bluuebunny/crossref_metadata_2025_split huggingface dataset:
P99 Rapid ventricular stimulation induces augmented conduction delay in Brugada syndrome patients
Authors: Yoon N , Jeong H K , Lee K H , Park H W , Cho J G 
Published: January 2020

Abstract

Background
The exact mechanism for Brugada Syndrome (BrS) is still not clear. There are two main physiologic hypotheses that have been suggested: the repolarization and the depolarization disorder models. Right ventricular (RV) activation delay was verified by echocardiography, conduction time in an explanted heart or in computer simulation. Verification of prolonged longitudinal activation time in human RV of only 5 patients of type-1 BrS and 5 controls was reported in 2008.

Methods
Bidirectional longitudinal activation times were assessed between RV outflow tract (RVot) and RV-apex (RVa) by stimulating and mapping RV endocardium in BrS patients. Conduction velocity was calculated considering ventricle size and distance between catheters.

Results
The studies were performed in controls (n = 18) and BrS patients (n = 6). There was no statistical difference in RP interval and QRS duration (PR 146 ± 21.7 vs 167 ± 45.2 ms, p = 0.325; QRS 102 ± 28.2 vs 122 ± 32.2 ms, p = 0.163). There was no difference of longitudinal activation time on stimulation at 500 ms (RVa to RVot: 63 ± 14.3 versus 80 ± 34.2 ms, p = 0.290; RVot to RVa: 50 ± 12.2 versus 76 ± 35.1 ms, p = 0.122). The BrS patients had longer longitudinal activation time on stimulation at 400 ms (RVa to RVot: 61 ± 15.2 versus 87 ± 28.7 ms, p = 0.009; RVot to RVa: 52 ± 11.1 versus 76 ± 35.3 ms, p = 0.029). The difference was not significant when isoproterenol was infused.

Conclusions
BrS patients display bidirectional longitudinal conduction delay when rapid stimulation. These findings support that BrS might be partly attributable to depolarization abnormality.
P100 Prospective mid-term assessment of frailty in patients implanted with left ventricular assist devices- any reversibility within different domains?
Authors: Fan K Y Y , Wong K L , Cheng K Y , Chow C , Au K L , Lee M Y 
Published: January 2020

Abstract

Background
The coalescence of the frailty phenotype and advanced heart failure (HF) presents a unique opportunity to assess any LVAD mediated improvement of cardiac output that may potentially improve the slowness, weakness, fatigue, weight loss and physical inactivity that comprise the frailty phenotype. We sought to determine whether implantation of LVAD could improve frailty in Chinese population.

Methods
From March 2015 to May 2018, 24 patients (pts) with advanced HF underwent LVAD implantation and 16 pts who remained on LVAD support for 18 months were assessed serially every six months. A new multi-disciplinary objective assessment of frailty with relevance to local Chinese population was designed to enable serial reassessment of patient’s clinical progress. The total maximum scores ranged from 0-7 [1. Physical score 0-5 namely exhaustion, poor appetite, weak hand grip, 6 minute hall walk test &lt;400m and reduced physical activity; 2. Cognitive (Montreal Cognitive Assessment-Hong Kong) &lt;22= 1; 3. Depression (Hospital Anxiety and Depression Scale) &gt; = 1].

Results
During the period studied, 5 pts received heart transplantation and 3 pts died. Mean age of remaining 16 pts (94% men) was 53 ± 13 years old. There was significant reduction in total frailty score mainly driven by significant reduction in physical domain. However, frailty was only completely reversible in 8 pts (50%). Improvement in frailty post LVAD were not associated with significant differences in measures of mood or cognition. (Figure 1)

Conclusions
The components of the frailty phenotype in pts with post LVAD surgery all have significant improvements. Absences of any association between improvements in the frailty phenotype and mood or cognition warranted further focused attention in the rehabilitation program for LVAD pts.
Abstract P100 Figure.
P101 Cardiac rehabilitation program for end-stage heart failure patients with left ventricular assist devices in Hong Kong
Authors: Fan K Y Y , Wong K L , Fu N , Cheng K Y , Chow Y M , Au K L , Au W K , Ho C 
Published: January 2020

