bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2767Outcomes and incremental prognostic value of renal function impairment after acute pulmonary embolism
Authors: Chopard R , Serzian G , Humbert S , Falvo N , Morel-Aleton M , Bonnet B , Kalbacher E , Obert L , Capellier G , Cottin Y , Schiele F , Meneveau N 
Published: October 2019

Abstract

Background
We explored the relation between adverse outcomes after acute pulmonary embolism (PE)and renal dysfunction classified by estimated glomerular filtration rate (eGFR) using the CKD-EPI equation. We assessed the incremental value of adding eGFR CKD-EPI to the ESC score for predicting 30d mortality.

Methods
Prospective, multicenter study of 1664 acute PE admitted from 01/2011 to 12/2017. Pts were categorized in 4 eGFR groups: Group 1 (eGFR ≥60 ml/min/1.73m2, n=1178), group 2 (45–59; n=257); group 3 (30–44; n=150), group 4 (≤29; n=79).

Results
All-cause and CV death at 30 days and 6 months were higher in group 3 (p=0.005 and p=0.03) and group 4 (p<0.001 and p<0.001 respectively) vs group 1. Major bleeding at 30d and 6m was higher in group 2 vs group 1 (p=0.003 for both). Renal dysfunction combined with the ESC prognostic algorithm for prediction of 30d death improved discriminatory capacity of the model and enabled reclassification in different risk categories in 27% of pts (Table).
Without eGFR CKD-EPI OR (95% CI) With eGFR CKD-EPI OR (95% CI) ESC algorithm 2.59 (1.95–3.43) 2.30 (1.72–3.07) eGFR CKD-EPI – 2.60 (1.62–4.7) Measures of fit   Bayes information criterion 607.30 599.32   Akaike information criterion 596.47 583.06   C-statistic 0.71* 0.77*   P (Hosmer-Lemeshow) 0.057 0.43   Integrated discrimination improvement – 0.054 (0.052–0.056)   Net reclassification improvement – 0.93 (0.90–0.95) Prognostic performance   Sensitivity 62.5 (51.2–72.3) 76.2 (61.5–90.2)   Specificity 64.2 (49.1–74.4) 69.9 (47.6–83.5)   Positive predictive value 10.1 (8.2–11.3) 16.2 (14.2–18.2)   Negative predictive value 0.97 (0.96–0.98) 98.1 (97.2–99.2)   Positive likelihood ratio 1.96 (1.12–3.41) 2.12 (1.54–3.12)   Negative likelihood ratio 0.50 (0.25–1.81) 0.54 (0.20–1.56)   Youden index 0.31 (0.28–0.34) 0.39 (0.36–0.41) Difference in C-statistic: *p=0.04.

Conclusion
Renal function impairment increases the rate of adverse events after acute PE. Combined with the ESC early mortality risk score, eGFR improves risk classification.
P2771A novel doppler index for the diagnosis of post pulmonary embolism impairment syndrome
Authors: Dzikowska-Diduch O , Kostrubiec M , Brodka K , Wyzgal-Chojecka A , Pacho P , Kurnicka K , Lichodziejewska B , Labyk A , Roik M , Pruszczyk P 
Published: October 2019

Abstract

Introduction
Follow-up studies demonstrated that after an episode of acute pulmonary embolism (PE), half of patients report functional limitation. Chronic thromboembolic pulmonary hypertension (CTEPH) is diagnosed in approximately 4%, while others are supposed to have heart failure with preserved ejection fraction (HFpEF) or chronic thromboembolic disease (CTED). Echo can not only assess tricuspidal regurgitation pressure gradient (TRPG) indicating pulmonary hypertension but also with tissue Doppler, E/e' ratio can diagnose left ventricular diastolic dysfunction. We tried to asses if a novel echo index: TRPG to E/e' could be useful in differentiation between CTEPH, CTED and HFpEF.

