0259 Shiftworkers are at Increased Risk of Developing Chronic Pain and Opioid Use Disorders: A Study of 116,000 UK Biobank Participants Over a Decade

Introduction

In the current epidemic of opioid-related deaths, and widespread use of opioids to treat chronic pain, there is a pressing need to understand the underlying risk factors that contribute to such devastating conditions. Shiftwork has been associated with adverse health outcomes. We tested whether shiftwork during middle age is linked to the development of chronic pain and opioid misuse.

Methods

We studied 116,474 participants in active employment between 2006–2010 (mean age 57±8; range 37–71) from the UK Biobank, who have been followed for up to 10 years until 2017. We included participants who were free from all forms of self-reported pain, and were not taking opioid medications at baseline. Chronic pain and opioid use disorder diagnoses were determined using hospitalization records and diagnostic coding from ICD-10. Multivariate logistic regression models were performed to examine the associations of shiftwork status (yes/no) and nightshift frequency (none/occasional/permanent) and with incident chronic pain and/or opioid use disorder during follow-up. Models were adjusted for demographics, education, Townsend deprivation index, major confounders (BMI, diabetes, bone fractures/injuries, operations, peripheral vascular disease, joint/inflammatory diseases, cancer, standing/manual labor at work) and covariates (smoking, alcohol, high cholesterol, depression/anxiety, and cardiovascular diseases).

Results

In total, 190 (1.6/1,000) developed chronic pain or opioid use disorders. Shiftworkers (n=17,673) saw a 1.5-fold increased risk (OR 1.56, 95% CI: 1.08–2.24, p=0.01) relative to day workers. Within shiftworkers, those who reported occasional nightshift work (n=3,966) were most vulnerable (OR 1.57, 95% CI: 1.06–2.34, p=0.02). Results remained similar after adjusting for baseline sleep duration, chronotype and insomnia.

Conclusion

Shiftwork, and in particular rotating nightshift work is associated with increased risk for developing chronic pain and opioid use disorders. Replication is required to confirm the findings and to examine underlying mechanisms.

Support

This work was supported by NIH grants T32GM007592, RF1AG064312, and RF1AG059867.

Paracetamol for patent ductus arteriosus in preterm infants: a UK national survey

Introduction: Evidence is emerging that paracetamol is a safe and effective alternative therapy for haemodynamically significant patent ductus arteriosus (hsPDA). Although there is no consensus opinion on its routine use for PDA in preterm infants, paracetamol is being used increasingly in many centres to treat hsPDA.Objective: We conducted a national survey to review the current practice in the UK and the prevalence of paracetamol use for hsPDA closure in preterm infants.Method: A web-based and telephone survey on the use of paracetamol for hsPDA closure in preterm infants was conducted. All neonatal intensive care and local neonatal units across the UK were contacted between May and August 2018.Results: 98% (143/146) neonatal units responded. The first-line medication for hsPDA closure was ibuprofen in 92% (131/143) units. 33% (47/143) of units used paracetamol; three units used it as first-line. The dose and duration of paracetamol varied greatly among the units with a dose of 15 mg/kg 6 hourly in 62% (29/47) units and a duration of 3 and 5 days in 33% (14/42) and 31% (13/42) of units, respectively. 44% (19/43) of units did routine blood investigations using paracetamol for monitoring patients on treatment and 21% (9/43) took paracetamol level in addition to other tests.Conclusion: 33% of the neonatal units across the UK offered paracetamol to treat hsPDA in preterm infants. Currently, there is a variation in practice regarding the dose, duration of paracetamol and monitoring of infants during its use for hsPDA closure. One strategy would be to develop national guidance once strong evidence is established to support its routine use for hsPDA in preterm infants.

