bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1655Lung ultrasound B-lines in patients with acute heart failure and comorbidities
Authors: Gargani L , Zavagli M , Barbarisi G , Marchiani C , Bandini G , Moggi-Pignone A 
Published: October 2019

Abstract

Background
Lung ultrasound assessment of B-lines is a sonographic method for a semi-quantitative evaluation of extravascular lung water, that can be employed to asssess and monitor pulmonary congestion in acute heart failure.

Purpose
To assess the degree and changes in B-lines during hospitalization for acute heart failure, independently of the etiology, and their correlation with patients' comorbidities.

Methods
Two-hundred and forty-one complete antero-lateral B-lines assessments were recorded in an old population of 73 patients (mean age 83.0±7.6 years, 54.8% males) admitted with a diagnosis of acute heart failure (AHF). Chronic obstructive pulmonary disease (COPD) was present in 30% patients, chronic kidney disease (CKD) was present in 31% patients, a previously known cardiac condition was present in 73% of patients. B-lines were evaluated according to standard protocol at admission (T1), at 24 hours (T2), 48 hours (T3) and at discharge (T4). NT-proBNP was assessed at admission and at discharge.

Results
Mean antero-lateral B-lines at T1 were 42±39 with a statistically significant reduction at T3 (25±23, p<0.001) and at T4 (16±22, p<0.001), but not at T2 (37±38, p=0.41) (see figure), with high variability in the percentage of B-lines reduction among patients, at all time points, and with 34% of patients with still significant pulmonary congestion at discharge (≥15 B-lines). B-lines number and changes did not differ in patients with and without COPD, CKD, or a previously known heart/valvular disease. A weak, albeit significant correlation was found between the percentage of B-lines change between admission and discharge and total diuresis (R=-0.25, p<0.05), delta (T3 values - T1 values) glomerular filtration rate (R=0.30, p<0.05) and delta NT-proBNP (R=0.31, p<0.05).
Dynamic changes of B-lines over time

Conclusions
In older patients hospitalized with AHF with multiple comorbidities, B-lines are present at admission and significantly reduce at 48 hours, although with high variability among different patients at all time points, and persistent significant congestion at discharge in about one third of patients. Lung ultrasound B-lines provide a specific and dynamic information about the degree and changes of pulmonary congestion, which is additive to other patient's characteristics.
P1660Therapy treatment, adherence and persistence in chronic heart failure patients: a populaion study, from 2005 to TO 2012 in Lombardy
Authors: Scalvini S , Bernocchi P , Paganoni A M , Frigerio M 
Published: October 2019

Abstract

Background
The treatment with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), beta blocker (BB), and aldosterone antagonist (AA), adherence and persistence to therapies, improve clinical status, prevent hospital admission and reduce mortality in patients with chronic heart failure (CHF).

Purpose
To analyze adherence and persistence to indicated therapies.

Methods
We analyzed, from the Lombardy healthcare system administrative database, the discharge forms of patients with HF-related diagnosis, recorded from 2000 to 2012. We evaluated the adherence using the proportion of days covered (PDC≥80%) method, adjusted for hospitalisations. Medication persistence was identified as a duration of time from initiation to discontinuation of therapy. Patient was considered non-persistent if does non-refill medication within a period of 30 days.

