bluuebunny/crossref_metadata_2025 huggingface dataset:
P3353Safety and performance of stress testing: results from 78220 nuclear cardiology studies performed over 15 years in Brazil
Authors: Vitola J V , Stier Jr A L , Kormann O J , Franca O , Silva J A , Bettini L A F , Maruiti R , Dippe Jr T , Kinzel T V R , Farias F R , Zapparoli M M , Cunha C , Prado P , Silva M M F , Cerci R J
Published: October 2019

Background

Stress testing for nuclear cardiology (NC) is safe for evaluating suspected or known coronary heart disease (CHD). Rates of serious adverse events (SAE) are low, roughly 1 death/myocardial infarction: 10,000 studies. However, this may vary depending on patient characteristics using different stress modalities.

Purpose

To describe the rates of SAE using different stress modalities in patients referred to NC.

Methods

We included all patients undergoing NC at Quanta in Curitiba, Brazil from 2003 to 2018. Stress modalities were categorized as: exercise (Ex), dipyridamole (Dip), a hybrid protocol of dypiridamole and low workload exercise (DipEx), and dobutamine (Dob). SAE during/after stress were recorded: cardiac arrest or ST segment elevation myocardial acute infarction (STEMI). Development of second or third degree atrial ventricular block (AVB) during stress and recovery were also recorded.

Results

From 78220 studies in 61984 patients (47% women, mean age 63 years-old), Ex was the most frequent stress modality (67%), followed by Dip (24%), DipEx (7%) and Dob (1,7%). Patients undergoing Ex were the youngest (mean age 60 vs 70 vs 65 vs 71 years old), the least likely of having hypertension (62 vs 78 vs 76 vs 75%) and diabetes (22 vs 35 vs 32 vs 32%) and had the lowest prevalence of known CHD (26 vs 35 vs 41 vs 30%, for Ex vs Dip vs DipEx vs Dob respectively, p<0.001 for all comparisons). Six patients had cardiac arrest and one STEMI, results in SAE rate of 1:11.144 studies. There was important differences among stress modalities, being higher for pharmacological stress, particularly DipEx (Table). This group had the highest prevalence of known CHD and higher baseline risk. AVB rates were higher when dipyridamole was used. All patients who arrested in the laboratory recovered with treatment.

Serious adverse events and stress in NC Adverse event Ex Dip DipEx Dob N=52,237 N=18,848 N=5,824 N=1,311 Cardiac Arrest or MI 1 : 17,412 1 : 9,424 1 : 2,912 None 2nd or 3rd Degree AVb 1 : 4,353 1 : 1,885 1 : 1,941 None Observe how adverse event rates different importantly in patients undergoing different stress modalities in NC.

Conclusion

In this large 15-year registry, rates of SAE related to stress testing in NC were low, albeit the SAE were much higher with pharmacological stress modalities, particularly with DipEx, which had the highest rate of patients with known CHD. Our findings suggest that the well-known 1:10,000 event rate does not necessarily apply to all stress modalities in NC. Physicians should take patient's baseline risk into account, particularly those requiring pharmacologic stress.
P3355Stress-induced left ventricular dyssynchrony predicts future cardiac events in patients with known or suspected coronary artery disease
Authors: Katoh S , Watanabe T , Arimoto T , Narumi T , Aono T , Goto J , Sugai T , Takahashi T , Tamura H , Nishiyama S , Takahashi H , Shishido T , Watanabe M
Published: October 2019

Background

Prognostic value of stress induced left ventricular (LV) dyssynchrony has not been fully understood.

The aim of this study was to evaluate the possible impact between cardiovascular events and stress induced worsening LV dyssynchrony.

Methods and results

One hundred and eighty consecutive subjects with known or suspected coronary artery disease (CAD) (142 men, mean age 68±12 years) underwent both gated myocardial single photon emission computed tomography (SPECT) with 99mTc-sestamibi or tetrofosmin according to a standard same day stress-rest protocol and coronary angiography or coronary computed tomography. The summed difference score (SDS) was calculated in every subjects. LV ejection fraction (EF) and phase Entropy at after stress and rest were determined by cardioREPO software. We determined %ΔEntropy = (stress Entropy - rest Entropy)/rest Entropy x100, as an indicator of stress-induced LV dyssynchrony. In the study population, the mean SDS was 2.7±3.9 and LVEF was 58±16%, stress and rest Entropy were 0.62±0.15 and 0.57±0.13, respectively.

%ΔEntropy was higher in patients with CAD than in those without CAD (3.3±11.5 vs. 10.2±15.0, respectively). Moreover, there was a strict correlation between the presence of CAD and %ΔEntropy, indicator of stress induced LV dyssynchrony (non-CAD vs. CAD and/or 1 vessel disease vs. multivessel disease: 4.3±12.5 vs. 8.8±15.6 vs. 12.7±14.3, respectively. p<0.05)

We examined all study subjects and they were divided into 2 groups by cut off value of the %ΔEntropy constructed with receiver operating characteristic curve (=15.4). Kaplan-Meier analysis revealed that future cardiovascular event rate was significantly higher in %ΔEntropy >15.4 group (20/57) than in %ΔEntropy <15.4 group (24/123) (Log-rank p<0.01). On the other hand, summed stress score and SDS were no significant differences between 2 groups.

However, SDS was higher in patients with future cardiovascular event than in those without cardiovascular event (4.4±5.4 vs. 2.2±3.2, respectively. p=0.001).

Conclusion

In patients with known or suspected CAD, stress-induced worsening LV dyssynchrony may predict the presence of CAD and future cardiac events.

