bluuebunny/crossref_metadata_2025 huggingface dataset:
P5461Left atrial dysfunction is a potent predictor of ischemic complications in hypertensive patients
Authors: Shorikova D , Shorikov E , Khukhlina O
Published: October 2019

Arterial hypertension (AH) is associated with abnormalities morphology and function of heart. The research of left ventricle size in patients with AH is mandatory and included in Guidelines. But enlargement of left atrium (LA) is common finding in AH. Despite of this fact, most AH studies ignore LA size. At the same time LA size is often used as a surrogate marker and considered risk factor cardiovascular events.

Materials and methods

298 patients with AH were included in the study (2011–2017), all the inhabitants of Bukovina region of Ukraine. In 28 patients from this cohort was registered episode of Transient Ischemic Attack (TIA) or Ischemic Stroke (IS). The patients with atrial fibrillation (all types) were excluded. LA volumes were calculated from apical four-chamber and two-chamber views by biplane Area-Length method - LA volume index, LA passive emptying volume (PEV), LA passive emptying fraction (PEF), LA active emptying volume (AEV), LA active emptying fraction (AEF), LA total emptying volume (TEV), LA total emptying fraction (TEF). Data were analyzed by SPSS version 20.

Results

LA diameter and indexed AEV and TEV were significantly higher in the group with TIA/IS compared with non-complicated AH (p<0.05), table. PEF and TEF were significantly lower at hypertensive patients with ischemic complications. There were no significant differences in indexed PEV and TEF (p>0.05), table. According to multivariate analysis was set the reliable linear regression between LA diameter, AEV and TEV with age (p<0.05), body mass index (p<0.05), glucose intolerance (p<0.05) and smoking (p<0.05) in all hypertensive patients, independently of TIA/IS complications.

LA parameters in comparison groups AH (n=270) AH, complicated TIA/IS (n=28) p LA diameter (mm) 35.6±4.1 37.4±4.9 <0.03 PEV (ml/m2) 7.4±2.8 7.6±3.1 0.72 AEV (ml/m2) 5.4±2.4 6.8±1.9 0.003 TEV (ml/m2) 12.9±2.2 14.9±3.1 <0.001 LA PEF (%) 32.3±8.4 28.9±7.3 0.04 LA AEF (%) 40.7±6.9 42.1±7.4 0.31 LA TEF (%) 64.1±5.9 61.3±4.2 <0.001 AH, Arterial Hypertension; TIA, Transient Ischemic Attack; IS, Ischemic Stroke.

Conclusion

LA function can be easily and non-invasively determined by performing 2D echocardiography and becoming parameter of interest as a marker of overall cardiac function. LA size and volume enlargement, LA dysfunction may be a good predictor of cardiovascular outcomes such as Transient Ischemic Attack or Ischemic Stroke in patients with arterial hypertension.
P5489Old ladies paradox: trends in the inpatient care of coronary heart disease 2005–2016 in Germany
Authors: Wahler S , Mueller A , Birkemeyer R
Published: October 2019

Objectives

Coronary heart disease (CHD) and subsequent illnesses are the most common cause of death in industrialized countries and they continue to lead the cause of death statistics.

In Germany, 2015 from all registered deaths 7.1% (n=65,686) are due to chronic CHD and 5.3% (n=49,210) due to acute myocardial infarction (AMI), but the proportion has fallen: Compared to 2003, when 10.9% (n=92,637) of the deceased of CHD and 7.5% of AMI (n=64,229).

It is established that there are sex-differences in prevalence and in the age of the persons concerned. E.g. 2015 AMI infarction is cause of death in 57% (n=27,835) men and 43% (n=21,375) women from 49% men (n=36,049) and 51% women (n=37,127) in 2003.

Aim of the study was, whether these differences in prevalence and diagnostic and interventional measurements in the hospital sector have shifted in recent years with the various entities of the acute coronary disease.

Methods

G-DRG Report-Browser 2005–2016 of the German DRG-Institute (InEK) and Federal Statistical Office data were used.

Analysis was carried out with Microsoft Excel and Access (version 2016).

Results

Inpatient cases of main diagnosis AMI increased from 2005 from 206,104 cases to 219,156 cases in 2016 (+6.3%).

Share of male increased from 62.5% to 66.6%.

The NSTEMI share increased from 39.7% in 2005 to 66.2% in 2016; a total 145.202 cases (+77.2% to 2005). The increase was smaller in older women: 60–70y: +33.7%; 70–80y: +44.5%; 80–90y: +61.9%The NSTEMI increase in men was slightly higher than in women; proportion of men 2005: 64.2%, 2016; 65.1%. The STEMIs number shrank from 104,082 in 2005 to 70,521 (−34.0%) in 2016. The relative reduction was very high in older women:

60–70y: −45.2%; 70–80y: −55.3%; 80–90y: −54.1%. Share of men 2005: 60.1%, 2015; 70.0%.

In 2008: 220,595 diagnostic-only coronarographies were conducted from a total of 690,745 coronarography measurements.

These numbers increased to 485.496 (+120.1%) and 869.002 (+25.8%) in 2016.

Share of the male decreased from 73.0% in 2008 to 65.6% in 2015.

The increase for all coronarographies was highest in older women: 50–60y: +60.7% 60–70y: +39.4%; 70–80y: +72.5%; 80–90y: +168,4%

The total number of percutaneous transluminal vascular interventions (PCI) increased from 2008 with 488,542 to 661,693 in 2016 (+35.4%). The relative increase in PCI was high in older women:

60–70y: +18.6%; 70–80y: +42.7%; 80–90y: +126.1%; >90y: +314.1%

Conclusions

The number of cases of ACS is declining since 2005. There is a significant shift from STEMI to NSTEMI events over the observation period.

