bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6378Characteristics of hypertensive iron ore miners with oral glucocorticoid induced diabetes mellitus and compromised lung function
Authors: Redkar V , Redkar S , Inamdar M , Inamdar A , Redkar S S , Jagtap M , Rane S , Kulkarni S V , Deshpande J , Gupta S 
Published: October 2019

Abstract

Introduction
Oral glucocorticoids are efficacious agents for treating respiratory diseases, with high risk to induce metabolic diseases including diabetes and hypertension

Purpose
To analyse the hypertensive patient population from the rural setting on ongoing glucocorticoid treatment and diagnosed as diabetic due to the extensive chronic methylprednisolone equivalent glucocorticoid dose of more than 4 mg/day for at least 3 months for treatment of respiratory ailments due to occupational hazard

Methods
We diagnosed the identified and analysed a subset of patients from the Redi iron ore miners (n=25,500), who were newly diagnosed diabetics (n=1100) and with associated systemic hypertension (systolic BP >140 mmHg, diastolic BP > than 90 mmHg). Patients diagnosed as Oral Glucocorticoid Induced Diabetes Mellitus (GIDM) and hypertensives (n=847; 572 males and 275 females) were characterised on metabolic parameters. t-test was utilised for statistical analysis

Results
We observed a high incidence of GIDM (4.31%) with a high rate of hypertension (77%, 847/1100). Mean SBP was 150 mmHg (SD ± 9.9, 95% CI 147–152), mean DBP was 90 mmHg (SD ± 8.9, 95% CI 88–92). BMI in GIDM with hypertension (GIDM-H) group was similar to GIDM group (26 kg/m2) (Table), with relatively older age in GIDM–H (53 vs 51 years). The glycemic parameters were relatively more deranged in GIDM-H group. There was significant correlation for a high propensity of relatively younger <50 years (n=506) and near normal weight people with BMI <26 kg/m2 (n=594) to develop GIDM (p=0.006)
Metabolic Parameters GIDM Vs GIDM-H Mean ±SD, min, max, 95% CI GIDM (n=1100) GIDM with Hypertension (n=847) Age (yrs) 51 (SD ±14, 95% CI 48–54) 53 (SD ±13, 95% CI 50–56) HbA1c (%) 7.1 (SD ±0.62, 95% CI 7–7.3), 7.2 (SD ±0.60, 95% CI 7.1–7.3) BMI (kg/m2) 26 (SD ±3.6, 95% CI 25–27) 26 (SD ±3.4, 95% CI 25–27) Fasting Plasma Glucose (mg/dl) 146 (SD ±49, 95% CI 136–155) 149 (SD ±48, 95% CI 138–160) Post Prandial Glucose (mg/dl) 207 (SD ±74, 95% CI 192 - 221) 212 (SD ±74, 95% CI 195–228)

Conclusions
The high rates of hypertension in patients with GIDM is an alarmingly problem which has pronounced harmful comorbid implications, especially in younger, economically productive population in limited resource setting. The health care professionals need to be educated to limit use of glucocorticoids to inhalational therapy with minimal systemic effects. Specific pathophysiological approach to address the steroid induced insulin resistance, strategies to reduce cardiovascular risk and damage, makes treatment of hypertension and GIDM difficult, which calls for action to limit the mining activities and mitigate risk of chronic complications
P6383Cardiac output during targeted temperature management and renal function after out-of-hospital cardiac arrest
Authors: Grand J , Hassager C , Bro-Jeppesen J , Wanscher M , Kjaergaard J 
Published: October 2019

Abstract

Background
After resuscitation from out-of-hospital cardiac arrest (OHCA), renal injury and hemodynamic instability are common. Low blood pressure during targeted temperature management (TTM) is associated with acute renal injury (AKI). The aim of this study is to test the hypothesis, that low cardiac output during TTM is associated with acute kidney injury after OHCA.