[Effectiveness evaluation of health belief model-based health education intervention for patients with hypertension in community settings]

Objective: To evaluate the effectiveness of health belief model-based health education intervention in improving blood pressure control of patients with hypertension in community settings. Methods: From September 2016 to September 2017, 400 newly diagnosed patients with hypertension were recruited from 6 community healthcare centers with comparable population size and health services in the Shunyi District of Beijing. All community healthcare centers were randomly assigned to the intervention group (206 patients) and the control group (194 patients). Patients in the intervention group received 3 lectures (20-30 min for each) of health belief model-based health education. Patients in the control group received usual care. The basic characteristics, health beliefs, and health literacy were collected, and blood pressure was measured before and after the intervention, respectively. The difference-in-difference model was used to analyze the change of blood pressure and the influencing factors between two groups before and after the intervention. Results: A total of 134 patients in the intervention group and 129 patients in the control group completed the study. After adjusting for the age, gender, family income, medical insurance, chronic diseases and family history, the score of perceived barriers was increased by 1.65 (P=0.016), and perceived seriousness was decreased by 0.73 (P=0.018). The systolic blood pressure of patients was decreased by 7.37 mmHg (1 mmHg=0.133 kPa, P=0.001) and diastolic blood pressure was decreased by 4.07 mmHg (P=0.014), respectively. The β (95%CI) values were -7.37 (-11.88,-2.86) and -4.07 (-7.30, -0.84). The perceived susceptibility and self-efficacy had a significant influence on the blood pressure of patients (P<0.05). Conclusion: Health belief model-based health education intervention could significantly improve the blood pressure control of patients with hypertension in the community settings.

161 Impact of right ventricular dysfunction on outcome in heart failure patients with mid-range ejection fraction with and without chronic respiratory diseases

Background

The impact of right ventricular (RV) dysfunction on outcome of heart failure patients with mid-range left ventricular ejection fraction (HFmrEF, 40-49%) is not well characterized yet. In this study, we observed the association between echocardiography defined RV dysfunction with outcomes and if the outcome was jointly affected by co-existed chronic respiratory diseases (CRD: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome) in HFmrEF patients

Methods

1090 HFmrEF patients referred to our department between 2009 and 2017 were included in this study. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (15-38) months. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed with the use of multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP).

Results

Mean age was 69 ± 13 years and 73.4% were male. The proportion of NYHA functional class III or IV was 24.8%. CRD was identified in 209 (19.2%) patients. 280 patients (25.7%, without CRD: 204, with CRD: 76) died and 2 patients (without CRD) underwent HTx. All-cause mortality/HTx was significantly higher in HFmrEF patients with CRD than without CRD (36.4% vs. 23.4%, P &lt; 0.001).

Besides CRD, Cox regression analysis showed that age, body mass index, and cardiac risk factors and comorbidities including diabetes, atrial fibrillation, dyslipidemia, coronary artery disease, kidney dysfunction (eGFR &lt;60ml/min/1.73qm), anemia were associated with increased all-cause mortality/HTx (all P &lt; 0.05). Multivariable Cox regression models showed that sPAP (HR 1.015, P = 0.002) and TAPSE (HR 0.962, P = 0.004) were independent determinants of all-cause mortality/HTx in patients without CRD, while sPAP served as independent determinant of all-cause mortality/HTx In patients with CRD (HR 1.018, P = 0.026) after adjusted for above mentioned confounders.

Patients without CRDs were further grouped into those with normal (sPAP ≤ 40mmHg and TAPSE≥14mm, n = 513); mild to moderate (sPAP &gt; 40mmHg or TAPSE &lt; 14mm, n = 387) and severe RV dysfunction (sPAP &gt; 40mmHg and TAPSE &lt; 14mm, n = 88). Severe RV dysfunction was independently associated with a 2-fold increased all-cause mortality/HTx as compared to normal RV function (HR 2.209, 95% CI 1.455-3.355, P &lt; 0.001).

Conclusions

Increased sPAP and reduced TAPSE are independent determinants of all-cause mortality in HFmrEF patients without CRD, and sPAP is an independent determinant of all-cause mortality in HFmrEF patients with CRD. Moreover, HFmrEF patients with severe RV dysfunction face a 2-fold increased all-cause mortality, as compared to patients with normal RV function and no CRD.

P904 Impact of significant functional mitral regurgitation and aortic stenosis on outcome of HFrEF patients

Background

Concomitant aortic stenosis (AS) and functional mitral regurgitation (FMR) are common in patients with left ventricular dysfunction. We evaluated the impact of significant valve diseases on outcome of patients with reduced left ventricular ejection fraction (HFrEF, LVEF &lt; 40%).

