bluuebunny/crossref_metadata_2025 huggingface dataset:
Copeptin, albumin and routine inflammatory markers are predictors of one-year mortality in patients with advanced heart failure underwent cardiac transplantation evaluation
Authors: Szygula Jurkiewicz B , Szczurek W , Skrzypek M , Romuk E , Gasior M
Published: November 2020

Introduction

Despite significant advances in the prevention and treatment of heart failure (HF), the prognosis for patients with advanced stage of the disease is still poor. Therefore, a better understanding of the underlying HF pathophysiological mechanisms is crucial to improve prognosis in patients with advanced HF. One important research area is the role of inflammation in the pathophysiology of HF.

Purpose

This study aimed to investigate factors associated with mortality in HF patients with particular emphasis placed on inflammatory markers.

Methods

This is a prospective analysis of 282 optimally treated HF patients hospitalised in Cardiology Department between 2016 and 2018 for heart transplantation (HT) evaluation. Patients with contraindications to HT were excluded from the study. At the baseline echocardiography, routine laboratory tests, an ergospirometric exercise test, and right heart catheterisation were performed in all patients. In addition, 10 ml of peripheral blood was collected to determine inflammatory biomarkers. Human procalcitonin and copeptin concentrations were measured by the sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit. A highly sensitive latex-based immunoassay was used to detect plasma C-reactive protein (CRP) using the COBAS Integra 70 analyzer. The end-point of the study was all-cause mortality during one-year follow-up. The study protocol was approved by the Local Ethics Committee of our medical university. All patients provided informed, voluntary consent to participate in the study.

Results

The median age of patients was 57 (51–60) and 87.6% of them were male. A total of 79 (28%) patients died during a one-year follow-up. Multivariate analysis of the Cox proportional hazard model confirmed that procalcitonin [hazard ratio (HR) 1.003 (1.002–1.003), p<0.001], high sensitivity C-reactive protein (CRP) [HR 1.109 (1.039–1.183), p<0.002], copeptin [HR 1.109 (1.019–1.207), p<0.02] and albumin [HR 0.925 (0.873–0.979), p<0.01] serum concentrations, as well as Erythrocyte Sedimentation Rate (ESR) [HR 1.031 (1.001–1.063) p<0.05] were associated with mortality during a one-year follow-up.

Conclusions

Our study demonstrated that higher procalcitonin, CRP and copeptin serum concentrations as well as higher ESR and lower albumin serum concentrations are independently associated with reduced survival in patients with advanced HF.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia
Donation after circulatory death hearts recipients compared to donation after brain death heart recipients have comparable systolic left ventricular function and better myocardial strain at 1 year
Authors: Ciarka A , Page A , Messer S , Pavlushkov E , Tsui S , Parameshwar J , Williams L , Aggraval B , Large S
Published: November 2020

Purpose

Cardiac transplantation from donation after circulatory death (DCD) has been implemented at our hospital since February 2015. Despite encouraging results some concerns may be raised about the impact of the warm ischemia and reperfusion injury on the myocardium status at longer follow-up. Therefore, we aimed to analyse systolic performance of the left ventricle at 1 year follow in DCD and donation after brain death (DBD) cardiac recipients, as assessed by echocardiography with myocardial deformation imaging.

Methods

We identified 46 consecutive DCD cardiac recipients who were transplanted from February 2015 to August 2018 and we matched them with 46 DBD cardiac recipients. Six and 7 patients from DCD and DBD group, respectively, died in the first-year post transplant. In the remaining patients we have compared the classical echocardiographic measurements as well as global longitudinal strain (GLS) and global circumferential strain (GCS) at 1-year follow-up.

Results

DCD and DBD patients did not present with differences in terms of classical echocardiographic parameters of left ventricular (LV) structure and systolic function at one-year follow-up. LVEDV was similar in DCD and DBD patients (101±24 vs. 95±32 ml, p=0.4 respectively), as well as LVESV (42±13 vs. 42±16 ml, p=0.9, respectively), LV ejection fraction (58±6 vs. 56±8%, p=0.22) and LV mass (156±39 vs. 163±38 gr, p=0.2, respectively). In contrast, myocardial deformation parameters, such as GLS and GCS, were better in DCD than in DBD (16.1 vs. −14.5%, p<0.01; and −25.2 vs. 22.3%, p<0.05, respectively). The diastolic LV function parameters were similar in DCD and DBD group, as evidenced by E wave velocity, A wave velocity and deceleration time of mitral inflow, however E over E prime was lower in DCD than in DBD recipients (7.7±8.7, p<0.05). Fractional area change of the right ventricle was higher in DCD in comparison with DBD (46±7 vs. 40±7%, p<0.01) while right atrial volume index was lower in DCD than in DBD (25±8 vs. 29±9 ml/m2, p<0.01). Other parameters of RV function (systolic excursion of the tricuspid annulus, TAPSE) were similar in both groups.

Conclusion

DCD and DBD heart recipients present with similar systolic LV function at 1-year follow, as assessed by classical echocardiographic parameters. DCD cardiac recipients have better myocardial deformation parameters as assessed by the speckle tracking, better systolic right ventricular function and lower filling pressures of the left ventricle.

