bluuebunny/crossref_metadata_2025 huggingface dataset:
P1839Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study
Authors: Nakashima C A K , Dallan L A O , Lisboa L A F , Hajjar L A , Soeiro A M , Silva B A , Costa M S S , Dornas C J C B , Dalcoquio T F , Furtado R H M , Baracioli L M , Fukushima J T , Gurbel P A , Giugliano R P , Nicolau J C
Published: October 2019

Background

Dual antiplatelet therapy is recommended for patients (pts) with acute coronary syndromes (ACS). However, 10–15% of pts have indication of coronary artery bypass graft (CABG) for the index event and current guidelines recommend stopping clopidogrel at least 5 days prior to CABG. This waiting time could increase hospital length of stay, thus having negative impacts on costs and clinical complications.

Purpose

To evaluate if release to CABG based on platelet aggregability by Multiplate AnalyzerTM would be non-inferior in comparison with common practice (5 days) in terms of 24-hours post-CABG bleeding.

Methods

The PLAT-CABG (NCT 02516267) is a randomized, open label, non-inferiority trial (boundary 25%) testing a strategy of platelet aggregability-guided release to CABG versus standard-of-care on the primary endpoint of chest tube drainage in the first 24 hours post CABG. A total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and with indication for CABG, were assigned to clopidogrel discontinued 5 days prior to CABG (control group) vs. daily measurements of platelet aggregability to ADP using Multiplate AnalyzerTM (intervention group) with CABG occurring after recovering from platelet inhibition (pre-defined as a threshold of 46 AU).

Results

The main results are depicted in the table

Main results of PLAT-CABG study Variables Control Group (n=95) Intervention Group (n=95) P-value for superiority P-value for non-inferiority Chest tube drainage (mL), Median (25th–75th) 350 (250–500) 350 (250–500) 0.680 0.001 Time symptom to CABG (hours), Median (25th–75th) 191 (150–281) 166 (119–225) <0.001 NA Time surgery indication to CABG (hours), Median (25th–75th) 136 (112–161) 112 (66–142) <0.001 NA CABG = coronary artery bypass graft.

Conclusion

Platelet-aggregability guided release to CABG is non-inferior to standard of care in ACS patients awaiting CABG in terms of peri-operative bleeding and significantly shortens the time to CABG.

Acknowledgement/Funding

Roche Diagnostica Brazil
P1858Meta-analysis of performance of risks scores for predicting outcomes after percutaneous Mitraclip implantation
Authors: Wang T K M , Wang M T M
Published: October 2019

Background

The Mitraclip is the most established percutaneous mitral valve intervention indicated for severe mitral regurgitation at high or prohibitive surgical risk. Risk stratification plays a critical role in selecting the appropriate treatment modality in high risk valve disease patients but have been rarely studied in this setting. We compared the performance of risk scores at predicting mortality after Mitraclip in this meta-analysis.

Methods

MEDLINE, Embase and Cochrane databases from 1 January 1980 to 31 December 2018 were searched. Two authors reviewed studies which reported c-statistics of risk models to predict mortality after Mitraclip for inclusion, followed by data extraction and pooled analyses.

Results

Amongst 494 articles searched, 47 full-text articles were evaluated, and 4 studies totalling 879 Mitraclip cases were included for analyses. Operative mortality was reported at 3.3–7.4% in three studies, and 1-year mortality 11.2%-13.5% in two studies. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.66 (0.57–0.75), EuroSCORE II 0.72 (0.60–0.85) and STS Score 0.64 (0.56–0.73). Respective Peto's odds ratios (95% confidence interval) to assess calibration were EuroSCORE 0.21 (0.14–0.31), EuroSCORE II 0.43 (0.24–0.76) and STS Score 0.36 (0.21–0.61). C-statistics (95% confidence interval) for 1-year mortality were EuroSCORE II 0.64 (0.57–0.70) and STS Score (0.58–0.64).

Conclusion

All scores over-estimated operative mortality, and EuroSCORE II had the best moderate discrimination while the other two scores were only modestly prognostic. Development of Mitraclip-specific scores may improve accuracy of risk stratification for this procedure to guide clinical decision-making.
P1861Influence of thermal conductivity on esophageal protection with a cooling device during high-power short-duration radiofrequency ablation
Authors: Kulstad E , Mercado-Montoya M , Shah S
Published: October 2019

Introduction

Recent clinical data show that high-power, short-duration (HPSD) radiofrequency (RF) ablation can result in a similar esophageal injury rate as traditional low-power, long-duration (LPLD) ablation. Existing methods to prevent esophageal injury have yielded mixed results and can result in prolonged procedure time, potentially increasing the incidence of post-operative cognitive dysfunction. A new esophageal cooling device currently available for whole-body temperature modulation is being studied for the prevention of esophageal injury during LPLD RF ablation and cryoablation. We sought to develop a mathematical model of HPSD ablation in order to quantify the capability of this new esophageal cooling device to protect from esophageal injury under high-power conditions.

Methods

Using a model we developed of HPSD RF ablation in the left atrium, we measured the change in esophageal lesion formation and the depth of lesions (measured as percent transmurality) with the esophageal cooling device in place and operating at a temperature from 5°C to 37°C. Tissue parameters, including thermal conductivity, were set to average values obtained from existing literature, and energy settings were evaluated at 50W for between 5 and 10 seconds, and at 90W for a duration of 4 seconds.

Results

Esophageal injury as measured by percent transmurality was considerably higher at 50W and 10s duration than at 90W of power with 4s duration, although both settings showed potential for esophageal injury. The protective effect of the esophageal cooling device was evident for both cases, with a greater effect when using 50W for 10s (Figure 1). At the coldest device settings, using a 5 min pre-cooling period also reduced the transmurality of the intended atrial lesions.

