bluuebunny/crossref_metadata_2025 huggingface dataset:
P5481Predictors of mortality in patients with non-anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Authors: Milasinovic D , Radomirovic M , Jelic D , Mehmedbegovic Z , Zobenica V , Dudic J , Zaharijev S , Zivkovic I , Pavlovic A , Obreski A , Dolicanin A , Vukcevic V , Asanin M , Stankovic G
Published: October 2019

Background

Previous studies have indicated that patients with non-anterior ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) have a more favorable prognosis compared with anterior STEMI, especially in the short term.

Purpose

Our aim was to identify predictors of increased 30-day mortality in patients with non-anterior STEMI undergoing primary PCI.

Methods

This analysis included 8188 patients referred to primary PCI during 2009–2017, from a prospective electronic registry of a high-volume catheterization laboratory, for whom 30-day follow-up was available. Non-anterior infarction was defined as presence of ST-segment elevation in inferior and/or lateral ECG leads or true posterior MI. Multivariable Cox regression was used to assess the mortality risk at 30 days.

Results

59.4% (n=4863) of the included patients presented with a non-anterior STEMI. Mortality rate was significantly lower in patients with non-anterior vs. anterior STEMI (4.2% vs. 8.3%, p<0.001). Older age (> median of 61, HR 2.2, p=0.002), baseline renal failure (eGFR <60, HR 4.0, p<0.001), Killip class ≥2 (HR 3.8, p<0.001), previous stroke (HR 1.8, p=0.004), non-culprit chronic total occlusion (CTO, HR 2.0, p<0.001) and final TIMI flow grade <3 in the infarct-related artery (HR 3.1, p<0.001) were independently associated with an increased risk of 30-day mortality in non-anterior STEMI. The presence of at least one of these high-risk factors was noted in 61.2% of patients with non-anterior STEMI and was associated with a significantly higher risk of 30-day mortality (HR 18.2, p<0.001), similarly to the overall risk associated with anterior STEMI (HR 22.9, p<0.001), as compared with patients with non-anterior STEMI but without any of the here identified high-risk factors (Figure).

Figure 1

Conclusions

Crude mortality rate was significantly lower in patients with non-anterior vs. anterior STEMI. However, the majority of non-anterior STEMI patients had at least one of the high-risk factors (older age, previous CVI, baseline renal failure, Killip class ≥2, non-culprit CTO or final TIMI flow <3), which predisposed these patients to a similar increase in short-term mortality risk as in patients with anterior STEMI.
P5490Sex-related differences in intrahospital outcome of patients undergoing PCI
Authors: Lezha M , Ceka A , Alimehmeti I , Goda A
Published: October 2019

Background

Cardiovascular diseases remain the number one cause of mortality in the world despite modern scientific and therapeutic advancement. Gender difference pathophysiology, treatment and outcome have been hypothesized and studied. Whether there are sex differences in the outcome after PCI remains controversial.

Aim of the study

We undertook this study to assess whether there are sex-related differences in intrahospital outcome of patients undergoing percutaneous coronary intervention.

Materials and methods

This is a prospective observational study. We enrolled consecutively all patients undergoing PCI in UHC “Mother Theresa” from April to October 2018 and were followed in the 1st Clinic of Cardiology. Data for 352 patients were collected, 261 males and 91 females. We excluded from the study patients that could not be followed.

Results

Women were older (5.27; 95% CI: 2.98–7.6; p<0.001), had more hypertension (p≤0.001), Diabetes Mellitus (p≤0.001), while men were more likely to be smokers (p≤0.001). Female sex had a higher unadjusted mortality rate (5.5% vs. 1.5%, p=0.039) which vanished after adjustments for age, co-morbidities and procedural or infarct related complications (p=0.237). The age-group with the highest mortality rate was that of 61–70 years. Women had more procedure related complications like inguinal hematomas (p=0.02), pseudo aneurisms (p=0.005) and contrast induced nephropathy (p=0.021). Female gender was associated with more severe peri-procedural arrhythmias in the setting of AMI (p=0.039). Total hospital stay was longer for women (p=0.001), after elective PCI (p=0.01) and after primary PCI (p=0.007). After multivariate analysis and adjustment, female gender remained an independent factor for prolonged hospitalization.

Conclusion

Female sex seems to have a tendency for higher mortality even after losing its significance after multivariate adjustments. Females get more myocardial infarction and procedural related complications and have longer hospital stays than men.
P5498Comparison of outcomes of acute coronary Syndrome in women above 80 years versus below 80 years in Israel from 2000 to 2016
Authors: Rubinstein R , Matetzky S , Beigel R , Iakobishvili Z , Goldenberg I , Shechter M
Published: October 2019

Background

While women≥80 years old have a high prevalence of coronary artery disease (CAD), little data exist regarding their outcome following acute coronary syndrome (ACS).

Methods

In a retrospective study based on data of 3518 ACS women patients who were enrolled in the ACS Israel Survey (ACSIS), we first evaluated and compared the clinical outcomes of 858 ACS women ≥80 years with 2660 ACS women <80 years, hospitalized during 2000–2016. Secondly, we evaluated the clinical outcome of 450 women ≥80 years hospitalized during 2000–2006 (“early period”) and compared them with 408 ACS women of the same age group hospitalized during 2008–2016 (“late period”).

Results

Implementation of the ACS AHA/ACC/ESC therapeutic guidelines was lower in ACS women ≥80 years compared with women <80 years. Multivariate Cox regression analysis demonstrated a worse 1-year survival rate in the ACS women ≥80 years compared with those <80 years. During the late period women >80 years were treated more frequently with guideline-recommended therapies compared with patients from the same age group who were hospitalized in the early period. A significant decline in in-hospital mortality rates in ACS women ≥80 years hospitalized in the late compared with the early period was demonstrated. However, 7-day, 30-day and 1-year mortality rates were not significantly changed.

