bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermodilution vs indirect fick cardiac output measurement in clinical practice: insights from a tertiary centre
Authors: Pereira A , Santos J.G , Loureiro M.J , Ferreira F , Almeida A.R , Cale R , Repolho D , Vitorino S , Morgado J , Pereira H
Published: November 2020

Introduction

Thermodilution (TD) and indirect Fick (IF) methods are widely used to measure cardiac output (CO). They are often used interchangeably to make critical clinical decisions, yet few studies have compared these approaches concerning agreement and comparative prognostic value as applied in medical practice.

Purpose

To assess agreement between TD and IF methods and to compare how well these methods predict mortality.

Methods

Retrospective cohort study including all consecutive right heart catheterizations performed in a referral pulmonary hypertension (PH) centre from 2010 to 2018. Cardiac index (CI) was calculated by indexed CO to body surface area. PH was classified according to the new definition of the 6st World Symposium on Pulmonary Hypertension 2018 [mean pulmonary arterial pressure (mPAP) >20 mmHg]. Patients with cardiac or extra-cardiac shunts or significant (moderate to severe or severe) tricuspid regurgitation were excluded. All-cause mortality over 1 year after right heart catheterization was recorded. Logistic regression was used to identify predictors of the adverse event.

Results

From a total of 569 procedures, 424 fulfilled the inclusion criteria: mean age 56.7±15.4 years, 67.3% female. Haemodynamic parameters were diagnosed of PH in 86.2% of cases: mPAP 35.3±15.3 mmHg, 83.6% pre-capillary subtype, 42.9% belonging to group 4 (chronic thromboembolic pulmonary hypertension) and 26.6% to group 1 (pulmonary arterial hypertension). Mean values of CO and CI were, respectively, 4.5±2.8 L/min and 2.5±0.8 L/min/m2 measured by TD and 4.6±2.4 L/min and 2.6±1.3 L/min/m2 measured by IF method. There was a median difference (IF minus TD) of - 0.03 / min to CO and - 0.05 L/min/m2 to CI but both meausres correlated only modestly (r=0.6 to TD and r=0.5 to IF). One-year all-cause mortality rate was 5.4% (median time to death was 50.5 days). Lower values of CO and CI assessed by TD were significantly associated with all-cause mortality occurrence (CO TD: 4.5±1.3 L/min versus 3.6±1.0 L/min, p<0.01; CI TD: 2.6±0.7 L/min/m2 versus 2.1±0.4 L/min/m2, p<0.01). No association was observed between CO (p=0.31) and CI (p=0.42) measured by IF method and the adverse event. Logistic regression identified 2 independent predictors of all-cause mortality: TD CO (OR 0.55, 95% CI 0.38–0.79, p<0.01) and TD CI (OR 0.34, 95% CI 0.17–0.67, p<0.01). Similar results were obtained when patients diagnosed with PH were independently analyzed.

Conclusions

There is only modest agreement between TD and IF CO and CI estimates. Despite being more time-consuming, TD measurements were predictors of all-cause mortality and present a highest prognostic value. These findings favored their used over IF in clinical practice.

Funding Acknowledgement

Type of funding source: None
Efficacy and outcomes of balloon pulmonary angioplasty in elderly vs non-elderly chronic thromboembolic pulmonary hypertension patients
Authors: Shinya Y , Kimura M , Kawakami T , Hiraide T , Moriyama H , Kataoka M , Endo J , Itabashi Y , Murata M , Kohno T , Fukuda K
Published: November 2020

Introduction

Balloon pulmonary angioplasty (BPA) has been reported as an effective and safe treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, its safety and efficacy in elderly patients remains unknown.

Purpose

We investigated the effect of BPA on hemodynamics and respiratory parameters, functional capacity, and short- and long-term outcome in elderly patients.

Methods

From November 2012 to May 2018, 141 consecutive CTEPH patients who underwent BPA in a single university hospital were enrolled (age: 65 [54.5–74] years old, WHO functional class [WHO-FC] II/III/IV; 35/96/10). Patients were divided into two groups according to the age; elderly (≥75 years, N=32) and young groups (<75 years, N=109). Hemodynamics (right-sided heart catheterization), biomarkers (brain natriuretic peptide), respiratory function (spirometry and diffusion capacity measurement), and functional capacity (6-minute walk distance [6MWD] and WHO-FC) were evaluated at baseline and 1-year post BPA. Procedure-related complications (in hospital death, use of percutaneous cardiopulmonary support [PCPS], and pulmonary injury) and all cause death during the follow up period were also assessed.

Results

At baseline, although elderly group had less severe hemodynamics (mPAP: 33.1±6.7 vs 39.0±11.8 mmHg, p<0.05), they had poor exercise capacity and reduced pulmonary diffusion capacity, compared with young group (6MWD: 264.6±101.3 vs 369.7±105.2 m, %DLco: 42.0±12.0 vs 50.2±12.7%, all p<0.05). BPA improved hemodynamics, biomarkers, exercise capacity, and pulmonary diffusion capacity in both elderly and young groups (all p<0.05). There was no in-hospital death or use of PCPS in both groups, although the incidence of pulmonary injury was higher in elderly group (14.3% vs 5.3%, p<0.01). Under the normalized hemodynamics 1-year after BPA in both groups, exercise capacity and pulmonary diffusion capacity were worse in the elderly group than young groups (p<0.01). The incidence of all-cause death in the follow up period was higher in elderly group, all of which were due to non-pulmonary hypertension (PH)-related death (p<0.01).

