bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4365Role of 3D speckle-tracking echocardiography system, using comparison with cardiac magnetic resonance imaging and to assess the contribution of regional RV function to global function in COPD patients
Authors: Sen N , Tanwar S , Jain A , Kalra B , Bansal M , Mehta A , Gokhroo R K 
Published: October 2019

Abstract

Background
Chronic obstructive pulmonary disease may alter right and left ventricular function by changing intrathoracic pressure. Pulmonary hyperinflation may increase right atrial pressure, leading to reduced venous return and subsequent reductions in RV pre-load. In COPD patients, hyperinflation has been directly correlated with reduced atrial chamber size, global RV dysfunction, and reduced LV filling. Accurate assessment of global and regional right ventricular (RV) systolic function is challenging.

Purpose
The aims of this study were to confirm the reliability and feasibility of a three-dimensional (3D) speckle-tracking echocardiography (STE) system, using comparison with cardiac magnetic resonance imaging (CMR), and to assess the contribution of regional RV function to global function.

Methods
In a retrospective, cross-sectional study setting, RV volumetric data were studied in 302 patients who were referred for both CMR and 3D echocardiography within 1 month. Three-dimensional STE-derived area strain, longitudinal strain, and circumferential strain were assessed as global, inlet, outflow, apical, and septal segments.

Results
208 patients (69%) had adequate 3D echocardiographic data. RV measurements derived from 3D STE and CMR were closely related (RV end-diastolic volume, R2=0.88; RV end-systolic volume, R2=0.81; RV ejection fraction [RVEF], R2=0.69; P<0.004 for all). RVEF and RV end-diastolic volume from 3D STE were slightly but significantly smaller than CMR values (mean differences, −2.8% and −7.8 mL for RVEF and RV end-diastolic volume, respectively). Among conventional echocardiographic parameters for RV function (tricuspid annular plane systolic excursion, fractional area change, S' of the tricuspid annulus, RV free wall two-dimensional longitudinal strain), only fractional area change was significantly related to RVEF (r=0.29, P=0.003). Among segmental 3D strain variables, inlet area strain (r=−0.48, P<0.002) and outflow circumferential strain (r=−0.37, P<0.003) were independent factors associated with CMR-derived RVEF.

Conclusions
Regional RV wall motion showed that heterogeneous segmental deformations affect global RV function differently; specifically, inlet area strain and outflow circumferential strain.RV volume and RVEF determined by STE were comparable with CMR measurements. Severity of COPD influences RV systolic dysfunction, which is reflected in speckle tracking 3D echocardiographic parameters.
P4368Estimation of pulmonary artery pressure from right atrial strain and tricuspid regurgitation velocity
Authors: Inoue K , Remme E W , Khan F H , Andersen O S , Gude E , Skulstad H , Smiseth O A 
Published: October 2019

Abstract

Background
Systolic pulmonary artery pressure (SPAP) can be estimated non-invasively as the sum of indices for right atrial (RA) pressure and tricuspid regurgitation (TR) pressure gradient. Although echocardiographic evaluation of inferior vena cava diameter and collapsibility is currently being used to estimate RA pressure (IVC method), RA strain may be an alternative since atrial strain is related to atrial pressure.

Objective
We tested if RA strain by speckle tracking echocardiography can be used as a surrogate of mean RA pressure (RA strain method), and by adding the TR pressure gradient, be used to estimate SPAP.

Methods
We retrospectively analyzed 91 patients (mean age, 58 years) referred to right heart catheterization due to unexplained dyspnea or suspected pulmonary hypertension. Echocardiography was performed within 24 hours of the invasive procedure. RA reservoir strain was calculated from apical four-chamber view. SPAP was calculated as the sum of peak TR pressure gradient and estimated RA pressure by the IVC or RA strain methods.

Results
Right heart catheterization showed SPAP and mean RA pressures of 51±20 mmHg and 9±6 mmHg, respectively. RA reservoir strain was inversely correlated with mean RA pressure (r=−0.61, p<0.01). Thus, we set mean RA pressure as 5, 10 and 15 mmHg depending on high (≥25%), middle (10–25%) and low (≤10%) values of RA reservoir strain. As shown in the figure, both the RA strain and IVC methods when combined with peak TR velocity, provided good estimates of invasively measured SPAP.