Material and methods
We analyzed data of consecutive 535 PE survivors (313 F, aged 61±17 yrs). 342/535 (64%) reported significant functional impairment after at least 6 months anticoagulation. All symptomatic subjects underwent detailed diagnostic workup which included standardized echocardiography, lung scintigraphy, pulmonary functional tests, and chest CT, RHC and coronary angiography when appropriate.

Results
Eventually, out of 342 symptomatic PE survivors (220 F, aged 65±15 yrs) CTEPH was diagnosed In 17 cases, CTED in 8 pts and HFpEF in 174 pts and in the remaining other causes were found (i.e. coronary artery disease, anemia, pulmonary disease). Doppler echocardiography showed that TRPG/E/e' was significantly increased in CTEPH and CTED patients when compared to subjects with HFpEF (Table 1).
Echocardiographic doppler assessment HFpEF p CTEPH p CTED p n=174 HFpEF vs CTEPH n=17 CTEPH vs CTED n=8 HFpEF vs CTED TRPG (mmHg) 26.7±8.9 <0.01 59.5±32.0 0.013 34.4±15.1 ns E/e' 11.1±2.9 ns 10.1±32.0 ns 8.9±2.0 ns TRPG / E/e' 2.5±1.0 <0.001 6.0±2.4 <0.01 3.8±1.1 0.013 TRPG, Tricuspidal regurgitation pressure gradient; CTEPH, Chronic thromboembolic pulmonary hypertension; CTED, Chronic thromboembolic disease; HFpEF, Heart failure with preserved ejection fraction.

Conclusion
Our data indicate that echocardiographic index TRPG/(E/e') may be helpful in the differentiation of functional limitation in patients after pulmonary embolism.
P2774Galectin-3, GDF-15, and ST2 in noninvasive assessment of myocardial remodelling in chronic thromboembolic pulmonary hypertension
Authors: Kriechbaum S D , Peters K , Ajnwojner R , Wolter J S , Haas M , Roller F , Keller T , Rolf A , Hamm C W , Mayer E , Guth S , Liebetrau C 
Published: October 2019

Abstract

Background
In chronic thromboembolic pulmonary hypertension (CTEPH), pulmonary artery obstruction leads to impaired pulmonary hemodynamics and secondary right heart failure, which is highly predictive of outcome. Thus, the extent of myocardial -especially right heart- remodelling is an indicator of disease severity.

Purpose
The aim of the present study was to assess growth differentiation factor-15 (GDF-15), galectin-3, and suppression of tumorigenicity 2 (ST2) as non-invasive biomarkers of myocardial remodelling in patients suffering from CTEPH.

Methods
We analysed the serum levels of GDF-15, galectin-3 and ST2 in a cohort of 64 CTEPH patients and in a control group of 25 patients without cardiovascular disease. The biomarker levels were further correlated with clinical, laboratory, and hemodynamic data, including 6-minute walking distance (6-MWD), N-terminal pro-brain natriuretic peptide (NT-proBNP), mean pulmonary artery pressure (meanPAP), pulmonary vascular resistance (PVR), and right atrial pressure (RAP).

Results
The biomarker levels in the control group were: galectin-3: 3.5 ng/l (IQR 2.7–4.0), GDF-15: 92.6 pg/ml (IQR 78.5–129.1), and ST2: 48.65 ng/l (IQR 35.5–57.0). CTEPH patients had higher levels of GDF-15 (196.7 pg/ml; IQR 128.4–302.8; p<0.001) and ST2 (52.6 ng/l; IQR 44.5–71.9; p=0.05) but not galectin-3 (3.4 ng/l; IQR 2.7–4.3; p=0.84). In the CTEPH cohort, patients with a meanPAP >35 mmHg (GDF-15: p=0.01; ST2: p=0.04) and patients with a PVR >500 dyn sec cm–5 (GDF-15: p=0.004; ST2: p=0.002) had significantly increased biomarker levels. For the detection of a meanPAP >35mmHg, ROC analysis revealed an AUC of 0.71 for GDF-15 and 0.67 for ST2. The level of GDF-15 correlated with the level of NT-proBNP (rrs=0.69; p≤0.001) and the RAP (rrs=0.54; p≤0.001) and inversely with the 6-MWD (rrs=−0.47; p≤0.001). The level of ST2 correlated with the level of NT-proBNP (rrs=0.67; p≤0.001) and the RAP (rrs=0.54; p≤0.001) and inversely with the 6-MWD (rrs=-0.31; p=0.02).

