bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1904Oral anticoagulation in patients undergoing elective cardioversion of atrial fibrillation. Real-life experience from Finland
Authors: Itainen-Stromberg S , Hekkala A.-M , Aro A , Vasankari T , Airaksinen J , Lehto M 
Published: October 2019

Abstract

Background
Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV). The real-life data evaluating the safety and efficacy of ECV in patients receiving NOACs is sparse.

Purpose
The aim was to investigate the use of NOACs and warfarin in ECV in a real-life setting and to assess how the chosen regimen affected the delay to ECV and rate of complications.

Methods
Consecutive AF patients undergoing ECVs in a large city in Finland between January 2015 and December 2016 were studied. Data on patient characteristics, delays to cardioversion, anticoagulation treatment, acute (<30 days) complications and regimen changes within one year were evaluated.

Results
Nine hundred patients (59.2% men; mean age, 68.0±10.0) underwent 992 ECVs, of which 596 (60.0%) were performed using NOACs and 396 (40.0%) using warfarin. The mean CHA2DS2-VASc score was 2.5 (±1.6). In patients without previous anticoagulation treatment, NOACs were associated with a shorter mean time to cardioversion than warfarin (51 vs. 68 days, respectively; P<0.001). Furthermore, patients receiving NOAC had fewer postponements of scheduled elective cardioversion compared with warfarin (12.6% vs. 37.4%, respectively, P<0.001). The most common reason for visit cancellation was an imbalance of warfarin therapy and labile INR values. Six thromboembolic events (0.6%) occurred: 4 (0.7%) in NOAC-treated patients and 2 (0.5%) in warfarin-treated patients. All patients who experienced a stroke or TIA had adequate anticoagulation therapy for at least 3 weeks preceding the cardioversion, and both patients in the warfarin group had an INR value >2 when thromboembolic complications occurred. Clinically relevant bleeding events occurred in 3 patients (0.5%) receiving NOACs and 7 patients (1.8%) receiving warfarin. Anticoagulation treatment was altered for 99 patients (11.0%) during the study period, with the majority (88.2%) of changes from warfarin to NOACs.

Conclusion
In this real-life study, the rates of thromboembolic and bleeding complications were low in AF patients undergoing ECV. Patients receiving NOAC therapy had a shorter time to cardioversion and fewer postponements of scheduled elective cardioversion compared with warfarin. Furthermore, patients receiving NOAC therapy had less anticoagulation treatment changes than patients on warfarin.

Acknowledgement/Funding
Finnish Foundation for Cardiovascular Research, Helsinki University Hospital District research fund, Boehringer-Ingelhem, Finnish Medical Foundation
P1906Modified frailty as a novel factor to predict the effectiveness of electrical cardioversion of atrial fibrillation in the elderly population
Authors: Mlynarska A , Mlynarski R , Marcisz C , Golba K S 
Published: October 2019

Abstract

Electrical cardioversion is one of the recognized methods of treatment of atrial fibrillation (AF)/maintenance of sinus rhythm. There are no factors that allow to predict the response to electrical cardioversion in the elderly population. Frailty is a common geriatric syndrome that embodies an elevated risk of catastrophic declines in health and function among older adults – we hypothesized that frailty can be a factor to predict the effectiveness electrical cardioversion.

Methods
199 consecutive patients over 60 years (average age 71.41±6.99; 40.2% W) with AF hospitalized due to electrical cardioversion. The follow-up period for maintenance of sinus rhythm was 180±14 days. The Tilburg Frailty Indicator was used to examine the frailty before cardioversion. A global score of 5 points or more let us to respond the frailty syndrome.

Results
174 patients out of 199 (87.4%) were found to have electrical cardioversion be effective. Frailty was recognized in 68 out of the 199 (34.17%). There was 66.2% (45/68) effectiveness in the frailty-affected group, whereas there was 99.2% (130/131) in the robust group; p=0.ehz748.0653. 87.9% patients have maintenance sinus rhythm after 6 months; in the frailty affected group it was 75% vs 94.6% in robust group; p=0.ehz748.0653. In the logistic regression, frailty (OR: 0.41, 95% CI: 0.2870–0.0,5851; p<0.0001) was emerged as an independent predictor of effectiveness of electrical cardioversion. The ROC curves for frailty in the effectiveness electrical cardioversion are presented in the figure below – left panel. The area under the curve is 0.856 (95% CI - 0.799–0.902). The cutoff value for a frailty recognition was 4 (p<0.0001). Similarly, in the logistic regression, frailty (OR: 0.65, 95% CI: 0.5010–0.8330; p=0.0003) was also emerged as an independent predictor of maintenance sinus rhythm. The ROC curves for frailty in the maintenance of sinus rhythm are presented in the figure – right panel. The area under the curve is 0.718 (95% CI - 0.650–0.779). The cutoff value for a frailty recognition in this case was also 4 (p<0.0001).
ROC curves