Acknowledgement/Funding

None
P3358Cardiovascular risk, aortic valve microcalcification and vascular microcalcification: is there a link?
Authors: Domingues C , Oliveira-Santos M , Castelo-Branco M , Silva R , Gomes A , Chichorro N , Abrunhosa A , Donato P , Pedroso De Lima J , Goncalves L , Vidigal Ferreira M J
Published: October 2019

18F-sodium fluoride (18F-NaF) has been used to evaluate aortic stenosis. It is know that its uptake is related with microcalcification. The purpose of this study is to assess the relationship between 18F-NaF uptake by the aortic valve and by the main arterial vessels and cardiovascular risk.

Twenty-five hypertensive patients without known cardiovascular disease or aortic stenosis underwent PET-CT with 18F-NaF. Cardiovascular risk was assessed through the ASCVD risk calculator. The patients had a mean age of 64.0±8.6 years and 56% were males. The mean ASCVD risk was of 28.8±19.0 (IQR: 10–48.5). The uptake of 18F-NaF assessed through the corrected uptake per lesion (CUL = max SUV – mean blood-pool SUV) was of 0.49±0.14 (IQR: 0.44–0.57) and the mean uptake in the aortic, coronary and carotid territories was of 0.66±0.21 (IQR: 0.53 - 0.76).The patients were classified according to the ASCVD: Group A: patients with a risk above the 50thpercentile of the ASCVD risk distribution (50thpercentile=25), 12 patients) and Group B: patients with a risk under or equal to the 50thpercentile of the ASCVD risk distribution, 13 patients.

The uptake of 18F-NaF in the aortic valve (AoV)and in the main vascular territories (VT) were evaluated in both groups: A vs B: AoV CUL = 0.57±0.09 vs 0. 42±0.14, p=0.005; VT= 0.78±0.16 vs 0.54±0.20, p=0.003. We also evaluate the relation between AoV uptake and VT uptake and they were significantly related (r=0.69, p=0.0001).

In conclusion on this study microcalcification of the aortic valve and in the main vessels, evaluated through 18F-NaF uptake, were related between them and with cardiovascular risk reinforcing the importance of cardiovascular risk prevention in aortic valve degeneration and vascular atherosclerosis.
P3360Quantitative assessment of tricuspid regurgitation using right and left ventricular stroke volumes obtained from tomographic equilibrium radionuclide ventriculography
Authors: Eyharts D , Lavie-Badie Y , Cazalbou S , Fournier P , Cariou E , Pascal P , Campelo F , Marcheix B , Galinier M , Berry I , Carrie D , Lairez O
Published: October 2019

Background

Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations.

Aims

To investigate the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the quantification of tricuspid regurgitation (TR).

Methods and results

Sixty-one patients (44 men; mean age 59±12 years) who underwent both t-ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. A sub-group of 22 patients underwent both t-ERV and CMR. Patients with mitral/aortic regurgitation by TTE were excluded of the study. TR regurgitant volume (RVol) was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from t-ERV. RVol tended to be higher using the ERV volumetric method as compared to PISA method (43±35 and 35±33 ml, respectively; P<0.0001). There was a significant correlation between RVol as assess by ERV and by TTE (R=0.95, P<0.0001). Intraclass correlation coefficient between TTE and ERV for TR quantification was 0.95 (P<0.0001). Among patients who underwent CMR, the correlation between RVol obtained by TTE and by t-ERV and CMR were R=0.81 and R=0.75, respectively (all P<0.0001), without difference between the two correlations (P=0.263).

Linear regression (left) and Bland-Altma

Conclusion

TR assessment using the t-ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.
P3363Severity of lymphoma is associated with aortic FDG uptake assessed by FDG PET/CT imaging
Authors: Solomou E , Koutagiar I , Vlachopoulos C , Georgakopoulos A , Sioni A , Giannouli S , Hontropoulos S , Stergiou I , Kafouris P , Karakitsios I , Gaitanis A , Terentes-Printzios D , Pianou N , Pouli A , Tousoulis D
Published: October 2019

Introduction

There is increasing evidence that metabolic disease burden in lymphoma modifies patients' outcome. However, the impact of disease severity on cardiovascular system remains unknown.

Purpose

To investigate whether lymphoma is associated with arterial inflammation by examining the relationship between disease burden and arterial F-18 Fluorodeoxyglucose (FDG) uptake assessed by positron emission tomography/computed tomography (PET/CT) in Hodgkin and non-Hodgkin sub-types.

Methods

Sixty-two patients (43 male, mean age 58±18 years) with Hodgkin (n=29) or non-Hodgkin lymphoma (n=33) underwent FDG PET/CT imaging before chemotherapy. Disease severity was quantified by total metabolic tumor volume (TMTV) that represents the volume exhibiting standard uptake values (SUV) ≥41% or ≥2.5 of maximum SUV within lymphoma regions, while aortic FDG uptake assessment was based on target-to-background ratio (TBR). Serum high sensitivity-C-reactive protein (hs-CRP), white blood count (WBC), ratio of neutrophils to lymphocytes (N/L), albumin and lactic acid dehydrogenase (LDH) values were recorded in all the patients.

Results

TMTV measurements correlated significantly with hs-CRP, WBC, N/L ratio, albumin and LDH. (Table) Patients with advanced stage disease (III-IV) had higher aortic TBR values compared to those with stage I-II disease (median 2.19 interquartile range (1.96–2.54) vs. 2.04 (1.83–2.15) p=0.046 respectively). Aortic TBR was related with N/L ratio (R=0.370, p=0.009), while no significant correlation was observed with either WBC or hs-CRP values (p=0.930 and p=0.296, respectively). There were significant associations between aortic TBR uptake and TMTV values even after adjustment for age, sex, LDH, albumin, N/L ratio, as well as for the number of cardiovascular risk factors of each patient (β=0.353, p=0.001, adjusted R2=0.318 for TMTV41%, β=0.442, p=0.001, adjusted R2=0.269 for TMTV2.5).

