bluuebunny/crossref_metadata_2025 huggingface dataset:
P5741Impaired arterial elastic properties and endothelial glycocalyx in patients with embolic stroke of undetermined source
Authors: Ikonomidis I , Frogoudaki A , Vrettou A R , Katogiannis K , Andreou I , Palaiodimou L , Vlastos D , Varoudi M , Pavlidis G , Lantinioti C , Zervas P , Efentakis P , Tsoumani M , Andreadou I , Tsivgoulis G
Published: October 2019

Background and purpose

Cardioembolism is a postulated mechanism of embolic stroke of undetermined source (ESUS). We investigated endothelial glycocalyx, aortic elastic properties, oxidative stress, and their association left atrial (LA) function in ESUS and healthy individuals.

Methods

In 90 ESUS patients (age 50.4±13.2) and 90 controls with similar risk factors, we measured: a) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 micrometers), a marker inversely related with glycocalyx thickness, b) pulse wave velocity (PWV), central systolic blood pressure (cSBP) and augmentation index (AIx), c) LA volume and strain using speckle-tracking imaging, d) Malondialdehyde (MDA) and protein carbonyls (PC), as oxidative stress markers.

Results

Compared to controls, ESUS had higher PWV, PBR MDA, and PC levels as well as higher LA volume and reduced reservoir LA strain (p<0.05). PBR>1.18 μm of microvessel ranging from 5–9μm and PWV>10.2m/s were associated with ESUS on multivariable analysis (odds ratio: 2.374 and 5.429, p<0.05 respectively) and increased the c-statistic of the initial model from 0.54 to 0.71. In ESUS, glycocalyx damage (increased PBR) was related with increased PWV (p<0.01) which was linked with LA reservoir strain after controlling for age, sex, and risk factors [p=0.03]. Increased MDA and PC were related with glycocalyx damage, increased PWV (r=0.67 and r=0.52) AIx, central SBP and aortic atheroma (p<0.01).

Conclusions

Arterial function and endothelial glycocalyx are severely impaired in ESUS and are linked to LA dysfunction suggesting their contribution to ESUS pathogenesis.
P5745The Impact Of Brain Atrophy In The Young Patientwith Severe Heart Failure
Authors: Sekiguchi H , Ishida I , Suzuki A , Shiga T , Hagiwara N
Published: October 2019

Background

Recently, several reports recognized the heart failure (HF) effected the brain impairment by impaired vascular blood flow and brain atrophy. However, there are no report mentioned the relationship brain atrophy and the mortality in young patient with severe HF.

Methods

A total 368 patients with severe HF form 2009 to 2014. We analyzed 117 patients aged under 55 years old without past history of cerebral artery disease. We evaluated the brain atrophy using head CT data by AZE VitualPlace and compared their clinical background, cardiac function, and the mortality.

Results

The mean age was 41±10 years (male 80%) and the average LVEF was 39±8%. The median follow-up period was 1.264 days. During the observations, we observed a total of 12 all cause death. The ROC analysis revealed that 10.2% of atrophy area was cut-off and the sensitivity was 80%, specificity was 69.5% and the area under the curve was 0.71. In univariate analysis, severe NYHA class, low LVEF, large brain atrophy (>10%) were significant factors as predictor of mortality (P<0.05). Interestingly, as a result of multiple analysis, only the large brain atrophy was independent predictor of mortality. Kaplan-Meier analysis resulted that the patients with the large brain atrophy as over 10% were statistically significant worse mortality than the other patients (P=0.02).

Conclusion

This is a first report to evaluate the brain atrophy area by CT in young severe HF patients. HF patients with ≥10% of brain atrophy have higher mortality.
P5750Manipulation strategy for crossing coronary chronic total occlusion: an update from the Japanese CTO-PCI expert registry
Authors: Tanaka H , Tsuchikane E , Sumitsuji S , Muramatsu T , Ashida K , Ito Y , Yamane M , Okamura A , Hosaka F , Katoh O
Published: October 2019

Background

The percutaneous coronary intervention (PCI) strategy for chronic total occlusion (CTO) based on the guidewire manipulation time remains infrequent.

Purpose

We aimed to assess CTO-PCI strategy on the basis of guidewire manipulation time.

Methods

A total of 5843 patients undergoing CTO PCI between January 2014 and December 2017 and enrolled in the Japanese CTO-PCI expert registry were assessed. Their CTO-PCI strategies, procedural outcomes, and guidewire manipulation time were analysed.

Results

The primary retrograde approach was performed on 1562 patients (26.7%). The overall guidewire and technical success rates were 92.8% and 90.6%, respectively. Median guidewire manipulation time of guidewire success and failure were 56 (interquatile range [IQR]: 22 to 111) min and 176 (IQR: 130 to 229) min, respectively. The average Japanese CTO score of the primary antegrade approach with the antegrade alone, the primary antegrade approach with the retrograde approach, and the primary retrograde approach were 1.7±1.1, 2.1±1.2, and 2.3±1.1, respectively (p<0.001). Median successful guidewire crossing time of single wiring in the antegrade alone was 23 (IQR: 11 to 44) min, and that of the primary retrograde approach was significantly shorter than that of the primary antegrade approach with the retrograde approach (107 [IQR: 70 to 161] min vs. 126 [IQR: 87 to 174] min; p<0.001). Reattempt, CTO length ≥20 mm, and proximal cap ambiguity were the predictors of guidewire failure in the primary antegrade approach with antegrade alone, but were not those in the primary retrograde approach.

