bluuebunny/crossref_metadata_2025 huggingface dataset:
P6405Potential for drug-drug interaction between vonoprazan and prasugrel on antiplatelet effect assessed by VerifyNow P2Y12 assay in patients with coronary artery disease
Authors: Koga S , Ikeda S , Akashi R , Yamagata Y , Yonekura T , Kawano H , Maemura K
Published: October 2019

Background

Vonoprazan is a potassium-competitive acid blocker increasingly used in Japan to prevent gastrointestinal bleeding in patients under dual antiplatelet therapy (DAPT) after coronary stents implantation. Since cytochrome P450 (CYP) 3A4 is involved in the primary metabolism of vonoprazan and prasugurel, there is a possibility that CYP-mediated drug-drug interaction between them can attenuate the antiplatelet function of prasugrel.

Purpose

The aim of this study was to investigate whether antiplatelet effect of prasugrel could be attenuated upon coadministration with vonoprazan compared to conventional proton pump inhibitors (PPIs).

Method

We evaluated 72 patients (57 males, 67±11 years) with coronary artery disease who were taking either vonoprazan (n=35) or PPIs (n=37) in combination with DAPT (aspirin and prasugrel) after drug-eluting stents implantation. PPIs included 21 esomeprazole, 8 lansoprazole, and 8 rabeprazole. Antiplatelet effects of prasugrel were assessed using VerifyNow P2Y12 assay. Primary measurements were P2Y12 reaction units (PRU) and P2Y12 percent inhibition. High on-treatment platelet reactivity (HPR) on prasugrel was defined as PRU >208. Administration period of vonoprazan or PPIs in combination with DAPT ≤7 days was defined as early administration period.

Results

Median administration period of vonoprazan or PPIs in combination with DAPT was 127 days. There were no significant differences in baseline clinical characteristics between patients with vonoprazan and PPIs. In the analysis for all subjects, patients with vonoprazan showed similar PRU (166±50 vs. 167±64, p=0.93) and percent inhibition (36±18 vs. 38±23, p=0.66) compared to those with PPIs. No significant differences were observed in the prevalence of HPR between patients with vonoprazan and PPIs (17 vs. 30%, p=0.27). In the analysis for patients in early administration period [vonoprazan (n=14) vs. PPIs (n=10)], there were no significant differences in PRU (166±47 vs. 186±82, p=0.45), percent inhibition (33±17 vs. 30±26, p=0.73), and prevalence of HPR (14 vs. 50%, p=0.085) between patients with vonoprazan and PPIs. In addition, the analysis for patients over early administration period [vonoprazan (n=21) vs. PPIs (n=27)] showed that PRU (166±55 vs. 160±57, p=0.73), percent inhibition (37±19 vs. 41±21, p=0.57), and prevalence of HPR (19 vs. 22%, p=1.00) were comparable between patients with vonoprazan and PPIs.

Conclusion

Compared to PPIs, vonoprazan did not exhibit significant inhibitory effects on the antiplatelet activity of prasugrel assessed by VerifyNow assay. These findings suggest that there are possibly no clinically harmful drug-drug interactions between vonoprazan and prasugrel.
P6409Ticagrelor and prasugrel versus clopidogrel in patients with acute coronary syndromes and chronic renal dysfunction: safety and efficacy
Authors: De Filippo O , D'Ascenzo F , Raposeiras-Roubin S , Peyracchia M , Gili S , Iannaccone M , Ariza-Sole A , Abu-Assi E , Liebetrau C , Manzano-Fernandez S , Montabone A , Henriques J P S , Quadri G , Giustetto C , Rinaldi M
Published: October 2019

Introduction

Safety and efficacy of prasugrel and ticagrelor in real-life ACS (Acute Coronary Syndrome) with renal dysfunction remain to be established.

Methods

Consecutive patients from RENAMI and BLEEMACS were stratified according to renal function and estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2). Myocardial infarction (MI) and BARC major bleedings (MB; BARC type 3 or 5) were the primary end-point. Independent impact of clopidogrel, prasugrel and ticagrelor were evaluated with Cox multivariate analysis.

Results

19255 patients were enrolled (mean eGFR: 90±39 ml/min/1.73m2). Patients with eGFR<60 mL/min/1.73m2, constituted the 12.9% of the population (2490 pts). After a mean follow up of 13±5 months, the global incidence of re-AMI was of 5.8% and 2.9% in patients with and in those without eGFR<60 mL/min/1.73m2 (p<0.0001) respectively. MB occurred in 5.7% and 3% (p<0.0001). At Cox multivariate analysis, clopidogrel compared to prasugrel and ticagrelor was associated with increased risk of MI both in those with eGFR>60 mL/min/1.73m2 (HR=3.3: 2.4–4.4, p<0.0001) as well as in patients with eGFR<60 mL/min/1.73m2 (HR=10.04: 3.1–32.3, p<0.0001). In contrast, both prasugrel (HR=0.07: 0.01–0.54, p=0.01) and Ticagrelor (HR=0.36: 0.16–0.81, p=0.01) were associated with decreased risk of MI in the latters. DAPT with ticagrelor or prasugrel did not increased risk of MB in patients with eGFR<60 mL/min/1.73m2, while in patients with eGFR>60 mL/min/1.73m2, ticagrelor was associated to a slightly higher risk of MB (HR=1.43: 1.09–1.89, p=0.009).