Methods
Single-center substudy of 171 patients included in the prospective, randomized TTM-trial. Hemodynamic evaluation was performed with serial measurements by pulmonary artery catheter. Mean arterial pressure ≥65 mmHg and central venous pressure of 10 to 15 mmHg were hemodynamic treatment goals. Acute kidney injury (AKI) was the primary endpoint and was defined according to the KDIGO-criteria. Differences between groups were tested by repeated measurements mixed models.

Measurements and main results
Of 152 patients with available hemodynamic data, 49 (32%) had AKI and 21 (14%) had AKI with need for renal replacement therapy (RRT) in the first three days. At admission, cardiac index was higher in the AKI-group (mean (confidence interval): 2.6 (2.2–3.0) L/min/m2 versus 2.2 (2.0–2.3) L/min/m2, p=0.003). During 24 hours of targeted temperature management, patients with AKI had increased heart rate (11 beats/min, pgroup<0.0001) and increased lactate (1 mmol/L, pgroup<0.0001) compared to patients without AKI. However, there was no overall difference in cardiac index (pgroup = 0.25) (Figure). In multivariate models, adjusting for potential confounders including targeted temperature, mean arterial pressure (odds ratio: 0.69 (0.50–0.96) per 5 mmHg increase, p=0.03), heart rate (1.04 (1.01–1.08) per beat/min increase, p=0.01) and lactate (1.59 (1.14–2.2) per mmol/L increase, p=0.006) were independently associated with AKI, but cardiac index remained unrelated with AKI.
Figure 1

Conclusions
Blood pressure, heart rate and lactate, but not cardiac output, during 24 hours of targeted temperature management were associated with renal injury in comatose OHCA-patients.

Acknowledgement/Funding
The research fund Gangstedfonden and the Research fund of Rigshospitalet has supported this study with unrestricted salary in Dr. Grand's PhD project.
P6396LDL cholesterol promotes neutrophil extracellular trap formation
Authors: Ondracek A S , Hofbauer T M , Wadowski P P , Mangold A , Gremmel T , Lang I M 
Published: October 2019

Abstract

Background
Pro-protein convertase subtilisin/kexin 9 (PCSK9) is a regulator of low density lipoprotein (LDL) receptor (LDLR) expression and has gained attention in the treatment of hyperlipidemia. Serum levels of LDL are correlated with numbers of activated neutrophils in the circulation of hyperlipidemic patients. Activated neutrophils can form neutrophil extracellular traps (NETs) by expelling their chromatin, and NETs have been recognized as important risk factors for acute myocardial infarction (AMI) and stroke.

Purpose
We analyzed the influence of serum LDL levels on neutrophil activation, their propensity to form NETs, and the correlation of NET surrogate markers with systemic inflammatory responses in AMI.

Methods
We recruited 249 consecutive patients with AMI (mean age 58 years, 20% females) and assessed laboratory parameters, inflammatory markers, and serum lipid profiles 72 h after primary percutaneous coronary intervention. Double-stranded DNA (dsDNA) and citrullinated histone H3 were determined from plasma as markers of in vivo NET formation. In a subset of patients (n=25), ex vivo NET formation in response to PCSK9 and ionomycin was analyzed, neutrophils were stained for CD11b, LDLR, and lectin-like oxidized LDLR (LOX-1) using flow cytometry at baseline and after activation with phorbol myristate acetate. PCSK9 levels were measured by ELISA.

Results
Patients with serum LDL levels above the median [median (IQR) LDL 111 mg/dl (87–141), mean ± SD LDL 115±41 mg/dl] had significantly higher concentrations of circulating dsDNA.
Levels of dsDNA [median 121 ng/ml, IQR 101–156] were linked with levels of the specific NET marker citH3 [median (IQR) 252 ng/ml (655–1600), rs=0.157]. Plasma concentrations of dsDNA and citH3 correlated significantly with CRP (dsDNA rs=0.328; citH3 rs=0.209), proBNP (dsDNA rs=0.286; citH3 rs=0.192), troponin T (dsDNA rs=0.282; citH3 rs=0.197), and IL-6 (dsDNA rs=0.242; citH3 rs=0.216).
In the subset of patients in whom neutrophils were characterized, pre-treatment of neutrophils with PCSK9 could significantly decrease ionomycin induced NET release in a dose-dependent manner. Levels of serum LDL were associated with spontaneous NET formation (r=0.504) ex vivo and activated CD11b on neutrophils (r=0.495).
LOX-1 expression correlated significantly with LDLR expression (rs=0.670) and PCSK9 levels (r=0.520). Patient neutrophil stimulation in whole blood led to a significant decrease of the LDLR positive neutrophil population. This effect was greater when PCSK9 levels were higher.