1-year survival by age groups

Conclusion

Adverse outcome rates of ACS women ≥80 years were significantly higher compared with those <80 years. In-hospital survival rates of ACS women patients >80 years improved during the 2000–2016 period; however, long-term survival rates were not significantly changed.

Acknowledgement/Funding

None
P5504Comparison of in-hospital clinical outcomes of acute myocardial infarction between nonagenarians and octogenarians: a propensity-score matched analysis
Authors: Seguchi M , Sakakura K , Yamamoto K , Taniguchi Y , Wada H , Momomura S , Fujita H
Published: October 2019

Background

Acute myocardial infarction (AMI) in the very elderly is associated with high morbidity and mortality. Because the majority of study population in clinical researches focusing on the very elderly with AMI were octogenarians, clinical evidences regarding AMI in nonagenarians are sparse. The aim of the present study was to compare in-hospital clinical outcomes of AMI between octogenarians and nonagenarians.

Methods

We included consecutive 415 very elderly (≥80 years) patients with AMI, and divided into the nonagenarian group (n=38) and the octogenarian group (n=377). Clinical characteristics and in-hospital outcomes were compared between the 2 groups. Furthermore, we used propensity-score matching to find the matched octogenarian group (n=38).

Results

Percutaneous coronary interventions (PCI) to the culprit of AMI were similarly performed between the nonagenarian (86.8%) and octogenarian (87.0%) groups The incidence of in-hospital death in the nonagenarian group (13.2%) was similar to that in the octogenarian group (14.6%) (P=0.811). The length of hospital stay was significantly shorter in the nonagenarian group (7.4±4.2 days) than that in the octogenarian group (15.4±19.4 days) (P<0.001). After using the propensity-score matching, the incidence of in-hospital death was less in the nonagenarian group (13.2%) than in the matched octogenarian group (21.1%) without reaching statistical significance (P=0.361). The length of hospitalization was significantly shorter in the nonagenarian group (7.4±4.2 days) than in the matched octogenarian group (17.8±37.0 days) (P=0.01).

Clinical outcomes Nonagenarian group (n=38) Octogenarian group (n=377) P value In-hospital death, n (%) 5 (13.2) 55 (14.6) 0.811 Length of hospital stay (days) 7.4±4.2 15.4±19.4 <0.001 Length of CCU stay (days) 3.3±2.5 4.7±5.1 0.109 LVEF (%) 48.2±9.2 50.8±13.7 0.152 Peak CPK (U/L) 1424.8±1580.8 1640.1±2394.4 0.912 CCU indicates Coronary care unit; LVEF, Left ventricular ejection fraction; CPK, Creatine kinase.

Flow-chart

Conclusions

The in-hospital mortality of nonagenarians with AMI was comparable to that of octogenarians with AMI. In-hospital outcomes in nonagenarians with AMI may be acceptable as long as acute medical management including PCI to the culprit of AMI is performed.

Acknowledgement/Funding

None
P5524Influence of bundle branch block in the long-term outcome of patients with acute coronary syndrome
Authors: Garcia Acuna J M , Cordero Fort A , Martinez A , Antunez P , Perez Dominguez M , Gonzalez Ferrero T , Cacho Antonio C , Torrelles A , Iglesias Alvarez D , Rigueiro Veloso P , Agra R , Pedreira Perez M , Gonzalez Juanatey J R
Published: October 2019

The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. This consideration is not taken into account in the management of patients with coronary syndrome without ST elevation (NSTEMI). We evaluate the evolution of patients with acute coronary syndrome and long-term bundle branch block.

Patients and methods

We included 8771 patients admitted to two tertiary hospitals between 2003 and 2017 with an acute coronary syndrome, 5673 NSTEMI (64.3%) and 3098 STEMI (35.7%). All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB). Long-term follow-up was performed (median 55 months) to assess mortality.

Results

A total of 8771 patients were included with a mean age of 66.1 years, 72.5% males, 4.1% (362) with LBBB and 5% (440) with RBBB. Patients with BBB were older, with more previous history of myocardial infarction and coronary revascularization and higher prevalence of cardiovascular risk factors. Medical treatment was similar but they were less often submitted to angioplasty. During the acute phase, patients with RBBB and LBBB presented a higher rate of heart failure than those without branch block (4.8% vs 9.1% vs 3.5%, p=0.0001); higher mortality (8.4% vs 10.5% vs 3.0%, p=0.0001); higher stroke rate (2.5% vs 1.4% vs 0.8%, p=0.001); higher rate of renal failure (8.2% vs 9.7% vs 3.9%, p=0.0001) and higher rate of reinfarction (3.0% vs 4.1% vs 1.7%, p=0.001). Patients who had a RBBB or an LBBB had a worse prognosis throughout the follow-up. Heart failure was present in 17.7% of the group with RBBB, 29.6% of LBBB and 11% in the group without branch block (p=0.0001). Mortality during follow-up was 31% in RBBB, 40.6% in LBBB and 18.7% without branch block (p=0.0001). In multivariate analysis of Cox, both RBBB (HR 1.55, 95% CI 1.23–1.98, p=0.0001) and LBBB (HR 1.48, 95% CI 1.22–1.53, p=0.001) were an independent predictors of all-cause mortality (adjustment for GRACE score, gender, treatment with betablockers, angiotensin conversor enzym inhibitors, statin and coronary revascularization).