Conclusion

BPA was effective in improving hemodynamics and respiratory parameters and functional capacity, in associated with no critical complication, regardless of the age. Elderly patients who were treated with BPA were associated with higher incidence of non-PH-related death.

Changes of mean PAP in the two groups

Funding Acknowledgement

Type of funding source: None
Treatment with macitentan for pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD): real-world experience from the combined OPUS and OrPHeUS data sets
Authors: McLaughlin V , Chin K , Kim N.H , Flynn M , Ong R , Wetherill G , Channick R
Published: November 2020

Introduction

Restrictive inclusion criteria can exclude some CHD-PAH patients from clinical trials. The OPsumit® USers (OPUS) Registry and the OPsumit® Historical USers (OrPHeUS) data sets provide real-world data in PAH patients newly started on macitentan, including patients with CHD-PAH regardless of defect type.

Purpose

To describe the characteristics, safety and clinical outcomes of CHD-PAH patients newly treated with macitentan.

Methods

OPUS is a prospective, US, multicentre, observational drug registry ongoing since April 2014. OrPHeUS was a retrospective, US, multicentre chart review; observation period Oct 2013–Mar 2017. This analysis reports information on CHD-PAH patients in the combined OPUS/OrPHeUS data set, descriptively compared with idiopathic/heritable PAH (I/HPAH) patients.

Results

As of Sept 2019, there were 4268 PAH patients with follow-up data, of whom 264 (6%) had CHD-PAH and 2396 (56%) had I/HPAH. For CHD-PAH and I/HPAH patients respectively at macitentan initiation: median age (Q1, Q3) was 48 (36, 62) and 65 (53, 73) years; 199 (75%) and 1748 (73%) were female; 67/114 (59%) and 802/1301 (62%) were WHO functional class III/IV; median (Q1, Q3) 6-minute walk distances were 350 (274, 420) and 289 (195, 375) m for the 82 and 840 patients with measurements; median (Q1, Q3) time from PAH diagnosis to macitentan initiation was 37.3 (4.5, 113.1) and 7.4 (1.4, 38.3) months; and 99 (38%) and 1056 (44%) initiated macitentan as monotherapy. The number of patients with ≥1 hepatic adverse event (HAE) was similar for CHD-PAH and I/HPAH (22 [8%] and 184 [8%]), as were the adverse event (AE) profiles (collected from OPUS only). Exposure, discontinuations, outcomes and most common AEs are shown in the table.

Conclusions

In general, compared with I/HPAH patients, CHD-PAH patients were younger and a greater proportion had prevalent disease than I/HPAH patients. Safety and outcomes were similar between the groups.

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): Actelion Pharmaceuticals Ltd
Impact of timing on major complications after thoracic endovascular aortic repair for uncomplicated type B aortic dissection
Authors: Xie E.M , Liu J.T , Yang F , Ding H.Y , Hu B.Q , Chen L.F , Yang X.Y , Luo J.F
Published: November 2020

Background

This study aimed to analyze the impact of the timing of intervention from presentation of symptoms to TEVAR and its relation to major complications for uncomplicated TBAD.

Methods

We retrospectively analyzed the data of 390 patients who underwent TEVAR for acute, subacute and chronic uncomplicated type B aortic dissection from January, 2010 to December 2017. Standard univariate and survival methods were used. The primary outcome of interest was in-hospital mortality. The Secondary outcomes of interest was long-term death and in-hospital adverse events, including postoperative coma, postoperative endoleak, postoperative stroke, postoperative spinal cord ischemia, postoperative limb ischemia, postoperative mesenteric ischemia/infraction.

Results

Of the 390 TEVARs for uncomplicated TBAD, 145 were performed within 14 days of presentation of symptoms (acute), 172 between 14 hours and 90 days (sub-acute), and 73 were beyond 90 days (chronic). Demographic characteristics were similar among groups (Table 1). A slight increase of in-hospital death, post-operative endoleak and limb ischemia, were observed in the acute intervention group compared with the sub-acute group (4.8% vs 2.3%, 11.7% vs 9.3%, 2.8% vs 2.3%, respectively). The chronic group patients had a highest rates of post-operative endoleak. However, there are no significantly differences between the three groups (Table 2). During long-term follow-up (median duration 36.9 months, interquartile range, 22.5–67.7 months), overall survival was similar among groups (log-rank test, P=0.280) (Figure).

Conclusion

TEVER performed for uncomplicated TBAD within 14 days to the presentation of symptoms, as compared with TEVAR between 14 hours and 90 days or beyond 90 days, neither appear to increase the risk of in-hospital complications nor long-term mortality.

Long-term All-cause Mortality

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): This research was supported by grant DFJH201807 from High-level Hospital Construction Project of Guangdong Provincial People's Hospital.
In-vivo blood flow parameters can predict at-risk aortic aneurysms and dissection: a comprehensive biomechanics model
Authors: Salmasi M , Jarral O.A , Pirola S , Sasidharan S , Pepper J , Oo A , Moore Jr J , Xu X.Y , Athanasiou T
Published: November 2020

Background

Abnormal blood flow patterns can alter the material properties of the thoracic aorta via altered vascular biology and tissue biomechanics. In-vivo haemodynamic assessment of the aorta is yet to penetrate clinical practice due to our limited understanding of its effect on aortic wall properties. The decision for surgical treatment is based on size thresholds, limited to a single measurement of aortic diameter from routine imaging, although many aortic dissections (40–60%) occur below these size thresholds. This multi-centre study aims to assess the clinical utility of biomechanics principles in thoracic aortic aneurysm (TAA) risk rupture prediction using a substantial sample size.