Conclusion
Frailty is a novel, independent factor that can be used to predict the effectiveness of electrical cardioversion and maintenance of sinus rhythm in the elderly population. Modifying the level of recognition in the Tilburg Frailty Indicator to a 4, improve the prediction of effectiveness of electrical cardioversion as well as maintenance of sinus rhythm.
P1911The impact of pulmonary vein morphology and orientation on the outcomes of cryoballoon ablation in patients with paroxysmal atrial fibrillation
Authors: Chichkova T Y U , Mamchur S E , Kachurina E N 
Published: October 2019

Abstract

Background
Circumferential contact of cryoballoon and pulmonary vein (PV) ostium is an important factor for pulmonary vein isolation (PVI). PV ostium shape and orientation can make challenges for PV occlusion.

Purpose
We aimed to assess the impact of pulmonary vein morphology and orientation on cryoablation outcomes in patients with paroxysmal AF.

Material and methods
The single-center prospective study included 122 patients (males: 46.7% (57), mean age 57 (53; 62) with drug-refractory paroxysmal AF. The mean AF duration was 4 years (2; 4). A multislice cardiac computed tomography (MSCT) was performed prior to CBA in order to evaluate the PV anatomy (maximal and minimal ostium diameters, ovality of PV ostium, angle of PV orientation in the frontal and axial plane (Figure1)). The presence of typical anatomy (4 separate ostia of PVs) was inclusion criteria. Procedures were performed with 28-mm second generation balloon. A procedural endpoint was the achievement of PVI. Outcomes of PVI were defined as freedom from any AF episodes documented by ECG from the end of blanking period to 12 months.

Results
PVI was achieved in 97.5% of PVs (476/488). Freedom from AF was 78.7%. Difficult occlusion of right inferior PV was observed in 12 patients and associated with a more horizontal PV orientation in the frontal plane: −15.2±6.20 versus −26.5±6.3°, p<0.001. A total of 11 (9%) patients experienced transient phrenic nerve injury (PNI) during ablation of right superior PV (RSPV). PNI was associated with the maximum and minimum diameter of the RSPV 20.0–24.0 mm (OR=13,2; 95% CI: 3.4–51; p<0.05) and 17.5–20.0 mm (OR=12.5; 95% CI: 4.7–41.9; p<0.05), respectively. Patients with AF recurrence had significantly larger maximum and minimum diameters of left superior PV (LSPV): 18.8 versus 17.5 mm, p=0.048, and 13.4 versus 12.5 mm, p=0.05, respectively. Ovality of PV ostium was larger in the recurrence group: 0.36 versus 0.18, p=0.05.
Figure 1. Evaluation of PV orientation

Conclusions
Evaluation of PV morphology and orientation can be used to predict CBA results. AF recurrence was associated with larger diameters and ovality of LSPV ostium. More horizontal RIPV orientation was associated with difficult PV occlusion. RSPV morphology can affect safety of procedure.
P1920Long-term outcomes of pulmonary vein isolation using second-generation cryoballoon during atrial fibrillation ablation: A single-center large-scale study
Authors: Canpolat U , Kocyigit D , Yalcin M U , Coteli C , Sener Y Z , Oksul M , Gurses K M , Evranos B , Yorgun H , Aytemir K 
Published: October 2019

Abstract

Background
Currently available second-generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exists about 1-year outcomes of CB2 ablation, data on long-term outcomes are scarce. Objective: We aimed to assess the long-term outcomes of PVI using CB2 in a large-scale symptomatic AF population at our tertiary referral center.

Methods
In this non-randomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa) free survival was defined as absence of AF, atrial flutter or atrial tachycardia recurrence >30 s following 3-months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models.