Conclusions

Although successful guidewire crossing time of the primary antegrade approach with the antegrade alone is short, that of the primary retrograde approach can be shorter than that of the primary antegrade approach with the retrograde approach. Choosing an appropriate CTO-PCI strategy leads to shortening of successful guidewire crossing time.
P5751Comparison of side branch dilation techniques after resorbable magnesium scaffold implantation: a bench study
Authors: De Pommereau A , Mogi S , De Hemptinne Q , Adjedj J , Varenne O , Picard F
Published: October 2019

Background

Resorbable magnesium scaffolds (RMS) have demonstrated good safety profile to treat de novo lesions. Nevertheless, bifurcations lesions involving a side branch>2.0mm in diameter were excluded from these studies and such lesions remain technically challenging due to concerns of scaffold deformation or fracture.

Purpose

We sought to evaluate different side branch dilation strategies after provisional T stenting strategy with RMS.

Methods

Using RMS in bifurcations phantoms, three different side branch dilation strategies after provisional T stenting were compared: POT-side-rePOT (rePOT), Kissing-Balloon Inflation (KBI) and Mini Kissing-Balloon Inflation (MKBI) strategies. In vitro experiments were performed under fluoroscopy in the catheterization laboratory. Struts and connectors fractures were evaluated by micro computed-tomography and apposition by optical coherence tomography (OCT). In addition, step by step proximal over-expansion was carried out with different incremental NC balloons and scaffolds were then re-inspected on micro-CT after each over-expansion.

Results

Twelve RMS (n=4 in each group) were successfully implanted. There was no difference on struts and connectors fractures among the 3 techniques as no fracture was visualized. OCT demonstrated that MKBI sequence significantly decreased global malapposition following SB inflation as compared with rePOT or KBI strategies (95.3% vs 88.3% of perfectly apposed struts; p<0,0001 and 93.6%; p=0.004, respectively for MKBI vs. rePOT and KBI). After step by step overexpansion, no strut or connector fracture could be visualized.

Stent strut apposition between in vitro models rePOT, n (%) KBI, n (%) MKBI, n (%) P value rePOT vs KBI P value rePOT vs MKBI P value KBI vs MKBI Overall bifurcation 1702/1928 (88.3%) 2062/2211 (93.6%) 1824/1913 (95.3%) p<0,0001 p<0,0001 p=0.004 MB proximal 376/390 (98.3%) 407/407 (100%) 398/398 (100%) p=0.0001 p=0.0001 p=NS MB bifurcation ostial 210/286 (77.5%) 326/391 (82%) 243/269 (89.8%) p=0.002 p<0,0001 p=0.01 MB bifurcation abostial 421/425 (99.3%) 421/421 (100%) 324/324 (100%) p=0.05 p=0.08 P=NS SB bifurcation ostial 147/227 (62.8%) 321/365 (88.3%) 256/306 (85%) p<0,0001 p<0,0001 p=NS SB bifurcation abostial 98/150 (70.3%) 128/168 (78%) 161/173 (95.5%) p=0.03 p<0,0001 p=0,0005 MB distal 450/450 (100%) 459/459 (100%) 442/443 (99.8%) p=NS p=NS p=NS Comparison between rePOT, KBI and MKBI. Abbreviations: POT, proximal optimization technique; MKBI, mini kissing balloon inflation; KBI, kissing balloon inflation.

Bifurcation exemples

Conclusion

Provisional RMS one stent technique on a bifurcation lesion is technically feasible with these 3 different strategies without scaffold fracture. MKBI strategy resulted in better apposition rates as compared to KBI or rePOT strategies.
P6016His bundle pacing versus biventricular pacing in cardiac resynchronization therapy: acute hemodynamic and electrophysiological effects
Authors: Salden F , Luermans J G , Westra S W , Cornelussen R , Ghosh S , Prinzen F W , Vernooy K
Published: October 2019

Background

Cardiac resynchronization therapy (CRT) is usually performed with a right (RV) and left ventricular (LV) lead. Previous observational studies showed promising results with His bundle pacing (HBP) in patients with left bundle branch block (LBBB) by capturing and recruiting the native His-Purkinje system as an alternative to provide ventricular resynchronization.

Objective

To investigate the effects of HBP as compared to conventional biventricular (BiV) pacing with respect to acute hemodynamic and electrophysiological effects in heart failure patients with LBBB.

Methods

RV apical and BiV pacing, using the implanted leads, and temporary HBP, using an electrophysiology catheter, was performed in 13 patients (QRS duration 168±16 ms) undergoing CRT implantation. Hemodynamic response (relative to baseline AAI pacing) was assessed as change in LVdP/dtmax. Multi-electrode body-surface mapping, what has been used previously to characterize electrical dyssynchrony in CRT patients, was evaluated using the standard deviation of activation times (SDAT) (figure, right panel).

Results

HBP resulted in a significant LV dP/dtmax increase, that was comparable to the increase during BiV pacing and significantly larger than RV pacing (figure, left panel). HBP resulted in a more homogenized electrical activation and larger reduction in SDAT than both conventional BiV pacing and RV pacing (figure, middle panel).

Conclusions

Acute HBP results in hemodynamic improvement and electrical resynchronization that is as good as conventional BiV pacing. These results suggest that HBP may serve as an alternative for conventional BiV pacing in LBBB patients, however prospective studies are needed to prove chronic clinical outcomes.

Acknowledgement/Funding

Medtronic is a subsidising party.
P6018Can chronic his bundle pacing be safely started in centers with lack of experience of this technique? Data from a multicentric registry
Authors: Chaumont C , Popescu E , Auquier N , Milhem A , Viart G , Savoure A , Godin B , Mirolo A , Eltchaninoff H , Anselme F
Published: October 2019

Introduction

Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered in part by technical challenges and limited implantation tool set. Recent studies assessed feasibility and safety in expert centers with a vast experience of HBP. These results may not apply to less experienced centers.

