bluuebunny/crossref_metadata_2025 huggingface dataset:
Change of myocardial fluorodeoxyglucose uptake distribution after specific therapy of pulmonary arterial hypertension patients
Authors: Kazimierczyk R , Szumowski P , Malek L.M , Blaszczak P , Jurgilewicz D , Hladunski M , Sobkowicz B , Mysliwiec J , Grzywna R , Musial W.J , Kaminski K.A
Published: November 2020

Background

Right ventricular (RV) function is a major determinant of survival in patients with pulmonary arterial hypertension (PAH). In our previous study, we confirmed that increased RV fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) (presented as higher ratio of FDG uptake of RV to LV) was associated with progressive RV dysfunction and preceded hemodynamic and clinical deterioration in PAH patients. Now, we obtained second PET/MRI assessments of the study group after 2-years of PAH-targeted treatment.

Aim

The aim of the study was to obtain change of cardiac FDG uptake in PAH patients after follow-up period and to indicate factors mainly affecting this change.

Methods

Twenty-eight PAH patients (51.32±15.91 years) had simultaneous PET/MRI scans performed during baseline visit. FDG was used and its uptake was quantified as mean standardized uptake value (SUV) for both left (LV) and RV. Second PET/MRI assessments were done after 2 years in the group of twenty patients (four deaths, four patients did not agree to perform additional scans).

Results

After follow-up period, we observed significant change of MRI-derived RV ejection fraction (45±10% to 51.2±12.7%, p=0.03), and improvement in hemodynamic parameters obtained from right heart catheterization (RHC) e.g. mean pulmonary artery pressure, mPAP (48.5±17.2 to 41.8±17.1 mmHg, p=0.01) and pulmonary vascular resistance, PVR (8.7±5.3 to 7.0±4.2 WU, p=0.04). Follow-up SUVRV/SUVLV ratio significantly correlated with follow-up RV hemodynamic parameters confirming relationship between RV function and cardiac metabolic alterations (Table 1). Interestingly, patients who had improvement in SUVRV/SUVLV (lower follow-up value than baseline, n=11) had significantly higher mPAP at baseline visit (58.9±18.7 vs 40.3±11.8 mmHg, p=0.02), suggesting that RV FDG accumulation in advanced PAH may decrease after the PAH-specific treatment in accordance with the degree of reduction in the pulmonary vascular resistance.

Conclusion

Impaired RV function is associated with increased glucose uptake of RV myocytes estimated by FDG PET in PAH patients. Targeted treatment may improve RV function and thus affect previously altered cardiac glucose uptake.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Polish National Science Centre
Aortic stiffness and hemodynamics in Loeys-Dietz syndrome by 4Dflow CMR: a comparison with healthy volunteers and patients with Marfan syndrome
Authors: Ruiz Munoz A , Guala A , Rodriguez-Palomares J.F , Dux-Santoy L , Servato L , Lopez-Sainz A , La Mura L , Gonzalez-Alujas T , Galian-Gay L , Gutierrez L , Johnson K , Wieben O , Ferreira I , Evangelista A , Teixido-Tura G
Published: November 2020

Background

Connective tissue disorders, such as Loeys-Dietz (LDS) and Marfan (MFS) syndromes, are rare genetic diseases associated with progressive aortic dilation. Aortic dissections have been observed at lower aortic root diameters in LDS than in MFS, and research on aortic flow dynamics and biomechanics in LDS is lacking.

Purpose

To evaluate rotational aortic flow and aortic stiffness in LDS compared to healthy volunteers (HV) and MFS patients, using 4Dflow CMR.

Methods

Twenty-one LDS and 44 MFS patients, without previous aortic dissection or surgery, and 44 HV underwent a non-contrast-enhanced 4D flow CMR. In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR) and local aortic diameters were obtained at 20 equidistant planes from the ascending (AAo) to the proximal descending aorta (DAo). Aortic stiffness was quantified at the AAo and DAo using pulse wave velocity (PWV).

Results

LDS patients had lower IRF at the distal AAo and proximal DAo compared to HV (p=0.053 and 0.004, respectively), once adjusted for age, stroke volume and local aortic diameter; but no differences were found with respect to MFS (Figure). Although SFRR at the proximal DAo was increased in LDS patients compared to both HV (p=0.037) and MFS populations (p=0.015), once adjusted for age and aortic diameter, the difference in magnitude was small (Figure). On the other hand, AAo and DAo PWV revealed stiffer aortas in LDS patients compared to HV but no differences versus MFS patients (Table).

Conclusions

LDS patients showed decreased in-plane rotational flow and abnormally-high regional aortic stiffness compared to healthy controls, and similar hemodynamics and aortic stiffness with respect to MFS patients

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Instituto de Salud Carlos III, La Maratό TV3
Sex-related differences in clinical features and in-hospital outcomes of acute aortic dissection type b
Authors: Takahashi T , Yoshino H , Akutsu K , Shimokawa T , Ogino H , Kunihara T , Usui M , Watanabe K , Kawata M , Masuhara H , Yamasaki M , Hagiya K , Yamamoto T , Nagao K , Takayama M
Published: November 2020

Background

Acute aortic dissection (AAD) is a life-threatening medical condition with high morbidity and mortality. The association between female sex and poorer outcomes following surgery for AAD type A has been reported; however, the sex-related differences in clinical features and in-hospital outcomes of AAD type B remain to be elucidated.

Methods

We studied a total of 1877 patients with AAD type B who were enrolled in the Tokyo Acute Aortic Super-network from January 2013 to December 2016. Clinical features and in-hospital outcomes were compared between sexes. Independent predictors of in-hospital mortality were assessed using a multivariable analysis.