Results
We considered 100,784 HF patients, mean (SD) age 74.54 (11.73) years: of them 636 patients were lost from database, 71,166 were alive (71.06%) and 28,982 did not survive (28.94%) at the end of the study. The mean (SD) number of hospitalizations were 2.16 (1.48) per patient (217,422 in total) and drug prescriptions were 12.28 (7.56) per patient (1,237.784 in total). 77% of patients were treated with ACEI/ARB, 64% with BB and 37% with AA. In the table, we reported the results on adherence and persistence measures.
Prescribed Therapy Total pts, No (%) Days covered, mean (SD) Adherent pts, No (%) Persistent pts, No (%) PDC (%), mean (SD) ACEI/ARB+BB+AA 20,831 (21%) 148 (102) 2,649 (13%) 2,068 (10%) 41 (28) ACEI/ARB+BB 33,617 (33%) 237 (110) 14,528 (43%) 11,165 (33%) 65 (30) ACEI/ARB+AA 9,327 (9%) 157 (107) 1,469 (16%) 1,149 (12%) 43 (29) AA+BB 3,070 (3%) 166 (105) 518 (17%) 386 (13%) 45 (29) ACEI/ARB 23,398 (23%) 270 (103) 13,487 (58%) 10,882 (47%) 74 (28) BB 6,806 (7%) 259 (105) 3,567 (52%) 2,782 (41%) 71 (29) AA 3,735 (4%) 204 (113) 1,133 (30%) 922 (25%) 56 (31) pts, patients.

Conclusions
Findings of this database analysis suggests that while treatment with ACEI/ARB and BB is in line of European Guideline, treatment with AA is very low. Despite recommendations, treatment with a combination of two or three HF drug classes decreases further. Adherence and persistence were moderate across all HF therapies of interest, although around 70% for ACEIs, BBs alone and in combination. This analysis evidences the need to understand the reasons for a limited use of the therapeutic guidelines and the need for much more work to improve adherence and persistence to therapy in CHF patients.
P1665Identifying metabolic treatment strategies for heart failure - A meta-analytic approach
Authors: Nguyen T D , Schenkl C , Schlattmann P , Heyne E , Doenst T , Schulze P C 
Published: October 2019

Abstract

Background
Current expert consensus suggests modulation of cardiac glucose oxidation (GO) or fatty acid oxidation (FAO) as a therapeutic approach for heart failure (HF). However, inconsistency exists and there is no systematic evidence supporting this concept.

Objective
We conducted a systematic review of preclinical studies to assess the role of metabolic treatment in HF. We aimed to identify, via meta-analytic techniques, specific metabolic strategies that potentially improve cardiac function.

Methods
We searched PubMed, Web of Science and reference lists of identified primary studies from inception to 31 December 2018. We included all interventional studies that assessed changes in cardiac function together with those in cardiac GO and/or FAO in established animal models of HF. Two investigators extracted study characteristics and data independently. We encompassed all available measures of cardiac function in the analysis instead of selecting one single outcome. Effect sizes were calculated as Hedges' g. We used I2 to estimate heterogeneity, metaregression to explore sources of heterogeneity and contour-enhanced funnel plot to assess publication bias.

Results
Our search returned 64 reports that fulfilled the inclusion criteria (n=1532 animals). The overall effect of treatments associated with metabolic changes was 0.78±0.16 g, p<0.001. There was a high heterogeneity (I2 = 86.7%) and no signs of publication bias. Metaregression revealed that treatments associated with an increase in GO (1.09±0.13 g, p<0.001) markedly enhance cardiac function. In contrast, those associated with decreased GO may worsen outcome. Although most experts suggest inhibiting FAO to improve cardiac function in HF, we found a beneficial result with a large total effect size for approaches that boost FAO (1.69±0.65 g, p<0.01).

Conclusions
Our data highlight the role of cardiac metabolism in treating HF. Specifically, increasing GO or FAO may considerably improve cardiac function. Furthermore, the findings challenge the common notion that inhibiting cardiac FAO is protective.
P1669Frequency and patterns of implantable cardiac defibrillator therapies in patients with ventricular assist devices
Authors: Gkouziouta A , Kogerakis N , Spartalis M , Kostopoulou A , Bonios M , Voudris V , Livanis E , Adamopoulos S 
Published: October 2019

Abstract

Purpose
Durable ventricular assist devices (VADs) use is a life-saving therapy in patients with end-stage heart failure. These patients are at high risk for ventricular arrhythmias. The pattern of ICD therapies in these patients is not well characterized.