Purpose

To evaluate feasibility and safety of permanent his bundle pacing in hospitals with limited technical training to this technique and to evaluate stability of his bundle capture thresholds at 3 months follow up.

Methods

We included all patients who underwent pacemaker implantation with attempt of HBP in three hospitals between September 2017 and December 2018. All the 5 operators were novice for HBP at the beginning of the study. Selective his bundle capture (HBC) was defined as concordance of QRS and T waves complexes with the native ECG (patients with underlying bundle branch block may normalize), presence of a delay between spike and QRS complex, absence of widening of the QRS at a low pacing output, and recordable his bundle electrogram. At 3 months follow-up, his bundle capture thresholds, R-wave amplitudes and pacing impedances were recorded.

Results

HPB was successful in 51 of 58 patients (87.9%); selective HBC was obtained in 40 patients while nonselective HBC occurred in 11 patients. Indication for pacemaker implantation was atrioventricular conduction disease in 31 patients (53%), sinus node dysfunction in 5 patients (9%) and AV nodal ablation for non-controlled atrial arrhythmias in 22 patients (38%). AV nodal ablation was performed during the same procedure in 14 patients. The mean procedure duration was 75±8 min, and mean fluoroscopy duration was 10±2 min. The mean HBP threshold was 1.47±0.27 V and did not increase after a 3 months follow-up (1.12±0.18 V). Only 7 patients (14%) had HBP threshold >2V/0.5ms. The mean impedance was 477±37 Ω and slightly decreased at 3 months (364±24Ω). The mean R-wave amplitude was 4.1±1 mV at implantation and 3.2±0.6 mV at 3 months. Bundle branch block correction was achieved in 5 of 7 patients with underlying left bundle branch block. There was no pericardial effusion, no pneumothorax and no device infection. Ventricular lead revision was required at 3 months in one patient for sudden threshold increase, without obvious dislodgement.

LBBB correction after HBP

Conclusion

His bundle pacing performed by novice operators to this technique appeared feasible and safe. The mean HBP threshold did not increase at 3 months follow-up.
P6141Associations between atmospheric parameters and haemostatic factors: a case control study
Authors: Boussoussou M , Boussoussou N , Rakovics M , Entz L , Nemes A
Published: October 2019

Background

One of the biggest health challenges in the 21st century is global climate change. The health effect of climate change is partly mediated through atmospheric parameters. There is a growing concern that atmospheric parameters might increase cardiovascular (CV) morbidity. Increased levels of haemostatic factors are predictors of CV events. The associations between CV diseases and atmospheric parameters have been widely reported, however there are few studies of atmospheric parameters' effects on markers of haemostasis.

Purpose

We examined the possible association between atmospheric parameters and several haemostatic markers.

Methods

The study consisted of 3800 hospitalized patients with acute CV diseases (ACVDs) and 260 healthy blood donors. We examined the relationship of haemoglobin (Hgb), white blood cells (WBC), thrombocytes (THR) and local atmospheric parameter conditions (temperature, atmospheric pressure, humidity, wind speed, atmospheric front) on a day-to-day basis in a 5-year period (2009–2013) using a General Additive Model with cubic splines of covariates, regularized by a ridge penalty, and employing generalized cross validation. Atmospheric parameters were allowed to have a lagged effect by up to 21 days.

Results

Among blood donors, the average of daily temperature lagged by 8–14 days had a significant effect on Hgb, exhibiting a U-shaped relationship, where higher Hgb values were associated with extremities of the observed temperature interval. For ACVD patients, all examined blood test variables has a significant association with at least some of the atmospheric parameters. Hgb was shown to have a negative linear relationship with mean daily humidity, and the average of daily temperature lagged by 15–21 days, while the average of daily temperature variation lagged by 2–7 days had highly non-linear effect. The relative strength of the association with Hgb was largest for daily temperature variation. WBC values had a slightly non-linear positive relationship with atmospheric pressure lagged by 1 day, with WBC being significantly increased above 1030 hPa. THR values decreased linearly with an increase in mean daily temperature averaged for days lagged 15–21. Atmospheric pressure lagged by 1 day also had a significant effect on THR, with a positive linear effect under 1010 and over 1020 hPa but no effect between. The relative effect of atmospheric pressure on THR was twice as large compared to temperature.

Conclusions

Our study showed that exposure to certain atmospheric parameters is associated with significant changes in haemostatic marker levels. In the context of global climate change, the importance of focusing on atmospheric parameters as minor CV risk factor is substantially growing. A better understanding of the fluctuation of the examined markers, in light of atmospheric parameters, appears to be of particular importance for future studies and could help establish new CV prevention strategies.
P6148Visually assessed coronary and cardiac calcium outperforms perfusion data during scintigraphy in the prediction of adverse outcomes
Authors: Suma S , Garibaldi S , Sartorio D , Pressman G , Gaibazzi N
Published: October 2019

Background

The presence and amount of calcium in the coronary arteries, but also in the heart valves and aorta, has been clearly associated with cardiovascular and all-cause mortality and this information might be prognostically useful during SPECT-CT examinations, where CT images are co-registered for attenuation correction of myocardial perfusion, but then discarded.

Objectives

This study sought to determine whether the assessment of calcifications of the coronary arteries, cardiac valves and thoracic aorta in the computed tomography images co-registered for attenuation correction during stress-scintigraphy (SPECT-CT) is associated with long-term mortality and cardiac events on top of other available data.