Table 1. Pearson correlation between indices of lymphomas' severity and serum biomarkers PET derived measurements Hs-CRP P-value Neutrophils to lymphocytes ratio P-value MTV41% 0.306 0.016 0.317 0.026 MTV2.5 0.312 0.013 0.389 0.006 Albumin LDH MTV41% −0.281 0.044 0.465 <0.001 MTV2.5 −0.419 0.002 0.616 <0.001

Conclusions

Aortic wall FDG uptake is related with disease severity and subtype of lymphoma indicating a vascular effect of lymphoma, as well as a new potential role of molecular imaging in cardio-oncology by evaluation of disease severity and its consequences to vascular beds with a single examination.
P3364Cardiac damage in a real-world severe aortic stenosis population
Authors: Ventura Gomes R , Pais J , Pereira A R , Sebaiti D , Cruz I , Almeida A R , Joao I , Pereira H
Published: October 2019

Introduction

The cardiac consequences of aortic stenosis, besides left ventricular ejection fraction and systolic pulmonary artery pressure, aren't considered in the recommendations for surgical intervention in patients (pts) with severe aortic stenosis (SAS). In 2017, a new staging echo classification was presented to accurately describe them.

Purpose

To evaluate this new echo classification in risk stratification of pts with SAS with or without AVR, in a real–world setting.

Methods

Retrospective cohort study of pts with SAS (mean transvalvular pressure gradient (MG) ≥40 mmHg or a peak transvalvular velocity (PTV) ≥4.0 m/s), examined between January 2014 and December 2016. Pts were classified according to the new staging echo classification (no extravalvular cardiac damage - Stage 0, left ventricular damage - Stage 1, left atrial or mitral valve damage - Stage 2, pulmonary vasculature or tricuspid valve damage - Stage 3, or right ventricular damage - Stage 4). Follow-up (FU) was 2.6±1.0 years. The primary outcome was a composite of cardiovascular death or heart failure hospitalization.

Results

212 pts with SAS were included (age 76.1±9.1 years, 31.6% men; aortic valve area 0.69±0.21cm2; PTV 4.5±0.4m/s; MG 48.5±11.6mmHg; LVEF 58.8±12.2%).

19 (9.0%) pts were classified as Stage 0, 29 (13.7%) as Stage 1, 129 (60.8%) as Stage 2, 12 (5.7%) as Stage 3 and 23 (10.8%) as Stage 4.

Pts with more advanced stages had more events (stage 0: 5.3%; stage 1: 10.3%; stage 2: 17.1%; stage 3: 50.0%; stage 4: 52.2%; p<0.0001). In the multivariate analysis, the classification system was also a predictor of the outcome, even when including the AVR in the model (table 1).

Similar findings in the uni and multivariate analysis were identified when analyzing only the pts with SAS and no aortic intervention (events in stage 0: 16.7%; stage 1: 18.2%; stage 2: 29.3%; stage 3: 75.0%; stage 4: 64.7%, p<0.005; Figure 1).

Table 1. Predictors of the outcome Variables Adjusted HR (95% CI) p-value Sex* 1.86 (1.01–3.44) 0.047 eGFR* 0.99 (0.98–1.01) 0.201 AVR* 8.97 (3.85–20.90) 0.0001 Classification* – 0.031   Stage 0 0.19 (0.02–1.537) 0.120   Stage 1 0.28 (0.08–1.01) 0.052   Stage 2 0.36 (0.17–0.74) 0,006   Stage 3 0.81 (0.30–2.19) 0.675   Stage 4 1 – *Variables with p<0.05 in univariate analysis.

Figure 1. Survival of SAS pts with no AVR

Conclusion

In a real-world experience, the new staging echo classification showed a significant relationship between the extent of cardiac damage at baseline and the primary outcome in pts with SAS, even after controlling for AVR. This classification was also able to identify the SAS pts who did not perform AVR and had a significant risk of adverse events.
P3371Impact of severe aortic stenosis on layer-specific longitudinal strain and its prognostic value
Authors: Ilardi F , Dulgheru R E , Marchetta S , Cimino S , D'Amico G , Manganaro R , Lancellotti P
Published: October 2019

Background

Global longitudinal strain (GLS) was used to detect early myocardial dysfunction in patients with aortic stenosis (AS), however few data are currently available on the different susceptibility of specific myocardial layer to increased wall stress and its prognostic role. The present study sought to investigate the relationship between changes in LV multilayer strain and the clinical outcome of patients with severe AS and preserved left ventricle ejection fraction (LVEF).

Methods

We included in the analysis 211 patients (56% males, mean age 73±12 years old) with severe AS and LVEF≥50%, divided in symptomatic (n=114) and asymptomatic group (n=97), and 50 controls matched for age and sex. Patients with moderate-to-severe concomitant valvulopathy and inadequate acoustic windows for evaluation by speckle tracking analysis were excluded. Clinical, demographic and resting echocardiographic data were recorded, including quantification of 2D GLS, subendocardial LS and subepicardial LS.

Results

Symptomatic patients had increased LV wall thickness and LV mass index than asymptomatic ones (p<0.001), higher transaortic mean pressure gradients (48±14 vs 44±13 mmHg, p=0.004), and lower aortic valve areas (0.42±0.09 vs 0.45±0.08 cm2/m2, p<0.017). GLS was significantly lower in patients with AS compared to controls, especially in symptomatic group (17.9±3.4 vs 19.1±3.1 vs 20.7±2.1%, p<0.001 in symptomatic, asymptomatic and control groups respectively) suggesting an early, subtle, myocardial dysfunction. In particular, the analysis of layer-specific myocardial deformation revealed a marked difference in both the subendocardial LS (20.1±4.9 vs 21.7±4.2 vs 23.4±2.5%, p<0.001) and subepicardial LS (15.8±3.1 vs 16.8±2.8 vs 18.3±1.8%, p<0.001). At multivariable logistic regression analysis, subendocardial LS was independently associated to symptoms (OR=1.148, p=0.014), together with indexed left atrial volume (OR=1.035, p=0.007) and LV concentric remodelling (OR=2.429, p=0.031). During a mean follow up of 38 months (IQ range 18–60 months), 12 patients with asymptomatic severe AS had a cardiovascular (CV) death. The presence of a subendocardial LS <22% at baseline was associated with a higher rate of CV events at 3 and 5-year follow-up (19% vs 5% at 3-year follow-up, and 22% vs 8% at 5-year follow-up, respectively; log-rank p=0.044).

