bluuebunny/crossref_metadata_2025_split huggingface dataset:
P15 Serum chloride as marker for prognosis for patient with acute decompensated heart failure: a systematic review and meta-analysis on prognosis
Authors: Evangelista L K , Ramos J D , Villanueva D L , Tiongson M D , Punzalan F E 
Published: January 2020

Abstract

Background
Several studies have suggested that hypochloremia is associated with adverse outcomes among patients with heart failure. The association appears to be more marked in those with acute decompensation.
Research Question: What is the association of hypochloremia with mortality and worsening heart failure among patients in acute decompensation?

Objective
Determine the association of admission hypochloremia to all-cause mortality, heart failure death and worsening heart failure among patients with acute decompensated heart failure.
Criteria for Inclusion of Studies: Studies were included if they satisfied the following criteria 1) observational cohort studies; 2) included patients admitted for acute decompensated heart failure; and 3) reported data on mortality and worsening heart failure in association with admission hypochloremia.

Methods
A systematic search using MEDLINE, Clinical Key, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases was done, from June 2018 to January 31, 2019. The characteristics of included studies were collated. Data abstraction and quality assessment, using the Newcastle-Ottawa Quality Assessment Scale, were done independently by two reviewers, and disagreements were settled by a third reviewer. Review Manager (RevMan) 5.3 was utilized to perform Mantel-Haenzel analysis of random effects and compute for relative risk.

Results
We included three high quality cohort studies involving 3,444 patients admitted for acute decompensated heart failure and having low serum chloride levels on admission. Our study shows that admission hypochloremia is associated with increased risk for all-cause mortality [RR 1.63, (95% CI 1.60 to 2.28, p &lt; 0.00001]. Risks for heart failure death as mentioned in one study and worsening heart failure also in one study are likewise increased with hypochloremia on admission.

Conclusion
Admission hypochloremia is associated with higher all-cause mortality among patients admitted for acute decompensated heart failure. The risk for heart failure death and worsening heart failure are also increased. Admission hypochloremia may be a useful prognosticator for heart failure patients.
P17 In-hospital mortality and clinical features of Japanese patients with acute myocardial infarction diagnosed by universal definition in real world from kanagawa-acute cardiovascular registry (K-ACTIVE)
Authors: Sone H , Mori H , Maeda A , Akashi Y , Ako J , Ikari Y , Ebina T , Sato N , Tamura K , Namiki A , Fukui K , Michishita I , Kimura K , Suzuki H 
Published: January 2020

Abstract

Background
Cardiac troponin (cTn) has been used as the preferred biomarker of myocardial injury for diagnosis of acute myocardial infraction (AMI) by universal definition. A large number of patients formerly classified by creatine kinase (CK) as unstable angina with the WHO criteria in Japan are now diagnosed by cTn as non-ST elevation myocardial infarction (NSTEMI). In this report, we aimed to understand its prevalence and clinical features of AMI diagnosed by using universal definition and the WHO criterial in real world.

Method
This registry is a cross-sectional study of 53 facilities in Kanagawa prefecture of Japan. 4372 AMI patients were enrolled who received primary percutaneous coronary intervention (PCI) between October 1, 2015 and January 29, 2019. Patients were divided into 3 groups, 3268 patients with ST elevation myocardial infarction (STEMI), 628 patients with NSTEMI patients who satisfied the WHO criteria with CK elevation beyond twice upper limit of normal (NSTEMI + CK), and 476 patients with NSTEMI who didn’t satisfy the WHO criteria without CK elevation (NSTEMI-CK).

Result
Baseline clinical characteristics of the study patients are shown in Table 1. In-hospital mortality was significantly lower in patients with NSTEMI-CK (1.9%) than in STEMI (6.0%, P &lt; 0.001) and NSTEMI + CK (5.3%, P &lt; 0.004) (Figure 1). Kaplan-Meier analyses for 0-30 days of cardiac death are shown in Figure 2. From day 0, the Kaplan-Meier curves began to diverge in favor of NSTEMI-CK for up to 30 days.