Methods
Our single-center retrospective cohort included 86 patients with ICDs and VADs followed at our Centre. Data collected included frequency of ICD therapies, type of therapy (appropriate vs. inappropriate; shocks vs. anti-tachycardia pacing (ATP)), and time-course of therapies.

Results
36 patients (42%) received ICD therapy during a mean follow-up period of 13.6 months. There were 105 episodes (2.9 episodes/patient) during which ICD therapies were delivered, with a total of 379 individual arrhythmias treated (3.6 arrhythmias per episode of therapy). 61.4% of therapies were appropriate, 8.4% were inappropriate, and 31.6% were unknown. Of the 79 episodes treated with appropriate therapy, 36 episodes (46%) required ICD shocks, whereas 43 episodes (54%) were treated with ATP alone. Overall, 33% of the total cohort and 81% of patients who received therapy received at least one ICD shock. Twenty-two patients (61%) received therapy between 1–3 times, while the remainder (14 patients, 39%) received therapy 3–10 times. Eighteen (17%) episodes occurred within the first month after LVAD implantation, with 10 (10%) occurring between 1–3 months, 53 (50%) occurring between 3–12 months, and 24 (23%) occurring more than one year after VAD implantation.

Conclusion
Analysis of our VAD cohort revealed three important findings: 1. ICD therapy is very common (42%) in the first year especially after LVAD implantation; 2. Ventricular arrhythmias are highly clustered in this cohort; 3. ATP is frequently effective. These findings have important implications on device follow-up and programming for this expanding patient population.
P1671Subclinical persistent hemolysis may affect late renal function deterioration after HeartMateII implantation
Authors: Iwasaki K , Seguchi O , Mochizuki H , Kimura Y , Kumai Y , Kuroda K , Nakajima S , Watanabe T , Yanase M , Matsumoto Y , Fukushima S , Fujita T , Kobayashi J , Fukushima N 
Published: October 2019

Abstract

Background
Late renal function dysfunction is an increasingly recognized complication in continuous flow left ventricular assist device (CF-LVAD) patients. Although hemolysis is prevalent in CF-LVAD patients and hemolysis may deteriorate renal function, the influence of persistent hemolysis on renal function in CF-LVAD patients remains to be investigated.

Purpose
To investigate the influence of persistent hemolysis on renal function in CF-LVAD patients, using lactate dehydrogenase (LDH) as a sensitive marker of hemolysis.

Methods
Excluding patients who died or underwent pump exchange for pump thrombosis, we retrospectively reviewed 65 consecutive adults who underwent HeartMateII implantation in our center from May 2011 to October 2017. Patient characteristics, chronotropic change of estimated glomerular filtration rate (eGFR) and LDH values weekly for 4 weeks and every 4 weeks between 4 and 48 weeks after implantation were collected. Then, calculating mean LDH during 48 weeks after implantation, study population was divided into low and high mean LDH groups at the median value of mean LDH.

Results
The median value of mean LDH was 304 U/l. Compared with low LDH patients, though high LDH patients were more likely female and had smaller body surface area, there were no significant difference in pre-operative eGFR between the groups (66.0±23.7 vs. 70.2±25.7 ml/min/1.73m2, p=0.495). After 40 weeks after implantation, high LDH patients had significantly lower eGFR than low LDH patients (71.0±23.7 vs. 87.1±31.4 ml/min/1.73m2, p=0.024). In multivariate linear regression analysis, mean LDH [parameter estimate: −0.10 (95% CI: −0.17 to −0.04), p=0.003] and post-operative pulse pressure [parameter estimate: 0.71 (95% CI: 0.05 to 1.37), p=0.036] were significantly associated with eGFR change during 48 weeks after HeartMateII implantation.
Univariate and multivariate linear regression analysis for eGFR change Univariate parameter estimate 95% CI p value Multivariate parameter estimate 95% CI p value Bilirubin, mg/dl 9.97 3.82 to 16.13 0.002 6.55 −0.43 to 13.53 0.065 BNP, pg/ml 0.01 0.00 to 0.02 0.044 0.00 −0.01 to 0.01 0.528 Mean LDH during 4 to 48 weeks, U/l −0.11 −0.18 to −0.05 <0.001 −0.10 −0.17 to −0.04 0.003 Pre-operative right atrial pressure, mmHg 1.43 0.35 to 2.51 0.010 −0.06 −1.52 to 1.40 0.935 Post-operative pulse pressure, mmHg 0.77 0.03 to 1.52 0.042 0.71 0.05 to 1.37 0.036