Cox regression model multivariate

Conclusions

The presence of RBBB or LBBB in the ECG of patients with an ACS is associated with a worse prognosis both during the hospital phase and in the long term. In addition, both bundle branch blocks are independent predictors of long-term mortality in patients with ACS.
P5548Hypertrophic cardiomyopathy and exercise restrictions: time to let the shackles off?
Authors: Liao Y W , Rasoul D , Cooper R M
Published: October 2019

Introduction

Physical activity is well known to have many health benefits. However, patients with hypertrophic cardiomyopathy (HCM) might carry an increased risk of sudden cardiac death (SCD) during physical activity. This threat has to be considered in the risk versus benefit analysis of physical activity versus a more sedentary lifestyle. Current guidelines focus primarily on what level of activity should be entirely excluded and what level is considered safe. However, it does not quantify nor qualify the amount of physical activity which should actively be undertaken. We aimed to analyse current evidence in attempt to answer this question.

Method

For this review, we focused on non-athletes who made up the majority of HCM patients. However, we found that majority of the current evidence were geared towards athletes. In total, we analysed 27 papers.

Results

Obesity is a well documented aetiology of many diseases and patients with HCM have been observed to have higher BMI. When considering physical activity of patients with HCM, both patients and current guidelines tend to focus on avoidance of risk and restriction of exercise. This is understandable given the consequence of SCD in HCM patients. A retrospective review of 78 patients found that at the time of cardiac catastrophe, 46 of them were engaged in sedentary activities. This is further backed up by a UK study which found only 35 of 185 patients died during exertion. A meta-analysis of 3449 non-athletes found only 7.8% had SCD caused by HCM. These results suggest that prescribed exercise can be safe in non-athletes.

A cross-sectional study of 187 HCM patients with left ventricular hypertrophy investigated if a history of vigorous exercise was associated with adverse events including ventricular arrhythmias. It found that vigorous exercise was not associated with ventricular arrhythmias. Saberi et al conducted the first randomised controlled trial (RCT) designed to investigate the effect of prescribed training in HCM patients. 136 patients were randomised into a normal activity group and a 16 week prescribed moderate- intensity training group. At 16 weeks, there was an absolute increase of 6% in the mean change in peak oxygen consumption (peak VO2) between the groups. This was an important finding as the HF-ACTION trial found that every 6% increase in peak VO2 was associated with an 8% lower risk for cardiovascular mortality.

Modified Mitchell's classification

Conclusion

Current guidelines on exercise for patients with HCM are very restrictive. The recommendations for level of exercise are focused on prohibition rather than encouraging a safe and sensible level of exercise. RESET-HCM is the first RCT of its kind which successfully shows that carefully guided exercise is not only safe but can also be beneficial for patients. With more studies targeting the role of exercise and activity in these patients, it is only a matter of time before our focus switches from restricting activity to sensible exercise prescription.
P5551Comparison of prognostic predictors of heart failure admission and progression to end-stage in hypertrophic cardiomyopathy
Authors: Nakagawa S , Okada A , Hamatani Y , Amano M , Takahama H , Amaki M , Hasegawa T , Kanzaki H , Yasuda S , Izumi C
Published: October 2019

Background

Heart failure (HF) is a common complication within the clinical spectrum of hypertrophic cardiomyopathy (HCM). HCM-related HF is recognized to be multifactorial, including outflow obstruction, diastolic dysfunction, or progression to end-stage; however, prognostic predictors of HF events are not fully understood. We sought to investigate predictors for various HF outcomes in HCM.

Methods

We studied 289 consecutive HCM patients with EF≥50%. Patients with outflow obstruction (peak pressure gradient ≥30mmHg) were defined as obstructive HCM. HF events assessed in this study were 1) HF admission and 2) progression to end-stage (EF<50%).

Results

The mean age was 63±16 years, 53% male, EF 61±5%, NYHA class 1.8±0.7, and 39% obstructive. During a median follow up of 5.2 [3.7–7.0] years, 48 HF admission and 19 progression to end-stage were observed. Only 8/48 (17%) patients with HF admission had progressed to end-stage; while 11/19 (58%) patients with progression to end-stage remained free from HF admission. Univariate Cox regression hazard analysis showed different prognostic predictors between HF admission and progression to end-stage (Table). Multivariate Cox regression hazard analysis showed atrial fibrillation was an independent predictor of HF admission (adjusted HR 2.711 [1.094–7.389], P=0.031); while LV end-systolic dimension was an independent predictor of progression to end-stage (adjusted HR 1.114 [1.018–1.229], P=0.025).

Cox hazard analysis for predicting event HF admission Progression to end-stage HR (95% CI) P value HR (95% CI) P value Age, 1 year 1.042 (1.017–1.071) <0.001 1.002 (0.975–1.035) 0.89 Male sex 1.052 (0.595–1.882) 0.86 2.853 (1.034–10.02) 0.043 Atrial fibrillation 3.247 (1.809–6.608) <0.001 1.434 (0.570–3.559) 0.44 Non-obstructive 0.850 (0.481–1.531) 0.58 5.439 (1.558–34.30) 0.005 LV end-diastolic dimension, 1mm 1.027 (0.981–1.077) 0.25 1.120 (1.035–1.218) 0.005 LV end-systolic dimension, 1mm 1.059 (1.008–1.110) 0.023 1.167 (1.080–1.258) <0.001 EF, 1% 0.974 (0.926–1.032) 0.36 0.894 (0.825–0.980) 0.018 LA volume, 1ml/m2 1.012 (1.001–1.020) 0.044 1.006 (0.978–1.023) 0.64 Transmitral E wave, 1m/s 1.013 (1.002–1.024) 0.025 1.006 (0.987–1.023) 0.50 Transmitral DcT, 1msec 0.999 (0.995–1.003) 0.59 0.985 (0.974–0.994) <0.001 E/e', 1.0 1.062 (1.012–1.109) 0.015 1.089 (1.010–1.164) 0.027

Conclusions

Different prognostic predictors were found for HF admission and progression to end-stage, suggesting the difficulty and multifactorial nature of HCM-related HF.
P5553Right ventricular involvement in hypertrophic cardiomyopathy: insights from a tertiary centre
Authors: Pereira A R , Cruz I , Almeida A R , Marques A , Alegria S , Gomes A C , Briosa A , Lopes L R , Ramalho M , Pereira H
Published: October 2019

Introduction

Hypertrophic cardiomyopathy (HCM) is the main cause of sudden cardiac death in the young and a cause of heart failure (HF) and death at any age. Nevertheless, adverse long-term outcomes are not easy to predict.