Methods

Baseline data were collected prospectively on 353 consecutive patients, referred for suspected coronary artery disease (CAD) with no previously known CAD who underwent stress SPECT-CT between Sept 2010 and Oct 2012. Retrospective analysis was performed on follow-up data for outcomes.

Results

Patients (mean age 72 years. 58% males) had a mean follow-up of 6.4 years, during which 48 died (15 from cardiovascular causes) and 10 had a non-fatal myocardial infarction (MI). Reversible myocardial perfusion defects were detected in 55 patients (15.6%), 39 of whom (11%) had more than mild defects. The presence of an overall visual calcium score >1 in the attenuation correction images was the most strong univariable (hazard ratio 8.99, p<0.0001) and multivariable (hazard ratio 4.76, p<0.0001) predictor of all-cause death or non-fatal MI on top of age, gender, irreversible myocardial perfusion defects and revascularization after the test.

Multivariable models Clinical + SPECT + Overall Calcium Ischemic Cardiac Events HR CI (95%) p-value χ2 Age 1.058 1.0234 to 1.093 0.0008 Male gender 1.63 0.88 to 3.024 0.1183 Fixed perfusion defect 3.924 1.63 to 9.426 0.0022 Overall Calcium >1 4.765 2.2 to 10.32 <0.0001 71.69

Kaplan-Meier

Conclusions

Visual assessment of coronary or overall coronary, cardiac and aortic calcium in the CT images used for attenuation correction during SPECT-CT is feasible, reproducible and strongly associated with hard cardiac events and all-cause death, beyond clinical variables and myocardial perfusion data. This incredibly easy visual calcium assessment does not require additional costs or radiation and may heavily impact on better risk-assessment of patients with suspected CAD undergoing SPECT-CT.
P6158Prognostic value of non-obstructive coronary artery disease detected on coronary computed tomography angiography among subjects with suspected coronary artery disease
Authors: Aljizeeri A , Alali Alfaris M , Ahmed D , Farea J , Elneama A , Suliman I , Ahmed A , Alharthi M , Alsaileek A , Al-Mallah M
Published: October 2019

Introduction

Coronary Computed Tomography Angiography (CTA) is an established technique for the detection of coronary artery disease (CAD). However, the prognostic value of non-obstructive CAD is not well defined. Thus, the aim of this analysis is to determine the prognostic value of non-obstructive CAD detected on CTA.

Methods

In the Multi-Center Multi-Ethnic Coronary Computed Tomography Angiography (MECCA) Study, 3209 subjects without known CAD underwent CTA. Patients with obstructive CAD were excluded from this analysis. Patients with ≤70% luminal coronary artery stenosis in vessels other than the left main were classified to have non-obstructive CAD while patients without any plaque were considered to have normal CTA. Patients were followed up for a median duration of 3.4 years for all-cause mortality (ACM). Multivariable Cox models were used to determine the independent predictors of event-free survival.

Results

A total of 1455 subjects had non-obstructive CAD and 1382 subjects had normal coronary arteries. Subjects with non-obstructive CAD were older (55.9±11 vs 46.2±11 years, p<0.001) and more likely to be males (56.8% vs 50.5%, p=0.001) and had more prevalent traditional risk factors. A total of 83 ACM were observed (4.4% in the non-obstructive group and 1.3% in the normal group, p<0.001). Patients with clinical events were older (61.8±14 vs 50.9±12 years, p<0.001) and have more prevalence of DM (42.2% vs 31.4%, p=0.031) and HTN (72.3% vs 54.3%, p=0.001). In Multivariable Cox models, non-obstructive CAD was associated with increased event rate (Hazard ratio 1.75, 95% CI 1.01–3.01, p=0.45).

Kaplan-Meier Survival Curves

Conclusions

Patients with non-obstructive CAD on CTA have a higher rate of all-cause mortality. Non-obstructive CAD on CTA enhances risk stratification among subjects suspected with CAD and should call for more aggressive guidelines directed medical therapy.

Acknowledgement/Funding

None
P6162Difference in progression to obstructive lesions according to the presence of high-risk plaque features
Authors: Lee S E , Pontone G , Gottlieb I , Hadamitzky M , Leipsic J A , Raff G , Stone P H , Samady H , Virmani R , Berman D S , Shaw L J , Narula J , Bax J J , Min J K , Chang H J
Published: October 2019

Background

It is still debatable whether the so-called high-risk plaque (HRP) simply represents a certain phase during the natural history of coronary atherosclerotic plaques or the disease progression would differ according to the presence of HRP.

Purpose

We determined whether the pattern of non-obstructive lesion progression into obstructive lesions would differ according to the presence of HRP.

Methods

Patients with non-obstructive coronary artery disease, defined as % diameter stenosis (%DS) ≥50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an inter-scan interval of ≥2 years. HRP was defined as lesions with ≥2 of positive remodelling, spotty calcification, and low-attenuation plaque. The total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions.

Results

A total of 1,115 non-obstructive lesions were identified from 327 patients (61.1±8.9 years old, 66.0% male). There were 690 non-HRP and 425 HRP lesions. HRP lesions possessed greater PAV and %DS at baseline compared to non-HRP lesions. However, the annualized total and non-calcified PAV change were greater in non-HRP lesions than in HRP lesions. On multivariate analysis, addition of baseline PAV and %DS to clinical risk factors improved the predictive power of the model (Table). When clinical risk factors, PAV, %DS, and HRP were all adjusted on Model 3, only baseline PAV and %DS independently predicted the development of obstructive lesions (hazard ratio (HR) 1.046 [95% confidence interval (CI): 1.026–1.066] and HR 1.087 [95% CI: 1.055–1.119], respectively, all p<0.001), while HRP did not (p>0.05).

