bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Presentation No. 84 Initial clinical experience with 6-hour enoxaparin regimen in opiate-treated patients undergoing primary percutaneous coronary intervention
Authors: Elamin Nadir , Ow Kok Weng , Parker William A E , Nelson Thomas A , Middle Janet , Hanson Jessica , Moyle Bethany , Krishnamurthy Arvindra , Barmby David , Morgan Kenneth , Adam Zulfiquar , Rothman Alexander , Morris Paul , Iqbal Javaid , Hall Ian , Conway Dwayne , Richardson James , Gunn Julian P , Storey Robert F
Published: October 2022

Background

Opioid treatment delays the onset of oral P2Y12 inhibitors in patients with acute ST-segment elevation myocardial infarction (STEMI), leading to suboptimal antithrombotic therapy during primary percutaneous coronary intervention (PPCI).

Material and methods

We retrospectively compared using a prolonged enoxaparin regimen (0.75 mg/kg bolus followed by 6-hour intravenous infusion) to using unfractionated heparin (UFH) with or without tirofiban in opioid-treated patients with STEMI who underwent PPCI. We compared the proportions of acute stent thrombosis (AST) and bleeding events according to the bleeding academic research consortium (BARC) within 24 hours post-PPCI.

Results

270 opioid-treated patients with a mean age of 63 [SD ± 12] years were enrolled, of which 49 (18%) were with diabetes mellitus (DM). 90 (34%) patients (mean age 61 [SD ± 11] years) received enoxaparin, 110 (41%) (mean age 65 [SD ± 14] years) UFH with tirofiban, and 69 (25%) (mean age 63 [SD ± 12] years) UFH only. Compared to the other strategies, a higher proportion of DM was observed in the enoxaparin-treated group (21%). No AST was associated with enoxaparin compared to 2 (1.8%) events in UFH with tirofiban and 1 (1.4%) in UFH only. The rate of severe bleeding events (BARC 2 and 3) was significantly lower in the enoxaparin-treated patients than in UFH with tirofiban (0 (0%) vs. 8 (7%), P = 0.01). 3 enoxaparin-treated patients needed switching to tirofiban as a bailout strategy due to distal vessel embolisation.

Conclusions

The novel 6-hour enoxaparin regimen is safe during PPCI and was associated with fewer bleeding events than UFH with tirofiban.
Poster No. 017 Cardioembolic Stroke at Prosthetic valve endocarditis
Authors: Hoxha Eneida , Rista Elvana , Kuka Somida , Collaku Ledio , Musabelliu Jona , Djamandi Jorida , Gjata Margarita
Published: October 2022

Background

Embolic events are frequent and life-threatening complications of infective endocarditis (IE), related to the migration of cardiac vegetations. Risk of embolism is very high in IE, with embolic events occurring in 20–50% of patients. The brain and spleen are the most common sites of embolism in left-sided IE. Stroke is a severe complication and is associated with increased morbidity and mortality rates.

Case presentation

A 73-year-old male presented to the Emergency Department, in May 2022 with right hemiparesis, aphasia and fever (38°C). He reported of a two day history of recurrent fever. His pre-existing comorbities included Diabetes Mellitus, Arterial Hypertension, and Atrial Fibrillation on anticoagulation therapy with Acenocoumarole and INR levels within normal range. His past medical history was significant for an Aortic Valve Replacement, in September 2021 and a subsequent hospitalization in January 2022 with Prosthetic Valve Endocarditis. At the time, he presented with recurrent fever up to 38.8°C, no significant findings in the transthoracic echocardiogram (TTE) and positive blood cultures for Enterococcus faecalis. He was started on antibiotic therapy.

Laboratory and imaging studies in his latest admission revealed a cardioembolic stroke.

Conclusion

Infective endocarditis can present with a wide variety of symptoms and early diagnosis can be challenging. Establishing the diagnosis early in the course of the disease, would enable a prompt implementation of empiric antibiotic therapy, potentially preventing serious complications. Keeping a high index of suspicion when evaluating patients at high risk for IE, might lead to more favorable outcomes of major complications associated with it.
Oral Presentation No. 019 Bi-directional cross talk between coagulation, fibrinolysis and inflammatory pathways in patients with ST-segment elevation myocardial infarction
Authors: Kanji Rahim , Gue Ying X , Farag Mohammed F , Mutch Nicola J , Gorog Diana A
Published: October 2022

Background

Impaired endogenous fibrinolysis is a risk factor for recurrent cardiovascular events in patients with acute coronary syndrome (ACS). Ongoing inflammation is also an adverse prognostic risk factor. While inflammatory markers are elevated in patients presenting with ST-segment elevation myocardial infarction (STEMI), whether there is a direct relationship between markers of inflammation at presentation, and the effectiveness of endogenous fibrinolysis in this setting, is unclear.

Our study aimed to assess the relationship between markers of inflammation, coagulation and fibrinolysis, in patients with STEMI.

Material and methods

We conducted a prospective, observational study in consecutive patients presenting with STEMI. Blood was drawn on admission after dual antiplatelet therapy loading, but before administration of anticoagulants. The sample was immediately tested to assess endogenous fibrinolysis using the point-of-care Global Thrombosis Test. In addition, blood samples were tested for leucocyte and neutrophil count, neutrophil-to-leucocyte ratio (NLR), platelet-to-leucocyte ratio (PLR), fibrinogen, standard coagulation markers and high sensitivity C-reactive protein (hs-CRP).

