bluuebunny/crossref_metadata_2025 huggingface dataset:
Heart rate variability in patients with pulmonary hypertension as assessed with long-term continuous cardiac monitoring correlates with other established risk assessment parameters
Authors: Andersen M O , Diederichsen S Z , Svendsen J H , Carlsen J ,   ASPIRE
Published: October 2021

Background

A few short-term monitoring studies (10 minutes–24 hours) have revealed lower heart rate variability (HRV) in patients with pulmonary hypertension (PH). This is the first study to apply continuous heart rate variability monitoring in pulmonary hypertension.

Purpose

Assessment of HRV as a non-invasive risk marker in pulmonary hypertension (PH) using long-term continuous monitoring.

Methods

Patients diagnosed with PH according to international guidelines were included in this prospective single-centre study. Patients were implanted with a Reveal LINQ (Medtronic) insertable cardiac monitor to record HRV. HRV was expressed as the mean of HRV in sinus rhythm during the full day for all days per patient (SDANN method). Pearson and Spearman correlations between HRV and established risk determinants were estimated.

Results

Thirty-two patients with PH were included. Twenty-two patients had pulmonary arterial hypertension (PAH) and 10 had chronic thromboembolic PH. During 50 patient-years of continuous monitoring (median: 654 (range: 394–714) days per patient), HRV was significantly correlated to the following risk determinants in PH (variable 1–3) in addition to other variables (variable 4–8): (1) WHO functional class (FC) (r=−0.55, p = <0.001) (Figure 1), (2) NT-proBNP (r=−0.5, p=0.003), (3) cardiac index (r=−0.45, p=0.03), (4) heart rate at night time (0 am–4 am) (r=−0.68, p=<0.001) (Figure 1), (5) TAPSE (r=0.41, p=0.025), (6) right ventricle ejection fraction (r=−0.37, p=0.014), (7) tricuspid regurgitation gradient (r=−0.38, p=0.045) and (8) right ventricle end diastolic volume (ml) (r=−0.37, p=0.035).

Conclusions

This is the first study to apply continuous monitoring of HRV in patients with PH. HRV was significantly correlated with several variables already being used in risk stratification. HRV may be an additional non-invasive variable in risk assessment in PH aiding in optimization of treatment.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Janssen
Intermediate stage atherosclerosis regression using combined methotrexate- mediated ultrasound sonoporation therapy and gold nanoparticles- mediated X- rays- based Auger electron therapy
Authors: Mehrad H
Published: October 2021

Background

Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. Atherosclerosis is the main cause of stroke and myocardial infarction. In atherosclerosis, local inflammation and associated macrophage activity can lead to foam cell-rich lesion formation, making inflammation an important therapeutic target in cerebrovascular and cardiovascular diseases.

Aims

In this study, we developed an experimental pulsed low level focused ultrasound system, and investigated its effectiveness on intermediate stage atherosclerosis regression accompanied by intravenous lipid-based encapsulated methotrexate nanoparticles administration and lipid based encapsulated gold nanoparticles-mediated X-rays-based Auger electron therapy in the golden Syrian hamster common carotid artery, wherein diagnostic B-mode ultrasound is combined with ultrasound therapy system, with a goal of increased safety.

Methods

In this study, common carotid arteries of hamsters submitted to intermediate stage atherosclerosis using intravascular balloon injury and high-cholesterol diet injury. Then common carotid arteries of the treatment group (n=10) at the injured region, underwent pulsed low level focused ultrasound (F=1.3 MHz, P=24 W, PD=100 ms)-mediated sonoporation therapy accompanied by intravenous lipid-based encapsulated methotrexate nanoparticles (10ml/kg) administration and lipid based encapsulated gold nanoparticles-mediated X-rays (25 Gy)-based Auger electron therapy. Wall mean thickness and percentage of luminal cross-sectional area of stenosis were measured by ultrasonography and histopathology.

Results

Results from ultrasonography and histopathology showed a significant reduction in the mean value for wall mean thickness, percentage of luminal cross-sectional area of stenosis, lipid-laden cells and lipid droplets density at the stenotic region in the treatment group compared with the other groups (P<0.05)

Conclusions

Enhanced apoptotic and anti-proliferative effect of methotrexate, induced by enhanced inertial cavitation-based sonoporation effect of focused ultrasound, due to collapsed capsules accompanied by enhanced apoptotic effect of Auger electron therapy, can cause to regress of the intermediate stage atherosclerosis and significantly dilate the luminal cross-sectional area of stenosis.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Mehrad Research Lab
The impact of malnutrition-inflammation-atherosclerosis (MIA) syndrome on the prognosis of elderly patients with chronic limb-threatening ischemia after endovascular therapy
Authors: Sonoda T , Kanda D , Ikeda Y , Anzaki K , Arikawa R , Ohmure K , Tokushige A , Ohishi M
Published: October 2021

Background

Chronic limb-threatening ischemia (CLTI) is known to the most advanced form of severe arteriosclerosis in peripheral artery disease and cause poor prognosis. Whereas malnutrition (M), inflammation (I) and atherosclerosis (A) are reported to be involved in the pathophysiology of end-stage renal disease with close relevancy and affect its clinical outcomes, the effect of such MIA syndrome on the mortality in elderly patients with CLTI has not been well evaluated.

Purpose

The aim of the present study was to investigate the influence of patient characteristics including MIA syndrome on the mortality in elderly CLTI patients <3 years after endovascular therapy (EVT).

