bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6226Association of functional iron deficiency with incident cardiovascular diseases and mortality in the general population
Authors: Schrage B , Ruebsamen N , Thorand B , Koenig W , Soederberg S , Wahlin A , Mathiesen E , Njolstad I , Kee F , Linneberg A , Kuulasmaa K , Salomaa V , Blankenberg S , Zeller T , Karakas M 
Published: October 2019

Abstract

Background
Functional iron deficiency (FID) has been established as a risk factor in patients with cardiovascular diseases (CVD). As opposed to absolute iron deficiency, it reflects stored iron as well as utilized iron and allows for a more accurate evaluation of individual iron status. However, evidence is scant on the relevance of FID to the incidence of CVD in the general population.

Aim
This study aimed to evaluate the association of FID with incident cardiovascular diseases and mortality endpoints in a large population-based cohort.

Methods
FID was defined as either ferritin below 100 μg/L or ferritin between 100 and 299 μg/L and transferrin saturation below 20%. Only individuals free of CVD at baseline from three population-based European cohorts were included. Multivariable-adjusted sex- and cohort-stratified Cox regression analyses were performed to evaluate the association of functional iron deficiency with incident cardiovascular diseases (coronary heart disease, cerebral infarction, heart failure and atrial fibrillation) as well as with all-cause and cardiovascular mortality. Adjustments were performed for sex (as strata), age (as time scale), smoking, total cholesterol, systolic blood pressure, diabetes, body mass index and high-sensitive C-reactive protein.

Results
In total, N=12146 individuals were included in the analysis with a median age of 59.0 years (25thpercentile 45.0, 75thpercentile 68.0), and 45.2% men. Incidence of FID was 64.3%. Median follow-up times were 12.3 to 21.8 years, with an all-cause mortality rate of 18.2% and a cardiovascular mortality rate of 6.2%. Incident coronary heart disease, cerebral infarction, heart failure and atrial fibrillation were observed in 8.7%, 6.5%, 5.9% and 11.7%, respectively.
FID was significantly associated with all-cause mortality (hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.01–1.24, p=0.034), cardiovascular death (HR 1.26, 95% CI 1.03–1.54, p=0.027) and incident coronary heart disease (HR 1.23, 95% CI 1.06–1.43, p<0.01). There was no significant association with the other tested endpoints.

Conclusion
In our analysis of population-based cohorts, FID showed a significant positive association with all-cause as well as cardiovascular mortality and incident coronary heart disease. Further research is needed to validate the role of FID as a cardiovascular risk factor in the general population and to evaluate the impact of iron supplementation on gender and outcome.
P6233The association between ideal cardiovascular health behavior and long-term risk profile and outcomes
Authors: Benderly M , Abu-Saad K , Kalter-Leibovici O 
Published: October 2019

Abstract

Background
Health behaviors are important contributors to cardiovascular health (CVH) across populations. Little data exist regarding the association between attaining health behavior goals and long-term health outcomes.

Methods
Ideal CVH behaviors (no tobacco smoking, normal body mass index, engagement in leisure physical activity and healthy dietary habits) based on the American Heart Association definition, were evaluated in a random Israeli population sample (N=1079) stratified by sex, ethnicity (Arabs and Jews) and age (range: 25–74 years). Negative binomial models were used for testing associations with health service utilization counts and the Cox proportional hazard models for the associations with major adverse cardiovascular events (MACE) and mortality. Median follow-up was 15.6 years (interquartile [IQ] rage: 12.9–16.1) for mortality and 9.7 (IQ range: 7.7–10.2) otherwise.