Objectives

To assess the prevalence and prognostic value of right ventricular (RV) involvement in patients (pts) with HCM.

Methods

Retrospective single-centre study of consecutive pts with HCM evaluated in a specialized consultation. Selected those submitted to cardiac magnetic resonance imaging (CMR) as the gold-standard for RV assessment. The primary endpoint (PE) was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, ventricular arrhythmias with hemodynamic instability and unplanned HF admission.

Results

Of a total of 181 pts, 104 fulfilled the inclusion criteria (mean age at first consultation 62.1±9.7 years, 63.5% male). Septal asymmetric phenotype was the most frequent (73.1%) and 24 pts (23.1%) had rest LV outflow tract obstruction. Mean value of maximum wall thickness was 18.8±4.6 mm. Regarding CMR parameters (Fig A), 5.8% had RV dysfunction and 2.9% RV free wall hypertrophy; no patient presented RV dilation. Late gadolinium enhancement (LGE) of joint points was observed in 47.1%. During follow-up (FU, mean 56.6±29.5 months), survival free of RV dysfunction was 94.3%. Only 5 pts developed RV compromise assessed by echocardiographic parameters: TAPSE 12.0±3.4 mm and pulsed tissue Doppler systolic annular velocity (tricuspid S') wave 7.3±0.9 cm/s. These pts were significantly older (p<0.01) and had higher values of average tissue doppler E/E' ratio at diagnosis (p<0.01). Global RV involvement (at diagnosis or during FU) were associated with increased values of indexed left atrial area (p<0.01), LV dysfunction (p=0.01), LGE of joint points (p=0.01) and higher values of NT-proBNP (p=0.01). In multivariate logistic regression, left atrial enlargement was the only independent predictor of global RV dysfunction (OR 1.9, 95% CI 1.1–3.2, p=0.01) and average E/E' ratio an independent predictor of RV dysfunction during FU (OR 1.3, 95% CI 1.1–1.5, p<0.01). PE rate was 10.6%. It was significantly higher in pts with global RV involvement and there was a significant difference in survival analysis (Fig B). Average E/E' ratio (OR 1.5, 95% CI 1.1–1.9, p=0.01) and RV ejection fraction (OR 0.8, 95% CI 0.7–0.9, p=0.01) were independent predictors of the outcome.

Conclusions

Although not common, RV dysfunction was associated with a higher rate of cardiovascular events. Average E/E' ratio, as a measure of left ventricular filling pressure, was a risk factor for both RV dysfunction and PE. Higher values of RV ejection fraction were protective of adverse events occurrence. Together, these results support a potential role of RV function in the risk stratification of HCM pts.
P5555Predictors of systemic embolisms in a large cohort of left ventricular noncompaction patients
Authors: Casas G , Oristrell G , Limeres J , Sao-Aviles A , Barriales R , Garcia-Pavia P , Diez C , Zorio E , Villacorta E , De Antonio M , Garcia-Pinilla J M , Valverde M , Evangelista A , Ferreira-Gonzalez I , Rodriguez-Palomares J F
Published: October 2019

Background

Left ventricular noncompaction (LVNC) is associated with an increased risk of systemic embolisms (SE). However, incidence and risk factors are not well established.

Purpose

To evaluate the rate of SE in LVNC and describe risk factors.

Methods

LNVC patients were included in a multicentric registry. Those with SE were considered for the analysis.

Results

514 patients with LVNC from 10 Spanish centres were recruited from 2000 to 2018. During a median follow-up of 4.2 years (IQR 1.9–7.1), 23 patients (4.5%) had a SE. Patients with SE (Table 1) were older at diagnosis, with no differences in gender and had similar cardiovascular risk factors. They were more frequently under oral anticoagulation (OAC). Besides, they had a more reduced LVEF, and more dilated LV and left atrium (LA). Late gadolinium enhancement (LGE) was more frequent, altogether suggesting a more severe phenotype.

Patients with SE had non-significantly higher rates of hospitalization for heart failure (33% vs 24%, p=0.31) and atrial fibrillation (35% vs 19%, p=0.10). In multivariate analysis, only LA diameter was an independent predictor of SE (OR 1.04, p=0.04). A LA diameter>45 mm had an independent 3 fold increased risk of SE (OR 3.04, p=0.02) (Image 1).

Table 1 Systemic embolisms (n=23) No systemic embolisms (n=491) p Men, n (%) 15 (65) 289 (56) 0.52 Median age at diagnosis (IQR), yr 60 (48–76) 48 (30–64) 0.02 Median follow up (IQR), yr 5.9 (3.1–7.8) 4.2 (1.8–7.1) 0.18 Hypertension, % 8 (33) 118 (24) 0.31 Diabetes mellitus, % 3 (14) 39 (8) 0.41 OAC, % 19 (83) 118 (24) 0.01 LVEF (SD), % 37 (15) 48 (17) 0.01 LVEDD (SD), mm 58 (11) 54 (10) 0.04 LVESD (SD), mm 45 (13) 38 (11) 0.01 LA diameter (SD), mm 46 (9) 39 (9) 0.01 LVEDV CMR (SD), mL 193 (75) 163 (70) 0.12 LVESV CMR (SD), mL 121 (64) 85 (64) 0.04 LGE, % 9 (40) 88 (18) 0.04