Conclusion
Our results demonstrate that GDF-15 and ST2, non-invasive biomarkers of myocardial remodelling, are significantly elevated in patients suffering from CTEPH. The correlation of biomarker levels with established outcome predictors suggests a use as indicators of disease severity.
P2780Accuracy of electronic healthcare records for diagnosis of stroke types in a large community-based prospective cohort study in China
Authors: Turnbull I J , Clarke R , Guo Y , Hacker A , Kartsonaki C , Bian Z , Sansome S , Chen H , Wu H , Xu X , Li L , Chen Z , Chen Y 
Published: October 2019

Abstract

Background and purpose
Reliable assessment of the determinants of major pathological types of stroke is dependent on the accuracy of diagnosis in population-based studies. We evaluated the diagnostic accuracy of stroke types in a large community-based cohort study involving health records collected in China.

Methods
In 2004–08, >0.5 million adults aged 30–79 years were recruited from general populations of 10 diverse areas (5 urban, 5 rural) in China. During an approximate 7-year follow-up, 37,694 stroke cases had been reported by linkage to electronic health records from disease-specific and mortality registries and from national health insurance agencies. For all reported stroke cases, hospital medical records were retrieved systematically and relevant data extracted for subsequent adjudication by specialists using bespoke electronic platforms.

Results
Among all reported incident stroke cases, 80% were ischaemic stroke (IS), 17% were intracerebral haemorrhage (ICH), and 1% were subarachnoid haemorrhage (SAH). To date, medical records have been retrieved for 29,632 cases, with reports of stroke diagnosis verified by public health staff in 27,115 (92%) cases, of which 3,778 (14%) were secondary diagnoses. Evidence of neuroimaging was found in 92% of all verified stroke cases. Of 23,337 primary stroke cases sent for specialist adjudication, a diagnosis of pathological stroke type was confirmed in 19,718 cases with the positive predictive values being 82.4% (95% confidence interval [CI], 82.0% - 82.8%) for IS, 97.8% (97.6 - 97.9) for ICH, and 98.2% (98.1 - 98.3) for SAH. Overall, the strength of association of systolic blood pressure was over 6-fold greater for confirmed than non-confirmed stroke cases and was nearly 3-fold greater for confirmed ICH than IS cases.
Diagnostic accuracy by stroke type Reported Retrieved Verified Adjudicated Confirmed Approximate 95% CI n n % n % n % n PPV, % IS 30,143 25,477 85 23,551 92 20,045 85 16,515 82.4 (82.0–82.8) ICH 6,484 3,486 54 3,079 88 2,919 95 2,854 97.8 (97.6–97.9) SAH 557 397 71 326 82 279 86 274 98.2 (98.1–98.3) Other 510 272 53 159 59 94 59 75 79.8 (79.4–80.2) IS indicates ischaemic stroke; ICH, intracerebral haemorrhage; SAH, subarachnoid haemorrhage; and PPV, positive predictive value.

Conclusions
The overall diagnostic accuracy of pathological stroke types obtained from hospital records in China is comparable to reports from Western populations. Despite advances in electronic healthcare records, reliable classification of stroke types requires clinical adjudication using additional relevant investigations.

Acknowledgement/Funding
Kadoorie Charitable Foundation, UK Wellcome Trust & National Natural Science Foundation and National Key Research and Development Program of China
P2786Current ESC guidelines for normal ascending aortic diameter: prevalence of aortic dilatation increases to 20% in a consecutive coronary CTA population
Authors: Kauhanen P , Saari P , Jaakkola P , Korhonen M , Parkkonen J , Vienonen J , Vanninen R , Liimatainen T , Hedman M 
Published: October 2019

Abstract

Introduction
Epidemiological studies on the prevalence of ascending aortic (AA) dilatation are scanty.

