bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3796Prediction of severe sleep apnea in patients with nocturnal bradycardia or conduction disorders
Authors: Szajerska-Kurasiewicz A , Loboda D , Simionescu K , Golba A , Dzierzawa M , Szady T , Kucia-Kuzma S , Turski M , Golba K S 
Published: October 2019

Abstract

Background
According to the 2018 ACC/AHA/HRS Bradycardia Clinical Practice Guidelines an effective treatment of obstructive sleep apnea (OSA) can prevent the need to implant a pacemaker.
The aim of the study was to create a prediction model of high risk of OSA in patients with bradycardia or conduction disorders during sleep and referred for pacemaker implantation.

Methods and results
The polysomnography was performed in 118 (20 female) high-cardiovascular risk patients; aged 60.1±11.7 years; body mass index (BMI) 32.65±7.1. Sleep-disordered breathing (SDB) as an apnea/hypopnea index (AHI) ≥5 per hour was observed in 101 (85.6%) subjects including moderate SDB (AHI≥15) in 28 (27.7%) and severe SDB (AHI≥30) in 43 (42.6%) subjects.
The risk of severe SDB increased with increasing BMI; if ≥30kg/m2 (AUC=0.725, sensitivity 81.4%, specificity 55.4%, p<0.0001), the neck size; if ≥43cm (AUC=0.74, sensitivity 60.0%, specificity 75.7%, p<0.0001).
The ECG Holter was performed in 93 patients and revealed in 27 of them bradycardia and/or conduction disorders during sleep: episodes of bradycardia <40 beats per minute in 19 (20.4%), sinus arrest in 7 (7.5%) and an atrioventricular block in 8 (8.6%). The neck size, BMI and AHI in these patients were larger: 45.8±4.0 vs. 42.6±3.0 cm (p=0.081), 37.5±8.4 vs. 30.4±5.5kg/m2 (p=0.0003) and 38.0±22.5 vs. 21.7±21.4 (p=0.0016) respectively.
When age, sex, BMI and neck size were taken into consideration using multivariate modeling the BMI and sex if male were revealed as independent predictors of clinically significant SDB (AHI ≥15); (p=0.0001, AUC for model 0.820) (figure 1).
Figure 1. Receiver-operating characteristic curve showed the best cut-off value of BMI >34,9 kg/m2 (sensitivity 72,73, specificity 78,12) to predict nocturnal bradycardia or conduction disorders in patients with sleep apnea and AHI index ≥15.

Conclusions
In patients who are being considered for a pacemaker implantation for bradycardia or conduction disorders during sleep, with BMI >30kg/m2 or the neck size over 43cm screening for sleep apnea syndrome is reasonable.
P3800Defibrillation for right ventricular dysfunction - An echocardiographic method for therapy selection
Authors: Montenegro Sa F , Almeida J , Fonseca P , Oliveira M , Goncalves H , Primo J , Braga P 
Published: October 2019

Abstract

Introduction
Cardiac resynchronization therapy (CRT) is recommended for heart failure (HF) patients with left ventricular ejection fraction (LVEF) <35% and QRS>130 mseg. We aim to identify if baseline transthoracic echocardiographic (TTE) data can predict the need for defibrillation therapies in a primary prevention HF population referred for CRT implant.

Methods
We analyzed 119 consecutive HF patients in primary prevention referred for CRT implantation between 2004 and 2016. All patients underwent TTE before implantation. During a mean follow-up time of 58.4±33.9 months, all patients were evaluated with device interrogation every 6 months. In order to determine which parameters can predict sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) occurrence, a multivariate analysis was performed including previous medical history, baseline laboratorial, electro and echocardiographic data.