Conclusions

LVNC carries a moderate mid-term risk of SE, which appears to be irrespective of atrial fibrillation and associated with age, LV dilatation and systolic dysfunction and mainly LA dilatation. This subgroup of patients should be considered for oral anticoagulation in primary prevention.
P5569Effective regurgitant oriffice area vs vena contracta method as predictors of outcomes in severe tricuspid regurgitation
Authors: Garcia Martin A , Hinojar R , Gonzalez Gomez A , Pascual Izco M , Plaza Martin M , Alonso Salinas G , Hernandez Jimenez S , Monteagudo J M , Casas Rojo E , Moya Mur J L , Jimenez Nacher J J , Ruiz Leria S , Barrios Alonso V , Zamorano J L , Fernandez Golfin C
Published: October 2019

Background

There is no gold standard echocardiographic method to evaluate tricuspid regurgitation (TR) severity. ESC guidelines recommend using a combination of several methods. The purpose of this study was to compare the prognostic value of the two most commonly used methods for the evaluation of the TR: Effective regurgitant orifice area (EROA) method and biplane vena contracta (VC) method.

Methods

Consecutive asymptomatic patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015–2018 were included.

TR severity was evaluated by a combination of several methods, including EROA method and biplane VC method, using EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.

Results

A total of 70 patients were included (mean age was 74±8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). During a median follow up of 18 months [IQR: 4–28], 35% of the patients reached the combined end-point (n=16 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died).

Patients with events showed a larger EROA (0.55 vs 0.40 p: 0.036) but no significance different was found in VC (8.03 vs 7.80 p: 0.27). Among both parameters, the tricuspid EROA was the only prognostic factor of the combined endpoint (EROA, HR 24.22 [1.54–380.86], p=0.023; VC, HR 1.022 [0.882–1.183]. A value of EROA of 0.42 reached the best accuracy to predicted poor outcomes (p<0.01).

Conclusion

Among the two most commonly used methods for the evaluation of the TR, EROA was the only method that obtained prognostic value during follow-up.
P5575Acute left ventricular mechanics changes after TAVR: the afterload concept revisited
Authors: Procopi A , Procopi N , Collet J P , Barthelemy O , Leprince P , Choussat R , Isnard R
Published: October 2019

Background

Recent studies have emphasized the prognostic value of mild left ventricular ejection fraction (LVEF) impairment in severe aortic stenosis. However, despite adaptive mechanisms to pressure overload, subtle impaired systolic function could be worsened by increased afterload and partly reversible immediately after its correction.

Objectives

The aim was to evaluate the short terms effects of transcatheter aortic valve replacement (TAVR) on LV systolic function assessed by global longitudinal strain (GLS). We hypothesized that abrupt decrease of LV afterload after TAVR could lead to immediate improvement of LV systolic function.

Methods

Patients referred to our Department for TAVR were included from January 2018 to July 2018 in this observational prospective single center study. Transthoracic echocardiography (TTE) was performed immediately before and 1–5 days after TAVR by the same operator and reviewed in a blind fashion.

Results

35 symptomatic patients with severe aortic stenosis referred for TAVR (age 84±5 y, 18 male, NYHA 2–3, orifice area 0.7±0.2 cm2, LVEF 66±13%, GLS −15.1±4.7%) were included. Only 9/35 (26%) had a LVEF ≤60%. Overall, no significant change in LVEF (65±14%; p=0.55) or GLS (−16.1±4.8%; p=0.11) occurred immediately after TAVR despite a dramatic decrease in transoartic mean pressure gradient (44±15 mm Hg versus 6±3 mmHg; p<0.0001). However in the subgroup of patients with LVEF ≤60%, a significant increase in GLS after TAVR was observed (−9.6±4.1% versus −12.1±3.3%; p=0.0039).

Improvement in GLS according to the LVEF

Conclusion

Following TAVR, an early improvement in LV systolic function assessed by GLS was observed only in patients with pre-existing mild LV systolic dysfunction. Further studies should evaluate whether this improvement is associated with better long term outcome.
P5577Preoperative transaortic pressure gradient predicts renal functional improvement after transcatheter aortic valve implantation in patients with chronic kidney disease
Authors: Oyabu K , Jujo K , Konami Y , Otsuki H , Tanaka K , Isomura S , Domoto S , Yamaguchi J , Niinami H , Hagiwara N
Published: October 2019

Introduction

Transcatheter aortic valve implantation (TAVI) theoretically increases renal blood flow through increasing cardiac output by relieving aortic valvular obstruction of blood flow from left ventricle, resulting in a renal functional recovery in patients with severe aortic valve stenosis (AS). However, procedural steps of TAVI including contrast use potentially damages renal medulla and may deteriorate renal function.

Purpose

The aim of this study was to investigate renal functional change and clarify preoperative predictors for renal functional improvement after TAVI in chronic kidney disease (CKD) patients with severe AS.

Methods

A total of 88 consecutive severe AS patients with CKD (grade >3) who underwent TAVI from 2015 to 2018 was enrolled in this observational study. They were divided into two groups depending on their renal functional improvement after TAVI that was defined as more than 10% increase in estimated glomerular filtration rate (eGFR) at discharge from their preoperative level.

Results

Among the whole candidates, 49 patients (55.7%) were improved their renal function. Patients with the lowest preoperative eGFR achieved the highest increase in eGFR after TAVI (CKD grade >4: +22.7±23.7%, Figure). Patients in the Improved group had lower hemoglobin level, higher mean transaortic pressure gradient (TAPG), and higher aortic valve gradient before TAVI, compared to those in the Non-improved group. However, contrast volume during the procedure was not significantly different between the groups. Multivariate logistic regression analysis revealed that high mean TAPG and low left ventricular ejection fraction (LVEF) before TAVI were independent predictors for the improvement of renal function (odds ratio (OR): 1.04, 95% confidence interval (CI): 1.00–1.08; OR: 0.94, 95% CI: 0.89–0.99, respectively), even after the adjustment of baseline eGFR level and hemoglobin level that were statistically significant on univariate logistic regression analysis. Receiver Operating Characteristic (ROC) curve showed the cut-off level of preoperative mean TAPG in renal functional improvement after TAVI as 47.0 mmHg (Sensitivity: 47.9%, Specificity: 79.5%, area under the curve: 0.62).