Results
None of the participants had all four ideal health behaviors at baseline, 68 (6%) had three, 308 (28%) had two, 547 (51%) had one, and 156 (14%) had none. Mean [standard deviation; SD] participant age was 49 [12], 51 [14], 52 [15] and 47 [15] for participants with 0, 1, 2 and 3 ideal health behaviors, respectively. With each additional ideal health behavior, the prevalence of male (range: 83% of subjects with no ideal behaviors to 40% of subjects with three), Arab (61% to 21%) and married (92% to 65%) participants decreased, and the prevalence of participants with higher socioeconomic determinants increased. A higher number of ideal health behavior was associated with lower baseline diastolic blood pressure (mean [SD]: 82 [9] mmHg for none, to 76 [9] mmHg for three ideal behaviors), and a more favorable baseline lipid profile. Adjusting for age, sex, ethnicity, marital status, education years, professional prestige and comorbidities (Charlson index), each additional ideal health behavior was associated with reduced risk of developing diabetes (Hazard Ratio [HR]: 0.73, 95% confidence interval [CI]: 0.58–0.91), hypertension (HR: 0.86, 95% CI: 0.71–1.03) and dyslipidemia (HR: 0.85, 95% CI: 0.74–0.98). Controlling for the same variables, the addition of one ideal health behavior was associated with fewer hospitalizations (rate ratio [RR]: 0.80; 95% CI: 0.69–0.93), and cardiology clinic visits (RR: 0.88; 95% CI: 0.75–1.03). The hazard ratio was 0.84 (95% CI: 0.62–1.14) for MACE and 0.82 (95% CI: 0.66–1.03) for all-cause mortality.

Conclusion
Attainment of all four cardiovascular health behaviors goals is rare across the population. A higher number of ideal health behaviors is associated with a lower risk of long-term diabetes, hypertension and dyslipidemia, fewer health service utilizations and a lower MACE and mortality risk.
P6238International cardiovascular disease risk calculators do not identify high risk in young hodgkin lymphoma survivors
Authors: Piddock K , Britton F , Goode V , White E , Greenstein A , Linton K M , Radford J 
Published: October 2019

Abstract

Background
Cardiotoxic therapy causes significant morbidity and mortality in patients (pts) treated for Hodgkin lymphoma (HL). Cardiovascular (CVS) risk calculators do not include cancer therapy despite epidemiological data demonstrating increased risk. We have assessed modifiable CVS risk factors and predicted risk of CVS disease in a cohort of HL survivors.

Hypothesis
Cardiovascular risk calculators will not identify high risk in young HL survivors.

Methods
Pts now aged ≤50 treated with doxorubicin and/or radiotherapy (RT) to cardiac tissue for HL >5 years ago were identified. Telephone review of CVS risk factors was offered to pts taking statins or already diagnosed with cerebrovascular or CVS disease. Remaining pts were offered clinical review to assess BMI, blood pressure, cholesterol and HbA1c. Carotid-radial pulse wave velocity (PWV) was measured if available. CVS risk was predicted using international risk calculators (European SCORE, QRISK3, Framingham).

Results
160 eligible pts were identified. Median age was 43 years (26–50) and 52% were female. Median time since treatment was 182 months (61–367). Pts received doxorubicin (n=150), with RT (n=97) or RT alone (n=10). Pts were excluded from study due to severe medical condition (n=8), recurrence (n=1), relocation (n=3) or death (n=1). Data were gathered at clinical review (n=70) or telephone review (n=26). Existing cardiovascular diagnoses included hypertension (n=5), transient ischaemic attack (n=2), valvular disease (n=3), heart failure (n=1), atrial fibrillation (n=2), complete heart block (n=1) and coronary artery disease (n=1).
At clinical review 51% pts had 3 or more modifiable risk factors with a median of 3 (0–5) per pt. Total cholesterol was >5.0 mmol/L in 58% of patients with a median of 5.2 mmol/L (3.2–8.6). Median systolic blood pressure was 125.5 mmHg (103–164). Median body mass index was 26.3 kg/m-2 (18.6–56.1) with 60% of patients classed as overweight or obese.Advice was offered to all smokers (9%), pts that drank alcohol above UK recommended levels (20%) or exercised below the recommended amount (60%). Risk calculators classified 1.4% (QRISK3) and 10% (Framingham) of pts at high risk of CVS disease and 0% (European SCORE) at high risk of CVS mortality. Pulse wave velocity measured in 34 pts was elevated (>8 m/s) in 76% of cases with a median 10.2 m/s (2.3–16.8).

Conclusions
Numerous modifiable CVS risk factors were identified in an HL survivor population known from epidemiological studies to be at high risk of CVS morbidity/mortality. None of the CVS risk calculators identified this high risk. Intriguing data indicate PWV may represent an accessible early indicator of CVS dysfunction. These data prompt comprehensive assessment and management of CVS risk factors in cancer survivors and review of the use of risk calculators in this population.

