bluuebunny/crossref_metadata_2025 huggingface dataset:
P1783Prognostic implications of significant tricuspid regurgitation in patients with atrial fibrillation in the absence of left-sided heart disease or pulmonary hypertension
Authors: Dietz M F , Prihadi E A , Van Der Bijl P , Ajmone Marsan N , Delgado V , Bax J J
Published: October 2019

Background

Tricuspid regurgitation (TR) can be caused by atrial fibrillation (AF) in the absence of left-sided heart disease or pulmonary hypertension. The prognostic impact of AF-TR has not been investigated.

Purpose

The aim of this study was to investigate the prognostic significance of TR in AF patients who do not show left-sided heart disease, pulmonary hypertension or primary structural abnormalities.

Methods

A total of 63 AF patients with moderate and severe TR were identified and matched by age and gender to 116 patients with AF without significant TR, resulting in a total study population of 179 patients (mean age 71±7 years, 59% male). As per design of the study, patients with primary TR, significant (moderate or severe) aortic and/or mitral valve disease, previous valvular surgery, congenital heart disease, left ventricular ejection fraction <50%, systolic pulmonary artery pressure >40mmHg, pacemaker or implantable cardioverter defibrillator leads in situ were excluded as well as patients with AF de novo. Patients were followed for the combined endpoint of all-cause mortality, hospitalization for heart failure and stroke.

Results

Patients with AF-TR had more often paroxysmal AF as compared to patients without TR (60% vs. 43%, p=0.028). In addition, right atrial volumes and the tricuspid annulus diameter (TAD) were significantly larger in patients with AF-TR compared to their counterparts (p<0.001 for all). Furthermore, tricuspid annular plane systolic excursion was significantly lower in patients with AF-TR (17±5 mm vs. 21±6 mm, p<0.001). During follow-up (median 62 [32–95] months) 55 events for the combined endpoint occurred. One- and 5-year event-free survival rates for patients with TR were 71% and 53%, compared to 92% and 85% for patients without TR, respectively (Log rank Chi-Square p<0.001; Figure). In the multivariable Cox proportional hazard model adjusted for age, gender, NYHA functional class >2, renal function, right ventricular (RV) function and TAD, the presence of significant TR was independently associated with the combined endpoint (HR, 2.495; 95% CI, 1.167–5.335; p=0.018), while RV function was not (HR, 1.026; 95% CI, 0.971–1.085; p=0.364).

Figure 1. Kaplan-Meier curves

Conclusion

In the absence of left-sided heart disease and pulmonary hypertension, significant TR is independently associated with worse event-free survival in patients with AF.
P1818Descending aortic thoracic diameter: a risk marker for major adverse cardiovascular outcomes in women
Authors: Rueda Ochoa O L , Bons L R , Rohde S , Ghoud K E L , Budde R , Ikram M K , Deckers J W , Vernooij M W , Franco O H , Van Der Lugt A , Roos-Hesselink J W , Bos D , Kavousi M
Published: October 2019

Background

Thoracic aortic diameters have been associated with cardiovascular risk factors and atherosclerosis. However, limited evidence regarding the role of thoracic aortic diameters as risk markers for major cardiovascular outcomes among women and men exist.

Purpose

To evaluate the independent associations between crude and indexed ascending and descending aortic (AA and DA) diameters with major cardiovascular outcomes among women and men and to provide optimal cutoff values associated with increased cardiovascular risk.

Methods and results

2178 women and men ≥55 years from the prospective population-based Rotterdam Study underwent multi-detector CT scan of thorax. Crude diameters of the AA and DA were measured and indexed by height, weight, body surface area (BSA) and body mass index (BMI). Incidence of stroke, coronary heart disease (CHD), heart failure (HF), cardiovascular and all-cause mortality were evaluated during 13 years of follow-up.

Weight-, BSA-, or BMI-indexed AA diameters showed significant associations with total or cardiovascular mortality in both sexes and height-indexed values showed association with HF in women. Crude AA diameters were associated with stroke in men and HF in women. For DA, crude and almost all indexed diameters showed significant associations with either stroke, HF, cardiovascular or total mortality in women. Only weight-, BSA- and BMI-indexed values were associated with total mortality in men. For crude DA diameter, the risk for stroke increased significantly at the 75th percentile among men while the risks for HF and cardiovascular mortality increased at the 75th and 85th percentiles respectively in women.