Esophageal protection in HPSD ablation

Conclusions

Esophageal cooling with a new patient temperature management device shows protective effects against thermal injury during RF ablation across a range of tissue thermal conductivity, using a variety of high-power settings, including 90W applied for 4 seconds. Adjusting the cooling power by adjusting the circulating water temperature in the device allows for a tailoring of the protective effects to operating conditions.

Acknowledgement/Funding

Attune Medical
P1863Establishing safe working parameters for radio frequency catheterization along with acoustic sensing
Authors: Refaat M , El Khoury W , Rmeity N , Mahmasani A , Al Aaraj J , Akiki M , Gebran A , Abbas R , Hajjar M , Oweis G
Published: October 2019

Background

Studies comparing angles of application in Radio Frequency (RF) catheter ablation other than 0 and 90 degrees are absent from the literature. Likewise, using acoustics to predict steam pop occurrences and prevent a catastrophic rupture of the myocardium has not been examined previously.

Purpose

Evaluate the effect of various parameters on the ablated volume and the probability of creating a boiling pop.

Methods

A low-cost testing and educational platform to work with generic RF catheters was set up. The in-vitro system allows controlling the blood flow surrogate over the cardiac tissue, the catheter contact force, electric power, and ablation time. Acoustic transducers have been employed with the setup to detect preliminary acoustic signals.

Results

Obtained results show a positive correlation between variations of the ablated surface geometry and power intensity changes. Generated figures provide percentages of a boiling pops for any given set of parameters fig1 (Top left: Probability of popping vs power and time). The probability of a boiling pop occurring increased if the ovine specimen is non-irrigated. The ratio of the burn correlates with the power and the angle of the catheter (30°, 45°, 60°, and 90°). However, the probability of the popping mostly depends on the power fig1 (Top right: Burn ratio vs power for 30°, 45°, 60°, and 90°) and fig1 (Bottom right: Cross sectional view of the corresponding lesions -same scale used for all images). Benign precursory bubbles detected by acoustics preceded the occurrence of catastrophic boiling pops fig1 (Bottom left: Acoustic signal showing a precursory pop before the major cavitation).

Figure 1

Conclusion

The established parameters for power intensity and exposure time should be respected to maintain a safe procedure. Acoustics can be further implemented to provide a warning for electrophysiologists before the occurrence of a boiling pop.

Acknowledgement/Funding

The funding for this project was provided from the URB and the MPP at the AUBMC and the AUB.
P1884Low lipid levels and high variability correlate with the risk of new-onset atrial fibrillation
Authors: Lee H , Lee S R , Choi E K , Han K D , Oh S
Published: October 2019

Background

High levels of lipids and lipid variability are established risk factors for atherosclerotic cardiovascular disease. We investigated their roles in the development of atrial fibrillation (AF). This is the largest cohort study yet on the association between lipid levels and AF, and the first study on the association between lipid variability and AF.

Methods

A nationwide population-based cohort of 3,828,652 adults (mean age 43.9 years) from the Korean National Health Insurance Service database without prevalent AF, not on lipid-lowering medication, and with at least 3 measurements of each lipid parameter at 1–2 year intervals over a 4-year period were included. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured, and lipid variability was calculated using variability independent of mean. The cohort was divided into quartiles by baseline lipid levels and lipid variability, and followed up for incident AF.

Results

During median 3.4 years of follow-up, AF was newly diagnosed in 13,240 (0.35%). AF development was inversely associated with TC and LDL-C levels (for top vs. bottom quartile; TC, hazard ratio [HR] 0.76, 95% confidence interval [95% CI] 0.72–0.80); LDL-C, HR 0.78, 95% CI 0.74–0.82) in both sexes, and with TG levels in men (HR 0.85, 95% CI 0.80–0.90). Meanwhile, AF development was associated with higher LDL-C and HDL-C variability (for top vs. bottom quartile; LDL-C, HR 1.16, 95% CI 1.10–1.22; HDL-C, HR 1.08, 95% CI 1.03–1.14) in both sexes, and with TC variability in men (HR 1.16, 95% CI 1.10–1.22).

Conclusions

Lower cholesterol levels (TC, LDL-C) and higher cholesterol variability (LDL-C, HDL-C) were associated with higher risk for AF. Low TG levels and high TC variability were also associated with AF incidence in men. These findings support the “cholesterol paradox” in AF, and suggest that cholesterol variability is also a risk factor for AF development.
P1886Validation of the MB-LATER score prediction ability for recurrent atrial fibrillation after electrical cardioversion
Authors: Marinkovic M , Mujovic N , Kovacevic V , Mihajlovic M , Vajagic L , Kocijancic A , Olafsson U , Andersen K , Arnar D O , Lip G Y H , Potpara T
Published: October 2019

Introduction

The MB-LATER score (Male, Bundle brunch block, Left atrium ≥47 mm, Type of AF [paroxysmal, persistent or long-standing persistent], and ER-AF=early recurrent AF during first three months) was originally developed for prediction of late AF recurrences post AF catheter ablation (CA-AF). Subsequently, the score has been internationally validated in multiple AF cohorts, showing a good prediction ability for recurrent AF post AF-CA. We assessed prediction ability of the MB-LATER score for recurrent AF after successful electrical cardioversion (ECV) of AF.

