bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of gender on long-term prognosis after transcatheter edge-to-edge repair for mitral regurgitation
Authors: Geyer M , Keller K , Born S , Bachmann K , Hell M M , Tamm A R , Ruf T F , Kreidel F , Petrescu A , Schnitzler K , Schmitt V H , Da Rocha E Silva J G , Schulz E , Munzel T , Von Bardeleben R S
Published: October 2021

Background

A symptomatic and prognostic benefit by Transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) has been proven. A variety of individual factors including female sex has been suggested to be associated with adverse outcome in cardio-surgical procedures.

Purpose

While gender is factored in common risk factor models for adverse outcome, evidence on sex-specific differences in long-term outcome after TEER for MR is limited. We aimed to investigate the impact of gender on prognosis in a large monocentric cohort with long-term follow-up.

Methods

We analyzed survival stratified for gender after successful isolated edge-to-edge repair of MR in the period between 06/2010 and 03/2018 (exclusion of combined forms of TMVR) in a monocentric retrospective cohort by performing survival analyses and cox regression analyses.

Results

Consecutively, 627 patients (47.0% females, 57.4% functional MR; survival status was available in 96.7%) entered the study and were followed for a median follow-up period of 462 days [IQR 142–945 days]. Survival rates were 97.6% at discharge, 75.7% after 1, 54.5% after 3, 37.6% after 5 and 21.7% after 7 years. Risk score as calculated by the Logistic Euroscore I did not differ significantly between females and males (at baseline: 25.0 [IQR 18.0/34.8] vs. 27.0 [18.4/40.1]%, p=0.093) and no relevant differences were found for in-hospital (2.0 vs. 2.7%, p=0.613), 30 days (4.8 vs. 6.5%, p=0.473) and 1-year mortality (27.0 vs. 25.3%, p=0.675). At the time of procedure, women were older (79.9 [IQR 75.6/84.4] vs. 78.3 [72.9/83.4] years, p<0.001), were less often affected by coronary artery disease (53.1% vs. 75.0% p<0.001), diabetes mellitus (23.7% vs. 31.3%, p=0.040) and impaired left ventricular function (44.5±12.9% vs. 38.9±13.4%, p<0.001). Regarding long-term survival, women had a better prognosis after MR-therapy, especially in functional etiology: e.g., 4-year survival in FMR 65.7 vs. 35.7%, p=0.006 (Figure 1). Remarkably, female sex was associated with a lower risk for long-term mortality in the Cox-regression models, especially in the FMR subgroup (total cohort: univariate HR 0.81 [0.62–1.04], p=0.101; FMR: univariate HR 0.68 [0.49–0.96], p=0.028).

Conclusion

In our cohort of patients undergoing TEER for MR, we found no evidence for an impaired short- and mid-term prognosis for female patients. In contrary and not as indicated by Logistic Euroscore, female sex was associated with better long-term survival in comparison to men despite higher median age, which might be partly explained by a slightly more favorable cardiovascular risk profile.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Quantification of physical activity with activity tracking after transfemoral aortic valve replacement (TAVR)
Authors: Zadrozny M , Humpfer F , Steffen J , Fischer J , Stocker T , Theiss H , Braun D , Massberg S , Hausleiter J , Deseive S
Published: October 2021

Background and hypothesis

TAVR is a well-established, safe and effective therapy for severe symptomatic aortic stenosis (AS), but improvement of physical activity after TAVR is difficult to assess objectively. The aim of this study was to quantify improvement of physical activity with Activity Tracking after TAVR with special focus on the different low-gradient subtypes of AS.

Methods

All patients who underwent TAVR for severe AS in our center between 01/2019 and 12/2019 were screened. Participants received an Activity Tracker for 7 days at two times: after hospital discharge following TAVR procedure and 6 months thereafter. The difference of mean daily steps was defined as study endpoint.

Results

The analysis is based on 230 patients. The median age was 79.7 years with 53.7% male participants. The median aortic valve area (AVA) was 0.75 cm2 and median mean pressure gradient was 38.7 mmHg (Table 1). The median amount of daily steps was 4409 [IQR 2581–7487] steps/day after hospital discharge and 5326 [IQR 3045–8668] steps/day 6 months thereafter. On a patient base, median difference of steps per day was Δ 529 [IQR −702–2152]). Whenever possible, patients were categorized into different subgroups of AS. Patients with high-gradient (HG) AS showed significant improvement in difference of daily steps at 6 months-FUP (Δ 951 [IQR −378–2.323], p<0.001), as well as patients with paradox low-flow-low-gradient (LFLG) AS (Δ 1392 [IQR −609–4444], p=0.02). Patients with classical LFLG AS also showed an improvement of daily steps at 6-months-FUP but without statistical significance (Δ 192 [IQR −687–770], p=0.79). Patients with a normal-flow-low-gradient (NFLG) AS have no significant difference in daily steps after 6-months and show a tendency of decline in daily steps at 6-months-FUP (Δ −300 [IQR −1334–1406], p=0.67) (Figure 1).