Correlation between CKDgrade and ΔeGFR

Conclusions

Preoperative high mean TAPG may predict renal functional improvement after TAVI in patients with deteriorated renal function. This non-invasive predictor may help clinicians to consider to perform TAVI in a challenging case with severe CKD.
P5578Integrated approach in assessment of valvular calcification activity in aortic stenosis
Authors: Murtazalieva P , Ryzhkova D , Irtyuga O , Zhiduleva E , Malev E , Moiseeva O
Published: October 2019

Introduction

Calcification is the key pathological process in aortic stenosis (AS) development. Circulating biomarkers and nuclear imaging methods could characterize the valvular calcification activity.

Purpose

To compare diagnostic values of serum fetiun A level and PET/CT with 18F NaF in assessment of aortic valve calcification.

Methods

88 pts with asymptomatic AS were included: 39pts with tricuspid aortic valve (TAV) and 49 pts with bicuspid aortic valve (BAV). ECHO was performed at baseline and in 16.6±4.2 months. At start serum level of fetuin A was measured by ELlSA in all pts and PET/CT with 18F NaF was performed in 60 of these pts (29 TAV pts and 31 BAV pts). Maximum standardized uptake value (SUV) was measured within circular region of interest (ROI) of 3.52 square millimeters that was drawn around areas of maximal 18F-NaF uptake in the valve. Blood-pool activity was estimated using maximum SUV within the same ROI, which was drawn on the left atrium. Ratio between maximum tissue and background SUV (TBR) was calculated. CT calcium scoring was performed using dedicated software.

Results

Pts with TAV were significantly older then BAV pts (62.4±5.3 yrs vs 55.9±8.4 yrs, p=0.003). TAV and BAV groups were comparable in AS severity by ECHO (peak aortic jet velocity (Vmax): 3.1±0.6 m/s vs 3.1±0.7 m/s, p=0.72). Both groups did not differ in valvular calcification degree (Agatston score 1433.9±1327.9 vs 1617.7±1404.5, p=0.59) and 18F-NaF uptake level (TBR 1.6±0.3 vs 1.6±0.5, p=0.64). Agatston score and TBR max 18F NaF were associated with AS severity measured by Vmax (r=0.58; p<0.0001 and r=0.46; p<0.0001 respectively). Fetuin A was significantly lower in pts with BAV compared to TAV pts (307.4±55.1 vs 342.6±78.2, p=0.02). The sensitivity and the specificity of fetuin A level in predicting of AS progression were 67% and 66%, respectively (AUC = 0.644 [95% CI: 0.527–0.750], p=0.04) with a cut-off value of 313.4 ng/ml. In BAV pts for cut-off value 313.4 ng/ml sensitivity and specificity were 81.8% and 59.4% respectively (AUC = 0.719 [95% CI: 0.561–0.845], p=0.006). There was no association revealed between fetuin A level and Agatston score, TBR 18F NaF.

Conclusions

Despite comparable valve calcification activity measured by PET/CT with 18F NaF in TAV and BAV pts, decreased circulating fetuin A was observed only in BAV pts, that may be related to different underlying pathophysiological mechanisms. Low serum fetuin-A level was associated with progression of AS, particularly in BAV pts.

Acknowledgement/Funding

Grant of Russian Foundation for Basic Research No. 18-015-00016
P5583Micro-movement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis
Authors: Hellhammer K , Piayda K , Veulemans V , Afzal S , Hennig I , Makosch M , Polzin A , Kelm M , Zeus T
Published: October 2019

Background

Precise positioning of the prosthesis is a crucial step during transcatheter aortic valve implantation. In some cases, contemporary self-expandable prostheses show micro-movement (MM) during the final phase of release.

Purpose

We aimed to establish a definition for MM, evaluated the incidence of MM using the CoreValve Evolut RTM, investigated potential risk factors for MM and the associated clinical outcomes.

Methods

MM was defined as movement of the prosthesis of at least 1.5 mm from its position directly before release compared to its final position. Patients were grouped according to the occurrence (+MM) or absence (-MM) of MM. Baseline characteristics, imaging data and outcome parameters in accordance with the updated valve academic research consortium (VARC-2) criteria were retrospectively analyzed.

Results

We identified 258 eligible patients. MM occurred in 31.8% (n=82) of cases with a mean magnitude of 2.8±2.2 mm in relation to the left coronary cusp and 3.0±2.1 mm to the non-coronary cusp. Clinical and hemodynamic outcomes were similar in both groups. The mean pressure gradient was effectively reduced after TAVI (-MM vs. +MM: 7±3.4 mmHg vs. 8±3.9 mmHg, p=0.326) with consistency over a follow-up period of at least three months (-MM vs. +MM: 6.7±3.7 mmHg vs. 7.9±8.4 mmHg, p=0.168). At three months follow-up most of the patients presented with no aortic regurgitation (-MM vs. +MM: 64% vs. 67.9%, p=0.569). Mild aortic regurgitation was observed in 34.2% of the -MM group and in 29.5% of the +MD group (p=0.414). Moderate aortic regurgitation occurred in 1.9% of all patients with no differences between groups (-MM vs. +MM: 1.9% vs. 2.6%, p=0.662). Patients with MM presented with a more symmetric calcification pattern (-MM vs. +MM: 27.3% vs. 40.2%; p=0.037) and a larger aortic valve area (-MM vs. +MM: 0.6 cm2 ± 0.3 vs. 0.7 cm2 ± 0.2; p=0.014), which was found to be a potential risk factor for the occurrence of MM in a multivariate regression analysis (OR 3.5; 95% CI: 1.1–10.9; p=0.032)