Acknowledgement/Funding
The Christie NHS Foundation Trust
P6241Two-year clinical outcomes of biodegradable polymer versus durable polymer drug-eluting stent implantation in hemodialysis patients after percutaneous coronary intervention
Authors: Okuno S , Ishihara T , Iida O , Asai M , Masuda M , Okamoto S , Nanto K , Kanda T , Tsujimura T , Matsuda Y , Hata Y , Uematsu H , Sato Y , Mano T 
Published: October 2019

Abstract

Background
Biodegradable polymer drug-eluting stent (BP-DES) has been developed to improve clinical outcomes after percutaneous coronary intervention (PCI) for patients presenting coronary artery disease (CAD). Although BP-DES showed non-inferior safety and efficacy to durable polymer DES (DP-DES) in several randomized clinical trials, hemodialysis (HD) patients, who have been well known as high risk population for adverse events, were excluded in the most of trials. Therefore, there are limited data comparing the clinical outcomes between BP-DES and DP-DES in HD patients with CAD after PCI.

Purpose
The purpose of this study was to investigate clinical outcomes in HD patients after BP-DES implantation compared with those after DP-DES implantation.

Methods
We retrospectively analyzed 234 HD patients (male 74%, mean age 71±10 years) undergoing PCI for 404 lesions with 472 DESs (71 patients for 138 lesions with 170 BP-DESs [91 Ultimaster and 79 Synergy] and 163 HD patients for 266 lesions with 302 DP-DESs [219 Xience, 53 Promus and 30 Resolute]) from 2011 to 2017. Two-year clinical outcomes were compared between BP-DES group and DP-DES group. The primary outcome measure was the incidence of target lesion revascularization (TLR), while the secondary outcome measures were the occurrence of cardiac death (CD), stent thrombosis (ST), myocardial infraction (MI), target vessel revascularization (TVR), non-TVR and major adverse cardiac event (MACE) defined as a composite of CD, MI, and TVR. Outcome measures were estimated by the Kaplan-Meier method and the differences between BP-DES group and DP-DES group were assessed by the log-rank test. We also conducted Cox's proportional hazard model to identify predictors for TLR occurrence.

Results
Baseline patient and lesion characteristics were similar between the two groups. The two-year incidence of TLR was not significantly different between BP-DES group and DP-DES group (14.1% vs. 22.2%, p=0.391). The two-year incidences of CD (17.3% vs. 17.5%, p=0.381), ST (0% vs. 3.9%, p=0.133), MI (4.2% vs. 5.8%, p=0.965), TVR (21.3% vs. 27.5%, p=0.586), non-TVR (26.1% vs. 31.3%, p=0.439) and MACE (41.1% vs. 42.6%, p=0.526) were also not different between the two groups. After multivariate analysis, diabetes mellitus (hazard ratio 1.97; 95% confidence interval 1.03–3.78, p=0.004) was independently associated with TLR occurrence in HD patients.
Two-year clinical outcomes of HD patient

Conclusions
At two-year follow-up after PCI, BP-DES had comparable safety and efficacy profiles to DP-DES in HD patients presenting CAD.

Acknowledgement/Funding
None
P6242Left ventricular global longitudinal strain to predict pulmonary edema in chronic kidney disease patients on haemodialysis
Authors: Meenakshi K , Rameshwar R 
Published: October 2019

Abstract

The left ventricular (LV) function remains preserved in the majority patients with chronic kidney disease (CKD). Despite this, Pulmonary edema can still occur in CKD patients with preserved ejection fraction during or after haemodialysis.
The aim of our study was to determine whether assessment of Left ventricular global longitudinal strain (LV GLS) in CKD patients, could be used to detect sub clinical LV dysfunction and hence the propensity to develop pulmonary edema during or post hemodialysis.
Our study cohort consisted of 105 CKD patients with normal Ejection fraction by transthoracic Echocardiography (TTE) and undergoing haemodialysis. There were 38 females and 67 males, ages ranging from 23 to 63yrs. They underwent detailed evaluation and assessment of risk factor profile, particularly the presence of hypertension and Diabetes. The Ejection fraction, presence of left ventricular hypertrophy (LVH), Left ventricular diastolic dysfunction (LVDD) and the LV GLS were assessed by TTE. Based on the findings, the male and female patients were divided into 3 groups. Group A with a GLS <−15, Group with a GLS between −15 and −18 and group C with GLS >−18. In group A, 81.1% of the males and 86.7% of the females developed pulmonary edema in contrast to 13% and 21.1% and 14.3% and 0% in groups B and C respectively. When LVDD was compared to the LV GLS it was found that in Group A, 80% of the males, and 88.2% of the females with LVDD developed pulmonary edema in contrast to 7% and 20% in group B and 0% and 0% in Group c respectively who had LVDD and developed pulmonary edema. In spite of having a normal LV diastolic function 100% of the males in group A developed pulmonary edema. Further, 92.8% of the males and 80% of the females in group B did not develop pulmonary edema despite having LVDD. So from our study, a cut of LV GLS value of −15 could predict pulmonary edema in CKD patients undergoing hemodialysis and although the majority were associated with LVDD, it could occur even in the absence of diastolic dysfunction. Further at LV GLS values >−15, the incidence of pulmonary edema was statistically significantly less despite having LVDD.