Results and conclusions

The cohort consisted of 129 patients (aged 66 ± 13 years, 78% male). Whole blood endogenous fibrinolysis time correlated with fibrinogen (r = 0.300, P = 0.001) and hs-CRP (r = 0.236, P = 0.011). Hs-CRP correlated with fibrinogen (r = 0.631, P < 0.001). There was no relationship between whole blood lysis time and leucocyte count, NLR, PLR, international normalised ratio or activated partial thromboplastin time.

The effectiveness of endogenous fibrinolysis in whole blood is related to fibrinogen and hs-CRP levels. Our findings strengthen the evidence for bi-directional cross talk between coagulation, fibrinolysis and inflammatory pathways, providing mechanistic insights that could help guide pharmacological strategies to treat hypofibrinolysis.
Poster No. 020 Increasing transvalvular gradient related to effectiveness of endogenous fibrinolysis in patients with severe aortic stenosis
Authors: Kanji Rahim , Panoulas Vasileios F , Duncan Alison , Davies Simon W , Luscher Thomas F , Mirsadraee Saeed S , Arachchillage Deepa R J , Gorog Diana A
Published: October 2022

Background

Patients with severe aortic stenosis (AS) are at risk of both bleeding and thrombotic events. The high shear and flow rates across the stenotic aortic valve (AV) degrade von Willebrand factor high molecular weight multimers increasing bleeding risk, but can also lead to platelet activation. The overall effect on thrombotic and endogenous fibrinolytic status remains unclear. We aimed to assess the relationship between AS severity and thrombotic and fibrinolytic profile.

Materials and methods

In a prospective, observational study, thrombotic and thrombolytic status was assessed in venous blood taken from patients with severe AS using the Global Thrombosis Test. This point-of-care technique measures the time for occlusive thrombus formation under high shear (OT), and the time for spontaneous lysis of the thrombus (LT). We related these parameters to indices of AS severity.

Results and conclusions

Our cohort comprised of 86 patients (age 79 ± 9 years, 58% male), of whom 25% were on single and 28% on dual antiplatelet medication, 47% on no antithrombotic therapy, and 1% on oral anticoagulation.

Lysis time was inversely related to AV peak (r = −0.242, P = 0.04) and mean (r = −0.286, P = 0.012) gradients. The severity of AS, by gradient or valve area, was not related to OT, although OT was inversely related to platelet count (r = −0.248, P = 0.029). Heterogeneity in antithrombotic medications may have masked a relationship between AS severity and OT.

We report that increasing severity of AS is related to more effective endogenous fibrinolysis, which may contribute to the increased propensity to bleeding.
Poster No. 025 Survival in octogenarians receiving implantable cardiac defibrillators: a single centre experience
Authors: Paray Nitish Behary , Spinthakis Nikolaos , Jeelani Mohammad Saddam , Kuriakose Jebby
Published: October 2022

Although the efficacy of implantable cardiac defibrillator (ICD) in preventing sudden cardiac death is well established in studies, patients ≥ 80 years are poorly represented, causing a paucity of data on outcomes in this subgroup.

In our single-centre retrospective study, data pertaining to patients > or = 80 years of age at device implant (n = 95) between January 2010 and January 2022 was extracted from device databases and clinical notes. Categorical variables were compared using Fisher's exact test. A Kaplan-Meier survival analysis with logrank test was performed. A Multivariable Cox Hazard regression model was used to analyse survival adjusting for QRS duration, left ventricular ejection fraction and device type.

Mean age of the cohort was 83.1 ± 3 years, with 85% (n = 81) being male. 73% (n = 69) of the population had ischaemic cardiomyopathy and 43% (n = 41) met the primary prevention indications. Median survival time post device implantation was 27 months. Survival at 5 years was 80%. The difference in survival rates between primary and secondary prevention groups was not statistically significant. Inappropriate shocks were delivered in 2 patients while 14 patients were successfully treated with appropriate therapy. Complications were encountered in 9% (n = 9) of cases, with a fatal outcome on one occasion.

ICD therapy is a well-tolerated intervention and may confer survival benefits in elderly patients, provided careful selection criteria are implemented. Advanced chronological age alone should not unduly influence the decision for ICD selection for survival benefit. There is an imperative for greater representation of this cohort in future trials.
Poster No. 026 Prognostic value of cardiac biomarkers in acute pulmonary embolism: can it add something?
Authors: Duarte Fabiana , Inês Barradas M , Oliveira Luís , Dos Santos Inês Coutinho , Machado Carina , Dourado Raquel , Tavares Anabela , Martins Dinis
Published: October 2022

Background

Acute pulmonary thromboembolism (PE) is a life-threatening disease. Cardiac biomarkers like lactate, NT-proBNP and troponin I have been reported to predict prognosis of acute PE however, the prognostic importance of these factors on long-term mortality is not known.

Objectives

To assess the prognostic role of biomarkers lactate, NT-proBNP and troponin I in acute PE.

Methods: We retrospectively assessed 131 consecutive patients diagnosed with acute PE. Prognostic impact of both lactate, NT-proBNP and troponin was assessed.

Results

Out of 131 patients with acute PE, the median age was 67.6 ± 15.3 years and 71.0% were female. Mean follow-up was 44.8 ± 37.3 months. Overall in-hospital mortality was 8.4%, 30-day mortality 13.0% and 1-year mortality 20.6%.

Twenty-six patients (19.8%) had a recent hospitalization and 21 (16.0%) a medical history of active cancer.

ROC curves shown that lactate has a good discriminatory power for in-hospital mortality, with an area under the curve (AUC) of 0.84 and p-value 0.001, unlike NT-proBNP (AUC 9.45, p-value 0.76) and troponin (AUC 0.64, p-value 0.12). Serum lactate equal or superior to 2.05 mmol/L were associated with higher in-hospital mortality (odds ratio [OR] 23.1, 95% confidence interval (CI) 2.8–187.7), when compared with lower levels. The impact of this parameter was independent of hypotension, tachycardia or active neoplasia (p-value 0.006, OR 21.3, 95% CI 2.4–187.3).