Purpose
To clarify prevalence of AA dilatation according to ESC 2014 guidelines and to study its risk factors.

Methods
This retrospective study included 1000 consecutive patients scheduled for diagnostic coronary artery computer tomography angiography (CCTA) with low to moderate pretest probability for coronary artery disease (CAD). AA diameter was measured at 3 planes; sinus valsalva, sinotubular junction and tubular part. Threshold for AA dilatation was set to >40 mm (ESC 2014). Traditional risk factors for AA dilatation were collected from medical records.
Aortic size index (ASI) was used as a comparative measurement. ASI is defined as the ratio between aortic diameter and body surface area (BSA). The threshold for AA dilatation was set to upper limit of normal distribution exceeding two standard deviations (95%).
Heart-aorta angle (HAA, Figure) was measured as one suggestive risk factor.

Results
Patients' mean age was 52.9±9.8 years, 66.5% were women. The prevalence of AA dilatation in the whole study population was 20.4% according to ESC 2014 guidelines. When patients with hypertension (n=445) or coronary calcifications or stenosis in CCTA (n=375) were excluded, the prevalence of AA dilatation was 14.5% in the population of normotensive patients without CAD (n=380).
According to the normal-distributed ASI values the threshold for normal dimension of sinus valsalva was defined as 23.5 mm/m2 and for tubular part 22.7 mm/m2 for normotensive patients without CAD. Using these thresholds, the prevalence of AA dilatation was 7.8% in the whole population and 7.1% in normotensive patients without CAD.
Smaller HAA was associated to AA dilatation. Median HAA was 125.6° (range: 119.2–131.5°) in patients with dilated AA and 130.1° (123.7–136.4°) in patients with non-dilated AA (p<0.001).
Higher BSA was associated to larger AA dimensions. Risk factors for AA dilatation (according to ESC criteria) were male gender, BAV, hypertension and smoking (p<0.01).
Figure 1

Conclusions
The prevalence of AA dilatation proved to be relatively high in this consecutive CCTA population when using ESC 2014 guidelines. Body size is associated to AA dimensions; thus, it seems reasonable to include BSA in the definition of AA dilatation.

Acknowledgement/Funding
Oiva Vaittinen will grant, Aarne Koskelo Foundation
P2787Gender differences in acute type B aortic dissection
Authors: Chatani R , Murai R , Kawase Y , Tada T , Kadota K 
Published: October 2019

Abstract

Background
The incidence of aortic dissection has been reported to be lower in women; however, women have a poor prognosis. Also, the incidence of false lumen thrombosis has been reported to be different between Europe, the United States, and Japan. We aimed to determine gender differences in long-term prognosis of acute type B aortic dissection.

Methods
We retrospectively reviewed 220 consecutive patients hospitalized for acute type B aortic dissection between January 2012 to December 2017. After exclusion criteria of unknown onset time, >14 days after the onset, in-hospital death, and aortic events requiring additional treatment during hospitalization were applied, 186 patients were analyzed by gender: 133 men and 53 women. The patient background, treatment method, prognosis, and outcome were compared and examined.

Results
Both the proportions of smoking history and patients receiving oxygen therapy during hospitalization were significantly higher in men (59% vs. 22%, p<0.01; 91% vs. 72%, p<0.01, respectively), whereas that of classical aortic dissection was similar between men and women (41% vs. 32%, p=0.36). The avoidance rate of a composite of all deaths and aortic events 2 years after discharge was similar (hazard ratio, 0.99; 95% confidence interval, 0.52 to 1.59; p=0.966).(Picture1)
Picture 1