Results

The mean age of the patients was 69±13 years and 549 (29%) were females. Female patients were older than males (74±13 years vs 67±13 years; p<0.001). Females had lower systolic blood pressure on admission (158±37 mmHg vs 164±38 mmHg; p=0.007) and were more likely to have altered consciousness level at presentation (8.7% vs 3.9%; p<0.001), intramural hematoma (IMH)-type AAD (62.7% vs 53.6%; p<0.001), and DeBakey type IIIa (28.4% vs 21.8%; p=0.002) compared with males. Females were treated with medical therapy alone more frequently (90.3% vs 85.9%; p=0.009) and had a higher in-hospital mortality rate (5.3% vs 2.6%; p=0.036). A multivariable analysis revealed that age [per year, odds ratio (OR) 1.06; 95% CI 1.04–1.09; p<0.001], altered consciousness level (OR 3.28; 95% CI 1.54–6.98; p=0.002), shock/hypotension (OR 14.0; 95% CI 5.92–33.1; p<0.001), classic-type AAD (OR 2.54; 95% CI 1.36–4.73; p=0.003), and medical therapy alone (OR 0.28; 95% CI 0.15–0.54; p<0.001) were independent predictors of in-hospital mortality, whereas female sex was not predictive of in-hospital mortality (OR 1.64; 95% CI 0.91–2.96; p=0.10).

Conclusion

In AAD type B, females were older and had altered consciousness level, IMH-type, and a less widespread dissection more frequently than males. The overall in-hospital mortality was higher in females; however, female sex was not associated with in-hospital mortality after multivariable adjustment.

Funding Acknowledgement

Type of funding source: None
Association of osteoprotegerin with ascending aortic dissection
Authors: Goliopoulou A , Antonopoulos A , Oikonomou E , Miliou A , Theofilis P , Skotsimara G , Mystakidi V.C , Tousoulis D
Published: November 2020

Background

Thoracic aortic dissections are among the cardiovascular diseases with the highest mortality rates. Their often belated diagnosis and, hence, poor prognosis call for further research of their pathophysiology and possible biomarkers that will aid early diagnosis and increase survival rates. Osteoprotegerin is a known biomarker in cardiovascular disease, but it is yet to be determined whether it participates in aortic disease and thoracic aortic dissection in particular.

Purpose

This clinical study aimed at researching the role of osteoprotegerin in thoracic aortic aneurysm and dissection.

Methods

We compared three groups of patients; 20 patients with ascending aortic aneurysm (AAA), 10 patients with acute ascending aortic dissection (AAD) and 16 patients with normal aortic diameter undergoing cardiac surgery for other indication (control group). Serum samples were obtained from patients before surgery and osteoprotegerin levels were measured using the ELISA method.

Results

One-way analysis of variance revealed a significant association between the examined groups of patients and levels of osteoprotegerin (AAD: 62.72±44.53 pmol/L, AAA: 33.43±8.08 pmol/L, Control: 48.61±29.47 pmol/L, p=0.03). Importantly, after post-hoc analysis osteoprotegerin levels were found to be increased in patients with AAD compared to patients with uncomplicated AAA (62.72±44.53 pmol/L vs 33.43±8.08 pmol/L, p=0.03) (Figure 1), whereas there was no statistically significant difference between patients with AAA and the control group (33.43±8.08 pmol/L vs 48.61±29.47 pmol/L, p=0.34).

Conclusions

These findings suggest that osteoprotegerin may participate in the pathophysiology of aortic dissection but not in mechanisms of aortic dilatation. Therefore, detection of elevated osteoprotegerin levels in patients with diagnosed ascending aortic aneurysms might suggest an increased probability of dissection and, therefore, aid the decision-making process.

Figure 1

Funding Acknowledgement

Type of funding source: None
Left ventricular global longitudinal peak strain deterioration in patients undergoing endovascular repair of abdominal aortic aneurysms: the effect of arterial stiffness
Authors: Marketou M , Papadopoulos G , Kontopodis N , Patrianakos A , Nakou H , Maragkoudakis S , Plevritaki A , Alevizaki A , Vardas P , Ioannou C , Parthenakis F
Published: November 2020

Purpose

Invasive abdominal aortic aneurysm (AAA) replacement with an endograft interposes between the normal arterial tree which may acutely reduce overall systemic compliance and increase the input impedance. We evaluated the impact of aortic reconstruction, using currently available grafts and endografts, on pulse wave velocity (pwv) and its effect on early cardiac systolic function indices in these patients.

Methods

A total of 73 men, mean age 70±8 years, were evaluated. Of these, 61 underwent endovascular repair (EVAR) and 12 open repair (OS). All patients underwent an assessment with a standard conventional transthoracic and a two-dimensional speckle tracking echocardiography at baseline, at 1 and 6 months after the intervention. Carotid - femoral (c-f) artery waveforms were measured and pwv was determined in all participants on each follow up visit.

Results

No significant changes in blood pressure were observed during the study period. Notably, our findings revealed a significant reduction in global longitudinal peak strain (GLPS) during the 6 months follow-up (from −19.7±−5.9% at baseline to −17.1±−5.9% at 6 months, p=0.03). C-r pwv showed a significant increase 6 months after the procedure (from 10.7±−2.9 m/sec at baseline to 13.9±3.3 m/sec at 6 months, p<0.001). A significant time effect was found on cf-pwv, which showed an increase at 1 month and remained thereafter (p=0.007). Additionally, a deterioration in GLS values was revealed, with a significant increase at 1 month that persisted 5 months later (p<0.001). No significant group effect was observed between EVAR and open repair (p=0.98) and there was no significant interaction (p=0.96). Notably, the difference of global longitudinal strain (ΔGLS) between baseline and 6 months significantly correlated with the corresponding changes in cf-pwv (r=0.494, p<0.0001).