Methods

Fifty-five patients undergoing surgery for root or ascending TAA were recruited from five cardiac centres. Bicuspid aortic valves and connective tissue disease were excluded from this study.Haemodynamic assessment Pre-operative 4-dimensional flow magnetic resonance imaging (4D-MRI) were conducted. Direct 4D-flow analysis and computational fluid dynamics (CFD) were performed creating detailed wall shear stress (WSS) maps across the whole aneurysms. Aortic wall assessment The aneurysmal aortic sample was obtained from surgery and subjected to region specific uniaxial failure tests in the circumferential and longitudinal directions, as well as delamination testing within the aortic media. Whole aneurysm histological characterisation was also conducted using computational pathology techniques. Blood flow, tissue mechanics and microstructural properties were used to develop a risk prediction model with assessment of elastin, collagen and smooth muscle cell composition, as well as failure strain assessment and dissection energy function.

Results

Outcomes of mechanical properties were: Young's Elastic Modulus as a measure of aortic stiffness (0.85 MPa ±0.69), as well as maximal tensile strength (0.49 MPa ± 0.36), which demonstrated reduced aortic wall strength in the outer curvature. This correlated with increased wall shear stress (WSS) (up to 10 Pa) and flow velocity (up to 43 l/min). Regions of abnormal flow and tissue mechanics correlated significantly with degraded medial microstructure (elastin abundance: 34 vs 66%; collagen abundance 26 vs 57%, p<0.05).

Conclusions

CFD modelling has the potential to provide a risk prediction of acute events in TAA beyond the current size classification, as validated by altered aortic tissue properties. Future longitudinal studies are warranted to validate this methods in moderately enlarging thoracic aortas.

Flow, mechanical, histology properties

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): NIHR Imperial College BRC
Effects of electronic cigarette on platelet and vascular function after one month of use
Authors: Ikonomidis I , Katogiannis K , Kostelli G , Kourea K , Kyriakou E , Kypraiou A , Thymis J , Benas D , Triantafyllou C , Andreadou I , Tsoumani M , Pavlidis G , Tsantes A.E , Iliodromitis E
Published: November 2020

Background and aims

Smoking is a major factor that contributes to the development of cardiovascular disease. Smoking cessation delays progress of coronary artery disease. Electronic cigarette is proposed as a bridge to smoking cessation. We examined its effects on platelet function after 1 month of use compared to tobacco smoking.

Patients and methods

40 current smokers (mean age 48 years±5) without cardiovascular disease were randomized to smoke either a conventional cigarette (conv-cig) or an electronic cigarette (e-cig) (electronic cigarette fluid with nicotine concentration of 12 mg/dL) for one month. All subjects smoked an electronic cigarette with nicotine concentration 12 mg/dL for one month. Measurements were performed at baseline and after one month of smoking the conventional or electronic cigarette. We measured a) perfused boundary region (PBR) of the sublingual arterial micro vessels (range 5–25 micrometers), a marker inversely related with glycocalyx thickness, b) pulse wave velocity (PWV), central systolic blood pressure (cSBP) and augmentation index (AIx), c) platelet function by two different methods, namely the novel Platelet Function Analyzer PFA-100 and the traditional Light Transmission Aggregometry (LTA) d) the exhaled CO level (parts per million-ppm) as a smoking status marker; and e) the plasma malondialdehyde (MDA) levels, as an oxidative stress burden index.

Results

After 1 month of electronic smoking, we did not observe any significant change in platelet function and arterial stiffness (p>0.05 for all markers) with the exception of a reduction of MDA (1.22±0.1 vs 1.09±0.1 μmol/L, p=0.03) and exhaled CO; 14.9±0.7 vs 5.9±0.7 ppm, p<0.001. Conversely, after continuation of conventional cigarette smoking for a month, platelet function was further impaired as assessed by PFA [125,5±31,1 vs 152,35±51,4 U, p=0.047) and by LTA (epinephrine as stimulator) [59,8%±16,1 vs 35,6%±19.1, p<0.001] and markers of arterial stiffness were deteriorated, as assessed by PWV (9,5±2,8 vs 10,3±2,9, p=0,028) and by Aixc (8,36±35,9 vs 30,4±21,6, p=0,004).

Conclusions

Electronic Cigarette smoking has a neutral effect on platelet function and arterial stiffness markers compared to conventional tobacco smoking which further deteriorates platelet and vascular function during one moth of use.

Funding Acknowledgement

Type of funding source: None
The impact of atrial fibrillation on one-year mortality in patients with severe peripheral artery diseases
Authors: Liu C.W , Su M.I
Published: November 2020

Background

Atrial fibrillation (Afib) was associated with the incidence of peripheral artery disease (PAD), but the effect of Afib on prognosis in patients with severe PAD remains unclear.

Purpose

We aimed to investigate the association between Afib and clinical outcomes.

Methods

We retrospectively enrolled consecutive patients with severe PAD receiving percutaneous transluminal angioplasty between 2013/1/1 and 2018/12/31. The study outcomes were all-cause mortality, cardiac-related mortality, major adverse cardiac events (MACE), and major adverse limb events (MALE) at one-year.