Conclusions

This study revealed that lactate has a better discriminatory power when compared to NT-proBNP and troponin in predicting prognosis in acute PE patients. Its routinely addition to current stratification tools could be of interest.
Poster No. 044 Cardiovascular risk factors and coronary heart disease in the young – a single centre analysis
Authors: Gonçalves Carolina Miguel , Cabral Margarida , Carvalho Mariana , Vazão Adriana , Fernandes Sara , Carvalho Rita , Saraiva Fátima , Morais João
Published: October 2022

Background

Cardiovascular events in the young appear to be increasing. Conversely, this is not the tendency reported in older adults. Identifying risk factors is of the uttermost importance to improve cardiovascular prevention.

Material and methods

Retrospective, single-centre analysis of patients with less than 45 years and suspected coronary heart disease who were subjected to cardiac catheterization in our centre during a 5-year period.

Results and conclusions

A total of 171 patients were included with a median age of 42 ± 6 years of which 82% were male. Overweight (73%), smoking (61%) and dyslipidemia (42%) were the most prevalent cardiovascular risk factors. Coronary heart disease was diagnosed in 67% of patients. After univariate analysis, gender (P = 0.049), age (P = 0.005), smoking (P = 0.032), low-density lipoprotein cholesterol (P = 0.005) and total cholesterol (P = 0.003) were significantly associated with disease in coronary angiography. After multivariate logistic regression, only age (OR = 1.123; CI 95% [1.036–1.217]; P < 0.005) and low-density lipoprotein cholesterol (OR = 1.016; CI 95% [1.004–1.028]; P = 0.009) remained as independent factors of coronary heart disease.

It is known that awareness regarding a healthy lifestyle should be raised in the general population. As several modifiable risk factors have an impact on cardiovascular disease, there is an urgent need to improve primary prevention. Conversely, a more thorough investigation is needed in the cases where no significant coronary disease is found.

According to our analysis, age and low-density lipoprotein cholesterol appear to have a stronger relevance in this young population.
Retracted: Poster No. 051 Is primary prevention with ASA a protective factor in acute coronary syndromes?
Authors: de Figueiredo Marta Paralta , Piçarra Bruno , Pais João , Santos Ana Rita
Published: October 2022

This abstract has been withdrawn. Please see: https://doi.org/10.1093/cvr/cvac183
Poster No. 052 The Influence of the CYP2C9 polymorphisms on the treatment with clopidogrel: combined data from the POPular Genetics & POPular AGE trials
Authors: Van Den Broek W W A , Mani N , Azzahhafi J , Berg J Ten
Published: October 2022

Background

The CYP2C9-enzym plays a role in the metabolization of clopidogrel. In patients treated with clopidogrel, carriage of a CYP2C9 loss-of-function (LoF) allele has been associated with attenuated pharmacokinetics leading to a diminished pharmacodynamic response and increased risk for stent thrombosis.

Material and methods

We aimed to determine the effect of the CYP2C9*2 and *3 LoF-alleles on thrombotic events and clopidogrel treatment discontinuation. A post-hoc analysis was performed in patients with available CYP2C9 genotype status included in the POPular Genetics and POPular Age trials, which enrolled patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, respectively. The primary thrombotic outcome was a composite of cardiovascular death, myocardial infarction or stroke.

Results

The CYP2C9 genotype was available in 2,257 patients, of which 878 were treated with clopidogrel (352 [40%] CYP2C9 LoF-allele carriers and 526 [60%] CYP2C9 LoF-allele noncarriers). There were no significant differences between CYP2C9 LoF-allele carriers and noncarriers for the combined thrombotic outcome (6.3% vs. 5.9%, HR 1.17 [0.67–2.03], P = 0.58), and the individual thrombotic outcomes. No differences were seen in clinically relevant bleeding (Bleeding Academic Research Consortium [BARC] 2–5 bleeding) as well as major bleeding (BARC 3 or 5 bleeding). Discontinuation rates for clopidogrel due to side-effects were numerically lower in CYP2C9 LoF carriers compared noncarriers (1.4% vs. 3.2%, HR 0.54 [0.26–1.13], P = 0.10), however this difference was not statistically significant.

Conclusions

Carriage of the CYP2C9 *2 or *3 LoF-alleles did not show an association with an increased thrombotic risk in patients treated with clopidogrel.

Funding

ZonMW.
Poster No. 071 Application of artificial intelligence in coronary CT angiography:a potential gatekeeper strategy?
Authors: Viegas José Miguel , Reis João Ferreira , Teixeira Rita , Jacinto Sofia , Mendonça Tiago , Ramos Ruben , Marques Hugo , Figueiredo Luísa , Earls James , Ferreira Rui Cruz
Published: October 2022

Introduction

Medical artificial intelligence (AI) is rapidly developing and moving from the research field to daily clinical practice. AI algorithms have demonstrated high performance and computational efficiency, reducing the degree of manual input and processing time.

Objectives

This study aimed to determine the impact of an AI-enabled coronary computed tomography angiography (CCTA) analysis for comprehensive evaluation in patients (P) with suspected coronary artery disease (CAD).

Methods

We analysed 100 CCTA exams from a cohort of symptomatic P with mild-to-moderately abnormal non-invasive ischemia test. Stenosis severity was assessed by level III experts (manual evaluation, MEv). A novel AI-based software tool (automatic evaluation, AEv) was also used to quantify coronary stenosis and characterize plaque phenotype. In P later referred for invasive coronary angiography (ICA), diagnostic and revascularization yields of MEv and AEv were compared.