Methods

The subject was 222 consecutive elderly (≥65 year) CLTI patients who were admitted to undergo endovascular therapy (EVT). We assessed nutritional status using Geriatric Nutritional Risk Index (GNRI) in this study, and defined patients with GNRI <92 at admission as malnutrition. We also assessed inflammatory status using hs-CRP. The patients were divided into four groups based on their nutrition and inflammatory status as follows; Group A; GNRI <92+hs-CRP ≥1 mg/dL, Group B; GNRI <92+hs-CRP <1 mg/dL, Group C; GNRI >92+hs-CRP ≥1 mg/dL, Group D; GNRI >92+hs-CRP <1 mg/dL. Patients in the group A were considered to be under MIA syndrome. We evaluated which Group affected prognosis of elderly CLTI patients after endovascular therapy (EVT).

Results

All-cause death after EVT were 37 cases (17%). In this study, all patients underwent successful EVT for target lesions. As a result of cox proportional hazards analysis, all-cause death was associated with MIA syndrome [hazard ratio (HR): 2.41, 95% confidence interval (CI): 1.13–5.17, p<0.001)], Clinical Fraility Scale (HR: 1.46, 95% CI: 1.127–1.93, p=0.005), and history of stroke (HR: 2.32, 95% CI: 1.11–4.86, p=0.026) in the univariate analysis. Multivariate cox proportional hazards analysis models after adjusted for the demographic characteristics of patients and clinically relevant factors for all-cause death after EVT revealed that MIA syndrome and history of stroke were independent risk factors (HR: 3.94, 95% CI: 1.34–11.63, p=0.013, HR: 3.06, 95% CI: 1.14–8.18, p=0.026,). Kaplan Meier analysis also elucidated that survival rate was significantly lower in Group A compared to those in other Groups (p=0.0131). Furthermore, cox proportional hazards models using each Group A to D revealed that only Group A was associated with all-cause death (Group A: HR 2.41, 95% CI: 1.13–5.17, p=0.024, Group B: HR 1.01, 95% CI: 0.41–2.46, p=0.976, Group C: HR 1.01, 95% CI: 0.35–2.88, p=0.987, Group D: HR 0.57, 95% CI: 0.30–1.13, p=0.109).

Conclusions

MIA syndrome was a strong predictor for incidence of all-cause death in elderly CLTI patients after EVT.

Funding Acknowledgement

Type of funding sources: None.
Incidence of myocardial infarction, heart failure, and cardiovascular mortality in patients with peripheral artery disease: nationwide trends between 1997 and 2016
Authors: Kamil S , Sehested T S G , Houlind K , Lassen J F , Gislason G , Dominguez H
Published: October 2021

Background

Over the past decades there has been a shift in cardiovascular (CV) risk factors with improved outcomes. Updated trends in incidence of myocardial infarction (MI) and heart failure (HF) in peripheral artery disease (PAD) are warranted.

Purpose

We aimed to investigate trends in the incidence of MI, HF, and CV mortality in PAD patients during the past two decades.

Methods

Nationwide registers were used to identify all patients aged ≥18 years, with first-time diagnosis of PAD between 1997 and 2016. Age-standardized incidence rates per 1,000 person-years (IR) were calculated to estimate trends of MI, HF, and CV mortality. Furthermore, risk of MI, HF, and CV mortality was estimated by 1-year cumulative-incidence with death as competing risk.

Results

A total of 136,746 patients with first-time diagnosis of PAD were included. Mean age was 70.01 [IQR 61–77 years], and 53.05% of the identified patients were male. The 1-year cumulative-incidence of MI in patients with PAD were 1.88% for year 1997–2000, 2.12% for year 2001–2005, 1.59% for year 2006–2010, and 1.32% for year 2011–2016, respectively. The 1-year cumulative-incidence of HF in patients with PAD were 1.71%, 1.48%, 1.25%, and 1.11% for the 1997–2000, 2001–2005, 2006–2010, and 2011–2016 year-groups, respectively. Furthermore the 1-year cumulative-incidence of CV mortality in patients with PAD were 12.0%, 9.41%, 8.75%, and 7.80% for the 1997–2000, 2001–2005, 2006–2010, and 2011–2016 year-groups, respectively. Likewise, the age-standardized incidence rates pr. 1,000 person-years showed increasing trends of MI up until 2002 with an estimated annual percent change (APC) of +0.6 (95% CI 3.3–16.1, p-value 0.2). After year 2002 the IR decreased significantly with an estimated APC of −5.0 (95% CI 3.7–6.3, p<0.0001). The age-standardized IR for HF decreased with an estimated APC of −3.3 (95% CI 2.0–4.6, p<0.0001), and similarly for CV death decreased by −3.5 (95% CI 3.0–4.0, p<0.0001).

Conclusion

The incidence of MI and HF in patients with PAD has significantly decreased over time together with a subsequent decline in CV mortality. This may suggest that the improvements in preventive strategies aimed at reducing CV risk are effective and contributes to lower incidence of MI and HF and thereby improved mortality rates in the past two decades.

Funding Acknowledgement

Type of funding sources: None.
The learning curve for interventional cardiologists performing acute stroke interventions
Authors: Piayda K , Hornung M , Grunwald I , Sievert K , Bertog S , Sievert H
Published: October 2021

Background

Endovascular treatment for acute stroke because of large vessel occlusion became the standard of care in certain clinical settings. Due to lack of trainees and specialized centers, interventional cardiologists joined multidisciplinary stroke teams, and contribute their extensive knowledge on acute cardiovascular interventions and catheter skills to optimize patient management and outcomes.

Purpose

To investigate if a learning curve exists for interventional cardiologists performing acute stroke interventions.

Methods

Consecutive patients undergoing acute endovascular stroke treatment from 07/2012 – 10/2020 at our center were reviewed. The interventional approach, lesion preparation and material selection were at the discretion of the performing cardiologist. Baseline characteristics, procedural information and in-hospital outcomes were retrospectively collected. Cases were chronologically sorted, divided into quartiles and outcomes were compared.