Conclusion

In ACS patients with eGFR<60 mL/min/1.73m2, prasugrel and ticagrelor are associated with lower risk of recurrent MI without significant increase in the risk of MB.
P6410Eligibility and preference of extended antithrombotic therapy for secondary prevention after an acute coronary syndrome
Authors: Candeias Faria D , Santos M , Roque D , Ferreira J , Beringuilho M , Augusto J
Published: October 2019

Background and purpose

Recent randomized controlled trials (RCTs) have evaluated the benefit of extended antithrombotic therapy in secondary prevention of Acute Coronary Syndromes (ACS). However, the numerous and strict enrollment criteria may limit the validity and reproducibility of the published results in clinical practice. We aimed to estimate the eligibility for participation in RCTs of a group of patients followed up for ACS.

Methods

We applied the enrollment criteria of 2 RCTs (PEGASUS [low-dose ticagrelor – 60mg twice daily] and COMPASS [low-dose rivaroxaban – 2.5mg twice daily) to 780patients with history of ACS.

Results

A total of 938 patients admitted for ACS during 30months. Mean age was 68.8±10.3 years, 70.4% (n=660) males. Baseline characteristics are summarised in Table 1. Median length of stay was 6.0 (IQR 3.0–11.0 days). In-hospital mortality was 7.9%. Mortality after discharge within 12 months was 9.7%. A total of 780 patients were screened for trial enrollment after 12 months of follow-up. The proportion of patients fulfilling the trial enrollment criteria were 32.1% for PEGASUS and 35.9% for COMPASS. 41.6% of patients were eligible for at least one RCT. The main reasons for ineligibility for RCTs were the presence of comorbidities for PEGASUS and bleeding risk for COMPASS (Figure 1). Patients not fulfilling enrollment criteria for any RCT (58.4%) were older (71.4±9.7 vs 65.2±10.2 years, p<0.0001), more likely to have worse renal function (CrCl 47.8±28.8 vs 73.9±21.2 ml/min/1.73m2, p<0.0001), less left ventricular ejection fraction (44.4±11.4 vs 51.9±7.5%, p<0.0001) and had longer length of stay (7 IQR 4–13 vs 5 IQR 3–8 days, p<0.0001). The main differences in eligible and ineligible patients in both RCTs are summarised in Table 2.

Baseline characteristics and differences

Conclusions

Patients enrolled in RCTs are only partly representative of the real world population with history of ACS, mainly due to the higher prevalence of comorbidities and bleeding risk factors in this population. It is uncertain if these patients still benefit from theses therapies as in the published RCTs.
P6429Epicardial adipose tissue is a robust measure of increased risk of myocardial infarction, a meta-analysis on over 6.600 patients
Authors: Hendricks S , Dykun I , Balcer B , Rassaf T , Mahabadi A A
Published: October 2019

Background

Epicardial adipose tissue surrounds the heart and the coronary arteries. Endocrine and paracrine activity is accredited to EAT. Studies descripted the association between increased EAT and traditional cardiovascular risk factors as well as coronary events. While computed tomography is the gold standard for the assessment of 3-dimensional EAT-volume, echocardiography based EAT thickness is an easy accessible alternative in particular in an emergency setting. So far, little is known, how quantification of EAT in patients presenting with chest pain could alter patient management.

Purpose

To perform a meta-analysis on existing studies, comparing EAT in patients with and without myocardial infarction, stratifying by imaging technique.

Methods

We performed a systematic search using the Pubmed, Cochrane, SCOPUS, and Web of Science databases for studies, describing EAT in patients with and without myocardial infarction. Manuscripts, published until 1st of October 2018, were included. We made our search specific and sensitive using Medical Subject Headings terms and free text and considered studies published in English language. Search terms used were “epicardial adipose tissue” or “pericardial adipose tissue” and “myocardial infarction”, “coronary events”, or “acute coronary syndrome”. For comparability, EAT measures were normalized to mean values for patients without myocardial infarction for each study separately. Random effect models were calculated. All analyses were performed using Review Manager 5.3.

Results

Overall, 6.641 patients (mean aged 58.9 years, 53% male) from 7 studies were included. Patients with myocardial infarction had 37% higher measures of EAT compared to patients without myocardial infarction (95% CI: 21–54%, Figure A). Comparing studies using echocardiography for assessment of EAT thickness with studies using computed tomography based EAT volume, similar relative differences in EAT with wide overlap of confidence intervals were observed (Echo measures: 40 [4–76]%, CT measures: 36 [16–57]%, Figure B and C). No relevant heterogeneity and inconsistency between groups was present in all analyses (detailed data not shown).

Figure 1

Conclusion

EAT is increased in patients with myocardial infarction. Our data suggests that quantification of EAT thickness using echocardiography distinguishes equally between patients with and without myocardial infarction as compared to 3-dimensional EAT volume from computed tomography. Therefore, it may be an easy accessible alternative in clinical settings. However, further studies are warranted to determine, whether quantification of EAT may lead to improved patient management.
P6438Trends of acute kidney injury following percutaneous coronary interventions
Authors: Karrthik A , Gad M , Bazarbashi N , Ahuja K , Kaur M , Sammour Y , Kapadia S , Abdallah M
Published: October 2019

Introduction

Acute kidney injury (AKI) is a significant in-hospital complication in patients undergoing percutaneous coronary interventions (PCI) and has been shown to be associated with poor outcomes. Prior studies have shown an upward trend of AKI post PCI which may be related to a multitude of factors. In this study, we aim to discern whether the recent changes in AKI definition, awareness of risk calculators, and preventive measures have been effective in changing the inclining trend.

Methods

Patients who underwent PCI during hospitalization were identified retrospectively in the Nationwide Readmission Database (NRD) from January 2010 to December 2014. All patients older than 18 years were included in the current study. Patient demographics and comorbidities were identified using appropriate ICD-9 codes. The primary outcome is the temporal trends of AKI following PCI and secondary outcomes are temporal trends in mortality, length of stay and hospitalization cost in patients with AKI. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages (%). All statistical tests were two-sided.