Conclusions

AAA repair not only leads to an increase in aortic stiffness, as measured by the increase in pwv, but also reduces cardiac systolic function. Our findings highlight the need a more intense cardiac surveillance program after aortic reconstruction. Further studies are needed to investigate how this may translate into long-term manifestations of cardiovascular complications and symptomatology.

Funding Acknowledgement

Type of funding source: None
Differential effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function, platelet activation and oxidative stress
Authors: Ikonomidis I , Vlastos D , Kostelli G , Kourea K , Katogiannis K , Tsoumani M , Parissis J , Thymis J , Andreadou I , Alexopoulos D
Published: November 2020

Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product.

Methods

We compared the effects of HNBC to those of tobacco cigarette (TCig), on arterial stiffness, oxidative stress, and platelet activation, acutely and after 1 month of switching to HNBC, as well as on endothelial, myocardial, and coronary function after 1 month of switching to HNBC. In the acute study, 50 smokers were randomised into smoking a single Tcig or an HNBC and after 60 minutes were crossed over to the alternate smoking (HNBC or Tcig). For the chronic phase, 75 smokers were examined. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. Pulse wave velocity (PWV) and biomarkers [malondialdehyde (MDA), protein carbonyls (PC), and thromboxane B2 (TXB2)] were assessed in the acute and chronic study. Myocardial deformation [global longitundinal strain (GLS), myocardial work index (GWI) and wasted myocardial work (GWW)], coronary flow reserve (CFR) by echocardiography, total arterial compliance (TAC), and flow-mediated dilation (FMD) were additionally assessed in the chronic study.

Results

Compared to baseline, TCig smoking acutely increased exhaled CO, PWV, MDA, and TxB2 (p<0.05), while no changes were observed after HNBC. Compared to resuming Tcig smoking, switching to HNBC for 1 month improved CO (mean change: −55% vs −2.4%), FMD (+55% vs +15%), CFR (+46% vs +4%), TAC (+9% vs −0.5%), GLS (+6% vs +1%), GWW (−19% vs +0.5%), MDA (−19% vs 1%), and TxB2 (−12% vs 4%) (p<0.05 for all comparisons).

Conclusions

HNBCs exert a less detrimental effect on vascular, cardiac and platelet function than tobacco

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Hellenic Association of Lipidiology, Atherosclerosis and Vascular disease
Longer sleep duration may negatively affect renal function
Authors: Mazidi M , Shekoohi N , Katsiki N , Banach M
Published: November 2020

Background

Observational studies evaluating the link between sleep duration and kidney function reported controversial results. In the present study, Mendelian Randomization (MR) analysis was applied to obtain unconfounded estimates of the casual association of genetically determined sleep duration with estimated glomerular filtration rate (eGFR) and the risk of chronic kidney disease (CKD).

Methods

Data from the largest genome-wide association studies (GWAS) on self-reported and accelerometer derived sleep duration, eGFR and CKD were analysed in total, as well as separately in diabetic and non-diabetic individuals. Inverse variance weighted method (IVW), weighted median (WM)-based method, MR-Egger, as well as MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were applied. To rule out the impact of single single-nucleotide polymorphism (SNP), the leave-one-out method was used.

Results

Overall, individuals with genetically longer self-reported sleep duration had a higher CKD risk (IVW: beta=0.358, p=0.047). Furthermore, in non-diabetics, longer self-reported sleep duration was negatively associated eGFR (IVW: beta=−0.024, p=0.020). Similarly, accelerometer derived sleep duration was negatively related to eGFR in the total population (IVW: beta=−0.019, p=0.047) and the non-diabetic individuals (IVW: beta=−0.025, p=0.014) (Table). No significant association was found between self-reported sleep duration and eGFR in the whole population (IVW: beta=−0.019, p=0.072) and T2DM patients (IVW: beta=0.028, p=0.484). None of the estimated associations was subjected to a significant level of heterogeneity. Furthermore, MR-PRESSO analysis did not show any chance of outliers for all estimates. The pleiotropy test, with very negligible intercept and insignificant p value. The results of the MR-RAPS were identical with the IVW estimates, highlighting again no possibility of pleiotropy. The leave-one-out method demonstrated that the links were not driven by single SNPs.

Conclusions

For the first time, the present study shed a light on the potential harmful effects of longer sleep duration (measured both objectively and subjectively) on kidney function. This finding was observed in the total population and in non-diabetic individuals, but not in those with diabetes. Further research is needed to elucidate the links between sleep duration, eGFR and CKD.

Funding Acknowledgement

Type of funding source: None
Time trends in use of cardioprotective medication in patients with peripheral artery disease between 1997 and 2016: a nationwide study
Authors: Kamil S , Sehested T.S.G , Houlind K , Lassen J.F , Gislason G , Dominguez H
Published: November 2020

Background

Peripheral artery disease (PAD) is associated with increased cardiovascular (CV) morbidity and mortality. Aggressive management of risk factors and lifestyle modification may improve outcomes for patients with PAD. The present study aims to investigate changes in use of cardioprotective medication after the incident diagnosis of PAD between 1997 and 2016.

Methods

By using Danish national healthcare registries, we identified all patients with first-time diagnosis of PAD between 1997 and 2016. These patients were classified into 2 main groups: PAD-all (n=167,762) that includes all PAD patients with or without a history of CVD, including myocardial infarction (MI), atrial fibrillation (AF), and stroke (n=167,761) and PAD-only (n=87,935) that comprise patients with PAD without a history of AF, MI, and stroke. We calculated temporal trends and assessed comparative use of cardioprotective medication in the first 12 months after the incident diagnosis of PAD.