Results

One-hundred-thirteen patients underwent endovascular procedures for acute stroke treatment. Patients were 72.9 SD 13.3 years old, and 51.5% were female. NIHSS at baseline was 15 [12–18]. In 92% the blood flow of the anterior circulation was affected. The door to needle (DTN) time decreased over time (Q1 1:19h [range0:54–1:58] vs. Q2 0:49h [range 0:34–1:32] vs. Q3 1:13h [range 0:56–1:31] vs. Q4 0:54 [range 0:37–1:08], p=0.003), as well as the procedure duration (time of vascular access to (full) reperfusion Q1 1:24h [range 0:44–2:23] vs. Q2 0:52h [range 0:32–1:16] vs. Q3 0:49h [range 0:27–1:15] vs. 0:44h [range 0:28–1:17], p=0.014) and the use of contrast medium (Q1 103.3mL [range 75.1–147.7] vs. Q2 123.5mL [range 60.5–149.9] vs. Q3 99.8mL [range 73–132] vs. Q4 74.8 mL [range 52.4–94.6], p=0.014). A stent retriever only strategy was preferred in the early stages (Q1 42.8% vs. Q2 53.5% vs. Q3 32.1% vs. Q4 17.2%. p=0.010), whereas a stent retriever plus aspiration strategy (Q1 17.8% vs. Q2 14.2% vs. Q3 28.5% vs. Q4 50%, p=0.122) became more popular later on. The combined quality endpoint comprising of TICI IIb/III flow after the procedure, no embolization to new territories and no symptomatic intracranial bleeding was reached 84%, with no difference between groups. Vascular access site complications were low (overall 3.5%) and NIHSS prior to discharge was comparable (Q1 3 [range 1.75–7.25] vs. Q2 4.5 [range 1.75–8.25] vs. Q3 5 [range 2–8] vs. Q4 4 [range 2–7], p=0.725). In-hospital death occurred in 21 (18.5%) patients.

Conclusions

A learning curve for interventional cardiologist performing acute stroke interventions could be observed in terms of optimized management strategies such as a reduced door to needle time and procedural aspects, like decreased procedure duration and contrast medium use over time. However, the quality of care was unaffected and continuously high.

Funding Acknowledgement

Type of funding sources: None.
Risk stratification for ischemic stroke and major bleeding in patients without atrial fibrillation – application of CHA2DS2-VASc and HAS-BLED scores
Authors: Nakano M , Kondo Y , Nakano M , Kajiyama T , Ito R , Takahira H , Kitagawa M , Sugawara M , Chiba T , Kobatashi Y
Published: October 2021

Background

Atrial fibrillation (AF) is the most common arrhythmia. AF-related stroke tends to be more severe, and the mortality rate is higher compared with stroke without AF. Recent cardiac implantable electronic devices (CIEDs) have led to an improvement in the early detection of AF episodes. Previous studies showed that AF episodes detected by CIEDs are associated with ischemic stroke. However, little is known about the relationship between new-onset AF and ischemic stroke events in Japanese patients with CIEDs who have no prior AF and take no anticoagulant therapy. ESC guidelines for the management of AF recommend the use of CHA2DS2-VASc score as class I to predict the risk of ischemic stroke in patients with AF. However, the validity of the CHA2DS2-VASc and HAS-BLED scores to predict ischemic stroke and major bleeding events in patients without AF remains unclear.

Objective

The purpose of this study was to identify the incidence of ischemic stroke and major bleeding events in CIEDs patients without AF and assess the validity of CHA2DS2-VASc and HAS-BLED scores in this population.

Methods

We retrospectively analyzed the database of our CIEDs clinic. Every 6 months, CIEDs were checked using remote monitoring system. We examined the characteristics and incidence of ischemic stroke and bleeding events. In addition, we investigated the relationship between CHA2DS2-VASc and HAS-BLED scores and the incidence of these events.

Results

We enrolled 620 consecutive patients who were followed up at our CIED clinic. We excluded patients who had a history of AF or had received anticoagulant therapies, 348 patients (follow-up period, 65±58 months; age, 70±16 years; male sex; 64%; defibrillator, 55%) were included in this study. The mean CHA2DS2-VASc and HAS-BLED scores were 2.8±1.5 points and 1.7±1.6 points, respectively. During the follow-up, 23 (6.6%) and 12 (3.4%) of 348 patients had ischemic stroke and major bleeding events, respectively. The incidence of ischemic stroke and major bleeding events stratified by the CHA2DS2-VASc and HAS-BLED scores were shown in Figure 1.

Conclusion

The risk stratification for ischemic stroke and major bleeding using the CHA2DS2-VASc and HAS-BLED scores is valid in patients without AF.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Clinical impact of intravascular ultrasound guidance in patients of ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug eluting stent
Authors: Kim B J , Park J I , Nam J H , Lee J H , Lee C H , Son J W , Park J S , Shin D G , Kim U , Her S H , Chang K Y , Ahn T H , Jeong M H , Rha S W , Kim H S ,   KAMIR-NIH registry investigators
Published: October 2021

Background

There is little data about clinical role of intravascular ultrasound (IVUS)-guided Percutaneous (PCI) in the setting of ST-segment elevation myocardial infarction (STEMI).

Methods

From 2005 to 2018, a total of 8,129 patients who underwent PCI with STEMI were investigated from the Korea Acute Myocardial Infarction Registry-National Institute of Health database. Patients with Non-ST segment elevation myocardial infarction, cardiogenic shock, bare metal stent implantation, thrombolytic treatment, and coronary artery bypass graft surgery were excluded. We categorized patients into two groups based on the treatment strategy: IVUS-guided PCI group (n=1,544), and coronary angiography guidance (CAG)-guided PCI group (n=6,585). The primary endpoint was composite of major adverse cardiovascular (MACE), including, cardiac death, myocardial infarction (MI), repeat target vessel revascularization (TVR) and stent thrombosis (ST).