Funding Acknowledgement

Type of funding source: None
Early ECMO overcomes primary graft dysfunction after heart transplant
Authors: Gkouziouta A , Miliopoulos D , Miliopoulos D , Dimopoulos S , Dimopoulos S , Karabinis A , Bonios M , Stavridis S , Karabinis A , Stavridis S , Adamopoulos S , Kogerakis N , Adamopoulos S , Kogerakis N
Published: November 2020

Introduction

Primary graft dysfunction (PGD) is the main cause of early mortality after heart transplantation. Despite affecting approximately 7–8% of all recipients, the etiology and optimal treatment of this condition remains unknown. Extracorporeal membrane oxygenation (ECMO) is a key treatment modality, however optimal timing of initiation has not been established.

Methods

A single-institution retrospective study was conducted. Between January 2003 and October 2019 a total of 13 recipients experienced PGD treated with ECMO. At the beginning of 2016, our institution adopted an early ECMO policy, with PGD patients placed on ECMO prior to leaving the OR at the time of transplant. Patients were stratified into pre-2016 (n=5) and post-2016 (n=8) cohorts. Outcomes including duration of support, ICU and total hospital stay, Ejection Fraction (EF), need for vasoactive or inotropic medication, in-hospital survival, 1-year survival, and complications were analyzed.

Results

Among the pre-2016 and post-2016 cohorts there was no difference in duration of ECMO, ICU stay, and total hospital stay. The average time from release of cross-clamp to initiation of ECMO was 8.04 vs 3.05 hrs in each cohort, respectively (p=0.02). In all patients, ECMO resulted in a reduction in the need for vasopressors and inotropes as assessed by the vasoactive inotrope score. LVEF normalized within the first 5 days of therapy for all patients and was sustained after decannulation. Complication rates among cohorts were similar with respect to bleeding, stroke, infection, and need for permanent dialysis. When compared to the post-2016 cohort, the pre-2016 cohort demonstrated significantly worse in-hospital (75% vs 100%, p=0.04) and 1-year (69% vs 100%, p=0.02) survival.

Conclusions

Early initiation of ECMO results in decreased mortality for PGD after heart transplant without an increased risk of complications.

Funding Acknowledgement

Type of funding source: None
Age-related difference of longitudinal associations of early/late cardiac systolic load with decline of preserved cardiac systolic function in Japanese men
Authors: Kumai K , Hirofumi H.T , Chikamori T.C , Yamashina A.Y
Published: November 2020

This prospective observational study was conducted to examine the longitudinal associations of early/late cardiac systolic load (ESL/LSL) with decline of preserved cardiac systolic function, and also to examine the age-related differences in their associations. In 3679 middle-aged Japanese healthy men (43±9 years), brachial-ankle pulse wave velocity (baPWV) which related to ESL, radial augmentation index (rAI) which related to LSL and pre-ejection period/ejection time (PEP/ET) were measured annually during a 9-year study period. In subjects aged <50 years old (n=2586), baPWV, rAI and PEP/ET were annually increased. The PEP/ET at both the start and end of study period were significantly increased from low to high tertile ranges of baPWV and also of rAI at the start of study period (Figure). In subjects aged >50 years old (n=1093), baPWV and PEP/ET, but not rAI, were annually increased. Then, the PEP/ET at both the start and end of study period were increased among the tertile ranges of baPWV but not in those of rAI (Figure). In the mixed model linear regression analysis, while the baPWV (estimate = 7.2x10–5, p<0.01) and rAI (estimate = 60.0x10–5, p<0.01) were longitudinally associated with the PEP/ET in subjects under 50 years of age, only baPWV had a significant longitudinal association with PEP/ET (estimate = 8.4x10–5, p<0.01) in subjects aged >50 years old. Thus, in Japanese healthy men, age-related differences in the progression of vascular functional abnormalities may result in a difference in their effect on the decline of preserved cardiac systolic function. Namely, while age-related increase in ESL related with arterial stiffness may decrease preserved cardiac systolic function in subjects of all ages, age-related increase in LSL related with pressure wave reflection may decrease this parameter only in subjects under 50 years of age.

Figure 1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Omron Health Care, Asahi Calpis Wellness
Trends in outcome and patient composition in dilated cardiomyopathy in Sweden over time
Authors: Sjoland H , Silverdal J , Bollano E , Pivodic A , Fu M
Published: November 2020

Background

We studied prognosis and patient composition over time in dilated cardiomyopathy (DCM): a well-defined category of heart failure (HF), often affecting younger individuals. We expected improved prognosis over time, due to emerging diagnostic and therapeutic options.

Methods

All patients from the Swedish Heart Failure Registry (SwedeHF) fulfilling criteria for DCM (exclusion of ischemic, valvular, or alcoholic etiology and affirmed by clinical judgment in the protocol) (n=3739), were analyzed with respect to three time periods of inclusion in the registry, 2003–2007 (n=814), 2008–2011 (n=1448), 2012–2016 (n=1477), regarding mortality, transplantations, and hospital admissions during one year after inclusion.

Results

Over the three time periods, registered cohorts were older with time (mean 59.3 years/ 60 years/ 61.0 years, p=0.0035), and the proportion of females incresased (24.1% / 27.2% / 30.7%, p=0.0006).

For clinical variables, the distribution of left ventricular ejection fraction (LVEF) with time showed significantly higher LVEF (p=0.0024), and functional classification (NYHA) showed lower class (p=0.0011). Hypertension as a comorbidity (i.e. not judged to be responsible for HF) was more frequently occurring with time: (34.0%/ 40.6%/ 44.1%, p<0.0001). As for HF treatment: use of device increased (p<0.0001 for categorical combinations), mineralocorticoid receptor antagonists (MRA) increased (41.9%/ 37.3%/ 46.7%, p=0.0023), and diuretics dropped (76.1%/ 71.1%/ 67.0%, p≤0.0001) in the different cohorts with time.