Conclusions

This is the first study of this sample size to evaluate physical activity after TAVR with an objective and reproducible method. Overall, physical activity improved significantly 6 months after TAVR and daily steps per day increased in all subtypes of AS besides NFLG AS, where a tendency of decline in daily steps without statistical significance was shown. However the increase in daily steps did not reach statistical significance in classical LFLG AS patients.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1
Validation of risk scores for permanent pacemaker implantation after TAVR
Authors: Fugar S , Deka K , Anderson C , Lama Von Buchwald C , Geroux R , Al-Amoodi M , White J , Kavinsky C
Published: October 2021

Background

Despite advances in transcatheter aortic valve replacement (TAVR) technology, High grade atrioventricular block (AVB) requiring permanent pacemaker (PPM) implantation remains a frequent complication after the procedure. National inpatient sample (NIS) score and the PACeR risk cores have been developed to help identify patients at an increased risk of requiring PPM.

Purpose

We sort to validate both risk stratification tools developed to predict the need for PPM after TAVR.

Methods

This is a single center retrospective study using consecutive patients who presented for TAVR at our institution from May 2012 till December 2020. Components from the two-scoring system previously published in literature was applied. Predictive accuracy of the scores were assessed using the C-statistics for discrimination and the Hosmer-Lemeshow goodness of fit test for calibration.

Results

A total of 663 patients underwent TAVR over the study period. Of those, 101 were excluded. The final cohort included in the analysis were 562 patients. Fifty-seven patients (10.1%) required PPM. In both scoring, higher scores suggested increased risk of PPM implantation (Figure 1). PACeR and NIS scores showed an area under the curve of 0.750 and 0.699 respectively Figure 2. Model calibration showed a P-value of 0.799 over PACER and 0.583 for the NIS score (P>0.5 implying a good fit).

Conclusion

The PACer risk score and NIS models were both validated in our database with acceptable outcomes. Overall, the PACeR risk scores proved to be more accurate in our database. Further studies in larger patient cohorts are needed to further validate these models.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Myocardial injury in patients hospitalized for SARS-CoV19: a maker or a marker of prognosis?
Authors: Montalto C , Ghio S , Pagnesi M , Cappelletti A , Baldetti L , Baldi E , Lombardi C , Lupi L , Metra M , Perlini S , Oltrona-Visconti L
Published: October 2021

Background

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, literature data are progressively accumulating, attesting to the possible prognostic role of cardiac troponins in patients who need hospitalization because of COVID-19 infection.

Purpose

To assess whether myocardial injury (measured by high sensitivity troponins) is an independent cause of disease severity and prognosis.

Methods

We performed a patient-level metanalysis (PROSPERO ID: CRD42020213209) in unselected patients hospitalized because of COVID-19 infection in whom the severity of respiratory failure was also evaluated at admission. To allow for comparison, troponin values were normalized to their threshold levels to obtain a normalized troponin (nTn) value which was used as a continuous variable in all analysis.

Results

A total of 722 patients were included in the analysis. Of note, patients who had elevated troponins at hospital admission had a significantly lower oxygenation status than those with normal nTn (PaO2/FiO2 232±215 vs. 276±124 mmHg/%; p<0.001). On the contrary, those with cardiovascular comorbidities had similar PaO2/FiO2 but higher nTn than those without (5.6817 vs. 2.1110 ng/mL; p=0.002).

After a median follow-up of 14 days, 180 deaths were observed. At multivariable regression analysis, age, male sex, moderate-severe renal dysfunction (eGFR <30 mL/min/m2) and lower PaO2/FiO2, were independent predictor of death (igure 1). The restricted cubic spline curves in Figure 2A and 2B show the hazard ratios (HRs) and 95% confidence interval for death according to nTn and PaO2/FiO2 levels as continuous variables. A linear increase in the HR is observed with lower PaO2/FiO2 values below the normal value of 300. On the contrary, the nTn spline curve is near-flat with large confidence interval for values above the normality thresholds.

Conclusion

In patients hospitalized for COVID-19, mortality is mainly driven by gender, age and respiratory failure while myocardial damage is not an independent predictor of worse survival when respiratory function is accounted for.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Long term prognosis and cardiovascular complications of patients with systemic sclerosis-related cardiomiopathy
Authors: Stronati G , Ribichini F , Benfaremo D , Dichiara C , Casella M , Dello Russo A , Guerra F , Moroncini G
Published: October 2021

Background

Both primary (SSc related cardiomyopathy) and secondary cardiac involvement in systemic sclerosis (SSc) is frequent albeit mostly asymptomatic. It represents a negative prognostic factor as almost 25% of SSc patients die from either heart failure or arrhythmia complications. Speckle tracking global longitudinal strain has been proven to be an effective tool both to identify and detect the progress of subclinical heart disease in SSc. The aim of our study was to assess the association between SSc diagnosis and the development of heart failure, pulmonary hypertension, death and need for hospitalization.

Materials and methods

We conducted an observational prospective study enrolling all patients with a diagnosis of SSc and no overt cardiac disease. We excluded all patients with a known diagnosis of pulmonary hypertension and atrial fibrillation. For each patient standard echocardiogram and GLS variables were collected.

Results

We enrolled 70 patients (61 females, age 56.2±15.4 years) who were followed for a median of 3 years. 68% of the patients had a limited variant of the disease.

All-cause mortality was 10% in a 5-year follow-up. During the same period, PH was reached in 13% of all patients, HF in 7% and 18% required at least one hospital admission for cardiovascular causes. A diagnosis of PH was associated with an increased risk of death (ARR 34%; p<0.001) and hospitalization for CV causes (ARR 73%; p<0.001). Moreover, a diagnosis of HF was associated with an increased risk of death (ARR 50%; p<0.001) and hospitalization for CV causes (ARR 61%; p<0.001). A 1% worsening of GLS was associated with an increased risk to develop PH in the following 5 years, both for the left ventricle (OR 1.2; 95% CI: 1.1–1.4; p=0.043) and for the right ventricle (OR 1.1; 95% CI: 1.1–1.3; p=0.045).