Abstract

Background
Implantation of modern durable left ventricular assist device (LVAD) in advanced heart failure (HF) patients is associated with increased survival and improved quality of life. Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to exercise capacity in HF patients but data on effect of EBCR in advanced HF patients with LVAD are limited.
Objectives
To evaluate the effect of EBCR program on the functional capacity of advanced heart failure patients with LVAD
Methods
Out of the current 64 LVAD recipients in Hong Kong, 43 patients who have had LVAD implanted and survived 1 year were screened. The EBCRP consisted of cardiorespiratory and strength training exercise once a week for a total of 24 sessions (6 months). The functional rehabilitation outcome was evaluated by 6 minute walk test (6MWT) at baseline, before LVAD implantation, pre-EBCR and by end of EBCP ( 6 months). The muscle strength was evaluated by an isokinetic knee extension strength test defined by 10 repetitive maximum (RM) torque of quadriceps strength before starting EBCR and at 6 months upon termination of EBCR.

Results
A total of 33 LVAD patients were recruited into our EBCR program. There were 27 (82%) men with mean age of 48.7± 13.6 years. Average duration from LVAD surgery to commencement of EBCR was 5.3 months. Baseline 6MWT could not be performed in 21 patients due to extreme poor functional class (NYHA class IV) with prolonged hospitalizations requiring inotropes and circulatory support. For the other 12 patients, there were no significant differences in 6 MWT at baseline and post LVAD before starting EBCP. Overall 6MWT significantly improved by end of EBCR (pre- EBCR mean 382.2, ±95.2m vs post -EBCR mean 440.8 ±88.2m p= 0.001). There were significant improvement in quadriceps strength by the end of EBCRP program. (pre- CRP 1.8 ± 2.5 kg vs post CRP 3.5 ± 3.5 kg p &lt; 0.001).

Conclusions
LVAD patients show high level of impairment of functional capacity despite after LVAD imaplntation with improved circulatory output. EBCR program allowed greater improvement in exercise capacity evolution and peripheral physiology such as muscle strengthening.
P107 Predictors of increased d-dimer level at follow-up period after transcatheter aortic valve implantation.Is oral anticoagulation therapy better?
Authors: Okai T , Mizutani K , Yamaguchi T , Ogawa M , Kajio K , Ito A , Iwata S , Takahashi Y , Izumiya Y , Murakami T , Shibata T , Yoshiyama M 
Published: January 2020

Abstract

Background
Recently, there are some reports that hypo-attenuated leaflet thickening (HALT) following transcatheter aortic valve implantation (TAVI) is incidentally detected by multi-slice computed tomography. It is believed that valve thrombosis causes HALT, because oral anticoagulation therapy (OAC) is effective for HALT regression. Furthermore, it is reported that d-dimer level increases in patients with HALT, and might be a key biomarker to detect HALT.

Purpose
We sought to investigate the predictors related to increased d-dimer level at 6 months after follow-up TAVI.

Methods
We enrolled 124 consecutive patients who underwent successful TAVI between 2016 and 2018. Study patients were classified into two groups according to antithrombotic therapy resume (OAC therapy or anti-platelet therapy).We set the primary endpoint as the d-dimer levels at 6 months after TAVI. To evaluate the risks of the primary endpoint, we employed a multivariable linear regression model, setting the primary endpoint as an objective variable and patient and clinical backgrounds as explanatory variables. Furthermore, we set the secondary endpoint as one-year bleeding event.

Results
The median age of patients was 83 years old (quartile 80-87). Patients who had taken OAC at 6 months follow-up after TAVI were 29.8%. The median d-dimer level at 6 months after TAVI was 1.3 (1.0-2.2) µg/ml, and OAC group had statistically lower d-dimer level at 6 months follow-up than those in non-OAC group (p = 0.020). Uni-variable liner regression model demonstrated that increased d-dimer level at follow-up had significant relationship with large effective orifice area (EOA) (p = 0.002) and low left ventricular ejection fraction (LVEF) (p = 0.048) after TAVI. Furthermore, large EOA (p = 0.003) and OAC therapy (p = 0.027) were independently associated with increased d-dimer level in multivariate analysis. Kaplan-Meier estimates revealed that there were no significant difference regarding one-year bleeding event between OAC group and non-OAC group (long-rank p = 0.167).