Conclusion
Left ventricular GLS appears to be a more reliable method than LVDD for predicting the occurrence of pulmonary edema during or post haemodialysis in CKD patients with normal LV Function, A LV GLS <15 would indicate the necessity for the implementation of appropriate precautions to prevent the occurrence of the same during dialysis. It can also be used in the long term follow up of patients.
P6247Comparative analysis for the implication of serum cardiac troponin measurements by conventional versus high-sensitivity assays in patients with traumatic brain injury
Authors: El-Menyar A , Al-Thani H 
Published: October 2019

Abstract

Background
Stress-induced myocardial injury is not well-studied in patients with head injury.

Objective
To assess the prognostic implication of positive (+ve) Troponins (Tn) measurements by conventional (CTn) versus High-Sensitivity (HsTnT) assay in patients with traumatic brain injury (TBI).

Methods
A retrospective analysis was conducted for patients who were admitted with TBI between 2010 and 2014. Patient demographics, clinical presentation, troponin assay results, TBI lesions, and hospital outcomes were analyzed and compared based on troponin assay (CTn versus HsTnT).

Results
Across the study period, 946 patients withTBI were admitted; of them 654 had troponin levels measured within 24 h post-injury (CTn=252 and HsTnT=402). The mean age was 31 years and 46% had positive troponins. There were 147 deaths (22.5%); of them 54% had +ve HsTnT, 23% had +ve CTn, 16% had –ve CTn and 7% had –ve HsTnT). When the troponin was tested ≤4h post-injury, the mortality was 10.2% in patients with –ve CTn and 4% in patients with –ve HsTnT. There was no documented obvious direct cardiac injury. Overall, patients with positive troponins had lower Glasgow Coma Scale (GCS), higher Injury Severity Scores and higher rates of brain edema (p=0.001), pneumonia and sepsis (p=0.001) than those with negative troponin results. In two different models, multivariate regression analysis showed that +ve CTn and +ve HsTnT were independent predictors of mortality (OR 3.94, 95% CI: 1.65–9.42) and (OR 3.39; 95% CI 1.39–8.36); respectively, after adjusting for age, injury severity scores, GCS, TBI type, neurosurgical intervention, sepsis, and chest injury.

Conclusion
Stress-induced myocyte injury is high in TBI. Positive serum troponins, irrespective of the assay type, are associated with poor outcomes post-TBI. Positive HsTnT could be used for early risk stratification and prognosis in brain injury. Further studies are needed to support our findings.
P6258Direct oral anticoagulants in non-valvular atrial fibrillation: accuracy of traditional bleeding scores in the elderly
Authors: Novello S , Graceffa A , Ninivaggi C , Greco G I , Bonfante F , Di Stasio F , Zambotti E , Zorzi A , Tavian T , Sartori M , Occhipinti G , Granziera S , Nante G , Sergi G , Manzato E 
Published: October 2019

Abstract

Background
Due to the fear of increased risk of bleeding, anticoagulation treatment is underutilized in the prevention of stroke in elderly patients with non-valvular atrial fibrillation (NVAF). Although direct oral anticoagulants (DOAC) are safer than VKA, still little is known about the risk factors associated with bleeding in elderly patients treated with DOAC. Furthermore, it is still uncertain whether the risk scores that are currently used can serve to effectively identify higher bleeding risk in elderly subjects.

Purpose
The aim of this study was to identify predictors of bleeding in a cohort of elderly people affected by NVAF treated with DOAC, and to evaluate the accuracy of risk scores for bleeding used at present.