Results

Our results showed an improved use of cardioprotective medication temporally in both groups. However, PAD-all were marginally better treated (Aspirin, 3.5% - 48.4%; Clopidogrel, 0% - 17.6%; VKA 0.9% - 7.8%; NOACs 0.0% - 10.1%; Statins, 1.9%- 58.1%; ACE-inhibitors, 1.2% - 20.6%), compared to PAD-only (Aspirin, 2.9% - 54.4%; Clopidogrel, 0% - 11.9%; VKA 0.9% - 2.4%; NOACs 0.0% - 3.4%; Statins, 1.5%- 56.9%; ACE-inhibitors, 0.9% - 17.2%), respectively. Proportion of PAD patients treated with any cardioprotective medication was greater among those with a history of MI or stroke. Whereas, PAD patients with a history of AF were substantially better treated with VKA and NOACs.

Conclusion

In this nationwide study, use of cardioprotective medication increased considerably with time, but there remains an underuse of guideline-recommended therapy in patients with PAD.

Funding Acknowledgement

Type of funding source: None
Paclitaxel-coated Zilver PTX drug-eluting stent treatment does not result in increased long-term all-cause mortality compared to uncoated devices from Japan post-market surveillance study
Authors: Yokoi H
Published: November 2020

Purpose

Favorable long-term outcomes with the Zilver PTX drug-eluting stent (DES) in treating patients with femoropopliteal lesions have been demonstrated. A multicenter, prospective, post-market surveillance study (PMS) in Japan evaluated this DES in a real-world patient population. Recently, meta-analysis that grouped both DES and drug-coated balloons (DCB) together indicated a higher incidence of late all-cause mortality for paclitaxel- based devices compared to uncoated balloon or bare-metal stent (BMS) at 2 years up to 5 years. To evaluate the long-term safety of the Zilver PTX DES, compared with BMS using Japan-PMS study.

Methods

The Japan DES PMS had no exclusion criteria and enrolled consecutive patients with symptomatic PAD involving the above-the-knee femoropopliteal arteries. Safety and effectiveness of the DES was evaluated in real-world patients with complex femoropopliteal artery lesions through 5 years. Follow-up in the study is complete. The concurrent Japan BMS PMS also had no exclusion criteria and enrolled consecutive patients with symptomatic PAD involving the above-the-knee femoropopliteal arteries. Patients who were enrolled in the BMS study but who also had a DES placed (n=18) were excluded from the current analysis. Follow-up in the BMS study was only required through 3 years and is complete.

Results

The Japan DES PMS enrolled 904 DES patients, and the Japan BMS PMS enrolled 190 BMS patients. In the DES group, there were 127 deaths through 3 years and 186deaths through 5 years. In the BMS group, there were 22 deaths through 3 years. Through 3 years, the risk of mortality was 15.7% for DES group and 15.3% for BMS group. Through 5 years, the risk of mortality was 25.8% for the DES group. There was no difference in mortality between the two groups (log-rank p=0.92).The Cox proportional hazards model revealed that CLI (p<0.0001), age (p<0.0001), gender (p=0.001), renal failure (p<0.0001) were significantly associated with mortality. Hypercholesterolemia (p=0.004) was associated with lower risk of mortality. Treatment with Zilver PTX (p=0.49) was not associated with mortality. In the covariate analysis of paclitaxel dose, the significant factors were identical to the treatment analysis, and there was no association or trend of paclitaxel dose (p=0.07) with mortality.

Conclusion

Analyses of the paclitaxel-coated Zilver PTX DES utilizing patient-level data from the Japan PMS demonstrated no increase in long-term all-cause mortality. The 5-year results from this real-world, all-comers study continue to show positive long-term outcomes and demonstrate the benefit of the Zilver PTX DES across a broad patient population.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): COOK
Comparison of endovascular infrapopliteal revascularization strategies based on the angiosome model in diabetic patients within critical limb ischemia
Authors: Kreider N , Remp T , Puntscher S , Koenig A , Siebert U , Stempfle H.U
Published: November 2020

Background

The relevance of an angiosome model for infrapopliteal endovascular interventions (EVT) in diabetic patients is still in debate because the lesions are more likely to be diffuse with a different pattern of collateral arteries ranging from reduced to normal caliber. The aim of this study was to analyse the outcome of two different endovascular infrapopliteal interventional strategies (Group I: angiosome-based direct revascularization -DR- vs. Group II: complete (direct + indirect) revascularization strategy -CR-) in diabetic patients with critical limb ischemia. Furthermore we analyzed the outcome if DR or CR failed and only indirect revascularization (IR) or no revascularization was possible. Both groups were differentiated in patients with collaterals, defined as an intact pedal arch (immediate or after pedal PTA).

Patients and methods

We performed a prospective cohort study in routine angiologic patients. The database includes 91 consecutive EVT with two intrapopliteal interventional strategies performed in 68 diabetic patients (pts.; 24 female, 44 male, mean age 73±10 years) between 2013–2015 and 2016–2019. The study included only patients with CLI (Rutherford class 4 or greater) with a critical subtotal stenosis or occlusion of at least one artery below the knee. EVT were performed mainly by an antegrade approach and with the use of 5F sheaths. In case of failure to recanalise, a retrograde approach was attempted. Positive clinical outcome was defined as wound healing without amputation or wound healing after minor amputation, combined with a symptom improvement to Rutherford category 0 or 1 after 6 months. The clinical outcome proportions were compared using the Fisher's exact test.

Results

An angiosome-based direct reperfusion (DR) of the artery supplying the ischemic tissue and a complete (both direct and indirect, CR) revascularization strategy demonstrated a similar positive clinical outcome (92,6% vs. 90,5%; p=0.594). Indirect revascularization showed a significantly lower positive outcome in comparison to a successful DR as well as CR strategy (33,3% vs 92,6%, p=0.0003; 40% vs 90,5%, p=0.001). IR outcome improved by the presence of collaterals (66,7% vs. 30,8%).