Results

100P, 52% male, mean age 68 ± 10 years, one-third had typical angina. Prevalence of obstructive CAD determined by MEv and AEv was 25% and 21%, respectively, with a significant association between both assessments (P < 0.001).

Based upon MEv, referring physician decided to proceed to ICA in 22P (21P with significant stenosis). For those undergoing ICA,13P also had obstructive CAD established by AEv. Diagnostic yields for MEv and AEv-guided ICA was 82% and 60%, and revascularization yields 73% and 60%, respectively.

AEv atherosclerosis quantification revealed significant differences between P who did not undergo ICA, P referred for ICA without significant stenosis and P with obstructive CAD on ICA: total (126 vs. 312 vs. 518 mm3, P < 0.001), calcified (23 vs. 197 vs. 222 mm3, P < 0.001), non-calcified (71 vs. 112 vs. 252 mm3, P < 0.001) and low-density plaque volume (1.1 vs. 3.0 vs. 4.4 mm3, P = 0.042).

Conclusion

A diagnostic strategy using AI-based analysis of coronary stenosis severity on CCTA had a similar performance compared to MEv. In addition, risk prediction can be enhanced by AI assessment of plaque composition. This study is an example of the potential role of AI in the CCTA workflow.
Poster No. 072 The profile of rhythm disorders in women with ischemic heart disease in a Romanian hospital
Authors: Andrada Irimie Diana , Dumitru Zdrenghea , Florina Fringu , Ioachim Popescu Mircea , Dana Pop
Published: October 2022

Background

In Europe, the mortality secundary to ischemic heart disease is an important cause of death among women. Rhythm disorders are frequently encountered in the context of this pathology. The aim of the study is to evaluate the profile of rhythm disorders in women with microvascular and obstructive coronary heart disease.

Materials and methods

We included in the study a number of 150 patients with ischemic heart disease documented by coronary angiography, with an average age of 63.24 ± 10.09 years, admited in the Cardiology Department of the Clinical Rehabilitation Hospital, Cluj-Napoca, Romania. The diagnosis of ischemic heart disease was established according to the recommendations of the 2019 ESC guideline.

Results

66.6% of patients presented with microvascular angina, and 33.33% with obstructive coronary heart disease. Women with microvascular angina were younger (61.07 ± 9.68 vs. 67.60 ± 9.55 years). Atrial arrhythmias were the most frequent arrhythmias diagnosed - 64.66%. The percentage of rhythm disorders was similar in the two groups, without statistically significant differences: atrial fibrillation (21 vs. 22%), other supraventricular arrhythmias (39 vs. 52%), ventricular extrasystoles (42 vs. 44%), sustained/nonsustained ventricular tachycardia (4 vs. 4%). This finding shows us that not only obstructive coronary artery disease, but also microvascular angina presents an arrhythmogenic risk. At the same time, there were no significant differences regarding the administration of antiarrhythmics, namely amiodarone and betablockers in the two forms of ischemic heart disease.

Conclusions

Women with microvascular angina present significant arrhythmias, therefore they must be carefully evaluated and treated accordingly.
Oral Presentation No. 079 Quality of life in patients after pulmonary embolism. Correlation with echocardiographic and biochemical parameters
Authors: Kardakari O L , Ballas C H , Lakkas L A , Giannou S O , Stamou I L , Samara I O , Kalogeras P E , Siaravas K O , Papaioannou E F , Mpouratzis B A , Sioros S P , Lambrinou E K , Dimakopoulos G E , Konstantinidis A T H , Naka K K , Michalis L K , Katsouras C S
Published: October 2022

Background

Pulmonary embolism (PE) is the third most common cause of cardiovascular death worldwide, after stroke and heart attack. Our purpose was to evaluate the patient's health-related quality of life (HR-QoL) after Acute Pulmonary Embolism (APE) and its association with biochemical and novel echocardiographic parameters of assessment of right ventricle (RV).

Material and methods

Successive patients with diagnosis of APE in a tertiary hospital were included in the study. RV evaluation and biochemical markers, (including Brain Natriuretic Peptide (BNP)) were recorded during hospitalization. HR-QoL was evaluated with the Greek version of the Pulmonary Embolism Quality of Life questionnaire (PEmb-Qol), at 1 and 3 months after the APE. Repeated measures analysis was used to assess changes in the PEmb-QoL dimensions and Pearson correlations to assess the relationships between RV global longitudinal strain (RV GLS) and the dimensions of Pemb-Qol.

Results and conclusions

One hundred consecutive patients were screened; 14 patients were excluded. The study sample consisted of 86 individuals (47 women) aged 69.7 ± 13.4 (mean ± SD) years. The differences between the two time points were statistically significant (P < 0.001) in all dimensions of HR-QoL. At 3 months, the dimensions of social limitations and intensity of complaints showed the highest rate of improvement. RV GLS values were correlated with quality of life in patient with APE (in 3 of the 6 dimensions of Pemb-Qol). While BNP, was related to the “intensity of complaints” dimension of Pemb-Qol,in patients with APE occurred during hospitalization for another reason (PE wasn't the cause of admission).
Oral Presentation No. 082 Pre-treatment with Dual Antiplatelet Therapy in NSTE-ACS: not always, not ever
Authors: de Almeida António Rocha
Published: October 2022

Background

Decision of which antithrombotic therapy strategy for non-persistent ST-segment elevation acute coronary syndromes (NSTE-ACS) remains controversial. European Cardiology Society guidelines ceased recommending pretreatment with P2Y12 receptor inhibitor in NSTE-ACS, based on Accoast Trial, which demonstrated absence of ischemic benefits and higher bleeding risk. However, sample studied didn't illustrate Portuguese reality.