Conclusion

MM occurred in nearly one third of patients and did not affect clinical and hemodynamic outcome. A larger aortic valve area was the only independent risk factor for the occurrence of MM.
P5594Comparison of non-vitamin K antagonist oral anticoagulants versus vitamin K antagonist on changes in pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension
Authors: Hosokawa K , Abe K , Tsutsui H
Published: October 2019

Background/Introduction

Chronic thromboembolic pulmonary hypertension (CTEPH) requires a lifelong anticoagulation therapy. However, the efficacy or safety of non-vitamin K antagonist oral anticoagulants (NOACs) have not been established in CTEPH.

Purpose

We aimed to evaluate the effects of NOACs on the changes in pulmonary vascular resistance (PVR) and their adverse events such as bleeding and clinical worsening in CTEPH.

Methods

We retrospectively compared the changes in PVR among CTEPH patients taking vitamin-K antagonists (VKA) (n=38) and those taking NOACs (n=46) to evaluate the effectiveness of NOACs for the prophylaxis of thrombotic disease progression in CTEPH. Also, we extracted incidence of clinically relevant bleeding and clinical worsening in CTEPH as an exploratory outcome measures. Clinical worsening in CTEPH was defined as composite outcome of death from any cause, lung transplantation and worsening pulmonary hypertension that resulted in hospitalization, addition of specific drug for pulmonary hypertension, or rescue pulmonary endarterectomy or balloon pulmonary angioplasty. Clinically relevant bleeding was defined as composite major bleeding and/or clinically relevant non-major bleeding, which is defined as bleeding associated with the need for medical intervention, contact with a physician, interruption of anticoagulation therapy, discomfort or impairment of activities of daily life.

Results

The changes in PVR (VKA group; −0.17±0.82 woods unit/year, NOACs group; −0.44±0.89 woods unit/year, p=0.32) were comparable between VKA and NOACs groups. The incidence of clinical worsening in CTEPH (VKA group; 1.8% per patient-year, NOACs group; 0% per patient-year) and clinically relevant bleeding (VKA group; 2.8% per patient-year, NOACs group; 2.8% per patient-year) was comparable between the VKA and NOACs groups. D-dimer levels (VKA group; 0.58±0.22 μg/ml, NOACs group; 0.67±0.47 μg/ml, p=0.41) were also comparable between the groups.

Conclusions

Our study revealed that NOACs had a similar effectiveness in the prevention of thrombotic disease progression in CTEPH as compared with VKA. The result suggest that NOACs might have similar efficacy and safety as VKA in daily clinical practice.

Acknowledgement/Funding

Japan Agency for Medical Research and Development
P5597Impact of time from onset to operation on surgical outcomes of acute type-A aortic dissection complicated with malperfusion syndrome
Authors: Nakai C , Tsukube T
Published: October 2019

Introduction

To determine the timing of operation might be the most important factors for surgical outcomes of acute type A aortic dissection (AADA), we analyzed our experience managing AADA complicated by malperfusion syndrome.

Method

Between 11/10 and 2/19, 184 patients with AADA were treated surgically, including 60 patients (32.6%) presented with malperfusion. The mean age of the patients was 71.3±13.3 and female was 94 (51.1%). Prevalences of malperfusions of brain, coronary, kidney, intestine, and extremities were 30 (16.3%), 16 (8.7%), 6 (3.3%), 3 (1.6%), and 23 (12.5%), respectively. Eighty-nine patients (48.4%) were repaired within 6 hours from onset of symptoms and 95 (51.6%) repaired after 6 hours from onset. Aortic repair included total arch replacement in 69 (37.5%) patients and hemiarch in 115 (62.5%). Effect of immediate aortic repair (within 6 hours from onset) and malperfusion syndromes on surgical outcomes of the patients were analyzed.

Results

Overall 30-days-survival rate after aortic repair for AADA was 93.5% (172/184). Early mortality after repairs with malperfusion was 13.3% (8/60): 11.9% (5/42) with immediate repair, and 16.7% (3/18) repaired after 6 hours from onset (late repair). Early mortality after repairs without malperfusion was 3.2% (4/124): 2.3% (1/44) with immediate repair, and 3.8% (3/80) with late repair. Early mortality after repairs with malperfusion was significantly higher than that without malperfusion. In each groups including 184 patients after aortic repair for AADA, 60 patients with malperfusion and 124 patients without malperfusion, there was no significant difference in early mortality rate between immediate repair group and late group.

Conclusion

Malperfusion syndrome was independent risk factor for aortic repairs of acute type-A aortic dissection, and time from onset to operation was not directly related to better outcomes in this patient cohort.
P5605The impact of institutional case volume on the Ppognosis of ruptured aortic aneurysms: a Japanese nationwide study
Authors: Yamaguchi T , Nakai M , Sumita Y , Nishimura K , Sakata Y , Ogino H
Published: October 2019

Background

To improve outcome for ruptured aortic aneurysms (rAA), centralization of treatment is potentially effective. However, there is no nationwide survey for the current managements and outcomes of rAA in Japan.

Purpose

The aim of this study was to assess the volume-outcome relationship for rAA treatment using the nationwide claim-based database.

Methods

Using the Japanese Registry Of All cardiac and vascular Diseases- Diagnostic Procedure Combination database, we identified patients admitted to 564 certified teaching-hospitals with rAA between April 1, 2012 and March 31, 2015. Institutional case volume (cardiovascular surgeries per year) was categorized into quartiles (Lowest, Low, High, and Highest) and the odds ratios (ORs) for in-hospital mortality and neurological status at discharge were analyzed for each quartile.