Conclusions

In case of successful intervention, both strategies (DR and CR) yielded a similarly high proportion of positive clinical outcome. The role of collaterals and the pedal arch are important for the clinical outcome in patients in whom only indirect revascularization was possible, because of unsuccessful CR or DR. The time of the procedure/radiation, the risk to reopen more than one vessel, the necessary amount of contrast medium and final the costs of the procedure should also be considered for an individually based decision process to perform an angiosome-based direct or a complete revascularization.

Funding Acknowledgement

Type of funding source: None
Comparison of different access sites (radial, brachial and femoral) for subclavian artery intervention
Authors: Ruzsa Z , Sandor N , Toth J , Deak M , Zafirovska B , Nemes B , Pirlet C.H , Merkely B , Bertrand O.F , Kedev S
Published: November 2020

Introduction

The primary purpose of this multicenter prospective register was to evaluate the success and complication rate of different access sites for subclavian artery intervention. Secondary purpose was to investigate the safety of the distal radial artery access for subclavian artery intervention.

Methods

The clinical and angiographic data of 223 consecutive patients with symptomatic subclavian and anonym artery stenosis treated via transradial (TR), transbrachial (TB) and transfemoral (TF) access between 2015 and 2019 were evaluated in a multicenter registry. The exclusion criteria of the intervention was the acute proximal subclavian artery thrombosis. Primary endpoint: angiographic outcome of the subclavian and anonym artery intervention, rate of major and minor access site complications. Secondary endpoints: procedural complications, consumption of the angioplasty equipment, cross over rate to another puncture site and hospitalization in days.

Results

The procedure was successful in 182/184 in TR, in 5/5 in TB and in 32/32 patients in TF group. The cross over rate in the TR, TB and TF group was 0%. Chronic total occlusion recanalization was successful in 75/77 cases in TR, and 15/15 cases in the TF group. Contrast consumption was 152±106 ml in TR, 99±22.5 ml in TB and 152±95 in TF group, respectively (p=ns). Cummulativ dose was 602±1205 mGray in RA, 455±210 mGray in BA and 1089±1674 mGray in FA group (p<0.05). Procedural complications occurred in 1/184 (0.5%) case in RA group, in 0 case (0%) in BA group and in 4/32 cases (12.5%) in the FA group (p<0.05). Major access site complication were detected in 3 patients (1.6%) in RA, in 1 patient in BA (20%) and in 1 patient in FA group (3.1%) (p<0.05). Minor access site complication were encountered in 9 patients in the RA (4.8%), in 1 patient in the BA (20%) and in 8 patients in the FA group (25%) (p<0.05). Distal radial access was used in 29 cases and proximal radial access in 155 patients. The rate of radial artery occlusion in proximal and distal radial group was 5.1% and 0% (p<0.05).

Conclusions

Subclavian artery intervention can be safely and effectively performed using radial access with acceptable morbidity and high technical success. Femoral and brachial access is associated with more access site complications than radial artery access. Distal radial access is associated with less radial artery occlusion than proximal radial artery access.

Funding Acknowledgement

Type of funding source: None
Long term clinical outcome after self-expandable nitinol stent implantation for femoropopliteal occlusive disease in hemodialysis patients
Authors: Ito R , Oshima S , Ishii H , Takahashi H , Umemoto N , Sakakibara T , Murohara T
Published: November 2020

Background

Endovascular therapy (EVT) using self-expandable bare nitinol stent (BNS) has been commonly accepted in patients with symptomatic femoropopliteal (FP) occlusive disease. However, poor clinical outcomes in hemodialysis (HD) patients are major problems. We investigated the impact of HD on clinical outcome after EVT in patients with FP disease.

Methods

A total of 427 consecutive HD patients undergoing successful EVT with BNS for FP disease were enrolled with 157 non-HD patients as a control group. They were followed-up for 5 years. We collected data on target lesion revascularization (TLR) rate, and limb salvage rate as well as survival rate. Propensity-score matching analysis was performed to investigate the true impact of HD on the outcome.

Results

Critical limb ischemia was observed in 44.0% of overall population (43.0% in HD group vs. 46.8% in non-HD group, p=0.42). Rates of diabetes (67.1% vs. 58.1%, p=0.045) and coronary artery disease (73.5% vs. 58.3%, p=0.0008) were higher, while age (70±10 years old vs. 76±10 years old, p<0.0001) and TASC2 C/D lesion (27.9% vs. 44.6%, p=0.0002) were lower in HD group compared to non-HD group. Pre-procedural C-reactive protein level (0.4mg/l vs. 0.3mg/l, p=0.045) was higher and serum albumin level (3.6g/dl vs. 3.8g/dl, p=0.0045) was lower in HD group than those in non-HD group. The freedom rate from TLR at 5 years was significantly lower in HD group than in non-HD group [47.2% vs. 65.2%, hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.23–2.64, p=0.0017]. The limb salvage rate was comparable between the groups (93.3% vs. 97.1%, HR 1.57, 95% CI 0.58–5.47, p=0.41), while the survival rate was significantly lower in HD group compared to non-HD group (60.6% vs. 86.0%, HR 2.53, 95% CI 1.56–4.36, p=0.0002). After propensity-score analysis, 250 patients (125 in each group) were matched without any difference of clinical characteristics in both groups. In the matched cohort, the freedom rate from TLR was still lower in HD group compared to non-HD group (46.7% vs. 66.6%, HR 2.25, 95% CI 1.35–3.87, p=0.0019). The adjusted limb salvage rate was consistently similar between the groups (95.4% vs. 97.3%, HR 1.10, 95% CI 0.20–5.94, p=0.91). Also, the adjusted survival rate was lower in HD group than in non-HD group (47.6% vs. 89.9%, HR 3.60, 95% CI 1.89–7.44, p<0.0001).