Conclusion
AMI patients showed distinct clinical features depends on the type. We should be aware of the difference for the diagnosis of AMI by using universal definitions.
Table 1. 　 STEMI (n = 3268) NSTEMI + CK (n = 628) NSTEMI-CK (n = 476) STEMI vs NSTEMI + CK P value STEMI vs NSTEMI-CK P value NSTEMI + CK vs NSTEMI-CK P value Age(years) 68(59-77) 69(61-78) 70(61-79) 　 　 　 Male 76% 77% 75% 0.54 0.74 0.47 Concomitant diseases 　 　 　 　 　 　 Hypertention 65.4% 70.5% 69.3% 0.013 0.097 0.65 Diabetes 33.5% 36.5% 37.3% 0.15 0.11 0.78 Dyslipidemia 56.1% 61.2% 61.3% 0.018 0.03 0.96 Hemodialysis 2.3% 2.1% 6.8% 0.86 &lt;0.001 0.01 Smoking 66.3% 63.1% 64.6% 0.13 0.48 0.62 Atrial fibrillation 9.6% 10.7% 14.4% 0.57 0.04 0.23 Previous MI 8.3% 17.3% 15.7% &lt;0.001 &lt;0.001 0.47 In-hospital mortality 6.0% 5.3% 1.9% 0.49 &lt;0.001 0.004
Abstract P17 Figure 1. 2.
P22 Complete versus culprit only revascularization in STEMI: a single centre experience
Authors: So T 
Published: January 2020

Abstract

Introduction
Multiple vessel disease in STEMI is not uncommon, approximately half of STEMI patient presented with multiple vessel disease. In STEMI with multiple vessel disease that is not in cardiogenic shock, it is unclear whether complete or culprit only revascularization achieve better clinical outcome. Several trials, such as PRAMI, The CvLPRIT study, DANAMI-3 PRIMULTI, have shown mortality benefit favoring complete revascularization. Yet in a lack of large scale randomized control trial, there is no strong evidence.

Purpose
To evaluate whether complete or culprit only revascularization in STEMI with multi-vessel disease (non-cardiogenic shock) achieve better clinical outcome

Method
A retrospective review of patient with STEMI and multiple vessel disease (defined as angiographic stenosis 70% and more than single vessel involvment) that is not cardiogenic shock. Data was collected in a local hospital in the period of 1/2013 to 12/2017. The end-point
follow-up was up to 12 months. Primary outcome was major adverse cardiac event (MACE), comprising all-cause mortality, recurrent myocardial infraction, heart failure, ventricular arrhythmia. The outcome variable was analyzed by time-to-first event survival analysis, Cox proportional hazard models was used to estimate hazard ratios and 95% confidence interval. Data was analyzed by software SPSS.

Result
A total number of 112 patients were included in the study. There are 69 patient in culprit group while 43 patient in complete group. In culprit only group, 17 out of 69 patients developed MACE
(24.6%) while in complete revascularization group, 11 out of 43 patients had MACE (25.6%) (Hazard ratio: 0.942; 95% confidence interval 0.441 to 2.011; p = 0.877).

Conclusion
There is no significant difference in MACE in complete revascularization and culprit only group in STEMI patient and multiple vessel disease (non-cardiogenic shock). Our result differs from previous trials, possibly due to sample size and study design. In view of heterogeneity of study design in different trials and absence of solid clinical evidence, further study is needed to determine the optimal strategy for revascularization in patient with STEMI and multiple vessel disease (non-cardiogenic shock).
P25 Polymorphism of CYP2C19 is associated with poor platelet response to clopidogrel and indirectly affect TIMIi-flow among asian patients with STEMI undergoing primary PCI
Authors: Kemalasari A , Sukmawan R , Adiarto S 
Published: January 2020