Conclusions

Pulmonary hypertension and heart failure often occur in patients with cardiac involvement. Both proved themselves to be associated with an increased risk of death and hospitalization for CV causes. Moreover, GLS worsening of both the left and right ventricles may allow us to predict the diagnosis of PH and therefore preemptively start appropriate management.

Funding Acknowledgement

Type of funding sources: None.
Beta-blockers to control symptoms in patients with pericarditis
Authors: Imazio M , Andreis A , Agosti A , Piroli F , Casula M , Paneva E , Avondo S , Barberi Squarotti G , Giustetto C , De Ferrari G M
Published: October 2021

Background

Exercise restriction is a non-pharmacological treatment of pericarditis that could reduce symptoms by slowing heart rate (HR). Beta-blockers allow pharmacological control of HR.

Aim

To explore the possible efficacy of beta-blockers to improve control of symptoms in patients with pericarditis.

Methods

We analysed consecutive cases with pericarditis referred to our centre. Beta-blockers were prescribed on top of standard anti-inflammatory therapy in symptomatic patients (chest pain and palpitations) with rest HR>75 beats/min. The primary end point was the persistence of pericardial pain at 3 weeks. The secondary end point was the occurrence of recurrent pericarditis at 18 months. Propensity score matching was used to generate 2 cohorts of 101 patients with and without beta-blockers with balanced baseline features. A clinical and echocardiographic follow-up was performed at 3 weeks, 1, 3, 6 months and then every 12 months.

Results

A total of 347 patients (mean age 53 years, 58% females, 48% with a recurrence, 81% with idiopathic/viral aetiology) were included. Among them, 128 patients (36.9%) were treated with beta-blockers. Peak C-reactive protein values were correlated with heart rate on first observation (r=0.48, p<0.001). Using propensity-score matched cohorts, patients treated with beta-blockers had a lower frequency of symptoms persistence at 3 weeks (respectively 4% vs. 14%; p=0.024) and a trend towards a reduction of recurrences at 18 months (p=0.069).

Conclusions

The use of beta-blockers on top of standard anti-inflammatory therapies was associated with improved symptom control. Additional studies are warranted to verify the efficacy of these drugs in this setting.

Funding Acknowledgement

Type of funding sources: None.
Retrospective comparison of percutaneous balloon pericardiotomy with pericardiocentesis versus pericardiocentesis alone for management of symptomatic pericardial effusions
Authors: Shirkhodaie C , Venturini J M , Shah A P , Nathan S , Paul J , Kalathiya R , Blair J E A
Published: October 2021

Background

Cardiac tamponade is a potentially life-threatening complication of pericardial effusion. Pericardiocentesis with drainage is the mainstay of treatment for patients with pericardial effusion and cardiac tamponade. Percutaneous balloon pericardiotomy (PBP) is an adjunct to pericardiocentesis that may alleviate the risk for recurrent effusion and repeat procedures. However, the efficacy of PBP plus pericardiocentesis compared to pericardiocentesis alone is not clear.

Purpose

We sought to determine whether PBP plus pericardiocentesis was associated with less recurrence of pericardial effusion than pericardiocentesis alone.

Methods

We conducted a single-centre retrospective analysis of patients ≥18 years old with non-iatrogenic pericardial effusion undergoing either pericardiocentesis alone or PBP plus pericardiocentesis for the first time. For PBP, a balloon was advanced over a guidewire until it crossed the pericardium and was then inflated until the balloon profile was fully expanded. Type of balloon used, and single or double balloon technique were left up to the operator. Recurrent pericardial effusion was defined as a large pericardial effusion on echocardiogram, pericardial effusion that caused hemodynamic compromise, or pericardial effusion that necessitated another intervention to drain at any time after initial procedure. Risk factors for recurrent pericardial effusion were also assessed.

Results

There were 208 patients who underwent pericardiocentesis, with 33 patients receiving PBP plus pericardiocentesis. In all patients, the rate of recurrent pericardial effusion was 15.9% and 15.2%, respectively (p=0.92). In patients with a cancer diagnosis at time of procedure, the rate of recurrent pericardial effusion was 17.8% and 16.7%, respectively (p=0.89). In patients with malignant pericardial effusion as confirmed by cytology, the rate of recurrent pericardial effusion was 20.4% and 13.3%, respectively (p=0.72). Patients with a connective tissue disease (CTD) had an increased odds ratio (OR) of recurrent pericardial effusion when compared to patients without a CTD (OR 3.19, 95% CI 1.31–7.77).

Conclusions

The results of this study suggest that PBP plus pericardiocentesis offers no significant benefit over pericardiocentesis alone at preventing recurrent pericardial effusion. This finding was true in all sub-groups, including patients with cancer and patients with malignant pericardial effusion. Patients with a CTD were three times more likely than patients without a CTD of having a recurrent pericardial effusion, independent of treatment strategy.