Results
Acute procedural success rate was 99.8% (1898/1902 PVs). Mean procedural and fluoroscopy time were 64.9±9.2 and 12.1±2.6, respectively. At median 39 (IQR: 26–56) months follow-up, ATa free survival was 78.6% after a single procedure (280/345 [81.2%] for paroxysmal AF vs 102/141 [72.3%] for persistent AF, p=0.019) and 84.4% after a mean 1.48±0.42 ablations.Cox regression analysis showed that left atrium diameter, duration of AF history and early ATa recurrence were found as the independent predictors of late recurrence. PNP was observed in 17 (3.5%) patients.
Figure 1

Conclusions
Second-generation CB based PVI is effective to maintain sinus rhythm in a significant proportion of paroxysmal and early persistent AF patients with an acceptable complication rates at long-term follow-up.
P1928Global telemedicine initiatives for combating ami
Authors: Mehta S , Botelho R , Niklitzchek S , Fernandez F , Cade J , Prudente M , Dusilek C , Hamdan N , Hurtado E , Lacativa M , Ceschim M , Torres M A , Vieira D , Pisana L , Quintero S 
Published: October 2019

Abstract

Background
Major disparities exist between developed and developing countries in Acute Myocardial Infarction (AMI) outcomes. Telemedicine has emerged as a powerful, cost-efficient, and scalable tool for population-based AMI management. We propose efficient telemedicine protocols as frontline AMI strategies for resource-constrained developing countries.

Purpose
To create a global template of using telemedicine protocols for treating AMI.

Methods
A hub and spoke strategy was utilized for Latin America Telemedicine Infarct Network (LATIN) to expand access in Brazil, Colombia, Mexico, and Argentina. Small clinics and primary care health centers in remote areas were strategically connected with 24/7 primary PCI facilities. Experts at 4 remote sites provided urgent EKG diagnosis and tele-consultation that triggered ambulance dispatch and implementation of standardized AMI protocols.

Results
784,947 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). With this expanded geographic reach, 8,448 (1.08%) patients were diagnosed with STEMI and 3,911 (46.3%) urgently reperfused, including 3,049 (78%) with Primary PCI. Time to Telemedicine Diagnosis (TTD) was 3 min, tele-accuracy 98.9%, D2B 51 min, and in-hospital mortality 5.2%. Major reasons for non-treatment were insurance denials, lack of ICU beds and chest pain >12 hours.

Conclusions
LATIN demonstrates the feasibility of a population-based and telemedicine guided AMI strategy that can hugely expand access. Telemedicine has important public health implications as a global approach to AMI care in developing countries.
P1932Predictors of DAPT use in patients beyond 1 year post myocardial infarction: Insights from the TIGRIS observational study
Authors: Russo J J , Yan A T , Pocock S J , Brieger D , Owen R , Andersson Sundell K , Granger C B , Cohen M G , Yasuda S , Nicolau J C , Brandrup-Wognsen G , Westermann D , Simon T , Goodman S G 
Published: October 2019

Abstract

Background
International guidelines vary in their recommendations for dual antiplatelet therapy (DAPT) use beyond 1 year post-myocardial infarction (MI).

Purpose
To identify predictors of DAPT use in patients ≥1 year post-MI prior to the publication of the DAPT score and the 2017 European Society of Cardiology (ESC) guidelines for DAPT in coronary artery disease.

Methods
TIGRIS (NCT01866904) was a prospective, multi-center (369 centers in 25 countries), observational study of patients 1 to 3 years post-MI between June 2013 and November 2014. We performed a multivariable logistic regression analysis to identify independent predictors of DAPT use at 396 days post-MI (365 + 31 days overrun period to allow intended DAPT discontinuation at 1 year). Patients on oral anticoagulation were excluded.

Results
Of 8464 patients enrolled (mean age 66 years, women 24%, ST-elevation MI 53%), 40% were on DAPT at 396 days post-MI (Figure). In the subset of patients on DAPT at 396 days post-MI, aspirin was combined with clopidogrel in 84%, prasugrel in 12%, and other antiplatelet agents in 4%. DAPT use at 396 days post-MI was independently associated with geographic region, age, PCI for the index MI, and a history of multivessel disease or angina (Table). Several variables included in the DAPT score and ESC guideline recommendations (diabetes, second prior MI, hypertension, peripheral artery disease, heart failure, smoking, and renal insufficiency) were not independent predictors of DAPT use at 396 days.
Independent predictors of DAPT @396 days Variable at enrolment Patients Odds ratio (95% CI) P-value Region: Europe 3813 Reference group 0.01 North America 923 1.65 (0.56, 4.86) Latin America 1084 2.55 (1.19, 5.47) Asia and Australia 2644 3.01 (1.42, 6.36) Age <65 years 3274 1.15 (1.04, 1.28) 0.005 PCI for index MI 6925 2.08 (1.82, 2.38) <0.0001 Multi-vessel disease 5598 1.37 (1.24, 1.52) <0.0001 History of angina 829 1.46 (1.24, 1.71) <0.0001
DAPT use at 396 days post-MI by region

Conclusion
During the study period, DAPT use ≥1 year post-MI was prevalent and appeared to be influenced by regional practices. Further research is needed to determine whether the DAPT score and the 2017 ESC guidelines for dual antiplatelet therapy have changed long-term DAPT use practices.