Conclusions
RA strain provides a semiquantitative measure of RA pressure, which can be used in combination with peak TR velocity to estimate SPAP. This approach can be used as an alternative when the IVC method is not available in cases with poor subcostal window.
P4374Biventricular systolic function analysis in patients with Marfan Syndrome using speckle-tracking 2D ecocardiography
Authors: Torres Sanabria M , Monivas Palomero V , Garcia Izquierdo Jaen E , Forteza Gil A , Gonzalez Mirelis J , Martin Lopez C E , Navarro Rico S , Aguilera Agudo C , Baena Herrera J , Mitroi C , Mingo Santos S 
Published: October 2019

Abstract

Background
Left Ventricular systolic disfunction has already been described in Marfan Syndrome (MS) in patients without valvular dysfunction using 2D and 3D speckle tracking echocardiography (STE). This dysfunction has been related to a more severe causal genetic mutation, which suggest the presence of a primary cardiomiopathy in these patients. Right ventricular function has been less studied so far. We sought to evaluate biventricular function in our cohort of MS patients with 2D-STE.

Methods
95 unoperated adult patients with MS and 32 healthy controls were prospectively enrolled. Patients with more than mild mitral or aortic regurgitation were excluded. Using STE we obtanied left ventricular global longitudinal strain (LVGLS) from the average of 16 segments from 4,2 and 3-chamber views and RVGLS values were obtained from the average of 6 segments from the apical 4-chamber view. We also measured classic parameters of systolic biventricular function (LVEF and TAPSE).

Results
Compared to controls, patients with MFS had significantly lower LVGLS and RVGLS (table 1). Values obtanied for LVGLS in MS patients were at the lower limit of normality stablished in the latest cuantification guidelines, while RVGLS and RV free wall LS were slightly above the limit of normality. LVEF and TAPSE were also slightly diminished in MS patients, though the differences found were clinically not relevant.
Results of statistical analysis MS (n=93) Controls (n=32) p Age (years) 32.84±12.4 32.41±7.98 0.85 Aortic Root Diameter Valsalva Sinuses (mm) 38.82±5.35 30.91±5.3 <0.001 LVGLS (%) −18.93±2.62 −21.52±2.26 <0.001 RVGLS (%) −21.25±3.54 −24.68±3.08 <0.001 RV free wall LS (%) −22.09±3.92 −25.56±3.63 <0.001 LVEF (%) 59.5±5.34 63.27±4.19 0.001 TAPSE (mm) 23.97±4.57 25.82±3.32 0.03 MS = Marfan Syndrome; LVGLS = Left ventricular global longitudinal strain; RVGLS = right ventricular global longitudinal strain.

Conclusions
Our study suggests that patients with MFS show lower biventricular strain compared with healthy controls. 2D-STE imaging may be useful to detect subclinical changes in cardiac function in patients with MFS and should be added to routine ecocardiographic evaluation in order to improve the follow-up and treatment of these patients.
P4382O2-pulse measure obtained by gas exchange analysis is an accurate esteeme of stroke volume?
Authors: Evangelista M , Alfonzetti E , Bandera F , Guazzi M 
Published: October 2019

Abstract

Background
It is axiomatic that exercise performances depends on cardiac output increase. Among several methods for noninvasively estimating stroke volume, O2 pulse (i.e. the ratio of VO2/HR) is generally used during gas exchange analysis, but its accuracy has never been well investigated.

Purpose
To test the validity and the accuracy of O2 pulse as a measure of stroke volume (SV) in comparison with the echocardiographic methods.

Methods
From 22nd of August 2016 to 30th of April 2018 our laboratory performed 259 cardiopulmonary exercise tests (CPET) combined with echo. The group of patients was characterized by a heterogeneous spectrum of diseases: 70 coronary artery disease, 10 heart failure with preserved ejection fraction, 13 heart failure with middle ejection fraction, 26 heart failure with reduced ejection fraction, 29 Fabry disease, 7 hypertrophic cardiomyopathy, 10 dilated cardiomyopathy, 30 aortic stenosis, 16 aortic regurgitation, 8 mitral stenosis, 76 mitral regurgitation, 6 tricuspid regurgitation, 7 congenital heart diseases. The median age was 65 yr (52,5; 74,5) and 61,5% of patients was male. In our group are present 20 healthy subjects with normal heart. O2 pulse was measured at rest, at 2 minutes, 4 minutes, 6 minutes and at maximum of stress. In some cases the maximum of stress correspond to 4- or 6-minutes of stress. All the echocardiographic images were taken with Epiq7C, Philips. The left ventricle SV was measured as SV = LVOT area x LVOT VTI, all the measures and the images where acquired by the same operator to reduce at minimum the external error introduce by the operator.