Conclusion
Our data indicate a role for LDL in boosting neutrophil activation depending on PCSK9.
P6404Myocardial infarction with nonobstructive coronary arteries: does aspirin have a place in the treatment of this entity?
Authors: Ferreira J , Freitas F , Goncalves V , Ferreira C , Milner J , Alves P , Marinho V , Monteiro S , Baptista R , Monteiro P , Goncalves L 
Published: October 2019

Abstract

Background
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is still a clinical enigma that is being increasingly recognised, as the number of coronary angiographies we perform in our centres also increase. However, the treatment for this entity is still a matter of important debate, not only due to the different causative mechanisms of this disease but also because there are no major trials regarding MINOCA treatment.

Purpose
To determine the association between acetylsalicylic acid (ASA) use after discharge and mortality after discharge in MINOCA patients admitted to a coronary care unit (CCU).

Methods
We analyzed data from 370 (11.7% of the global sample) patients admitted with MINOCA in our CCU. Patients with other final diagnoses, missing mortality data, previous acute myocardial infarction, contra-indications to aspirin and known heart failure before admission were excluded. All patients underwent transthoracic echocardiography and coronary angiography at any point during hospitalisation. After adjusting data for relevant comorbidities we then compared mortality after hospital discharge between the ASA group and the no-ASA group.

Results
Of all MINOCA patients admitted in our CCU, 84 (22.7%) were diagnosed with ST-elevation myocardial infarction (STEMI) and 286 (77.3%) with non-ST elevation myocardial infarction (NSTEMI). 296 (80%) patients received ASA after discharge. Both groups were homogeneous as we did not find any significant differences between groups regarding age (p=0.106), left ventricle ejection fraction (p=0.100), GRACE score at hospitalisation (p=0.150), Killip-Kimball class at hospitalisation (p=0.604), incidence of acute kidney injury (p=0.450), maximum c-reactive protein during stay (p=0.804) and low-density lipoprotein levels at hospitalization (p=0.055). There was also no difference in the incidence of diabetes (p=0.350), exposure to daily stress (p=0.767), active smoking (p=0.569), dyslipidemia (p=0.229), hypertension (p=0.057) and type of myocardial infarction (STEMI vs NSTEMI – p=0.215). In this MINOCA cohort (5 years follow-up) a total of 47 patients died (12.7%). ASA vs. no-ASA 1-month (3.1% vs. 0.0%, p=0.214), 6-month (4.5% vs. 1.4%, p=0.317), 1-year (5.9% vs 5.6%, p=0.900), 3-year (10.5% vs. 8.3%, p=0.668) and 5-year (13.3% vs. 12.5%, p=0.860) all-cause mortality was not significantly different. The same non-significant trend towards higher mortality with ASA was obtained when survival curves were taken into account.

Conclusions
MINOCA remains a challenging entity. In our study, the systematic use of ASA in all patients following MINOCA was not associated with better survival after long-term follow-up.
P6408Potential benefit of ticagrelor monotherapy for patients with hypertension undergoing percutaneous coronary intervention: insights from the Global Leaders trial
Authors: Modolo R , Chichareon P , De Faria A P , Steg P G , Hamm C , Vranckx P , Valgimigli M , Windecker S , Onuma Y , Serruys P W 
Published: October 2019

Abstract

Background
Hypertension is one of the most frequent modifiable risk factors for coronary artery disease. Due to the increased risk of bleeding associated with it, hypertensive patients might benefit from an antiplatelet monotherapy following percutaneous coronary intervention.