Conclusion

The freedom rate from TLR at 5 years after BNS implantation for FP disease were significantly lower in HD group than in non-HD group, though the limb salvage rate was similar between the groups. The survival rate was consistently lower in HD group compared to non-HD group. HD status had a great impact on TLR and mortality after EVT with BNS in patients with FP disease.

Funding Acknowledgement

Type of funding source: None
Validity of ultrasound arterial wall vascularization for assessment of vascular inflammation
Authors: Sato W , Kobayashi Y , Otaka M , Unuma M , Yamanaka T , Suto Y , Sato T , Iino T , Seki K , Suzuki T , Terata K , Iino K , Watanabe H
Published: November 2020

Background

Vascular inflammation plays a fundamental role in most vascular diseases including atherosclerosis and vasculitis syndrome, in which arterial wall vascularization (AWV) frequently develops. Visualization of AWV is informative in detecting the vascular inflammation but is challenging. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low-velocity flows. We examined an availability of SMI for assessment of the instability of atherosclerotic plaques and the activity of Takayasu arteritis (TA).

Methods and results

The study consists of two independent and consecutive parts A and B, examined in carotid stenosis (A) and TA (B), respectively. In part A, 12 patients with symptomatic severe carotid stenosis (CS group) scheduled for carotid endarterectomy were enrolled. In six of 12 patients, preoperative ultrasonography with SMI showed intraplaque neovascularization at the plaque shoulder. Postoperatively, histopathology confirmed the neovessels at the corresponding sites of visualized AWV. SMI had a sensitivity of 67%, specificity of 90% for detection of AWV in CS group. In SMI analysis, false positive findings were caused by motion artifact and arterial wall calcification, and a false negative finding is attributed by intraplaque hemorrhage. In part B, 10 patients with TA were enrolled. All patients underwent 18F-FDG-PET/CT, and its vascular uptake were compared with AWV detected by SMI. Bilateral common carotid arteries (CCA), internal carotid arteries and common iliac arteries were examined by SMI. Active vascular 18F-FDG uptake (max SUV >2.1) were found at five sites in three patients, which were not significantly correlated with the prevalence of macaroni sign, increase in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Of note, SMI revealed AWV at five sites corresponding to uptake of 18F-FDG, with a sensitivity/specificity of 100% and 98%, positive predictive value 71%, and a negative predictive value 100%.

Conclusion

SMI enables visualization of AWV at vulnerable plaque in CS patients and at 18F-FDG positive sites in TA patients. SMI has potential as a modality to detect the vascular inflammation.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Scientific Research, Japan
The correlations between anti-factor Xa activity values and PT/APTT at peak and trough times in patients with venous thromboembolism using high dose of apixaban
Authors: Ono R , Fukushima K , Yamazaki T , Takahashi H , Hori Y
Published: November 2020

Background

The high dose (20mg/day) of apixaban is used for the initial treatment of venous thromboembolism for the first week. Although patients taking direct oral anticoagulants do not require routine coagulation monitoring, the correlations between anti-factor Xa activity (AXA) and routine coagulation markers such as prothrombin time (PT) and activated partial thromboplastin time (APTT) at peak and trough times especially when using high dose of apixaban have not been reported so far.

Purpose

The purpose is to assess the correlations between AXA values and PT/APTT at peak and trough times in patients with venous thromboembolism using high dose of Apixaban.

Methods

Twenty-six patients (10 male; 71±15 years) with proximal venous thromboembolism or pulmonary embolism using high dose (20mg/day) of apixaban were enrolled. We measured AXA, using chromogenic assay with the HemosIL Liquid Heparin kit, PT and APTT at peak and trough times. The peak time was defined as 3 hours after the intake of apixaban, and the trough time was defined as that immediately before the intake of apixaban.

Results

A significant and strong positive correlation was observed between AXA and PT at both peak and trough times (R=0.795, p<0.01 and R=0.766, p<0.01, respectively). A significant and moderate positive correlation was observed between AXA and APTT at trough time (R=0.527, p<0.01), but no correlation was observed between AXA and APTT at peak time (R=0.366, p=0.07).

Conclusion

Our findings reveal the relationship between AXA and PT at peak and trough times has a significant strong correlation. These results suggest measuring of PT may be alternative and effective way of monitoring of AXA values when using high dose of apixaban.

Figure 1

Funding Acknowledgement

Type of funding source: None
Assessment of of twenty-five variants of polymorphic genes for lipid and carbohydrate metabolism, vascular inflammation and the neurotransmitter system in the first non-cardioembolic ischemic stroke
Authors: Shishkova V.N , Adasheva T.V , Stakhovskaya L.V , Remennic A.Y.U , Valyaeva V.V
Published: November 2020

The study of the relationship between various of gene polymorphism: APOA-V (rs34282181), APOA-V (rs619054), APOC-IV (rs1132899), LPL (rs199675233), LP(a) (rs41267817), APOB (rs1042031), APOB (rs676210), APOC-IV (rs1132899), APOH (rs4581), ANGPT4 (rs1044250), APOE (rs5174), APOE (rs 7412), APOE (rs 429358), APOD (rs7659), ADIPOQ (rs17366743), ADIPOQ (rs185847354), ADIROR (rs12342), TNFα (rs1800620), VEGFA (rs 62401172), IL6 (rs56383910), IL8 (rs1803205), MTHFR (rs1801131), MTHFR (rs1801133), GRM 1 (rs1047005), GRM 3 (rs2228595), BDNF (rs6265) and the development of the first non-cardioembolic ischemic stroke

Material and methods

The alleles frequencies and genotypes assessed for 25 mono-nucleotide polymorphic gene variants in 206 patients, who had first non-cardioembolic ischemic stroke, and 206 persons with no stroke, comparable with age, gender, place of living and ethnicity. Genotyping of polymorphisms was done with the prepared TaqMan probes.