Abstract

Background
The platelet response to clopidogrel treatment is very important in patients with myocardial infarction undergoing primary PCI. Asian populations have been shown to have higher proportion of CYP2C19 gene polymorphism that may alter biotransformation of clopidogrel, than Caucasians. However, It is unclear whether platelet reactivity measured by P2Y12 reaction unit (PRU) is affected by CYP2C19 polymorphism, and whether it will impair coronary flow among Asian patients with STEMI after primary PCI. Purpose: We sought to define whether polymorphisms on CYP2C19 genes will affect platelet reactivity response to Clopidgrel therapy, and whether subsequently it will affect the TIMI flow in Asian patients with STEMI undergoing primary PCI. Method: We studied 90 patients with STEMI receiving 600 mg loading dose of clopidogrel prior to primary PCI. High-on-treatment platelet reactivity was evaluated using the VerifyNow Assay. Patients with platelet reactivity more than 208 PRU are categorized as non-responders to Clopidogrel. Genotyping of CYP2C19 was performed by real-time polymerase chain reaction (PCR). Post primary PCI TIMI flow was categorized into good (TIMI flow 3), and impaired (TIMI flow &lt;3). Results: Among all 90 patients (median age = 54.5 years old; 93.3% male), there were 36.6 % patients with CYP2C19 polymorhisms, carrying *2 or *3 alleles. Platelet reactivity test revealed 23.4% of all patients were Clopidogrel non-responders. Multivariate analysis showed CYP2C19 polymorphism is associated with Clopidogrel non-reponders (OR 4.7, p = 0.030), along with other factors such as: Diabetes, Renal impairment, and use of proton pump inhibitor drugs. After successful stent implantation during primary PCI, there were 24.4% patients still with TIMI flow &lt; 3. There was no direct correlation between CYP2C19 polymorphism and TIMI flow &lt; 3 after primary PCI. However, we found significant association between Clopidogrel non-reponders and TMI flow &lt; 3 after primary PCI in those STEMI patients (OR 3.3, p = 0.046). Conclusions: In Asian patients with STEMI receiving clopidogrel prior to primary PCI, the CYP2C19 polymorphisms is associated with poor platelet response to Clopidogrel therapy. The Clopidogrel non-responders is associated with impaired TIMI flow after primary PCI.
P29 Arrest of progression of cardiac amyloidosis after chemotherapy predicts favorable outcome in patients with light-chain amyloidosis
Authors: Koyama J , Minamisawa M , Kuwahara K 
Published: January 2020

Abstract

Funding Acknowledgements
none

Background
Many studies demonstrated that cardiac involvement predicts poor prognosis in patients with systemic light-chain amyloidosis (AL). There is no data about the effect of the arrest of progression of cardiac amyloidosis on prognosis after chemotherapy.

Hypothesis
Arrest of progression of cardiac amyloidosis is associated with favorable outcome in patients with light-chain amyloidosis.

Methods
Among 126 consecutive patients with AL, we prospectively examined 94 patients serially after optimal therapy. The mean follow-up period was 1405 ± 1510 days (median value 734 days, inter quartile range 176-2343 days). Wall thickness was measured from left ventricular (LV) m-mode trace. We defined the cardiac involvement as mean LV wall thickness &gt;12mm, and the regression or progression of cardiac amyloidosis as change in LV mean wall thickness &gt;1mm.

Results
Among 94 patients with AL, 28 patients (30%) showed regression by definition above, 35 patients (37%) showed no interval change and 31 patients (33%) showed progression of cardiac amyloidosis. Survival analysis of 3 groups demonstrated that the regression and arrest of progression groups showed better outcome compared with the progression group (Log-rank test P &lt; 0.0001).