Results
We included 86.6% (n=106) males, mean age at implant 65.5±9.7 years. A CRT-defibrillator (CRT-D) was implanted in 82 (64.2%) patients and a VT or VF was documented in 16 patients (13.4%). Baseline characteristics are presented in the table. After multivariate analysis, baseline right ventricular dysfunction (defined as TAPSE≤18mm) was an independent predictor for VT or VF occurrence (OR=4.83, 95CI 1.67–6.25, p=0.002).
Baseline characteristics VT/VF (n=16) No VT/VF (n=103) P-value Age (years, mean ± SD) 62,4±7,9 66,2±9,5 0,135 Female gender (n, %) 2 (12,5) 14 (15,1) 0,572 Ischemic cardiomyopathy (n, %) 7 (43,8) 21 (22,6) 0,073 NYHA III + IV (n, %) 13 (81,3) 76 (73,8) 0,984 QRS width (mseg, mean ± SD) 168,5±19,5 177,6±22,2 0,142 Atrial fibrillation (n, %) 5 (31,3) 17 (18,3) 0,089 LVEF (%, mean ± SD) 24,6±4,8 26,3±6,3 0,302 TAPSE (mm, mean ± SD) 14,9±4,9 17,9±4,3 0,034 PASP (mmHg, mean ± SD) 48,5±9,4 43,5±14,6 0,419 Mitral regurgitation (moderate or greater, n, %) 5 (31,3) 24 (28,9) 0,077 iVol (mL/m2, mean ± SD) 134,2±36,6 128,7±44,1 0,690 CRT-D implantation (n, %) 16 (100,0) 60 (64,5) 0,002

Conclusion
In a real-world HF population, right ventricular dysfunction defined by echocardiography was an independent predictor for VT or VF occurrence. This may help more accurate patient selection for CRT-D implantation.
P3805Mortality predictors and outcome in patients after upgrade from implantable cardioverter-defibrillator to cardiac resynchronization therapy in comparison to CRT-D de novo implantation
Authors: Jedrzejczyk-Patej E , Mazurek M , Kowalska W , Bugajski M , Konieczny-Kozielska A , Kozielski J , Podolecki T , Kowalski O , Kalarus Z , Sredniawa B , Lenarczyk R 
Published: October 2019

Abstract

Background
Over a quarter of all cardiac resynchronization therapy (CRT) implants are upgrades from previous devices, mainly from implantable cardioverter-defibrillator (ICD). In comparison to CRT with defibrillator (CRT-D) de novo implantation, upgrade from ICD to CRT-D carries higher risk of complications. Limited number of studies evaluated predictors of death in patients undergoing upgrade from ICD to CRT-D.

Aim
To determine mortality predictors and outcome in patients undergoing upgrade from ICD to CRT-D in comparison to subjects with CRT-D de novo implantation.

Methods
Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in tertiary care university hospital, in a densely inhabited, urban region of Poland (480 subjects [84.3%] with CRT-D de novo implantation; 115 patients [15.7%] upgraded from ICD to CRT-D).

Results
The median follow-up was 1692 days (range: 457–3067). All-cause mortality in patients upgraded from ICD was significantly higher than in subjects with CRT-D implanted de novo (43.5% vs. 35.5%, P=0.045). On multivariable regression analysis, left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P=0.002), creatinine level at baseline (HR 1.01, 95% CI 1.00–1.02, P=0.01), NYHA IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P=0.049) and cardiac device-related infective endocarditis (CDRIE) during follow up (HR 2.42, 95% CI 1.02–5.75, P=0.046) were identified as independent predictors of higher mortality in patients with CRT-D upgraded from ICD.

Conclusions
Mortality rate in patients upgraded from ICD is higher in comparison to CRT-D de novo implanted subjects, and reaches almost 45% within 4.5 years. Left ventricular dimensions, creatinine level, high NYHA class at baseline and infective endocarditis during follow up are independent mortality predictors in patients with CRT-D upgraded from ICD.
P3807Impact of unipolar vs bipolar left ventricular pacing using a quadripolar lead on heart failure hospitalization in patients undergoing cardiac resynchronization therapy
Authors: Mittal S , Stivland T , Wold N , Hammill E , Stein K M 
Published: October 2019

Abstract

Background
Unipolar (uni) pacing from a bipolar left ventricular (LV) pacing lead in cardiac resynchronization therapy (CRT) patients (pts) has been associated with worse outcomes than bipolar (bi) pacing (MADIT CRT and ALTITUDE analyses). However, it is unknown whether the same is true with quadripolar LV pacing leads.