Methods

The retrospective study included a Serbian and Icelandic centre, enrolling patients post successful ECV of AF in the period between January 2014 and February 2016. Of 580 patients, 136 (23.4%) were excluded because incomplete data needed for the MB-LATER score calculation. AF episodes lasting ≤7 days before ECV were classified as paroxysmal AF, and the ER-AF component of the MB-LATER score was excluded from the analysis because of different clinical implications in the setting of ECV. The study outcome was defined as the time to first recurrence of AF post successful ECV. Patients post successful ECV were seen at 1 and 6 months post ECV and every 12 months thereafter.

Results

Among 444 patients (median age 68 years [IQR 60.0–74.6], 289 males [65.2%], 200 [45.0%] with non-paroxysmal AF. AF re-occurred in 283 patients (63.7%) after a median of 233.5 [IQR 44–366]) days post successful ECV. Patients with recurrent AF had significantly higher median MB-LATER score than those without (1 [IQR 1–2] vs. 2 [IQR 1–2], p<0.001). On univariate analysis, the MB-LATER score was significantly associated with time to AF recurrence post ECV (Hazard Ratio 1.20; 95% CI 1.07–1.35, p=0.003), showing modest but statistically significant prediction ability for recurrent AF post successful ECV (c-statistic 0.61; 95% CI 0.56–0.66, p<0.001). The Kaplan-Meyer survival free from AF post successful ECV was significantly better for patients with a MB-LATER score of <2 than for those with a score of ≥2 (log-rank p=0.005) (Fig 1.).

Figure 1

Conclusion

In our analysis of an international cohort of AF patients post successful ECV, the MB-LATER score showed a modest but statistically significant prediction ability for recurrent AF post ECV. Reliable prediction of recurrent AF post ECV could inform patient selection and treatment decision-making. Further prospective validation of the MB-LATER score prediction ability for recurrent AF post ECV is underway.
P1894Serum light-chain neurofilament is associated with brain atrophy in patients with atrial fibrillation
Authors: Aeschbacher S , Meyre P , Sinnecker T , Ammann P , Auricchio A S , Kobza R , Shah D , Sticherling C , Ehret G , Kuhne M , Osswald S , Conen D , Bonati L H , Kuhle J , Wurfel J
Published: October 2019

Background and aims

There is emerging evidence that atrial fibrillation (AF) is associated with cognitive dysfunction, increased risk for dementia and reduced brain volume independent of stroke, but the underlying mechanisms of these associations remain unclear. Here, we investigated the association of serum light-chain neurofilament (sNfL), a neuroaxonal injury biomarker, with brain atrophy in AF patients.

Methods

Explorative analysis from the Swiss-AF cohort study, a multicenter prospective observationalstudy which recruited patients aged ≥45 years with documented AF (NCT02105844). In baseline blood samples, sNfL concentrations were measured in duplicates using a single-molecule array assay. Brain MRI was obtained at baseline and at two years using a standardized protocol including a 3D T1-weighted MPRAGE sequence, on which Structural Image Evaluation using Normalization of Atrophy (SIENA) with optimized parameters for brain extraction was applied to calculate the two-year percentage whole brain volume change (PBVC).

Results

We included 245 Swiss-AF patients (median age 73, 73% male). Two-year PBVC was significantly associated with baseline sNfL in linear regression, with a 0.09% whole brain volume decrease per 10 pg/ml sNfL increase (95% CI [0.05–0.13], p<0.001). This association remained significant after adjustment for age, history of stroke and other vascular risk factors.

Neurofilament and brain atrophy

Conclusion

Increasing baseline sNfL was predictive of higher two-year brain atrophy rates independent of stroke history in AF patients. This association might reflect a chronic neurodegenerative process in AF.

Acknowledgement/Funding

Swiss National Science Foundation
P1907Propensity score matched analysis of antazoline mesylate vs. amiodarone or propafenone for pharmacological cardioversion of short-duration atrial fibrillation
Authors: Wybraniec M , Wrobel W , Wilkosz K , Wrona K , Bula K , Kolasa J , Mizia-Stec K
Published: October 2019

Background

Former studies corroborated promising quinidine-like properties of antazoline mesylate facilitating rapid cardioversion atrial fibrillation (AF). Still, paucity of data exists concerning direct comparison of antazoline to other antiarrhythmic agents.

Purpose

The study aimed to verify the hypothesis that intravenous antazoline is non-inferior to amiodarone and/or propafenone in terms of rhythm conversion rate and safety among patients with AF.

Methods

After reviewing 2344 consecutive medical records with I48 code of international classification of diseases (ICD), 505 eligible patients (21.5%) with paroxysmal or persistent AF who underwent emergent pharmacological cardioversion in the real-world setting of emergency department were enrolled in retrospective observational analysis. The choice of antiarrhythmic drug was left to the discretion of attending physician. Antazoline group was separately matched with corresponding amiodarone (n=218) and propafenone (n=90) cohort using propensity score matching (PSM) with nearest neighbor algorithm (ratio 1:1), adjusting for age, sex, arterial hypertension, diabetes, depressed left ventricular ejection fraction, coronary artery disease, history of stroke, AF ablation, CHA2DS2-VASc score, chronic kidney disease and duration of AF episode. The primary endpoint was restoration of sinus rhythm in the emergency department.