Genotyping of single nucleotide polymorphisms of genes: APOA-V (rs34282181), APOA-V (rs619054), APOC-IV (rs1132899), LPL (rs199675233), LP(a) (rs41267817), APOB (rs1042031), APOB (rs676210), APOC-IV (rs1132899), APOH (rs4581), ANGPT4 (rs1044250), APOE (rs5174), APOE (rs 7412), APOE (rs 429358), APOD (rs7659), ADIPOQ (rs17366743), ADIPOQ (rs185847354), ADIROR (rs12342), TNFα (rs1800620), VEGFA (rs 62401172), IL6 (rs56383910), IL8 (rs1803205), MTHFR (rs1801131), MTHFR (rs1801133), GRM 1 (rs1047005), GRM 3 (rs2228595), BDNF (rs6265) using ready-made TaqMan probes was carried out.

Results

For polymorphisms ApoD (rs7659), ApoA5 (rs619054), ApoB (rs676210), IL8 (rs1803205) there was significant difference between groups in the variety of minor alleles and genotypes.

Conclusions

There is significant relation of mononucleotide polymorhpisms of the genes APOD (rs7659), ApoA5 (rs619054), ApoB (rs676210), IL8 (rs1803205) with the development of the first non-cardioembolic ischemic stroke In the studied groups.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Moscow Center for Neurorehabilitation
Blood-based biomarkers for the long-term prognosis after acute ischemic stroke – results of the Linz Stroke Unit (LISU) study
Authors: Dieplinger B , Bocksrucker C , Egger M , Bundschuh C , Mueller T
Published: November 2020

Background

The aim of our study was to evaluate the long-term prognostic value of blood-based biomarkers in comparison to the established National Institute of Health stroke scale (NIHSS) score in patients with acute ischemic stroke.

Methods

We measured plasma concentrations of IL-6, NT-proBNP, D-dimer, hs-cTnT, sST2, MR-proADM, MR-proANP, CT-proET-1, Copeptin, and Procalcitonin in 721 consecutive acute ischemic stroke patients within 24 h after admission to our stroke unit. Endpoint was all-cause mortality at 3 years.

Results

During follow-up, 199 patients died (28%). In univariate Cox proportional hazards regression analyses using a dichotomized approach according to median values, all blood-based biomarkers were associated with prognosis. However, in the multivariate analysis after adjustment for several clinical variables, only IL-6 >7 pg/mL (risk ratio, 3.00; 95% CI, 2.03–4.44; P<0.001), NT-proBNP >447 ng/L (risk ratio, 2.67; 95% CI, 1.81–3.92; P<0.001), NIHSS score >3 (risk ratio, 2.24; 95% CI, 1.63–3.07; P<0.001), Copeptin >13 pmol/L (risk ratio, 1.87; 95% CI, 1.34–2.61; P<0.001), and hs-cTnT >14 ng/L (risk ratio, 1.74; 95% CI, 1.21–2.49; P=0.001) remained independent predictors. ROC curve analysis for mortality prediction demonstrated a higher area under the curve (AUC) for IL-6 and NT-proBNP, respectively, when compared to the NIHSS score (IL-6 AUC 0.81 vs. NIHSS AUC 0.75; P=0.016 and NT-proBNP AUC 0.80 vs. NIHSS AUC 0.75; P=0.039) and similar AUCs when comparing the NIHSS with hs-TnT (hs-TnT AUC 0.77) and Copeptin (Copeptin AUC 0.72).

Conclusions

In this large cohort of patients with acute ischemic stroke the blood-based biomarkers IL-6, NT-proBNP, hs-cTnT, and Copeptin were strong and independent prognostic markers for 3-year all-cause mortality. IL-6 and NT-proBNP even outperformed the NIHSS score for long-term mortality prediction.

ROC plots for 3-year all-cause mortality

Funding Acknowledgement

Type of funding source: None
The CRP/albumin ratio: a novel predictor of in-stent restenosis after carotid artery stenting
Authors: Calik A.N , Cinar T , Inan D , Genc D , Kuplay H , Karatas M.B , Emre A
Published: November 2020

Background

In-stent restenosis (ISR) remains a potential problem and raises concerns about the long-term safety and efficacy of carotid artery stenting (CAS). As inflammation has a pivotal role in the pathogenesis of ISR, a novel and more sensitive inflammatory marker, CRP/albumin ratio (CAR) may be used to predict ISR in patients undergoing CAS.

Purpose

The present study aimed to assess the predictive value of preprocedural C-reactive protein/albumin ratio (CAR) for ISR after CAS.

Method

In this retrospective study, 206 patients who underwent successful CAS procedure in a tertiary heart centre were included. For each patient, both C-reactive protein (CRP) and serum albumin were determined before the index procedure. The CAR was calculated by dividing serum CRP by serum albumin level. The main end-point of the study was ISR during long-term follow-up.

Results

ISR developed in 34 (16.5%) out of 206 patients after a mean follow-up of 24.2±1.5 months. The CAR was significantly elevated in patients with ISR compared to those who were not (0.99 [1.3] vs. 0.15 [0.2], p<0.01, respectively). In a multivariate Cox regression analysis, the CAR was an independent predictor of ISR (HR: 1.85, 95% CI: 1.29–2.64, p<0.01). A ROC curve analysis revealed that the optimal value of CAR in predicting ISR was >0.53 with a sensitivity of 100% and a specificity of 97.1% [area under curve (AUC) 0.98, p<0.001].

