bluuebunny/crossref_metadata_2025_split huggingface dataset:
2140Association of arterial stiffness with left atrial structure and phasic function: a community-based cohort study
Authors: Yoshida Y , Nakanishi K , Daimon M , Ishiwata J , Sawada N , Hirokawa M , Kaneko H , Nakao T , Mizuno Y , Morita H , Di Tullio M R , Yatomi Y , Homma S , Komuro I 
Published: October 2019

Abstract

Background
Increased arterial stiffness is recognized as an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. Cardio-ankle vascular index (CAVI) is emerging as an important tool to assess arterial stiffness noninvasively which is derived from the concept of stiffness β index and is less dependent on blood pressure at the time of measurement than pulse wave velocity.

Purpose
This study aimed to investigate the association of arterial stiffness with left atrial (LA) volume and phasic function in a community-based cohort.

Methods
We included 1,156 participants without overt cardiovascular disease who underwent extensive cardiovascular examination. Arterial stiffness was evaluated by CAVI. Speckle-tracking echocardiography was employed to evaluate LA phasic function including reservoir, conduit and pump strain as well as left ventricular global longitudinal strain (LVGLS).

Results
CAVI was negatively correlated with reservoir and conduit strain (r=−0.37 and −0.45, both p<0.001; Figure), whereas weakly, but positively correlated with LA volume index and pump strain (r=0.12 and 0.09, both p<0.01). In multivariable analysis, CAVI was significantly associated with reservoir and conduit strain independent of traditional cardiovascular risk factors, pertinent laboratory parameters and LV morphology and function including LVGLS (standardized β=−0.22 and −0.26, respectively, both p<0.001), whereas there was no independent association with LA volume index and pump strain. In the categorical analysis, the abnormal CAVI (≥9.0) carried the significant risk of impaired reservoir (<31.4%) and conduit (<12.4%) strain (adjusted odds ratio = 2.63 and 3.71 vs. normal CAVI, both p<0.01) in a fully-adjusted model including laboratory and echocardiographic parameters.
Figure 1

Conclusion
Arterial stiffness was independently associated with LA reservoir and conduit function, even in the absence of overt cardiovascular disease. This association may explain the higher incidence of atrial fibrillation in individuals with increased arterial stiffness.
2167Impact of dual-chamber pacing with closed loop stimulation on quality of life in patients with recurrent reflex vasovagal syncope: results from the SPAIN study
Authors: Baron Esquivias G , Morillo C M , Moya A M , Martinez Alday J D , Ruiz-Granell R , Lacunza J D , Garcia-Civera R , Gutierrez-Carretero E , Romero-Garrido R 
Published: October 2019

Abstract

Background
Reflex vasovagal syncope (VVS) is one of the most common causes of syncope and, when recurrent, can have devastating consequences on the quality of life of patients despite pharmacological interventions. The closed loop stimulation (CLS) pacing algorithm converts, during an incipient VVS, variations in right intracardiac impedance into heart rate adaptation. The study SPAIN was the first randomized, double-blind trial robustly showing a strong reduction in syncopal recurrence in patients paced with dual-chamber (DDD)-CLS. (NCT01621464).

Purpose
To evaluate whether the differences observed in the SPAIN study regarding syncope burden and time to recurrence translate into improvements on quality of life.

Methods
This study analysed quality of life data from the SPAIN study: a randomized, prospective, double-blind, multicenter trial conducted in 10 Spanish and 1 Canadian centers. Ethics Committee approval was obtained at each participating center. Patients aged ≥40 years, with ≥5 VVS episodes and cardioinhibitory response to head-up tilt testing were included. After implant, patients were randomized 1:1 to active DDD-CLS mode for 12 months followed by sham DDI mode for the remaining 12 months or vice-versa. Quality of life was assessed via the Short Form-36 (SF-36) health survey before randomization (baseline), and at 12- and 24-month follow-up. The change in quality of life during the entire follow-up relative to baseline was compared between each pacing mode (DDD-CLS vs. DDI).

Results
Fifty-four patients were enrolled with a mean age of 56.3±10.6 years and a median of 12 syncopal episodes before randomization. Median SF-36 scores greatly increased from baseline in the DDD-CLS group across the 8 domains, whereas the response was variable in the DDI group. Comparing both pacing algorithms, median SF-36 scores were higher in the DDD-CLS group, with differences reaching statistical significance for “physical role” and “vitality” domains (p-value =0.006 and 0.014, respectively). Pacing sequence or treatment period did not significantly influence the response (p-value >0.05 for all the domains).