Purpose
We sought to investigate the effect of 1-month DAPT followed by 23-month ticagrelor monotherapy (ticagrelor monotherapy) compared with the reference arm, 12-month DAPT followed by 12-month aspirin monotherapy (standard DAPT), on clinical outcomes in patients with hypertension undergoing PCI.

Methods
This is a post-hoc analysis of the prospective, multi-center, open-label, all-comers, randomized controlled trial Global Leaders, that tested ticagrelor monotherapy versus standard DAPT in patients receiving PCI with biolimus A9-eluting stent. Patients were stratified by the hypertension status. The primary endpoint for the present analysis was the patient oriented composite endpoint (POCE - defined as composite of all-cause death, any stroke, any MI, or all revascularization) and safety endpoint of BARC type 3 or 5 bleeding, both at 2 years. Event rates are presented as Kaplan-Meier estimates (%).

Results
In Global Leaders 15,991 patients were randomized, 23 (0.14%) requested complete deletion of their data from the database and 54 (0.34%) had no information on hypertension status. Of the 15,914 (99.52%) included in the analysis 11,715 were hypertensive. In the non-hypertensive patients, comparing ticagrelor monotherapy with standard DAPT, no difference was found regarding POCE (12.17% vs. 12.13%, HR 1.004, 95% CI 0.843 to 1.195, p=0.965) nor bleeding (1.71% vs. 1.72%, HR 1.0, 95% CI 0.628 to 1.592, p=1.0, respectively). In hypertensive patients the experimental treatment of ticagrelor monotherapy resulted in less POCE (13.62% vs. 15.04%, HR 0.898, 95% CI 0.816 to 0.988, p=0.028, p for interaction=0.271) with similar bleeding (2.21% vs. 2.26%, HR 0.976, 95% CI 0.765 to 1.246, p=0.846), compared with the standard DAPT at 2 years.

Conclusion
In this sub-group analysis of Global Leaders, in patients with hypertension undergoing PCI the experimental treatment of 1-month DAPT followed by 23-month ticagrelor monotherapy may offer ischemic protection without increasing bleeding. The results must be interpreted cautiously as there was no interaction between treatment strategy and the status of hypertension. Thus, the present results are hypothesis generating.

Acknowledgement/Funding
ECRI - Astra Zeneca - Biosensors - Medicine Company
P6441New continuous glucose monitoring reveals hypoglycemia risk in both diabetic and nondiabetic patients with acute myocardial infarction
Authors: Kuroda M , Kawata M , Matsuura A , Adachi K , Hirayama Y , Matsuura T , Matsumoto A , Kodaira M , Kintsu M , Suzuki Y 
Published: October 2019

Abstract

Background
There has been growing evidence that the glucose fluctuation is an important contributing factor to the development of coronary artery disease. However, whether large glucose fluctuation, especially hypoglycemia, may be associated with acute myocardial infarction (AMI) remains largely unknown.

Aim
As new continuous glucose monitoring (CGM) has recently become available to evaluate glucose fluctuation from immediately after an emergency visit, this study sought to investigate glucose fluctuation and the occurrence of hypoglycemia in patients with AMI.

Methods
In this prospective study, 93 consecutive patients with AMI from April 2017 to November 2018 were enrolled. Subcutaneous interstitial glucose levels were monitored from emergency room to discharge using the CGM System. Based on the CGM data, 24-h mean glucose levels, the time in hyperglycemia and hypoglycemia and the occurrence of hypoglycemia, defined as less than 70 mg/dL, were measured, and the mean amplitude of glycemic excursions (MAGE) were calculated.