Results
As first step we analysed the absolute value of O2-pulse and SV at rest and during the different steps of exercise to see if and how they behave. In the figure attached is possible to see that both the values increased during the exercise with a small reduction at the maximum that may be explained by a premature interruption of the exercise. Secondly we analysed the correlation between O2 pulse and LVOT-SV at rest and during 2-, 4-, 6- minutes of exercise and at maximum which was respectively: r=0,23 (p<0,0001), r=0,36 (p<0,0001), r=0,30 (p<0,0001), r=0,25 (p<0,0001) and r=0,51 (p<0,0001) (see figure 2).
The analysis has been possible in 259 patients at rest, in 246 at 2-minutes of stress, in 221 at 4-minutes of stress and in 149 patients at 6-minutes of stress. At maximum of exercise, the analysis has been carried out in 229 patients, but we need to keep in mind that maximum of stress includes both 4- and 6-minutes of exercises according to the capability of each patients.

Conclusion
In our analysis we show an incremental trend during exercise of O2-Pulse value and of LVOT-SV. At rest and during exercise it is present a good correlation between O2-pulse and LVOT-SV. These data reinforce the concept that O2 pulse reflects an estimation of SV and may explain its reported prognostic validity in prospective studies.
P4389Effect of cigarette smoking on carotid artery atherosclerosis: a community-based cohort study
Authors: Kiriyama H , Kaneko H , Itoh H , Yoshida Y , Nakanishi K , Mizuno Y , Daimon M , Morita H , Yatomi Y , Yamamichi N , Komuro I 
Published: October 2019

Abstract

Background
Cigarette smoking is closely associated with the development of cardiovascular diseases (CVD), and the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines recommend smoking bans.On the other hand, the relationship between cigarette smoking and subclinical atherosclerosis has not been fully studied. Carotid intima-media thickness (cIMT) is commonly used as a subclinical atherosclerosis marker, and a carotid plaque feature is also known to be an important predictor of cardiovascular diseases.

Purpose
We sought to clarify the association between cigarette smoking and subclinical atherosclerosis by evaluating carotid plaque including cIMT and carotid plaque features in general population.

Methods and results
Among 1,209 participants with no prior coronary artery disease who received a medical check-up with cardiovascular examination at our institution, 450 participants (37.2%) were smokers (including both past and current smokers). We defined carotid plaque as cIMT ≥1.1 mm and high-risk plaque as carotid plaque with hypoechoic dominant and/or plaque ulceration. The value of cIMT and the rate of carotid plaque were not different between smokers and never smokers (Figure A & B). However, the rate of carotid high-risk plaque was significantly higher in participants with smokers than those with never smokers (29.7%, vs 23.5%, p=0.011) (Figure C). Even after adjustment with covariates including age, gender and traditional cardiovascular risk factors, cigarette smoking was independently associated with high-risk plaque formation (odds ratio 1.384, 95% CI 1.020–1.877; p=0.037). According to the subgroup analysis classified by age, cigarette smoking was associated with not only the development of high-risk plaque but also the increased value of cIMT in the subgroup over 60 years old, whereas only the rate of high-risk plaque was higher in smokers than never smokers in the subgroup under 60 years old.
Carotid plaque and smoking

Conclusion
The development of high-risk carotid artery plaque may precede thickening of cIMT in cigarette smokers, suggesting that the novel insight for the pathological mechanism underlying cardiovascular events and cigarette smoking.
P4394Two-year therapeutic effectiveness of pharmacotherapy versus electronic cigarettes for smoking cessation: A single-center experience
Authors: Ioakeimidis N , Vlachopoulos C , Georgakopoulos C , Dima I , Gardikioti V , Solomou E , Gardikioti V , Oikonomou E , Tousoulis D 
Published: October 2019

Abstract

Purpose
Aim of this study is to compare the long-term (2-year) effectiveness of e-cigarettes (EC) vs pharmacotherapy for smoking cessation.