Conclusions
This study suggests that large EOA after TAVI is associated with increased d-dimer levels at 6 months after TAVI, and OAC therapy might have a potential to decrease d-dimer level after TAVI without increase of bleeding events.
Abstract P107 Figure: One-year bleeding event
P112 Early respiratory changes after transcatheter aortic valve replacement
Authors: Furuichi Y , Shimizu J , Higuchi R 
Published: January 2020

Abstract

Funding Acknowledgements
Sakakibara heart Institute

Introduction
Transcatheter aortic valve replacement (TAVR) is an alternative treatment for inoperative or high-risk patients requiring surgical aortic valve replacement (SAVR). In previous studies, the vital capacity falls to about 50% immediately after SAVR. Although the vital capacity recovers to about 60-70% in one week, it does not recover to preoperative levels at 3 months following SAVR 1)2). TAVR is expected to preserve respiratory function because TAVR does not require a sternotomy.

Purpose
The purpose of this study was to investigate early stage respiratory function after a TAVR. We assumed that respiratory function is not reduced after a TAVR.

Methods
This prospective study was approved by the local ethics committee of our Institute. Written informed consent was obtained from all patients. The subjects were patients who underwent TAVI at our Institute from July 2017 to March 2019. Exclusion criteria included patients who refused to provide informed consent, emergent cases, NYHA (New York Heart Association) Class IV patients, patients receiving inotropes, patients under mechanical ventilation, patients enrolled in other studies, or patients for whom conducting pulmonary function tests were judged to be difficult. The pulmonary function test was conducted once a day until one week after the TAVR procedure.

Results
The target number was 100, and we ceased registration when informed consent was obtained from 100 patients. TAVR was conducted for 142 cases in this period and 42 cases were excluded. After informed consent was obtained, 17 cases were excluded because they met the exclusion criteria, and the analysis was conducted with 83 cases. The vital capacity and % of vital capacity were significantly reduced from the first day to the sixth day and recovered to preoperative levels at the seventh day after TAVR. The forced expiratory volume was significantly reduced from the first day to the fifth day, and recovered to preoperative levels at the sixth day after TAVR. The percentage of forced expiratory volume at one second was not significantly reduced.

Conclusions
The respiratory function was reduced in the early stages after TAVR. The respiratory function was reduced mostly on the first day after TAVR and recovered to preoperative levels on the seventh day after TAVR. After TAVR, the respiratory function recovered earlier than after SAVR. We believe that TAVR is more suitable for patients with reduced respiratory function.
Abstract P112 Figure. respiratory function after TAVR
P177 Left atrial strain in patients with cardiac amyloidosis. Relationship to left atrial amyloid deposition focusing on prognosis
Authors: Misumi K , Miura H , Morita Y , Amano H , Ueda H I , Izumi C , Fukuda T , Noguchi T , Yasuda S 
Published: January 2020

Abstract

Background
In cardiac amyloidosis (CA), the left atrium (LA) is frequently infiltrated by the amyloid fibrils. It is currently known that LA strain is a marker of LA function and prognosis in many cardiac diseases, however its significance in CA remains unknown.

Purpose
Our aim was to investigate correlation between LA strain measured by Cardiovascular Magnetic Resonance (CMR) and amyloid deposit in LA, and also evaluate the LA strain on the prognostic significance.

Methods and results
Of 74 consecutive patients with biopsy-proven CA, we analyzed 42 patients (age 72 ± 10 years; 76 % males) with contrast-enhanced CMR, and examined LA late gadolinium enhancement (LGE) and CMR derived LA strain using feature tracking method. Of the 42 patients, 29 patients (69 %) was transthyretin cardiac amyloidosis (ATTR-CA) in the majority. We divided these 42 patients into two groups according to the CMR measured peak atrial longitudinal strain (PALS) (&gt; = or &lt; median); high-strain (&gt; = 6.67 %, n = 21) and low-strain (＜ 6.67 %, n = 21) and compared the patient’s characteristics, blood test data, echocardiography and CMR parameters. There were no significant differences between two groups in these parameters but in the extent of LA-LGE (54 % vs 80 %, p = 0.008). The PALS correlated with the extent of LA-LGE (ρ= 0.50, p = 0.001). In multivariate analysis including LVEF, E/e’ and BNP, LA-LGE was an independent determinant of PALS. During three-year follow up, the LA strain significantly related to heart failure hospitalization in the ATTR-CA patients (p = 0.036)(Figure).

Conclusions
In CA patients, CMR measured LA longitudinal strain correlates with the LA-LGE. It also provides useful information for poor prognosis of patients with ATTR-CA.
Abstract P177 Figure. Heart failure hospitalization in ATTR-CA
P178 Sinus rhythm restoration by catheter ablation improved cognitive function in elderly patients with atrial fibrillation
Authors: Fujiyoshi K , Minami M , Saito D , Hashimoto T , Yoshizawa T , Oikawa J , Tojo T , Yamaoka-Tojo M , Ako J 
Published: January 2020

Abstract

Background
Atrial fibrillation (AF) may cause cognitive impairment. However, the impact of sinus rhythm (SR) restoration by catheter ablation on the improvement of cognitive function remains to be elucidated.