Results

The study consisted of 222 patients with age 74±11 years, the stage of Rutherford classification 4.6±0.8, 54% male, and 12.6% presented with acute limb ischemia. The patients with Afib vs. without Afib had significantly greater ratios of all-cause mortality (42.9% vs. 20.1%, P=0.014) and MACE (32.1% vs. 14.4%, P=0.028). A trend toward significant association was found regarding one-year cardiac mortality (21.4% vs. 10.3%, P=0.111). No significant difference was found with respect of MALE (17.9% vs. 14.9%, P=0.778). After we adjusted for confounders in each study outcome, Afib was independently associated with all-cause mortality (adjusted HR: 2.153, 95% CI: 1.084–4.276, P=0.029) and MACE (adjusted HR: 2.338, 95% CI: 1.054–2.188, P=0.037). Other predictors associated with all-cause mortality included the presence of acute limb ischemia (adjusted HR: 2.898, 95% CI: 1.504–5.586, P=0.001), Rutherford classification (adjusted HR: 1.930, 95% CI: 1.191–3.128, P=0.008), and heart rate (adjusted HR: 1.018, 95% CI: 1.001–1.035, P=0.035). The other predictor associated with MACE was heart rate (adjusted HR: 1.020, 95% CI: 1.002–1.037, P=0.025)

Conclusions

Afib was significantly associated with increased risks of all-cause mortality and MACE at one year in the patients with severe PAD, and future studies may investigate whether use of oral anti-coagulants benefits to these patients.

Funding Acknowledgement

Type of funding source: None
Risk of lower limb amputation in diabetes patients with and without coronary artery disease – a cohort study from Western Denmark
Authors: Olesen K.K.W , Gyldenkerne C , Thim T , Thomsen R.W , Maeng M
Published: November 2020

Background

Diabetes patients are at greater risk of lower limb amputation due to a higher risk of peripheral artery disease (PAD) and peripheral neuropathy. The effect of concomitant coronary artery disease (CAD) is less explored.

Purpose

We examined the risk of PAD, lower limb revascularization, and lower limb amputation in diabetes and non-diabetes patients with and without CAD examined by coronary angiography.

Methods

We included all patients who underwent coronary angiography between 2003–2016 in Western Denmark. Patients with a history of PAD or previous lower limb revascularization or amputation were excluded. Patients were stratified by diabetes and CAD status and followed in prospective registries for a maximum of 10 years. Outcomes were PAD, lower limb revascularization, and lower limb amputation. We estimated 10-year cumulative incidence and adjusted hazard ratios (aHR) using patients with neither diabetes nor CAD as reference. We also examined the effect of CAD extent, insulin treatment, and duration of diabetes in the diabetes group.

Results

A total of 118,787 coronary angiography patients were included of whom 17,482 (14.7%) had diabetes. Median follow-up was 6.8 years. Patients with both diabetes and CAD had the highest risk of PAD (aHR 3.90, 95% CI 3.55–4.28), lower limb revascularization (aHR 4.61, 95% CI 3.85–5.52), and lower limb amputation (aHR 9.49, 95% CI 7.27–12.39), compared with patients with neither diabetes nor CAD. Extent of CAD, insulin treatment, and duration of diabetes were all associated with increased risks of PAD and amputation in the diabetes group. CAD only patients had higher 10-year risk of PAD compared to diabetes only patients (7.9% versus 6.9%), but had lower risk of amputation (0.6% versus 2.4%, Figure). CAD only patients were most often amputated at hip/femur level, while diabetes only patients most often were amputated at ankle/foot/toe level.

Conclusions

Presence of CAD in patients with diabetes was an indicator of high risk of PAD and lower limb amputation, and the risk depended on severity of both CAD and diabetes.

Figure 1

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital
Prognostic role of polyvascular involvement in patients with symptomatic peripheral artery disease
Authors: Dopheide J.F , Adam L , Khorrami Borozadi M , Kaspar M , Baumgartner I , Drexel H
Published: November 2020

Background

Patients with peripheral artery disease (PAD) are at very high risk of future cardiovascular events. However, clinical experience suggests that PAD has a wide range of prognosis due to a different atherosclerotic extent with further vascular beds affected, i.e. coronary artery disease (CAD) and/ or cerebrovascular disease (CeVD).

Purpose

We hypothesized that patients with a polyvascular extent (+ CAD and/ or CeVD) of PAD have poorer prognosis compared to those with PAD alone.

Methods

Single center longitudinal observational study with 1380 symptomatic PAD patients over a period from 2009 to 2019 (mean observational time: 60±32 months). We related the atherosclerotic extent (PAD, +1 vascular region (+/− CAD or CeVD) (+1V), +2 vascular regions (+CAD and CeVD) (+2V) to all-cause and cardiovascular mortality as well as to cardiovascular event rate.

Results

Baseline demographics showed that polyvascular patients (+1V and +2V) were older, suffered more often from diabetes, hypertension, dyslipidemia and had more severe impairment of their kidney function (all p<0.0001) compared to PAD patients without further vascular beds affected. Polyvascular patients received more often a complete guideline conform treatment with anti-platelet therapy, ACE Inhibitors, smoking cessation and statin medication. This was mainly due to the low rate of statin use in PAD aonly patients compared to polyvascular patients (+1V and +2V; p<0.001). Despite of the adequate treatment, all-cause and cardiovascular mortality rate was higher in polyvascular patients (+1V: 22%; +2V: 35%) than in PAD only patients (13%; p<0.0001), as well as the rate of cardiovascular events (p<0.05).

Conclusion

PAD patients with a polyvascular involvement receive an adequate guideline conform treatment. Nevertheless, mortality is higher in this population. Conversely, our data suggest, that an intensified treatment for patients with PAD alone might help to avoid progression into a polyvascular disease and in consequence an increased mortality in this population.