Material and methods

Cohort of 2194 NSTE-ACS patients from a multicenter national registry, treated according standard of care, between 2010–2019, was compared with Accoast Trial 1996 results of patients no pretreatment sample.

Results and conclusions

There was no statistically significant difference on age, sex distribution, aspirin or antithrombin therapy. 96.5% of Portuguese sample were pretreated with dual antiplatelet therapy (DAPT). Trial's sample had median time to coronary angiography (CA) of 4.2 hours and femoral access in 57.0% and Portuguese group had a median time of 12 h-36 h till CA, and femoral access in 11.6%. Just 0.7% had urgent surgery in Portuguese sample. There was more cardiovascular caused deaths, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa bailout (9.8%) on trial sample, against only 5.0% on ours. Pretreatment group had slighter increase of TIMI major bleeding (1.8% vs. 1.4%), with median timing 3.5 days after.

Earlier CA may explain trial's absence of ischemic benefits. Later bleeding complications might be associated with DAPT strategy itself, and not with timing. Due to lack availability, surgery wasn't done before 5 days. Hence, DAPT pretreatment shouldn't be for all NSTE-ACS, nevertheless, can be valid option, according to bleeding and ischemic risk, CA timing, access, or surgery availability.
Oral Presentation No. 093 Assessing different noncoding RNAs as markers of platelet reactivity
Authors: Gutmann Clemens , Barwari Temo , Schulte Christian , Singh Bhawana , Theofilatos Konstantinos , Joshi Abhishek , Zampetaki Anna , Chan Melissa V , Armstrong Paul C , Kiechl Stefan , Willeit Johann , Warner Timothy D , Mayr Manuel
Published: October 2022

Background

Antiplatelet therapy (APT) has improved cardiovascular outcomes, but some patients develop thrombosis despite APT. Adjusting APT to platelet reactivity with conventional platelet reactivity tests has proven unsuccessful. Many circulating noncoding RNAs (ncRNAs) are derived from platelets and could serve as novel platelet function markers.

Material and methods

Platelet reactivity was assessed using light transmission aggregometry (LTA) in the Bruneck 2015 study (N = 338), using the agonists arachidonic acid, adenosine diphosphate, collagen, TRAP-6 amide and U46619. LTA platelet releasates were then used for RT-qPCR of five platelet-enriched microRNAs, three circular RNAs and two long non-coding RNAs. Platelet-poor plasma (PPP) was used as negative control.

Results and conclusions

Platelet agonists induced aggregation and ncRNA release, with aspirin takers (N = 155) showing lower ncRNA release than individuals not on aspirin (N = 183). Agonist responsiveness differed among ncRNAs, with miR-150 being hyperresponsive to adenosine diphosphate and miR-21 being hyperresponsive to arachidonic acid, whereas other ncRNAs were most strongly released to collagen, suggesting a selective release mechanism. In individuals not on aspirin, the inflammation markers C-reactive protein and granulocyte counts correlated positively with platelet-derived ncRNAs in PPP, while they correlated inversely with platelet-derived ncRNAs in releasates. These correlations were not present in aspirin takers. Higher PPP levels and lower releasate levels of platelet-derived ncRNAs in inflammation suggest platelet exhaustion ex vivo due to platelet pre-activation in vivo.

Funding sources

British Heart Foundation, VASCage (Centre for Promoting Vascular Health in the Ageing Community) of the Austrian Research Promotion Agency FFG (COMET program - Competence Centers for Excellent Technologies).
Poster No. 106 Can we optimize d-dimer cut off value to predict pulmonary embolism in covid-19 patients?
Authors: Fernandes Rafaela , Ferreira Joana Moura , Alves Ana Rita , Almeida Gabriela , Lopes Vanessa , Cunha Gil , Costa Gonçalo , Monteiro Eric , Guimarães Joana , Fernandes Diogo , Gomes Ana Rita , Rosa João Borges , Campos Gustavo , Campos Diana , Loureiro Carolina , Almeida José Paulo , Martinho Sofia , Martins Paulo , Gonçalves Lino
Published: October 2022

Background

Covid-19 is associated with an increased risk of pulmonary embolism (PE) therefore, should the cut off d-dimer value be adjusted for these patients?

Material and methods

Retrospective and observational study to understand if there is a d-dimer cut-off that could guide clinics to perform a thoracic computed tomography angiography (CTA) in patients with covid-19. The population was covid-19 patients admitted to covid-19 dedicated wards of a University Hospital Centre for one year.

Results and conclusions

725 (52%) patients with covid-19 had a d-dimer value dosed during the first 5 days of the disease. Those, 63 (9%) did a CTA with a diagnosis of 16 (25%) PE. Gender was equally represented, median age was 70 years (ID = 3.49) and the majority (94%) survived. Thirteen (81%) patients with PE had a d-dimer value above 2500 ng/mL (OR = 9.244, 95% CI 2.248–9.837), with 7 (54%) with values over 10000 ng/mL, but in 3 (9%) it was under 1500 ng/mL. Seventy-three (63%) of patients with a d-dimer over 1500 ng/mL did not had a thoracic CTA performed. In our population PE was not a frequent outcome. The results are influenced by the low number of thoracic CTA performed because, even tough the cut-off d-dimer value used at our hospital to perform a thoracic CTA to exclude PE is 1500 ng/mL, most patients with that d-dimer value did not take the exam and so PE could not be excluded. Although in most PE cases the d-dimer value was above 2500 ng/mL, the results of our study cannot verify if that is a better cut-off value.
Oral Presentation No. 107 Achieving higher efficacy without compromising safety with Factor XI inhibitors versus low-molecular-weight heparin for the prevention of venous thromboembolism in major orthopedic surgery – Systematic Review and Meta-Analysis
Authors: Presume João , Ferreira Jorge , Ribeiras Regina , Mendes Miguel
Published: October 2022

Background

In recent years, many important advances have been seen in anticoagulation therapy. However, bleeding risk is still a major concern. Factor XI inhibition has emerged as a potential advantageous target to minimize this risk.