Methods
A total of 57 consecutive elderly patients (70.8 ± 4.8 years old) who underwent catheter ablation for AF were prospectively enrolled. The change of cognitive function for 6 months was compared between patients with SR restoration (at least 3 months; n = 49) and patients with AF recurrence (n = 8). Cognitive function was evaluated by the mini-mental state examination (MMSE).

Results
There was no significant difference in baseline characteristics between the 2 groups, including MMSE score (27.3 ± 2.6 vs. 27.6 ± 1.5 points; p = 0.793). The change of MMSE score was significantly greater in patients with SR restoration than those with AF recurrence (0.28 ± 0.70 vs. − 0.50 ± 0.75 points; p = 0.006; Figure). The general liner modeling revealed that SR restoration (effect estimate, 0.369; 95% confidence interval, 0.110 to 0.627; p = 0.006) was independently associated with the change of MMSE score.

Conclusion
In elderly AF patients, successful restoration of SR by catheter ablation was associated with the improvement of cognitive function.
Abstract P178 Figure
P181 Implantable cardioverter defibrillator and cardiac resynchronisation therapy use in New Zealand
Authors: Foo F S , Lee M , Kerr A J 
Published: January 2020

Abstract

Introduction
The ANZACS-QI DEVICE registry is a national registry designed to collect data on all cardiac implantable electronic devices (CIED) implanted in New Zealand (NZ). This study aims to provide a contemporary analysis of the clinical characteristics and implant details of patients receiving implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT), including CRT-Pacemaker (CRT-P) and CRT-Defibrillator (CRT-D).

Methods
Complete datasets of ICD, CRT-D and CRT-P implants from the ANZACS-QI DEVICE registry from 1st January 2014 to 31st December 2017 were analysed.

Results
A total of 1579 ICD implants were identified. Of the 1152 (73.0%) new implants, 565 (49.0%) were for primary prevention and 587 (51.0%) were for secondary prevention. The baseline demographics of both groups were similar, with a median age of 62 and predominantly male (79.2-81.4%), with European (63.7-66.8%) and Maori (21.1-24.8%) being the most common ethnicities. The mean BMI was 29.6-30.2 kg/m², with most patients (75.2-80.7%) being in sinus rhythm at the time of ICD implant. Compared to the secondary prevention group, the primary prevention group had more patients with a history of heart failure (80.4% vs 39.7%), worse heart failure symptoms (NYHA Class II-III 77.1% vs 47.3%), poorer left ventricular ejection fraction (LVEF) (mean 25.1% vs 30.3%) and the aetiology was more likely to be non-ischaemic (57.5% vs 44.2%). The mean QRS duration was longer (129.9ms vs 113.4ms), with a higher incidence of left bundle branch block (31.9% vs 16.0%) and a correspondingly higher rate of CRT-D implants (27.4% vs 8.3%).
In the 427 (27.0%) ICD replacements, over a mean duration of 6.27 years, 46.6% had delivered appropriate therapy (including 38.4% with appropriate ICD shocks) whilst 17.8% had delivered inappropriate therapy.
Compared to primary prevention CRT-D (n = 155), patients receiving CRT-P (n = 175) were older (median age 74 vs 66) and more likely to be female (38.3% vs 19.4%). CRT-D patients had longer mean QRS duration (169.2ms vs 160.8ms) and poorer LVEF (mean 24.3% vs 28.7%).

Conclusion
This analysis provides contemporary data on ICD and CRT use in New Zealand. Primary prevention ICD patients were more likely to have a history of heart failure, worse heart failure symptoms, more prolonged QRS duration, left bundle branch block and poorer LV function compared to secondary prevention ICD. Compared to primary prevention CRT-D, patients receiving CRT-P were older and more likely to be female.
P183 Arterial stiffness was inversely associated with left ventricular diastolic function in indigenous Papuan populations
Authors: Ishida A , Isotani A , Fujisawa M , Garcia Del Saz E , Okumiya K , Kimura Y , Manuaba I , Kareth M , Rantetampang A , Ohya Y , Matsubayashi K 
Published: January 2020

Abstract

Background
Age-related increase in systolic pressure is known to be absent in indigenous Papuan populations, partially because of their life-long low-sodium and high-potassium diets.

