0.003). Switching from chronic ACEI to ARB treatment decreased platelet reactivity (permanent ACEI vs. 3 months after switching: 50.3±20.9% vs. 34.7±20.9%; p=0.033). ACEI reduced ETP from prior to 3 months post ACEI (1527±437 nM*min vs. 1088±631 nM*min; p=0.025). ARB did not affect ETP (1526±587 nM*min vs. 1369±516 nM*min; p=0.3). PAR1 levels rose from 37.38±10.97% before to 49.53±6.04% after ACEI treatment (p=0.036). ARB did not have an effect on PAR1 (33.16±11.73 vs. 32.86±8.99; p=0.89). ACEI slightly decreased plasma thrombin concentration. ARB treatment showed a minor but again not significant decrease in TAT complexes as well. (TAT complexes prior vs. 3 months post ACEI: 8.4±11.9 μg/l vs. 6.3±6.8 μg/l; p=0.99, permanent ACEI vs. 3 months after switching to ARB: 4.3±1.9 μg/l vs. 3.0±1.0 μg/l; p=0.3).

Conclusion
ACEI increased platelet reactivity. This can be reversed by switching to ARB. The mechanism behind RAAS influencing platelet function needs to be further investigated in larger trials.

Acknowledgement/Funding
Medical Faculty of the Heinrich-Heine-University Düsseldorf
P4569Differential prognostic impact of blood glucose levels at the acute stage of myocardial infarction according to HbA1c. The FAST-MI programme
Authors: Danchin N , Puymirat E , Ducrocq G , Henry P , Collet J P , Genee O , Joseph T , Belle L , Naccache N , Ferrieres J , Schiele F , Simon T 
Published: October 2019

Abstract

Background
Hyperglycemia is a well-known prognostic marker in patients with acute myocardial infarction (AMI), associated with higher mortality compared with normoglycemia. Whether the prognostic impact of glycemic status at the acute stage of AMI is similar in patients with chronic dysglycemia has not been extensively explored.

Aims and methods
Using data from the nationwide French FAST-MI cohorts (2005, 2010 and 2015), we analysed the association between glycemia at entry and 30-day death, according to HbA1c level. From the 13,130 patients included, 5,452 had both glycemia and HbA1c assessed at entry. Of those, 1173 (21.5%) had an HbA1c ≥7%.

Results
In patients with HbA1c <7%, LVEF was inversely correlated with glycemic levels (55±11% for glycemia <100, 52±11% for glycemia 100–140, 50±12% for glycemia 140–160 and 49±12% for glycemia >180 mg/dl); a graded association between admission glycemia and 30-day mortality was observed, ranging from 0.7% in normoglycemic patients to 6.3% in patients with admission glycemia >180 mg/dl. In contrast, in patients with HbA1c ≥7%, LVEF was not correlated with glycemia (<100 mg/dl: 49±14%, >180 mg/dl 49±12%), and mortality was the highest in patients with normoglycemia (9.2%) and the lowest in patients with glycemia between 140 and 180 mg/dl (3.1%) (Figure). In multivariate analyses adjusting for baseline characteristics and early management, normoglycemia was associated with a decreased risk of 30-day mortality in patients with HbA1c <7% (HR 0.27, 95% confidence interval 0.10–0.73, P=0.01), while it was associated with a two-fold increase in mortality in patients with HbA1c ≥7% (HR 2.49, 95% confidence interval 1.02–6.09, P=0.046).
Figure 1. 30-day death

Conclusion
In AMI patients with high HbA1c levels on admission, normoglycemia is associated with higher early mortality than hyperglycemia. In contrast, a graded correlation is observed between admission glycemia and early mortality in patients with HbA1c <7%. Management of glycemia at the acute stage of MI might require different measures according to the initial HbA1c level.

Acknowledgement/Funding
Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier
P4579Prediction of CABG indication in patients admitted for NSTEMI with the new CABG DAPE2S score
Authors: Faria Da Mota T , Azevedo P , Fernandes R , S J , Guedes J , Bento D , Marques N , Santos W , Mimoso J , Jesus I 
Published: October 2019

Abstract

Introduction
A significant number of patients admitted for Non-ST Elevation Myocardial Infarction (NSTEMI) have multivessel complex coronary artery disease (CAD) and benefit from Coronary Artery Bypass Graft surgery (CABG). These patients frequently present high-risk surgical profiles, constituting a challenging group when it comes to balancing ischemic and haemorrhagic risk.

Objective
To develop a simple predictive risk model of referral to CABG in patients admitted for NSTEMI.

Methods
The authors present a retrospective, descriptive and correlational study including all patients admitted for NSTEMI in a Cardiology department between the 1st of October 2010 and the 1st of October 2018. Demographic profile, clinical characteristics, risk factors and hospitalization data of NSTEMI patients referred to CABG were studied, and a correlational analysis was performed with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%). Independent predictors of CABG in patients with NSTEMI were identified through Binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was subsequently applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.