Conclusions
The arrest of progression of cardiac amyloidosis predicts favorable outcome in patients with AL amyloidosis.
Abstract P29 Figure. Kaplan-Meier Curve of 3 groups
P41 Correlation of doppler ultrasound assessment of carotid femoral pulse wave velocity with coronary artery disease
Authors: Singh R P , Tewari S , Kapoor A , Goel P K , Garg N , Kumar S , Khanna R 
Published: January 2020

Abstract

Funding Acknowledgements
self

Background
Arterial stiffness is an important cardiovascular risk factor. Carotid femoral pulse wave velocity (cfPWV) is simple noninvasive method to determine aortic stiffness. Arterial stiffness measures, cfPWV in particular, have been found to be correlate with stroke and peripheral artery disease. Usually SphygmoCor or Complior are used to calculate cfPWV. Doppler ultrasound can serve as an alternative to these methods.

Purpose
To assess cfPWV using doppler ultrasound and study its correlation with coronary artery disease and its severity.

Methods
cfPWV was assessed by ultrasound Doppler in patient aged 20-70 years undergoing coronary angiography. cfPWV was measured by sequential recordings of arterial pressure waveform at the carotid and femoral arteries with a Doppler ultrasound with ECG gating and calculated as the distance between the carotid and the femoral sampling site divided by the time interval.

Result
Of the 358 subjects studied, 243 had coronary artery disease(CAD) (&gt;50% diameter stenosis) and were further divided into single, double or triple vessel disease groups. 115 patients had mild CAD (&lt; 50% stenosis) or no CAD and served as controls. Baseline characteristics were similar except diabetes (more common in CAD group)(39.09% v/s 27.82%). cfPWV was found to increase with age in all groups. cfPWV was not significantly affected by sex, diabetes, dyslipidemia, BMI, smoking or hypothyroidism. Mean cfPWV was significantly higher in patients with CAD (8.99 v/s 6.51 m/s, p &lt; 0.001) and hypertensives (8.71 v/s 7.83 m/s, p &lt; 0.001). Patients with triple vessel disease(TVD) had significantly higher cfPWV (10.12 m/s) than those with double(DVD)(8.84 m/s) or single vessel disease(SVD)(8.28m/s)(p &lt; 0.001). Multinomial logistic regression revealed an odds ratio of 2.00, 2.375 and 3.368 respectively for SVD, DVD and TVD groups in comparison to controls (p &lt; 0.001). cfPWV value &gt; 7.25 m/s predicted CAD with sensitivity 78.6 % and specificity 74.8% (AUC =0.848, P &lt; 0.001).

Conclusion
Carotid femoral pulse wave velocity can be measured noninvasively by ultrasound Doppler. cfPWV increases with age and hypertension and has strong correlation with coronary artery disease and its severity. The cfPWV can be an independent risk factor and may be utilized for cardiovascular risk prediction.
Abstract P41 Figure. cfPWV in various subgroups.
P44 Impact of the distal radial artery approach in nursing service
Authors: Moriyama S , Sakai R , Tagaito S , Kanamori Y , Mizohashi T , Tamada S , Nomoto M , Kokuhata K , Mizuguchi Y , Takahashi A 
Published: January 2020

Abstract

Background
The distal transradial approach (dTRA) is a newly developed technique expected to reduce bleeding and other complications, such as occlusions, arising from the nature of the puncture site during transradial access. However, there is a paucity of data with regard to the nursing workload during or after achieving hemostasis. The present study aimed to evaluate the workload of the nursing service associated with dTRA in patients undergoing diagnostic coronary angiography (CAG).

Methods
Two-hundred patients who underwent CAG using a 4-Fr sheath system in our hospital between October 2017 and September 2018 were enrolled in the study. Of the total, 100 patients underwent dTRA for CAG (dTRA group), and the other 100 patients underwent the conventional transradial approach (TRA) for CAG (TRA group). After CAG, continuous compression was performed for 3 hours in the TRA group using a TR Band™, which is a hemostasis device for TRA, to remove 2 ccs and 3 ccs of air at 30 and 120 minutes, respectively. If bleeding occurred, 1 to 2 ccs were replaced using the band, followed by a wait time of 15 minutes. Similarly, continuous compression was performed in the dTRA group usingSTEPTY™, a compression tape with a 6-mm-thick pad at the central portion, and the patient’s arm was wrapped in an elastic bandage for 2 hours after CAG. We compared the dTRA and TRA groups in terms of nursing workload associated with the achievement of hemostasis and the complications related to the puncture site.