Results

The study population (mean age of 67 (59; 74) years; 53.7% females) was characterized by median AF episode duration of 10.5 (5; 24) hours. Antazoline alone was administered in 23.4% of patients (n=118); amiodarone in 47.5% (n=240); propafenone in 9.9% (n=50); while 19.2% (n=97) received ≥2 antiarrhythmic drugs. Before PSM adjustment, antazoline had comparable rhythm conversion rate to propafenone (85.6% vs. 80.0%; P=0.367) and higher than amiodarone treatment (vs. 66.7%, P=0.0002), and greater than combined amiodarone/propafenone group (68.6%; RR 1.25; 95% CI: 1.12–1.39, P=0.0001). After PSM, the use of antazoline was associated with the efficacy similar to propafenone (82.2% vs. 80.0%, RR 1.03; 95% CI: 0.84–1.25, P=0.788) and superior to amiodarone (85.3% vs. 67.0%, RR 1.27, 95% CI: 1.09–1.48, P=0.0019, number needed to treat 5.5; Figure). No major adverse actions were reported in the antazoline group.

Conclusion

Antazoline appears to be an efficacious and safe drug for pharmacological cardioversion of AF in real-life setting, which is at least non-inferior to existing antiarrhythmic drugs.

Acknowledgement/Funding

None
P1917Can cryoballoon ablation produce alterations in cardiac and extra-cardiac autonomic nervous system in patients with atrial fibrillation?
Authors: Sakabe S , Unno K , Mori T , Horiguchi M , Takamura T , Tone K , Izumi D , Maeno K , Seko T , Kasai A
Published: October 2019

Background

Cryoballoon ablation (CBA) during pulmonary vein isolation (PVI) for atrial fibrillation (AF) can cause direct thermal injury to structures adjacent to the left atrium, including the periatrial ganglionated plexi (GP). In contrast, it has not been clarified whether cardiac autonomic nervous system (CANS) modification by CBA could indirectly affect extra-CANS.

Purpose

This study was aimed to investigate the impact of CBA on extra-CANS as well as CANS in AF patients.

Methods

Ninety-three Consecutive patients who underwent initial CBA in our institute were enrolled. Among them, 64 subjects (age 67±9 years; male gender 52%; CHADS2 score 1.2±1.0; diabetes mellitus 16%; β-blocker therapy 23%) had paroxysmal AF (G-P) and 29 (age 66±7 years; male gender 90%; CHADS2 score 1.3±1.0; diabetes mellitus 24%; β-blocker therapy 34%) had sustained AF (G-S). In G-P, resting sinus heart rate (R-HR) and coefficient of variation of the R-R intervals (CVR-R) during sinus rhythm were measured in resting 12-lead electrocardiogram before and after CBA as an index of CANS. Decrease in CVR-R after PVI reflects the vagal nerve injury by the procedure. Pupil movement reflects the autonomic nervous function. In both groups, pupillary light reflex, as an indicator of extra-CANS activity, was measured by infrared videopupillography (Iriscorder® Dual C10641, Hamamatsu Photonics, Hamamatsu, Japan) before and after CBA. Velocity of dilatation (VD) is related to sympathetic function, and velocity of contraction (VC) is associated with the balance between sympathetic and vagal tone. All CBA were treated with second generation 28mm cryoballoons (CB). CB temperature was down to a minimum of −60°C and target application time was 180 seconds.

Results

Complete PVI was achieved in all patients, in which touch-up radiofrequency ablation for the PVI was required in 4 cases of G-S. In G-P, R-HR significantly increased (59.2±9.2bpm to 72.5±8.3bpm, p<0.01) and CVR-R significantly decreased (2.32±1.1% to 1.61±0.61%, p<0.01) after CBA, while VC and VD did not significantly change (3.83±1.03mm2/sec to 3.64±0.96mm2/sec and 1.83±0.62mm2/sec to 1.86±0.84mm2/sec, respectively). In G-S, there were not significant changes between before and after CBA in VC and VD (3.77±0.80mm2/sec to 3.71±0.99mm2/sec and 1.81±0.49mm2/sec to 1.80±0.59mm2/sec, respectively). There were no significant differences between two groups in VC and VD before the procedure.

Conclusion

These results suggest that CBA seems to result in local parasympathetic denervation due to damage of adjacent structures including ganglionated plexi while the alteration of CANS by CBA does not seem to efferently affect extra-CANS.
P1918Comparison of the clinical outcome of pulmonary vein isolation with cryoballoon and radiofrequency ablation for atrial fibrillation with pulmonary vein triggers
Authors: Nitta G , Inaba O , Kato S , Kono T , Ikenouchi T , Murata K , Matsuda J , Kanoh M , Inamura Y , Takamiya T , Negi K , Sato A , Yamato T , Matsumura Y , Nitta J
Published: October 2019

Background

Pulmonary vein isolation (PVI) using radiofrequency (RF) or cryoballoon (CB) has been an established treatment for atrial fibrillation. PVI using RF is the most common method with a rather complex technique of a point-by-point tissue heating and navigation of electro-anatomical-guided mapping system, and PVI with CB is also the common method with a relatively simple technique of freezing balloon occlusion. These 2 types of ablation are comparable in terms of the efficacy of the PVI procedure.

Purpose

The data on the clinical outcome of each AF type with PV triggers has been limited. We compared the outcome of success rate between RF and CB group with respect to each AF type, and further assessed the efficacy of pulmonary vein isolation for AF patients with the origin of only PV.

Methods

A total of 3402 AF patients (age 64±11; 2463 males) underwent initial PVI from May 2009 to July 2018 (PAF: 67%, non-PAF: 37%). Radiofrequency using irrigation-tip catheter was employed to 1796 patients since May 2009 (RF-PAF: 55%, RF-non-PAF: 45%). Second-generation cryoballoon was employed to other 1606 patients since September 2014 (CB-PAF: 81%, CB-non-PAF: 19%). In CB group, PV touch-up ablation with RF was needed for 113 patients (7%) (CB-PAF: 6%, CB-non-PAF: 13%; p<0.001). After PVI, additional ablation for non-PV foci was undergone after the induction by using isoproterenol infusion and rapid atrial pacing (RF-AF: 34%, CB-AF: 32%; p=0.107).