Results

Among the 2,712,473 patients who underwent PCI from 2010 to 2014, 162,286 (6%) patients developed AKI post PCI. Mean age was 69.22±12.34 years and 65% of them were males. The percentage of cases with AKI rose almost twofold from 2010 to 2014 (4.8% to 8.1%, p-value <0.005), despite the lack of a significant change in patient's demographics and comorbidities over the years. Among patients with a history of Chronic Kidney Disease (CKD) the incidence of AKI increased from 20.3% to 24.2%, and in patients without CKD history the incidence of AKI almost doubled (2.6% to 5.0%) from 2010 to 2014. There was a slight decrease in in-hospital mortality (9.4% to 8.8%) and median length of stay (7 days to 5 days), and a slight increase in the mean cost of hospitalization ($124,755.1 to $133,902.17) from 2010 to 2014.

AKI Incidence and mortality trend

Conclusion

This large cohort study shows a consistent uptrend of AKI in patients undergoing PCI from 2010 to 2014. Despite this, the mortality and length of stay are decreasing while the cost of hospitalization only slightly increased in patients with AKI. Thus, future drives to implement renal protective measures and advanced studies to identify new preventive therapies are needed to reduce the incidence of AKI post-PCI.
P6451Genetics of recent-onset dilated cardiomyopathy as a predictor of left ventricular reverse remodelling
Authors: Chaloupka A , Krejci J , Piherova L , Grochova I , Binova J , Stranecky V , Kmoch S , Spinarova L , Kubanek M
Published: October 2019

Background

Recent-onset dilated cardiomyopathy (RODCM) is a disease of heterogeneous aetiology including genetic, inflammatory, toxic and metabolic causes. Recognition of the genetic component could improve diagnostic management and risk stratification. Left ventricular reverse remodelling (LVRR) has been identified as a marker of favourable prognosis in RODCM.

Purpose

In this pilot study, we are first to assess the genetic background of RODCM in the Czech Republic by whole-exome sequencing and correlate genotype with LV reverse remodelling.

Methods

In this multi-centre prospective observational study, we enrolled 83 patients with RODCM and a history of symptoms of less than 6 months, for whole-exome sequencing. All patients underwent 12-month clinical and echocardiographic follow-up. LVRR was defined as an absolute increase in left ventricular ejec-tion fraction >10% accompanied by a relative decrease of left ventricular end-diastolic diameter >10% at 12 months.

Results

Whole-exome sequencing identified at least one disease-related variant in 45 patients (54%). As expected, the gene spectrum of identified variants in RODCM was quite wide comprising a total of 28 different genes, with the majority of truncating variants in titin gene which was found in 10 (12%) patients. LVRR occurred in 28 patients (34%), most often in carriers of isolated titin truncating variants, followed by individuals with a negative, or inconclusive results and carriers of other disease-related variants (56% vs. 42% vs. 19%, P 0.041).

Genotype and LVRR Exom negative or non conclusive Isolated titin truncating variant Other variant or combination P-value (n=38) (n=9) (n=36) 12 months ΔLVEF absolute (%) 16 (6–23) 15 (9–34) 6 (3–15) 0.036* 12 months ΔLVEF >10% (n=44; 53%) 24 (63%) 7 (78%) 13 (36%) 0.019* 12 months ΔLVEDD <−10% (n=34; 41%) 18 (47%) 6 (67%) 10 (28%) 0.058 LVRR – 12 months, ΔLVEF >10% and ΔLVEDD <−10% (n=28; 34%) 16 (42%) 5 (56%) 7 (19%) 0.041* n, number; ΔLVEF, change of left ventricular ejection fraction; ΔLVEDD, change of left ventricular end-diastolic diameter; LVRR, left ventricular reverse remodelling. *Statistically significant result.

Gene distribution in RODCM

Conclusion

A substantial proportion of RODCM cases has genetic background. Carriers of titin truncating variants are more likely to reach LVRR at 12 months, which could be seen as a positive prognostic marker of disease development. Genetic testing could contribute to better prognosis prediction and individualised treatment of patients with RODCM.

Acknowledgement/Funding

This study was supported by the research grant of the Ministry of Health, Czech Republic: MZ 15-27682A. All rights reserved.
P6454Antithrombotic therapy and cardiovascular events in patients with left ventricular thrombus
Authors: Lattuca B , Bouziri N , Portal J J , Zhou J , Zeitouni M , Kerneis M , Guedeney P , Legrand L , Hammoudi N , Isnard R , Pousset F , Collet J P , Vicaut E , Montalescot G , Silvain J
Published: October 2019

Background

Left Ventricular Thrombus (LVT) is associated with a high risk of thromboembolic complications such as stroke. Contemporary data are lacking on the management, prognosis and treatment of LVT, particularly with the emergence of the non-vitamin K antagonist anticoagulants (NOACs).

Purpose

To study the time and predictive factors associated with thrombus regression on treatment and its association with survival, embolic and bleeding complications.

Methods

From January 2011 to January 2018, a computerized case sensitive search of LVT was performed on 90 065 consecutive echocardiogram reports. All patients with a confirmed LVT were included in this analysis after imaging review by two independent experts. Repeated echocardiographic data, treatment management and clinical outcomes were collected during follow-up. Major adverse cardiac events (MACE), defined as the composite of death, ischemic stroke or transient ischemic attack (TIA), myocardial infarction (MI) or embolic peripheral artery occlusion were analyzed as well as major bleeding events (BARC ≥3) and the predictive factors and impact of LVT regression.

Results

We identified 174 patients with a suspected LVT of whom 159 had confirmed LVT on two different cardiac imaging exams. Ischemic cardiomyopathy was the main cause of LVT (n=125, 78.6%) including 56 (35.2%) patients with an acute ST segment elevation MI. The mean left ventricular ejection fraction was 31.9±12.5% with predominant (98.1%) apical location of the LVT.