PAD polyvascular outcomes

Funding Acknowledgement

Type of funding source: None
Utility of superb microvascular imaging for assessment of foot perfusion in patients with critical limb ischemia
Authors: Suto Y , Sato W , Kobayashi Y , Otaka M , Unuma M , Yamanka T , Sato T , Seki K , Iino T , Suzuki T , Terata K , Iino K , Watanabe H
Published: November 2020

Background

Recently, an increasing attention has been paid to foot microcirculation in critical limb ischemia (CLI). Although skin perfusion pressure (SPP) is the most frequently used marker of microcirculation, SPP is often unmeasurable at the most ischemic site in the foot. A new ultrasound technique (superb micro-vascular imaging [SMI]) allows the detection of extremely low velocity flows and enables the quantitative verification as vascular index (VI). We examined the diagnostic value of SMI-based VI in assessing foot perfusion when planning endovascular treatment (EVT).

Methods

Consecutive 50 patients with CLI were enrolled. All cases underwent EVT for superficial femoral arteries. SMI-based VI of plantar, dorsal, medial heel, lateral heel and toe's area were obtained before and after EVT, and those were compared with SPP (plantar and dorsal) or ankle-brachial index (ABI) representing macrocirculation.

Results

Based on the six angiosomes concept, SMI enabled to visualize microcirculation in all subjects, but SPP was not feasible in 13% of all subjects at the most ischemic site. After EVT, ABIs were significantly increased from 0.64±0.19 to 0.85±0.27 (P=0.0003). Plantar SPP also increased from 39.6±20.4 mmHg to 58.5±27.1 mmHg (p=0.002). SMI-based VI significantly increased in each sites based on the six angiosomes concept. Of note, plantar SMI-based VI significantly increased from 5.1±3.2% to 10.6±6.6% (p<0.0001), suggesting improvement of foot perfusion. Plantar SMI-based VI was well correlated with plantar-SPP both before and after EVT (p=0.002, r=0.663). Plantar VI was also informative in showing a rapid improvement of foot perfusion during EVT.

Conclusion

SMI enabled to visualize the foot microcirculation on the basis of angiosomes concept. SMI has potential as an alternative to SPP.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in -Aid for Scientific Reseach, Japan
Immunological analysis of carotid artery plaques and its relationship to the gray scale median value obtained by ultrasound
Authors: Pitha J , Cermakova H , Kubatova H , Kauerova S , Kralova Lesna I , Simek O , Janousek L , Poledne R , Fronek J
Published: November 2020

Introduction

A gray scale median (GSM) value established by ultrasound could potentially reflect atherosclerotic plaque stability in carotid arteries, this stability could be also assessed by the measurements potential pro- and antiiflammatory characteristics of macrophages detected in the plaque. We analyzed association between the GSM value and several macrophage characteristics in carotid artery plaques.

Methods

Twenty-four patients (14 men, mean age 66.4±4.4 years) underwent ultrasound scan to determine the GSM value in maximum of one day before carotid endarterectomy. Immediately after removal, atherosclerotic plaques were processed for and analyzed by flow cytometric analysis. CD14, CD16, CD36, CD163 and CD206 markers were used to evaluate macrophage polarization.

Results

The GSM value ranged from 0 to 146. The majority of macrophages were established as CD14+CD16+. These macrophages also often co-expressed CD206, CD36 and CD163 while the expression of CD206 and CD36 in CD14+CD16- cells was lower and the expression of CD163 was almost negligible. Pro- and antiiflammatory macrophage phenotypes based on combination of different expression of CD markers did not correlate with the GSM value. In addition, no significant relationship was found between the GSM value and the presence of traditional cardiovascular risk factors. In patients with history of diabetes mellitus significantly lower percentage of CD14+CD16+CD206- macrophages was observed than in non.diabetics (p<0.05).

Conclusion

The GSM value did not correlate with potential pro- and antiiflammatory macrophage phenotypes. In addition, in contrast to published data, no relationship was found between the GSM value and the presence of cardiovascular risk factors

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Supported by Ministry of Health, Czech Republic - conceptual development of research organization; Thanks to courtesy of professor Andrew Nicolaides we used software developed by him and his colleagues to assess structure of carotid plaques by ultrasound.
Impact of frailty on super elderly patients with peripheral artery disease from the I-PAD 3 year registry
Authors: Nishikawa K , Nagae A , Miura T , Katoh T , Kanzaki Y , Abe N , Yokota D , Yanagisawa T , Senda K , Wakabayashi T , Oyama Y , Okina Y , Nakazawa S , Tsukada S , Kagoshima M
Published: November 2020

Background

Unlike age, frailty is often not taken into account in treatment indications of Endovascular treatment (EVT). One of the reason is that there was little known the relationship between frailty and the outcome of EVT for super elderly patients with peripheral artery disease (PAD). We investigate impacts of frailty on the super elderly patient prognosis who underwent EVT.

Purpose

To investigate impacts of frailty on the super elderly patient prognosis who underwent EVT.

Methods

From August 2015 to July 2016, 335 consecutive patients who underwent EVT were enrolled in the I-PAD registry from 7 institutes in Nagano prefecture. Among them, we selected and analyzed 91 super elderly PAD patients (≥80 years-old) and divided them into two groups:those with moderate or higher frailty (Clinical Frailty Scale (CFS) ≥6, n=28) and those without (CFS ≤5, n=63). The primary endpoints were cardiovascular death and major adverse cardiovascular and limb events (MACLE), defined as a composite of cardiovascular death, myocardial infarction, stroke, admission for heart failure, major amputation and revascularization.