Mortality (6.9%, 5.1%, 5.5%), transplantation (0.5%, 0.8%, 0.6%) and hospital admissions for HF (28.4%, 26.3%, 24.6%) were stable over time (ns for all), whereas cardiovascular (CV) (33.8%, 33.8%, 29.7%, p=0.043) and all cause admissions (39.1%, 38.8%, 33.7%, p=0.0099) decreased. After adjustment for age, sex, LVEF, NYHA, hypertension and device treatment only all cause admissions remained significantly decreased.

Conclusion

In this nationwide study between 2003–2016, one-year outcome in DCM in Sweden remained stationary over time, despite advances in HF therapy. During the time period, we observed a continuous change in the clinical profile in the DCM population.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Region Västra Götaland agreement concerning research and education of physicians.
The nationwide registry of hospitalized heart failure patients in Japan: Japanese Registry Of Acute Decompensated Heart Failure (JROADHF)
Authors: Ide T , Kaku H , Matsushima S , Tohyama T.I , Enzan N , Funakoshi K , Sumita Y , Nakai M , Nishimura K , Fukuda H , Hatano M , Komuro I , Tsutsui H
Published: November 2020

Background and aim

Heart failure (HF) is a growing healthcare problem worldwide. This study aimed to describe clinical characteristics and long-term outcomes of HF patients in Japan.

Methods and results

JROADHF (the Japanese Registry Of Acute Decompensated Heart Failure) is a retrospective, multicentre, nationwide observational database of 13,238 patients hospitalized due to HF in 128 hospitals randomly selected from Japanese Circulation Society (JCS)-certified teaching hospitals during 2013. At inclusion, demographic and clinical data were collected from medical records with linkage to a nationwide claim-based database, the Japanese Diagnosis Procedure Combination (DPC). Patients were followed up to 5 years after discharge at each participating site. Patients were old as the median age of 81 years and women were older (74.8±12.8 vs 81.6±11.1 y.o). Mean left ventricular ejection fraction (LVEF) was 47%, and 45% were HF with preserved ejection fraction of >50% (HFpEF). Causes of HF included ischemic in 27%, valvular in 19%, arrhythmia in 17%, and hypertensive in 16%. Median length of hospital stay was 18 days and in-hospital mortality was 7.7%. All-cause mortality during 1 and 4 years were 22.3% and 48.4%, respectively. Hospitalization rates due to HF within 1 and 4 years were as high as 30.5 and 48.4%, respectively.

Conclusions

Contemporary nationwide registry revealed that hospitalized HF patients were elder and had more HFpEF, and their prognosis was still poor compared to the data shown in prior registries.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development (AMED) Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus
Usefulness of the society for cardiovascular angiography and intervention classification for predicting in-hospital mortality in patients with acute decompensated heart failure
Authors: Burgos L , Talavera L , Baro Vila R , Acosta A , Cabral M , Buscio M , Diez M
Published: November 2020

Introduction

Recently a multidisciplinary group of the Society for Cardiovascular Angiography and Interventions (SCAI) derived a new classification schema for cardiogenic shock (CS), simple, clinically based and suitable for rapid assessment at the bedside but also arbitrary. Validation in different clinical datasets, specifically in patients with acute decompensated heart failure (ADHF), is necessary to establish the utility of this proposed classification schema.

Purpose

We aimed to evaluate the ability of a new SCAI CS staging classification to predict in-hospital mortality in patients with ADHF.

Methods

We conducted a single-center cohort study, performing a retrospective analysis of prospectively collected data of consecutive patients admitted with ADHF as a primary diagnosis between January 2015 and January 2019. We excluded patients who were hospitalized for an acute coronary syndrome. Patients were assigned to the modified SCAI Classification for CS: Stage A is “at risk” for CS, stage B is “beginning” shock, stage C is “classic”, stage D is “deteriorating”, and E is “extremis”, and in-hospital mortality was evaluated for each group. All-cause mortality was compared across SCAI stages using Kaplan-Meier analysis and log-rank test. Cox proportional hazards models were used to determine the association between SCAI stages and in-hospital mortality after adjusting for age, gender, left ventricular ejection fraction, use of vasoactive medication, mechanical circulatory assist devices, mechanical ventilation, percutaneous coronary intervention and cardiac surgery.

Results

Among 668 patients with a mean age of 74.9±12 years, 63.9% were male. In-hospital mortality was 11.2%. According to SCAI classification, the proportion of patients in stages A through E was 51.7%, 26.7%, 14.4%, 4.6% and 2.5%. The unadjusted mortality in each stages was: A 0.6%, B 4.5%, C 32.3%, D 61.3%, and E 88.2% (Log Rank P<0.0001). After multivariable adjustment, each SCAI shock stage remained associated with increased in-hospital mortality (all P<0.001 compared to stage A). Compared with SCAI shock stage A, adjusted hazard ratio (HR) values in SCAI shock stages B through E were 5.2, 31, 107, and 185, respectively (Figure).

Conclusion

In this large clinical cohort of patients with ADHF exclusively, the new SCAI CS staging classification was associated with in-hospital mortality. This finding supports the rationale of the classification in this setting, further prospective trials are needed to validate these findings.