Conclusion

In patients with severe AS, LS impairment involves all myocardial layers and is more prominent in the advanced phases of the disease. In this setting, the subendocardial LS appears to be independently associated to symptoms than subepicardial LS. In asymptomatic patients, a reduced value of subendocardial LS is associated with higher CV mortality at 3- and 5-year follow-up.
P3374Quantification of mitral valve regurgitation volume by 2D and 3D echocardiography compared with cardiac magnetic resonance: a systematic review and meta-analysis
Authors: Skoldborg V , Abdulla J
Published: October 2019

Background

Accurate determination of mitral valve regurgitation (MVR) volume as a measure of left ventricular overload is of great clinical importance for timing of valve repair. The reliability of different echocardiographic methods for assessment of severity of MVR, particularly in severe cases, is currently unclear.

Purpose

We sought to shed light on this issue by means of a systematic literature review (SLR) and meta-analysis, in which we combined results of all available published studies comparing the different echocardiographic methods with cardiac magnetic resonance (CMR) as standard reference.

Methods

Electronic databases PubMed and Web of Science were searched for studies examining 2-dimensional (D) and 3D transthoracic and transoesophageal echocardiography (TTE and TEE), using proximal isovelocity surface area (PISA) and volumetric methods and comparing these with CMR. Estimated mean bias with limits of agreements (LoA) derived from Bland-Altman tests and correlations coefficients (R) were pooled together using a weighted inverse variance method.

Results

Twenty prospective studies were eligible for meta-analysis. Overall 1187 patients with primary or secondary, mild to severe MVR were included. The mean age was 59±13 years and male gender constituted 678 (57%) of patients. Meta-analysis of bias and LoA comparing all echocardiographic methods with CMR showed moderate overestimation and poor agreement with a bias and LoA of 8.24 (−3.55, 20.03) ml, and moderate correlation with R=0.74 (0.70–0.78) p<0.001, Fig 1. 3D-PISA followed by 3D-volumetric methods showed better agreement with an underestimation of −3.20 (−12.33, 5.92) ml, R=0.84 (0.78–0.89) p<0.001 and overestimation of 4.61 (−10.17, 19.39) ml, R=0.90 (0.86, 0.94) p<0.001, respectively. 2D volumetric method showed the poorest agreement with a bias and LoA of 23.56 (−4.19, 51.31) ml, and a moderate correlation with R=0.64 (0.54–0.73), p<0.001. In 172 patients with severe degree of MVR, echocardiographic techniques (2D and 3D) were able to correctly quantify regurgitation severity only in 114 (66%) of cases.

Conclusions

Echocardiographic methods either under- or overestimate the severity of MVR volume, however, 3D-PISA seems to be more reliable. CMR should be considered particularly in cases of severe MVR where a decision-making prior to valve surgery deems necessary. Powerful randomized studies are needed to further assess the accuracy of different echocardiographic methods in relation to CMR.
P3382Vascular calcium Index: an imaging tool to predict vascular complications and major bleeding in TF-TAVI
Authors: Felix-Oliveira A , Campante Teles R , Ferreira A , Brito J , Goncalves P A , Raposo L , Gabriel H M , Nolasco T , Cunha G , Abecasis J , Saraiva C , Almeida M S , Mendes M
Published: October 2019

Introduction

Vascular calcification has been associated with worse outcomes in transfemoral TAVI (TF-TAVI). However, there is currently no simple method to assess it and identify different patterns of calcification in an objective and quantitative manner. The purpose of this study was to develop a quantitative score of aortic (Ao) and ileofemural (IF) calcification and to assess its ability to predict life-threatening bleeding (LTB) and major vascular complications during TF-TAVI.

Methods

Case-control single center retrospective study of patients undergoing TF-TAVI between Nov2015 and Aug2018 including 183 consecutive patients (99 women, mean age 83±3 years, mean Euroscore II - ESII - 6.0±4.1). The Vascular Calcium Score was calculated for the entire Ao and IF vessels using a modified Agatston score derived from contrast-enhanced CT images, with calcium threshold locally adjusted for luminal attenuation (mean attenuation + 5x SD). A luminal attenuation threshold >600UH impaired vascular calcium evaluation and patients were excluded. LTB and major vascular complications were adjudicated according to the VARC-2 classification and identified by chart review by and independent team.

Results

Thirty patients (16%) suffered major bleeding and 13 (7%) experienced LTB. Major vascular injury occurred in 11 patients (6%). The median total vascular calcium score (TCS) was 11752 AU (IQR: 6388–19844) and median IF score (IFS) was 2210AU (IQR: 865–4170). TCS indexed for body surface area (TCSi) was predictor of LTB (AUC: 0.78±0.07, p<0.05) and of major vascular complications (AUC: 0.85±0.05, p<0.05). After multivariate analysis, iTCS and glomerular filtration rate (GFR) remained as predictors of LTB with an HR of 1.11 for each increase in 1000UA/m2 of TCSi (95% CI: 1.03–1.18) and 0.94 (95% CI: 0.88–0.985) respectively, independently of the ESII. iTCS and GFR were also independently associated with major vascular complications (p<0.05). Patients with an iTCS above 9750AU/m2 have an odds ratio of 7.7 (95% CI: 2.0 - 29.2) for LTB. This cut-off has a sensitivity of 77% and a specificity of 70% for LTB. Similarly, patients with an iTCS above 9750AU/m2 have an odds ratio of 10.3 (95% CI: 22 - 49.3) for major vascular injury.