Objectives

We conducted a systematic review and meta-analysis of current evidence on factor XI inhibitors for thromboprophylaxis in major orthopedic surgery.

Methods

We performed a systematic search of electronic databases (Pubmed, CENTRAL, and Scopus) until May of 2022. Studies were considered eligible if they were RCTsevaluating factor XI inhibitors in thromboprophylaxis vs. low-molecular-weight heparins (LMWH). For analysis purposes, we considered efficacy (Venous Thromboembolism [VTE], symptomatic VTE) and safety (major and clinically relevant non-major [CRNM] bleeding events; major bleeding events; blood transfusion necessities; adverse events; major adverse events) outcomes.

Results

Overall, 4 RCTs were included, with a total of 2269 patients, 372 VTE events, and 50 major or CRNM bleeding events. Regarding efficacy outcomes, factor XI inhibitors were associated with a significant reduction in the incidence of VTE events (OR 0.50; 95%CI [0.36, 0.69]). Concerning safety outcomes, factor XI inhibitors significantly reducedmajor or CRNM bleeding events (OR 0.41 [0.22; 0.75]). It was also associated with a lower percentage of patients needing a blood transfusion, despite not meeting statistical significance (OR 0.69; 95%CI [0.32; 1.48]). Incidence of adverse events and major adverse events were similar between groups.

Conclusion

Factor XI inhibitors showed a significant reduction in the incidence of VTE and bleeding events among patients submitted to major orthopedic surgery.
Poster No. 108 Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis
Authors: Presume João , Gomes Daniel , Ferreira Jorge , Albuquerque Francisco , Almeida Manuel Sousa , Uva Miguel Sousa , Aguiar Carlos , Mendes Miguel
Published: October 2022

Double antiplatelet therapy (DAPT) with both aspirin and P2Y12 inhibitors in patients with STEMI has been shown to be associated with better clinical outcomes. Yet, there is uncertainty regarding the optimal timing for its initiation. This study is a systematic review and meta-analysis of the current evidence on pretreatment with P2Y12 inhibitors in patients with STEMI submitted to primary percutaneous coronary intervention (PCI).

We performed a systematic search of electronic databases Pubmed, CENTRAL and Scopus until April/22. Studies were considered eligible if they were comparing P2Y12 inhibitor upstream administration vs. downstream use in patients with STEMI submitted to PCI. Studies with patients treated with fibrinolysis or medical therapy only were excluded. Outcomes were assessed at the shortest follow-up available.

Out of 2336 articles, 18 studies were included (3 RCT and 17 non-RCT), with a total of 79300 patients (52439 in the pretreatment arm). Pretreatment was associated with a reduction in definite stent thrombosis (OR 0.59 [0.37–0.94]), all-cause death (OR 0.77 [0.60–0.97]) and cardiogenic shock (OR 0.60 [0.48–0.75]). It was also associated with lower incidence of TIMI flow < 3 pre-PCI (OR 0.78 [0.67–0.92]). However, it was not associated with a significant reduction in recurrent MI (OR 0.93 [0.57–1.52]). Regarding safety outcomes, pretreatment was not associated with higher risk of major bleeding events (OR 0.83 [0.75–0.92]).

Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with better pre-PCI coronary perfusion, lower risk for definite stent thrombosis, cardiogenic shock, and all-cause mortality. No sign of potential harm from this approach was encountered.
Poster No. 111 Therapeutic Options and Outcomes in Mid Aortic Syndrome A systematic review and meta-analysis
Authors: Van Kimmenade Roland R J , Cortenbach Kimberley , Yosofi Bahram , Rodwell Laura , Meek Jelena , Patel Ritesh , Prakash Siddharth , Riksen Niels , Jenniskens Sjoerd , Dirven Mark , de Ruiten Marco
Published: October 2022

Objective

Mid-Aortic Syndrome (MAS) is narrowing of the distal thoracic and/or abdominal aorta with congenital, inflammatory or idiopathic aetiology. If untreated, prognosis is poor due to hypertensive complications yet follow-up data are sparse. The aim of this study was to investigate hypertension during follow-up after medical, endovascular, and surgical therapy.

Design and methods

A meta-analysis of case series and reports, focusing on the incidence of hypertension during the follow-up of juvenile (0–17 years) and adult MAS patients after medical, endovascular or surgical therapy. Search queries were performed in PubMed, Embase, and Web of Science; eligible articles underwent quality control. Descriptive statistics were reported based on available data, individual patient data meta-analyses were performed using a one-stage approach, accounting for clustering by case series or decades of reporting for case reports. For the meta-analysis, missing outcome and aetiology data were multiply imputed.

Results

The number of juveniles and adults who underwent endovascular therapy (33.7% versus 27.3%; P = .42) and surgery (52.2% versus 58.0%; P = .46) was similar. At baseline, 92.4% of juveniles and 87.5% of adults were hypertensive, decreasing to 23.2% and 24.1% during a follow-up of 23 (juveniles) and 18 (adults) months. In juveniles, after endovascular therapy more hypertension was found compared to surgery (38.1% versus 10.8%; P = .020). Meta-analysis demonstrated a trend for hypertension after endovascular therapy in juveniles, whereas hypertension was more prevalent following surgery in adults compared to endovascular therapy or medication.