Results
A total of 2476 patients were included, 668 (27%) of which were female, with a mean age of 68,5±13,4 years. In the studied sample, 273 patients (11%) were proposed to CABG. The authors found a significant association between CABG and multiple clinical, laboratorial and therapeutical variables, but after multivariate analysis only male sex, previous Diabetes Mellitus, previous angina, previous Percutaneous coronary intervention, absence of a normal EKG, ST segment depression at admission, sinus rythm and brain natriuretic peptide (BNP) >100pg/mL proved to be independent predictors of referral. Using these variables, the authors developed a risk model to predict CABG referral in NSTEMI patients: −0,614 − (0,756 x female sex) + (0,305 x diabetes) + (0,631 x angina) − (1,513 x previous PCI) + (1,216 x sinus rythm) + (0,672 x ST depression) − (0,806 x normal EKG) + (0,562 x BNP>100). In this function, variables should be substituted by 1 or 0, depending on wheter the condition they specify is present or absent. The optimal discrimination cutoff was 0,23, with a 64% sensibility and 59% specificity, and a discriminant power of 60%.

Conclusion
Being able to predict referral to surgical revascularization in NSTEMI may help physicians to optimize a specific approach in each patient, in particular with regard to anti-thrombotic strategies. The authors developed a risk predicting model for CABG in NSTEMI patients based on simple clinical and laboratory variables, which will require validation in a larger cohort, before it can be applied in a clinical context.
P4591Impact of extent of non-culprit lesions on one-year outcomes in patients with acute myocardial infarction
Authors: Tanaka T , Akahori H , Imanaka T , Miki K , Yoshihara N , Yanaka K , Ishihara M 
Published: October 2019

Abstract

Background
Presence of severe stenosis in non-infarct related arteries, i.e. multi-vessel disease (MVD), is associated with poor outcomes after acute myocardial infarction (AMI). However, impact of mild to moderate stenosis in non-culprit lesions remains unclear.Gensini score is an angiographic application grading the extent of coronary artery lesions including mild to moderate stenosis.

Purpose
To evaluate whether the extent of non-culprit lesion is related to one-year outcomes after AMI.

Methods
This study consisted of consecutive 168 patients who underwent primary percutaneous coronary intervention (PPCI) for AMI between 2015 and 2017. Patients with coronary bypass grafts were excluded from the analysis. To assess the extent of non-culprit lesions, we used “non-culprit Gensini score”, which is calculated by excluding score of the culprit lesion from the original Gensini score. Patients were divided into 2 groups by the median ofnon-culprit Gensini score: low score (0–14, n=84) and high score (>15, n=84). Major adverse cardiac events (MACE) included all cause of deaths, non-fatal MI, stroke and ischemia driven coronary revascularization during one-year follow-up period.

Results
MVDwas more frequent in patients with high score than those in those with low score (90% vs 25%, P<0.05). Kaplan-Mayer curves of patients with and without MVD are shown in left figure, and curves of patients with low score and those with high score are shown in right figure. Multivariable analysis showed that high score was an independent predictor of one-year MACE (HR 5.28, 95% CI 1.93–14.9, P<0.05), but MVD was not (HR 0.56, 95% CI 0.23–1.54, P=0.25) (Table).
Multivariable analyses Univariable analyses Multivariable analyses HR (95% CI) P-value HR (95% CI) P-value Age 1.03 (1.01, 1.06) <0.05 1.15 (0.99, 1.05) 0.31 eGFR (<45ml/min/1.73m2) 2.95 (1.59, 5.38) <0.05 2.35 (1.26, 4.35) <0.05 Multi-vessel disease 1.84 (1.01, 3.55) <0.05 0.56 (0.23, 1.54) 0.25 Non-culprit-Gensini score (>15) 3.37 (1.79, 6.78) <0.05 5.28 (1.93, 14.9) <0.05 HR = hazard ratio; CI = confidence interval; eGFR = estimated glomerular filtration rate.
Kaplan-Meier curves

Conclusion
These findings suggested that extent of mild to moderate stenosis in non-culprit lesions might affect the prognosis after AMI in patients undergoing PPCI. Non-culprit Gensini score may be useful to predict outcomes of patients with AMI.

Acknowledgement/Funding
None
P4598Clinical implications and predictors of coronary perforations during chronic total occlusion percutaneous coronary interventions: insights from the multicenterLatin America CTO LATAM registry
Authors: Harada Ribeiro M , Belli K C , Piccaro P , Padilla L T , Silva A C B , Santiago R , De Paula J E T , Ribeiro E E , Franken M , Quadros A S , Campos C M 
Published: October 2019

Abstract

Background
Chronic total occlusions are still considered one of the most challenging procedures in the field of interventional cardiology and the most feared complication are the perforations. In past studies and series from Asia, Europe and United States the rate of perforations in percutaneous coronary interventions are described as 0.2% whereas this rate increases to 3% when recanalization of a chronic total occlusion is attempted.

Purpose
Our study sought to identify the frequency, predictors and clinical implications of coronary perforations in chronic total occlusion percutaneous interventions in a contemporary registry with data from Latin America.