Results

The median follow-up period was 2.7 years. Freedom rate from cardiovascular death and MACLE were significantly lower among patients with moderate or higher frailty than among those without (47.0% vs. 58.0%, P=0.03; 39.1% vs. 68.5%, P<0.01).

Conclusion

The prognosis of super elderly patients with moderate or higher frailty is worse than those without.

Funding Acknowledgement

Type of funding source: None
Declining incidence and mortality of ischaemic stroke between 1996–2016: a nationwide study
Authors: Yafasova A , Fosboel E.L , Christiansen M.N , Vinding N.E , Andersson C , Kruuse C , Johnsen S.P , Gislason G.H , Torp-Pedersen C.T , Koeber L , Butt J.H
Published: November 2020

Background

The incidence and mortality of ischaemic heart disease have been declining over many years. The development with ischaemic stroke is less well studied, and with an increasing elderly population, there is a need for large-scale studies. Recent changes in stroke prevention and treatments may have affected the incidence and mortality of ischaemic stroke.

Purpose

To examine time trends and sex and age differences in the incidence and mortality of first-time ischaemic stroke in Denmark between 1996–2016.

Methods

In this observational cohort study, we used Danish nationwide registries to identify all individuals >18 years of age admitted with a first-time diagnosis of ischaemic stroke between 1996–2016. We calculated age- and sex-stratified annual incidence rates and absolute 30-day and 1-year mortality risks. Further, we calculated annual incidence rate ratios using multivariable Poisson regression, odds ratios for 30-day mortality using multivariable logistic regression, and hazard ratios for 1-year mortality using multivariable Cox regression.

Results

The study population consisted of 224,617 individuals >18 years of age with first-time ischaemic stroke between 1996–2016. The figure displays the unadjusted incidence rates and 1-year mortality risks of ischaemic stroke by calendar year. The overall unadjusted incidence rates of ischaemic stroke per 1,000 person-years increased from 1996 (2.43 [95% confidence interval [CI], 2.38–2.47]) to 2002 (2.91 [95% CI, 2.86–2.96]) and then gradually decreased to below the initial level until 2016 (1.99 [95% CI, 1.95–2.03]). Men had higher incidence rates than women in all age groups except in patients between 18–30 years and >85 years. The absolute mortality risk decreased between 1996–2016 (30-day mortality from 17.1% to 7.6% and 1-year mortality from 30.9% to 17.3%). Women had higher mortality than men in the age groups 55–64 years and >85 years. Similar trends were observed for all analyses after multivariable adjustment.

Conclusions

The overall incidence of first-time hospitalization for ischaemic stroke increased from 1996–2002 and then gradually decreased to below the initial level until 2016. The absolute 30-day and 1-year mortality risk decreased between 1996–2016. These findings correspond to the increased awareness of stroke prevention and introduction of new treatment options during the study period.

Trends in stroke incidence and mortality

Funding Acknowledgement

Type of funding source: None
Impaired heart rate variability triangular index to identify clinically silent strokes in patients with atrial fibrillation
Authors: Haemmerle P , Eick C , Bauer A , Rizas K.D , Coslovsky M , Krisai P , Vesin J.M , Beer J , Moschovitis G , Bonati L.H , Sticherling C , Conen D , Osswald S , Kuehne M , Zuern C.S
Published: November 2020

Introduction

The identification of clinically silent strokes in patients with atrial fibrillation (AF) is of high clinical relevance as they have been linked to cognitive impairment. Overt strokes have been associated with disturbances of the autonomic nervous system.

Purpose

We therefore hypothesize that impaired heart rate variability (HRV) can identify AF patients with clinically silent strokes.

Methods

We enrolled 1358 patients with AF without a history of stroke or transient ischemic attack from the multicenter SWISS-AF cohort study who were in sinus rhythm (SR-group, n=816) or AF (AF-group, n=542) on a 5 minute resting ECG recording. HRV triangular index (HRVI), the standard deviation of normal-to-normal intervals (SDNN) and the mean heart rate (MHR) were calculated. Brain MRI was performed at baseline to assess the presence of large non-cortical or cortical infarcts, which were considered silent strokes without history of stroke or transient ischemic attack. We constructed binary logistic regression models to analyze the association between HRV parameters and silent strokes.

Results

At baseline, silent strokes were detected in 10.5% in the SR group and 19.9% in the AF group. In the SR-group, HRVI <15 was the only parameter independently associated with the presence of silent strokes (odds ratio (OR) 1.69; 95% confidence interval (CI): 1.04–2.72; p=0.033) after adjustment for various clinical covariates (age, sex, systolic blood pressure, history of hypertension, history of diabetes, history of heart failure, prior myocardial infarction, prior major bleeding, intake of oral anticoagulation, antiarrhythmics or betablockers). Similarly, in the AF-group, HRVI<15 was independently associated with the presence of silent strokes (OR 1.65, 95% CI: 1.05–2.57; p=0.028). SDNN<70ms and MHR<80 were not associated with silent strokes, neither in the SR group, nor in the AF group (Figure).

Conclusions

Reduced HRVI is independently associated with the presence of clinically silent strokes in an AF population, both when assessed during SR and during AF. Our data suggest that a short-term measurement of HRV in routine ECG recordings might contribute to identifying AF patients with clinically silent strokes.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation
Patterns of coronary vascular involvement in patients with heart failure due to cardiac amyloidosis
Authors: Yacob O , Beyene S , Melaku G , Hideo-Kajita A , Kuku K , Brathwaite E , Wilson V , Ozaki Y , Dan K , Sheikh F , Mohammed S , Garcia-Garcia H
Published: November 2020

Background

Amyloidosis is a group of protein-folding disorders characterised by organ deposits, derived from one of several amyloidogenic precursor proteins. The involvement of coronary arteries has been previously described in amyloidosis, however the pattern of the disease in the coronaries is still unknown.