Conclusions
High mean LDH and low pulse pressure were associated with a significant decrease in eGFR late after HeartMateII implantation. Subclinical persistent hemolysis may be associated with late renal function deterioration in CF-LVAD patients.
P1674High intensity interval exercise program in heart failure patients seems to benefit cardiac power along with aorto-ventricular mechanical pump capacity and cardiorespiratory indices
Authors: Chrysohoou C , Angelis A , Titsinakis G , Tsiachris D , Aggelopoulos P , Koulouris N G , Vogiatzis I , Tousoulis D 
Published: October 2019

Abstract

Background
Cardiac power has been suggested as the most power predictor of mortality in heart failure (HF) patients. In those patients aorta elastic properties and compensation is lost, systolic (and pulse) pressure are therefore reduced and associated with a decrease in ejection duration and pump efficiency. Cardiac rehabilitation programs have showed enhancement in cardiac performance and quality of life in HF patients.

Aim
Aim of this work was to evaluate the effect of high-intensity interval exercise (i.e., 30 sec at 100% of max workload, followed by 30 sec at rest, on a day-by-day 30 minutes working-out schedule for 12 weeks), on cardiac power, diastolic function indices, right ventricle performance and cardiorespiratory parameters among chronic HF patients.

Methods
72 consecutive HF patients (NYHA class II-IV, ejection fraction <50%) who completed the study (exercise training group, n=33, 63±9 years, 88% men, and control group, n=39, 56±11 years, 82% men), underwent cardiopulmonary stress test, non-invasive high-fidelity tonometry of the radial artery, pulse wave velocity measurement using a SphygmoCor device, and echocardiography before and after completion of the training program. Cardiac power output (CPO) (W) was calculated as mean arterial pressure × CO/451, where mean arterial pressure = [(systolic blood pressure − diastolic blood pressure)/3] + diastolic blood pressure.

Results
Both groups reported similar medical characteristics and physical activity status. General mixed effects models revealed that the intervention group increased 6MWT (by 13%, p<0.05); increased cycle ergometry WRpeak (by 25%, p<0.01), showed higher O2max by 31% (p<0.001) and lower VE/VCO2 (p=0.05), whereas patients in the control group showed nosignificant changes in the aforementioned indices. Also, in the intervention group Emv/Vp was decreased by 14% (p=0.06); E to A ratio by 24% (p=0.004) and E to Emv ratio by 8% (p=0.05); while Stv increased by 25% (p=0.01). Most importantly, the intervention group reduced pulse wave velocity by 9% (p=0.05) and increased augmentation index by 26%; and VTI by 4% (p=0.05); Those parameters were not significantly changed on control group (all p>0.05).

Conclusion
Hight intensity exercise rehabilitation program revealed beneficial effect on left ventricular diastolic indices and right ventricle performance. As, in those patients compensation of the aorta is also lost and the LV cannot generate the extra force necessary to completely overcome the late systolic augmented pressure, the increase in the augmented pressure (AIa) observed in the intervention group reflects the benefit in aorto-ventricular coupling and cardiac power that boosts systolic pressure and restores a positive influence in pressure, like in early stages of HF.