Methods

A total of 1264 consecutive HFrEF patients referred to our department between 2009 and 2017 were screened. Transthoracic echocardiography was performed at baseline visit in all patients. Patients with primary MR or received mitral valve operation before or after baseline visit (n = 64) as well as patients underwent aortic valve replacement (AVR) before baseline visit (n = 66) were excluded. Finally, 1134 HFrEF patients were included for final analysis, and all completed a median clinical follow-up of 26 (12-40) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx).

Results

Moderate or severe FMR or AS was detected in 902 (79.5%) and in 119 (10.5%) patients by echocardiography, respectively. Of patients with significant AS, 47 patients underwent AVR shortly after baseline visit. In total, 353 (31.2%, including HTx n = 11) HFrEF patients died or underwent HTx during follow-up.

Age, body mass index, diabetes, atrial fibrillation, coronary artery disease, chronic respiratory diseases, and renal dysfunction (all P &lt; 0.05) were defined as clinical covariates associated with all-cause mortality/HTx and served as potential confounders in the multivariable Cox regression models. All-cause mortality/HTx was significantly higher in HFrEF patients with significant FMR than patients without significant FMR (33.8% vs. 20.7%, P &lt; 0.001).

Multivariable Cox regression analysis showed significant FMR remained as an independent determinant of all-cause mortality/HTx in patients with HFrEF after adjusted for above mentioned confounders (HR 1.39, 95% CI 1.02-1.90, P = 0.035).

Patients with significant AS without AVR faced increased risk of all-cause mortality/HTx as compared to patients without significant AS (HR 2.34, P &lt; 0.001), while risk of all-cause mortality/HTx was significantly lower in patients with significant AS and underwent AVR as compared to patients without significant AS after adjustment for confounders (HR 0.36, P = 0.008).

In the subgroup of HFrEF patients with significant FMR, significant AS without AVR was independently associated with increased all-cause mortality/HTx as compared to patients without significant AS (HR 2.30, P &lt; 0.001), while outcome is better in AS and FMR patients underwent AVR as compared to patients with significant FMR and without significant AS (survival: 85.4% vs. 67.5%, P &lt; 0.001; HR 0.34, P = 0.010) after adjustment for potential confounding factors.

Conclusion

Moderate to severe FMR and/or AS is incrementally related to higher all-cause mortality/HTx in HFrEF patients. AVR could significantly improve the survival of HFrEF patients with concomitant significant AS and FMR.

P1751 Right ventricular dysfunction in heart failure patients with reduced ejection fraction with and without chronic respiratory diseases: A treacherous combination for the ominous outcome?

Background

Right ventricular (RV) dysfunction is common in heart failure patients. In the present study, we determined the impact of echocardiography defined RV dysfunction on outcomes in heart failure patients with reduced ejection fraction (&lt;40%, HFrEF) with and without chronic respiratory diseases (CRDs: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome).

Methods

A total of 1264 HFrEF patients (Mean age: 68 ± 13 years; male: 76.3%) referred to our department between 2009 and 2017 were included. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (12-40) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed by multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP).

Results

The proportion of NYHA functional class III-IV was 42.2%. Mean LVEF was 29.4 ± 7.0%. CRDs was identified in 276 (21.8%) patients, 399 (30.5%, without CRDs n = 290, with CRDs n = 109) patients died (n = 386) or underwent HTx (n = 13). All-cause mortality/HTx was significantly higher in HFrEF patients with CRDs than without CRDs (39.5% vs. 29.4%, P = 0.001).

Cox regression analysis showed that age, BMI, and other cardiac risk factors and comorbidities including diabetes, atrial fibrillation, coronary artery disease, kidney dysfunction, and anemia were associated with all-cause mortality/HTx (all P &lt; 0.05) besides CRDs. Multivariable Cox regression models showed that sPAP (HR 1.016, P &lt; 0.001), TAPSE (HR 0.964, P = 0.003), RAA (HR 1.030, P &lt; 0.001), and RVD (HR 1.029, P &lt; 0.001) were independent determinants of all-cause mortality/HTx in HFrEF patients without CRDs, but not in HFrEF patients with CRDs after adjusted for above mentioned confounders.