Purpose

The aim of this study is to characterise the pattern and severity of coronary artery lesions in cardiac amyloidosis.

Methods

We retrospectively compared patients with heart failure who tested positive (i.e. biopsy or gene tests – HF/CA+) against those that tested negative (HF/CA−) for cardiac amyloidosis. Groups were compared demographically and angiographically for qualitative and quantitative variables to determine patterns of involvement in the major epicardial coronary vessels.

Results

In total, 110 heart failure patients were included in the study, of whom 55 were HF/CA+ patients (88 lesions) and 55 were HF/CA− patients (66 lesions). Despite the advanced age in the HF/CA+, (74.53±11.02 vs 54.11±15.08; p=0.05), severe calcification was reported in HF/CA− group (4.5% vs to 0.0%; p=0.018). The HF/CA+ group also had fewer ostial lesions (3.4% vs. 15.15%, p=0.0095), reduced TIMI flow grade (83% vs 76%; p=0.21) and a higher TIMI frame count (30±12 Vs 27±11 frames; p=0.06). In the HF/CA+ group, compared to women, men had a significant number of tandem lesions (14.55% vs 0.0%, p=0.02). Men trended to have more ulcerations in comparison to women (9.09% vs 0.0%; p=0.15).

Conclusion

Overall, patients with HF/CA+ were older but found to have lesser calcified lesions, ostial involvement and a reduced anterograde blood flow. This is the first report outlining the coronary lesions in patients with HF/CA+.

Funding Acknowledgement

Type of funding source: None
Bioresorbable scaffold versus drug coated balloon for treatment of in-stent-restenosis – long-term outcomes of the randomized ABSORB-ISR trial
Authors: Bossard M , Attinger A , Wolfrum M , Moccetti F , Zasada W , Mehmann B , Kobza R , Toggweiler S , Cuculi F
Published: November 2020

Background

Observational studies showed promising results after treatment of coronary instent-restenosis (ISR) using the everolimus-eluting bioresorbable vascular scaffold (BVS) Absorb®.

Purpose

We compared long-term outcomes after treatment of ISR with BVS versus the paclitaxel-eluting drug coated balloon (PE-DCB) SeQuent® Please, which is commonly used for treatment of ISR.

Methods

This was randomized-controlled trial of Absorb® BVS versus SeQuent® Please PE-DCB in an all-comers population with clinically relevant ISR. The patients were randomized in a 1:1 fashion. The angiographic primary endpoint was late lumen loss (LLL) at 9 months. Clinical follow-ups (FU) up to 48 months were conducted.

Results

Totally, 53 patients and lesions were enrolled. The mean age was 66.7±9.8 years, 23 (43.4%) had an acute coronary syndrome (ACS) and 16 (30.2%) were diabetic. PCI was successful in all patients. After 9 months, the mean LLL did not significantly differ between patients treated with BVS versus PE-DCB (median 0.41 (interquartile range (IQR) 0.15; 1.23)mm versus 0.27 (IQR 0.13; 0.66)mm, p=0.86). Moreover, mean lumen area on optical coherence tomography (OCT) did not significantly differ (median 5.47 (IQR 4.44; 7.69)mm2 versus 6.70 (IQR 5.00; 7.82)mm2, p=0.24). Rates of significant ISR (angiographic stenosis >70%) were similar with BVS versus PE-DCB (7 (30.4%) versus 6 (27.3%), p=0.81). The target vessel revascularization rates were 9 (33.3%) versus 9 (34.6%) using the BVS versus PE-DCB (p=0.72), also highlighted in the Figure below). No stent/ scaffold thrombosis occurred during FU. The study was prematurely stopped due to withdrawal of the Absorb® BVS in September 2017.

Conclusions

In this randomized pilot study, we found no significant difference in angiographic, OCT and clinical endpoints after treatment of ISR lesions using the Absorb BVS versus SeQuent® Please PE-DCB during long-term follow-up (≥48months). However, rates of target vessel revascularization were very high in both groups (>30%).

TVR and TLF with BVS or PE-DCB for ISR

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Abbott Vascular
Safety and efficacy of different arterial pressure bandages following percutaneous coronary interventions from radial access: preliminary data of the RAD-PRESS trial
Authors: Nemeth B , Nowotta F , Ruzsa Z , Szuk T , Becker D , Merkely B , Edes I.F
Published: November 2020

Background

The overwhelming majority of diagnostic coronary angiographies and percutaneous coronary interventions (PCIs) are performed via radial access as recommended by the current European revascularization guidelines. Using dedicated pressure bandages for the radial access site in high-volume centres can be a significant part of the budget of catheterization laboratories, therefore we developed a cost-effective pressure bandage utilizing wrapped empty glass vials of intravenous medications. Furthermore, compression time of the radial puncture site following PCI is a predictor of radial artery occlusion, therefore shortening the period of compression to as short as possible is feasible.

Purpose

Our aim was to validate efficacy and safety of our cost-effective pressure bandage by comparing it to two dedicated devices, as well as reducing length of compression to as short as possible.