Conclusions

Complications and hypertension in MAS during follow-up were more common in juveniles after endovascular treatment, whereas surgery in adults was associated with more hypertension.
Poster No. 113 Case report: the challenges in diagnosing congenital double-chambered left ventricle in adults
Authors: Lu Mengfei , Appiah Joseph , Lim-Cooke Mae-Sing
Published: October 2022

Background

Double-chambered left ventricle is a congenital condition that rarely presents in adulthood. This case report illustrates the common cardiac imaging modalities and presents the diagnostic challenges.

Material and method

Clinical history and cardiac imaging was obtained using electronic systems and E-letters. Literature search was performed using PubMed with keywords including double-chambered ventricle and congenital heart disease.

Discussion

A 76-year-old female presented with breathlessness, her transthoracic echocardiogram (TTE) showed severely impaired bi-ventricular function. An incidental echogenic structure was identified and treated initially as a left ventricular (LV) thrombus. Follow-up cardiac magnetic resonance (CMR) with perfusion confirmed the LV apical mass, but thought was more in keeping with a tumour. Further investigations with a gated cardiac Computerised Tomography (CT) and a review of the original CMR demonstrated appearances that were consistent with a developmental congenital double-chambered left ventricle rather than a false aneurysm or thrombus. This was confirmed on repeat CMR and with enhancement and transoesophageal echocardiogram (TOE) on 3D reconstruction. A discussion between Cardiologist and Cardiac Surgeons concluded that she is unlikely to benefit from any surgical intervention. The patient has since had significant improvement in LV function with medical therapy.

Conclusions

This report highlights an interesting case where congenital double-chambered left ventricle can act as a mimic for left ventricular thrombus or tumour. Current cardiac imaging modalities can be used in combination to achieve the diagnosis. It also demonstrates that pharmacological therapy alone is an adequate treatment to manage the symptoms of severely impaired bi-ventricular function in these patients.
Poster No. 117 rs12526196 polymorphism in CCN2 gene is an independent risk factor for ascending thoracic aortic aneurysm
Authors: Rodríguez Isabel , Tejera-Muñoz Antonio , Del Río-García Álvaro , Mohamedi Yamina , Fernández María Martín , Chiminazzo Valentina , Suárez-Álvarez Beatriz , López-Larrea Carlos , Ruiz-Ortega Marta , Rodrigues-Díez Raúl
Published: October 2022

Background

The Cellular Communication Network Factor-2 (CCN2/CTGF) has been traditionally described as a downstream mediator of other profibrotic factors including transforming growth factor (TGF)-ß and Angiotensin II. However, recent evidence from our group demonstrated the direct role of CCN2 in maintaining aortic wall homeostasis and, in addition, the development of acute and lethal aortic aneurysm induced by Angiotensin II in absence of CCN2 in mice. In order to translate these findings to humans, we evaluated the potential association between three polymorphisms in the CCN2 gene and the presence of thoracic aortic aneurysm (TAA).

Material and methods

69 patients with TAA and 297 controls were genotyped for rs6918698, rs9402373 and rs12526196 polymorphisms related to CCN2 gene.Multivariable logistic regression models were performed.

Results and conclusions

While no associations were found between rs6918698 and rs9402373 with TAA development, patients carrying the C allele from rs12526196 polymorphism have a higher probability of suffering TAA compared to patients with TT genotype, independently of other risk factors such as sex, age, hypertension, type of valvulopathy and presence of bicuspid aortic valve (OR = 3.17; 95% CI = 1.30–7.88;P = 0.011). This study extrapolates to humans the relevance of CCN2 in aortic aneurysm observed in mice and postulate, for the first time, a protective role to CCN2 in aortic aneurysm pathology. Our results encourage future research to explore new variants, polymorphisms or mutations, in the CCN2 gene that could be predisposing to TAA development.

Funding

Research funded by ISCIII (PI20/000140, PI18/00694, PI19/00184, PI20/00639); RICORS2040-KIDNEY-DISEASE (RD21/0005/0002, RD21/0005/0017); Sara-Borrell-CD20/00042; Miguel-Servet-CP18/00106; Sociedad Española de Nefrología.
Poster No. 118 TheIL6rs1800795polymorphism is associated with ascending thoracic aortic dilatation in bicuspid aortic valve patients
Authors: Rodríguez Isabel , Junco-Vicente Alejandro , Rolle-Sóñora Valeria , Del Río-García Álvaro , Solache-Berrocal Guillermo , Morís César , Fernández María Martín
Published: October 2022

Antecedentes

Los pacientes con válvula aórtica bicúspide (BAV), en comparación con las personas con válvula aórtica tricúspide normal, tienen un mayor riesgo de desarrollar dilatación de la aorta ascendente (DAA). La disfunción valvular significativa no explica una complicación aórtica desafortunada y, por lo tanto, los mecanismos moleculares involucrados se encuentran bajo investigación. Uno de los procesos involucrados es la inflamación y las citocinas como la interleucina-6 están asociados con las dimensiones aórticas y con la degeneración de la matriz extracelular aórtica en modelos animales. . Por este motivo, nos propusimos analizar un polimorfismo del gen de la interleucina-6 (IL6), que regula positivamente la transcripción y traducción del gen, en pacientes con VAB.

Material y métodos

Presentamos una serie de 119 pacientes con VAB genotipados para el polimorfismo rs1800795 en la región promotora del gen IL6 . Se realizaron modelos de regresión logística multivariable.