Results
The nursing-service workload associated with the management of hemostasis, including the nursing hours, the time taken to measure vitals, and the recording times were found to be significantly shorter for the dTRA group compared to that of the TRA group (2.1 ± 0.5 vs 4.1 ± 0.7 times, p &lt; 0.001; 2.1 ± 0.4 vs 4.1 ± 0.7 times, p &lt; 0.001; 2.1 ± 0.4 vs 4.1 ± 0.6 times, p &lt; 0.001, respectively). Further, the number of cases requiring treatment for bleeding was fewer in the dTRA group than in the TRA group (3 vs 12 cases, p &lt; 0.05).

Conclusions
The workload of the nursing service associated with achieving hemostasis in the dTRA group was significantly lower compared to that in the TRA group. The introduction of dTRA for routine coronary catheterization possibly help in reducing the complications and the nursing workload in daily nursing practices.
P92 A novel method of correcting the left ventricular stroke volume by Doppler echocardiography: comparison with multidetector computed tomography
Authors: Toriyama C , Abe H , Nishida H , Nakamura M , Ohashi T , Iida Y , Kosugi S , Ozaki T , Shinouchi K , Mishima T , Date M , Ueda Y , Uematsu M , Koretsune Y 
Published: January 2020

Abstract

Background
Although transthoracic Doppler echocardiography is widely used for estimating left ventricular stroke volume (SV), accelerated blood flow in the left ventricular (LV) outflow tract may lead to overestimation. SV can be calculated accurately from left ventricular end-systolic and end-diastolic volume determined by multi-detector computed tomography (MDCT). However, radiation exposure as well as the use of contrast medium hampers its routine use.

Purpose
The purpose of this study was to examine whether the correction of SV measured by pulsed wave Doppler echocardiography (SVdop) can accurately predicts SV obtained by MDCT (SVct).
Methods： We enrolled consecutive 61 patients who underwent both MDCT and transthoracic echocardiography. Patients with moderate or severe valvular diseases and valve replacement surgery were excluded. Correction of SV was explored with SVct as a reference.
Results： Univariate analysis showed that SVdop (r = 0.42, P = 0.0007) and patient age (r=-0.50, P &lt; 0.0001) were significantly correlated with SVct. On the other hand, left ventricular ejection fraction calculated by Teicholz method (EFteich) (r = 0.19, P = 0.14), systolic blood pressure (r = 0.07, P = NS), and LV mass index (r=-0.02, P = NS) were not correlated with SVct. Multivariate analysis showed that SVdop, patient age and EFteich were the independent predictive factors for SVct (R2 = 0.49, P &lt; 0.0001). Based on these correlations, we postulated SV as: corrected SV = SVdop × 0.40 + EFteich × 0.46 – age × 0.67 + 44.77. As expected, the correlation between corrected SV and SVct significantly improved (r = 0.70, P &lt; 0.0001). Bland-Altman plot analysis showed that corrected SV significantly reduced the variation between SVdop and SVct, and diminished the overestimation of SVdop (Figure).
Conclusion： The new correction formula of SVdop may correct the overestimation of SV obtained by pulsed wave Doppler echocardiography, although the formula remains to be validated in a separate cohort of patients.
Abstract P92 Figure
P97 Effect of rhythm control therapy for asymptomatic atrial fibrillation
Authors: Onishi N , Oi M , Jinnai T , Kaitani K , Harita T , Nishiuchi S , Tamura T 
Published: January 2020

Abstract

Background/Introduction
Cather ablation (CA) for atrial fibrillation (AF) as rhythm control therapy has widely spread. However, the indication of CA for the patients with asymptomatic AF is controversial (2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS).