Acknowledgement/Funding
None
P1675Evolution of lactate dehydrogenase levels in patients with HeartMate II, HeartWare and HeartMate 3 left ventricular assist devices during first-year follow-up
Authors: Yalcin Y C , Muslem R , Papageorgiou G , Tedford R J , Constantinescu A A , Birim O C , Brugts J J , Manintveld O C , Hsu S , Leebeek F W G , Bogers A J J C , Caliskan K 
Published: October 2019

Abstract

Background
Lactate dehydrogenase (LDH) is considered as a biomarker of thrombotic events in patients receiving a left ventricular assist device (LVAD).

Purpose
This study aimed to investigate the evolution of LDH levels over time between patients supported with a HeartMate II (HMII), HeartMate 3 (HM3) or HeartWare (HVAD) LVAD during their first-year post implantation.

Methods
We analyzed in this multi-center retrospective study, all patients with HMII, HM3 and HVAD LVAD implanted between December 2006 and April 2017. Patients were classified into three groups based on their device type. Loess splines over time were used to depict the repeated measurements of LDH.

Results
In total, 134 patients received an LVAD (77% male, mean age 55 [46–61]), of whom 64 (48%) were HMII, 22 (16%) HM3 and 48 (36%) were HVAD. Loess splines over time indicate that there could be a considerable difference between evolution of LDH (Figure). During the first-year follow-up, 3 (5%) patients had a confirmed and 10 (16%) patients had a suspected pump thrombosis in the HMII group. For the HVAD, there were 6 (13%) patients with confirmed thrombosis and 1 (2%) case of suspected thrombosis, whereas none of the patients in the HM3 group experienced a suspected or confirmed pump thrombosis (p=0.01). The 1-year overall survival rate for HM II, HM3 and HVAD was 84%, 86% and 72% respectively (p=0.311). The overall stroke-free rate at one year was: 89%, 77% and 91% for HMII, HVAD and HM3 respectively (p=0.15).
Means of observed LDH values over time

Conclusion
During the first-year post LVAD implantation, there appear to be different evolutions of LDH levels over time in HMII device patients compared to HVAD or HM3 device patients. Given differences in baseline hemolysis levels between devices, currently used LDH thresholds for detection of impending pump thrombosis may be less sensitive and thus thresholds may be device specific.
P1685Risk factors and earliest signs of heart damage in young adults with hypertension
Authors: Chevplyanskaya O , Dudarev M V 
Published: October 2019

Abstract

Background
It is well known that the risk of cardiovascular complications becomes higher even in high normal BP ranges. High normal BP is usually asymptomatic in young age. It is important to establish the main risk factors and the initial signs of cardiac dysfunction at early stages of arterial hypertension (AH) formation.

Objective
To assess the prevalence of leading risk factors and to investigate the global longitudinal strain rate of left ventricle (LV) by speckle tracking (STE) method in young men with high normal pressure.

Methods
The study involved 80 patients aged 22 (20; 25) years. The first group (I) included 55 subjects with high normal office BP values (130–139/85–89 mm Hg), the second group (II) consisted of 25 subjects with office BP less than 130/85 mm Hg. Anthropometric and blood biochemical parameters were tested in all subjects. The heart status was assessed according to transthoracic echocardiography-data. The test was performed on an expert class apparatus General Electric Vivid 7 in the B and M mode by the pulse wave and color flow Doppler. LV functional status was assessed by STE with GLPS analysis. STE data was obtained in B-mode from three apical positions with a frame rate of 80–90 per minute. longitudinal peak systolic strain (LPSS) in basal, midwall and apical segments as well as a LV walls was assessed in the compared groups. The parameters tested are presented as median, interquartile range, average and standard deviation.