With the cut-off values (sPAP &gt; 40mmHg, TAPSE &lt; 12mm, RAA &gt; 25cm², and RVD &gt; 36mm) derived from the 3rd quartiles, patients without CRDs were further grouped as normal RV function (all 4 parameters normal, n = 427); mild to moderate RV dysfunction (1 or 2 parameters abnormal, n = 467) and severe RV dysfunction (≥3 parameters abnormal, n = 94). Risk of all-cause mortality/HTx was significantly higher in HFrEF patients with severe (51.1%) and mild to moderate RV dysfunction (34.7%) as compared to patients with normal RV function (18.7%, severe vs. normal: HR 1.616 , 95% CI 1.232-2.119, P = 0.001; mild to moderate vs. normal HR: 2.657, 95% CI 1.845-3.824, P &lt; 0.001).

Conclusions

RV dysfunction is significantly associated with increased all-cause mortality in HFrEF patients without CRDs. Increased sPAP, RAA, RVD and decreased TAPSE are independent determinants of worse outcomes in HFrEF patients without CRDs, but not in HFrEF patients with CRDs.

MicroRNA-411 plays a protective role in diabetic retinopathy through targeted regulating Robo4

OBJECTIVE

The aim of this study was to explore the role of microRNA-411 in diabetic retinopathy (DR) and to further understand its mechanism of action.

MATERIALS AND METHODS

A rat model of diabetes (20 in the DM group) and a normal control group (20 in the control group) was established. The changes in blood glucose and body weight were compared between the two groups. At the same time, the expression changes in microRNA-411 and Roundabout 4 (ROBO4) in the two groups of rats were detected. The biological prediction of the potential binding sites of ROBO4 and microRNA-411 was verified by the Dual-Luciferase reporter gene assay, and the regulatory relationship of microRNA-411 to ROBO4 was verified in human retinal pigment epithelial cells (ARPE-19). Meanwhile, we investigated the effects of high glucose and hypoxia on the viability of ARPE-19 cells and explored whether microRNA-411 has a regulatory role in the effects. Finally, a cell reverse experiment was designed to verify whether microRNA-411 functions through ROBO4.

RESULTS

Compared with the NC group, the blood glucose of the DM group was significantly increased while the body weight was reduced. In addition, the expression level of microRNA-411 was markedly decreased in diabetic rats, and the mRNA and protein levels of ROBO4 were notably increased, which were all dependent on time. Biological prediction revealed that ROBO4 might be a potential target gene of microRNA-411, and the results of the Dual-Luciferase reporter gene assay confirmed that there is a binding relationship between them; meanwhile, microRNA-411 was proved to be able to inhibit the expression level of ROBO4 in vivo and in vitro. Both high glucose and hypoxia could inhibit the proliferation of ARPE-19 cells and increase the monolayer permeability. Additionally, up-regulation of microRNA-411 or down-regulation of ROBO4 could partially reverse this phenomenon. Cell reverse experiment showed that overexpression of ROBO4 partially reversed the protective effect of microRNA-411 on DR.

CONCLUSIONS

MicroRNA-411 was down-regulated in the rat model of diabetic retinopathy and played a protective role in this disease, which might be achieved by negatively regulating the expression level of ROBO4.

P3551Right ventricular dysfunction in heart failure patients with reduced ejection fraction with and without chronic respiratory diseases: A treacherous combination for the ominous outcome?

Background

Right ventricular (RV) dysfunction is common in heart failure patients. In the present study, we determined the impact of echocardiography defined RV dysfunction on outcomes in heart failure patients with reduced ejection fraction (<40%, HFrEF) with and without chronic respiratory diseases (CRDs: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome).

Methods

A total of 1264 HFrEF patients (Mean age: 68±13 years; male: 76.3%) referred to our department between 2009 and 2017 were included. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (12–40) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed by multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP).