Conclusions
We demonstrated the beneficial effect of this physiological pacing algorithm on the quality of life of patients, as evidenced by the improvement in all the domains of the SF-36 when stimulated in DDD-CLS as compared to the sham DDI mode.
2225“New-onset atrial fibrillation efter cardiac surgery is associated with increased long-term morbidity and mortality”: a population-based study from the SWEDEHEART-registry
Authors: Taha A , Jeppsson A , Friberg L , Nielsen S , Ahlsson A , Bjorck S , Bergfeldt L 
Published: October 2019

Abstract

Background
New-onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, but the prognostic implications are not settled. In contrast to previous reports, a recent Danish study in coronary bypass surgery (CABG) patients (Butt et al. JAMA Cardiol 2018) did not show any increased risk for thromboembolic complications in POAF patients.

Purpose
To compare long-term outcome in patients with vs. without POAF after CABG.

Methods
All CABG patients in Sweden 2005–2015 (n=38040) were included in a retrospective population-based cohort study. Data from the SWEDEHEART registry, the National Patient Registry and the National Population Registry were merged. POAF was defined as any new-onset atrial fibrillation (AF) episode up to the 30thpostoperative day. Inverse Probability Treatment Weighting (IPTW) adjusted Cox regression models were used to compare outcome variables after the first 30 postoperative days until the end of follow-up (median 5 years, range 0–10). The models were adjusted for age, gender, CHA2DS2-VASc score, co-morbidity, and medications.

Results
The mean age of the entire cohort was 68 years, 79% were men and 90% had a CHA2DS2-VASc score ≥2. The incidence of POAF was 28.5% (10845/38040). During follow-up POAF, patients had a significantly higher adjusted risk for all-cause mortality [Hazard Ratio (HR) 1.16 (95% CI 1.09–1.24)], ischemic stroke [HR 1.19 (1.09–1.30)], transient ischemic attack [HR 1.17 (1.03–1.33)], pulmonary embolism [HR 1.24 (1.01–1.54)], myocardial infarction [HR 1.14 (1.04–1.25)], heart failure hospitalizations [HR.1.46 (1.35–1.59)] and recurrent AF [HR 4.33 (4.09–4.65)].

Conclusions
POAF was in this comparatively large study associated with increased risk for mortality and morbidity during long-term follow-up after CABG and is hence not a trivial complication.
2373Effect of ethninicty on in-hospital outcomes of takotsubo cardiomyopathy, data from the national inpatient sample database
Authors: Zaghlol R , Desale S , Barac A 
Published: October 2019

Abstract

Background
The effect of ethnicity on in-hospital outcomes of takotsubo cardiomyopathy (TC) is unknown.

Purpose
To investigate ethnic variations in hospital outcomes of TC in a large nationwide sample.

Methods
The National Inpatient Sample (NIS) database was searched from 2004 to 2014 for the ICD-9-CM code 429.83 to obtain weighted estimates of TC hospitalizations. Based on self-reported ethnicity, African-Americans (AA) and Hispanics were compared to Caucasians for differences in baseline characteristics and in-hospital outcomes. Multivariate regression models were used to adjust for potential confounders.