Comparison of C-statistics of per-lesion analysis to predict progression to obstructive lesion C-statistics (95% CI) P Model 1: Baseline PAV 0.880 (0.879–0.884) – Model 2: Model 1 + baseline %DS 0.938 (0.937–0.939) vs. Model 1: <0.001 Model 3: Model 2 + HRP 0.935 (0.934–0.937) vs. Model 2: 0.004 Adjusted for age, male sex, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, smoking, body mass index, and statin use.

Conclusion

The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV was the most important predictor for lesions developing into obstructive lesions rather than the presence of HRP features at baseline.

Acknowledgement/Funding

This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).
P6165Sex differences in compositional plaque volume progression in patients with stable coronary artery disease: observations from a serial CCTA registry
Authors: Lee S E , Andreini D , Budoff M J , Cademartiri F , Hadamitzky M , Marques H , Leipsic J A , Stone P H , Samady H , Narula J , Berman D S , Shaw L J , Bax J J , Min J K , Chang H J
Published: October 2019

Background

It is unclear whether sex impacts the plaque volume (PV) progression in patients with stable coronary artery disease (CAD).

Purpose

To explore whether the total and compositional PV progression rate differ according to sex.

Methods

We performed a prospective multinational registry of consecutive patients who underwent serial CCTA at ≥2-year interval. Total and compositional PV at baseline and follow-up were quantitatively analysed and normalized using the analysed total vessel length. Multivariate linear regression models were constructed for each women and men.

Results

Of the 1,255 patients included (median CT interval 3.8 years), 543 were women and 712 were men. Women were older (62±9 years vs. 59±9 years, p<0.001) and had higher total cholesterol level (195±41mg/dL vs. 187±39mg/dL, p=0.002). Prevalence of hypertension, diabetes, and family history of CAD were not different (all p>0.05).

At baseline, men possessed greater total PV (131.5±230.5mm3 vs. 97.7±193.6mm3, p=0.005) and a higher prevalence of high-risk plaques (HRP) than women (31% vs. 20%, p<0.001). Annual total PV progression rate was greater in men, driven by the greater non-calcified PV progression (TABLE).

In multivariate analysis (TABLE), although total PV progression rate was not different, women were associated with greater calcified PV progression (β=2.83, p=0.004) but slower non-calcified PV progression (β=-3.39, p=0.008) and less development of HRP (β=-0.18, p=0.049) than men.

CCTA findings according to sex Univariate analysis Female Sex in Multivariable Analysis Women (n=543) Men (n=712) P β SE P Agatston CACS, /year 0.44±0.7 0.4±0.7 0.332 0.106 0.04 0.006 Total PVnormalized, mm3/year 14.7±23.4 17.8±26.2 0.026 -0.56 1.33 0.677 Calcified PVnormalized, mm3/year 10.5±21.5 10.0±19.1 0.670 2.83 0.98 0.004 Non-calcified PVnormalized, mm3/year 4.2±17.3 7.8±21.2 0.001 -3.39 1.28 0.008 Development of high-risk plaque*, n (%) 86 (15.8) 139 (19.5) 0.092 -0.18 0.09 0.049 In linear multivariate regression analysis adjusted with age, race, HTN, DM, family history, smoking, LDL, statin, anti-platelets, beta-blockers, and PV at baseline, women were associated with greater calcified PV progression and slower non-calcified PV progression. (High-risk plaque was defined as ≥2 of low-attenuation plaque, spotty calcification, and positive remodelling.)

Conclusion

In this large CCTA cohort, we found that the compositional PV progression differs according to sex. These findings, which are hypothesis generating, suggest that comprehensive plaque evaluation may contribute to further refine risk stratification according to sex.

Acknowledgement/Funding

This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).
P6167Low leptin plasma levels are associated with progression of coronary atherosclerosis in patients with stable coronary artery disease from the SMARTool Study
Authors: Caselli C , Rocchiccioli S , Rosendael A , Buechel R , Teresinska A , Pizzi M N , Smith J M , Poddighe R , Campolo J , Vozzi F , Knuuti J , Pelosi G , Parodi O , Scholte A , Neglia D
Published: October 2019

Background

Leptin is an adipokine involved in energy homeostasis and has been related with established vascular risk factors. However, studies on the association of leptin plasma levels with coronary artery disease (CAD) have yielded conflicting results.

Purpose

Aim of the present study was to evaluate the association between leptin plasma levels and presence, severity and progression of coronary atherosclerosis in patients with suspected stable CAD.

Methods

In a cohort of 257 patients with symptoms of stable CAD enrolled in the SMARTool study, coronary computed tomography angiography (CTA), plasma leptin levels and clinical and bio-humoral CAD risk profile (including glucose, lipid and inflammation variables) were obtained at enrolment and after 6±1yrs of follow-up. Sixty-four patients were revascularized and the remaining 193 represent the population for the present study. CTA findings were categorised as no-minimal CAD (<30% stenosis), non-obstructive CAD (30%-50% stenosis) and obstructive CAD (≥50% stenosis in at least one major coronary vessel). A CTA risk score (based on plaque extent, severity, composition, and location) was calculated at baseline and at follow-up to assess coronary atherosclerotic burden and its progression (Δ CTA score≥5).