Results

IVUS-guided PCI was performed in 19% patients (1544/8129). After propensity score matching, there were no statistically difference in the rate of cardiac death (0% in IVUS vs. 0.26% in CAG, p=0.947), MI (2.01% vs. 2.01%, p=0.408), TVR (1.23% vs. 0.91%, p=0.131), ST (0.32% vs. 0.45%, p=0.828) and composite of MACE at 1 year between two groups (2.01% vs. 2.40%, p=0.843). Independent risk factors for MACE were diabetes mellitus and multi-vessel disease, but not IVUS-guided PCI (HR 1.167, 95% CI, 0.896–1.520, p=0.251).

Conclusion

This study suggests that routine usage of IVUS in the setting of STEMI may not be necessary. Large-scaled random study will be needed for further evaluation.

Funding Acknowledgement

Type of funding sources: None.
Simultaneous intracoronary testing for endothelial dysfunction and coronary vasospasm in patient with angina and non-obstructive coronary artery disease
Authors: Feenstra R G T , Boerhout C K M , Woudstra J , Vink C E M , De Waard G A , Appelman Y , Eringa E C , Marques K M J , De Winter R J , Van De Hoef T P , Beijk M A M , Piek J J
Published: October 2021

Introduction

Currently, two different theories exist on testing for coronary functional disorders in patients with angina and no obstructive coronary artery disease (ANOCA) where either invasive testing for endothelial function or coronary spasm provocation is performed. In this study we aim to assess the concomitant occurrence of both conditions in a cohort of patients with ANOCA undergoing both endothelial function testing and spasm provocation.

Methods

In this retrospective study, we included 114 patients that have undergone invasive coronary vasomotor function testing for coronary endothelial function and coronary artery spasm provocation. Endothelial dysfunction was defined as a <50% increase in coronary blood flow and/or epicardial coronary diameter reduction compared to baseline in reaction coronary acetylcholine concentrations up to 10–6 mol/L. Coronary artery spasm (CAS), defined as VSA and/or MVA due to microvascular spasm, was defined according to the COVADIS criteria in reaction to coronary acetylcholine concentration up to 10–5 mol/L.

Results

Among the 114 patients, 90 (78%) could be diagnosed with endothelial dysfunction and 71 (62%) with CAS. In most patients, 60 (54%), endothelial dysfunction and CAS can be diagnosed concurrently, whereas only 30 had endothelial dysfunction without CAS and 11 patients had CAS with a normal endothelial function.

Conclusion

In this cohort of ANOCA patients undergoing testing for coronary endothelial function and spasm provocation a large overlap of concurrent endothelial dysfunction and spasm provocation was found. These findings suggest a role for simultaneous endothelial function testing and spasm provocation in coronary vasomotor function protocols in order to adequately identify endotypes of ANOCA.

Funding Acknowledgement

Type of funding sources: None.
LGE-cMRI assessment of volume controlled reperfusion method in primary percutaneous coronary intervention in patients with ST elevated myocardial infarction
Authors: He J , Yang X C , Wang L F ,   VCR
Published: October 2021

Objectives

We create a procedure based on postconditioning and gradual reperfusion, “Volume Controlled Reperfusion Revascularization” method (VCR)in primary percutaneous coronary intervention. The aim of this experimental study is to assess feasibility and effect of VCR and if this method will attenuate reperfusion injury in microvascular obstruction.

Methods

VCR method, Basically, contemporaneous forward blood flow balloon inflation blocking at the occlusion site and prolonged distal reperfusion via aspiration catheter. Active NC balloon inflation at occlusion site, while keeping NC balloon inflation, aspiration catheter was positioned 10–15mm advanced of NC balloon, intra-aspiration catheter infusion of mixture solution (artery blood 10ml+ heparin NS 10ml), 20ml/min for 10mins, adjust volume and speed according to blood pressure and heart rate variation. Stent or DCB as usual. After several successful operation on RCA, 10 patients with acute ST-segment elevation myocardial infarction (STEMI)with angiography confirmed proximal complete occlusion on dominant blood vessel were non-randomly enrolled (symptom to angiography <12h). 5 cases in VCR group with volume-controlled reperfusion revascularization method, 5 cases in control group with conventional PCI method. Microvascular obstruction (MVO) has been calculated by late gadolinium-enhanced cardiovascular magnetic resonance (LGE-cMRI). Base line information, angiographic features before and after procedure, in-hospital status and MVO were compared.

Results

Successful PCI procedure, safe in-hospital treatment and LGE-cMRI assessment for MVO. Group difference were found in age group and PCI to MRI interval (53.8±7.6 vs 70.2±4.44, P=0.0031; 7.4±2.3 vs 10.4±1.67, P=0.046) between VCR and control group, respectively. There was no statistic difference in other base line information, peak myocardial enzyme, and BNP. MVO and MVO mass ratio was significantly lower in VCR group (0.78±0.96 vs 2.80±1.37, P=0.0317; 0.00585±0.00080 vs 0.02493±0.01501, P=0.0372). TIMI III blood flow found in VCR group. Re-myocardial infraction nor target vessel revascularization was documented in-hospital or 30-days follow up.

Conclusion

Among the selected small sample cases, volume-controlled reperfusion method procedure was clinical safe and feasible without additional side effect. TIMI III blood flow and less MVO were documented.

Funding Acknowledgement

Type of funding sources: None. LGE-cMRI results in VCR and controlCase illustration of VCR procedure
Outcomes after percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (cabg)
Authors: Cohen N S , Dinh D , Ajani A , Clark D , Brennan A , Nan Tie E , Dagan M , Hamilton G , Sebastian M , Shaw J , Oqueli E , Freeman M , Reid C , Stub D , Duffy S J
Published: October 2021

Background

In patients with prior CABG requiring subsequent PCI there is uncertainty whether bypass grafts or native coronary arteries should be targeted.