Anticoagulation therapy was achieved with vitamin K antagonists, NOACs and parenteral heparins in 48.7%, 22.8% and 27.8% of patients, respectively. Concomitant antiplatelet therapy was prescribed in 67.9% of patients. Total LVT regression was reached in two third of patients (62.3%, n=99) within a median time of 103 [32–392] days. Independent predictors of total LVT regression were an ischemic cardiomyopathy (HR: 0.36 [0.19–0.70], p=0.002), a larger baseline thrombus area (HR=0.66 [0.45–0.96], p<0.031) and a prolonged anticoagulation therapy over 3 months (HR=0.11 [0.05–0.22], p<0.0001).

During a median follow-up of 632 [187–1126] days, MACE occurred in 59 (37.1%) patients with a 18.9% rate of mortality and 13.2% of major bleeding. Patients with a total LVT regression had a non-significant lower rate of MACE as compared with patients without total LVT regression (35.4% vs. 40.0%; HR=0.71 [0.42–1.21]; p=0.20), and a significant lower rate of mortality (15.2% vs. 25.0%; HR=0.48 [0.23–0.98]; p=0.039).

Occurence of mortality (A) and MACE (B)

Conclusions

The prognosis of LVT remains severe with a high risk of major cardiovascular event and mortality. Total LVT regression, mostly reached in 3 months, can be obtained with both vitamin K antagonists and NOACs and is associated with a better prognosis.
P6460The significance of syncope as a presenting symptom in patients with intermediate risk pulmonary embolism
Authors: Natanzon S S , Beigel R , Chernomordik F , Mazin I , Herscovici R , Goitein O , Ben-Zekry S , Grupper A , Matetzky S
Published: October 2019

Background

Intermediate risk pulmonary emboli patients are a challenging group with high risk of recurrent VTE, hemodynamic instability and mortality. A gap of knowledge has emerged regarding predictors of clinical deterioration. The prognostic role of syncope presentation is debatable. We thought to investigate the ability of syncope to predict in-hospital complications and the need of escalation therapy among intermediate risk PE patients admitted to the ICCU.

Methods

Consecutive cohort of all patients hospitalized with a diagnosis of PE, classified as intermediate risk and admitted to the intensive cardiac care unit at the Sheba medical center between the years 2008–2016. Primary outcome: MACE consisting of either one of or a combination of: mechanical ventilation, hemodynamic instability and need for inotropic support, Secondary reperfusion and in-hospital mortality. Secondary outcomes: Each of the individual components including major bleeding and renal failure

Results

213 intermediate risk PE patients were analyzed. 40 patients (19%) presented with syncope. Syncope patients had significant higher RV/LV ratio upon computed tomography (1.7±0.6 vs. 1.4±0.4, p=0.011). The presence of either moderate or severe RV dysfunction was more prevalent, without statistical significance (57.5% vs. 41%, p=0.076).

Syncope patients had higher prevalence of escalation therapy (28.9% vs 9.4%, p=0.003), as well as in the following individual secondary endpoints: mechanical ventilation (10% vs 1.8%, p=0.026), hemodynamic instability (17.9% vs 2.9%, p=0.02), bleeding rates (15% vs 2.4%, p=0.004), and increased need of inotropic support (10% vs 0.6%, p=0.005). There was no significant difference in the need for reperfusion therapy, both surgical (5% vs. 0.6%, p=0.093) and non- surgical (7.5% vs 6.4%, p=0.732), and in-hospital mortality (2.5% vs 0%, p=0.190).

Secondary Outcomes

Conclusion

The presence of syncope as a presenting symptom is associated with more complicated in-hospital clinical course. These patients warrant more aggressive monitoring and assessment for the need of escalation therapy.
P6498Linkage analysis of transvalvular flow patterns, histopathology and target gene expression in aortic valve disease
Authors: Gross T , Lindner D , Ojeda F M , Blankenberg S , Reichenspurner H , Westermann D , Girdauskas E
Published: October 2019

Objectives

Recent studies have shown that shear stress can alter the integrity and gene expression of the aortic wall. We aim to analyze the link between jet dynamic, histological alterations, and gene expression patterns of the proximal aorta in patients with aortic valve disease.

Methods

We prospectively identified a total of 139 consecutive patients who were referred for aortic valve replacement (AVR) from January 2012 through December 2015. All patients underwent pre-operative MRI assessment to determine the maximal shear stress area of the proximal aorta. Depending of the aorta diameter we subdivided our study population in three subgroup (i.e., patients with a diameter ≤40mm, 41–49mm and ≥50mm). Based on the MRI results, two aortic wall tissue samples were collected during surgery. One sample were acquired from an area of low wall shear stress (WSS) and the second from the area of maximal WSS. The samples were graded in seven histopathologic features.

For RNA isolation the tissue was disrupted using a Tissue Lyser II (Qiagen). For the gene expression analysis of h18S, hCCL2, hCOL1A1, hVCAM1, and hELN reverse transcription of RNA was carried out using the High-capacity cDNA kit (life-technologies,USA). Therefore, 125 ng total RNA from tissue samples were reversely transcribed into cDNA.

Results

Regardless of the aortic valve functional lesion (i.e., stenosis or regurgitation), the maximal area of WSS was in the major curvature of the proximal aorta (73%, n=102). We observed that in both tissue samples just the orientation of vascular smooth muscle cell was strongly related to the diameter of the ascending aorta (p=0.004 vs. p=0.0032). In the whole study population any significant correlation was found between maximal cross-sectional aortic diameter and genes expression. However, in the subgroup analysis we identified that the tissue samples who were exposed to higher wall shear stress and presented a diameter ≥50mm, showed a statically significant gene over-expresion of COL1A1 (p=0.041) and ELN (p=0.01). In the tissue samples with a low WSS we also identified a significant over-expression of CCL2 (p=0.005) and COL1A1 (p=0.01).