Conclusions

A quantitative score for vascular calcification in contrast-enhanced CT images was developed. iTCS was independently associated with life-threatening bleeding and major vascular complications.
P3383Left atrial appendage and left atrial morphology is associated with cryptogenic stroke
Authors: Adukauskaite A , Barbieri F , Senoner T , Plank F , Knoflach M , Boehme C , Hintringer F , Mueller S , Dichtl W , Feuchtner G
Published: October 2019

Background

Stroke causes a high burden of morbidity and mortality worldwide. Approximately 30% of stroke cases remain cryptogenic (CS), of which one third is due to occult atrial fibrillation (AF) with left atrial appendage (LAA) being the most frequent thrombus source.

Hence, aim of our study was to assess if LAA morphological parameters analysed by computed tomography angiography (CTA) are associated with CS.

Methods and materials

In 184 patients (Table 1), 82 CS patients and 102 controls (age median 62 (52,2–72), 40.2% females), matched for BMI, a CTA was performed, and LAA morphology evaluated retrospectively.

LAA morphology was classified into 5 types (Figure 1): Cactus, Cauliflower, Chicken-wing, Windsock and the new “Seahorse” with a distinctive tip angulation of ≤90° and 2 bends (Z-shape). Further measurements included: LAA tip angulation (≤90°, 91–110°, >110°), LAA lobe number, LAA ostium size (length) and angulation, left atrium wall thickness (LAWT).

Results

LAA and left atrium (LA) parameters associated with CS on multivariable analysis after adjusting for CHA2DS2-VASc score were: Chicken-wing type (OR 2.15; 95% CI: 1.01–4.56, p=0.046), a greater lobe number (OR 2.01; 95% CI: 1.52–2.64, p<0.001), a greater middle and mean LAWT (respectively, OR 2.13; 95% CI: 1.49–3.05, p<0.001, OR 2.64; 95% CI: 1.63–4.29, p<0.001), a larger (length, OR 1.08; 95% CI: 1.0–1.16, p=0.039) and a less bent LAA ostium (OR 1.02; 95% CI: 1.01–1.03, p=0.006). In contrast, a sharp-angled LAA tip (≤90°) was protective from CS (OR 0.43; 95% CI: 0.23–0.83, p=0.012) on multivariable analysis.

Table1. Clinical patient characteristics CS (n=82) Non-stroke (n=102) p value Females 21 (25.6%) 53 (52%) p<0.001 Age, y 66.5 (57–73) 57.5 (50–70) 0.001 BMI, kg/m2 25.6 (23.9–28.2) 26 (23.3–30.1) 0.320 CHA2DS2-VASc score 2 (1–3) 2 (1–3) 0.387 AF (paroxysmal/permanent) 0 4 0.071 Hypertension 68 (82.9%) 54 (56.3%) p<0.001 Diabetes mellitus, type 2 16 (19.8%) 11 (11.5%) 0.145 Values are given in median ± IQR. AF, atrial fibrillation; BMI, body mass index.

LAA and LA morphology in CTA.

Conclusion

In CS, a Chicken-wing LAA, a greater number of lobes and a thicker LA wall are independently associated with CS while a sharp LAA tip (≤90°) mostly seen in Seahorse type LAA is protective. Such “high-risk” LAA and LA morphology could help to select CS patients benefiting from extended rhythm-monitoring to detect an occult AF, however, further prospective studies are needed to confirm this hypothesis.
P3387Cholesterol crystals in superficial plaque layer detected by optical coherence tomography as a new morphological feature for plaque rupture
Authors: Katayama Y , Tanaka A , Kitabata H , Kashiwagi M , Terada K , Emori H , Shiono Y , Kuroi A , Matsuo Y , Ino Y , Kubo T , Hozumi T , Akasaka T
Published: October 2019

Background

While plaque rupture (PR) is the leading cause of acute myocardial infarction (AMI), other etiologies are also involved in the onset of AMI. Cholesterol crystals (CCs) are usually present abundantly in atherosclerotic plaques, especially in the culprit site of AMI. However, the relationship between in vivo CCs and PR is unclear. Optical coherence tomography (OCT) is a high-resolution imaging technique that allows for the in vivo identification of various plaque characteristics including PR and CCs.

Purpose

The aim of this study was to investigate prevalence and distribution of CCs between patients with AMI with PR, AMI without PR, and SAP.

Method

This study consisted of 146 patients with coronary artery disease (AMI with PR; n=64, AMI without PR; n=41, and SAP; n=41) who underwent OCT prior to percutaneous coronary intervention. Plaque characteristics in OCT images were assessed according to the consensus document. We classified the distribution of CCs as follows; superficial type CCs were defined by any of the CCs invading the fibrous cap and remaining CCs as deep type CCs.

Result

There was no statistical difference in clinical characteristics among the three groups. The % diameter stenosis was significantly smaller in the SAP group than others (AMI with PR 91±12% vs. AMI without PR 86±13% vs. SAP 65±9%, p<0.001). The prevalence of CCs was significantly higher in the AMI with PR group than others (AMI with PR 78% vs. AMI without PR 41% vs. SAP 39%, p<0.001). The prevalence of superficial type CCs was significantly different among the groups (AMI with PR 72% vs. AMI without PR 24% vs. SAP 7%, p<0.001). Multivariable logistic analysis demonstrated that lipid plaque (OR 84.5, 95% CI [6.30–11332.33], p<0.001) and superficial type CC (OR 9.5, 95% CI [2.61–34.89], p<0.001) were independent predictors of PR.

Conclusion

Plaque with CCs invading the fibrous cap is frequently associated with PR in patients with AMI, suggesting. In vivo CC detection is a new morphological feature for plaque rupture.