Conclusion
The long-term prognosis of acute type B aortic dissection treated by medical therapy during hospitalization was equivalent in men and women despite gender differences in several background factors.
P2797Clinical outcomes of an ultra-thin strut sirolimus-eluting stent with biodegradable polymer in all-comers patients undergoing coronary intervention
Authors: Menown I B A , De Silva R , Mitra R , Balachandran K , More R , Spyrou N , Zaman A , Raja Y , Tulwar S , Sinha M , Glover J , Clifford P , Ordoubadi F , Elghamaz A 
Published: October 2019

Abstract

Background
Thin stent struts may be associated with reduced vessel injury and use of biodegradable polymers may further improve long term outcomes. However, data with earlier stents has been inconsistent; thus further studies with newer devices are needed.

Purpose
To evaluate the efficacy and safety of a new ultra-thin (65um) strut cobalt chromium sirolimus-eluting stent with a hybrid design (closed cell at ends and open cells in middle to reduce edge injury and optimise conformability) in all-comers patients undergoing percutaneous coronary intervention (PCI).

Methods
We enrolled 752 patients from 14 sites undergoing PCI into a prospective, non-randomised, multi-centre, open-label, observational registry. Inclusion of patients with complex anatomy (long stent lengths, bifurcations and chronic total occlusions) was encouraged. Clinical follow-up was scheduled at 1, 9, 12 and 24 months. The primary endpoint was incidence of major adverse cardiac events (MACE) - cardiac death, non-fatal myocardial infarction (MI), or target vessel revascularization (TVR) - at 9 months.

Results
Mean patient age was 64.7±12.2 years, 20.7% had diabetes, 58.8% had dyslipidaemia, 40.4% had multi-vessel disease, 22% had previous PCI, 4.7% had previous coronary-artery bypass graft, and 19.6% had a clinical history of previous MI. Mean lesion length was 25.7±17.3 mm. The primary endpoint of cumulative MACE up to 9 months (from 624 patients reaching 9 months follow-up) occurred in 12 patients (1.92%), including 6 (0.96%) cardiac death, 5 (0.80%) MI and 6 (0.96%) clinically indicated TVR. Definite stent thrombosis was reported in 3 patients (0.48%) and probable stent thrombosis in 2 patients (0.32%).

Conclusions
Use of an ultra-thin strut biodegradable polymer sirolimus-eluting stent in all-comers patients undergoing PCI was associated with good clinical efficacy and safety.

Acknowledgement/Funding
Meril Life
P2806A novel sirolimus drug eluting stent for Small-Vessel Disease: results from en-ABL e-registry
Authors: Testa L , Dani S , Desai D , Pandya R , Parekh P , Vasavada A , Bhalani N , Sheth C , Sharma A , Shah D 
Published: October 2019

Abstract

Objective
The aim of the study was to assess the clinical outcome of Abluminus DES in patients with small vessels.

Background
Percutaneous coronary intervention (PCI) of small coronary vessel (≤2.75 mm) associated with more chances of restenosis and repeat revascularization even when drug eluting stent employed.

Methods
A total of 2,500 patients enrolled in en-ABL e-registry which is a prospective, multicentre observational post market registry. Out of 2,500 patients, 1,253 patients had small vessel (SV, ≤2.75 mm) while 1,247 had large vessel (LV, >3mm) disease. The primary endpoint was major adverse cardiac events (MACE) which is composite of cardiac death, target vessel myocardial infraction (TV-MI) and target lesion/vessel revascularization (TLR) at 1 year follow up. The secondary endpoint were stent thrombosis and MACE up to 2 years.

Results
Baseline characteristics were well matched in both groups. In the SV group had higher prevalence of diabetes as compared to large vessel 43.0% vs 25.7%. Total 1,400 lesions treated with 1,612 Abluminus DES and 1,569 lesions treated with 1,675 Abluminus DES in SV and LV groups respectively. The mean diameter of stent was 2.61±0.23 and 3.3±0.3 mm in SV and LV groups respectively. There was a significant difference in MACE in treatment groups (3.7% vs. 1.4%, p=0.004 respectively) at 1 year. No significant differences were observed between SV and LV groups in terms of death/myocardial infarction or stent thrombosis. There were increment of only one TLR and no stent thrombosis reported at 2-year follow-up.