Conclusions

Tissue samples from the slow WSS area with a proximal aortic diameter ≥50mm presented elevated levels of inflammatory response genes (i.e, CCL2). On the other hand, samples that were exposed to higher WSS demonstrated more relation to changes in the architecture of the connective fibres (i.e., elastin and collagen).

Acknowledgement/Funding

None
P6506Circulating microparticles preceding endothelial dysfunction and inflammatory process in patients with pseudoexfoliative glaucoma
Authors: Oikonomou E , Bourouki E , Moschos M , Siasos G , Siasou G , Gouliopoulos N , Paraskevopoulos T H , Papageorgiou N , Miliou A , Zacharia E , Mistakidi C V , Tousoulis D
Published: October 2019

Background

Pseudoexfoliative glaucoma (PEX) is a type of glaucoma characterized by the secretion of a grey-white, fibrogranular material in several tissues. Microparticles are shed membrane vesicles released from a variety of cell types in response to cellular activation or apoptosis and correlate with the pathogenesis of cardiovascular diseases. Endothelial MPs may be used as biomarkers of endothelial function.

Purpose

To evaluated the role of endothelial dysfunction, arterial stiffness and systemic inflammation in patients with PEX compared to patients with Primary open angle glaucoma (POAG) and control subjects as well as the possible pathophysiologic role of a specific microparticle profile associated with endothelial damage.

Methods

We enrolled 29 subjects with PEX, 57 subjects with POAG and 44 control subjects. Endothelial function was evaluated by flow-mediated dilation (FMD). Pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Growth differentiation factor-15 (GDF-15) and intercellular adhesion molecule1 (ICAM1) were measured to evaluate systemic inflammatory status. Total circulating MPs and EMPs were isolated and analysed by flow cytometry, utilizing specific labels for EMPs (CD 144+) and Annexin V staining for phospatidylserine bearing-MPs (AnnexinV + MPs).

Results

There was a linear impairment in FMD (p=0.005), PWV (p=0.007) and Aix (p=0.02) and a stepwise increase in GDF-15 (p=0.001) and sICAM-1 levels (p=0.08) between the three study groups (control, POAG, PEX). Interestingly, the PEX subjects expressed greater levels of total circulating MPs (Annexin V+) [1698 (1199–5894) MPs/μL vs. 1641 (1470–2705) MPs/μL. vs 493 (417–1512) MPs/μL, p=0.004] and EMPs (CD144+)[1412 (645–1760) MPs/μL3 vs 1380 (498–2496) MPs/μL vs 34 (184–870) MPs/μL, p<0.001] compared to POAG and control subjects.

Conclusion

Pseudoexfoliative glaucoma is associated with impaired endothelial function, arterial wall properties and vascular inflammation with a parallel increase in EMPs. Our findings indicate the significant role of endothelial damage in the progress of glaucomatous disease especially in subjects with pseudoexfoliative glaucoma.
P6519Transulnar approach vs. left radial access in STEMI patients: experiences from a single high volume center
Authors: Zafirovska Taleska B , Petkoska D , Jovkovski A , Vasilev I , Kitanovski D , Kedev S
Published: October 2019

Background

Transulnar and left radial artery approach are alternative wrist access sites from right TRA for coronary diagnostic and interventional procedures. Using wrist approach in all STEMI patients can decrease access site bleeding and vascular complications, improve patient outcomes and reduce MACCE, allowing rapid ambulation.

Purpose

To compare the results of the two most common wrist access crossover sites from right TRA in a large single center registry of consecutive STEMI PPCI patients.

Methods

From March 2011 until December 2017, 5048 consecutive STEMI patients that underwent catheterization were included in a single center prospective registry. Right radial access was used in 97% (4891) of patients. From the total number of STEMI patients, Transulnar approach was used in 95 (1.9%) patients. LRA was used in 43 (0.8%), TFA in 8 (0.1%) and TBA in 11 (0.2%). We compared two groups of patients with TUA and LRA by analyzing access site complications, procedural characteristics, procedural and fluoroscopy time.

Results

All procedures were successfully performed through TUA and LRA. Procedural time was slightly longer in STEMI patients with LRA transfer (41±16 vs. 38±16 min), but there was no significant difference between patients with TUA and LRA transfer in terms of fluoroscopy time (10±9.3 vs. 10±6.8 min), procedural success and vascular complications. Patients with TUA had significantly smaller number of anomalies 1% vs. 14% in LRA and were less prone to high degree spasm 1% vs. 4,6%. Both access sites had similar number of patients with multiple access site punctures 7.3% vs. 6.9%. Hand ischemia was not observed in any patient on day 1 after procedure and on 1 month follow-up. None of the patients showed nerve injury. Minor access site hematomas were similar with 2% EASY type 1 hematoma present in both groups.

TUA vs. LRA STEMI STEMI (n=5048) LRA TUA P value ACCESS 43 (0,8%) 95 (1,9%) Anomalies 7 (14%) 1 (1%) P<0,0001 Multiple punctures >3 3 (6,9%) 7 (7,3%) NA High grade spasm 2 (4.6%) 1 (1%) P<0.0001 Procedure time 41±16 min 38±16.4 min 0.0250 Fluoroscopy time 10±6.8 10±9.3 NA STEMI = ST segment elevation myocardial infarction; LRA = Left Radial Access; TUA = Transulnar Access.