Methods

We analysed data from 2,764 patients with prior CABG in the Melbourne Interventional Group registry (2005–2018), divided into two groups: those undergoing PCI to a native vessel (n=1,928) and those with PCI to a graft vessel (n=836).

Results

Patients with a graft vessel PCI were older, had more high-risk clinical characteristics (prior MI, heart failure, ejection fraction <50%, renal impairment, peripheral and cerebrovascular disease), and high-risk procedural features (ACC/AHA types B2/C lesions). However, patients in the native vessel group were more likely to have PCI to a chronic total occlusion. The majority of graft PCI were to saphenous vein grafts (84%), with 10% to radial and 6% to LIMA/RIMA grafts. Distal embolic protection devices were used in 30% of graft PCI. Patients with graft PCI had higher rates of no reflow (6.3% vs. 1.5%; p<0.001), coronary perforation (p=0.016) and inpatient stent thrombosis (p=0.028). However, 30-day mortality and major adverse cardiovascular and cerebrovascular events (MACCE) were similar. Unadjusted long-term mortality (median follow up 4.8 years) was higher in patients who had undergone a graft PCI (44% vs. 32%, p<0.001), but following Cox proportional hazards modelling, PCI vessel type was not a predictor of long-term mortality (HR 1.13; 95% CI 0.96–1.33, p=0.14).

Conclusions

Early clinical outcomes and risk-adjusted long-term mortality are similar for patients with prior CABG undergoing PCI to a native vessel or a bypass graft.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): The Alfred Hospital
Impact of COVID-19 lockdowns on STEMI percutaneous interventions
Authors: Zlochiver V , Perez Moreno A C , Hall J , Hommeida M , Allaqaband S Q , Bajwa T , Jan M F
Published: October 2021

Background

Measures taken to mitigate the spread of coronavirus disease 2019 (COVID-19) have been correlated to a decline in the number of patients seeking medical care for emergency cardiovascular illness. Here we evaluate the impact of a state-wide lockdown on ST-elevation myocardial infarction (STEMI) care.

Purpose

The purpose of this study is to help understand the impact of COVID-related lockdowns on STEMI interventions.

Methods

All consecutive adult patients admitted with an acute STEMI diagnosis and percutaneous intervention (PCI) performed between January 17, 2020, and July 14, 2020, at five sites across our health care network, were included in this study. Patient demographics, medical history and procedure details were collected retrospectively from electronic medical records. Data were segregated according to date into pre-lockdown, lockdown (March 17 to May 13, 2020) and post-lockdown groups.

Results

A total of 225 patients formed the study cohort. Median age was 62 (IQR: 53–71) years. Patients were predominantly male (n=154, 68%), white (n=208, 92%), hypertensive (n=139, 61%) and dyslipidemic (n=135, 60%). The average weekly rate of STEMI PCIs performed pre-lockdown decreased by 40% during the lockdown from 10.9 to 6.5 PCIs per week (p<0.05). Door-to-balloon (D2B) times increased from 42 (IQR: 28–68) min pre-lockdown to 53 (IQR: 40–72) min during the lockdown (p=0.01). No significant differences were observed in in-hospital mortality or cardiac troponin measurements within 24 h of procedure between the three groups.

Conclusion

Adverse effects of COVID-19-related lockdowns on acute STEMI care include a decrease in PCI volumes and prolonged D2B times. Our results provide valuable data-driven criteria to help inform patient decisions to seek care and to find ways to protect healthcare workers without compromising timely critical intervention.

Funding Acknowledgement

Type of funding sources: None.
Comparative analysis of sequential pot-side-pot and kissing balloon techniques in patients with coronary bifurcation lesions treated with single stent strategy: propensity score analysis
Authors: Cetinkal G , Balaban Kocas B , Keskin K , Kilci H , Ser O , Yildiz S S , Sigirci S , Gurdal A , Sumerkan M C , Kilickesmez K
Published: October 2021

Objectives

It is unknown whether the novel re-POT technique is more effective than commonly preferred kissing balloon inflation (KBI) in patients with non-complex coronary bifurcation lesions (CBL) treated with single-stent strategy. Our aim was to compare the efficacy of re-POT and KBI techniques in one-stent strategy of non-complex CBL.

Methods

283 patients were retrospectively analyzed (re-POT group, n=149; KBI group, n=134). Primary end-points of the study were defined as; in-hospital and 30-day mortality, contrast induced acute kidney injury (CI-AKI), stent thrombosis (ST), side branch (SB) dissection and need for SB stenting. Characteristics of patients at baseline were balanced by using propensity score inverse probability weighting (IPW).

Results

Procedure time (minute, 30.6±8.5 vs 34.3±11.6; p=0.003) and contrast volume (mL, 153.7±42.4 vs 171.1±58.2; p=0.004) were significantly lower in re-POT group. Besides, SB residual stenosis and number of patients with >50% SB residual stenosis remained significantly higher in re-POT group both in general and true bifurcation subgroup analysis (20.3±19.8% vs 16.5±16.4%, p=0.02; 11.9% vs 5.7%, p=0.01 and 24.1±23.2% vs 18.8±18.7%, p=0.03; 17.6% vs 6.6%, p=0.005; respectively). Combined clinical adverse outcomes were similar between groups. (Figure 1) SB dissection (10.2% vs 20.1%, p=0.001) and need for SB stenting (12.6% vs 19%, p=0.04) were reached statistically significance in KBI group after adjustment. (Figure 2)

Conclusions

Re-POT may be a simple and safe technique with a shorter procedure time and lower incidence of adverse events in non-complex CBL treated with single-stent strategy.