Funding Acknowledgement

Type of funding sources: None.
Paradoxical increase in ambulatory systolic blood pressure in coarctation of aorta as compared to idiopathic hypertension
Authors: Iftikhar M , Devara J , Shaik L , Katta R , Goda A , Egbe A , Connolly H
Published: October 2021

Background

The relationship between office vs ambulatory blood pressure (BP) indices is well-studied in patients with idiopathic hypertension, and based on these data, it is known that average 24-hour ambulatory BP is typically lower than office BP. However, emerging data show that office systolic BP (SBP) underestimates arterial afterload in patients with coarctation of aorta (COA), and minimal increase in stroke volume during low intensity exercise results in exaggerated rise in SBP as compared to those with idiopathic hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with idiopathic hypertension.

Methods

Case-control study of 118 COA patients and 118 patients with idiopathic hypertension matched by age, sex, body mass index and office SBP.

Results

Although both groups had similar office SBP (132±17 mmHg) by design, the COA group had paradoxical increases in 24-hour ambulatory SBP (135±14 vs 126±13, p<0.001) and daytime ambulatory SBP (142±16 vs 130±13, p<0.001), and less nocturnal dipping (−3±5 vs −9±4, p<0.001). The COA group also had a higher prevalence of masked hypertension (36 [31%] vs 14 [12%], p<0.001), and worse arterial function indices.

Conclusion

These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating idiopathic hypertension guidelines recommendations to the treatment of COA. It also provides rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population.

Funding Acknowledgement

Type of funding sources: None.
Cross sectional imaging is transforming the diagnosis of rare congenital defects
Authors: Orchard E , Njue F , Kelion A
Published: October 2021

Aim

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly in which at least one of the pulmonary veins do not drain into the left atrium. Patients with PAPVC can often be asymptomatic and the presence of right heart dilatation on echo should prompt assessment of pulmonary venous anatomy.

The aim of this study was to compare the anatomical features of a contemporary cohort of patients with PAPVC with previous historical cohorts, in order to determine whether the use of 3 dimensional imaging techniques has altered the diagnostic yield of PAPVC anatomical subtypes.

Methods

A retrospective review of patients diagnosed with PAPVC on the basis of CT and/or MRI imaging, between 2010 and 2020.

Results

45 cases of PAPVC were found. 60% were women with an average age of 53 years (17–85 years). 25 cases were diagnosed on MRI and 20 on CT, with CT scanning being used with increasing frequency during the period covered.

The most common pattern was right-sided involvement, with isolated right PAPVC in 36 patients (80%) – see chart 1. Of these, the majority had isolated right upper PAPVC (19, 53%); 13 (36%) had right upper and middle PAPVC, 1 had isolated right middle PAPVC, 2 had isolated right lower PAPVC, and 1 had unilateral right-sided PAPVC. Bilateral involvement was seen in 4 patients (9%), isolated left-sided involvement in 3 (7%), and right upper and middle and left upper PAPVC in 2 (4%).

Associated sinus venosus defects (SVDs) were only detected in 15 cases (33%): 14 had right-sided APVC and 1 had bilateral upper PAPVC. There were 13 superior SVDs, 1 inferior SVD and 1 coronary sinus SVD (see chart 2).

13 of the 27 (48%) women had Turner's Syndrome, Most had right-sided PAPVC (8, 61%), with bilateral involvement in 3 (23%) and left-sided PAPVC in 4 (31%) – see chart 3.

17 (38%) of the patients have had their PAPVC surgically redirected, of which 13 (29%) had an associated SVD.

Conclusion

With Increasing use of cross sectional imaging, we are seeing anatomical heterogeneity in patterns of PAPVC compared to historical cohorts1,2. Interatrial communications were less frequently seen, with unusual patterns of drainage seen more frequently in our Turner's Syndrome group.

Funding Acknowledgement

Type of funding sources: None. CT scan of bilateral PAPVC
Trends and outcomes of acute pulmonary embolism transfers: a nationwide cohort sample 2008–2018
Authors: Elkaryoni A , Allen S , Newman J , Fareed J , Bechara C , Bunte M , Darki A
Published: October 2021

Background

Acute pulmonary embolism (PE) is associated with a high morbidity and mortality. There is paucity of data describing outcomes of patients with PE transferred from a different acute care hospital. We hypothesized that outcomes of patients transferred for PE care may be suboptimal potentially as a result of treatment delays due to non-protocolized transfer plan for this cohort of patients.

Methods

We used the Nationwide Inpatient Sample (NIS) from 2008–2018 to identify patients hospitalized with a primary diagnosis of acute PE by using International Classification of Diseases-9th, and 10th revision-clinical modification codes. Patients were subgrouped according to the transfer status by using the NIS transfer data element. The primary outcome was in-hospital mortality. The secondary outcomes were the annual trends of PE transfers and in-hospital mortality over study period. Chi-square test was used to compare categorical variables while Mann-Whitney U test was used for continuous variables. A multivariate logistic regression model of clinically relevant variables including hypertension, diabetes mellitus, atrial fibrillation, heart failure, coronary artery disease, chronic lung disease, chronic kidney disease, length of stay, age, and gender were conducted for the primary outcome.

Results

A total of 396,214 patients with an acute PE met inclusion criteria. Among this patient cohort, 8.1% of patients were transferred from an outside facility. Patients that were transferred for PE management were older [median age 66.0 years (interquartile range (IQR), 49–83) vs 64.0 (IQR, 48–80) years, p<0.001], had longer length of stay [median 5.0 (IQR, 1–9) days vs 4.0 (IQR, 1–7) days, p<0.001], and had a higher number of comorbidities. The in-hospital mortality among PE transfers was higher compared to those that were not transferred (5.7% vs 2.8%, p<0.001). After adjustment using multivariate regression model, transfer for PE care was associated with increased risk of mortality (odds ratio 1.8 (95% confidence interval, 1.1–2.9; p=0.013). Transfers for PE care notably increased over the study period (5.8% in 2008 to 11.3% in 2018, p<0.001). Trends of in-hospital mortality among PE transfers did not change over time while there was a decrease in mortality among patients that were not transferred for management of their PE (3.2% in 2008 to 2.6% in 2018, p<0.001).