Methods
We reported the data of a prospective multi center Latin American registry from January to December 2018 in 1066 patients who underwent chronic total occlusion percutaneous interventions in 30 centers in the following countries: Brazil, Argentina, Puerto Rico, Chile, Colombia, Ecuador and Mexico. Coronary perforation was defined as evidence of extravasation dye or blood from the coronary artery during or following the procedure. A stepwise logistic regression was performed to investigate the independent predictors of coronary perforations.

Results
The mean age was 64.2±10.7 years, 79.8% were male, 35.3% diabetics and 6.7% had heart failure. The most commonly involved CTO vessel was right coronary artery (41.4%), the mean J-CTO score was 2.0±1.3 and the mean CL score was 2.7±1.6. The overall procedural success rate was 81.9%. Coronary perforation occurred in 3.3% of cases: type 1 in 1.8%, Type 2 in 0.9% and Type 3 in 0.6%. In comparison with patients without coronary perforation was observed, those with such complication required more often blood transfusion (8.6% vs. 0.7%; p<0.001), experienced more cardiac tamponade (13.4% vs. 0.4%; p<0.001), but not all-cause in-hospital mortality (0 vs. 1.0%; p=1.0; respectively). At multivariate analysis, the independent predictor of coronary perforation was an activated clotting time (ACT) during PCI >470 seconds (OR 6.5; 95% CI 2.4 - 17.3; p<0.001), baseline heart failure (OR 4.2; 95% CI 1.2 - 14.6) and J-CTO score ≥2 (OR7.5; 95% CI 1.0–59.1).

Conclusions
Coronary perforation during percutaneous interventions in Latin America occurred in 3.3% of patients, being related with adverse events but not in-hospital all-cause mortality. Pharmacological management, high anatomical complexity and heart failure were identified as independent predictors of this still and so feared complication.

Acknowledgement/Funding
None
P4621Incidence, management, and in-hospital mortality of cardiogenic shock complicating ST-elevated myocardial infarction in China: insights from the China Acute Myocardial Infarction Registry
Authors: Ning Y , Chen G H , Yang J G , Yang Y J , Tian C Y , Wang Y , Xu H Y 
Published: October 2019

Abstract

Background and purpose
Limited data is available on the situation of cardiogenic shock (CS) complicating ST-elevated myocardial infarction (STEMI) in China. This study aims to disclose the incidence, management and in-hospital mortality (IHM) of patients with STEMI complicated by CS (STEMICS) in China and at different levels of hospitals.

Methods
We queried the 2013–2016 China Acute Myocardial Infarction (CAMI) registry databases to identify patients with STEMI and/or CS (developing before or during hospitalization). The overall and different hospital-level incidence of STEMICS and IHM were analyzed.

Results
Of 28230 STEMI patients, 2273 patients (8.05%) had CS. The incidence of STEMICS in provincial, prefectural and county-level hospitals were 5.23%, 8.46% and 13.76% (p<0.001), respectively. Primary PCI (PPCI) was performed on 675 patients (29.7%) with STEMICS. The proportion of STEMICS patients undertaking PPCI in provincial, prefectural and county-level hospitals were 46.53%, 31.48% and 8.00% (p<0.001). The overall IHM rate of patients with STEMICS was 49.8% with no difference among the different hospital levels. However, the IHM rate of prehospital STEMICS in county-level hospitals were significantly higher than that in prefectural and provincial hospitals (42.3% versus 33.3% and 28.3%, respectively; p<0.01), while that of in-hospital STEMICS were similar among the different hospital levels (66.5%, 66.9% and 62.2%; provincial, prefectural and county-level hospitals, respectively). After adjustment, the difference of IHM in prehospital STEMICS between county-level hospitals and the other two levels no longer existed. However, once PPCI was excluded from the multivariable adjustment model, the IHM of prehospital STEMICS remained higher in county-level hospitals.
Table 1. Differences in IHM of prehospital STEMICS between county-level hospitals and other two levels of hospitals before or after adjustment Provincial hospitals/ County-level hospitals Prefectural hospitals/ County-level hospitals Unadjusted OR (95% CI) 0.54 (0.36, 0.80); P=0.0019 0.68 (0.49, 0.94); P=0.0193 Adjusted OR* (95% CI) 0.63 (0.34, 1.17); P=0.1455 0.64 (0.38, 1.08); P=0.0962 Adjusted OR† (95% CI) 0.49 (0.27, 0.90); P=0.0214 0.54 (0.32, 0.91); P=0.0198 IHM: in-hospital mortality; OR: odd ratio; CI: confidence interval. *Adjusted for baseline characteristics, in-hospital medications and primary PCI; †adjusted for baseline characteristics and in-hospital medications.
Figure 1. Flowchart

Conclusion
The overall incidence and IHM rate of STEMICS in China are still high. Especially, higher IHM rate of prehospital STEMICS is observed in county-level hospitals, which may be attributed to the lower implementation rate of PPCI.

Acknowledgement/Funding
CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)