Methods

We designed the RAD-PRESS trial, major inclusion criteria of which were first puncture of a radial artery with a diameter greater than 1.8mm, PCI performed as per guidelines utilizing a 6 French guiding catheter and age below 80 years. Patients were then randomized to receive one of three pressure bandages: the glass vial, Seal-One or the gold standard TR-band. Release of pressure was performed as fast as possible in 10-minute steps, and guided by pulse oximetry. Hematoma formation was thoroughly checked for all patients and categorized using the Easy scale. Radial artery patency was investigated by ultrasound 24 hours after final removal of the bandage. The data of 40 patients of every group was analysed.

Results

Population characteristics were similar among the groups. Length of compression time (126±10, 142±11 and 144±11 mins for Vial, Seal-One and TR-band, respectively, p>0.05), hematoma formation (Easy Grade 1 in 17.5%, 15.0% and 10.0%, Easy Grade 2 in 5.0%, 7.5% and 7.5% for Vial, Seal-One and TR-band, respectively, all p>0.05) were not significantly different among the groups. Radial artery occlusion occurred in only 2 patients (Vial and TR-Band groups), accounting for 1.7% of the cases.

Conclusions

The cost-effective wrapped vial strategy to compress the radial puncture site was comparable to both Seal-One and the gold standard TR-band regarding safety and efficacy. Furthermore, compression time could be safely shortened to approximately 2.5 hours.

Funding Acknowledgement

Type of funding source: None
Impact of intraprocedural stent thrombosis on outcomes of percutaneous coronary intervention: a meta-analysis
Authors: Aggarwal A , Jain A , Kohli V
Published: November 2020

Background

Intraprocedural stent thrombosis (IPST), defined as the development of occlusive or nonocclusive new thrombus in or adjacent to a recently implanted stent before completion of PCI. IPST even though a rare entity, yet is associated with worse prognosis amongst all intraprocedural thrombotic events.

Purpose

Data regarding the impact of IPST is scarce and needs further investigation.

Methods

We performed literature search of all published full-length articles that studied and compared data on patients with IPST and with no IPST during PCI. We calculated odds ratios via the random effects model for 30 day and 1 year outcomes.

Results

Our literature search yielded 3 studies (1 retrospective, 2 observational post-hoc analysis) relevant to the meta-analysis. Total 19272 patients were included. IPST occurred in 159 patients (0.8%). At 30 days, IPST was associated with statistically significant higher all-cause mortality (OR 10.79, 95% CI [6.31, 18.45] p<0.00001), MI (OR 4.82, 95% CI [2.39, 9.73] p<0.0001), target vessel revascularization (TVR) (OR 6.70, 95% CI [3.38, 13.29] p<0.00001), definite stent thrombosis (OR 10.44, 95% CI [5.87, 18.58] p<0.00001), definite or probable stent thrombosis (OR 9.28), 95% CI [5.54, 15.56] p<0.00001) and death or MI or TVR (OR 7.20], 95% CI [4.10, 12.64] p<0.00001), than those without IPST. At one year, results remained statistically significant for higher mortality (OR 4.27, 95% CI [1.92, 9.49] p=0.0004) and death or MI or TVR (OR 2.91, 95% CI [1.58, 5.36] p=0.0006) in patients with IPST.

Conclusions

IPST even though is a rare occurrence, is associated with more adverse ischemic events, including higher mortality at 30 days and 1 year.

Funding Acknowledgement

Type of funding source: None
Four-year results of the AIDA trial: comparison of Absorb bioresorbable scaffold with Xience everolimus-eluting metallic stent in daily clinical practice
Authors: Kerkmeijer L.S.M , Tijssen R.Y.G , Kraak R.P , Hofma S.H , Arkenbout E.K , Van Der Schaaf R.J , Weevers A.P.J , Tijssen J.G.P , Piek J.J , Henriques J.P.S , De Winter R.J , Wykrzykowska J.J
Published: November 2020

Aims

Absorb bioresorbable scaffold (BRS) related events were noticed between 1 and 3 years – the approximate time of active scaffold bioresorption. This resulted in the recommendation for 3 year DAPT after Absorb BRS implantation. We aimed to evaluate the safety and efficacy of the Absorb BRS in comparison with Xience everolimus-eluting stent (EES) at 4 years follow-up in large unselected population. In addition, we aimed to assess the value of prolonged DAPT against scaffold thrombosis.

Methods

AIDA was an investigator-initiated, non-inferiority, multicenter, randomized, all-comers trial. Target vessel failure (a composite of cardiac death, target-vessel myocardial infarction and target-vessel revascularization) and device thrombosis at 4-year follow-up are the primary focus of this analysis. During the trial recommendation for DAPT was changed to up to 3-years post Absorb BVS implantation. Whether this adaption influenced the results after Absorb BVS will be assessed.

Results

Between August 2013 and December 2015, 1,845 patients were enrolled, of whom 924 were randomized to treatment with Absorb BRS and 921 to Xience EES. The baseline characteristics in the two study arms were well balanced. Of all patients, 18% had diabetes mellitus, more than 50% presented with ACS and the median SYNTAX score was 11. In the Absorb BRS arm, 97% of lesions were predilated and in 74% post-dilatation was performed. Four-year clinical outcomes are currently being adjudicated by an independent clinical event committee. The results will be available at EuroPCR 2020.

Conclusions

Absorb BRS is associated with higher rates of scaffold thrombosis throughout 3-year of follow-up. The performance of Absorb BRS beyond 3-years, in comparison with the Xience EES, in a large unselected population will be presented. (ClinicalTrials.gov Identifier: NCT01858077)

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Abbott