TUA vs.LRA STEMI

Conclusion

Both transulnar and left radial access are safe and feasible alternatives to the default right radial approach, decreasing the need of TFA crossover in STEMI patients.
P6524The comparison of radial artery occlusion rate after distal radial artery puncture between hemodialysis and non-hemodialysis patients
Authors: Yokota S , Tobita K , Hayashi T , Mashimo Y , Miyashita H , Yokoyama H , Nishimoto T , Shishido K , Yamanaka F , Mizuno S , Murakami M , Tanaka Y , Takahashi S , Saito S
Published: October 2019

Background

In recent years it has been attempted to use a distal radial artery (DRA) as a puncture site for cardiac catheterization and intervention. A patency of radial artery is important in hemodialysis patients because the radial artery is source as an arteriovenous shunt. However, the incidence of radial artery occlusion (RAO) is not known after DRA puncture.

Purpose

To compare RAO rates after DRA puncture between dialysis and non-dialysis patients.

Method

This was retrospective, observational and single center study. All consecutive 1,533 patients undergoing DRA puncture were analyzed. The primary endpoint is RAO rates. The secondary endpoint is composite bleeding adverse event rates. These endpoints were evaluated by a vascular echocardiography several hours or the next day after the procedure.

Result

Among 1,533 patients, 26 were dialysis patients and 1,504 were non-dialysis patients. 1,386 people (90.5%) succeeded in puncture. Radial artery occlusion occurred in 7 patients (0.4%), all of whom were non-dialysis patients. There was no significant difference of RAO rate in dialysis patients and non-dialysis patients.

Conclusion

When performing DRA puncture, the probability of radial artery occlusion is not higher in dialysis patients than non-dialysis patients. The DRA puncture may be one of the option as puncture site even in dialysis patients.
P6527Patients discharged on the same day following elective PCI report equal satisfaction using health related quality of life instruments as compared to usual care: results from a randomized trial
Authors: Bogale N B , Melberg T M , Skadberg M S , Aasen G A , Nilsen D N , Barvik S B , Ogne C O , Bader M B , Bonarjee V B , Larsen A L
Published: October 2019

Background

Earlier observations in the era of femoral procedures using warfarin as the anticoagulant agent have shown safety following same day discharge after elective percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD). Procedures have evolved with most European centres adopting radial procedures with corresponding improvement in technique and equipment. Adoption of “radial lounges” has improved and simplified the observation routines with early ambulation. Antiplatelet therapy has also become more efficacious. The safety of same day discharge has been demonstrated. The economic benefit of such a strategy is significant with reported cost reductions of approximately 50%. Patient reported satisfaction is also shown to be comparable to standard care.

The current bed availability in health care facilities has made it a necessity to explore measures to reduce bed occupancy rates. Reduction in bed occupancy can further permit health personell to focus on other duties and obligations in wards with patients requiring hospitalization. Early discharge may cause anxiety and dissatisfaction among patients.

Purpose

The aim of our study was to evaluate safety and patient satisfaction of same discharge following uncomplicated elective radial access PCI.

Methods

Randomized controlled single center study. Eligible patients scheduled for elective PCI with radial access were prescreened following predefined inclusion and exclusion criteria. Health related quality of life instruments (HRQOL), Seattle Angina Questionnaire (SAQ), Short form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) were completed by the patients and received at base line and at 30 days post-procedure. All same day discharged patients were contacted by phone by a specialized study nurse the day after the procedure.

Results

517 patients were screened between November 2015 and November 2018 and 82 patients with mean age of 65 years were block randomized post-procedure. 38 patients were randomized to same day discharge after 6 hours of observation and 44 patients to standard care group which necessitated an overnight hospitalization. 11 female patients and 71 male patients were included.

No adverse events were registered in either group. No significant difference between groups were observed in the SAQ (treatment satisfaction score p=0.48, angina frequency scale p=0.58), SF-36 (SF vitality p=0.93) or HADS (HADS anxiety + depression p=0.15).

Changes of HADS score

Conclusions

Discharge on the same day following uncomplicated PCI for stable angina is safe and patient health related quality of life instruments confirm that patients are equally satisfied with this new care strategy when compared to usual care.

Acknowledgement/Funding

Stavanger University Hospital
P6541Wrist band photoplethysmography pulse morphology-based autocorrelation analysis enables atrial fibrillation detection without the need of pulse detection
Authors: Valiaho E.-S , Kuoppa P , Lipponen J A , Martikainen T J , Jantti H , Rissanen T T , Kolk I , Castren M , Halonen J , Tarvainen M P , Hartikainen J E K
Published: October 2019

Background

Atrial fibrillation (AF) is often asymptomatic and intermittent making its detection a major clinical challenge. A photoplethysmography (PPG) wrist band with algorithm-based detection of AF provides a promising solution for screening of AF. However, the shapes of individual pulse waveforms vary in AF decreasing pulse detection accuracy.

Purpose

The purpose of this study was to evaluate the utility of PPG wrist band pulse morphology in detection of AF.

Methods

A 5-minute PPG was recorded with a PPG wrist band from patients with AF or sinus rhythm. A simultaneously registered ECG served as the golden standard for the rhythm analysis and was interpreted by two cardiologists. In addition to using the inter-beat-interval (IBI) based AFEvidence algorithm in comparison, we extracted a feature straight from the PPG signal, without the need of pulse detection. This feature was calculated as the average of absolute autocorrelation values over different lags. The feature describes the regularity of the PPG signal and is decreased if the shape and periodicity of pulse waves vary. The performance of this PPG morphology-based method in detection of AF was evaluated and compared to the AFEvidence.

Results

The study population consisted of 213 patients (106 AF, 107 sinus rhythm). The sensitivity and specificity of PPG morphology-based autocorrelation AF detection method were 98.1% and 94.4%. For AFEvidence, the sensitivity and specificity were 96.2% and 98.1%, respectively (p=0.146 between the methods, McNemar test).