In all forms of the ACS, the proportion of men in is increasing.

The rate of coronary diagnostic and coronary intervention in men is disproportionately high in relation to disease rate. Paradoxically the share of examinations older women without further action increases strongly, despite their share in the disease was small and is still decreasing.
P5503Long term prosnoctic benefit of complete revascularizaction in elderly non ST elevation myocardial infarction patients
Authors: Abou Jokh Casas C , Agra Bermejo R , Cordero A , Garcia Acuna J M , Rigueiro Veloso P , Iglesias Alvarez D , Alvarez Alvarez B , Diaz B , Alvarez Rodriguez L , Roman Rego A , Cid Alvarez B , Cinza Sanjurjo S , Gonzalez Juanatey J R
Published: October 2019

Background

The benefit of complete or culprit vessel revascularization in elderly patients (>75 years) with Acute Coronary Syndrome without ST-segment elevation (NSTEMI), and multivessel disease (MVD) remains debated.

Purpose

We aimed to study the current long-term prognostic benefit of complete revascularization in an elderly population with NSTEMI and MVD.

Methods

We performed a retrospective cohort study of 1722 consecutive elderly NSTEMI patients. Baseline patient characteristics were examined and a follow-up period was established for the registry of death and first major cardiovascular event (MACE). We performed a propensity-matching analysis to draw up two groups of patients paired according to whether or not they had been completely revascularized. The prognostic value of the revascularization to predict events during follow-up was analyzed using Cox regression.

Results

Among the study participants, 30.4% (n=524) underwent complete revascularization and 69.6% (n=1198) had culprit vessel revascularization performed. Patients in these groups have different clinical and pharmacological profiles. After the propensity score analysis, the population was divided into two groups: complete revascularization (n=353) and culprit vessel revascularization (n=353).The median follow-up was 45.7 months. All cause mortality (52.1% vs 28.6%, p<0.001), cardiovascular mortality (39.1% vs 18.4%, p<0.001) and MACE rates were significantly higher in patients with incomplete revascularization compared with those with complete revascularization.

Kaplan-Meyer curves for main endpoints

Conclusion

In our study, the long-term benefit of complete revascularization in an elderly population with NSTEMI and MVD was observed.
P5536Comparison of safety and effectiveness between right and left radial artery approach in percutaneous coronary intervention for acute coronary syndrome. Propensity score analysis of data from the ORPKI
Authors: Tokarek T , Dziewierz A , Plens K , Rakowski T , Dudek D , Siudak Z
Published: October 2019

Introduction

The use of the radial approach (RA) for percutaneous coronary intervention (PCI) has gradually increased. Several studies demonstrated that radial artery is associated with significant reduction in major adverse cardiac events for both coronary angiography and PCI in acute coronary syndrome (ACS). However, it is still unclear if the side of RA has influence on clinical outcomes in an all-comer population in ACS settings.

Purpose

We sought to evaluate safety, feasibility, and clinical outcomes of right radial approach (RRA) compared to left radial approach (LRA) during PCI in “real-world” patients with ACS.

Methods

A total of 234,087 consecutive patients with ACS treated with PCI and stent implantation via radial approach between 2014 and 2017 in 151 invasive cardiology centers on the Polish territory. Data was based on the ORPKI Polish National Registry. Patients treated with RRA and LRA were compared using a propensity score analysis to avoid possible selection bias. The analysis was done in an “as-treated” manner.

Results

Procedure was conducted using RRA and LRA in 180,378 (77.1%) and 53,709 (22.9%) patients, respectively. After propensity score matching higher total amount of contrast (174.28 (±75.56) vs. 166.95 (±70.57) [ml]; P=0.001) and radiation doses were reported in PCI with left radial artery utilization (1210.21 (±1003.53) vs. 1054.07 (±1024.17) [mGy]; p=0.001). No differences were observed between RRA and LRA in rate of periprocedural adverse events such as myocardial infarction (0.08% vs. 0.08%; p=0.9) stroke (0.02% vs. 0.01%; p=0.1), no-reflow phenomenon (0.64%vs. 0.56%; p=0.1) and death (0.25% vs. 0.24%; p=0.7). A trend towards a lower rate of access-site-related bleeding during PCI was observed in RRA group (0.08% vs. 0.05%; p=0.066). Coronary artery perforation (0.21% vs. 0.16%; p=0.05) and cardiac arrest (0.56% vs 0.42%; p=0.01) were reported more often during PCI conducted with LRA.

Conclusions

Both radial approaches seems to be equally effective in the setting of PCI in ACS. However, utilization of left radial artery was associated with trend toward increased risk of access-site bleeding and higher rate of periprocedural complications as compared to RRA. Higher amount of contrast and radiation doses used in LRA procedures might be equivalent of generally lower experience with this access site.

Acknowledgement/Funding

None
P5540Familial clustering of spontaneous coronary artery dissection
Authors: McGrath-Cadell L , Hesselson S , Iismaa S E , Mishra K , Wong C M Y , Fatkin D , Dunwoodie S L , Harvey R , Holloway C J , Muller D W M , Giannoulatou E , Graham R M
Published: October 2019

Background

There is increasing evidence that patients with spontaneous coronary artery dissection (SCAD) have an underlying genetic susceptibility (Goel et al JAMA Intern Med175:821–826, 2015). Moreover, in a collaborative study involving 1,055 SCAD cases and 7,190 controls, we recently reported the first risk allele for SCAD, a variant (rs9349379-A) in the PHACTR1/EDN1 genetic locus (Adlam et al J Amer Coll Cardiol73:58–66, 2019).