Purpose
To determine whether there is a difference in heart failure hospitalization (HFH) following CRT implantation in pts undergoing uni vs. bi LV pacing.

Methods
All pts enrolled in the NAVIGATE study were implanted with a CRT-D (RESONATE, Boston Scientific) using a quadripolar LV lead (ACUITY X4 Spiral Long, Spiral Short, or Straight). Pts were followed, and data collected on HFH and mortality. Vectors were programmed at the discretion of the implanter. Outcomes were adjusted for age, gender, NYHA class, ischemic etiology, conduction disorder pattern, EF, LV lead location, and LV lead shape.

Results
The study cohort included 2080 pts; 1781 pts had bi and 299 pts had uni LV pacing. Bi LV had higher % female, NYHA II/III, non-ischemic, LBBB, spiral shape, lateral and apical locations. During follow-up, the adjusted likelihood of HFH was significantly lower in pts undergoing bi LV pacing (HR 0.75, 0.58–0.97, p=0.027, Figure). Mortality was similar between the two groups.

Conclusions
In this large prospective study, uni LV pacing was associated with significantly greater likelihood of need for HFH during a 4-year follow-up period. These data suggest that routine programming in a bi configuration may be better for post-CRT pts. However, further study is needed to confirm causality and mechanism of this finding.
P3829Antiarrhythmic effects of Sacubitrilat (LBQ657) on Ca2+ homeostasis in ventricular cardiomyocytes
Authors: Eiringhaus J , Wuensche C , Herting J , Hasenfuss G , Sossalla S , Fischer T 
Published: October 2019

Abstract

Background and objectives
Simultaneous inhibition of neprilysin and angiotensin II receptors by sacubitril/valsartan was shown to significantly reduce morbidity and mortality in heart failure patients compared to sole interference with the renin angiotensin system. Beneficial effects of increased levels of natriuretic peptides following neprilysin inhibition have been suggested, whereas direct effects of sacubitrilat on myocardial Ca2+ cycling properties remain elusive.

Methods and results
Under basal conditions the combination of active neprilysin-inhibitior sacubitrilat (LBQ657) and angiotensin II receptor inhibitor valsartan did not influence diastolic Ca2+ spark frequency (CaSpF) nor arrhythmogenic SR Ca2+ leak in murine ventricular cardiomyocytes (confocal microscopy, n CMs/hearts=80/7 vs. 100/7, P=0.91/0.99). In contrast, sacubitrilat/valsartan treatment significanty reduced CaSpF by 35±9% and SR Ca2+ leak by 45±9% in CMs that had been put under catecholaminergic stress (isoproterenol 10nM, n=81/7 vs. 62/7, P<0.001 both). This effect could be clearly be attributed to the neprilysin inhibitor sacubitrilat as sole sacubitrilat treatment also reduced both parameters by similar degrees (reduction of CaSpF by 57±7% and SR Ca2+ leak by 76±5%; n=101/4 vs. 108/4, P<0.01 both) whereas sole valsartan treatment did not affect diastolic SR Ca2+ leak. Of note, systolic Ca2+ release, SR Ca2+ load and Ca2+ transient kinetics of murine CMs were not compromised upon treatment with sacubitrilat (epifluorescence microscopy, n=41/6 vs. 39/6). Importantly, sacubitrilat/valsartan in combination as well as sacubitrilat alone also reduced diastolic CaSpF and SR Ca2+ leak by 40–74% in human left-ventricular CMs from patients with end-stage heart failure (n=71/8 vs. 78/8, P<0.05).