Methods
We analyzed data from 173 smokers visiting our unit from January 2012 to December 2016 followed for two years. Of them, 128 were treated with varenicline for 3 months and 45 used EC for 3 months to quit smoking.

Results
There were not significant differences in severity of nicotine dependence and cigarette consumption (pack-years) between the two groups. Compared to smokers under varenicline therapy, EC users were younger (38±7 vs 49±12 years, P<0.01). The two groups had no gender difference and similar prevalence of traditional risk factors and coronary artery disease. Figure shows the smoking abstinence rates at the end of treatment period (3 months) and the continuous abstinence rates at 2 years. At the end of treatment period, 79 (62%) of subjects under therapy with varenicline were abstinent from smoking while 31 (69%) of individuals using EC did not smoke combustile cigarettes 3 months after the initiation of vaping. The continuous abstinence rates at 2 years was significantly higher among individuals treated with varenicline compared to EC (41% vs 24%, P<0.05). Interestingly, at 2 years, 12 EC users (27%) continued vaping alone and 21 (47%) were dual (EC and tobacco cigarette) users.
EC vs varenicline and smoking abstinence

Conclusions
Our preliminary data indicate that smokers who received varenicline had significantly higher continuous abstinence rates compared to individuals who used EC at a 2-year follow-up. Furthermore, almost half of the later group maintained dual use.
P4402Effect of carnitine supplementation on progression of carotid plaque in the metabolic syndrome: the ECoM study
Authors: Johri A , Hetu M F , Heyland D K , Herr J E , Norman P , Matangi M F , Lahaye A , Saunders F W , Spence J D 
Published: October 2019

Abstract

Background/Introduction
L-carnitine (L-C) has been investigated as a potential therapy for cardiovascular (CV) disease, but its direct effects on human atherosclerosis are unknown. Epidemiological studies suggest a possible reduction of CV risk factors following treatment, whereas animal studies have shown that L-C may increase pro-atherogenic metabolites.

Purpose
The purpose of this study was to determine whether L-C therapy led to atherosclerosis progression or regression by direct quantification of carotid atherosclerotic lesions in patients with metabolic syndrome (MetS).

Methods
This study was a Phase 2, prospective, parallel, double blinded, randomized, placebo-controlled, two-center trial. MetS was defined according to the International Diabetes Federation harmonized definition, where presence of any 3 of the 5 following risk factors constituted a diagnosis: elevated waist circumference; elevated triglycerides; reduced HDL or treated; elevated blood pressure or treated; elevated glucose or HbA1c or treated. Participants with a baseline carotid total plaque volume (TPV) ≥50 mm3 were randomized to placebo or 2 g L-C daily for 6 months. Plaque progression was quantified by 3D carotid ultrasound for change in TPV and reduction in vessel lumen area (% area stenosis, Fig. 1). Absolute differences were assessed on the raw scale, while percent change on the log scale. Analysis of covariance (ANCOVA) was used to assess within- and between-arm differences.

Results
Of the 177 participants randomized, 157 completed the study (L-C n=76, placebo n=81). No statistically significant difference between arms was found in the primary outcome (TPV). However, there was progression of plaque stenosis in the treatment arm: the L-C group had an increase in stenosis of 9.8% (p=0.01) higher than the placebo arm, and a 2.7% (p=0.03) greater absolute change. Total cholesterol and LDL levels (0.10 mmol/L and 0.05 mmol/L, respectively) were higher in the intervention arm compared to the placebo arm (−0.06 mmol/L and −0.07 mmol/L).
Figure 1

Conclusions
We observed progression of atherosclerosis with L-C therapy compared to placebo in patients with MetS. The clear lack of benefit of L-C therapy in this population raises serious concerns for its further use as a potential therapy. Given its association with pro-atherogenic metabolites our study offers further understanding of the atherosclerotic process.

Acknowledgement/Funding
Heart and Stroke Foundation of Canada
P4404Prognostic value of novel nocturnal oxygen saturation metrics in patients with obstructive sleep apnoea and high cardiovascular event risk
Authors: Linz D , Loffler K , Sanders P , Catcheside P , Anderson C , Redline S , McEvoy D , Baumert M 
Published: October 2019

Abstract

Aim
To determine prognostic value of novel oximetry-derived metrics in patients with obstructive sleep apnoea (OSA) and high cardiovascular (CV) event risk.