Results

CTA findings showed obstructive CAD in 11% of patients at baseline and in 15% at follow-up (p<0.0001). CTA risk score, was 8.03±7.80 at baseline and increased to 10.33±8.17 at follow-up (p<0.0001) with CAD progression in 20% of patients. Leptin plasma levels were inversely related with CTA findings both at baseline and follow-up (Figure). In a Cox model, baseline plasma leptin was an independent predictor of CAD progression, after adjustment for clinical risk factors, biomarkers, and treatment (HR 0.572, 95% CI 0.393–0.834, P=0.0037).

Figure 1

Conclusion

Plasma leptin is inversely associated with coronary atherosclerotic burden and disease progression in patients with stable CAD. This association is independent of known factors affecting leptin levels. These results could prompt further investigations on the pathophysiological mechanisms of this association.

Acknowledgement/Funding

EU H2020 research and innovation program under grant agreement No 689068
P6175Prediction of coronary revascularization by coronary computed tomography angiography derived fractional flow reserve - different algorithms for interpretation
Authors: Madsen K T , Veien K T , Noergaard B L , Larsen P , Deibjerg L , Husain M , Junker A , Kusk M W , Thomsen K K , Rohold A , Jensen L O , Sand N P
Published: October 2019

Introduction

Coronary CT angiography (CTA) derived fractional flow reserve (FFRct) is increasingly used for guiding referral to invasive procedures in patients with stable chest pain. However, optimal interpretation of FFRct-analysis in terms of location and threshold of applied FFRct-values is unclear.

Purpose

To evaluate the clinical performance of various vessel-specific physiological FFRct derived measures of ischemia for prediction of standard of care guided coronary revascularization in patients with stable chest pain and coronary artery disease as determined by coronary CTA.

Methods

Retrospective study in patients with stable chest pain referred for coronary angiography based on coronary CTA. Standard acquired coronary CTA data sets were transmitted for core-laboratory analysis at HeartFlow. Any FFRct value in the major coronary arteries ≥1.8 mm in diameter, including side branches, were registered. Lesions were categorized as positive for ischemia using 6 different algorithms: Lowest in vessel FFRct-value (1) ≤0.75 or (2) ≤0.80; 2 cm distal-to-lesion FFRct-value (3) ≤0.75 or (4) ≤0.80; ΔFFRct (5) ≥0.06 or a combination of 2 and 5. The personnel responsible for downstream patient management had no information regarding FFRct test results.

Results

A total of 172 patients were included. Revascularization was performed in 62 (35%) patients. The diagnostic performance of different FFRct algorithms for predicting standard of care guided coronary revascularization is shown in the Table.

Revascularization Predictions by FFRct N=172 Diagnostic performance FFRCT false negative FFRCT false positive Values given as (%) No. of revasc vessels No. of abnormal vessels FFRCT Algorithm Sens Spec PPV NPV Acc 1 2 3 1 2 3 Distal FFRCT ≤0.75 77 68 58 84 72 12 2 0 29 5 1 Distal FFRCT ≤0.80 92 43 48 90 61 5 0 0 40 20 3 Lesion-specific FFRCT ≤0.75 68 86 74 83 80 17 3 0 12 3 0 Lesion-specific FFRCT ≤0.80 82 78 68 89 80 10 2 0 21 3 1 ΔFFRCT ≥0.06 98 36 47 98 59 1 0 0 51 19 0 Combinationa 92 54 53 92 67 5 0 0 39 12 0 aDistal FFRCT ≤0.80 and ΔFFRCT ≥0.06. Sens = sensitivity; Spec = specificity; PPV = positive predictive value; NPV = negative predictive value; Acc = accuracy; FFRCT = fractional flow reserve derived from coronary CTA; ΔFFRCT = difference between FFRCT-value immediately proximal and distal to lesion; Revasc = revascularized.

Conclusion

The diagnostic performance of FFRct in terms of predicting standard of care guided coronary revascularization is dependent on the applied algorithm for interpretation of the FFRct-analysis.
P6176Added value of computed tomography fractional flow reserve (FFRCT) in the diagnosis of coronary artery disease (CAD)
Authors: Peper J , Schaap J , Kelder J C , Grobbee D E , Swaans M J
Published: October 2019

Purpose

Multiple non-invasive tests are performed as part of the standard protocol to diagnose CAD, but all are limited to either anatomical or functional assessments. FFRCT is a new non-invasive test that combines anatomical and functional characteristics based on the principles of invasive FFR. This study aims to evaluate the added value of FFRCT beyond the currently used tests.

Methods

Patients having the clinical suspicion of angina pectoris between 2010 and 2011 were included in this cross-sectional study. All underwent exercise stress electrocardiography (X-ECG), SPECT, CT coronary angiography (CCTA) and FFRCT as part of the Horoscope study. Invasive coronary angiography (ICA) and FFR were used as reference standard. Missing values were multiple imputed and five combined models mimicking the clinical workflow were fitted. The area under the receiver operating characteristic (AUROC) curve and Akaike Information Criteria (AIC) were used for comparison.

Results

89 (44%) of the 202 patients included in the analysis had a FFR of ≤0.80, while positive tests were found for X-ECG, SPECT, CCTA and FFRCT in 41%, 47%, 53% and 50% of the cases. The model including pre-test-likelihood and X-ECG had an AUROC of 0.78 (AIC: 236), which significantly increases to 0.89 by adding SPECT (AIC: 170), to 0.87 by adding CCTA (AIC: 191), to 0.92 when adding FFRCT (AIC: 155) and to 0.94 when adding CCTA and SPECT (AIC: 1 40).