Conclusion
This study demonstrates that neprilysin-inhibition directly exerts beneficial effects on Ca2+ homeostasis in human heart failure. We can show for the first time that neprilysin-inhibition by sacubitrilat yields a strong reduction of arrhythmogenic SR Ca2+ leak without affecting systolic Ca2+ release. These effects might contribute to the mortality benefit of sacubitril/valsartan treatment in the PARADIGM Study.

Acknowledgement/Funding
THF was funded by the Deutsche Forschungsgemeinschaft (DFG) through the SFB 1002 (A11). SS is supported by the Marga und Walter Boll-Stiftung.
P3837Both left atrial and left ventricular multilayer longitudinal strain are impaired in early stages of arterial hypertension in postmenopausal women
Authors: Sokolova M V , Kolesnyk M Y 
Published: October 2019

Abstract

Background
Left ventricular (LV) hypertrophy and left atrial (LA) dilation are powerful prognostic predictors in arterial hypertension (AH). However, their use is limited in the early stages of hypertensive heart disease. LV and LA global longitudinal strain (GLS) are promising diagnostic markers for identification of early myocardial dysfunction. The purpose of the study was to evaluate the longitudinal deformation of left heart chambers in hypertensive postmenopausal women prior to LV hypertrophy and LA dilation development.

Methods
The study enrolled 100 postmenopausal hypertensive women (mean age 57.5±4.1 years), divided into 2 groups, and 26 healthy females (control group). The 1st group included 32 women with structurally normal hearts and the 2nd group consisted of 68 females with LV hypertrophy (LV mass index >95 g/m2) and LA dilation (LA volume index >34 ml/m2). LV multilayer GLS was calculated with 2D speckle tracking echocardiography. LA GLS was computed by averaging 12 segmental values with both P- and R- wave ECG-triggering. Strain was measured in contractile and reservoir phase, calculating GLS as sum of these values with P-wave variant, and as maximal peak of curves with R-wave method. The data are presented as median and interquartile range.

Results
The LV GLS was significantly lower in hypertensive women with structurally normal hearts in all myocardial layers compared to healthy females (table). The LA longitudinal strain was reduced due to the deterioration of reservoir phase. The reduction of LA GLS in hypertensive women with structurally normal hearts was detected using R-wave triggering method only (opposite to P-wave method).
Left heart chambers longitudinal strain Parameter Control group 1st group 2nd group p LV GLS endo, % −23.75 (−20.3; −25.15) −21.25 (−19.6; −22.35)* −21.2 (−20.14; −22.9)* 0.047 LV GLS mid, % −21.4 (−18.5; −22.6) −19.1 (−17.8; −20.45)* −19.1 (−17.95; −20.15)* 0.03 LV GLS epi, % −18.7 (−16.75; −20.2) −16.95 (−15.95; −18.5)* −17.1 (−15.96; −18.05)* 0.03 P-wave triggering   LA LS in contractile phase, % −15.75 (−13.41; −16.37) −15.38 (−13.69; −17.77) −14.99 (−12.97; −16.89) 0.47   LA LS in reservoir phase, % 17.19 (15.4; 20.2) 13.19 (8.8; 18.03)* 13.54 (10.45; 16.19)* 0.0004   LA GLS, % 31.01 (25.11; 35.59) 28.37 (24.29; 32.5) 26.73 (23.21; 30.54)* 0.02 R-wave triggering   LA GLS, % 38.3 (34.54; 43.43) 33.63 (30.11; 36.28)* 30.77 (26.23; 36.11)* 0.0002 *p<0.05 compared to control group.

Conclusions
LV multilayer and LA GLS are reduced prior to LV hypertrophy and LA dilation development in hypertensive postmenopausal women and may be considered as early signs of myocardial dysfunction.
P3839Hypertension or hypertrophic cardiomyopathy? Using cardiovascular magnetic resonance imaging to unmask the great imitator
Authors: Keteepe-Arachi T , Malhotra A , Basu J , Parry-Williams G , Ensam B , Miles C , Dassanayake S , MacLachlan H , Ibrahim B , Papdakis M , Tome M , Khong T , Sharma S , Anderson L 
Published: October 2019

Abstract

Background
Structural cardiac adaptations due to hypertension (HTN) present a diagnostic challenge when differentiating from hypertrophic cardiomyopathy (HCM), using traditional imaging techniques such as echocardiography (echo). Cardiac magnetic resonance imaging (CMR) offers reproducible anatomical, functional quantification and myocardial tissue characterisation which discriminates between hypertension and HCM.