Results

In all PAF patients, AF free survival rate was significantly superior in CB group (2-years Kaplan-Meir event rate, CB 83.2%, RF 75.2%; log-rank p<0.001). The percentage of patients with non-PV foci was almost equivalent in both group (CB 30%, RF 31%, p=0.644). And in PAF patients with only PV-foci, AF free survival rate was significantly superior in CB group (2-years Kaplan-Meir event rate, CB 85.0%, RF 78.8%; log-rank p<0.001). On the other hand, in all non-PAF patients, AF free survival rate was almost equivalent in both non-PAF group (2-years Kaplan-Meir event rate, CB 65.5%, RF-non-PAF 70.0%; log-rank p=0.9). The percentage of patients with non-PV foci was almost equivalent in both group (CB 40%, RF 39%, p=0.731), And in non-PAF patients with only PV-foci, AF free survival rate was almost equivalent in both non-PAF group (2-years Kaplan-Meir event rate, CB 69.7%, RF 73.0%; log-rank p=0.376).

Conclusions

Our study showed better outcome of PVI with CB for PAF patients with PV triggers, and indicated the non-inferiority of PVI with CB for non-PAF patients with PV triggers to PVI with RF.
P1942A trait of inflammation pathogenesis in human atherosclerosis: inflammasome driven interleukin-1 signaling in complex atherosclerotic plaques via hyperlipidemia trained innate immunity
Authors: Jiang X , Wang F , Wang J , Gistera A , Roy J , Berne G P , Hedin U , Lerman A , Hansson G K , Herrmann J , Yan Z
Published: October 2019

A trait of inflammation pathogenesis in human atherosclerosis: inflammasome driven interleukin-1 signalling in complex atherosclerotic plaques via hyperlipidemia trained innate immunity

Objectives

We aimed to investigate interleukin (IL)-1 generation and the regulatory role of inflammasome in human advanced atherosclerosis.

Background

IL-1β is key contributor to the inflammatory process associated with atherosclerosis and its complications. Recent studies suggested that IL-1β blockade reduces the burden of inflammation and recurrence of cardiovascular events. Yet, other cytokines in IL-1 family and the regulation of IL-1 generation in patients with atherosclerosis remains poorly understood.

Methods and results

A focused transcriptomic analysis in human atherosclerotic specimens discovered that human atherosclerotic plaques host a broad reservoir of inflammasome components, characterised by expression of canonical inflammasome gene NLRP6, NLRP12, NLRC4, NLRP3 and non-canonical inflammasome gene caspase 4 significantly elevated in the symptomatic plaques versus the asymptomatic plaques. Upregulation of NLRP3 inflammasome expression in plaque validated by immunohistochemistry staining suggested it as a distinctive characteristic of plaque vulnerability and complexity. Functional studies on atherosclerotic explants obtained from patients undergoing carotid endarterectomy revealed constitutive generation of IL-1β accompanied by secretion of comparable levels of IL-1α from the majority of the plaques, while IL-18 and IL-33 generation from some of the plaques. Stimulation of the plaques with inflammasome activators showed an inducible generation of both IL-1α and IL-1β, not IL-18 or IL-33, mediated by specific canonical and non-canonical inflammasome pathways. Analysis on the medication records of these patients indicated that plaques from patients with suboptimally controlled hyperlipidemia, imaging signs for plaque instability and inadequate statins therapy possessed higher recruitable production of IL-1β, suggesting the conventional atherogenic factor in regulation of inflammasome immunity and disease activity. Mechanistic studies on tissue and cells isolated from atheromatous plaques demonstrate that generation of mature IL-1β is via a mechanism controlled by NLRP3 and the effector caspase-1.

Conclusions

The study supports a profound canonical and non-canonical inflammasomes mediated plaque IL-1α/β generation, via a key mechanism by NLRP3 and caspase-1. The results provide biological insights into the clinical merit of high-intensity cholesterol lowering and anti-IL-1 signalling-directed therapies in high-risk patients with atherosclerosis.

Acknowledgement/Funding

KI-Mayo collaboration project, the Swedish Research Council, the Swedish Heart-Lung Foundation, European Union FP7 projects, the NIH
P1952Value of GRACE risk score in risk stratification in acute coronary syndrome patients undergoing PCI in the Global Leaders study
Authors: Komiyama H , Chichareon P , Hamm C , Juni P , Valgimigli M , Vranckx P , Windecker S , Onuma Y , Stegg G , Serruys P
Published: October 2019

Aims

We sought to evaluate the value of GRACE risk score in stratifying acute coronary syndrome patients undergoing percutaneous coronary intervention in the Global Leaders study.

Methods

Global Leaders study was a prospective, multi-center, open-label, all-comers, randomized controlled trial comparing ticagrelor monotherapy after 1 month of dual antiplatelet therapy (DAPT) as experimental therapy with aspirin monotherapy after 12 months of conventional DAPT (reference therapy) in patients who received PCI with biolimus-A9 eluting stent. We assessed the predictive value of GRACE risk score in ACS patients undergoing PCI in the present analysis. Patients were stratified according to GRACE risk score into low (1–108), moderate (109–140), High (141–372) risk group. Clinical outcomes at 2 years after PCI were assessed and compared among risk groups. Interaction between GRACE risk score and antiplatelet regimen were analyzed by the interaction term in Cox model.