Acknowledgement/Funding
AstraZeneca AB, Södertälje, Sweden
P1933Comparing treatment recommendations for the DAPT and PRECISE-DAPT scores after percutaneous coronary intervention
Authors: Boudreau R , Fu A , Barry Q , Perry-Nguyen D , Tran U , Simmard T , Le May M , Labinaz M , Dick A , Glover C , Froeschl M , Hibbert B , Chong A Y , So D 
Published: October 2019

Abstract

Background
Dual antiplatelet therapy (DAPT), with aspirin and a P2Y12 inhibitor, is the standard therapy for patients following PCI. Duration of treatment with DAPT has been controversial despite large studies. Current guidelines recommend treatment duration be individualized based on risk of ischemia and bleeding. To facilitate treatment decisions, risk assessment tools, including the DAPT and PRECISE-DAPT scores, have been developed.

Purpose
As components of these scores differ, the variability of recommendation remains unknown. We set to evaluate inter-tool concordance in treatment recommendation in a cohort of patients after PCI.

Methods
Using data from our local PCI registry, we calculated the PRECISE-DAPT at baseline following PCI and the DAPT after 1 year of treatment for 311 consecutive patients with complete data for both scores to be calculated. Based on their DAPT and PRECISE-DAPT scores, patients were grouped into concordant for long-term treatment (DAPT ≥2 and PRECISE-DAPT <25) or concordant for shortened treatment (DAPT <2 and PRECISE- DAPT ≥25). All other patients were considered discordant. We then performed a concordance analysis using Cohen's kappa to measure degree of agreement.

Results
Among the 311 patients, mean age was 63.4 (SD 11.6); 245 (79%) were men, 93 (29.9%) had history of a prior MI, 130 (41.8%) were current smokers, 32 (10.3%) had a history of CHF or LVEF <30%, 82 (26.3%) had diabetes and 196 (63.0%) were previously diagnosed with hypertension. Index event consisted of a STEMI in 101 (32.4%), NSTEMI in 93 (29.9%), unstable angina in 27 (8.7%), stable angina in 67 (21.5%) and the remaining 23 (7.4%) had other indications for PCI. Mean DAPT score was 1.52 (SD 1.37). Mean PRECISE-DAPT was 17.65 (SD 12.73). The DAPT recommended long-term treatment for 162 (52.1%) and shortened treatment for 149 (47.9%). The PRECISE-DAPT recommended long-term treatment for 245 (78.9%) and shortened treatment for 66 (21.2%). The overall proportion of agreement between the two risk scores was 56.6% with a Cohen's kappa index of 0.110 (95% CI, 0.017 to 0.204). See Table.
Concordance Analysis PRECISE-DAPT Score Recommendation Long Term (N=245) Shortened (N=66) DAPT Score Recommendation Long Term (N=162) 136 (43.7%) 26 (8.4%) Concordant for Long Term Treatment Shortened (N=149) 109 (35%) 40 (12.8%) Concordant for Shortened Treatment

Conclusion
Comparison of the DAPT score and the PRECISE-DAPT score showed concordance in treatment recommendation in only 56.6% of patients. Given the poor agreement between these tools, prospective concurrent evaluations and correlation to outcomes will be required in future studies.
P1946Hypertension prevalence, awareness, treatment and control and 10-year estimated CVD risk in East and West Africa: pooled analysis of data from 4 African countries
Authors: Samson O , Muhihi A , Mohamed S , Ameh S , Ochimana C , Oluwasanu B , Bolarinwa A O , Sewankambo N , Danaei G 
Published: October 2019

Abstract

Background
Though the prevalence of hypertension is rising in Sub-Saharan Africa, few studies have characterized the epidemiology and management of hypertension across many heterogeneous communities. We assessed prevalence, awareness, treatment and control of hypertension and estimated the 10-year cardiovascular risk across six sites in East and West Africa.