Acknowledgement/Funding

This study was supported by a grant from JSPS KAKENHI (17K09557).
P3389Angioscopic differences in quality and quantity of neointima in patients experiencing an acute coronary syndrome treated with bare metal, first-, second-, and third generation drug-eluting stents
Authors: Matsuura T , Ueno M , Watanabe H , Yasuda M , Nakamura T , Takase T , Yamaji K , Iwanaga Y , Miyazaki S
Published: October 2019

Background

Although drug-eluting stents (DES) have substantially reduced the need for early target lesion revascularization (TLR) compared with bare-metal stents (BMS) by inhibiting neointima hyperplasia, early generation DES have been associated with an increased risk of very late stent failure (VLSF) due to stent thrombosis and TLR after 1 year. Although the incidence of VLSF is reduced with newer generation DES, VLSF remains an unresolved problem and its mechanisms are not fully explored.

Purpose

The purpose of this study was to evaluate quality and quantity of neointima and presence of thrombus by using coronary angioscopy at long-term follow-up in patients who experienced an acute coronary syndrome (ACS) treated with BMS and DES on dual antiplatelet therapy.

Methods

Coronary angioscopy was performed at 6 and 10 months after BMS and DES implantation, respectively, in ACS patients. We assessed neointimal coverage (NC) of the stent struts, yellow color grade (YG) of stented segment and the existence of thrombus. Angioscopic NC was defined as follows: grade 0= fully visible struts; grade 1= visible struts through thin neointima; grade 2= no visible struts. We determined maximum (Max-NC) and minimum coverage (Min-NC) grades and the dominant NC grades. YG was classified into 4 grades (0= white; 1= slight yellow; 2= yellow; 3= intensive yellow). The obtained findings were compared with BMS, first-generation (1st-) DES, second-generation (2nd-) DES and third-generation (3rd-) DES.

Results

A total of 212 patients were enrolled: BMS (n=127), 1st DES (n=26, sirolimus-eluting stent), 2nd-DES (n=38, permanent polymer everolimus-eluting stent), and 3rd-DES (n=21, bioresorbable polymer everolimus-eluting stent). Max-NC and Min-NC grade were significantly lower with 1st- and 2nd-DES than with BMS and 3rd-DES (Figure). The same trend was also observed in the dominant NC grades. There was a lower trend of YG in BMS and 3rd-DES than in 1st or 2nd-DES (Figure). The presence of thrombus was significantly lower in 3rd-DES in comparison with BMS, 1st-, and 2nd-DES (3rd-DES 0%, BMS 20.5%, 1st-DES 24%, 2nd-DES 13.5%, P=0.01).

Figure 1

Conclusion

Patients treated with 3rd-DES have higher NC grade, lower incidence of intrastent thrombus, and lower YG than in 1st and 2nd-DES. These findings may explain the lower incidence of VLSF associated with these newer generation stent platforms.
P3397Risk Or Benefit IN Screening for CArdiovascular disease (ROBINSCA): results from screening for a high cardiovascular disease risk by using a risk prediction model or coronary artery calcium scoring
Authors: Denissen S , Van Der Aalst C M , Vonder M , Gratama J W , Adriaansen H J , Dijkstra J , Kuijpers D , Van Der Harst P , Braam R L , Van Dijkman P R M , Van Bruggen R , Beltman F W , Oudkerk M , De Koning H J
Published: October 2019

Introduction

The ROBINSCA (Risk Or Benefit IN Screening for CArdiovascular disease) trial is a large-scale population-based randomized controlled screening trial with the aim to investigate whether screening for a high risk of cardiovascular disease (CVD) by means of either the Systematic COronary Risk Evaluation (SCORE) model or coronary artery calcium (CAC) scoring followed by preventive treatment is effective in reducing morbidity and mortality from coronary heart disease (CHD). This study shows the results of the CVD risks as assessed by the two screening tools.

Methods

Based on the Dutch population registry, 394,058 men aged 45–74 years and women aged 55–74 years received an information brochure, an invitation to participate in the trial, a baseline questionnaire with waist circumference tape and an informed consent form. Eligible individuals with an expected high CVD risk were randomized (1:1:1) into a control arm (n=14,519), intervention arm A (n=14,478) or intervention arm B (n=14,450). In the control arm, usual care was continued. In intervention arm A, participants were screened for a high risk of CVD using the SCORE model based on traditional risk factors. In intervention arm B, CAC scoring after computed tomography scanning was used for screening. After screening en risk communication, preventive treatment according to the Dutch guidelines is advised for high risk persons.

Results

Screening uptake was 84.2% in intervention arm A and 89.6% in intervention arm B. Of the screened participants, 48.7% was female, median age at screening was 62 (Interquartile Range 10), 35.2% was high educated, 19.6% was baseline smoker and 41.4% had a positive family history of myocardial infarction. The assessed CVD risk status according to SCORE screening was stratified into three risk categories; 45.1% was at low risk (SCORE<10%), 26.5% was at intermediate risk (SCORE 10–20%), and 28.4% was at high risk (SCORE ≥20%). According to CAC screening, 76.0% was at low risk (Agatston <100), 15.1% was at high risk (Agatston 100–399), and 8.9% was at very high risk (Agatston ≥400). Associations between baseline variables and increased CVD risk will be analyzed soon and will be available in summer 2019.

Conclusions

Using different screening tools resulted in reclassification of the CVD risk. CAC screening caused a substantial shift to more low risk individuals. This might, when screening is found to be effective, lead to less overtreatment in prevention of CVD events. Future 5-year follow-up data should provide evidence about whether population-based screening with subsequent preventive treatment is (cost-)effective in reducing CHD-related morbidity and mortality.
P3399Influence of TCF21 rs12190287 in the coronary artery disease risk prediction. An association study in a Portuguese population
Authors: Sousa J , Mendonca M , Pereira A , Mendonca F , Monteiro J , Neto M , Sousa A C , Henriques E , Freitas S , Guerra G , Borges S , Ornelas I , Drumond A , Palma Dos Reis R
Published: October 2019

TCF21 is a member of the basic-helix-loop-helix (bHLH) transcriptor factor family, being critical for embryogenesis of the heart, kidney and spleen. TCF21 also regulates epicardium-derived cells differentiation into smooth muscle and fibroblast lineages.