Purpose
The aim of this study was to investigate the age-related change in left ventricular (LV) systolic and diastolic function and the relationship with arterial hemodynamics among the indigenous Papuan highland people.

Methods
Indices of arterial hemodynamics were measured using oscillometric brachial cuff-based sphygmomanometer (Mobil-O-Graph). Brachial-ankle pulse wave velocity (baPWV) was measured using a semiautomatic device (form ABI/baPWV). LV systolic and diastolic function was evaluated by 2-dimensional echocardiography and tissue-Doppler imaging using Vivid iq.

Results
A total of 81 native Papuans (median age 42 years, 47% women) were enrolled in this study. None of the subjects took any medicines, particularly antihypertensive drugs. All participants presented in sinus rhythm. With ageing, LV mass index remained unchanged, and LV ejection fraction increased, but mildly reduced (40–50%) in 3 participants. Transmitral E-wave velocity slightly decrease but the change was not significant. Transmitral A-wave velocity markedly increased (ρ=0.60, P &lt; 0.001) and E/A ratio decreased with age (ρ=-0.52, P &lt; 0.001). Age-related change of E-wave deceleration time was not significant. Septal e′ (ρ=-0.60, P &lt; 0.001) and lateral e′ decreased (ρ=-0.53, P &lt; 0.001) and average E/e′ increased with age (ρ=0.44, P &lt; 0.001). Left atrial volume index did not change significantly with age. In multivariate regression analysis, baPWV was independently associated with E/e" ratio both before and after adjustment for age, sex, body mass index, mean arterial pressure, and heart rate; however, indices of wave reflection including augmentation index and reflection magnitude were not associated with E/e′. Only age and heart rate were inversely associated with E/A ratio.

Conclusion
LV systolic function was preserved in indigenous Papuan populations; however, LV diastolic function decreased with ageing. Age-related arterial stiffening, not wave reflection, was inversely related to LV diastolic function.
P187 Late outcomes of all patients at a single center with diabetes mellitus undergoing SYNTAX scoring after angiographic screening for the FREEDOM trial
Authors: Femia G , Kim S , Burgess S , Eftal M , Ullah I , Dignan R , Mussap C , French J K 
Published: January 2020

Abstract

Background
The Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi-Vessel Disease (FREEDOM) trial randomized only a minority of screened patients with diabetes mellitus (DM) and 2-3 vessel disease (MVD), representing an high risk diabetic MVD cohort.

Methods
Consecutive patients with DM underwent angiographic screening from June 2006 to March 2010 at Liverpool Hospital, Sydney, Australia, for the FREEDOM trial; SYNTAX Scores (SS) were subsequently performed. Patients had late follow-up to determine late rates of death, non-fatal MI and stroke.

Results
Among 1263 patients with DM 833 (66%) had 0-1 vessel disease and 430 (34%) had MVD of whom 139 had prior coronary artery bypass grafting (CABG), and SS were 0 in 272, 1-9 in 336, 10-22 in 264, 23-32 in 109, and 271 patients had SS ≥33. Revascularisation was performed by coronary artery bypass grafting (CABG) in 139 (11%), 486 (38%) underwent PCI, and 638 (51%) did not undergo a revascularization procedure; respective mean ages were 63.5, 64.2 and 64.7 years; p = 0.39, and presentation rates with an ACS were 52%, 57% and 37%; p &lt; 0.05. Amongst patients with MVD, those undergoing CABG had lower rates of MACE than either PCI or medical therapy (22%, 40%, and 51% respectively; p &lt; 0.001). Kaplan-Meier curves (Figure) with respect to SS and late events are shown for: A) Death; B) Non-fatal MI; C) Death/MI/Stroke; D) Late Revascularization. Multi-variable analyses found independent predictors of late mortality were age &gt;75 (HR 6.2), prior MI (HR 1.1), prior CABG (HR 1.6); and LVEF &lt;40% (all p &lt; 0.05). Predictors of late MI were older age, ACS presentation at screening, LVEF &lt; 40% and insulin use.

Conclusions
Among diabetic patients who screened for the FREEDOM Trial, among 34% with MVD CABG was associated with lower rates of non-fatal MI and MACE compared to PCI and medical therapy. The poorest outcomes were observed in DM patients with MVD managed with medical therapy alone.
Abstract P187 Figure. SYNTAX scores &late events in diabetics