Conclusion

Patients transferred for PE care tend to be more complex and have a higher risk of mortality relative to patients that do not require transfer of care. Despite the increased transfer rate of PE patients over time, the mortality rates have not improved. Further prospective research should evaluate the characteristics of treatment and further assess patient risk to help develop transfer protocols that may reduce risk for patients with PE requiring higher acuity care.

Funding Acknowledgement

Type of funding sources: None.
High-risk acute pulmonary embolism in a Portuguese centre: are we doing enough?
Authors: Martinho M , Cale R , Alegria S , Ferreira F , Loureiro M J , Judas T , Ferreira M , Gomes A , Delerue F , Pereira H
Published: October 2021

Introduction

For high-risk acute Pulmonary Embolism patients (HR-PE pts), reperfusion treatment is imperative to improve mortality. Although systemic thrombolysis (ST) is generally an appropriate first-line therapy, several population-based studies report its underuse. Data on epidemiology, management and outcomes of HR-PE in Portugal is scarce.

Purpose

Estimate the reperfusion rate in HR-PE pts, the reasons for non-reperfusion (NR) and how it influences outcomes.

Methods

Retrospective single-centre registry of consecutive HR-PE pts between 2008–2018, defined by the 2019 ESC guidelines criteria. Independent predictors for NR were assessed by multivariate logistic regression. The cumulative incidence of PE-related mortality at 30 days was calculated according to the Kaplan-Meier method and differences stratified by reperfusion were assessed using the log-rank test.

Results

Of a total of 1955 pts admitted with acute PE, 74 (3.8%) had HD instability at admission (mean age 68±15 years). The majority of pts (68.5%) came from the emergency department while the remaining 31.5% were already hospitalized for other reasons. The total reperfusion rate was 50% - 35pts were submitted to systemic thrombolysis, 1pt to first-line percutaneous embolectomy and 1pt to rescue endovascular treatment. Age was an independent predictor of NR (63±17 vs 73±12, p=0.02) with >75 years representing 15 times the risk of non-treatment (OR 15.5, 95% CI 3.23–74.25, p<0.001). Absolute contraindication for thrombolysis was present in 29.7% (22pts), with recent major surgery (13pts) and recent cerebral event (8pts) as the most common reasons. The presence of an absolute contraindication for systemic thrombolysis was also an independent predictor of NR (66.7% vs 13.6%; OR 13.3, 95% CI 2.51–70.65, p=0.002). Being hospitalized was associated with the presence of absolute contraindications for thrombolysis (68.2% vs 14.0%, p<0.001) and was also an independent predictor of NR (38% vs 77.3%; OR 8.49, 95% CI 1.56–46.11, p=0.013). PE-related death at 30 days was 28.4% (21pts), which was significantly lower in the reperfusion group (17.1% vs 38.9%, p=0.042). At a mean follow-up of 2.5±3.3 years, survival rate was 33.8% (figure 1).

Conclusions

Low reperfusion rate due to contraindications for thrombolysis was associated with high PE-related mortality. This data suggests that it is necessary to implement interventional alternative strategies, at a national level, to improve outcomes.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Survival rate according to reperfusion.
Association of 12204590 polymorphism with the development of acute cerebrovascular event
Authors: Chernova A , Nikulina S , Nikulin D
Published: October 2021

Purpose

To study SNP rs12204590 (T > A) with development of Acute Cerebrovascular Event in the patients with cardiovascular pathology and risk factors of its development who are representatives of the east Siberian population.

Material and methods

260 patients with Acute Cerebrovascular Event participated in a research (age [57.0; 51.0–62.0]) and 272 patients of control group (age [55.0; 51.0–62.0].). Among the patients who transferred Acute Cerebrovascular Event, 157 men and 103 women. The control group included 170 men and 102 women. Inspection of the main group included: collecting complaints, anamnesis, clinical examination, computer tomography of a brain, electrocardiography, echo, ultrasonic of arteries, daily monitoring of arterial blood pressure and cardiac rhythm, analysis of a coagulant system of blood. Patients of the main group had the following cardiovascular pathology and risk factors: arterial hypertension, supraventricular tachycardia, dislipidemiya, atherosclerosis brachiocephalic of arteries, disturbances of a system of a hemostasis. The control group is examined within the international HAPIEE project. The molecular and genetic research was conducted by PCR method in real time. Statistical processing of material was carried out with use of set of the Statistica for Windows 7.0, Excel and SPSS 22 application programs.

Results

The connection of the genotype of TA SNP rs12204590 (T > A) with the development of Acute Cerebrovascular Event in a general group of patients was confirmed, but no statistically significant associations were obtained when patients were divided into subgroups depending on cardiovascular pathology and risk factors.

Conclusion

The genotype of TA SNP rs12204590 (T > A), compared to the genotypes of TT and AA, reduces the risk of developing Acute Cerebrovascular Event, including in patients with arterial hypertension. The genotype of AA SNP rs12204590 (T > A) increases the risk of developing Acute Cerebrovascular Event in males.