Purpose

We sought to determine the clinical characteristics and initial genetic data for 11 families, in which more than one member has had an episode of SCAD.

Methods

Participants were recruited largely via a social media platform. Informed consent was obtained in all cases for analysis of genetic information using whole genome sequencing, as well as collection of clinical information. SCAD was confirmed by review of coronary angiogram images and clinical data collected by phone interview, as well as review of specialist letters and hospital records.

Results

Of 235 participants recruited to date, 23 cases showed familial clustering involving sister-sister pairs in six families, three first-degree cousins in one family (picture), two first-degree cousins in two families, a mother-son pair, and a family with concordant monozygotic twins, that is both twins having had SCAD. In an additional family, SCAD is discordant in monozygotic twins. A comparison of symptoms, age at SCAD, clinical syndrome, cardiovascular risk factors, SCAD risk factors, environmental triggers, SCAD location, acute management, left ventricular function and recurrent SCAD events in these families versus isolated cases, will be presented. Three sister-sister pairs have undergone whole genome sequencing and these data sets are undergoing segregation analysis to identify rare variants that are present exclusively in affected family members.

Family E Pedigree. Shaded circles represent first cousins affected with SCAD. The top number represents age (in years) of the SCAD event and the bottom number represents current age (in years).

Conclusions

To our knowledge, this is the largest assembly of SCAD cases with familial clustering reported to date. It provides strong evidence supporting an underlying genetic basis for SCAD, which most likely is a multi-genic disorder that also involves important gene-environment interactions.
P5545Predictors of 10-year mortality and re-intervention in patients with multivessel coronary disease, reduced systolic left ventricular function, after complete revascularization by PCI or CABG
Authors: Popov T , Dejanovic J , Petrovic M , Srdanovic I , Tadic S , Vulin A , Redzek A , Kovacevic M , Drljevic V , Popov I
Published: October 2019

Introduction

In patients with multivessel coronary disease, the decision on revascularization should be made through a heart team. Whether there is an optimal method and what are the predictors of mortality and repeated interventions is the subject of numerous studies.

Purpose

To determine what are the predictors of 10-year mortality and repeated interventions in patients with multivessel coronary disease and reduced systolic left ventricular function in which complete revascularization is done through percutaneous coronary intervention (PCI) and surgical aortocoronary bypass (CABG).

Methods

The survey included 178 patients who underwent elective revascularization of multivessel coronary disease in one center during 2008 through PCI or bypass, according to the heart team's decision. All subjects had a reduced left ventricular systolic function, ejection fraction less than 50%. The study excluded patients with acute coronary syndrome. The basic demographic and clinical characteristics of the subjects and risk factors were analyzed.

Results

Ten-year mortality was 31.4%, without a significant difference between the examined groups (in the PCI group 25 patients (30.5%) in the bypass group 30 (32.3%), p>0.05). In subjects with letal outcome during 10-year follow-up, lower hemoglobin levels in discharge, enlarged cardiac cavities, increased internal diameter of left ventricle in systole (LVIDs) and enlarged left atrium, lower systolic left ventricular function, higher EUROscore and higher NYHA class in discharge. The enlarged left ventricular diameter in systole (OR 2.28 (1.27–4.11), p=0.006) and the NYHA class (OR 2.49 (1.22–5.08), p=0.012) are independent predictors ten-year mortality. In the group of patients undergoing surgical revascularization, independent predictors of 10-year mortality are higher levels of uric acid (OR 1,006 (1,000–1,011), P=0,047) and lower serum hemoglobin at discharge (OR 0,959 (0,919–0,999), P=0.046), while in PCI group LVIDs (OR 2.89 (1.351–6.196), p=0.006). During the 10-year follow-up, repeated PCI was performed in 12 (14.5%) patients in the PCI group and in 3 (3.2%) patients in the CABG group, p=0.012. No surgical revascularization was performed during follow up. Diabetes mellitus is an independent predictor of reintervention in the PCI group (OR 4.12 (1.153–14.703), p=0.029).

Conclusion

Mortality predictors during ten years of follow-up in subjects following a revascularization of multivessel coronary disease, and with reduced left ventricular systolic function, are increased systolic left ventricular diameter and higher NYHA class in discharge. Reintervention is more commonly performed after PCI and the presence of diabetes mellitus is an independent predictor.
P5561MicroRNA-208b gene expression levels as a biomarkers of left ventricular dysfunction in patients with acute myocarditis
Authors: Marketou M , Kontaraki J , Fragiadakis K , Konstantinou J , Maragkoudakis S , Lempidakis D , Plevritaki A , Plataki M , Papadopoulos D , Vougia D , Vardas P , Partthenakis F
Published: October 2019

Purpose

MicroRNAs (miRs) play a major role in protein regulation by post-transcriptional gene expression and cell to cell interaction. Recently, they have been emerged as important modulators in cardiovascular development and disease. Our aim was to determine whether cardiac related miRs such as miR-208b was differentially expressed in peripheral blood mononuclear cells from patients with acute myocarditis. We also evaluated their expression levels in peripheral blood mononuclear cells in relation with left ventricular global longitudinal peak strain (GLPS) in those patients.

Methods

We assessed the expression levels of miR-208b in 45 patients with acute myocarditis (38 men, mean age 31±10 years) and 22 healthy individuals (18 men, mean age 33±9 years). Blood samples were taken on admission and miR expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. All patients were also underwent an assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography.