Funding Acknowledgement

Type of funding sources: None. Adverse clinical outcomes; weighted
Use of sirolimus-coated balloon in de novo lesions; Mid-term follow-up from a single-centre registry
Authors: Loku Waduge B H , Kalkat H , Saif A , Fawzy A M , Athulorala S , Bhatia G , Kumar N , Freestone B , Ment J , Lee K , Pitt M , Pulikal G , Basavarajaiah S
Published: October 2021

Introduction

Use of drug coated balloons (DCBs) in coronary intervention is escalating and the guidelines recommend its use in restenotic lesions. However, recent data suggest it can also be considered in a subset of denovo lesions especially; small vessels, ostium of an important side-branch and in patients unable to tolerate dual antiplatelet therapy for a prolonged period. Most DCBs used elute Paclitaxcel, but there is no data on Sirolimus eluting DCB, which is the drug of choice in currently available drug eluting stents. In this study, we report outcomes from the use of a Sirolimus coated balloon (SCB) in de novo coronary lesions.

Methods

We retrospectively analysed all patients treated with an SCB between April and December 2018. Results are reported as cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularisation (TLR), target vessel revascularisation (TVR) and MACE (combination of cardiac death, target vessel MI and TLR).

Results

During the study period, 351 patients (with 414 lesions) with de novo lesions were treated with an SCB. The mean age of patients was 65.6±11.5 years, 275 (78%) were male and 39% (n=212) had diabetes. Most lesions treated were in the LAD/diagonal system (n=173, 42%). Predilatation was performed in 98% (405 lesions). Bailout stenting (with a drug eluting stent) was required in 7% lesions (n=30), of which 11 were due to dissections and 19 were due to recoil >50% following DCB use. The mean diameter and length of DCBs were 2.47 mm and 26 mm respectively.

During a median follow-up of 322-days (11-months) cardiac death was reported in 8 patients (2.3%). Target vessel MI was in 3%; n=10, TLR and TVR per lesion were 8% (n=34) and 9% (n=37) respectively. The MACE rate was 11%. There were no documented cases of acute vessel closure.

Conclusion

The mid-term outcome from the first ever study on sirolimus coated balloons in de novo lesions appears promising with low rates of hard endpoints with no documented cases of acute vessel closure. The MACE rates appear promising, although we need longer follow-up which is ongoing and we will be able to report outcomes from even longer follow-up during the presentation.

Funding Acknowledgement

Type of funding sources: None.
Urgent vs non-urgent transcatheter aortic valve implantation outcomes
Authors: Castelo A , Grazina A , Mendonca T , Rodrigues I , Garcia Bras P , Vaz Ferreira V , Ramos R , Fiarresga A , Cacela D , Cruz Ferreira R
Published: October 2021

Background

There are limited data about the outcomes of non-elective transcatheter aortic valve implantation (TAVI), but some studies suggest that these patients have worst results.

Purpose

To compare outcomes in patients submitted to urgent versus elective TAVI.

Methods

Retrospective analysis of consecutive patients (P) submitted to TAVI between 2018 and 2020 in a tertiary center. Baseline characteristics and outcomes after the procedure were collected. Urgent TAVIwas considered when patients were not electively admitted for the procedure but required the intervention on the current admission for medical reasons and could not be sent home without a definitive procedure.

Results

A total of 208P (55,3% female) were included, with a mean age of 82±7 years. Patients submitted to urgent TAVI (57P, 27,4%) had worse baseline characteristics, with higher EuroScore risk (10,7% vs 5,4%, p<0,001), STS score (7,3% vs 4,4%, p<0,001), and natriuretic peptide B (1350 vs 728 pg/mL, p=0,021), lower left ventricle ejection fraction (44% vs 50%, p<0,001), more diabetes (49,1% vs 33,1%, p=0,033), peripheral artery disease (22,8% vs 4,6%, p<0,001) and worse accesses (21,2% vs 5%, p=0,002). In univariable analysis, urgent TAVI was associated with higher intra-hospital mortality (14% vs 4%, p=0,01), 30-days mortality (17,5% vs 4%, p=0,001) and 30-days cardiovascular mortality (17,5% vs 3,3%, p<0,001), life- threatening bleeding (17,9% vs 4%, p=0,001), acute kidney injury (16,1% vs 4,7%, p=0,007), vascular complications (16,1 vs 4%, p=0,003) and longer hospital and intensive care unit stay (30 vs 12 days, p<0,001 and 6 vs 4 days, p=0,025 respectively), but not with post-TAVI hospital stay (12 vs 10 days, p=0,37). When adjusted to the differences in baseline characteristics, in a multivariable analysis, urgent TAVI was only associated with longer hospital stay (p<0,0001). There were no differences in outcomes between groups beyond the first 30 days after the procedure, including mortality and hospital admissions.

Conclusion

Patients submitted to urgent TAVI tend to have worse short-term outcomes, but this seems to be attributable to the worse baseline characteristics of these cases instead of the urgent nature of the procedure. Even with the adjustment for baseline differences, these patients have longer global hospital stays, but they don't have latter post-TAVI discharge.

Funding Acknowledgement

Type of funding sources: None.
Periprocedural and short-term stroke after transcatheter aortic valve implantation – what are the outcomes and how can we predict it
Authors: Castelo A , Grazina A , Mendonca T , Rodrigues I , Vaz Ferreira V , Garcia Bras P , Ramos R , Fiarresga A , Cacela D , Cruz Ferreira R
Published: October 2021

Background

Stroke is a known complication after transcatheter aortic valve implantation (TAVI). Although risk factors for its occurrence are being suggested, we still don't have clear tools to predict which patients will most probably have it and how to prevent it.

Purpose

To identify possible clinical and procedural predictors of early post-TAVI stroke.