Funding Acknowledgement

Type of funding sources: None.
Interventional cardiology in times of COVID-19: impact on a terciary centre
Authors: Azul Freitas A , Ferreira C , Martinho S , Goncalves V , Almeida J , Rosa J , Campos G , Jorge E , Goncalves L
Published: October 2021

Introduction

Cardiovascular diseases are the leading cause of death worldwide and the pandemic caused by coronavirus disease 2019 (COVID-19) has forced profound changes in the care of patients with cardiac conditions. In Portugal, an increase in mortality beyond that attributed solely to COVID-19 was observed. We aimed to realize how COVID-19 has changed the activity of our Interventional Cardiology Unit.

Methods

We retrospectively assessed all patients submitted to any interventional procedure in 2019 and 2020 in our hospital. A total of 7621 patients and 9163 procedures were evaluated. The mean weekly numbers of coronarography, angioplasty, right heart catheterization and structural heart intervention during 2019 were assessed and were compared with the first COVID-19 wave (comprising March and April 2020) and the second COVID-19 wave (including the time period from October to end of December 2020).

Results

Mean age was 65.2±16.6 years with 72% being male. In the first COVID-19 wave there was a significant reduction in the mean weekly numbers of all procedures, with a 64% decline in coronarographies (30.9±29.3 vs 87.2±12.9, P<0.001), 48% in angiographies (15.7±10.9 vs 30.2±5.7, P=0.004), 51% in right heart catheterizations (5.3±5.9 vs 10.9±4.5, P=0.002) and 57% in structural heart interventions (1.1±1.9 vs 2.6±2, P=0.044). Although there was an evident recovery in activity (figure 1), comparing to 2019, the second wave also showed a significant lower number of procedures, with 24% fewer coronarographies (66.6±20.6 vs 87.2±12.9, P=0.003) and 13% fewer angiographies (26.4±7.6 vs 30.2±5.7, P=0.004). Contrariwise, in the second wave there was no difference in the number of right heart catheterizations (7.3±6.1 vs 10.9±4.5, P=0.055) or structural heart interventions (1.6±1.6 vs 2.6±2, P=0.106).

Conclusions

In our Interventional Cardiology Unit, COVID-19 led to a significant reduction of procedures in the first and second pandemic waves. The effect on the increase in morbidity and mortality has yet to be determined. Health authorities should focus attention in defining measures to amend the consequences of this documented activity reduction.

Funding Acknowledgement

Type of funding sources: None. Figure 1
Stent strategies in left main bifurcation lesions: the simpler, the better?
Authors: Oliveira Campos G , Leite L , Santos M , Paiva L , Jorge E , Silva J , Matos V , Oliveira H , Costa M , Goncalves L
Published: October 2021

Introduction

Although percutaneous coronary intervention (PCI) for ostial or midshaft lesions in left main (LM) disease has shown similar results as compared with coronary artery bypass grafting (CABG), distal LM bifurcations are associated with an increase in procedural complexity and higher rates of target lesion revascularization. Several studies have investigated the optimal stenting strategy in patients with coronary bifurcation lesions and showed no benefit for systematic two-stent approach in comparison with provisional stenting. This is reflected in the current guidelines that recommend provisional stenting of the side branch as the preferred approach for most bifurcation lesions. However, there is still debate about the optimal strategy according to lesion location.

Objectives

This analysis aimed to compare the clinical outcomes of LM bifurcation PCI using a provisional strategy versus a two-stent strategy.

Methods

Retrospective, observational study including patients submitted to LM bifurcation (Medina 1,1,1) PCI between January 2010 and December 2019. Data was collected from the emergency department and hospitalization registries. Patients were divided according to the stenting approach. We made a global analysis including baseline clinical and angiographic data. The primary endpoint was target lesion failure (TLF), defined as the composite of myocardial infarction, cardiac death, and target lesion revascularization (TLR). Secondary endpoints included the individual components.

Results

A total of 106 patients were included (median age 74 [66–82], 79 (74.5%) males), 57 (53.8%) submitted to provisional stenting and 49 (46.2%) to a two-stent technique. Baseline characteristics were well matched (table 1). The mean SYNTAX score was 29.6±10.0 and LM stenosis grade was ≥70% in all lesions. Median follow-up was 26.6 [12.0–48.6] months. No differences were found regarding the primary endpoint (TLF in provisional stenting was 21.7% vs 21.4%, HR 2.432; 95% confidence interval, 0.472–12.450; p=0.233.). Although target lesion revascularization within the LM complex was numerically higher in the two-stent group (10.2% vs. 3.5%, p=0.245), the opposite was found in cardiac death (provisional group 10.5% vs. 4.3%, p=0.289).

Conclusions

Besides being a “simpler” technique, provisional stenting had no significant differences in outcomes compared to two-stent techniques. Without further evidence, revascularization strategies should primarily rely on operator expertise.

Funding Acknowledgement

Type of funding sources: None.
Permanent pacemaker implantation post transcatheter aortic valve replacement- the role of pacing burden
Authors: Natanzon S S , Fardman A , Barbash I , Guetta V , Segev A , Maor E , Fefer P , Nof E , Koren-Morag N , Beinart R
Published: October 2021

Introduction

Previous studies have provided inconsistent results regarding the clinical impact of new permanent pacemaker (PPM) post TAVR. Our aim is to evaluate whether new PPM post TAVR is associated with higher 1-year mortality and/or heart failure hospitalizations and whether pacing burden is related to adverse outcomes.