Purpose
To identify hypertensive individuals with undiagnosed HCM using CMR imaging.

Methods
100 consecutive hypertensive patients underwent CMR at a tertiary centre dedicated blood pressure clinic (55% male, mean age 51 years). In keeping with ESC guidelines, end diastolic wall thickness (EDWT) ≥15mm identified individuals within the “grey zone” between hypertension and with a potential HCM diagnosis. 19 individuals were referred on to the dedicated inherited cardiac conditions clinic for further evaluation. Four patients expressed a definitive LV phenotype and were diagnosed with HCM. CMR parameters were compared in three groups: Hypertensive (HTN), “grey zone” Hypertensive (GZH) and HCM.

Results
CMR demonstrated end diastolic wall thickness (EDWT) >11 mm in 50% of hypertensives. 73% of the referred patients were Afro-Caribbean (AC) and all 4 HCM patients were AC. All referrals demonstrated EDWTs ≥14mm, 9 (47%) demonstrated late gadolinium enhancement of which 3 (16%) had HCM. Three had asymmetrical septal hypertrophy – 2 were in the HCM cohort and one underwent endomyocardial biopsy confirming HTN. Left ventricular mass index (LVMI) was significantly higher in GZH compared to HTN (p<0.0001) and in HCM compared to HTN (p=0.0004). EDWT was significantly greater in GZH compared to HTN (p<0.0001) and in HCM compared to HTN (p=0.0002). There was no significant difference in these parameters between GZH and HCM.
Table 1. P-values for CMR data in hypertensive (HTN), gray zone hypertensive (GZH) and hypertrophic cardiomyopathy (HCM) cohorts CMR Parameter HCM vs. HTN GZH vs. HTN GZH vs. HCM EDVI NS p=0.025 NS EDWT p=0.0002 p<0.0001 NS LVMI p=0.0004 p<0.0001 NS

Conclusion
This study reports a 4% prevalence of HCM among hypertensive patients - 20 x greater than in the general population - which would be left undiagnosed using echo alone. Screening hypertensive individuals with CMR is not routine but we advocate its use in these individuals especially in Afro Caribbeans and in those in the “grey zone”, to identify undiagnosed HCM, which has significant implications for lifestyle modification and family screening.

Acknowledgement/Funding
Cardiac Risk in the Young
P3840Impact of potent P2Y12 inhibitors in adverse events reduction in diabetic patients with Acute Coronary Syndromes. An analysis from ACHILLES Registry
Authors: Esteve Pastor M A , Ruiz-Nodar J M , Rivera-Caravaca J M , Orenes-Pinero E , Tello-Montoliu A , Veliz-Martinez A , Carrillo-Aleman L , Candela E , Sandin Rollan M , Lozano T , Macias-Villanego M J , Pernias-Escrig V , Nunez-Martinez L , Vicente-Ibarra N , Marin F 
Published: October 2019

Abstract

Background
Diabetic patients (DM) with an acute coronary syndrome (ACS) have a worse prognosis than non-diabetic patients. The new P2Y12 inhibitors, both ticagrelor and prasugrel, have shown efficacy in cardiovascular event reduction in patients with DM and ACS.

Purpose
The main objective of this study was to analyze the use of antiplatelet agents, prognosis and adverse events during the follow-up in diabetic patients admitted after an acute coronary syndrome.

Methods
These patients belong to ACHILLES registry. All patients with type 1 ACS were included prospectively in a national, prospective and multicenter registry. We analyzed baseline characteristics and comorbidities focusing on the presence of DM and the use of potent antiplatelet agents (ticagrelor and prasugrel) in those patients. After 1 year of follow-up, adverse events in diabetic patients were analyzed according to the type of antiplatelet used [clopidogrel vs new antiplatelet drugs (NAD)].