Results

GLPS was significantly reduced in the group of myocarditis compared to healthy individuals (from −13.7 ± −7.9% versus −22.2±6.7%, p<0.05). Myocarditis patients showed significantly higher miR-208b (28.5±6.6 versus 6.40±1.1, p<0.001) expression levels compared to control group. miR-208b gene expression levels at baseline revealed a significant negative correlation with GLPS on admission (r=−0.51, p<0.05). This correlation was independent of the patients' clinical parameters.

Conclusions

Our data reveal that miR-208b gene expression levels are upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals. In addition, miR-208b levels have a prognostic value in the deterioration of left ventricular GLPS in those patients. Thus, miR-208b may represent a promising biomarkers in myocarditis or a potential therapeutic target in the future.
P5572Percutaneous edge-to-edge repair for the treatment of acute decompensated severe mitral regurgitation: a single-centre experience
Authors: Vimalesvaran K , Kelly L , Vazir A , Smith R
Published: October 2019

Background

Patients with acute, decompensated severe mitral regurgitation (MR) are poorly served by surgical or medical treatments and is associated with high mortality. Percutaneous edge-to-edge mitral valve repair (PMVR) with the MitraClip system is potentially a less-invasive life-saving procedure. While PMVR has demonstrated efficacy in stable patients with severe MR, there is limited evidence for its use in patients suffering from prolonged cardiogenic shock, recurrent or persistent pulmonary oedema, and haemodynamic instability.

Purpose

The aim of this study was to evaluate the effectiveness of emergency PMVR in haemodynamically unstable patients with decompensated MR who were unsuitable for surgical intervention.

Methods

We performed a retrospective review of all patients who underwent emergency PMVR from January 2015 to January 2019 in a single centre. Inclusion criteria were patients with acute decompensated severe MR and shock (defined at the time of procedure as dependence on one or more of: intravenous (IV) inotropes; afterload reduction for persistent pulmonary oedema; mechanical circulatory support; and invasive respiratory support). Outcome measures were pre- and post-procedural MR severity grade, mortality at six months, and incidence of further mitral valve intervention.

Results

Of 183 consecutive patients undergoing PMVR, 14 (8%) patients fulfilled the inclusion criteria. Median age was 70 (range 55–88, IQR 23), and 8 were female. At the time of admission, 7 (50%) were in cardiogenic shock and 7 were in persistent pulmonary oedema. MR was functional in 7 (50%) patients and degenerative in 7, of which 4 were secondary to acute papillary muscle rupture. All patients had Grade 4 MR at presentation and were considered too high-risk for surgery by the Heart Team. Median Euroscore II was 14.4 (8.1–54.6, IQR 9.1). Post-procedure, 13 patients (93%) of patients had Grade 3 MR or less. Eleven (79%) patients were successfully weaned from mechanical support and intravenous drugs. The remaining three patients died of persistent arrhythmia, stroke or heart failure within 4 weeks. At six-months, 9 out of 12 patients (75%) were alive and 2 were lost to follow-up. No patients underwent further mitral valve intervention.

Conclusions

This small case-series suggests that PMVR may be a feasible and life-saving procedure in patients presenting with acute, decompensated severe MR who were unsuitable for surgery. It was associated with reversal of cardiogenic shock and good short-term survival in the majority of patients. These patients are typically considered critically unwell with very high mortality. These promising results may inform larger, prospective studies to manage this otherwise under-served patient cohort.
P5599Prognostic impact of quality indicators on outcomes of acute aortic dissection in Japan
Authors: Yamaguchi T , Nakai M , Sumita Y , Miyamoto Y , Matsuda H , Inoue Y , Yoshino H , Okita Y , Minatoya K , Ueda Y , Ogino H
Published: October 2019

Background

Despite recent advances in diagnosis and management, the mortality of acute aortic dissection (AAD) remains high.

Purpose

This study aims to develop quality indicators (QIs) for the management of AAD, and to evaluate the associations between QIs and outcomes of AAD in a Japanese nationwide administrative database.

Methods

A total of 18,348 patients suffered from AAD (Type A: 10,131, Type B: 8,217) in the Japanese Registry of All Cardiac and Vascular Diseases database between 2012 and 2015 were studied. A systematic review was performed to establish initial index items for QIs. Evaluation was performed through the expert consensus meeting using a Delphi method. Associations between developed QIs and the mortality were determined by multivariate mixed logistic regression analyses.

Results

A total of nine QIs (five structural and four processatic) were developed. Achievements of developed QIs (High: 7–9, Middle: 4–6, Low: 0–3) were significantly associated with lower in-hospital mortality even after adjustment for covariates in both type A (Middle: odds ratio [OR], 0.257; 95% confidence interval [CI], 0.211–0.312; P<0.001; High: OR, 0.064; 95% CI, 0.047–0.086; P<0.001 vs. Low) and type B (Middle: OR, 0.447; 95% CI, 0.338–0.590; P<0.001; High: OR, 0.128; 95% CI, 0.077–0.215; P<0.001 vs. Low). Additionally, achievements of structural and processatic QIs were consistently associated with reduced in-hospital mortality.

QIs and in-hospital mortality

Conclusions

Developed QIs for AAD management were significantly associated with lower in-hospital mortality. Evaluation of each hospital's management with QIs could be helpful to equalize quality of treatment and to fill the evidence-to-practice gaps in the real-world treatment.
P5611Feasibility of distal radial access for carotid interventions: the RADCAR-DISTAL pilot study
Authors: Ruzsa Z , Nardai S , Nemes B , Orias V , Vegh E , Merkely B
Published: October 2019

Aims

The aim of our study was to demonstrate the feasibility and safety of the distal transradial approach (DTRA) for carotid artery stenting (CAS).