Results

Overall, 1245 patients underwent TAVR between the years 2008–2019 and were included in our analysis with a median follow up of 2.3 years (IQR 1–4). 191 (15%) had a new PPM implantation during index admission. Compared to patients without PPM those implanted had significantly higher 1-year mortality rate (18% vs 11%, p-0.007) as well has higher combined outcome of mortality and HF hospitalizations. There was no difference in pacing burden between survivors and non survivors in all models examined: first and last clinic visit, maximal pacing during the first-year post implantation and the difference in pacing trend between visits. Older age, peripheral artery disease (PAD) and previous myocardial infarction (MI) were independently associated with mortality or combined outcome of mortality and HF hospitalizations.

Conclusion

New pacemaker implantation post TAVR is associated with higher 1-year mortality and HF hospitalization, however pacing burden isn't associated with adverse clinical course.

Funding Acknowledgement

Type of funding sources: None.
Impact of severe mitral annular calcification on paravalvular leak after transcatheter aortic valve implantation
Authors: Soulaidopoulos S , Drakopoulou M , Stathogiannis K , Oikonomou G , Toskas P , Benetos G , Synetos A , Latsios G , Tsioufis K , Toutouzas K
Published: October 2021

Aims

Paravalvular leak (PVL) remains a frequent complication after transcatheter aortic valve implantation (TAVI) and seems to affect short- and long-term survival.

Purpose

The aim of this study was: 1) to identify anatomical predictors of PVL after TAVI and 2) assess the impact of PVL on cumulative survival.

Methods and results

Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA) ≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to the presence of PVL after TAVI and were followed up postoperatively with clinical and echocardiographic assessment. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium 2. In total, 291 patients were included (male: 50.2%, mean age: 80±7.6 years) in our study. Of these, 165 (56,8%) presented at least mild PVL after TAVI (mild: 85,5%, moderate: 13.3% and severe: 1.2%). The median follow-up period was 27.3 [min. 0, max 113 months. Two patients with severe PVL were excluded from the analysis. In the follow up period, there was no significant difference regarding all-cause mortality between patients with and those without PVL after TAVI, independently from the degree of PVL (log rank: 0.991 - Figure 1). Severe aortic annulus calcification, the presence of a bicuspid aortic valve and aortic root angulation, as assessed by computed tomography (CT), were found to associate with PVL after TAVI in univariate analysis. In the multivariate analysis, severe aortic annulus calcification was found to be the only independent predictor of mild or moderate PVL after TAVI [Exp(B): 1.540, 95% Confidence Interval: 1.067–2.224, B=0.432, p=0.021].

Conclusion

The presence of mild or moderate PVL after TAVI was not found to affect cumulative survival in the 27 months of follow up period. Severe annulus calcification assessed by CT-scan, was found to be the only independent predictor of PVL after TAVI.

Funding Acknowledgement

Type of funding sources: None.
EuroScore II is the best predictive model for the off pump coronary artery bypass graft surgery
Authors: Rosler A , Nectoux P , Constantin G , Holz B S , Cardoso D , Letti E , Sales M C , Lucchese F A
Published: October 2021

Background

Coronary artery bypass graft surgery (CABG) is the most common cardiac surgery performed in the world and a significant part of these surgeries are performed without cardiopulmonary bypass (off pump). Although none of the main surgical risk scores include pump use in their prediction model, the scores are widely used in risk stratification, including for patients who will be submitted to off pump CABG.

Purpose

To analyse and compare the predictive accuracy of EuroScore I, EuroScore II and STS Score for 30-day mortality after off pump CABG.

Methods

Single-centre cohort with 943 patients consecutively submitted to off pump CABG between January 2010 and December 2020. 31 baseline and operative variables were analysed. The primary outcome was the occurrence of death in the first 30 days after the surgery. Descriptive analysis, normality for quantitative data and univariate inference were performed to compare proportions and means between the survival group (n=930) and death group (n=13). Next, three logistic regression models were performed. Each of them had 30-day mortality as a dependent variable and one of the scores as an independent variable. The probabilities generated by the three models were saved and analysed by ROC curves. Thus, it was possible to assess the predictive accuracy of each of the scores. Finally, the values of the areas under the curves were compared using the DeLong test. The level of significance was 5% and the analysis was performed using the Python 3.0 programming language.

Results

The mean age of the general group was 63 years old and there was a predominance of male patients (68.4%). The means of the three evaluated risk scores were significantly higher in the Death group (p<0,05). This pattern confirmed the findings of higher prevalence of several comorbidities in the death group. The 30-day mortality rate was 1.37%. Through the analysis of regressions and the probabilities generated through them, it was possible to verify that the predictive accuracy of EuroScore II was significantly higher than that of the other two scores. While the predictive accuracy of EuroScore II was 77.3%, the accuracy of two other scores was in the range of 69% (AUC EsI: 0.697; AUC EsII: 0.773; AUC STS: 0.695; p=0.029).

Conclusion

EuroScore II seems to be the most adequate surgical risk score for the assessment of mortality risk of patients who will undergoing to off pump CABG. The score had a predictive accuracy of 77.3%, almost 8% more than the other two scores. Therefore, although EuroScore II does not include in its model the use of cardiopulmonary bypass, it has a satisfactory accuracy to be used in clinical-surgical practice. On the other hand, the EuroScore I and the STS Score showed predictive accuracy not adequate for this type of surgery.