Purpose
This study was aimed to examine the effect of CA for asymptomatic AF patients.

Methods
In a total of 522 consecutive patients who were hospitalized for the initial CA for AF, 123 patients (23.6%) who were asymptomatic were retrospectively analyzed. "Asymptomatic AF" was defined when the patients had no complaints during the medical interviews. Quality of life (QOL) was evaluated with the AF QOL Questionnaire score (AFQLQ, invented by the Japanese Society of Electrocardiology) before CA and at 1 year after a single CA.

Results
A total of 79 patients were persistent AF (64.2%). Sinus rhythm maintenance rate at 3 yeas after CA was 57.0% in a single session and 84.8% in multiple sessions. In cardiac echo data at baseline, 3 months, 6 months, and 1 year after CA, left ventricular ejection fraction (LVEF) and left atrium diameter (LAD) were improved in the initial three months after a single CA (LVEF; 62.8 ± 8.0%→64.4 ± 6.5%, p = 0.045, LAD; 39.7 ± 6.1mm→35.3 ± 7.0mm, p = 0.0002). In LA volume measured with CT before and after CA, LA reverse remodeling was observed (102.7 ± 32.3ml→72.4 ± 24.1ml, p&lt;.0001). In AFQLQ2 (severity of symptoms), there was no significant difference (16.3 ± 2.2→15.9 ± 1.7 out of 18, p = 0.69). However, in AFQLQ1 (frequency of symptoms) and AFQLQ3 (limitations of activities and mental anxiety), the score was improved (20.2 ± 4.5→23.4 ± 1.1 out of 24, p&lt;.0001 and 47.6 ± 7.8→51.3 ± 6.1 out of 56, p = 0.0001). Moreover, in low LVEF patients (LVEF &lt; 50%, n = 8), LVEF was remarkably improved (44.1 ± 4.0%→56.3 ± 10.8%, p = 0.034).

Conclusions
The improvement of LVEF and LA reverse remodeling can be expected at the early stage after CA, because of the reduction of AF burden. Moreover, the further improvement of QOL can be expected after CA, even in the patients with "asymptomatic" AF.
P98 Distal myopathy induced the onset of arrhythmogenic right ventricular cardiomyopathy in a pedigree carrying novel DSG2 null variant
Authors: Wang D , Chen P , Li Z , Yu B , Ma F , Li X , Wang D-W 
Published: January 2020

Abstract

Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiac disease predominantly caused by variants in desmosome genes. Variants in human Desmoglein-2 (DSG2) gene can cause ARVC with incomplete penetrance. However, it remains unknown whether ARVC would penetrate by distal myopathy.

Methods
We performed targeted next-generation sequencing using a cardiomyopathy/ion channelopathy panel in a Chinese ARVC pedigree. Plasmids of DSG2 were constructed, and pathogenicity of the DSG2 variant was investigated by real-time PCR, western blots, Immunofluorescence, and electron microscope.

Results
We identified a novel nonsense variant in DSG2 (c.710T &gt; A, p.Leu237Ter) and a reported pathogenic missense variant of distal myopathy in MYH7 (c. 1322C &gt; T, p.Thr441Met) in the proband of an ARVC pedigree. The functional analyses suggested that the nonsense variant could affect the expression and cell location of DSG2, and the number and shape of desmosomes were affected as well, indicating that the variant was implicated in the pathogenesis of ARVC. We found only patients carrying the distal myopathy pathogenic variant would manifested early-onset severe ARVC phenotype, which suggested that MYH7-p.Thr441Met variant could induced the onset of ARVC in the DSG2-p.Leu237Ter variant carriers.

Conclusions
Our study identified a novel null variant in DSG2 gene (c.710T &gt; A, p.Leu237Ter) in an ARVC pedigree with incomplete penetrance. Only patients who carried a distal myopathy associated variant in MYH7 (c. 1322C &gt; T, p.Thr441Met) would induce the onset of ARVC with early-onset and severe symptoms.