Methods and results

We included 209 consecutive patients (151 Trans-Radial Access (TRA) and 58 DTRA) treated in a single center by CAS with cerebral protection between 2016 and 2018. DTRA punctures were performed by ultrasound guidance, and the carotid artery cannulations were done using a 6.5 F coronary sheathless guiding catheter. The groups showed similar demographic profile regarding age, gender and comorbidities, however the proportion of symptomatic patients was significantly higher in the DTRA cohort (DTRA: 75,86% vs. TRA: 46.36% p<0.001). Procedural success rate was similarly high in both groups, while the overall complication rate was very low, with no major adverse events and only a few vascular complications. The cannulation times were similar, while the overall procedure length was slightly higher in the DTRA group. The cumulative X-ray dose was similarly low regardless the access used.

Conclusion

DTRA is a safe and effective alternative of conventional trans-radial approach for CAS, with a potential to further improve the patient comfort.
P5679Utility of late iodine enhancement computed tomography with image subtraction in the evaluation of cardiac resynchronization therapy response
Authors: Pezel T , Mika D , Laissy J P , Moubarak G
Published: October 2019

Background

Despite the impressive results of the large CRT trials, it has been observed that, on an individual basis, about 30% of patients fail to respond to cardiac resynchronization therapy (CRT). The evaluation of left ventricular (LV) dyssynchrony, myocardial scar, and coronary venous anatomy by image subtraction in Late Iodine Enhancement Computed Tomography (LIE-CT) has the potential to comprehensively characterize non-responders.

Purpose

To assess the feasibility and the utility of image subtraction in LIE-CT in CRT patients and compare findings between responders and non-responders.

Methods

Monocentric prospective study of CRT patients at least 6 months after implantation who underwent post-procedural CT between March and October 2018. CRT-responders were defined as patients with an absolute increase in LV ejection fraction >5%.

CT-derived residual global and segmental dyssynchrony metrics, extent and location of myocardial scar, coronary venous anatomy, and position of LV lead relative to scar and segment of latest mechanical contraction were analyzed.

Results

Among the 29 patients (mean age 71±12 years; 72% men), 18 were responders (62%). All CT metrics evaluating residual dyssynchrony such as wall motion indexand wall thickness indexwere worse in non-responders (p<0.0001 for both). In LIE-CT, predictive factors of CRT-non-response were an LV lead localized in an region of myocardial scar (p=0.0007), in a region with akinesia or dyskinesia (p=0.007), and with myocardial thickness <6mm (p=0.002). Percentage of fibrosis of the myocardial mass and the presence of fibrosis in postero-lateral region were not predictive of CRT-non-response (p=0.9 and p=0.3, respectively). Of the 11 non-responder patients, 8 (73%) had at least one other coronary venous branch visualized by CT; and among those, 3 (38%) were located in an non-akinetic area with late segmental contraction.

Wall Motion and LIE-CT

Conclusion

Image subtraction in LIE-CT in patients who had CRT is feasible and allows better characterization of CRT-non-responders, who have a greater amount of residual dyssynchrony than responders. Distribution of fibrosis in relation to the LV lead and presence of alternative venous branches may help patient management.
P5681Improved electrical performance/stability of a novel active fixation coronary sinus lead compared to passive fixation leads: a multi-centre study
Authors: Gerontitis D , Wardley J , Chapman M , Zegard A , Sammut E , Bates M , Waddingham P , Diab I , Chow A , Leyva F , Turley A , Williams I , Ullah W
Published: October 2019

Background

A novel active fixation coronary sinus (CS) lead, Attain Stability, has been released in a bipolar and quadripolar configuration, with the hypothesis it will improve targeted lead positioning and stability independent of vessel anatomy.

Purpose

To compare implant procedure parameters and electrical performance/stability of a novel active fixation lead with passive fixation CS leads.

Methods

This was a retrospective study involving 6 major UK cardiac centres. Patients who received active leads were compared with passive lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macro/micro-displacements, defined as displacements requiring repositioning procedures, or an increase in threshold≥0.5 volts or pulse width≥0.5msec, or a change in pacing polarity). Multivariate analysis was performed to establish predictors of the primary outcome, assessing fixation mechanism (active or passive), number of poles (quad or bipolar), contributing hospital and follow-up duration.

Results

736 patients were included (241 with active leads, 495 with passive leads). There were no group differences in the baseline characteristics with respect to age, gender, EF, NYHA class, and co-morbidities, P>0.05 for all. The primary endpoint rate was 31% (74/241) in the active and 43% (213/495) in the passive fixation group (P=0.002). 6 patients in the active group and 14 in the passive group required CS lead repositioning procedures. The results of the multivariate analysis are presented in the Table. The use of active leads was associated with a significant reduction in lead displacements, odds ratio 0.62 (95% CI 0.43–0.9), P=0.012. There were differences in favour of passive compared with active leads in procedure duration, 120 [96–149] minutes vs 128 [105–155] minutes (P=0.011), and fluoroscopy time, 17 [11–26] minutes vs 18.5 [13–27] minutes (P=0.028). The median duration of follow up was similar (active vs passive): 31 [17–47] weeks vs 34 [16–71] weeks, (P=0.052).

Odds Ratio (95% Confidence Interval) P-value Active fixation CS lead 0.62 (0.43–0.9) 0.012 Quadripolar (rather than Bipolar) lead 1.26 (0.75–2.11) 0.376 Follow-up Duration (weeks) 1.005 (1.001–1.008) 0.025 Also included in the model: contributing hospital, which was significant.

Conclusion

In this large, multi-centre study, active fixation Attain Stability CS leads demonstrated superior electrical performance/stability compared with passive fixation leads, with minimal increases in implant procedure and fluoroscopy times.