Results
Both groups were comparable in age. Smoking (25.9% and 28.6%, p=0.54) and total cholesterol (48,1% and 45,5%; p=0,11) were highly prevalent in groups I and II. Overweight is registered significantly more frequently in subjects with high BP (41.5% and 14.3 respectively, p=0.0009). Family history of premature cardiovascular disease, heart rate, diabetes, uric acid were comparable in both groups. The GLPS value was significantly lower in the group with high normal BP than in the reference group: −19,1 (−17,71; −20,2) and −20,9 (−20,6; −22,4) (p=0,0014). The decrease of LPSS at the basal and midwall segments was recorded more often in subjects with high normal BP (p=0.0008 and p=0.0003, respectively). LPSS in all LV walls was significantly lower in group I. LPSS in anteroseptal wall was 18.7±3.4 and 21.1±4.1, p=0.029; in anterior wall it was 19.8±2.9 and 22.3±3.0, p=0.006; in lateral wall it was 18.7±3.3 and 20.9±1.9, p=0.004; in inferolateral wall it was 18.7±3.3 and 21.1±3.2, p=0.017), in inferior was (19.8±3,1 and 22.3±2.2, p=0,002), in inferoseptal was (17.2±3.4 and 19.8±1.6, p=0.0007) in groups I and II, respectively. The nature of revealed changes in the subjects with high blood pressure requires further targeted investigation.

Conclusion
The multisegment GLPS decrease may be the earliest marker of myocardial dysfunction in the initial stages of hypertension. The contribution of overweight is evident in the persistent BP increase.
P1690Lab-on-a-chip based self-monitoring device for dietary intake of potassium and sodium: the LAB-CHIPS study
Authors: Vendeville A C , Kaasjager H A H , Musson R E A , Spiering W 
Published: October 2019

Abstract

Background
Dietary sodium restriction and upholding adequate potassium intake is an important lifestyle modification strategy advocated in guidelines for the management of hypertension and for lowering cardiovascular risk in the general population. The gold standard for estimating sodium and potassium intake, 24-hour urine collection (24hUc), is time consuming and cumbersome, but most importantly not a good indicator of dietary habit due to day-to-day variation. New lab-on-a-chip technology has been developed to measure urinary sodium, potassium and creatinine excretion in a single drop of urine using microcapillary electrophoreses combined with conductivity analyses. Self-monitoring can be done at home over a longer period of time. Results are readily available.

Purpose
To assess agreement between 24hUc and the lab-on-a-chip self-monitoring device for estimating past 24h dietary sodium and potassium intake for single and multiple self-tests by using the Kawasaki, INTERSALT and Tanaka formulae.

Methods
Healthy participants (n=12) were asked to adhere to three different weekly dietary sodium restriction goals. Participants received verbal and written information to aim between 3.3 and 5.0 grams of sodium intake a day during week 1 (“normal”), >3.3<5.0 grams in week 2 (low) and >5.0 grams during week 3 (high). Weekly measurement instructions consisted of one self-test on day 1 through 6 and multiple self-tests (n=3) combined with a 24hUc on day 7. To estimate 24h sodium and potassium intake, Kawasaki, INTERSALT and Tanaka formulas were used. The Bland-Altman method was used to calculate the agreement.

Results
The agreement (mg/day) for sodium between 24hUc and a self-test on first morning urine (fmu) (Kawasaki), was −102±804 (normal), −860±592 (low) and 340±1406 (high). For multiple self-tests (n=3) performed on 24hUc days, using the INTERSALT formula, the agreement was: 577±832 (normal), −701±721 (low) and 1788±911 (high). Any combination of same day single or multiple INTERSALT or Tanaka self-tests and fmu Kawasaki did not result in better agreement. For potassium the agreement between 24hUc and fmu (Kawaksaki) was 1071±966 (normal), 1376±678 (low) and 1654±880 (high). Using the Tanaka formula resulted in further underestimation and thus worse agreement for same day self-tests and fmu.

Conclusion
In this study, agreement between 24hUc and the lab-on-a-chip self-monitoring device for estimating past 24h dietary sodium intake was best for a fmu self-test calculated with the Kawasaki formula. For estimating potassium intake, a fmu self-test with help of the Kawasaki formula overestimated potassium intake considerably. This lab-on-a-chip self-monitoring device has the potential to improve current lifestyle modification strategies.