Methods
Data on outpatients aged ≥75 years, naïve for DOAC therapy, who started therapy with Dabigatran, Rivaroxaban, Apixaban or Edoxaban for the prevention of thromboembolism during FANV were analyzed. HASBLED, ATRIA, OBRI and ORBIT scores were calculated for each patient. Patients had follow-up for 12 months during which deaths, therapy discontinuation and adverse events such as thromboembolism and bleeding were reported. Potential predictors of bleeding and the predictive value of each bleeding score were tested using univariate Cox regression; testing accuracy was evaluated using ROC curves.

Results
A total of 291 patients (52.9% female, mean age 82.85±5.18 years) had a median follow-up time of 11 (10–12) months. The incidence rate of major bleeding was 4.7 per 100 patient-years, the rate of intracranial bleeding was 0.4 per 100 patient-years. Patients who had major bleeding were more often affected by heart failure (63.6% vs 25%; p=0.009) and thrombocytopenia (36.4% vs 7.4%; p=0,009). However in the multivariate analysis only heart failure remained statistically associated with major bleeding (HR 3.83, 95% CI 1.06–13.85; p=0.041). None of tested bleeding risk scores was able to predict major bleeding in our cohort. HASBLED and ORBIT scores were able to predict major and non-major clinically relevant bleeding (HR 1.32; 95% CI 1.01–1.71; p=0.042 and HR 1.20; 95% CI 1.00- 1.43; p=0.046); only the ORBIT score was found to be statistically significant, but with weak discriminatory power at ROC curves (AUC 0.59; 95% CI 0.51–0.68; p=0.041).

Conclusions
In our cohort of elderly patients aged 75 or older, anticoagulated for NVAF, heart failure history was the only effective predictor of major bleeding risk during DOAC treatment. None of the bleeding risk scores used currently have demonstrated a good discriminatory power in our cohort. As predictive factors of bleedings in DOAC-treated patients may not be the same as those for VKA-treated patients and those in elderly may also be differ in younger people, it calls for more investigation on the topic.
P6259Unfavourable vascular risk profile of smokers with testosterone deficiency
Authors: Ioakeimidis N , Vlachopoulos C , Georgakopoulos C , Angelis A , Terentes-Printzios D , Sigala E , Rokkas K , Katsi V , Tousoulis D 
Published: October 2019

Abstract

Purpose
Testosterone deficiency and cigarette smoking are both associated with increased cardiovascular (CV) mortality risk. We examined whether vascular function and structure parameters are significantly impaired in smokers with low testosterone levels.

Methods
Carotid intima media thickness (cIMT) and aortic pulse wave velocity (aPWV) were measured in a total of 690 patients (mean 58±7 yrs) without manifest CV/atherosclerotic disease. All patients underwent exercise stress test (and coronary angiography) to reveal coronary artery disease (CAD). Plasma total testosterone (TT) levels were measured in all patients.

Results
Participants were divided into four subgroups according to smoking (yes/no) and measured low or normal TT levels (low TT<3.5 ng/ml). The subgroups had similar prevalence of hypertension and smoking and comparable LDL-C levels. The mean age of patients with low TT was greater than that of subjects with normal TT (P<0.05). Aortic PWV was significantly higher in smokers with low TT compared to smokers with normal TT (P=0.01) and non-smokers with either low TT (P=0.005) or normal TT (P<0.001) (left plot). Similarly, cIMT was significantly higher in smokers with low TT compared to smokers with normal TT (P=0.01) and non-smokers with either low TT (P=0.005) or normal TT (P<0.001) (right plot). All associations remained statistically significant after adjustment for age. Among smokers with low TT both aPWV and cIMT significantly increased with increasing cigarette smoking intensity (all P<0.05), whereas the associations between smoking intensity and either aPWV or cIMT were not significant among smokers with normal TT concentration (all P=NS). Interestingly, the prevalence of angiographically documented CAD was significantly higher among smokers with low TT (18%) compared to the CAD prevalence of the three other subgroups (overall P<0.001).
TT level, smoking and vascular profile

Conclusions
Carotid IMT and aortic PWV are significantly increased and the prevalence of angiographically documented CAD is greater in smokers with testosterone deficiency. Further studies should be conducted to evaluate how much of the unfavorable effect of both cigarette smoking and testosterone deficiency on coronary atherosclerotic burden is mediated by their associations with function and structure changes in the vascular wall.