PPG samples of AF and sinus rhythm

Conclusions

The PPG morphology-based autocorrelation method detects AF with good accuracy without the need of pulse detection. The method seems promising in detection of AF and should be studied further.

Acknowledgement/Funding

None
P6543Screen-detected atrial fibrillation in a one-minute single-lead ECG predicts mortality in elderly subjects
Authors: Zink M D , Mischke K , Keszei A , Rummey C , Freedman B , Neumann G , Tolksdorf A , Frank F , Wienstroer J , Kuth N , Schulz J B , Marx N
Published: October 2019

Background

Atrial fibrillation (AF) is the most common arrhythmia associated with increased morbidity and mortality. Current guidelines recommend opportunistic screening for AF but the prognostic impact of screen-detected AF is unclear.

Methods

We performed a 4-week, prospective, pharmacy-based AF screening study in 7107 elderly citizens (≥65 years) using a hand-held, automated, one-minute single-lead ECG (SL-ECG) recording device. Prevalence and incidence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days.

Results

Automated SL-ECG analyses revealed heartbeat irregularities suspicious of AF in 432 (6.1%) participants with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalised for CV causes. Total mortality was 2.3% in participants with a SL-ECG suspicious of AF and 0.8% in subjects with a normal SL-ECG (HR 2.93; 95% CI: 1.49, 5.77; P=0.002, Figure 1A); hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI: 1.52, 2.84; P<0.001, Figure 1B). Compared with subjects without a history of AF at baseline and a normal SL-ECG, participants with newly diagnosed AF or known AF had a significantly higher mortality risk with HRs of 2.63 (95% CI: 1.04, 6.63; p=0.04) and 2.68 (95% CI: 1.45, 4.98; p=0.002), respectively. After multivariable adjustment, a SL-ECG recording suspicious of AF remained a significant predictor of death or hospitalization for CV causes.

Figure 1

Conclusions

Pharmacy-based, automated, one-minute SL-ECG screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next one year.

Acknowledgement/Funding

Unrestricted research grant by Pfizer/BMS. Matthias Zink received a DGK electrophysiology grant (funded by St. Jude Medical).
P6545Pacing as new predictor for atrial high rate episodes in patients with dual-chamber pacemakers and no history of atrial fibrillation
Authors: Benezet Mazuecos J , Devesa Arbiol A , Garcia Talavera C S , Iglesias J A , Serrano E , Rubio J M , Sanchez-Borque P , Miracle A
Published: October 2019

Introduction

Both atrial and ventricular pacing (AP/VP) have been related to a higher risk of clinical atrial fibrillation (AF) documented on ECG. Subclinical AF is detected as atrial high rate episodes (AHRE) by cardiac implantable electronic devices and is related to a higher risk of stroke.

Purpose

The aim of this study was to determine whether the percentage of AP and/or VP in patients with pacemakers and no history of AF is related with the future development of subclinical AF (AHRE) and/or clinical AF (ECG documented).

Methods

From February 2012 to September 2015 we recruited patients with dual chamber pacemakers and no prior history of AF. Patients were followed at 3 months and every year then after. Subclinical AF, clinical AF and cardiovascular events were registered. AHRE (subclinical AF) was defined as an episode of atrial rate ≥225 bpm with a minimum duration of 5 min. Clinical AF was defined as ECG documented AF. Percentage of AP/VP was determined as the mean AP/VP during the first three visits. Mortality and cardiovascular events (including AF, stroke and hospitalization for heart failure) were also recorded.

Results

249 patients (57% men; 75±9 years-old) were included. Mean time from pacemaker implantation was 9 months and the main indication was AV-block in 53% of the patients. Mean CHA2DS2-VASc score was 3.5±1.5. After a mean follow-up of 33±11 months, 38.5% of patients developed subclinical AF and 10.4% clinical AF. Patients with AP≥50% presented significantly higher risk of AHRE (62.5% vs 32.3%, OR 3.48; 95% CI [1.93–6.4] p<0.01) and clinical AF (18.7% vs 8.6%, OR 2.4; 95% CI [1.05–5.52] p<0.05). Patients with VP≥50% presented significantly higher risk of AHRE (46.4% vs 31.6%, OR 1.87; 95% CI [1.10–3.24] p<0.05) and clinical AF (25.9% vs 9.7%, OR 2.7; 95% CI [1.13–7.72] p<0.05). The percentage of AP and VP were not related to a higher risk of cardiovascular events or mortality. Multivariate analysis showed that AP≥50% was an independent predictor for AHRE (OR 2.4; 95% CI [1.19–4.97] p=0.014).

Conclusions

Pacing is related to a higher risk for developing subclinical and clinical AF in patients with dual-chamber pacemakers and no history of previous AF. Our data suggest, that patients presenting a high percentage of AP and VP should be closely followed during routinely pacemaker check-ups assessing for subclinical AF, especially in those with AP ≥50%.
P6549Conventional single lead ventricular pacemaker against leadless pacemaker system in real-world patients: prospective one center study. CARDIOCHUS Registry
Authors: Martinez Sande J L , Garcia-Seara J , Gonzalez-Melchor L , Rodriguez-Manero M , Lopez-Canoa J N , Alvarez-Rodriguez L , Romero-Roche L , Fernandez-Lopez X A , Abou-Jokh-Casas C , Vidal-Perez R C , Gonzalez-Juanatey J R
Published: October 2019

Background

As more experience is obtained with leadless pacemakers systems (LPM), a great group of patients is considered for its implantation. There are issues that cannot be completely avoided with conventional transvenous pacemaker (VVI-PM) such as infectious or pocket related complications in which LPM are clearly superior.