Conclusion
This result suggests the efficacy and safety of novel Abluminus DES in small vessel disease.
P2811Impact of ticagrelor monotherapy on two-year clinical outcomes in patients with long stenting: insights from the Global Leaders trial
Authors: Takahashi K , Chichareon P , Modolo R , Kogame N , Chang C C , Tomaniak M , Hamm C , Steg P G , Stoll H P , Onuma Y , Valgimigli M , Vranckx P , Windecker S , Serruys P W 
Published: October 2019

Abstract

Background/Introduction
Data on the efficacy and safety of different antiplatelet regimens are limited in patients with increasing total stent length (TSL).

Purpose
To evaluate the impact of the experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with increasing TSL.

Methods
The present post-hoc analysis of the Global Leaders trial evaluated the primary endpoint (the composite of the all-cause death and new Q-wave myocardial infarction [MI]) at two years in patients with increasing TSL. In addition, the patient-oriented composite endpoint (POCE) (the composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (the composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also assessed.

Results
The cohort of 15,450 patients treated with a biolimus-eluting biodegradable polymer stents were included in this analysis. In the longer TSL group (≥46mm), the experimental strategy significantly reduced the risk of the primary endpoint (3.78% vs. 5.68%, hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.49–0.90, p=0.008, P interaction=0.042) as well as POCE (14.57% vs. 18.11%, HR: 0.79, 95% CI: 0.67–0.92, p=0.003, P interaction=0.010) and NACE (16.07% vs. 19.64%, HR: 0.80, 95% CI: 0.69–0.93, p=0.004, P interaction=0.012) at two years. The risk of BARC type 3 or 5 bleeding at two years was similar between the two antiplatelet regimens.
KM in patients with long stenting

Conclusion
Ticagrelor monotherapy significantly reduced the risk of the primary endpoint, POCE and NACE with a similar risk of BARC type 3 or 5 bleeding at two years in patients with the longer TSL.

Acknowledgement/Funding
The Global Leaders trial was supported by unrestricted grants from AstraZeneca, Biosensors, and The Medicines Company. ECRI (European Cardiovascular R
P2822Seasonal variation in in-hospital cardiac arrest and associated mortality
Authors: Tsang J , Sulaiman S , Jahangir A 
Published: October 2019

Abstract

Background
Previous reports have documented seasonal variation in out-of-hospital cardiac arrest (OHCA), with peak incidence in winter months, regardless of geographical region. However, seasonal variation in in-hospital cardiac arrest (IHCA) has not been well studied.

Purpose
To assess seasonal variation in incidence of in-hospital cardiac arrest, as well as gender and mortality differences.

Methods
We queried the 2014 National Inpatient Service (NIS) database for the total numbers of inpatient hospitalizations and in-hospital cardiac arrests for each month, as identified by ICD-9 codes (99.60 and 99.63). The trend for each month was plotted to assess seasonal variations in hospitalizations, IHCA, and mortality.
Seasonal Variations in IHCA

Results
The mean age of the study population was 57.3±0.2 years and 58.9% were female. Out of 29,717,872 total inpatient hospitalizations in 2014, the overall IHCA event for the year was 0.38%. Females were more likely to be hospitalized; however, males were more likely to have IHCA. These gender differences persisted throughout the year. Overall, more hospitalizations and IHCA were seen in the winter compared to the summer, and this trend was seen in both men and women. The highest incidence of in-hospital cardiac events occurred in January and the lowest incidence occurred in June. There was no seasonal variation in mortality in both male and female patients who suffered IHCA.

Conclusion(s)
In this observational study, seasonal variation is present in in-hospital cardiac arrest. Cardiac events are highest in the winter months as compared to the summer months; however, the mechanism of this variation is unknown and warrants further study.

Acknowledgement/Funding
None