Results

Of 7086 eligible patients, 3925 (55.4%) died in hospital. Mortality rates decreased from 69.4% in the lowest-volume to 43.8% in the highest-volume category (P<0.001). The favourable impact of institutional case volume was sustained even after adjustment for covariates (Low-volume: OR, 0.83; 95% confidence interval [CI], 0.65–1.07; P=0.147; High-volume: OR, 0.69; 95% CI, 0.54–0.89; P=0.005; and Highest-volume: OR, 0.55; 95% CI, 0.42–0.72; P<0.001 vs. Lowest-volume). Additionally, other three institutional parameters (increased aortic surgery volume, cardiovascular surgeons' volume, and certified cardiologists' volume) were consistently associated with reduced in-hospital mortality. The rate of coma at discharge was the lowest in the Highest-volume group (P<0.001).

Institutional volume and mortality

Conclusions

Increased institutional volume was associated with lower in-hospital mortality. Establishing regionally tailored systems to transfer patients to high-volume centers is needed to improve outcomes.
P5609Outcomes of chimney technique for aortic arch diseases: a single-center experience with 226 cases
Authors: Ding H Y , Zhu Y , Luo S Y , Xie E M , Liu Y , Huang W H , Luo J F
Published: October 2019

Objective

The aim of the present study is to report our single-center experience with chimney technique for aortic arch diseases and the early- and mid-term outcomes in these patients.

Methods

From August 2012 to October 2017, 226 patients (mean age 54±12 years; 197 men) with aortic arch diseases underwent thoracic endovascular aortic repair combined with chimney stents. Pathologies included type B aortic dissection (n=185), aortic arch aneurysm/descending thoracic aortic aneurysm (n=13), aortic arch pseudoaneurysm (n=10), penetrating aortic ulcer (n=7), intramural hematoma (n=7), and aortic rupture (n=4).

Results

The aortic stent-grafts were deployed in zone 0 (n=22), zone 1 (n=13), and zone 2 (n=191). A total of 230 chimney stents were deployed (innominate artery, n=21; right common carotid artery, n=1; left common carotid artery, n=13; left subclavian artery, n=195). The technical success rate was 84% (189/226) and immediate type Ia endoleak occurred in 37 (16%) patients. In the early-term, four patients died, of which from aortic rupture (n=1), ventricular fibrillation (n=1) or major stroke (n=2). Four major strokes occurred (two patients died and two recovered), but no reintervention was recorded. Spinal cord ischemia developed in three patients. The mean duration of follow-up was 22±16 months. Late type Ia endoleaks were recorded in two patients. Chimney stent occlusions were recorded in six patients. During follow-up, five patients died, of which from aortic rupture (n=3), cerebral hemorrhage (n=1) or rectal cancer (n=1). Two major strokes occurred (one patient died and one recovered) and reintervention performed in one case.

Conclusion

The chimney technique for aortic arch diseases is safe and feasible. And long-term follow-up observation is needed.
P5615A randomised study comparing FFR-guided paclitaxel-coated balloon angioplasty vs. drug-eluting bioresorbable scaffolds with 9 months invasive follow-up
Authors: Otto S , Heitkamp K , Exner C , Stadler S , Franz M , Moebius-Winkler S , Schulze P C , Poerner T C
Published: October 2019

Background

Elimination of a permanent metallic stent from standard PCI techniques is desirable since mid- and longterm adverse reactions are attributed to an intracoronary foreign body.

Purpose

To investigate two “metal-free” PCI techniques using either drug-coated balloons (DCB) or bioresorbable scaffolds (BRS) in stable coronary artery disease regarding their safety and efficacy (NCT02607241) and clinical course.

Methods

59 patients (table 1) were prospectively randomized for elective PCI of de novo stenosis with either BRS implantation (N=28) or with DCB only angioplasty (N=31). The DCB only arm was treated by a previously implemented protocol including sequential balloon predilations and repetitive FFR (fractional flow reserve) measurements. Stenting was deferred if FFR was >0.80 and in the absence of flow-limiting dissections after final DCB dilatation. All BRS were post-dilated using a non-compliant balloon. All BVS were post-dilated (non-compliant balloon). Optical coherence tomography (OCT) was performed during index procedure and at 9-month f/u.

Results

Both groups were well balanced without significant differences in clinical characteristics (table 1). Procedural success was achieved in 89.3% in the BRS and 77.4% in the DCB group. Parameter of quantitative coronary angiography are shown in the table 2. The predefined primary end point (efficacy) net luminal gain was significantly larger in the DCB group (noninferiority t-Test, margin: 0.2mm, 80% power). Accordingly, the secondary endpoint late lumen loss indicated with −0.20±0.73 vessel enlargement at the stenotic site in the DCB group at 9-month f/u. Target lesion failure during 9-month f/u occurred much more in the BRS group (14.3% (N=4) vs. 3.2% (N=1), p=0.180) but did not reach significance in this small sample size. In detail, there were 2 scaffold thrombosis despite OCT-guided index procedure in the BRS group with subsequent myocardial infarction, and 2 restenosis in the BRS vs. 1 restenosis in the DCB group requiring repeat target lesion revascularization. Due to safety concerns of BRS and the worldwide recall of Absorb BRS the study was prematurely terminated.

Conclusion

Our data add evidence for FFR-guided “DCB only” PCI as an attractive, safe and feasible alternative by showing a favorable longterm course contrary to the late lumen loss of conventional coronary stents. The Absorb BRS is potentially harmful with a high percentage of target lesion failure including scaffold thrombosis despite OCT-guided implantation and should be avoided.