Adjusted in-hospital Mortality as a Func

Funding Acknowledgement

Type of funding source: None
Pre-test probability of obstructive coronary artery disease in the new guidelines: too much, too little or just enough?
Authors: Lopes P , Albuquerque F , Freitas P , Rocha B , Cunha G , Mendes G , Abecasis J , Santos A , Saraiva C , Mendes M , Ferreira A
Published: November 2020

Background

Previous 2013 ESC guidelines recommended the use of the Modified Diamond-Forrester method to assess the pre-test probability (PTP) of obstructive coronary artery disease (CAD). The 2019 ESC Chronic Coronary Syndrome guidelines updated this recommendation with a major downgrade in PTP. The aim of this study was to compare the performance of these two methods in patients with stable chest pain undergoing coronary computed tomography angiography (CCTA) for suspected CAD.

Methods

We performed a retrospective analysis on prospectively collected data from a cohort of consecutive patients undergoing CCTA for suspected CAD from October 2016 to 2019. Key exclusion criteria were age <30 years-old, known CAD, suspected acute coronary syndrome or symptoms other than chest pain. Obstructive CAD was defined as any luminal stenosis ≥50% on CCTA. Whenever invasive coronary angiography (ICA) was subsequently performed, patients were reclassified if luminal stenosis was <50%. The two PTP prediction models were assessed for calibration and discrimination.

Results

A total of 320 patients (median age 63 years [IQR 53–70], 59% women) were included. Chest pain characteristics were: 48% atypical angina, 38% non-anginal chest pain, 14% typical angina. The observed prevalence of obstructive CAD was 16.3% (n=52). Patients with obstructive CAD were more often male, were significantly older and had a higher prevalence of typical angina and cardiovascular risk factors (except for family history of CAD). On average, individual PTP was 22.1% lower in the new guidelines. The 2013 prediction model significantly overestimated the likelihood of obstructive CAD (mean PTP 37.3% vs 16.3%; relative overestimation of 130%, p-value for miscalibration 0.005). The updated 2019 method showed good calibration for predicting the likelihood of obstructive CAD (mean PTP 15.2% vs 16.3%; relative underestimation of 6.5%, p-value for miscalibration 0.712). The two approaches showed similar discriminative power, with a C-statistics of 0.730 and 0.735 for the 2013 and 2019 methods, respectively (p-value for comparison 0.933). Stratification by gender produced similar results.

Conclusions

In patients with stable chest pain undergoing CCTA, the updated 2019 prediction model allows for a more precise estimation of pre-test probabilities of obstructive CAD than the previous model. Adoption of this new score may improve disease prediction and change the downstream diagnostic pathway in a significant proportion of cases.

Graph 1

Funding Acknowledgement

Type of funding source: None
Use of coronary physiology in chronic coronary syndromes in Germany from 2007–2017
Authors: Von Zur Muhlen C , Kaier K , Heidt T , Staudacher D , Zehender M , Bode C.H , Stachon P
Published: November 2020

Objectives

Coronary physiology is increasingly used in evaluating coronary stenosis, but the penetrance of FFR (Fractional Flow Reserve) or resting indices (e.g. iwFR or RFR) in daily clinical routine is not known.

Methods

The number of coronary angiographies and use of coronary physiology (CP) in patients with chronic coronary syndromes (CCS) in Germany was identified by ICD and OPS codes.

Results

From 2007 to 2017, there was a constant increase in CP usage, with an application rate of 9.19% in 2017. Patients with use of CP were younger (68.8 vs. 70.8 years), had less often severe co-morbidities (peripheral or carotid disease, chronic obstructive pulmonary disease, pulmonary hypertension, renal disease, atrial fibrillation, diabetes), had milder symptoms (10.4 vs. 14.4% in NYHA class III or IV), and a lower EuroSCORE (6.1 vs. 8.3%). Less coronary stents were implanted in patients with use of CP (0.6 vs. 0.8, 95% CI: −0.14–0.26; p<0.001), even after risk adjustment for co-morbidities. Concerning in-hospital outcomes, acute kidney injury occurred less in CP (1.8 vs 3.7%) with subsequent shorter hospital stays (4.3 vs. 5.9 days). Also in-hospital morbidity was lower in CP (0.28 vs. 1.5%), even after risk adjustment (OR 0.28, p<0.001, 95% CI: 0.23–0.36).

Conclusions

In 2017, coronary physiology was used in 9.19% of patients with CCS in Germany. CP resulted in better in-hospital outcomes and less stent implantations. The reasons for a reduced use of CP in patients with significant co-morbidities, and their impact on clinical outcomes require further attention and evaluation in the future.

Funding Acknowledgement

Type of funding source: None
A contemporary definition of periprocedural myocardial injury after percutaneous coronary intervention of chronic total occlusions
Authors: Winter M.P , Goliasch G , Ayoub M , Bartko P , Mashayekhi K , Ferenc M , Buettner H , Hengstenberg C , Neumann F.J , Toma A
Published: November 2020

Background

Coronary chronic total occlusion (CTO) recanalization represents the most technically challenging percutaneous coronary interventions (PCI). The complexity harbours a significant increased risk risk for complications with CTO PCI as compared to non-CTO PCI. However there are evidenced biomarker cut-off levels that help to identify those patients at risk for an unfavorable clinical outcome.

Objective

This study aimed to assess the prognostic impact of postprocedural troponin T increase and mortality in patients undergoing CTO-PCI in order to define the threshold, where procedural related myocardial injury drives mortality.