Methods

Retrospective analysis of consecutive patients (P) submitted to TAVI between 2009 and 2020 in a tertiary center. Baseline characteristics, procedural information and stroke in first 30 days after TAVIwere collected.

Results

A total of 494P (56,1% female) were included, with a mean age of 82±6 years (minimum 45 and maximum 95 years- old). The majority (98,4%) had at least one cardiovascular risk factor (83,2% hypertension, 67,6% dyslipidemia, 64% excess weight, 36,8% diabetes, 11,9% smoking). Half patients had chronic kidney disease, 34,8% atrial fibrillation, 16,4% peripheral artery disease, 15,4% porcelain aorta, and 12,3% a previous stroke. The procedure was done via transfemoral access in 460P (93,1%), subclavian artery in 16P (3,2%), transcava in 10P (2%) and transaortic in 7P (1,4%). Aortic valve pre-dilation was done in 35,6% and post-dilation in 31,2%. In the first 30 days after TAVI 19P (3,8%) had a stroke (11P with a major and 8P with a minor stroke). Patients with stroke had more hypertension (100% vs 82,4%, p=0.045), higher BMI (29 vs 27, p=0.039) and more frequently porcelain aorta (36,8% vs 15,5%, p=0,014). They also tended to have more peripheral artery disease (31,6% vs 15,7%, p=0,066). There weren't other differences in baseline characteristics between the two groups. Considering the aspects related to the procedure, post-dilation was the only predictor of events (58,8% vs 32%, p=0,021). In a multivariable analysis including clinical and procedural predictors, porcelain aorta (p=0,048, OR = 2,895) and post-dilation (p=0,042, OR = 2,844) were the independent predictors. Stroke after TAVI was associated with longer hospital stay (36 vs 15days, p<0,001) and intensive care unit stay (12 vs 3 days, p<0,001), higher intra-hospital mortality (14,8% vs 3,2%, p=0,002), global 30-day mortality (12,1% vs 3,3%, p=0,0011) and cardiovascular 30-day mortality (11,5% vs 3,4%, p=0,038).

Conclusion

Periprocedural and 30-day stroke is a relatively uncommon but potentially devastating complication after TAVI. There are clinical and procedural characteristics that are associated with a higher risk and should be considered when selecting patients for treatment and strategies to prevent events.

Funding Acknowledgement

Type of funding sources: None.
Effects of a diuretic regimen on body weight and echocardiographic parameters of the tricuspid valve in patients scheduled for transcatheter tricuspid annuloplasty
Authors: Landendinger M , Haug J , Achenbach S , Arnold M B
Published: October 2021

Background

Echocardiographic severity of tricuspid regurgitation is known to be highly variable and strongly related to the volume status of the individual patient. Interventional therapies for tricuspid valve repair or replacement are dependent on reliable measurements in order to select the appropriate device size.

Purpose

In patients scheduled for transcatheter tricuspid valve annuloplasty, we sought to evaluate the effects of a diuretic regimen started at the screening visit on body weight and tricuspid valve dimensions at the time point of transcatheter intervention.

Methods

After successful screening for transcatheter tricuspid annuloplasty, an individualized intensified diuretic regimen was initiated in 15 patients. At baseline and at the timepoint of the intervention, body weight and 3D echocardiographic dimensions of the tricuspid valve were documented and compared.

Results

The cohort comprised 6 males and 9 females (mean age 77±7 years) with severe or higher degree functional tricuspid regurgitation. In all patients not more than mild pulmonary artery hypertension was present (PaP mean 29±5 mmHg). The interval between the screening visit and the timepoint of the procedure was 64±50 days. At baseline mean body weight was 72±12 kg. In 11 patients a reduction of the body weight could be achieved, with a median weight reduction of 2.2 kg (min/max 1.2/6.4 kg). Overall, the average relative reduction of the tricuspid annulur perimeter was 13% (p<0,001), of the tricuspid valve area 2.7% (n.s.), the anterseptal diameter 3.3% (n.s.), while the bicommissural diameter remained almost unchanged (0.4%; n.s.). The average predicted required band length changed by only 1.5% (n.s.). The strongest correlations were found between the absolute change in body weight and the change of the tricuspid valve area (r=0.48), relative change in body weight and relative change of tricuspid valve area (r=0.52), absolute change in body weight and absolute change in predicted band length (r=0.48), and relative changes of the respective variables (r=0.52). More importantly, in 13 out of 15 patients the band size which would have been selected was identical between the screening and the annuloplasty procedure. Only in two patients a smaller device was implanted than predicted at the screening visit.

Conclusion

Instituting a diuretic therapy in candidates for transcatheter tricuspid annuloplasty prior to the procedure helps to keep tricuspid valve dimensions in a stable range. Changes in body weight in patients with functional tricuspid regurgitation are correlated to changes of tricuspid valve dimensions.

Funding Acknowledgement

Type of funding sources: None.
Transcatheter aortic valve implantation outcomes compared between bicuspid aortic and tricuspid aortic valve stenosis: an updated systematic review and meta-analysis
Authors: Aedma S , Gupta R , Mahajan S , Mahajan P , Patel M , Malik A , Naik A , Mehta S , Patel N C
Published: October 2021

Background

TAVI has emerged as an attractive treatment modality based on promising recent trial data. Patients with BAV, a commonly encountered clinical condition have largely been excluded from a majority of trials.

Purpose

Elderly patients with BAV and severe AS are increasingly encountered in clinical practice. This meta-analysis compares clinical outcomes between bicuspid and tricuspid AV patients to address the current knowledge-gap and identify optimal management strategies of these patients.

Methods

A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify the available observational studies comparing outcomes of TAVI in BAV and TAV patients. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints.