Results
Of 1,717 patients, 1,294 patients [mean age 65.0±13.3 years, 952 (73.6%) male] were finally analyzed (excluding patients discharged with oral anticoagulation). Diabetic patients had high prevalence of cardiovascular risk factors such as hypertension (54.9% vs 81.1%; p<0.001), dyslipidemia (50.7% vs 72.8%; p<0.001) or chronic kidney disease (22.1% vs 31.9%; p<0.001). Diabetic patients had also higher rate of non-invasive management of ACS compared to non-diabetic patients (4.5% vs 9.1%; p=0.002). At discharge, the use of NAD in patients with DM was 40.4% compared to 50.8% in non-diabetic patients (p<0.001).
After 1 year of follow-up, 64 (5.0%/year) patients had a new ACS, 46 (3.6%/year) patients died due to cardiovascular causes, 76 (6.1%/year) died for any cause and 28 (2.2%/year) patients had a major bleeding events. The use of clopidogrel in diabetic patients was associated with an increase in all-cause mortality [HR 2.90; 95% CI (1.27–6.629), p=0.011] and in MACE [HR 2.14; 95% CI (1.22–3.77), p=0.008.] Diabetic patients treated with NAD had no differences in terms of major bleeding but those patients presented a significant reduction in cardiovascular mortality and MACE with NAD use.
Event Free Survival according NAD Use

Conclusions
Patients with DM and ACS had high prevalence of concomitant cardiovascular risk factors but lower use of NAD compared with non-diabetic patients, despite DM patients had greater baseline risk. The use of NAD therapy was associated with a significant reduction in all-cause mortality, cardiovascular mortality and MACE without differences in major bleeding events.
P3843Ischemic-bleeding balance according to history of prior bleeding in patients with acute coronary syndrome during treatment with dual antiplatelet therapy
Authors: Dominguez Erquicia P , Raposeiras Roubin S , Abu-Assi E , D'Ascenzo F , Manzano Fernandez S , Saucedo J , Simao Henriques J P , Ariza Sole A , Cespon Fernandez M , Munoz Pousa I , Caneiro Queija B , Cobas Paz R J , Dominguez Rodriguez L M , Iniguez Romo A 
Published: October 2019

Abstract

Introduction
ESC guidelines recommend short-term dual antiplatelet therapy (DAPT) in patients with high bleeding risk. In this sense, patients with prior admissions by bleeding are considered of high-risk of bleeding. With our study, we aimed to show the ischemic-bleeding profile of patients with prior bleeding in comparison with those without prior bleeding during treatment with DAPT.

Methods
The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without prior admission by bleeding. The impact of prior prior bleeding in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction, whereas for bleeding risk we have considered major bleeding defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal.

Results
From the 26,076 ACS patients, 1,105 have PAD (4.2%). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), 640 had myocardial infarction (2.5%) and 685 had major bleeding (2.6%). After propensity-score matching, we obtained two matched groups of 1,101 patients. In comparison with patients without prior bleeding, those with prior bleeding had higher risk of major bleeding (sHR 2.03, 95% CI 1.33–3.11, p=0.001) with similar risk of myocardial infarction (sHR 0.98, 95% CI 0.61–1.59, p=0.945), in comparison with those without PAD. The cumulative incidence of myocardial infarction was 31 and 32 per 1,000 patients/year in patients with and without prior bleeding, respectively. The cumulative incidence of major bleeding was 63 and 29 per 1,000 patients/year in patients with and without prior bleeding, respectively. The difference between myocardial infarction rate and major bleeding rate was −32 and +3 per 1,000 patient-years in patients with and without prior bleeding (Figure).

Conclusions
Patients with ACS and prior history of bleeding have a significant increment of bleeding risk during treatment with DAPT. In these patients, short-term DAPT (6 months) should be recommended.