Resultados y conclusiones

Nuestros pacientes, todos con VAB, tenían una mediana de edad de 55 años, 76,5% hombres, 29,4% fumadores, 30% dislipidémicos, 35,3% hipertensos, 12,6% diabéticos y 44% con DAA de 39 a 49 mm. Homocigotos El genotipo para el alelo C del polimorfismo IL6 fue significativamente menos frecuente en pacientes con dilatación (OR = 0,32, IC del 95% = 0,11–0,96, P = 0,035). Tras ajustar por variables de confusión como sexo, edad, hipertensión arterial y valvulopatía, los pacientes portadores del genotipo CC seguían teniendo menor probabilidad de padecer DAA (OR = 0,25; IC95% = 0,07–0,76; P = 0,02).

La identificación de individuos con predisposición genética para el desarrollo de DAA es fundamental en beneficio de un seguimiento médico más estrecho. Son necesarios más estudios para evaluar su uso en la aortopatía bicúspide.

Investigación financiada por la Sociedad Española de Cardiología; ISCIII-PI1800694; Fundación-Asturcor;Programa Severo-Ochoa.
Clinical Case 03—Coronary subclavian steal syndrome: an unusual cause of acute myocardial infarction
Authors: Pinho Ana Isabel , de Carvalho Miguel Martins , Oliveira Cátia , Santos Luís Daniel , Proença Tânia , Pinto Ricardo Alves , Amador Ana Filipa , da Costa Catarina Martins , Calvão João , Cabrita André , Marques Catarina , Nóbrega Leandro , Dias Lara , Pinto Roberto , Rodrigues Rui André , Macedo Filipe
Published: October 2022

A 69-year-old male presented with typical angina while showering. He had history of CABG in 2008 (left internal mammary arterial [LIMA] to the first marginal and intermediate arteries and RIMA to the LAD artery), with preserved biventricular systolic function. On physical examination, an upper-arm systolic blood pressure differential >20mmHg and a decreased pulse amplitude on the left side was found. ECG revealed sinus tachycardia with RBBB, ST-segment depression and inverted T-waves in the lateral and inferior leads. Troponin and BNP levels were elevated. Echocardiogram showed reduced left ventricular ejection fraction (22%) and de novo akinesia of the inferior and posterior walls. The diagnosis of non-ST-segment elevation myocardial infarction was assumed. Coronary angiography revealed patent bypass grafts without disease and a 90% stenosis of the left subclavian artery (LSA) proximal to the ostia of the LIMA, with retrograde flow ‘stealing’ the myocardial blood supply. Ultrasound scan detected systolic reversal of flow in the left vertebral artery, suggesting subclavian-vertebral steal phenomenon. CT-angiography revealed a 14-mm stenosis with a useful lumen of 2 mm in the LSA. A percutaneous balloon angioplasty with stenting of the LSA was performed by the Vascular team, restoring the normal blood supply. Coronary subclavian steal syndrome can manifest as myocardial infarction or heart failure, due to functional LIMA graft failure by inadequate blood supply to the myocardium. Anamnesis and physical examination are fundamental in order not to miss the diagnosis. Subclavian angiography is the gold standard to confirm the diagnosis and can be performed during coronary angiography. Revascularization of the LSA is the definitive treatment. Figure 1Coronary angiography revealed chronic occluded native coronary vessels with patency and no significant disease of the bypass grafts, and high grade (90%) left subclavian artery (LSA) stenosis proximal to the ostia of the LIMA, conditioning the blood flow to the left upper limb and ‘stealing’ the myocardial blood supply because of retrograde flow in the LIMA graft.
Clinical Case 08—A challenging clinical case: acute limb ischemia as a presentation of a left ventricular thrombus in a patient with heart failure with reduced ejection fraction
Authors: Paz Driotes Daniel Eduardo , Leiva Veronica Vanesa Gomez
Published: October 2022

A 57-year-old male with arterial hypertension, diabetes mellitus, ischemic heart disease and coronary bypass in 2018, was admitted to the hospital with a 1-day evolution of sudden pain of strong intensity in the lower right limb. On physical examination, lower right limb showed erythrocyanosis, multiple distal ulcers, absence of hair, distal coldness up to the level of the knee, capillary refill >5 seconds, with absence of pedal and popliteal pulses. Arterial echo-Doppler of the lower right limb was performed, which reported common femoral and superficial femoral arterial insufficiency, with no flow in the distal third of the femoral, popliteal, tibial, and peroneal arteries. AngioCT of the lower limbs reported bilateral chronic arterial insufficiency with no flow from the superficial femoral artery to the popliteal and anterior tibial arteries of the right leg. A transthoracic echocardiogram was performed, which reported dilated heart disease with a left ventricular ejection fraction of 16% and an apical thrombus in the left ventricle of approximately 1.2 cm × 4.1 cm. Anticoagulation with unfractionated heparin was started, and thrombectomy of the lower right limb was evaluated, with a high probability of amputation due to irreversibility of ischemia. However, due to a high probability of surgical complications, conservative management was decided. Due to Virchow’s triad, patients with ischemic heart disease and heart failure with reduced ejection fraction are at high risk of intraventricular thrombi and subsequent embolization; therefore, the use of prophylactic anticoagulation should be considered to prevent this type of complication despite the evidence is controversial. Figure 1A. 3D reconstruction of AngioCT of the lower limbs, arterial phase, red arrow indicates occluded flow in the form of a pencil point in the proximal third of the right superficial femoral artery, suggesting arterial thombosis. B and C. 4C EchoTT with an image of a large, consolidated thrombus with well-defined edges in the apex attached to the wall running over the interventricular septum (green arrow).