Acknowledgement/Funding

None
P5986Clinical outcomes of age in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Replacement
Authors: Munoz-Garcia E , Munoz-Garcia M , Munoz Garcia A J , Carrasco-Chinchilla F , Dominguez-Franco A J , Alonso-Briales J H , Hernandez-Garcia J M , Jimenez-Navarro M F , Gomez-Doblas J J
Published: October 2019

Transcatheter Aortic valve Replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement for patients considered at high or prohibitive operative risk. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes in according to age. The aim of this study was to determine the survival and the clinical outcomes on based of age. after TAVR with the CoreValve prosthesis.

Methods

From April 2008 to December 2017, the CoreValve and Sapiens 3 prosthesis were implanted in 667 patients with symptomatic severe aortic stenosis with deemed high risk on base to age, <80 years and ≥80 years old

Results

The mean age in patients <80 compared with ≥80 years, was 73.6±7 vs. 83.4±2.8 years and the logistic EuroSCORE and STS score were 16.3±11% vs. 18.1±11%. In-hospital mortality was 3.4%, and the combined endpoint of death, vascular complications, myocardial infarction, majopr bleeding or stroke had a rate of 18.3%. The late mortality (beyond 30 days) was 40.5%. When compared both groups, there were no differences for the presence of threatening bleeding 3.5% vs. 3.6% (HR = 1.033 [IC95% 0.452–2.360], p=0.557), myocardial infarction4.2% vs. 2.9% (HR = 0.67 [IC95% 0.290–1,530], p=0.0.226), stroke 8.9% vs. 9.4% (HR = 1.067 [IC95% 0.625–1.821], p=0.814) and mortality 44.5% vs. 41.1% (HR=0.971388 [IC95% 0.639–1.188], p=0.214) and there was difference in between groups in hospitalizations for heart failure 13.8% vs. 7.7% (HR = 1.374 [IC95% 1.037–1.821], p=0.008. Survival at 1, 2, 3, 4, 5 were similar in both groups (86.9% vs. 89.8%, 78.4 vs. 78.3%, 65.5 vs. 72.5%, 57.9% vs. 62.8% and 51.1 vs. 52.8%>; log Rank 0.992, p=0.319), respectively, after a mean follow-up of 43.9±27 months.

Conclusions

TAVR is associated with significant survival benefit throughout 3.2 years of follow-up. Survival during follow-up was similar in patients with <80 compared with ≥80 years old.
P6144Trends of mortality in patients with acute coronary syndromes submitted to urgent myocardial revascularization procedures in Brazil
Authors: Moreira H , Bittar N A , Venancio I M , Silva N T , Lima A M S , Souza M R
Published: October 2019

Background

Acute Coronary Syndromes (ACS) are the most common and life-threatening manifestation of cardiovascular diseases. This disease burden along with progress in cardiovascular technology has led to substantial growth in the number of cardiovascular procedures performed in ACS management. In Brazil, there are no contemporary data about in-hospital mortality related to urgent myocardial revascularization procedures.

Purpose

To describe trends in mortality in patients with ACS who underwent urgent myocardial revascularization procedures in Brazil, between 2008 and 2016.

Methods

Data on hospital admission and in-hospital mortality were obtained from the database of the Brazilian Public Health System (DATASUS) over a nine-years period (2008–2016). All admissions due to ACS were identified using standard ICD codes. Additionally, data about percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) performed as an urgency were retrieved. Trend analyses over the period were performed using Poisson regression.

Results

Between 2008 and 2016, 472,810 urgent myocardial revascularization procedures were performed, of which 370,018 (78.3%) were PCI and 102,792 (21.7%) were CABG. The in-hospital mortality in patients with ACS submitted to PCI was 3.4%, and 6.8% among those submitted to CABG. There was an increase in the number of PCI procedures from 26,929 in 2008 to 53,542 in 2016 (98%), although the mortality remained stable (3.3% to 3.6%, respectively). CABG procedures also raised 77%, from 9,535 in 2008 to 12,262 in 2016, but the observed related mortality decreased from 8.0% to 6.3%, respectively. However, disparities among Brazilian geographical regions were noted: in 2016, mortality among ACS patients who underwent urgent PCI was lower in Southeast (3.2%) and higher in the Northeast Region (5.9%). The Southeast Region also presented the lowest CABG related mortality (5.7%), whereas the Midwest had the higher death rates (7.8%).

Conclusions

In this contemporary analysis based on national public health data, there was an increase in the number of urgent myocardial revascularization procedures in patients hospitalized for ACS in Brazil. Despite stable death rates in patients undergoing PCI, CABG-related mortality decreased significantly. Due to the heterogeneity of results among the different geographical Regions of the country, there are still opportunities to improve these national results.
P6152Incremental prognostic utility of functionally non-significant coronary stenosis in patients undergoing coronary computed tomogram angiography
Authors: Alashi A , Huttcenteno E , Schoenhagen P , Popovic Z B , Cremer P , Kalahasti V , Jellis C , Renapurkar R , Rodriguez L L , Flamm S D , Desai M Y
Published: October 2019

Background

In patients with suspected coronary artery disease (CAD) who underwent coronary computed tomographic angiography (CCTA), the prognostic value of nonobstructive stenosis is not entirely understood.

Aims

We sought to assess the long-term incremental prognostic utility of functionally non-significant CAD in patients without known prior CAD who underwent CCTA.