Methods

We enrolled a total of 3712 consecutive patients undergoing PCI for at least one CTO lesion and performed comprehensive troponin Tmeasurements 6, 8, and 24 hours after the procedure. All-cause mortality was defined as the primary study endpoint.

Results

Using spline curve analysis, we observed that a more than 18-fold increase of troponin above the upper reference limit (URL) is significantly associated with mortality. In the Cox regression analysis we observed a crude hazard ratio (HR) of 2.32 (95% CI 1.83–2.93, P<0.001) for a ≥18fold increase compared to patients with post-procedural troponin increase <18-fold of the URL.Results remained virtually unchanged after bootstrap- or clinical confounder-based adjustment.

Conclusion

This large-scale outcome study demonstrates for the first time the prognostic value of post-procedural troponin T elevation after PCI in CTO patients. We could define a threshold for procedure related myocardial injury in CTO patients that differ non- CTO patients and may help guide the postprocedural clinical care in this high risk patient population.

Figure 1

Funding Acknowledgement

Type of funding source: None
Coronary lesion complexity in patients with familial hypercholesterolemia hospitalized for an acute myocardial infarction: data from the French RICO Survey
Authors: Yao H , Farnier M , Salignon-Vernay C , Chague F , Brunel P , Maza M , Brunet D , Bichat F , Beer J.C , Cottin Y , Zeller M
Published: November 2020

Background

Although patients with familial heterozygous hypercholesterolemia (FH) are at high risk of early myocardial infarction (MI), coronary artery disease (CAD) burden of FH patients with acute MI remains to be investigated.

Methods

All consecutive patients hospitalized for an acute MI in a multicenter database (RICO) from 2012–2017 who underwent coronary angiography were considered. FH (n=86) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥6). The angiographic features of FH patients were compared with patients without FH (score 0–2) (n=166), after matching for age, sex and diabetes (1:2).

Results

When compared with patients without FH, patients with FH had higher prevalence of personal and familial history of CAD (17 vs 5%, and 74 vs 5%, p=0.002 and p<0.001, respectively), and hypertension (54 vs 36%, p=0.006). Chronic statin treatment was used in only 45% of FH patients. At coronary angiography, FH had increased extent of CAD (SYNTAX score 11 (4–21) vs 8 (3–16), p=0.049) and multivessel disease (58% vs 43%, p=0.021). Significant stenosis was more frequent in left and right marginal coronary arteries. FH patients showed a trend toward more complex lesions, with less thrombus (28 vs 39%, p=0.076), but a 2 times higher rate of bifurcation lesions and calcifications (23 vs 12% and 20 vs 10%, p=0.021 and p=0.036).

Conclusions

This study addressing the coronary lesions features of FH patients with acute MI shows that FH patients had more severe CAD burden, and were characterized by complex anatomy features.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): ARS Bourgogne Franche Comté, CHU Dijon Bourgogne
Cholesterol uptake capacity: a new measure of HDL functionality as a predictor of subsequent revascularization in patients undergoing percutaneous coronary intervention
Authors: Fujimoto D , Otake H , Kawamori H , Toba T , Nagao M , Sugizaki Y , Nagasawa A , Takeshige R , Harada A , Murakami K , Iino T , Irino Y , Toh R , Hirata K
Published: November 2020

Background

Recent studies have demonstrated the importance of high-density lipoprotein (HDL) functionality in the development of de novo coronary artery disease by using the cholesterol-efflux capacity, a measure of the ability of HDL to promote cholesterol removal from lipid-laden macrophages. Recently, we developed a rapid cell-free assay system to directly evaluate the capacity of HDL to accept additional cholesterol; the measurement of the cholesterol-uptake capacity (CUC) enables HDL functionality to be readily evaluated in our daily practice. However, prognostic implication of CUC measurement at the timing of percutaneous coronary intervention (PCI) remains unclear.

Purpose

We aimed to evaluate the association between baseline CUC and revascularization during follow-up in the patients who underwent PCI.

Methods

We retrospectively reviewed the patients who underwent PCI with follow-up coronary angiography (CAG) or ischemic-driven revascularization. The patients who had the frozen blood samples of which CUC were measurable at the index PCI and follow-up CAG or revascularization were enrolled. We excluded the patients under hemodialysis.

Results

Among a total of 703 consecutive patients who underwent PCI between Dec 2014 and Mar 2019, we finally enrolled 74 patients who underwent ischemic-driven revascularization (revascularization group) and 183 patients who underwent follow-up CAG without revascularization (non-revascularization group).There were no significant difference in baseline traditional cardiovascular risk factors between the groups. However, the presence of diabetes was significantly more frequent in the revascularization group (63.5% vs 41.0%; P=0.001) than in the non-revascularization group. CUC at the index PCI was significantly lower in the revascularization group than in the non-revascularization group (87.0±19.5 vs 93.9±19.2; P=0.004). Multivariate logistic regression analysis revealed that impaired HDL functionality assessed by decreased CUC level at the index PCI (odds ratio; 0.984, 95% confidence interval; 0.969–1.000) was independently associated with subsequent revascularization after PCI. Indeed, there was a graded inverse association between increasing tertiles of CUC levels and the incidence of revascularization during a median follow-up of 881 days (Figure). Especially in the subgroup analysis of non-diabetic patients, decreased CUC level at the index PCI was independently associated with subsequent revascularization (odds ratio; 0.947, 95% confidence interval; 0.915–0.981), while not in diabetic population.