Results
Of 103891 hospital admissions identified, 89624 (86.3%) were Caucasians, 8026 (7.7%) were AA and 6241 (6%) were Hispanics. Caucasians were older with more females as compared to AA and Hispanics (67.5 [0.13] vs 61.8 [0.45] vs 63.2 [0.52] years, p<0.0001) and (78135 [87.2%] vs 6672 [83.1%] vs 5196 [83.3%], p<0.0001) respectively. Patients' demographics and baseline characteristics are shown in table 1. In unadjusted analysis (Figure 1), compared to Caucasians, AA had more cardiac arrests (304 [3.79%] vs 2569 [2.87%], p=0.038), invasive mechanical ventilation (1671 [20.8%] vs 15897 [17.7%], p<0.002) and tracheostomies (242 [3%] vs 1600 [1.8%], p=0.0009). When comparing Hispanics to Caucasians, Hispanics had higher mortality (426 [6.83%] vs 4573 [5.1] deaths, p=0.007). In adjusted analysis for baseline characteristics differences and hospital location/teaching status, AA had less cardiogenic shocks (OR=0.71 [95% CI 0.56–0.91], p=0.006) and intraaortic balloon pump support (OR= 0.6 [95% CI 0.39- 0.93], p=0.023) but required longer hospitalization (1.64 vs 1.56 log transformed-days, p=0.0001) as compared to Caucasians. Hispanics still had higher mortality than Caucasians (OR =1.27 [95% CI 1.01–1.61], p=0.04).
Table 1. Patients' demographics and baseline characteristics Parameter Caucasians African Americans Hispanics Total p-value Age, years 67.46 (0.13) 61.77 (0.45) 63.15 (0.52) 66.76 (0.12) <0.0001 Females 78,135 (87.18%) 6,672 (83.13%) 5,196 (83.25%) 90,003 (86.63%) <0.0001 Congestive heart failure 20,693 (23.09%) 2,066 (25.73%) 1,395 (22.36%) 24,155 (23.25%) 0.055 Chronic lung disease 26,815 (29.92%) 1,971 (24.54%) 1,200 (19.22%) 29,986 (28.86%) <0.0001 Diabetes mellitus 15,295 (17.07%) 2,071 (25.79%) 1,711 (27.41%) 19,077 (18.36%) <0.0001 Chronic kidney disease 9,065 (10.11%) 1,315 (16.37%) 795 (12.74%) 11,174 (10.76%) <0.0001 Smoking 29,535 (32.95%) 2,660 (33.13%) 1,303 (20.87%) 33,498 (32.24%) <0.0001
Figure 1. In-Hospital Outcomes

Conclusion
There is ethnic variation in hospital outcomes of takotsubo cardiomyopathy, some of which may be related to differences in patients' demographics and baseline characteristics.

Acknowledgement/Funding
Medstar Georgetown University Hospital/ Washington Hospital Center graduate medical education department funded the purchase of the database
2404The use of wearable cardioverter defibrillator in France
Authors: Marijon E , Garcia R , Gras D , Sadoul N , Guedon-Moreau L , Leclercq C , Extramiana F , Lellouche N , Defaye P , Combes N 
Published: October 2019

Abstract

Background
The wearable cardioverter defibrillator (WCD) has been shown to be useful during transient periods of high sudden cardiac death risk, and the issue of compliance recently pointed out. This Registry was designed to provide real-world data on WCD use in France, in terms of compliance, potential adverse events, as well as efficacy.

Methods and results
Multicenter evaluation (WEARIT FRANCE Registry) was conducted in France between January 2017 and March 2018. Overall, 1,157 patients were analyzed: 950 with ischemic heart disease (82%, including 647 patients after myocardial infarction), 119 after ICD explant (10%), and 88 pre-transplant (8%). The median age was 61 years; the median ejection fraction was 25%. Median WCD wear time was 62 days, with median daily use of 23.4 hours. Less than 1% of patients did not wear WCD at least 4 hours per day. During follow-up, a total of 42 sustained ventricular tachyarrhythmias (VT/VF) occurred in 36 patients, of whom 50% (n=18) received appropriate WCD shocks, giving an incidence of appropriate therapy of 1.56%. The rate of all VT/VF episodes were 3.1% among patients with ischemic cardiomyopathy (n=29/950) versus 3.4% for the others (n=7/207). Of the ischemic patients wearing beyond 30 days (N=784), 5 received appropriate therapy of VT/VF episodes. Overall shock survival was 100%. At the end of the WCD period, 586 patients (51%) were implanted with an implantable cardioverter defibrillator. Eight patients (0.69%) received inappropriate WCD shocks. Regarding the apparent very low proportion of women considered for WCD therapy, we aimed to appreciate in which extent

Conclusions
In this multicenter nationwide WCD evaluation, 3.1% of patients presented with sustained VT/VF with 47% of those patients developing VT/VF after 30 days. The incidence of inappropriate therapy was low. The compliance to WCD in this real life evaluation was very high. These data suggest that the WCD, when worn appropriately, may be helpful in the arsenal to protect high-risk patients against SCD, especially in case of transient risk situations.

Acknowledgement/Funding
Zoll
2405When do cardiac rhythm management device complications occur?
Authors: Brough C E P , Wright D J 
Published: October 2019

Abstract

Background
The rate of implantation of cardiac rhythm management devices continues to increase but it is difficult to compare the complication rates of routine cardiac implantable electronic device procedures as the follow-up durations published in literature vary widely (peri-procedure to 3 years).

Purpose
We demonstrate the appropriate follow-up duration for a complication to be attributed to an index procedure, by analysing the complications within the first year of routine cardiac implantable electronic device procedures (primary implant, generator replacement, lead revision only, generator and lead revision, system upgrade and reburial) and the timing of complication interventions.