Funding Acknowledgement

Type of funding sources: None. Predictive accuracies of risk scores
Osteoporosis after heart transplantation with reference to immunosuppression and renal function
Authors: Lofdahl E L , Radegran G R
Published: October 2021

Background

Osteoporosis is commonly found in heart transplantation (HT) recipients, and may develop as an adverse effect of the immunosuppressive therapy, as well as be a consequence of factors associated with heart failure prior to HT. Chronic kidney disease (CKD) is furthermore, like osteoporosis, frequently found in the HT patient population, and may also arise as a side-effect of the immunosuppressive therapy.

Aims and method

We sought to describe the bone mineral density (BMD) evolution, predictors of osteoporosis, and survival, as well as incidence of osteoporosis in relation to CKD up to 10 years after HT. The project was conducted as a retrospective cohort study including patients who underwent HT at an age of at least 20 years between January 1988 and June 2016 at our center. The project was approved by the local ethics board (approval nos. 2010/114, 2011/777, 2014/92).

Results

Pre-transplant BMD was a negative predictor of osteoporosis during the first post-operative year, with a HR of 0.13 (95% CI 0.063; 0.26; P<0.001) and 0.54 (95% CI 0.34; 0.85; P<0.001) in the lumbar spine and femoral neck, respectively, adjusted for age, gender, BMI, and immunosuppressive therapy. Similarly, pre-transplant BMD was a negative predictor of osteoporosis also up to 10 years after HT, with a HR of 0.19 (95% CI 0.11; 0.32; P<0.001) and 0.55 (95% CI 0.39; 0.78; P=0.001), in the lumbar spine and femoral neck, respectively, adjusted for age, gender, BMI, and immunosuppressive therapy. CKD stage 3 or worse before HT was associated with a greater gain in BMD after HT compared with CKD stage less than 3 or normal kidney function (−2.5% [−5.6; 0.6] versus −6.6% [−8.8;-4.5], P=0.029), and was not associated with osteoporosis (Figure 1). Also, the cumulative incidence of osteoporosis in the lumbar spine after HT was higher in the group with CKD stage less than 3 or normal kidney function.

Conclusions

The greatest drop in BMD occurs within the first year after HT. Short- and long-term incidence of osteoporosis is positively associated with pre-transplant bone strength, suggesting that early initiation of osteoporosis preventive treatment, pharmacologically and non-pharmacologically, may be beneficial in preventing long- and short-term fracture-related morbidity and morbidity after HT. Moreover, CKD stage 3 or worse before HT was associated with higher lumbar BMD after HT, and was not a predictor of osteoporosis. CKD stage less than 3 or normal kidney function before HT exhibited a greater BMD loss in the lumbar spine. Finally, the change in GFR during the first postoperative year was not associated with long-term BMD loss or osteoporosis.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Anna-Lisa & Sven-Erik Lundgren's Foundation and ALF's Foundations, Lund, Sweden Figure 1
Correlation arterial stiffness and central blood pressure with obstructive sleep apnea in patients with resistant arterial hypertension
Authors: Rekovets O , Sirenko Y , Krushynska N , Torbas O , Kushnir S , Primak G , Granich V , Sidorenko P , Polishchuk S , Zhyvilo I , Radchenko G , Botsyuk Y
Published: October 2021

The aim assess correlation the arterial stiffness in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA)

Design

185 patients with AH were enrolled into the study. They were divided on 2 groups: OSA group – 148 patients were found to have OSA, indicated by at mean AHI of 38.1±2.5 h–1, and control group – 37 patients without OSA, mean AHI 3.02±0.25 h–1 (P<0.001). Patients of both groups were comparable on age, growth, total cholesterol level and office systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Results

Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event/h) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event/h) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg/m2, P<0.05), uric acid level (6.7±0.1 vs 5.6±0.4 mg/dl, P<0,05), higher carotid-femoral pulse wave velocity (PWVcf) (12.1±0.5 vs 10.2 m/s, P<0,05) and central systolic blood pressure (CSBP) (143.8±2.7 vs 136.2±3.4 mm Hg, P<0,05).

Patients of both groups had comparable office blood pressure (SBP 145.6±1.67 vs 138.4±3.66 mm Hg, P=0.057 and DBP 93.6+±1.18 vs 89.1±2.11 mm Hg, P=0.073), but significantly higher 24-h systolic and diastolic blood pressure. We suggest that in the study some patients with OSA had masked arterial hypertension.

Daytime sleepiness in OSA patients was associated with structural remodeling of the left ventricle myocardium and more expressed arterial stiffness: ESS score was independently correlated with snoring duration (β=−0.008; P=0.021), interventricular septum thickness (β=0.023; P=0.026), LVMI (β=−0.037; P=0.039) and indexes of central pulse wave: ejection duration (ED) (β=−0.020; P<0.001) and subendocardial viability ratio (SEVR) (β=−0.224; P=0.012). Nocturnal hypoxemia in OSA patients was associated with increased aortic stiffness and higher central blood pressure: desaturation index was independently correlated with Aix (β=4.167; P=0.009), Aix75 (β=−3.929; P=0.006) and central DBP (β=0.151; P=0.004).

Conclusion

In patients with RH and OSA nocturnal hypoxemia correlation with increased aortic stiffness and higher central blood pressure.

Funding Acknowledgement

Type of funding sources: None.