Results
The majority of patients [n=57, 61% (non-DM)] did not have diabetes and 36 patients had diabetes (DM). The occurrence of hypoglycemia within 24 hours after admission was observed in 49 patients [DM: n=11 (30.6%), non-DM: n=38 (66.7%)]. MAGE within 24 hours after admission were 100±47 in DM patients and 67±20 in non-DM patients. The mean time in hypoglycemia within 24 hours after admission was 148 minutes [DM: 100±260 minutes, non-DM: 178±287 minutes]. The occurrence of hypoglycemia during a hospital stay (mean 11.5 days) was detected in 76 patients [DM: n=28 (77.8%), non-DM: n=48 (84.2%)].
Representative case of hypoglycemia

Conclusion
Not only in DM patients but also in non-DM patients with AMI, large glucose fluctuation and high incidence of hypoglycemia were observed using new CGM system. Further investigations should address the rationale for the early detection and control of glucose fluctuation for AMI patients.
P6445Stress hyperglycemia and in-hospital mortality in patients with ST-segment elevation myocardial infarction
Authors: Kong M G , Park H W , Choi H O , Seo H S , Suh J , Cho Y H , Lee N H 
Published: October 2019

Abstract

Introduction
Stress hyperglycemia is common in acute ill patients and associated with poor clinical outcomes. Some studies demonstrated the association of stress hyperglycemia and poor outcomes in acute MI. However, current results for the impact of stress hyperglycemia on mortality in acute MI who underwent PCI are insufficient.

Purpose
We aimed to evaluate the impact of stress hyperglycemia on clinical outcomes of patients with STEMI underwent primary PCI in large scale multi-center registry.

Methods
From 2007 to 2014, in 1,538 patients of the INTERSTELLAR (Incheon-Bucheon Cohort of Patients Undergoing Primary PCI for Acute ST-Elevation Myocardial Infarction) cohort, 997 patients without diabetes who underwent primary PCI for STEMI were retrospectively analyzed. We defined random glucose more than 200mg/dl at admission without diabetic history or results of HbA1C more than 6.5% as stress hyperglycemia. The primary endpoint was in-hospital all-cause death and the secondary endpoint was all-cause death within 1 year after index PCI.

Results
From 997 nondiabetic cohort population, 117 patients with stress hyperglycemia and 880 patients without stress hyperglycemia were enrolled. Baseline characteristics including age, sex, hypertension, hyperlipidemia, atrial fibrillation, left main disease, and multivessel disease were not significantly different between two groups. However, systolic blood pressure was lower (111.2±39.2 vs. 125.5±28.1, p<0.001) and hypoxic liver injury was frequent (31.0% vs. 20.1%, p=0.007) in stress hyperglycemia. In-hospital and 1-year all-cause mortality were higher in stress hyperglycemia (13.7% vs. 2.7%, p<0.001; 15.4% vs. 3.8%, p<0.001, respectively). However, there is no significant difference in post-discharge mortality rate. Stress hyperglycemia was a significant independent predictor of in-hospital death (adjusted OR: 5.67, 95% CI: 2.40–13.39; p<0.001). Hypotension (defined less than 90mmHg) and left ventricular dysfunction (defined less than 40% of LVEF on echocardiography) were significantly associated with stress hyperglycemia (adjusted OR: 5.72, 95% CI: 3.33–9.82; p<0.001; adjusted OR: 2.38, 95% CI: 1.49–3.82; p<0.001, respectively).
Landmark analysis of all-cause death

Conclusions
In nondiabetic patients who underwent primary PCI for STEMI, stress hyperglycemia is significantly associated with an increased in-hospital all-cause mortality but did not increase post-discharge mortality within 1 year.
P6466Novel index with combined echocardiographic parameter and CT parameter (pPAT) is useful for screening pulmonary hypertension in Systemic Sclerosis Patients
Authors: Orihara Y , Asakura M , Okuhara Y , Matsumoto Y , Masai K , Goda A , Masuyama T , Ishihara M 
Published: October 2019

Abstract

Background
Systemic sclerosis (SSc) patients with pulmonary arterial hypertension (PAH) had poor survival rate. Usual index of estimating PH is tricuspid regurgitate jet pressure gradient (TRPG). Accurate assessment of PAH is important for the management of SSc patients. However, estimated mean pulmonary arterial pressure (mPAP) using TRPG by echocardiography does not always reflect actual mPAP by right heart catheterization (RHC) in SSc patients. On the other hand, recent reports have shown that rPA, a ratio of diameter of pulmonary artery to ascending aorta (PA/Ao) calculated by computed tomography (CT), was associated with mPAP. However, both index are not sufficient for evaluation of PH. We hypothesized that the product of TRPG and rPA (pPAT) could estimate mPAP of SSc patients more accurately than TRPG or rPA.