Methods
A retrospective database was constructed of all de novo CIED operations performed at a tertiary cardio-thoracic centre between April 2008 – March 2016. Procedures were identified from theatre logbooks, with demographic and procedural data extracted from contemporaneously maintained health records (paper and electronic). Objective complications were defined as follows; 1. Any pneumothorax identified on chest x-ray, 2. Any pericardial effusion identified on transthoracic echocardiogram performed post procedure due to intra-operative clinical concern, 3. Haematoma requiring surgical evacuation, 4. Device pocket revision or system reburial, 5. Lead intervention requiring repositioning or placement of a new lead and 6. System explant/ extraction due to any indication. Post-operative complications were identified through theatre log books and cross-referenced with 3 contemporaneously maintained records (clinical health records, TOMCAT electronic database, audit department archive). All data collection was performed by a single investigator, independent of the procedures performed and operating physicians.

Results
10,125 procedures were reviewed; 6,583 primary implant procedures, 2,170 generator replacements, 382 lead revisions, 253 generator and lead interventions, 575 system upgrades and 162 reburial procedures. The procedures involved 3,403 female patients and 6,722 male, with a median age 73 years (±13.7). 2,303 procedures were acute and 7,822 elective. The complication rates were; 4.3% primary implant, 4.0% generator replacements, 12.6% lead revisions, 13.0% generator and lead interventions, 6.9% system upgrades and 22.8% reburial procedures. The timing of complication intervention varied significantly (Figure 1).
Timing of Complication Intervention

Conclusion
Complications within the first year of any cardiac implantable electronic device intervention is common, particularly system reburials, lead revisions and generator and lead procedures. 10% of complications after generator replacement, system upgrades or reburial procedures occurred at between 36–52 weeks. For lead and combined generator and lead procedures this figure rose to approximately 15%.
2407Influence of transvenous lead extraction procedure on function of tricuspid apparatus
Authors: Polewczyk A , Nowosielecka D , Tomaszewski A , Brzozowski W , Szczesniak Stanczyk D , Tulecki L , Tomkow K , Czajkowski M , Jachec W , Kutarski A 
Published: October 2019

Abstract

Background
Accidental damage of tricuspid apparatus remain known complication of TLE procedure but our knowledge is limited due lack of separate analysis in the literature.

Purpose
The goal of this study was analysis of the appearance of lead extraction related tricuspid valve dysfunction using trans-chest and trans-oesophageal echocardiography.

Methods
Between March 2006 and December 2018 we performed 2900 TLE procedures using conventional mechanical sheaths in 1760 male and 1140 female patients (mean age 66.6y). 4811 leads (mean implant duration 91.5 months) were removed due to non-infective indications in 65.3%. Full radiological success was obtained in 95.7% procedures, partial in 4.0%, clinical success in 98.0%, full procedural success in 96.1%. Major complications (MC) appeared in 8 (1.8%).

Results
Results are presented in the table

Conclusions
TLE using conventional mechanical sheaths is effective. Tricuspid valve dysfunction different degree is frequent finding in candidates for TLE. TLE procedure brings risk (7.2%) of different degree damage of tricuspid leflet (significant in 1.5%) or even chordae tendinae (4%). Patients with severe lead extraction related tricuspid valve dysfunction needs exact follow-up and some of them can be candidates for cardiac surgery. On the other hand in not so rare cases of lead related tricuspid valve dysfunction – lead removal/replacement can to bring improvement of tricuspid valve function (6.1%).
2408How can we improve the success of cardiac resynchronization therapy implantation?
Authors: Nunes Ferreira A , Antonio Silverio P , R Agostinho J , Aguiar-Ricardo I , Rigueira J , Santos R , Cunha N , Rodrigues T , Bernardes A , J Pinto F , De Sousa J , Marques P 
Published: October 2019

Abstract

Introduction
The left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) is one of the most important and complex steps, leading to implantation failure in 10–15% of cases. New LV lead implantation techniques are needed to allow better resynchronization and decrease mortality and hospitalizations.

Objectives
To evaluate the efficacy and safety of the snare technique in the LV lead implantation in cases of standard technique failure.

Methods
Prospective, single-center study of patients undergoing CRT implantation since 2015. Demographic, clinical, and CRT implantation techniques were evaluated, taking into account the vessel with the best resynchronization capacity. The snare technique, through the active traction of the lead to the target vessel, was used in cases of standard technique failure. Time to surgical revision and mortality were evaluated by the Cox regression and Kaplan-Meier methods. Major complications, defined as reasons for prolonged hospitalization or potentially fatal, were evaluated.