ROC-curves for all diagnostic models Model 1 Model 2 Model 3 Model 4 Model 5 Basic model + SPECT + CCTA + CCTA + FFRCT +SPECT + CCTA AIC 236.0 169.8 190.8 154.5 140.1 AUC 0.78 0.89 0.87 0.92 0.94 ROC-curves for all diagnostic models and its AIC and AUC. FFRCT has an improved AUC compared to the basic model and the models including SPECT or CCTA alone, while its AIC is decreased. The model including both SPECT and CCTA has the highest AUC and the lowest AIC and seems therefore the preferable strategy.

ROC curve

Conclusion

This study shows adding FFRCT leads to an increased AUROC and a decreased AIC compared to the basic model. It therefore improves the diagnostic work-up beyond SPECT or CCTA alone in the diagnosis of CAD.
P6200Effect of LPA gene on CAD risk among diabetic patients
Authors: Borges S , Palma Dos Reis R , Pereira A , Mendonca F , Sousa J , Monteiro J , Neto M , Sousa A C , Rodrigues M , Henriques E , Ornelas I , Freitas A I , Drumond A , Mendonca M I
Published: October 2019

Introduction

Previous research reported that LPA gene is a strong and independent predictor of CAD in non-diabetic patients but not in patients with type 2 diabetes. These results suggest that LPA gene might contribute less to CAD risk in patients with T2DM than in general population.

Objective

Investigate, in our population, the association between LPA gene CT variant and CAD risk among diabetic patients.

Methods

3050 individuals (1619 coronary patients and 1431 controls) were genotyped for LPA rs3798220 TT/CT. Pearson's chi-squared test was applied to evaluate the association between LPA variants and CAD, firstly, in the general population and, secondly, in the group of patients with T2DM (n=735). Multivariate logistic regression was performed with LPA CT variant and 6 traditional risk factors (TRF) (smoking, dyslipidemia, diabetes, hypertension, family history of CAD and physical inactivity) in both general and diabetic population.

Results

In total population, LPA CT variant was found to be strongly and significantly associated with CAD with an OR of 2.32 (95% CI: 1.56–3.45; p<0.0001). However, this association was less pronounced in the diabetic population with a CAD risk of 1.38 (95% CI: 0.56–3.43) without statistical significance (p=0.485). In the presence of 6 major TRF, multivariate analysis showed that LPA CT remained a strong and independent predictor of CAD risk (OR= 2.34; 95% CI: 1.52–3.62; p<0.0001). In diabetic population, LPA was no longer an independent predictor for CAD by multivariate analysis.

Conclusions

Our results show that the effect of LPA gene on CAD risk among diabetic patients might be different from that in the general population. Diabetes status is such a strong risk factor that may attenuate the genetic effects of LPA on CAD risk. This may indicate a complex role of Lp (a) and diabetes interaction in cardiometabolic diseases.
P6212The NAILED ACS trial - telephone-based long-term follow-up reduces risk factors after 36 months
Authors: Henriksson R , Huber D , Mooe T
Published: October 2019

Background

Cardiovascular secondary preventive strategies need improvement. The proportion of patients reaching guideline recommended treatment targets are low.

Purpose

We investigated if nurse-led, telephone-based follow-up including medical titration was superior to usual care in controlling blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels 36 months after an acute coronary syndrome (ACS).

Methods

All patients admitted with ACS at the local county hospital between 1st January 2010 and 31st December 2014 were screened for inclusion based on their ability to participate in a telephone-based follow-up. Participants were randomized into two parallel groups, an intervention group and a control group receiving usual care. BP and LDL-C were measured at one month, 12, 24 and 36 months. The intervention group received counseling and medical titration to attain treatment targets of BP (<140/<90 mmHG) and LDL-C (<2.5/<1.8 mmol/L). The primary outcome was LDL-C at 36 months.

Results

Out of 962 randomized patients, 797 were available for analysis after 36 months. In the intervention group, mean systolic blood pressure (SBP) was 4.1 mmHg lower (95% CI 1.7 - 6.4, p=0.001), diastolic blood pressure (DBP) was 2.8 mmHg lower (95% CI 1.4- 4.4, p<0.001) and mean LDL-C was 0.26 mmol/L lower (95% CI 0.12 - 0.4, p<0.001) when compared to the control group. The proportion of patients reaching treatment target goals was also significantly higher in the intervention group.

Conclusions

After 36 months of follow-up the nurse-led, telephone-based intervention led to significantly lower systolic blood pressure, diastolic blood pressure and LDL-C levels when compared to the control group. The intervention group also had a larger proportion of patients reaching target values.

Acknowledgement/Funding

The study received funding from the research and development unit, Region Jämtland Härjedalen.
P6213The influence of working-age on attendance to cardiac rehabilitation: a gender comparison
Authors: Astley C , Chew D P , Keech W , Nicholls S , Beltrame J , Horsfall M , Tavella R , Tirimacco R , Clark R
Published: October 2019

Introduction

Despite guidelines recommending referral to cardiac rehabilitation (CR), attendance remains poor. Literature cites a complexity of clinical, psychological and social factors as barriers to CR attendance and, females may attend less than males. Social factors including work commitments, may influence attendance, with many Australian CR programs offered during office hours, making access difficult. The Australian retirement age for females and males differs; (females >60 years and males >65 years). We hypothesised that working-age may influence attendance to CR.

Purpose

In a CR-referred population this study sought to compare working-age of males and females and the association with CR attendance.

Methods

Data from 24 country and metropolitan CR services between 2013 and 2015 were linked to 49,909 CR-eligible patients defined as, discharged alive with a primary cardiac-related diagnosis and/or interventional procedure, identified through public hospital administrative data (Figure). Only CR-referred patients were included, with males and females categorised by three age groups: <60, 60–65 and >65 years, comparing attendance in univariate analysis. Adjustment for clinical and psychological (International Classification of Disease-10 Australian Modification mental health diagnostic-related group diagnoses) factors were conducted using multi-logistic regression.