Results

The proportion of NYHA functional class III-IV was 42.2%. Mean LVEF was 29.4±7.0%. CRDs was identified in 276 (21.8%) patients, 399 (30.5%, without CRDs n=290, with CRDs n=109) patients died (n=386) or underwent HTx (n=13). All-cause mortality/HTx was significantly higher in HFrEF patients with CRDs than without CRDs (39.5% vs. 29.4%, P=0.001).

Cox regression analysis showed that age, BMI, and other cardiac risk factors and comorbidities including diabetes, atrial fibrillation, coronary artery disease, kidney dysfunction, and anemia were associated with all-cause mortality/HTx (all P<0.05) besides CRDs. Multivariable Cox regression models showed that sPAP (HR 1.016, P<0.001), TAPSE (HR 0.964, P=0.003), RAA (HR 1.030, P<0.001), and RVD (HR 1.029, P<0.001) were independent determinants of all-cause mortality/HTx in HFrEF patients without CRDs, but not in HFrEF patients with CRDs after adjusted for above mentioned confounders.

With the cut-off values (sPAP>40mmHg, TAPSE<12mm, RAA>25cm2, and RVD>36mm) derived from the 3rd quartiles, patients without CRDs were further grouped as normal RV function (all 4 parameters normal, n=427); mild to moderate RV dysfunction (1 or 2 parameters abnormal, n=467) and severe RV dysfunction (≥3 parameters abnormal, n=94). Risk of all-cause mortality/HTx was significantly higher in HFrEF patients with severe (51.1%) and mild to moderate RV dysfunction (34.7%) as compared to patients with normal RV function (18.7%, severe vs. normal: HR 1.616, 95% CI 1.232–2.119, P=0.001; mild to moderate vs. normal HR: 2.657, 95% CI 1.845–3.824, P<0.001).

Conclusions

RV dysfunction is significantly associated with increased all-cause mortality in HFrEF patients without CRDs. Increased sPAP, RAA, RVD and decreased TAPSE are independent determinants of worse outcomes in HFrEF patients without CRDs, but not in HFrEF patients with CRDs.

P3545Association between diastolic dysfunction and two-year survival in heart failure patients with mid-range or reduced left ventricular ejection fraction

Background

Extensive studies have demonstrated prognostic impact of echocardiographic defined diastolic dysfunction (DD) in patients with preserved as well as reduced left ventricular ejection fraction (LVEF). Nevertheless, it remains controversial whether evaluation of DD could provide additional prognostic information in heart failure (HF) patients with impaired systolic function. The purpose of present study, therefore, is to investigate the prognostic impact of echocardiography-defined DD on survival in HF patients hospitalized in our centre from 2009 to 2017 with mid-range LVEF (HFmrEF, LVEF 41–49%) and reduced LVEF (HFrEF, LVEF<40%).

Methods

A total of 2018 patients with echocardiography-evidenced LVEF<50% and hospitalized in our centre between July 2009 to December 2017 were included. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 24 (IQR 13–36) months by medical record review or telephone interview. The primary endpoint was all-cause mortality or heart transplantation (HTx). Patients were divided into mild, moderate and severe DD according to recent guidelines.

Results

The mean age was 69±13 years in the HFmrEF group and 68±13 years in the HFrEF group. All-cause mortality/HTx rate was significantly higher in the HFrEF (all-cause death n=318 and HTx n=11, 30.9%) group than in patients with HFmrEF (all-cause death n=235 and HTx n=2, 24.9%, P=0.003). All-cause mortality/HTx rate increased in proportion to DD severity in HFmrEF patients: 17.1% (54/315) in the mild DD group, 25.4% (115/452) in the moderate DD group, and 37.0% (68/184) in the severe DD group (P<0.001) and in HFrEF patients: 18.9% (43/228) in the mild DD group, 30.3% (146/482) in the moderate DD group, and 39.2% (140/357) in the severe DD group (P<0.001). Multivariable Cox regression analysis showed that Doppler parameter early-diastolic mitral inflow velocity to septal mitral annular velocity ratio (E/E') >14 (HR 1.41, 95% CI 1.06–1.89, P=0.020) and peak tricuspid regurgitation velocity (TRVmax) >2.8m/s (HR 1.75, 95% CI 1.33–2.29, P<0.001) were independent determinants of all-cause mortality/HTx in patients with HFmrEF; while E/E'>14 (HR 1.48, 95% CI 1.08–2.04, P=0.015) remained as an independent determinant of all-cause mortality/HTx in patients with HFrEF after adjustment for clinical and other echocardiographic confounders. Besides DD-related parameters, after adjustment with age and sex, lower tricuspid and mitral annular plane systolic excursions (TAPSE and MAPSE) were also closely related to higher mortality/HTx rate in both HFmrEF and HFrEF patients.