Aim

Investigate the impact of TCF21 rs12190287 in the prediction and discrimination of CAD risk, individually or into a genetic risk score (GRS) formed by a set of 13 genetic variants.

Methods

We performed a case-control study with 3050 subjects (1619 coronary patients with 53.3±8 years; 78.9% male and 1431 controls with 52.8±8 years; 76.6% male) from GENEMACOR study. We investigated all traditional risk factors (TRF), as well as 13 genetic variants from GWAS with unknown pathophysiological pathway so far, including TCF21 (rs12190287), ZC3HC1 (rs11556924), PSRC1/SORTI (rs599839), PHACTR1 (rs1332844), MIA3 (rs17465637), SMAD3 (rs17228212), ZNF259 (rs964184), ADAMTS7 (rs3825807), CDKN2B (rs4977574), 9p21.3 (rs1333049), KIF6 (rs20455), PCSK9 (rs2114580) and GJA4 (rs618675). A multiplicative genetic risk score with these 13 genetic variants (m13GRS), was calculated. Subsequently, two logistic regressions were performed; primarily with all the TRF and all the genes individually and the second with TRF and m13GRS.

Results

The first multivariate analysis shows that, besides the strong association of the TRF with CAD risk (with smoking status on the top of the list, with an OR of 3.2; p<0.0001), TCF21 rs12190287 was the most significant variant from all the studied genetic set with a CAD risk of 1.5 (95% CI: 1.1–1.9; p=0.004), followed by the well-known genetic determinant CDKN2B rs4977574 (OR=1.4; 95% CI: 1.1–1.7; p<0.002) and ZC3HC1 rs11556924 (OR=1.3; 95% CI: 1.0–1.7; p=0.034). When GRS is included to the model, all the TRF remain in the equation by the same order, and the m13GRS persisted as an independent predictor for CAD risk (OR=1.7; 95% CI: 1.4–2.0; p<0.0001).

Conclusion

TCF21 rs12190287 is a risk factor for CAD in the Portuguese population, either individually or incorporated in a m13GRS. TCF21 risk is independent from TRF. In the future, TCF21 can provide a new clues to identify patients at high cardiovascular risk and become a potential target for gene therapy.
P3413Preventable premature CVD mortality and mortality trends in eight Northern Dimension partnership countries
Authors: Jousilahti P , Vohlonen I , Vienonen M
Published: October 2019

Background

In 2016 an EU-funded international study of premature deaths and their causes in eight Northern Dimension (ND) partnership and associated countries (Belarus, Estonia, Germany, Finland, Latvia, Lithuania, Poland and Sweden) was conducted.

Purpose

The aim of the study was to examine the present situation and 10-year trends of preventable premature loss of life in countries sharing the same geographical area, but having considerable differences in history and social and economic development.

Methods

Potential Years of Life Lost (PYLL) is a method to examine premature avoidable mortality which combines the number of deaths with the age of dying. Based on the WHO definition on premature mortality, CVD deaths (ICD codes I00-I425, I427-I99) before the age of 70 years were considered premature. Age-standardized PYLL-rates per 100,000 person years were calculated in 2003, 2009 and 2013 based on the official mortality statistics of each country.

Results

Premature CVD mortality and mortality trends varied largely between the participating countries. In 2013, premature CVD mortality was highest in Belarus and lowest in Sweden. Largest relative decrease from 2003 to 2013 was observed in Estonia and smallest in Lithuania.

Years of life lost due to premature CVD mortality per 100,000. Country Men 2013 Women 2013 Men and women 2003 Men and women 2013 Relative reduction 2003–2013 Belarus 3235 922 2884 1978 −31% Estonia 1509 444 1607 939 −42% Finland 716 220 681 467 −31% Germany 618 254 638 435 −32% Latvia 2532 633 2158 1512 −30% Lithuania 2442 649 1616 1477 −9% Poland 1482 436 1182 945 −20% Sweden 485 202 462 345 −25%

Conclusions

Enormous health gain can be achieved by effectively applying evidence-based CVD prevention in Europe.

Acknowledgement/Funding

European union
P3420Is there an association between Saharan dust events and acute coronary syndrome incidence?
Authors: Baez-Ferrer N , Dominguez Rodriguez A , Hernandez-Vaquero D , Rodriguez S , Avanzas P , Abreu-Gonzalez P , Cuevas E
Published: October 2019

Background

Asian dust and air pollution have been recently recognized as triggers in the incidence of acute myocardial infarction. The inflow of dust from the Sahara into Spain causes an increase in particulate matter (PM) levels in the atmosphere. The proximity to the Western Coast of Morocco and the Sahara Desert promotes the seasonality arrival of natural PM on the Canary Islands (Spain), leading to high concentrations of PM with an aerodynamic diameter over 10μm (PM10). The association of dust transport from the Sahara to the Atlantic Ocean and Mediterranean areas over the incidence of acute coronary syndromes (ACS), is unknown.

Purpose

The aim of the present study was to elucidate whether Saharan dust events in the dust belt - Canary Islands - is associated with the incidence of ACS.

Methods

We retrospectively collected data of hospitalizations due to ACS in 2416 consecutive patients from a tertiary care hospital in Tenerife (Canary Islands–Spain), from December 2012 to December 2017. Taking advantage of Canary Islands location, we characterized the Saharan dust events using PMx measurements and dust modeling. Concentrations of PM10 and reactive gases are measured in the Air Quality Network of the Canary Islands by using the European reference method. We applied the time-stratified case crossover design to examine the association between Saharan dust events and the incidence of ACS. This design allows us to adjust for individual confounders, season, time trend and the day of week. Using conditional Poisson regression models, we estimated the impact of PM10 Saharan dust events on the incidence of ACS. Because the effects of Saharan dust events could persist over the course of a few days, we examined the lag effect from Day 0 to Day 5.