Results
486 CRTs were implanted since 2015 (73.9% males, 73 years (IQR 66–79), median follow-up of 487 days (IQR 175–749), 91% for heart failure, dilated cardiomyopathy in 55.4%. In 17.3% of these patients (n=84), LV lead was implanted through the snare technique, 94% of the cases in a lateral vein, 100% efficacy in the positioning in the intended vessel.
Comparing the snare technique with the standard technique, patients implanted with snare presented a lower all-cause surgical revision (HR 0.31, 95% CI 0.094–0.98, p=0.035), with a number needed to treat of 25 patients to prevent one surgical revision, and a lower revision rate due to LV lead implant failure/dislodgement (Log Rank 5.1, p=0.024). There were no surgical revisions for LV lead repositioning in patients undergoing the snare technique. The rate of major complications (4.8% vs 3.0%, p=0.41), 30-day mortality (3.5% vs 1.8%, p=0.28) and all-cause mortality (13.1% vs 13.9%, p=0.47) were similar to the standard procedure. Major complications in both groups were pericardial effusion and contrast nephropathy.
The snare technique presented a longer procedure duration (104 vs 78 min, p<0.01) and fluoroscopy time (26.6 vs 15.5 min, p<0.01). Over time, there was a learning curve with reduction in procedure duration and fluoroscopy time.

Conclusion
The snare technique allows LV lead implantation in the vein with the best resynchronization characteristics, increasing the success rate in the implantation of CRT. It also reduced all-cause surgical revisions and surgical revisions due to LV lead implant failure/dislodgement, with a favourable safety profile similar to the standard technique.
2409ALERT-CS - Development of an ECG-based cardiac syncope risk calculator
Authors: Zimmermann T , Du Fay De Lavallaz J , Walter J E , Strebel I , Nestelberger T , Badertscher P , Boeddinghaus J , Twerenbold R , Koechlin L , Lohrmann J , Steude J S , Gualandro D M , Kuehne M , Reichlin T , Mueller C 
Published: October 2019

Abstract

Background
Syncope is a common symptom with rising incidence, often leading to emergency department (ED) visits. Early determination of diagnosis is often difficult in patients with syncope and there is an unmet clinical need for tools that can support physicians in their decision making. We hypothesized that an electrocardiogram (ECG)-based cardiac syncope risk calculator might create a simple and attractive clinical decision tool for the diagnosis and risk stratification of patients with syncope.

Methods
Based on a large prospective diagnostic international multicenter study enrolling patients who presented to the ED with syncope, we derived a cardiac syncope risk calculator by penalized stepwise backward-selection and multivariable logistic regression utilizing predefined ECG criteria. Primary diagnostic endpoint was cardiac syncope, as adjudicated by two independent physicians taking into account all available information including cardiac work-up and 12-month follow-up. Major adverse cardiac events (MACE) including life-threatening arrhythmias, myocardial infarction, pulmonary embolism, stroke, transient ischemic attack, valvular surgery, and death within 30 days were the prognostic endpoint.

Results
Median age in our cohort was 71 years and 40% of patients were women. Of all 2007 patients enrolled, 1696 patients were eligible for the prognostic analysis and 1550 patients were eligible for the diagnostic analysis.
We identified seven ECG criteria (rhythm, heart rate, corrected QT-interval, ST-segment depression, atrioventricular-block, bundle-branch-block and ventricular extrasystole/non-sustained ventricular tachycardia) as significant predictors for cardiac syncope and combined them into the bAseL Ecg Risk calculaTor for Cardiac Syncope (ALERT-CS). Diagnostic accuracy for cardiac syncope, as quantified by the area under the receiver operating characteristic curve (AUC), was high (AUC 0.80, 95%-confidence interval (CI) 0.77 to 0.83), and significantly higher compared to that of the EGSYS score (AUC 0.73, 95%-CI 0.70 to 0.76, p<0.001). Prognostic verification of the ALERT-CS to predict 30-day overall MACE showed similar accuracy (AUC 0.75, 95%-CI 0.71 to 0.79).
Comparison of diagnostic discrimination

Conclusion
Combining seven ECG criteria within a simple risk calculator for cardiac syncope may aid physicians in the diagnosis and risk stratification of patients presenting to the ED with syncope.

Acknowledgement/Funding
Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Basel