Conclusion

Serum CUC level at the index procedure was associated with subsequent revascularization especially in non-diabetic patients who underwent PCI.

Funding Acknowledgement

Type of funding source: None
Complement component-7 is a long-term predictor of all-cause mortality in chest-pain patients with suspected acute coronary syndrome
Authors: Aarsetoey R , Ueland T , Aukrust P , Michelsen A.E , Ponitz V , Brugger-Andersen T , Leon De La Fuente R , Staines H , Nilsen D.W.T
Published: November 2020

Introduction

The complement cascade is an important component of the innate immune system. Complement activation plays a major role in chronic inflammation and has been associated with atherosclerosis, atherosclerotic plaque destabilization and increased risk of cardiovascular events. Complement component 7 (C7) binds C5bC6 complex being part of the terminal complement complex (TCC/C5b-9).

Purpose

To investigate the prognostic utility of complement C7 for long-term outcome in patients with suspected acute coronary syndrome (ACS).

Methods

Complement C7 plasma-levels were measured by enzyme immunoassay in admission samples from 1823 patients included in a transatlantic prospective cohort study, which consecutively included hospital admitted chest-pain patients with clinically suspected ACS from South-Western Norway and Northern Argentina. Data were pooled for analysis. Univariable- and multivariable Cox proportional-hazards models were fitted for the analysis of all-cause mortality, cardiac death and sudden cardiac death (SCD) within 24 months, applying both quartiles (Q1–4) and loge-transformed continuous values of complement C7.

Results

There were 253 (13.9%) deaths, of which 150 (8.2%) were categorized as cardiac death and 76 (4.2%) as SCD. Complement C7 levels were significantly higher in patients who died as compared to long-term survivors [176.9 (142.1–228.7) μg/mL versus 139.8 (110.6–179.7) μg/mL (median, 25 and 75% percentile), p<0.001], and were significantly associated with 24-month survival [log rank p<0.001 for all-cause mortality and cardiac death, log rank p=0.035 for SCD]. In univariable analysis, patients with complement C7-concentrations in the highest quartiles had significantly increased risk of all-cause mortality (Figure 1), cardiac death [Q4: Hazard Ratio (HR) 4.58 (95% confidence interval (CI): 2.65–7.92), p<0.001, Q3: HR 2.69 (95% CI: 1.51–4.80), p=0.001] and SCD [Q4: HR 2.83 (95% CI: 1.36–5.90), p=0.005, Q3: HR 2.33 (95% CI: 1.10–4.92), p=0.027] compared to patients in the lowest quartile (Q1). After adjusting for conventional clinical risk factors for coronary heart disease, complement C7-concentrations in Q4 [HR 2.09 (95% CI: 1.23–3.57), p=0.007] and Q3 [HR 2.21 (95% CI: 1.29–3.81), p=0.004] remained significantly associated with all-cause mortality, reproduced using loge-transformed continuous values.

Conclusion

High levels of complement C7 were found to independently predict long-term all-cause mortality in chest-pain patients with clinically suspected ACS.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Western Norway Regional Health Authority
Low serum calcium levels on admission independently predict mortality in patients with acute myocardial infarction
Authors: Su W , Zhu J.G , Wang M , Zhao X.Q , Li W.P , Chen H , Li H.W
Published: November 2020

Background

Serum calcium levels were reported to be associated with risk of cardiovascular diseases. The aim of this study was to analyze the association between serum calcium levels and all-cause mortality in patients with acute myocardial infarction (AMI).

Methods

A total of consecutive 3886 AMI patients with serum calcium data available were included in this analysis. The baseline characteristics, including clinical and laboratory parameters were collected. Patients were classified into 4 equally-sized groups based on serum calcium values (≤2.15, 2.16–2.23, 2.24–2.31, ≥2.32 mmol/L). Serum calcium tests were finished within 12 hours after admission. Patients were followed up for a median of 2.0 years (interquartile range 0.6–4.0). The primary endpoint was all-cause mortality.

Results

Compared to upper quartiles of serum calcium groups, subjects in the lowest quartile group (≤2.15 mmol/L) were older, lower body mass index (BMI), had lower levels of LDL-C and albumin, but higher level of NTproBNP. During a median follow-up period of 2.0 years, all-cause death occurred significantly more in the lowest quartile group (19.8%, 11.9%, 8.0% and 9.2% among the 4 groups from lowest to highest quartile, p<0.001 for trend). After adjusting for potentially confounding variables, the Cox analysis revealed that low serum calcium levels independently predict subsequent all-cause mortality (OR=0.36, 95% CI: 0.18–0.73), and identified that older age, lower BMI, smoking, and higher levels of creatinine were also independently associated with increased risk of mortality.

Conclusion

Low serum calcium levels on admission independently predict mortality in patients with AMI. Further studies are required to determine whether calcium supplementation could improve outcomes in AMI patients with hypocalcemia.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Beijing Natural Science Foundation (no. 7194253);Scientific Research Common Program of Beijing Municipal Commission of Education (KM201910025017)
Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry
Authors: Xu S.L , Luo J , Li H.Q , Li Z.Q , Liu B.X , Qin X.M , Gong M.M , Shi B.B , Wei Y.D
Published: November 2020

Background

New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization.

Methods

This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics.

Results

A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p<0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p<0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p<0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008).

Conclusion

NOAF complicating AMI is strongly associated with an increased long-term risk of heart.