Results

GRACE risk score was calculated from 8 clinical parameters at presentation. Among ACS patients, 1664 patients were categorized in low risk group, 2903 patients were in moderate risk group, and 2028 patients were in high risk group. The rate of all-cause mortality, any stroke, patient-oriented composite endpoint (POCE) were highest in the high-risk group at 2 years (All-cause mortality; low risk 1.4%, moderate risk 2.5%, high risk 6.1%, log rank test p value <0.0001, any stroke; low risk 0.7%, moderate risk 1.0%, high risk 2.0%, log rank test p value 0.001, POCE; low risk 12.4%, moderate risk 11.9%, high risk 16.61%, log rank test p value <0.0001). The rate of myocardial infarction, all revascularization and definite or probable stent thrombosis were not different among three groups. There was no interaction between GRACE risk score and treatment regimen on clinical outcomes at 2 years.

Conclusion

GRACE risk score is valuable in identifying ACS patients with highest risk of all-cause mortality, any stroke and POCE at 2 years after PCI. In ACS, ticagrelor monotherapy did not improve the outcomes at 2 years in the three strata of the GRACE risk score.
P1955The CHADS-VASc score is a predictor of No-Reflow in patients with NSTEMI
Authors: Barman H A , Kahyaoglu S K , Durmaz E D , Atici A A , Okuyan E O , Sahin I S
Published: October 2019

Introduction

No-reflow (NR) is one of the major complications associated with primary percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to elucidate the relationship between the CHA2DS2-VASc score and NR phenomena in patients with NSTEMI.

Methods

A total number of 428 consecutive patients with NSTEMI were assessed for this study. Patients were divided into 2 groups, those with NR, NR(+) (n=84), and those without NR, NR(−) (n=307), according to their post-PCI, no-reflow status. The thrombus burden was classified according to the TIMI thrombus grade (TTG). CHA2DS2-VASc scores were calculated for all patients.

Results

The CHA2DS2-VASc score was significantly higher in the NR(+) group compared to the NR(−) (3.48±1.19 vs 1.81±0.82, p<0.001). After a multivariate regression analysis, a higher CHA2DS2-VASc score (OR: 6.52, 95% CI: 3.51–12.14, p<0.001), hs-Troponin (OR: 1.077, 95% CI: 1.056–1.099, p<0.001) and TTG (OR: 1.563, 95% CI: 1.134–2.154, p=0.006) were independent predictors of NR. In-hospital mortality rates were significantly higher in the NR(+) group compared to the NR(−) (15% vs. 5%, p<0.001).

Table 1. Demographic, clinical, and angiographic characteristic of the patients Variables NR(−) (n=307) NR(+) (n=84) p Age, years, mean ± SD 55.50±8.95 56.67±8.80 0.248 Female gender, n (%) 83 (%27) 25 (%30) 0.536 CHF, n (%) 30 (%10) 17 (%20) 0.019 HT, n (%) 116 (%38) 45 (%54) 0.004 DM, n (%) 67 (%22) 30 (%36) 0.009 Previous stroke/TIA, n (%) 9 (%3) 9 (%11) <0.001 CHA2DS2-VASc score, mean ± SD 1.81±0.82 3.48±1.19 <0.001 LVEF (%), mean ± SD 56.11±9.31 51.15±11.32 <0.001 hs-troponin (pg/ml) (NRI <14pg/ml) 56.59±11.83 114.23±26.42 <0.001 Serum creatinine, mean ± SD, mg/dl 0.89±0.13 0.91±0.22 0.852 Hemoglobin (g/dl) 14.16±1.76 14.10±1.74 0.782 TTG, median 1 (0–3) 3 (1–5) <0.001 TTG(4,5), n (%) 70 (%23) 36 (%42) <0.001 In-hospital mortality, n (%) 16 (%5) 13 (%15) <0.001

Conclusions

In conclusion, CHA2DS2-VASc score is associated with higher risk of no-reflow in patients with NSTEMI undergoing PCI.

Acknowledgement/Funding

None
P1959Impact of hemodialysis in patients undergoing bypass surgery for peripheral arterial disease - 10-year follow-up study
Authors: Kumada Y , Ishii H , Oshima T , Sakakibara T , Ito R , Takahashi H , Murohara T
Published: October 2019

Background

Although lower extremities bypass surgery has been commonly performed as the standard option to treat peripheral artery disease (PAD) even in patients on hemodialysis (HD) as well as general population, poorer prognosis still remains major problems in this specific population. In this 10-year follow-up study, we investigated the impact of HD after surgical revascularization in patients with PAD.

Methods

A total of 660 patients undergoing successfully bypass surgery were enrolled. Patients with acute limb ischemia were excluded. We compared 392 HD patients with 428 limbs and 268 non-HD (NHD) patients with 296 limbs during 10 years follow-up period. Primary endpoint was defined as major adverse cardiovascular events (MACE) including all-cause death, non-fatal myocardial infarction and stroke. Second endpoint was major adverse limb events (MALE) including any revascularization and major amputation. To minimize the differences of clinical characteristics between the two groups, propensity score adjusting with all baseline variables was performed.