Results

Between 2013–2015, 15,089 patients were referred to CR with 4,819 <60 years, 1,943 between 60–65 years and 8,327 >65 years. Of referrals a total of 4,286 (28.4%) attended CR, 1134 (35%) of whom were female. Univariate analysis observed total attendance by age group ranged between 26–32%, with females less likely to attend than males (<60 years; 25.3% v 32.2%, p<0.001, 60–65 years; 29.5% v 33.2%, p=0.130 and >65 years; 23.2% v 23.6%, p<0.001). Multivariate analysis observed more attendance in the 60–65 years group compared to <60 years (odds ratio (OR): 1.15 [95% confidence interval [CI]: 1.00–1.32], p=0.036) with females less likely to attend than males (OR: 0.81, [95% CI; 0.70–0.95], p=0.009). No interaction between the working age classification and gender were observed.

Conclusion

In an Australian cohort, working-age observed no influence on cardiac rehabilitation program attendance, with the period of female retirement age observing a 19% reduction in attendance. Further research on the complexity of factors that may be barriers to attendance is essential to evaluate how to improve cardiac rehabilitation programs to better suit the needs of our cardiac patients.

Acknowledgement/Funding

Flinders University partnership grant and South Australian Department of Health Local Health Networks
P6222Changes in main CVD risk factors in Finland 1992–2017
Authors: Jousilahti P , Laatikainen T , Harkanen T , Borodulin K , Harald K , Koskinen S , Mannisto S , Peltonen M , Sundvall J , Valsta L , Vartiainen E
Published: October 2019

Background

Systematic monitoring of cardiovascular disease (CVD) risk factors started in eastern Finland already in the 1970s as part of the North Karelia Project. Later on risk factor monitoring was extended to other parts of the country.

Purpose

In this study we report the trends of main CVD risk factors in Finland from 1992 to 2017.

Methods

Study population consists of a population-based random sample of 31 402 men and women aged 25–64 years who participated in the FINRISK Studies from 1992 to 2012, and in the FinHealth Study in 2017. Data collection was done every five years. Participation rate decreased from 76% in 1992 to 56% in 2017. Study protocol included self-reported questionnaire data on smoking and other health behavior, measurements of height, weight and blood pressure, and venous blood sample for laboratory analysis. Blood pressure was measured two times, and the average of the measurements was calculated, total serum cholesterol was analyzed using enzymatic method, and LDL cholesterol was calculated using Friedewald formula.

Results

Smoking prevalence, mean blood pressure and total and LDL cholesterol levels declined markedly during the 25 year follow up but BMI, waist circumference and prevalence of obesity increased (table).

CVD risk factor change from 1992 to 2017 Risk factor Men 1992 Men 2017 p value Women 1992 Women 2017 p value Smoking (%) 36.7 20.6 <0.001 25.9 16.5 <0.001 SBP (mmHg) 136.6 131.2 <0.001 130.3 124.5 <0.001 DBP (mmHg) 82.7 81.6 <0.001 78.6 77.8 <0.001 Chol (mmol/L) 5.66 5.17 <0.001 5.42 5.18 <0.001 LDL chol (mmol/L) 3.54 3.16 <0.001 3.26 3.03 <0.001 BMI (kg/m2) 26.2 27.2 <0.001 25.1 26.4 <0.001 WC (cm) 92.8 96.1 <0.001 79.2 86.2 <0.001 Obesity (%) 15.7 23.2 <0.001 14.8 22.7 <0.001

Conclusions

The levels of main traditional CVD risk factors have markedly decreased among the Finnish population during the last 25 years but in the same time, obesity has become a major public health challenge.
P6252Diagnostic and prognostic accuracy of preoperative NT-proBNP added to revised cardiac risk index in elderly patients with hip fracture
Authors: Iglesias Garriz I , Ruiz-Villa M D , Idoate J , Jimenez Mola S , Sanchez-Robles A , Fernandez Vazquez F
Published: October 2019

Background

The identification of patients at highest risk after surgery for hip fracture could be of clinical value to implement post-operative actions to lessen mortality. We sought to investigate the utility of Revised Cardiac Risk Index (RCRI) and NT-proBNP in this scenario.

Methods

Patients older than 75 years with hip fracture treated with surgery were prospectively included. The end-point was overall mortality at 30 days.

Results

We enrolled 410 patients surgically-treated for hip fracture, 31 (7.6%) died during the 30-day follow-up. Patients who died were 3.5 years older (95% CI 1.3 to 5.6); p=0.001, and had a lower prevalence of diabetes mellitus.The prevalence of heart failure was more prevalent among patients who died: difference of proportions 35.7% (95% CI 16.0 to 55.3); p<0.001 and more patients were not in sinus rhythm with a difference of 25.4% (95% CI 5.6 to 45.1); p<0.001. Adding NT-proBNP to a logistic regression model with RCRI as an independent variable, improved the diagnostic and prognostic metrics, with significant changes in specificity (0.59 vs 0.70, p<0.001) and predictive values: positive likelihood ratio (LR) 1.89 vs 2.49, p<0.001, negative LR 0.38 vs 0.33, p<0.001. The C-statistic (0.69 vs 0.77, p=0.002) and the net reclassification improvement were also improved.

Conclusion

Adding preoperative NT-proBNP to RCRI to appraise the risk of overall 30-day mortality rate after hip surgery improves the prediction accuracy of RCRI alone.