Cumulative incidence of outcome

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai
The GRACE scale in the prognosis of patients with Takotsubo syndrome
Authors: Zalewska-Adamiec M , Kuzma L , Dobrzycki S , Bachorzewska-Gajewska H
Published: November 2020

Background

The prognosis of Takotsubo syndrome (TTS) is comparable to that of the non-ST-elevation myocardial infarction (NSTEMI). The GRACE scale is used to assess the risk of premature and long-term mortality in patients with NSTEMI in order to select the most favorable treatment strategy.

Methods

101 patients with TTS were hospitalized in 4 centers of invasive cardiology in Podlaskie Voivodeship during the period 2008–2012 were included in the study. The patients were divided into 2 groups: I – 52 patients (GRACE ≤140 points) and II – 49 patients (GRACE >140 points).

Results

The mean GRACE score in study group was 138.66. The course of Takotsubo in the patients with higher GRACE scores was associated with higher incidence of pneumonia (36,7% vs 7,69%, p=0,0004), rhythm abnormalities (17,3% vs 3,85%, p=0,026) and serious complications (cardiogenic shock, pulmonary edema, and sudden cardiac arrest) (30,6% vs 5,77%, p=0,001).

The mean observation period was 7.2 years. A significantly higher risk of 6-month (18,37% vs 3,85%, p=0,019),1-year (22,45 vs 3,85%, p=0,005), 3-year (40,82 vs 3,85%, p<0,0001), 5-year (42,86% vs 3,85%, p<0,0001) and 7-year mortality (53,06% vs 9,62%, p<0,0001) was observed in the group of patients with a GRACE score ≥140. The death risk factors in the multivariate analysis performed were low BMI, low eGFR, and a higher GRACE score

The ROC curve presents the discriminatory scores of the GRACE scale for the follow-up prognosis. The area under ROC curve (AUC) for the GRACE scale was 0.805 (95% CI - 0.718–0.892, p<0.001), with a cut-off value of 153 points, sensitivity of 74%, and specificity of 77% for TTS.

Conclusion

The GRACE scale is highly valuable for the prognosis of death risk in patients with TTS in the early and follow-up period.

Funding Acknowledgement

Type of funding source: None
Longitudinal strain in patients with severe aortic regurgitation: superiority to ejection fraction for detection of myocardial dysfunction
Authors: Reil J.C , Reil G.-H , Necker N , Borer J , Sievers H.H , Ensminger S , Marquetand C , Stierle U , Schaefers H.J , Langer H.F , Aboud A
Published: November 2020

Objectives

The aim of the study was to analyse LV systolic function and mechanical energetics in asymptomatic patients with severe aortic regurgitation (AR) to seek a new hemodynamic concept for timing for surgery.

Background

Current guidelines suggest surgery for patients with severe AR including clinical symptoms, subnormal LV ejection fraction (EF), or markedly abnormal left ventricular dimensions. However, the optimal measure to detect intrinsic myocardial systolic dysfunction in the presence of normal LVEF remains elusive.

Methods

Strain and echo-derived single beat pressure-volume analyses were performed in cohorts with severe AR without indication for surgery (ARNS; LVEDD <70mm, EF >50%, n=41), with indication for surgery (ARS; n=19) and in healthy, age-matched controls (C; n=20). Additionally, end-systolic elastance (Ees=LV contractility), stroke work (SW) and total energy (PVA) were calculated.

Results

Patients with ARNS demonstrated significant depression of LV contractility vs. C: Ees (1.5mmHg/ml ±0.7 vs. 2.25mmHg/ml ±0.7; p<0.001), despite comparable ejection fractions (EF: 0.56±0.05 vs. 0.60±0.07; p=0.10). Accordingly, global longitudinal strain (GLS) was decreased (−16.0±2.5% vs. −21.5±2%; p<0.001), end-diastolic volume markedly enlarged (236ml ±90 vs. 136ml ±30; p<0.001), as were PVA and SW indicating waste of energy. The correlation of GLS vs. Ees was good (r=−0.68; p<0.001). Results of ARS-patients were consistently worse.

Conclusion

Patients with severe AR and normal LVEF showed depressed LV contractility and waste of energy when assessed by Ees and GLS, both correlating well with each other. Hence, GLS may outperform LV dimensions for predicting timing for surgery and clinical outcomes in AR patients.

Funding Acknowledgement

Type of funding source: None
Invasive exercise hemodynamics in patients with severe primary mitral regurgitation and preserved ejection fraction predicts future valve surgery
Authors: Hein M , Neu J.N , Dorfs S.D , Doerken S.D , Zeh W.Z , Neumann N.J , Minners J.M , Jander N.J
Published: November 2020

Background

The role of invasive exercise hemodynamics in the management of asymptomatic patients with severe primary mitral regurgitation (MR) is unclear.

Methods and results

We compared the predictive power of parameters of invasive exercise testing for future valve surgery to guideline-defined non-invasive criteria. Maximal pulmonary capillary wedge pressure (PCWP), PCWP normalized to workload and weight (PCWL), and invasive maximal systolic pulmonary artery pressure (SPAP) were assessed in 113 asymptomatic patients with severe primary MR between 1996 and 2012. Mean age was 52±11 years, 16% were female, ejection fraction was ≥55% in all patients. During a median follow up of 4.5 years (IQR2.0; 8.3) 54 patients (48%) underwent valve surgery. In univariate analysis PCWP (P<0.001), PCWL (P<0.001), and maximal SPAP (P=0.009) were significantly associated with future mitral valve surgery. In multivariate analysis maximum PCWP and PCWL predicted future mitral valve surgery (HR 2.1 (1.44–3.10), P=0.005 and HR 1.31 (1.14–1.52), P<0.001, respectively) whereas SPAP did not. Adding maximum PCWP >25mmHg to a Cox regression model based on non-invasive guideline criteria resulted in a significant increase in the area under the curve (0.61 to 0.68, P=0.02).