Results

Prevalence of diabetes (53.3% vs. 35.2%), critical limb ischemia (77.5% vs. 52.1%) and infra-popliteal artery (48.2% vs. 19.6%) were higher in HD group compared to NHD group (p<0.0001 in all), inversely, age was younger in HD group than in NHD group (67±9 years vs. 71±9 years, p<0.0001). The 30-day mortality rate was comparable (3.1% in HD group vs. 1.5% in NHD group, p=0.19). The 10-year event-free survival rate for MACE was significantly lower in HD group compared to NHD group (45.3% vs. 67.4%, p<0.0001) and for MALE (60.0% vs. 80.0%, p=0.0007), respectively. After propensity score adjustment, the freedom rate from MACE was still lower in HD group compared to NHD group [45.6% vs. 67.6%, hazard ratio (HR) 1.89, 95% confidence interval (CI) 1.33–2.72, p=0.0003], however, the rate from MALE was statistically comparable between the two group (65.7% vs. 76.9%, 1.27, 95% CI 0.87–1.90, p=0.21). Furthermore, although the 10-year limb salvage rate was crudely lower in HD group compared to NHD group (80.6% vs. 91.6%, HR 1.57, 95% CI 1.05–2.40, p=0.0027), it was comparable after propensity score adjustment (89.4% vs. 90.1%, HR 1.09, 95% CI 0.59–1.88, p=0.79). Also, the mortality rate was consistently lower in HD patients (adjusted HR 2.37, 95% CI 1.62–3.50, p<0.0001).

Conclusion

The long-term freedom rate from MACE and mortality was markedly lower in HD patients compared to non-HD patients. However, the rate from MALE, especially limb salvage rate was similar between HD and NHD after adjustment for clinical characteristics. These results suggest that detection at the early stage of PAD may potentially improve the poor outcomes in this high risk population.
P2242Prognostic impact of CT derived quantified coronary artery plaque volume: A 10 year follow-up study
Authors: Deseive S D C , Straub R , Kupke M , Broersen A , Kitslaar P , Hadamitzky M , Massberg S , Hausleiter J
Published: October 2019

Background

Automated plaque quantification derived from coronary CT angiogragphy (CCTA) datasets provides exact and reliable assessment of coronary atherosclerosis burden.

Purpose

To investigate the long-term predictive value of quantified coronary plaque volume (PV) in comparison to Calcium Score (CACS).

Methods

Dedicated software was used to quantify PV in 1577 patients. A combination of cardiac death and acute coronary syndrome was used as endpoint. Incremental prognostic value was tested with c-statistics and continuous net reclassification improvement (NRI). The Morise Score was used to summarize patients clinical risk profile.

Results

Patients were followed for 10.4 years. The combined endpoint occurred in 59 patients, of whom 36 suffered from cardiac death, 18 had non-fatal myocardial infarction and 5 presented with unstable angina requiring revascularisation. The additive predictive value of PV and CACS was tested against a baseline model (c-index 0.741) including clinical risk and the number of diseased coronary segments (segment-Involvement score). While PV provided additive prognostic value (rise in c-index to 0.763, p=0.01 and NRI 0.247, p=0.03), CACS did not (c-index 0.749, p=0.2 and NRI 0.162, p=0.12).

A threshold of 110.5 mm3, which was established by a previous analysis of our group, provided excellent separation of patients into low (no PV), intermediate (PV <110.5 mm3) and high (PV >110.5 mm3) risk categories based upon quantified PV (see attached Figure).

Conclusion

Quantification of PV from CCTA datasets provides excellent prognostic information on long-term follow-up.
P2248Impact of Lipoprotein (a) levels on the presence and severity of coronary artery disease in female patients: a large cross-sectional Chinese cohort study
Authors: Wu N Q , Liu S L , Guo Y L , Zhu C G , Gao Y , Sun J , Xu R X , Liu G , Dong Q , Li J J
Published: October 2019

Background

Lipoprotein (a) [Lp(a)] is recently recognized as a risk factor of atherosclerosis, and the development of coronary artery disease (CAD) in women is not fully understood.

Purpose

The present study aimed to examine the association of Lp(a) levels with the presence and severity of (CAD) in female patients pre- and post-menopause.

Methods

A total of 3712 female patients who received coronary angiography were consecutively enrolled. The level of Lp(a) was measured and compared among patients with and without CAD or myocardial infarction (MI), pre- or post- menopause. The association of Lp(a) with the presence of CAD and the severity of coronary atherosclerosis assessed by Gensini Score were examined.

Results

The average of Lp(a) levels were elevated as age increased in female subjects. Notably, women after menopause had higher Lp(a) levels compared with that before menopause [16.8 mg/dL (IQR 7.54–41.12 mg/dL) vs. 14.7 mg/dL (IQR 6.72–30.82 mg/dL), p=0.002]. Furthermore, multiple logistic regression analysis identified that Lp(a) >30mg/dL was an independent risk factor of CAD in the postmenopausal female (OR1.38, 95% CI 1.13–1.69, p=0.002). Finally, Lp(a) had a positive correlation with Gensini score (r=0.11, p<0.001), and Lp(a) >30mg/dL was an independent risk factor for high Gensini score (OR 1.43, 95% CI 1.14–1.79, p<0.001). While such results were not observed in the premenopausal females.

Baseline characteristics of all patients Before menopause (n=525) Post menopause (n=3187) P value Age, (years) 46 (42–49) 62 (58–68) <0.001* Hypertension, n (%) 231 (44.00) 2097 (65.80) <0.001* Diabetes mellitus, n (%) 68 (12.95) 849 (26.64) <0.001* LDL-C (mmol/L) 2.73±1.05 2.77±0.99 0.366 Lp(a) (mg/dL) 14.7 (6.72–30.82) 16.8 (7.54–41.12) 0.002* Data are expressed as mean ± SD or median (interquartile range) and numbers (percentages). BMI, body mass index; TC, total cholesterol; TG, triglyceride; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; Lp(a), lipoprotein(a); HsCRP, high-sensitivity C-reactive protein. *Statistically significant differences exist between two groups. CAD, coronary artery disease.