Results

16 Observational studies met inclusion criteria, comprising 10,053 patients with BAV and 173,307 patients with TAV that underwent TAVI. No significant differences in 30-day and long-term mortality rates were observed. Patients with BAV had an increased risk of stroke (OR 1.23; 95% CI [1.06–1.44], p=0.007), re-intervention (OR 1.90; 95% CI [1.15–3.15], p=0.01), paravalvular leak (OR 1.42; 95% CI [1.25–1.61], p<0.ehab724.22251), conversion to open surgery (OR 1.93; 95% CI [1.21–3.07], p=0.006), and new pacemaker implantation (1.57; 95% CI (1.06 - 2.33, p=0.02). Adverse event rates are lower with the use of newer generation of valves. No significant difference in major vascular complications, major bleeding, or incidence of AKI was noted.

Conclusions

Complication rates for BAV TAVI are higher, but mortality is similar to TAV TAVI indicating TAVI is an appropriate alternative for intermediate-high risk patients with BAV. A better understanding of valve anatomy, physician expertise, the use of newer-generation valves can help reduce these complications.

Funding Acknowledgement

Type of funding sources: None.
Circulating microRNA-133a and its associations with left ventricular hypertrophy in men with arterial hypertension
Authors: Koval S , Yushko K , Snihurska I , Mysnychenko O
Published: October 2021

Introduction

Arterial hypertension (AH) is the most common cardiovascular (CV) diseases and one of the major a risk factor for CV complications and mortality. An important reason for the development and progression of a number of CV diseases are epigenetic factors regulating gene expression, which include microRNAs. MicroRNA-133a is one the epigenetics factor, which has cardioprotective properties, but its role in the development of left ventricular hypertrophy (LVH) in patients with AH, including men, is not well understood.

Purpose

The aim of the study was to investigate the circulating microRNA-133a levels, its associations with left ventricular (LV) parameters and LVH in men with AH.

Methods

In study was included 57 men with AH grades 2–3 aged 43 to 64. The main group consists of 32 patients with LVH and the comparison group consists of 25 patients without LVH. The main and the comparison groups were comparable in age and duration of hypertension. The control group consisted of 22 practically healthy men of comparable age. The LVH was determined according to the 2018 ESC/ESH guidelines. Circulating plasma microRNA-133a levels were obtained by polymerase chain reaction using the CFX96 Touch System, “TaqMan microRNA Assay” and “TaqMan® Universal PCR Master Mix” reagent kits.

Results

In men with AH (total group) the levels of microRNA-133a were significantly lower than in practically healthy men in the control group (0.212 [0.091; 0.364]) vs (0.402 [0.178; 0.513]), p<0.05). The levels of microRNA-133a in main group were significantly lower than in comparison group and control group (0.125 [0.078; 0.295] vs 0.276 [0.126; 0.397], p<0.05 and 0.402 [0.178; 0.513]), p<0.05). In the main group (men with AH and LVH) there was a statistically significant negative correlation between microRNA-133a levels and LV mass index (R=−0.42, p<0.01) with no significant correlation with ejection fraction or E/e' (averaged) ratio (p>0.05). In men with AH of the comparison group (without LVH) there were not significant associations of microRNA-133a levels with LV parameters (p>0.05).

Conclusion

The obtained results may indicate a significant role of decreased circulating plasma microRNA-133a levels in men with AH in the pathogenesis and development of the LVH.

Funding Acknowledgement

Type of funding sources: None.
Relationship between transient symptomatic hypotensive episodes and 24-hour blood pressure variability in patients with arterial hypertension
Authors: Ermasova S , Popov K , Shvarts Y
Published: October 2021

Purpose

Low blood pressure may be as harmful as high. Symptomatic hypotensive episodes should be a manifestation of circulatory disorders of hypertension – mediated organs especially among hypertensive patients. However, the association of such episodes with blood pressure variability is unknown.

Aim

To study the relationship between the symptomatic hypotensive episodes and the daily blood pressure variability according to the ambulatory blood pressure monitoring (ABPM) in patients with hypertension.

Materials and methods

106 patients aged between 40 and 65 years with hypertension were studied. A questionnaire developed by the authors was used to identify symptomatic hypotension. During the study all the subjects had ABPM. Daily blood pressure variability was defined as standard deviation.

Results

Among all patients, symptomatic hypotensive episodes were observed in 60.6%. Among patients without myocardial infarction or stroke in anamnesis - 52.4%, with ones - 75% participants (p=0.05). Among patient without myocardial infarction or stroke and with symptomatic hypotensive episodes, the high variability of daily systolic BP was observed in 36% of the subjects and averaged 14.3 mm Hg, in the absence of symptomatic hypotensive episodes, the variability of daily systolic BP was 16.3 mm Hg, with a variety of blood pressure exceeding the norm, 80% of the participants (p<0.05).

In case of stroke or myocardial infarction in anamnesis and the presence of symptomatic hypotensive episodes, the systolic BP variability of daytime (18.0 mm Hg) and nighttime (14.8 mm Hg) was the highest. The proportion of participants with daily systolic BP variability exceeding the norm was 78%. In the absence of symptomatic hypotensive episodes, the blood pressure variability indicators did not deviate from the norm (p<0.05).

Conclusion

Heart attack and/or stroke in anamnesis with symptomatic hypotensive episodes are associated with lower daily systolic BP variability (14.3 mm Hg) in comparison with patients without symptomatic hypotensive episodes (16.3 mm Hg). If there were stroke or myocardial infarction in anamnesis, patients with symptomatic hypotensive episodes have higher daily systolic BP variability (18.0 mm Hg) than without hypotensive episodes (14.5 mm Hg). Symptomatic hypotensive episodes are not unidirectionally associated with the variability of blood pressure, the character of the relationship is associated with the presence of heart attack and/or stroke diseases in anamnesis.

Funding Acknowledgement

Type of funding sources: None.