Figure 1. Kaplan-Meier curves

Conclusion

Our results indicate that all-cause mortality/HTx rate increases in proportion to DD severity in both HFmrEF and HFrEF patients.

P4513Impact of right ventricular dysfunction on outcome in heart failure patients with mid-range ejection fraction with and without chronic respiratory diseases

Background

The impact of right ventricular (RV) dysfunction on outcome of heart failure patients with mid-range left ventricular ejection fraction (HFmrEF, 40–49%) is not well characterized yet. In this study, we observed the association between echocardiography defined RV dysfunction with outcomes and if the outcome was jointly affected by co-existed chronic respiratory diseases (CRD: asthma, chronic obstructive pulmonary disease, occupational lung diseases, sleep apnea syndrome) in HFmrEF patients

Methods

1090 HFmrEF patients referred to our department between 2009 and 2017 were included in this study. Baseline demographic and clinical data were obtained by reviewing the medical records. All patients subsequently completed a median clinical follow-up of 26 (15–38) months. The primary endpoint was all-cause mortality or heart transplantation (HTx). Right heart morphology and function were assessed with the use of multiple echocardiographic parameters, including right atrial area (RAA), RV mid diameter (RVD), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP).

Results

Mean age was 69±13 years and 73.4% were male. The proportion of NYHA functional class III or IV was 24.8%. CRD was identified in 209 (19.2%) patients. 280 patients (25.7%, without CRD: 204, with CRD: 76) died and 2 patients (without CRD) underwent HTx. All-cause mortality/HTx was significantly higher in HFmrEF patients with CRD than without CRD (36.4% vs. 23.4%, P<0.001).

Besides CRD, Cox regression analysis showed that age, body mass index, and cardiac risk factors and comorbidities including diabetes, atrial fibrillation, dyslipidemia, coronary artery disease, kidney dysfunction (eGFR <60ml/min/1.73qm), anemia were associated with increased all-cause mortality/HTx (all P<0.05). Multivariable Cox regression models showed that sPAP (HR 1.015, P=0.002) and TAPSE (HR 0.962, P=0.004) were independent determinants of all-cause mortality/HTx in patients without CRD, while sPAP served as independent determinant of all-cause mortality/HTx In patients with CRD (HR 1.018, P=0.026) after adjusted for above mentioned confounders.

Patients without CRDs were further grouped into those with normal (sPAP≤40mmHg and TAPSE≥14mm, n=513); mild to moderate (sPAP>40mmHg or TAPSE<14mm, n=387) and severe RV dysfunction (sPAP>40mmHg and TAPSE<14mm, n=88). Severe RV dysfunction was independently associated with a 2-fold increased all-cause mortality/HTx as compared to normal RV function (HR 2.209, 95% CI 1.455–3.355, P<0.001).

Conclusions

Increased sPAP and reduced TAPSE are independent determinants of all-cause mortality in HFmrEF patients without CRD, and sPAP is an independent determinant of all-cause mortality in HFmrEF patients with CRD. Moreover, HFmrEF patients with severe RV dysfunction face a 2-fold increased all-cause mortality, as compared to patients with normal RV function and no CRD.

P1715Management and outcome in patients with non-ischemic cardiogenic shock and Impella CP use

Background and purpose

From the various mechanical cardiac assist devices and indications available, use of the percutaneous intraventricular Impella CP pump is usually restricted to acute ischemic shock or prophylactic indications in high-risk interventions. In the present study, we investigated clinical usefulness of the Impella CP device in patients with non-ischemic cardiogenic shock as compared to acute ischemia.