Lp(a) in pre- and post-menopausal women

Conclusion

The present study indicated that circulating Lp(a) levels were independently associated with the presence and severity of CAD in the postmenopausal female, suggesting that further study may be needed to examine the role of Lp(a) in the development of CAD in female individuals with different menopausal status.
P2258Pulse wave velocity, total arterial compliance, and cardiac structure and function in late life
Authors: Teramoto K , Cheng S , Claggett B , Solomon S , Heiss G , Tanaka H , Matsushita K , Shah A
Published: October 2019

Background

Coupled abnormalities in arterial and left ventricular (LV) stiffness characterize aging and heart failure with preserved ejection fraction. We hypothesized that two measures of aortic stiffness, pulse wave velocity (PWV; reflecting segmental arterial wall stress in late systole) and total arterial compliance (TAC; reflecting distensibility of entire arterial system) differentially relate to cardiac structure and function in the elderly.

Methods

Among participants in the Atherosclerosis Risk In Community (ARIC) study, we assessed the cross-sectional relationship of carotid-femoral PWV (cfPWV) and TAC with echocardiographic measures of cardiac structure and function using multivariable linear regression adjusting for demographics and co-morbidities. TAC defined as stroke volume over pulse pressure [mL/mmHg]. Exclusions were LVEF <50%, prevalent HF, ≥moderate valvular disease.

Results

Of the 4,141 participants included in this study, mean age was 75±5 years, 41% were male, and 80% were white. Mean values were: cfPWV: 11.7±3.4 m/sec; TAC: 1.1±0.3 mL/mmHg. Greater cfPWV was associated with greater LV mass, worse systolic function, and worse diastolic function (Table). In contrast, worse TAC was not related to LV structure and did not demonstrate consistent relationships with measures of LV diastolic function, but was associated with worse LV longitudinal strain.

Echo measures cfPWV (1SD increase) TAC (1SD decrease) β Coefficient p-value β Coefficient p-value Cardiac structure Mean wall thickness, cm 0.10 <0.001 -0.01 0.499 LVMI, g/m2 0.04 0.016 0.02 0.299 LVEDVI, ml/m2 -0.07 <0.001 -0.02 0.332 LV systolic function LVEF (Simpson's), % -0.04 0.01 -0.16 <0.001 Longitudinal strain, % 0.14 <0.001 0.19 <0.001 LV diastolic function Septal e', cm/sec -0.08 <0.001 -0.02 0.169 E/e' septal 0.04 0.005 -0.02 0.138 LAVI, ml/m2 -0.05 0.003 -0.04 0.026

Conclusion

Two non-invasive measures of aortic stiffness, cfPWV and TAC, demonstrate differential associations with LV structure and function in late life. Greater cfPWV is more robustly associated with LV structure and function than TAC.
P2276Sudden cardiac death in non-ischemic systolic heart failure: do we only need LVEF to decide ICD implantation?
Authors: Mercier T , Hebbar E , Fertin M , Marquie C , Lamblin N , De Groote P
Published: October 2019

Background

Implantable cardioverter defibrillator (ICD) is recommended in patients (pts) with non-ischaemic heart failure with left ventricular systolic dysfunction who receive optimal medical therapy (OMT) in order to prevent sudden cardiac death (SCD). However, the results of the DANISH study have recently shown the limits of these recommendations. It is therefore mandatory to reconsider the risk stratification of SCD in this population.

Purpose

The purpose of our study is to determine independent predictors of severe arrhythmic events (AE in pts with non-ischemic systolic heart failure.

Methods

Between January 1998 and December 2014, all consecutive outpatients with non-ischemic systolic heart failure, receiving OMT and without a history of significant arrhythmic events, were included. We performed to all the pts a clinical and biological evaluation, an echocardiography, a cardiopulmonary exercise test, a radionuclide angiography and a Holter-ECG. Follow-up was performed either by direct examination, by contact with the general practitioner or the cardiologist and by remote monitoring if available. The composite primary endpoint was the occurrence of SCD, recovered cardiac arrest, sustained ventricular tachycardia, or appropriate therapy by the ICD.

Results

We included 910 pts with a mean age of 53±12 years, 244 (27%) were women, LVEF was 36±10%. Most of the pts received renin-angiotensin blockers (97%) and betablockers (84%), 77% received diuretics and 41% spironolactone. During a median follow-up period of 6.33 [3.29–10.18] years, 160 (17.6%) pts presented the composite primary endpoint. The median time between the assessment and the occurrence of AE was 4.05 [1.68–7.85] years. The most powerful independent predictor of AE was non-sustained ventricular tachycardia (≥3 ectopic beats) (HR: 2.8 [1.66–4.72], p<0.0001). The other independent factors of AE were left atrial diameter (HR: 1.03 [1.01–1.06], p<0.0001); gender (HR: 0.71 [0.55–0.92], p=0.010); digoxin intake (HR: 1.63 [1.10–2.44], p=0.016); QRS duration (HR: 1.01 [1.00–1.01], p=0.022), sinus rhythm (HR: 0.70 [0.56–0.87], p=0.001). LVEF, as a quantitative parameter, was not an independent predictor of AE. However, LVEF dichotomized with a value of 35% was a modest predictor of AE (HR =1.38 [1.12–1.70], p=0.002). Neither the NYHA classification nor the parameters of the cardiopulmonary exercise test were independent factors of AE occurrence.

Conclusion

LVEF is not the most powerful predictor of severe arrhythmic events in outpatients with non-ischemic systolic heart failure receiving optimal medical therapy. New risk scores are required. We found that in addition to LVEF, gender, QRS duration, sinus rhythm, left atrial diameter and more particularly non-sustained ventricular tachycardia were independent predictors of AE. This score needs to be validated in an independent population.

Acknowledgement/Funding

None