Purpose
We investigated the usefulness of the product of TRPG and rPA for detecting actual mPAP in SSc patients.

Methods
Thirty-six SSc patients who suspected PH were enrolled retrospectively. We defined PH as resting mPAP from RHC of >25 mmHg. We measured both a widest pulmonary artery diameter and an adjacent ascending aorta diameter at the same level of the bifurcation of the main pulmonary artery using CT images.

Results
The average age was 67 years old and average mPAP by RHC was 24.7 mmHg. Mean TRPG and mean rPA were 35.1 mmHg and 1.06, respectively. Furthermore, mean pPAT was 37.9. We found pPAT had a stronger correlation with actual mPAP (r=0.848, p<0.001) than TRPG (r=0.754, p<0.001) or rPA (r=0.584, p<0.001). On ROC analysis, pPAT predicted PH with high accuracy for a cut-off of 33.1. In order to evaluate the usefulness of pPAT, we compared false-negative patients between two cutoff values of TRPG 34 mmHg described in ESC guideline and pPAT 33.1. Among the patients with TRPG <34mmHg, 4 patients (18%) had PH. In contrast, when screening PH using pPAT, the diagnosis of PH was missed in only one patient.
Figure 1

Conclusion
The product of TRPG and PA/Ao (pPAT) could be a novel and useful noninvasive index for identifying PH in SSc patients.
P6473Impact of prosthesis choice on mortality after transfemoral transcatheter aortic valve implantation in patients with reduced versus preserved left-ventricular ejection fraction
Authors: El Chilali K , Kahlert H A , Riebisch M , Mincu R I , Al-Rashid F , Totzeck M , Lind A , Janosi R A , Rassaf T , Kahlert P 
Published: October 2019

Abstract

Background
Outcomes of transfemoral transcatheter aortic valve implantation (TF-TAVI) with a self-expanding (SEP) and a balloon-expandable prosthesis (BEP) seem to be comparable, though head-to-head comparisons, especially in certain patient subsets, are sparse. In addition, patients with a reduced left-ventricular ejection fraction (rEF, ≤40%) appear to be at higher risk for an increased mortality after TF-TAVI than patients with a preserved left-ventricular ejection fraction (pEF). As it remains unclear, whether outcomes of patients with rEF differ between TF-TAVI using SEP and BEP, we sought to compare all-cause mortality of patients with rEF using a SEP or a BEP.

Methods
We retrospectively analyzed data of 679 single-center TF-TAVI patients, which were stratified by baseline ejection fraction (rEF versus pEF) and type of implanted prosthesis (SEP versus BEP). Patients were censored at death or completion of 1-year follow-up, whichever occurred first.

Results
Twenty-one percent of patients had rEF, and these patients had a higher 1-year mortality compared to patients with pEF (28% vs. 19%, p=0.007). SEP were implanted in 149 patients (49 patients with rEF), while BEP were implanted in 538 patients (92 patients with rEF). All-cause 1-year mortality was similar after SEP- and BEP-implantation (16% vs 19%, p=0.516) in patients with pEF. In patients with rEF, however, 1-year mortality was higher after SEP- than after BEP-implantation (43% vs. 21%, p=0.004, see figure). Patients with rEF had a higher incidence of new permanent pacemaker implantation (26.5% vs. 13%, p=0.046) and paravalvular leak ≥2 (21% vs. 10%, p=0.07) after SEP- than after BEP-implantation, but both factors could not explain the excess mortality after SEP-implantation in multivariate analysis.

Conclusion
Patients with rEF had a higher 30-day and 1-year mortality after TF-TAVI when a SEP instead of a BEP was used. Further studies are needed to confirm and explain this finding.