Methods

In this retrospective single-center analysis, patients who received an Impella CP between 2013 and 2017 due to non-ischemic cardiogenic shock were age-matched 2:1 with patients receiving the device due to ischemic cardiogenic shock. Inclusion criteria were therapy refractory hemodynamic instability with severe left ventricular systolic dysfunction and serum lactate >2.0 mmol/l at implantation. Basic clinical data, indications for mechanical ventricular support, and outcome were obtained in all patients with non-ischemic as well as ischemic shock and compared between both groups. Continuous variables are expressed as mean ± standard deviation or median (quartiles). Categorical variables are presented as count and percent.

Results

25 patients had cardiogenic shock due to non-ischemic reasons, and were compared to 50 patients with cardiogenic shock due to acute myocardial infarction. Resuscitation rates before implantation of Impella CP were high (32 vs 42%; P=0.402). At implantation, patients with non-ischemic cardiogenic shock had lower levels of HsTNT (110.65 [57.87–322.1] vs 1610 [450.8–3861.5] pg/ml; P=0.001) and LDH (377 [279–608] vs 616 [371.3–1109] U/I; P=0.007), while age (59±16 vs 61.7±11; P=0.401), GFR (43.5 [33.2–59.7] vs 48 [35.75–69] ml/min; P=0.290), CRP (5.17 [3.27–10.26] vs 10.97 [3.23–17.2] mg/dl; P=0.195), catecholamine-index (30.6 [10.6–116.9] vs 47.6 [11.7–90] μg/kg/min; P=0.663), and serum lactate (2.6 [2.2–5.8] vs 2.9 [1.3–6.6] mg/dl; P=0.424) were comparable between both groups. There was a trend for longer duration of Impella support in the non-ischemic groups (5 [2–7.5] vs 3 [2–5.25] days, P=0.211). Rates of hemodialysis (52 vs 47%; P=0.680) and transition to ECMO (13.6 vs 22.2%; P=0.521) were comparable. No significant difference was found regarding both 30-days survival (48 vs 30%; P=0.126, Figure 1) as well in-hospital mortality (66.7 vs 74%; P=0.512) although there was a trend for better survival in the non-ischemic group.

30-days survival

Conclusions

The current results position short-time use of the Impella CP as an alternative in the treatment of patients with cardiogenic shock due to underlying non-ischemic cardiomyopathy and/or complicating additional factors. However, additional studies are needed to test whether these findings can be confirmed in larger patient populations and which subgroups might benefit most from Impella therapy.

The effects of Fe2+ on sulfur-oxidizing bacteria (SOB) driven autotrophic denitrification

With the short-term exposure to Fe²⁺, the mechanism of autotrophic denitrification and sulfide oxidation and the correlation between microbial community changes and environmental factors have been explored in the ADSOB process. RSM was used to optimize conditions for the maximum nitrate reduction and sulfide oxidation. About 88% of nitrate could be autotrophically denitrified to nitrogen by utilizing sulfide as the electron donor with the molar ratio C/N of 1.14 and S/N of 0.99 at pH 7.1. Lower Fe²⁺ additions can reduce TDS inhibition with dissolved sulfide to form FeS precipitates, while high amount of Fe²⁺ limited the mass transfer of NO₃^- and intermediate products such as S⁰ may be generated. High-throughput sequencing and RDA analysis revealed the correlation between ferrous iron, environmental factors and microorganisms. Sulfurospirillum, Rhodanobacter, Thauera and Thiobacillus were all slightly promoted at NFL level and inhibited at NFH level. And the narrow angles of the arrows indicated that Thauera, Sulfurospirillum and Thiobacillus were positively correlated with SO₄^2- concentrations, while large angles indicated these bacteria were inversely related with TDS and NO₃- arrows, which further confirmed that these bacteria played a dominant role in the ADSOB process, and can reduce NO₃- by the oxidation of TDS. The correlation further indicated that lower Fe²⁺ additions have a promoting effect, while high concentrations have an inhibiting effect.