Methods

We included 2142 consecutive patients (51±14 years, 53% men) without prior documented CAD who underwent CCTA between 2008–2016 (excluding anomalous coronaries and functionally significant CAD). Traditional risk factors were recorded and pretest likelihood of CAD was calculated. All epicardial coronary arteries were classified as follows: No plaque, minimal luminal irregularities (<25%), mild (25–49%) stenosis and moderate (50–69%) stenosis. All moderate stenoses were confirmed to be not functionally significant by follow-up stress testing/invasive angiography with fractional flow reserve assessment. Plaque was characterized as noncalcified, calcified or mixed. High-risk plaque features (spotty calcification, napkin ring, low attenuation plaque and positive remodeling) were recorded. During follow-up, a composite of death or myocardial infarction was recorded.

Results

188 (9%) patients had low, 1712 (80%) had intermediate and 242 (11%) patients had high pre-test likelihood of CAD. 45%, 10%, 52% and 22% had hypertension, diabetes, Dyslipedimia and history of smoking respectively. Breakdown of CAD severity was: 1197 (56%) none, 480 (22%) minimal, 267 (13%) mild and 198 (9%) moderate stenoses. 82 (4%) had noncalcified, 245 (11%) had calcified and 618 (29%) had mixed plaque. 465 (22%) had high-risk plaque features. At 6±3 years, 90 (4%) patients had composite events (68 deaths) and 24 (1%) needed coronary revascularization >90 days post-CCTA. 880 (41%) were on statins post-CCTA. Results of multivariable Cox Survival Analysis are shown in Figure 1A. Kaplan-Meier survival curves for a) more severe CAD and b) high-risk plaque features (vs. not) are shown in Figure 1B and C. Longer-term event rates for increasing CAD were 2.8%, 4.6%, 6% and 9.6%, respectively.

Conclusion

In mostly low/intermediate risk patients without documented CAD who underwent CCTA, a higher burden of nonobstructive coronary plaque (or presence of high-risk features) provide incremental prognostic value. Initiating statin therapy following detection of plaque on CCTA was associated with improved longer-term freedom from composite events.
P6169Ultra-low radiation 70kv-coronary computed tomography angiography with low-dose contrast media using dual source computed tomography
Authors: Komatsu S , Takahashi S , Yutani C , Takewa M , Ohara T , Kodama K
Published: October 2019

Background

The major concerns with coronary computed tomography angiography (CCTA) is the amount of contrast media (CM) injected and the radiation dose.

Purpose

To establish low radiation CCTA with low amount of contrast media.

Methods

Consecutive 60 patients (body weight ≤70mg or less and Agatston score ≤400) who were scheduled coronary computed tomography angiography were enrolled. Dual-source scanner (SOMATOM Force, Siemens, Germany) was used and CM used was Iopamidol 370mg/I (Bayer, Germany). Coronary CT angiography was performed with Turbo Flash Spiral and Sinogram Affirmed Iterative Reconstruction was done. The dose of contrast media was decided according to our original predicting system for 300HU. This study was approved by the local ethics committee and all patients gave written, informed consent. Exclusion criteria for CCTA were low Agatston score (<50), atrial fibrillation, allergy to CM, renal insufficiency (glomerular filtration rate <60 mL/min/1.73 mm2), pregnancy, congenital heart disease, low left ventricular function, and coronary artery bypass graft. All segments were evaluated using a 5-point scale: 5, excellent and easily assessable,; 4, good, mild artifacts at 1 segment and assessable; 3, evaluable, moderate artifacts on a few segments; 2, evaluable, diagnostic combined with axial images; and 1, not assessable.

Results

All patients successfully performed CCTA. Age averaged 46±15 yo (mean±S.D.) and body mass index averaged 22.5±3.0. Used CM was 12±7ml and intracoronary CT number 329±28HU. Dose-length product averaged 21.7±15.0 mGy cm and effective dose averaged 0.30±0.21mSv. Image quality averaged 4.8±0.7. CCTA with the lowest effective dose was 0.04mSv and CCTA with the lowest CM was 4ml.

Conclusions

Ultra-low dose 70kV-CCTA with low dose of contrast media can be performed using dual source computed tomography in patients with body weight ≤70mg or less and Agatston score ≤400.
P6201Beneficial effect of ezetimibe-atorvastatin combination therapy in patients with a mutation in ABCG5 or ABCG8 gene
Authors: Tada H , Nohara N A , Kawashiri M K , Takamura M T
Published: October 2019

Background

Use of ezetimibe on top of statin therapy has been shown to be effective to reduce LDL cholesterol level in hypercholesterolemic patients. However, little is known regarding the individual variety of the effectiveness of ezetimibe. We hypothesized that hypercholesterolemic patients with a mutation in ABCG5 or ABCG8 gene exhibit better response to ezetimibe that those without, based on the fact that ezetimibe is hyper-effective for in patients with sitosterolemia caused by ABCG5 or ABCG8 genetic mutations.

Methods

Electronical medical record were reviewed in a total of 321 hypercholesterolemic patients (baseline LDL cholesterol = 192±46 mg/dl) prescribed ezetimibe 10 mg daily on top of atorvastatin 10mg daily who had undergone genetic analysis of ABCG5 or ABCG8 gene in our institute since 2006 to 2017. Pathogenicity of the variants were determined using standard variant filtering schema, including minor allele frequency, in silico annotation tools. Patients were divided into 2 groups based on the presence of ABCG5 or ABCG8 mutation. We compared the percent reduction of LDL cholesterol as well as the achieved LDL cholesterol levels between these 2 groups.

Results

We found 26 (8%) individuals who exhibit deleterious mutations in ABCG5 or ABCG8 gene. Baseline characteristics under the atorvastatin 10mg therapy were comparable in age, gender, and LDL cholesterol level between 2 groups. Under these conditions, percent reduction of LDL cholesterol in mutation positive group was significantly larger than that of mutation negative group (28±16% vs. 39±21%, p<0.05). As a result, the achieved LDL cholesterol level in mutation positive group was significantly lower than that of mutation negative group (87±29 mg/dl vs. 72±26% mg/dl, p<0.05).