Purpose

The aim of the study was to compare the clinical and device performance between LPM and VVIPM in the same period of time in a “real-world” population.

Methods

We performed a prospective, observational, one center study, including all patients with a single chamber pacemaker implantation within 3 years (June 2015-December 2018) and its mid-term follow-up. All clinical, electrical and echocardiographic characteristics, as well as implantation characteristics and complications, were described.

Results

We included a total of 339 patients with transvenous pacemakers, 195 patients with VVI-PM and 144 LPM. There were no significant differences in mortality between both groups during the follow-up (12,3±10 months), Figure 1. Although there were no significant differences in major complications (P-value 0,54), the number of total complications was lower in the LPM group (P-value 0,01) at the expense of fewer minor ones (P-value 0,02), Table 1.

Table 1. Complications TVP (195) LPM (144) P value Major complications 11 (5.6%) 6 (4.2%) 0.54 Minor complications 10 (5.1%) 0 (0.0%) 0.01 Total Complications 21 (10.7%) 6 (4,2%) 0.02

Figure 1

Conclusions

In our study, during the med-term follow-up, there were no significant differences in terms of mortality and the major complications between LMP and VVI-PM. Although, the number of minor complications were less with the LMP.
P6558Novel predictor of newly atrial high rate episode in the population of dual chamber devices
Authors: Nishinarita R , Niwano S , Oikawa J , Saito D , Matsuura G , Arakawa Y , Shirakawa Y , Kobayashi S , Horiguchi A , Nakamura H , Ishizue N , Igarashi G , Kishihara J , Fukaya H , Ako J
Published: October 2019

Background

Among patients who underwent dual chamber devices (DDD) implantation, new occurrence of atrial fibrillation (AF) is higher compared to general population. However, it is unclear which factors affect new onset AF. Previous studies reported that the prolonged P wave dispersion (PWD) in sinus rhythm could be considered as an index for progression of conduction disturbance as the arrhythmogenic state for AF. In this study, we sought to elucidate the clinical factors including PWD associated with silent atrial high rate episode (AHRE) in the population of DDD.

Methods

The study population consisted of 101 patients with DDD from 2010 to 2014. All patients were measured PWD at the time of implantation. AHRE was defined as any episode of sustained atrial tachyarrhythmia (>170 bpm). AHREs were evaluated during initial 1 year after the implantation. They were divided into AHRE group (n=34) and non-AHRE group (n=67) and various clinical parameters were compared.

Results

The mean age was 75±11 years old. The AHRE groups showed higher rate of diagnosis of sick sinus syndrome (p=0.05) and longer PWD (62.6±13.1 versus 38.2±13.9 ms, p<0.0001) in comparison with non-AHRE group. Multivariate analysis revealed that the PWD was significant independent factors for the prediction of new appearance of AHRE (OR: 1.12; 95% CI, 1.07–1.17; p<0.0001). Cut-off value for parameter was determined by ROC curves achieving highest sensitivity and specificity, 48 mm was the best point of PWD (sensitivity of 73.8%, specificity of 77.9%, AUC 0.78).

ROC curve

Conclusion

PWD were significant predictor for new appearance of AHRE in patients with DDD.
P6560Delayed ablation of atrioventricular nodal reentry tachycardia as a risk factor for future atrial fibrillation
Authors: Ferreira Fonseca M , Parreira L , Farinha J , Marinheiro R , Esteves A , Pinheiro A , Mesquita D , Amador P , Lopes A , Caria R
Published: October 2019

Introduction

Atrioventricular nodal reentry tachycardia (AVNRT) is the most common type of supraventricular tachycardia. Most of the patients experience recurrent symptoms for years before electrocardiographic documentation and AVNRT ablation. The effects of these ongoing episodes of AVNRT on atrial structure and function, and their influence on new-onset atrial fibrillation (AF) in patients with delayed AVNRT ablation are unknown.

Purpose

To assess if delayed ablation of AVNRT was associated with the development of AF.

Methods

We retrospectively evaluated patients subjected to AVNRT ablation between 2009 and 2016. Patients with history of AF previous to ablation were excluded. We evaluated age at the time of AVNRT ablation, the presence of cardiovascular risk factors, left atrial (LA) dilatation and the presence of frequent premature atrial contractions (PACs) (by 24-hour holter monitoring, defined as >30/h). During follow-up we assessed the occurrence of sustained AF episodes and age at the time of the first AF episode.

Results

We studied 130 patients that underwent AVNRT ablation. Mean follow-up time was 75±27 months and seventeen patients (13%) had new-onset AF during follow-up. Patients who developed AF were more often males (35% vs. 22%, p=0,015), older at the time of AVNRT ablation (60±16 vs. 50±15, p=0,01), had a higher prevalence of hypertension (64% vs. 35%, p=0,03), diabetes mellitus (35% vs. 6%, p=0,02), LA dilation (41% vs. 7%, p=0,01) and frequent PACs (24% vs. 2%, p=0,03). In Univariable Cox regression analysis all these available variables were associated with AF occurrence during follow-up. However, in Multivariable Cox regression analysis, only age at the time of the ablation procedure was independently associated with AF occurrence (Table 1).

Multivariable Analysis HR 95% CI P value Age at ablation 8.762 3.308–23.20 <0.001 Age at the time of the first AF episode 0.113 0.043–0.302 <0.001 LA dilation 0.408 0.113–1.472 0.171 Frequent PACs 1.016 0.156–6.611 0.987

Conclusion

In this group of patients the occurrence of new-onset AF during follow-up was independently associated with delayed AVNRT ablation. These findings suggest that longer atrial exposure to AVNRT episodes before ablation may be associated with LA structural and functional changes leading to higher occurrence of AF.