Methods and results
Ancillary study of the Sleep Apnoea CV Endpoints (SAVE) randomised controlled trial, which investigated the effects of CPAP treatment on secondary CV event outcomes in 2687 participants with moderate-severe OSA and established CV disease. Associations between baseline characteristics, standard sleep and pulse oximetry-derived metrics, and CV outcomes were determined in Cox proportional hazards regression models stratified for treatment allocation. Metrics evaluated included: oxygen desaturation index, time below 90% oxygen saturation (SpO2), average SpO2across recordings (mean SpO2), across episodic desaturation events (desaturation SpO2), and baseline interpolated through episodic desaturation events (baseline SpO2); duration and desaturation/resaturation time ratio of episodic desaturation events; and mean and standard deviation of pulse rate. No SpO2 metric was associated with the composite outcome. Mean and baseline SpO2 were negatively associated with heart failure (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69–0.95; P=0.009 and 0.78, 0.67–0.90; P=0.001, respectively) and myocardial infarction risk (0.86, 0.77–0.95; P=0.003 and 0.81, 0.73–0.90; P<0.001, respectively) and marginally positively associated with stroke risk (1.09, 1.00–1.20; P=0.065 and 1.13, 1.02–1.26; P=0.020, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted heart failure (area under the receiver-operating-characteristic curve 0.86, 95% CI 0.79–0.93).

Conclusions
Higher mean and baseline SpO2 were associated with reduced risk of heart failure and myocardial infarction, and small increases in stroke rate. Desaturation shape may have predictive utility for future CV events.
Clinical trial registration: clinicaltrials (NCT00738179).
P4414Effects of lorcaserin on the cardiometabolic risk factors in overweight or obese patients: a systematic review and meta-analysis
Authors: Kuo H H , Liu M E , Lin P L , Liu L.Y.-M 
Published: October 2019

Abstract

Introduction
Lorcaserin is a selective serotonin 2c receptor agonist approved as an anti-obesity agent. The additional cardiometabolic benefits associated with lorcaserin have not been conclusively established.

Purpose
To examine the effects of lorcaserin on blood pressure, heart rate and other metabolic parameters in overweight or obese patients from randomized controlled clinical trials (RCTs).

Methods
A literature search was conducted on PubMed, EMBASE, and Cochrane Central using search terms: “lorcaserin”, “Belviq”, and “randomized controlled trials” without language restrictions. RCTs with a follow-up period of at least 24 weeks were included for the meta-analysis.

Results
Five studies with 9349 patients in the lorcaserin group and 9370 patients in the placebo group were included. Compared with placebo, lorcaserin not only reduced weight (mean difference [MD] = −3.03 kg, 95% CI: −3.42, −2.63, P<0.ehz745.08171, I2 =68%), waist circumference (MD=−2.27 cm, 95% CI: −2.71, −1.83, P<0.ehz745.08171, I2=57%) and BMI (MD=−1.11 kg/m2, 95% CI: −1.27, −0.96, P<0.ehz745.08171, I2=68%), but also improved SBP (MD=−0.75 mmHg, 95% CI: −1.12, −0.38, P<0.0001, I2=0%), DBP (MD=−0.70 mmHg, 95% CI: −0.93, −0.48, P<0.ehz745.08171, I2=0%), heart rate (MD=−0.94 bpm, 95% CI: −1.28, −0.60, P<0.ehz745.08171, I2=0%), LDL (MD=−1.47 mg/dL, 95% CI: −2.21, −0.74, P<0.0001, I2=0%), HDL (MD=0.55 mg/dL, 95% CI: 0.08, 1.01, P=0.02, I2=18%), triglycerides (MD=−8.71 mg/dL, 95% CI: −12.14, −5.28, P<0.ehz745.08171, I2=71%), and fasting plasma glucose (MD=−5.69 mg/L, 95% CI: −9.5, −1.87, P=0.003, I2=93%). Our findings support that lorcaserin has consistent and favourable effects on blood pressure, heart rate, and all criteria of metabolic syndrome.
Summary of lorcaserin effects

Conclusion
Lorcaserin improved all cardiometabolic parameters modestly in addition to its weight loss effect in overweight or obese patients. More research is needed to determine its long-term cardiovascular benefits.