Methods
Between June and August 2018, we conducted household-based surveys in 6 rural, semi-urban and urban settings in Kenya, Nigeria, Tanzania and Uganda to enroll community-dwelling adults (aged >18 years) collect data including age, gender, smoking, anthropometric measures, health insurance, utilization of health care facilities. We defined hypertension as systolic blood pressure of at least 140 mm Hg, or diastolic blood pressure of at least 90 mm Hg, or self-reported antihypertensive medication use. We used country specific Globorisk prediction equations to estimate 10-year CVD risk.

Results
A total 3,150 participants with a mean age of 40 years (SD 15), 61% of whom were women, 8% had ever smoked, and 33% were overweight/obese. About 23.7% (95% CI 22.2, 25.2) of the entire sample had hypertension, of whom 60.6% (56.8, 64.3) were diagnosed. Among diagnosed, 61.7% (57.2, 66.1) were taking antihypertensives, and 27.7% (22.7, 33.1) had controlled BP. The prevalence of hypertension was 38.6% in Ikire-Nigeria, 25.1% Ukonga-Tanzania, 23.3% in Oyo-Nigeria, 21.6% in Okpok-Nigeria, 20.4% in Soroti-Uganda, and 9.7% in Viwandani-Kenya. The overall median estimated 10-yr CVD risk was low 4.6% IQR (2.3, 9.6) and 8.6% had 10-yr CVD risk >10%. (Figure 1)

Conclusion
Among African adults aged >18 years, nearly a quarter have hypertension, three in 5 being treated, and fewer than three in ten had BP under control. The low number of people in control is ubiquitous in all sites and warrants greater prevention strategies, better screening and more effective and affordable treatment options than what is currently available.
P1951Serial left ventricular global longitudinal strain and mortality in patients with Takotsubo cardiomyopathy
Authors: Isaza N , Alashi A , Faulx J , Popovic Z B , Menon V , Faulx M , Griffin B P , Desai M Y 
Published: October 2019

Abstract

Background
Recent studies on Takotsubo cardiomyopathy (TC) have challenged the common conception that it is a relatively benign condition with functional recovery observed in the majority of cases. However, it is important to recognize that overt functional recovery might not reflect the true regional recovery, which might have an adverse impact on survival.

Objective
We sought to assess baseline and follow-up left ventricular function characteristics and their impact on longer-term mortality in patients presenting with documented Takotsubo cardiomyopathy (TC) at a tertiary centre.

Methods
339 patients (66±14 years, 88% women) presented to our centre between 2006 and 2018 with acute anginal symptoms and were subsequently diagnosed with TC following clinical and angiographic evaluation. All patients returned for a follow-up evaluation including transthoracic echocardiography (TTE). Baseline and follow-up (3–6 months after TC diagnosis) LV ejection fraction (LVEF) and LV global longitudinal strain (LV-GLS using velocity vector imaging) were recorded on TTE. The primary endpoint was longer-term mortality.

Results
Hypertension, dyslipidaemia, and diabetes were present in 71%, 56%, and 26% of patients. Baseline mean troponin I peak, LVEF and LV-GLS were 0.9±7 ng/ml, 36±9%, and 11±3%; respectively. 94% had baseline LVEF<50%, 272 (80%) had apical ballooning, and 94% had LV-GLS worse than −18%. No patient had angiographically obstructive coronary artery disease. At 3–6 months follow-up, mean LVEF, and LV-GLS improved to 57±9% and 16±3%, respectively. 87% of patients had LVEF >50%, but in 70% LV-GLS remained worse than −18%. After 3.3±3 years, 72 patients (21%) died. On multivariable Cox survival analysis (adjusted for age, gender, baseline troponin peak and follow up LVEF), follow up LV-GLS was independently associated with longer-term mortality (hazard ratio 1.12 [95% confidence interval 1.05, 1.20], p<0.001). Significantly more patients with follow up LV-GLS worse than −18% died vs. those with LV-GLS better than −18% (57/237 [24%] vs. 15/102 [15%], log-rank statistic p-value 0.01, Kaplan-Meier figure 1).
Kaplan-Meier curve of freedom from death

Conclusions
In this large single-centre study of patients with documented TC (majority women), 87% recovered LVEF at 3–6 months, but in 70% LV-GLS remained worse than −18%, which was independently associated with higher longer-term mortality.