Results

The occurrence of Saharan dust events observed 0–5 days before the ACS was not significantly associated with the incidence of ACS. PM10 (μg/m3) effect was: lag 0 (IRR: 0.999, 95% CI: 0.977–1.022), lag 1 (IRR: 1.025, 95% CI: 0.988–1.063), lag 2 (IRR: 0.98, 95% CI: 0.928–1.042), lag 3 (IRR: 0.976, 95% CI: 0.944–1.011), lag 4 (IRR: 0.996, 95% CI: 0.983–1.008) and lag 5 (IRR: 0.996, 95% CI: 0.984–1.007). (Figure 1)

Poisson regression model of PM10

Conclusions

This negative study, the first to assess the impact of Saharan dust events as a potential trigger in the onset of ACS, shows that African dust is unlikely to be associated with the incidence of ACS.
P3421Increased air pollution expressed as PM10 concentration and winter time are related to the frequency of percutaneous coronary interventions in patients with acute coronary syndromes
Authors: Januszek R J , Staszczak B S , Bartus J B , Plens K P , Surdacki A S , Bartus S B , Dudek D D
Published: October 2019

Background

According to epidemiological studies, increased air pollution has negative impact on the cardiovascular system. However, the extent of the air pollution's impact on the frequency of the occurrence of specific subtypes of coronary artery diseases (CAD) has not yet been established with absolute certainty.

Purpose

The aim of the study was to assess the relationship between increased air pollution expressed as particulate air matter (PM10) concentrations and the occurrence of acute coronary syndromes (ACSs).

Methods

Based on the data published by the Chief Inspectorate for Environmental Protection, we selected six cities (six catheter laboratories [cath labs]) with low pollution according to PM10 (“non-polluted”) and five cities (six cath labs) with the highest pollution (“polluted”). These locations served as a basis for the determination of 24/7 cath labs and the frequency of percutaneous coronary interventions in patients (PCIs) with subsequent types of CAD with special outlook on the ACSs. The current study accounted 10,239 patients in the polluted area and 5,648 patients from the non-polluted region treated with PCI and included patients with stable angina and ACSs. Analysing the period of 365 days, the number of patients undergoing angioplasty in monitored cath labs and the mean daily concentration of PM10 in all selected cities were calculated for each day. In order to better visualise air pollution trends and the frequency of performing PCI in patients with ACS, we have created new time intervals for weeks. Additionally, due to the difference in pollution levels, the analysed period was divided into winter (13 weeks) and non-winter weeks (39 weeks).

Results

The annual average concentration of PM10 amounts to 50.95 μg/m3 in polluted cities and 26.62 μg/m3 in non-polluted ones, which was significantly different (p<0.01) (Fig. 1). It was proven that for both groups, the rise in PM10 pollution levels is connected with the increased frequency of PCIs in patients with ACSs (polluted p<0.01 and non-polluted p<0.01 areas). Moreover, we calculated that in the non-polluted regions, the increase in PM10 concentration by every 1 μg/m3 causes 0.22 additional ACS angioplasties per week. In polluted regions, the same increase in PM10 concentration causes 0.18 additional ACS angioplasties per week. In non-winter weeks, the mean number of ACS PCIs expressed in promiles was lower than in winter weeks in polluted (18.56±2.41 vs. 21.23±3.98, p=0.03) and non-polluted cities (18.68±2.98 vs. 20.88±2.57, p=0.02).

Figure 1. Biplot chart according to the extent of pollution expressed as PM10 and sample size for selected Cathlabs.

Conclusions

The study shows that the increase in air pollution expressed as PM10 concentration and winter time influences the frequency of ACS related PCIs.
P3425Alpha-linolenic acid may lower the rate of atherosclerotic cardiovascular disease in subjects with a low intake of marine n-3 fatty acids
Authors: Bork C S , Venoe S K , Lasota A N , Lundbye-Christensen S , Tjoenneland A , Overvad K , Schmidt E B
Published: October 2019

Introduction

Previous studies investigating the association between intake of the plant-derived n-3 fatty acid alpha-linolenic and atherosclerotic cardiovascular disease (ASCVD) have shown conflicting results. However, the effect of ALA intake on ASCVD may depend on the intake of marine n-3 fatty acids.

Purpose

We aimed to explore the association between ALA intake and risk of ASCVD in subjects consuming below and above the 10th percentile of marine n-3 fatty acids, respectively.

Methods

We followed men and women enrolled into the Danish Diet, Cancer and Health cohort (n=57.053) by linkage with nationwide registers and identified all incident ASCVD cases. All participants were aged 50 to 65 years at baseline. ASCVD was defined as the first registration of myocardial infarction, peripheral artery disease or ischemic stroke due to large artery atherosclerosis or small-vessel occlusions. Intake of ALA and marine n-3 fatty acids was assessed using a validated food frequency questionnaire and expressed as energy-adjusted intake. Statistical analyses were conducted using Cox proportional hazard regression.

Results

During a median of 13.4 years of follow-up, we identified a total of 3958 incident ASCVD cases including 366 cases among subjects in the lowest 10th percentile of consumption of marine n-3 fatty acids (<252 mg/day). In multivariable analyses, we found a statistically significant inverse association between ALA modelled as a restricted cubic spline and the rate of ASCVD (p=0.005) in subjects with a low intake of marine n-3 fatty acids, whereas no statistically significant association was found between ALA intake and ASCVD in subjects with a higher intake of marine n-3 fatty acids (p=0.155) (Figure).

Conclusion

Intake of ALA may be associated with a lower rate of ASCVD in subjects with a low intake of marine n-3 fatty acids.

Acknowledgement/Funding

The Danish Heart Foundation (17-R115-A7415-22060), Helene and Georg Jensens and Ethel Merethe and Christian Pontoppidan's Fund.