Conclusion

These results suggest that ezetimibe-atorvastatin combination therapy might be more beneficial in hypercholesterolemic patients with a mutation in ABCG5 or ABCG8 gene.
P6338Discussing prognosis with heart failure patients; the view of the cardiologist
Authors: Van Der Wal M H L , Hjelmfors L , Stromberg A , Jaarsma T
Published: October 2019

Background

Discussing prognosis is advocated in recent Heart Failure (HF) ESC guidelines. However, there is a lot of discussion about roles, responsibilities and timing with regard to discussing prognosis with HF patients and their family. The purpose of this study was to describe the views of cardiologists with regard to discussing prognosis with HF patients, experienced barriers and how difficult it is to have such conversations.

Methods

A total of 275 cardiologists (125 in the Netherlands; 150 in Sweden) were invited by email to participate in a survey. The questionnaire was adapted from a validated questionnaire for HF-nurses consisting of 10 items on communicating prognosis. Participants were asked to select at which time they would discuss prognosis for the first time and which barriers they experience in these discussions. Finally, they were asked to rate how difficult it is to discuss prognosis on a scale from 1 (not difficult at all) to 10 (very difficult).

Results

A total of 88 cardiologists (43 Dutch; 45 Swedish; response rate 32%) participated in the study (mean age 49±10; 28% women). Most of the cardiologists (82%) stated that discussing prognosis should be discussed with all HF patients. In their view, this could be done by the own cardiologist (97%), but also by a cardiologist on the ward (72%), the HF nurse (51%) or the GP (28%). In total 47% stated that prognosis should be discussed when the patient is diagnosed and 18% answered that it should take place preferably at the first period of decompensation. Fifteen percent reported to discuss it only in case of a serious deterioration of the condition of the patient. There were no significant differences in views between Dutch and Swedish cardiologists.

Most important barriers to discuss prognosis were “cognitive problems of the patient” (69%) and “too little time to discuss the topic” (64%). Other important barriers were `the patient is not ready for it' (60%) and “fear that the patient would be worried/lose hope” (50%).

Although the mean reported difficulty in discussing prognosis was rather low (4,2±2), 34% of the cardiologists rated >6. Swedish cardiologists found it more difficult compared to their Dutch colleagues (3,7±2 vs. 4,7±2; p<0.05)

Conclusion

A considerable number of cardiologists suggested to discuss prognosis with all HF patients at the time the patient is diagnosed. Barriers to discuss this were related to the patient (cognitive problems, not ready to discuss), the organisation (lack of time) or the cardiologist (fear of making the patient worried or losing hope). Swedish cardiologists experienced discussing prognosis more difficult compared to Dutch cardiologist. Although most of the cardiologists reported that the responsible cardiologist should discuss prognosis with the patient, also other healthcare professionals (cardiologist on the ward, HF nurse, GP) could discuss this. A team approach to improve discussing prognosis with HF patients therefor seems important.
P6348Phospholamban antisense oligonucleotides drive the reversal of cardiac dysfunction and multiple heart failure parameters during murine dilated cardiomyopathy
Authors: Spaeter D , Hidalgo Gonzalez A , Elbeck Z , Yeh S T , Siga H , Damle S S , Palmer M , Kuo C , Wang Q D , Chien K R , Fritsche-Danielson R , Hansson K , Mullick A E , Knoell R
Published: October 2019

Background

Mice lacking muscle LIM protein (Mlp/Cspr3 −/−) develop dilated cardiomyopathy (DCM). Previous work established this model to be amenable to improvements in cardiac function by genetic ablation of phospholamban (PLN).

Purpose

To test the hypothesis that therapeutic reductions of PLN would similarly improve cardiac function, Mlp KO mice were administered an antisense oligonucleotide (ASO) targeting PLN.

Methods

Echocardiography measurements of ejection fraction (EF), end-diastolic volume (EDV) and end-systolic volume (ESV) were performed before and after treatment. In addition, global transcriptome profiling using 3'RNA-seq was performed to identify gene expression changes in diseased Mlp KO mice and following PLN ASO treatments. Mlp KO mice with ejection fraction (EF%) of less than 45% (median, 37.6%; interquartile range, 32.2–42.0%) were treated with vehicle (n=10) or PLN ASO (n=9) for 4 weeks.

Results

Three subcutaneous injections of PLN ASO were administered to Mlp KO mice resulting in 50–70% PLN reductions. Echocardiography performed at study end revealed improvements of EF (60±8 vs. 46±12%), ESV (31±11 vs. 56±21μl) and EDV (79±22 vs. 100±25μl) with PLN ASO treatment. Corrected for baseline values, PLN ASO treatment improved all echocardiographic measurements (p<0.001). Transcriptional analyses revealed that PLN ASO treatment reduced expression of heart failure related markers, such as Myh7 (−70%), Nppa (−72%), Nppb (−71%), Acta1 (−84%) and Ankrd1 (−40%), p<0.05 vs. vehicle. In addition, genes not previously known to be dysregulated in this model, Edn3 and Xirp2, were identified and shown to be reduced following PLN ASO treatment by 71% and 67%, respectively (p<0.001). Bioinformatic analysis suggested improvement of known and novel heart failure associated pathways by PLN inhibition in this model.

In conclusion, antisense inhibition of PLN reduced functional and transcriptional indices of heart failure in a DCM model. In view of the failed CUPID trials, a gene therapy approach to improve SERCA2a activity, targeting PLN with ASO may be advantageous due to a likely more robust pharmacological profile.