Conclusion

The present study demonstrated that CAR, a new inflammatory-based index, is a strong independent predictor of ISR after CAS. As a simple and easily accessible parameter, this index may be used for the assessment of ISR in patients who are treated with CAS.

Funding Acknowledgement

Type of funding source: None
Which characteristics of patent foramen ovale and associated anatomical structures determine risk of cryptogenic brain ischemia?
Authors: Dubrava J , Sidlo R
Published: November 2020

Background

Linking of the characteristics of persistent foramen ovale (PFO) and associated septal/atrial structures to a causal role in cryptogenic stroke is not definitely known.

Purpose

In a prospective study to assess the risk of morphological and functional features of PFO and selected septal/atrial structures for cryptogenic stroke or transient ischemic attack (TIA).

Methods

A total of 1 270 consecutive patients underwent contrast transesophageal echocardiography – 702 patients with cryptogenic brain ischemia and 568 controls without the history of stroke or TIA. We compared 224 patients with cryptogenic stroke or TIA and PFO (31.9% of all patients with brain ischemia) to 106 controls with PFO (18.7% of the control group) (p<0.001). We analyzed diameter and length of the PFO, presence of the large PFO (diameter ≥4 mm), long PFO (length ≥10 mm), atrial septal aneurysm (excursion ≥15 mm), Eustachian valve or Chiari network, shunt severity (graded with a 1–3 scale) and the right-to-left shunt present under basal conditions.

Results

All parameters of PFO significantly increased relatíve risk (RR) of cryptogenic stroke/TIA vs population without PFO [RR (95% CI); p]: PFO – 2.04 (1.57; 2.66); <0.001, large PFO – 4.99 (2.67; 9.39); <0.001, PFO with diameter ≥ median 2.4 mm – 3.20 (2.19; 4.68); <0.001, long PFO – 2.25 (1.65; 3.06); <0.001, PFO with length ≥ median 12 mm – 2.26 (1.61; 3.17); <0.001, moderate or large shunt – 2.25 (1.65; 3.08); <0.001, shunt present under basal conditions – 2.47 (1.74; 3.52); <0.001. None of the associated structures (atrial septal aneurysm, atrial septal aneurysm + PFO, Eustachian valve or Chiari network, atrial septal defect) significantly increased RR of cryptogenic stroke/TIA vs population without the respective structure. In a multivariable logistic regression model PFO diameter ≥ median 2.4 mm and long PFO emerged as significant risk factors of stroke or TIA. Patients with brain ischemia had significantly larger PFO diameter and higher prevalence of large PFO compared to controls (3.1±2.0 mm vs 2.3±1.4 mm, p<0.001; 8.8% vs 2.1%, p<0.001). Symptomatic patients had significantly higher prevalence of long tunnel (23.2% vs 12.3%, p<0.001) and of moderate/large shunt (22.2% vs 11.8%, p<0.001). There was no significant difference between patients and controls in prevalence of atrial septal aneurysm, atrial septal aneurysm + PFO, Eustachian valve or Chiari network, atrial septal defect.

Conclusions

Among the parameters of PFO large diameter was the most powerful risk factor of cryptogenic brain ischemia. Long PFO, moderate/large shunt and shunt present under basal conditions also significantly increased the risk. Associated septal/atrial structures were not found as risk factors.

Funding Acknowledgement

Type of funding source: None
Comparison of upper extremity versus lower extremity vein injections of bubble contrast in assessment of patent foramen ovale
Authors: Mutlu D , Durmaz E , Karpuz M.H , Karadag B , Ikitimur B , Koca D , Raimoglu U , Ohtaroglu Tokdil K , Tokdil H , Ongen Z
Published: November 2020

Background

Patent foramen ovale (PFO) is one of the causes of cardioembolism and closure of PFO is recommended by the current guidelines in patients with recurrent stroke. Transoesophageal echocardiography (TEE) using bubble-contrast study is the gold standard imaging modality for the assessment of interatrial septum. Upper-extremity veins are the most common way of injection, however, the presence of Eustachian valve and flow dynamics when bubble-contrast injection performed via upper extremity veins limits the assessment of interatrial septum in several cases. In this study, we aimed to compare the efficacy of bubble-contrast study between upper extremity injection and lower extremity injection.

Material/Methods

Patients with a suspicion of cardioembolism who were undergoing TEE study were included in this study. After routine assessment of cardiac structures, the bubble-contrast study was performed using agitated saline from both upper-extremity vein and lower-extremity vein with Valsalva manoeuvre. Right-to-left shunt and numbers of bubbles transmitted from the septum were recorded.

Results

We prospectively included 45 patients and 21 PFOs were detected. There were 9 patients with prominent Eustachian valve and in 6 patients Eustachian valve hampered the complete opacification of the right atrium. In 3 patients flow from the superior vena cava was directed towards the tricuspid valve and hampered the complete opacification. Among 21 patients with PFO, in 6 patients right-to-left shunt was not observed when agitated-saline was injected via the upper-extremity vein, however, the shunt was observed when the agitated-saline was injected via the lower-extremity vein. In 14 patients amount of bubbles passing through the interatrial septum were significantly higher when the injection was performed via the lower-extremity vein especially in patients with prominent Eustachian valve.

Conclusion

Our preliminary results indicated that compared to upper-extremity veins, injection via the lower-extremity veins provides better opacification of right atrial septum and assessment of interatrial septum. Therefore, injection through the lower-extremity veins would be the preferred choice particularly in patients with prominent Eustachian valve or downward directed flow from the superior vena cava.

Figure 1

Funding Acknowledgement

Type of funding source: None