Conclusion

In asymptomatic patients with severe primary mitral regurgitation and preserved left ventricular function invasive exercise hemodynamics improves information derived from current non-invasive guideline criteria.

Figure 1

Funding Acknowledgement

Type of funding source: None
Early single center experience with a novel transcatheter anuloplasty system for the treatment of functional tricuspid regurgitation
Authors: Landendinger M , Smolka S , Marwan M , Troebs M , Anneken L , Gaede L , Achenbach S , Arnold M
Published: November 2020

Background

Functional tricuspid regurgitation (TR) is increasingly recognized as relevant, but undertreated clinical entity. Since surgical repair or replacement of the tricuspid valve is associated with high mortality, many patients with with severe tricuspid regurgitation are not referred to surgery. Transcatheter anuloplasty is a new interventional treatment option for tricuspid regurgitation. We report the outcome of a consecutive single-center series of 11 patients treated with this technique.

Methods

Clinical and procedural data as well as mid-term outcome of a series comprising 11 consecutive patients (9 female, mean age 80±5 years, mean LV-EF 53±7, mean PAP 27±4 mmHg) who underwent transcatheter tricuspid anuloplasty for secondary tricuspid regurgitation in a 12-month period (Octover 2018–October 2019) were systematically collected, including pre- and post-procedural transthoracic/transesophageal echocardiogryphy (TTE/TEE). Patients were selected for the procedure based on clinical, echocardiographic and CT findings. All patients were treated using the Cardioband® system (Hersteller, Ort) in general anesthesia under 4D-TEE guidance.

Results

Mean procedural duration was 259±46 min across all 11 patients. Device success was 91%. In one patient extensive tricuspid annular excursions prevented anuloplasty band implantation. The mean grade of TR severity was reduced from 3.5 to 2.1, p=0,00016 (vena contracta decreased from 11±4 to 6±3 mm, p=0,0047).73% of all patients achieved pos-procedure TR severity ≤2. Procedural complications were infrequent: one patient required coronary stent implantation to the RCA kinking and in an further patient, transient 3rd degree AV bock occurred during the procedure. No patient died during the index hospital stay or during the follow up period (median follow up of 4 months). The NYHA classification improved from a median of III before the procedure to a median of II at follow-up (p=0,00022).

Conclusion

Transcatheter tricuspid annuloplasty permits effective treatment of functional tricuspid regurgitation with a low complication rate and sustained symptomatic improvement.

Funding Acknowledgement

Type of funding source: None
Safety and feasibility of retrograde inoue balloon for balloon aortic valvuloplasty without rapid ventricular pacing during transcatheter aortic valve implantation
Authors: Ninomiya R , Ishida M , Tosaka K , Kanehama N , Ishikawa Y , Fusazaki T , Kin H , Morino Y
Published: November 2020

Background

Although rapid ventricular pacing (RVP) is commonly performed for preparation of transcatheter aortic valve implantation (TAVI). It has been reported that multiple and / or prolonged RVP is associated with adverse clinical outcomes of TAVI. Retrograde Inoue-Balloon was designed for balloon aortic valvuloplasty (BAV) without RVP to prevent slip of balloon by way of central waist during biphasic inflation.

Purpose

The purpose of this study was to evaluate safety and feasibility of Retrograde Inoue-Balloon for TAVI preparation.

Methods

From December 2013 to December 2019, 427 consecutive patients who performed TAVI for severe aortic valve stenosis, were retrospectively enrolled in Iwate Medical University. Of them, 227 (53%) patients (mean age 83±5 years, male 41%), underwent retrograde BAV before prosthetic valve implantation, comprised this study population. Retrograde BAV procedures were divided into two groups; patients used Inoue-Balloon without RVP and those did conventional balloon with RVP. The primary endpoint was defined as combined adverse events of 30-day mortality, cerebral infarction, and critical complications after BAV (aortic dissection, aortic rupture and cardiopulmonary arrest). The secondary endpoint was set as prolonged hypotension after BAV.

Result

Inoue-Balloon (IB) and conventional balloon (CB) were used for 73 patients (32%) and 154 (68%) patients, respectively. Both balloons were succeeded to through and expand of aortic valve in all cases. In the CB group, cardiopulmonary arrest occurred in 2.0% after BAV, cerebral infarction was observed in 3.9%, and 30-day death in 3.3%. On the other hand, no major complications were observed except one aortic dissection in the IB group. In logistic regression analysis adjusted by sex and age, the incidence of combined adverse events was significantly lower in the IB group (OR 0.17, 95% CI 0.009–0.917, P=0.037). Furthermore, the IB group had significantly a lower incidence of prolonged hypotension following BAV compared with CB group (4.1% vs 19.5%, p=0.002).

Conclusion

Balloon aortic valvuloplasty using retrograde Inoue-balloon without rapid ventricular pacing is safe and feasible, and may improve clinical outcomes of TAVI.

Funding Acknowledgement

Type of funding source: None