Conclusions

Our study suggests a role for descending thoracic aortic diameter as a marker for increased cardiovascular risk, in particular for stroke, heart failure and cardiovascular mortality among women. The cut points for increased risk for several of cardiovascular outcomes were below the 95th percentile of the distribution of aortic diameters.
P1823Aortic walls elastic properties assessment with ultrafast ultrasound imaging in case of bicuspid aortic valve
Authors: Goudot G , Mirault T , Cheng C , Gruest M , Amoah J , Pedreira O , Khider L , Pernot M , Messas E
Published: October 2019

Background

Magnetic resonance imaging allows evaluation of aortic stiffness by the maximum rate of systolic distension (MRSD) a new prognosis factor of aortic dilatation in patients with bicuspid aortic valve (BAV). MRSD requires a continuous monitoring of the aortic diameter during the cardiac cycle, not accessible to conventional echocardiography contrary to ultrafast ultrasound imaging (UF).

Purpose

To develop specific aortic sequences in ultrafast ultrasound imaging (UF) to provide access to the aortic MRSD

Methods

Tissue Doppler allowed a precise estimation of the movement of each wall and the fine variation of the aortic diameter. To automatically track the anterior and posterior aortic walls during the cardiac cycle, we developed in the laboratory a specific interface (Figure). MRSD was the maximum of the derivative of the diameter chande over time. To assess this new technique, 24 patients (10 BAV patients and 14 controls, mean age 45.8 vs. 40.7 years, p=0.464, respectively) were consecutively included at a reference center for BAV. The ascending aorta was evaluated at the sinus of Valsalva, the tubular aorta and the aortic arch with a phased array probe (Supersonic Imagine) and dedicated sequences at 2000 frames/s.

Results

The lab-made interface allowed to track the aortic diameter and to calculate the MRSD from the UF acquisitions for each patient. We found lower MRSD at the sinus of Valsalva in case of BAV in accordance with previously demonstrated higher stiffness at this segment by our team (Table).

Table 1. UF Aortic parameters for BAV patients and controls BAV patients Controls p (Mann Whitney) Sinus of Valsalva Diameter (mm) 26.2 [22.4–32.5] 27.09 [23.5–29.5] 0.796 MRSD (s–1) 1.05 [0.73–1.19] 1.51 [1.28–1.99] 0.023 Tubular ascending aorta Diameter 31.4 [29.4–32.2] 28.9 [22.6–31.5] 0.328 MRSD 0.94 [0.59–1.27] 1.09 [0.87–1.41] 0.353 Aortic arch Diameter 24.2 [23.7–24.8] 24.2 [18.9–24.5] 0.673 MRSD 0.57 [0.35–1.07] 0.85 [0.76–1.02] 0.257 Results are median [25th–75th percentile].

Figure 1

Conclusion

UF allows evaluation of aortic stiffness by MRSD using dedicated sequence and interface. As echocardiography, UF is easily accessible and therefore deserves attention from cardiologists taking care of BAV patients to evaluate the segmental aortic remodeling associated with BAV.
P1902Comparison of efficacy of different anticoagulation strategies used during pulmonary vein isolation in left atrial blood samples
Authors: Hajas O , Bagoly Z S , Toth N K , Sarkady F , Kovacs K B , Kappelmayer J , Csiba L , Csanadi Z
Published: October 2019

Introduction

Ablation of atrial fibrillation is based on the isolation of the pulmonary veins (PVI) from the left atrium. Cerebral thromboembolism is a rare but serious complication of PVI, which highlights the importance of peri-procedural anticoagulation.

Aim

Studying the coagulation and endothelium activation during PVI in case of using different anticoagulation protocols.

Method

52 patients undergoing PVI with cryoballoon technique were involved and were grouped according to three different pre-procedural anticoagulation strategies: in the first group patients received no anticoagulation before the procedure (non anticoag., 24 patients)-, in the second group patients received uninterrupted vitamin K antagonist therapy, and their INR value was in therapeutic range on the day of the procedure (VKA group, 11 patients) and in the third group patients were on uninterrupted dabigatran therapy (dabigatran group, 17 patients).

Two blood samples were taken during PVI from the left atrium, the first one before ablation or iv. heparin administration, the second one directly after the last application at the end of the procedure. The samples were used to measure D-dimer, plasmin antiplasmin (PAP) complex, a2 plasmin inhibitor (a2PI), plasminogen, FVIII activity, von Willebrand factor (VWF) antigen levels.

Results

D-dimer levels increased in all three groups after ablation, but in the samples of patients on dabigatran therapy we detected significantly lower D-dimer levels in the pre- and post-procedural samples compared to patients on other therapeutic strategies (median values before or after PVI: non anticoag.: 0.48 and 1.09 mgFEU/L; VKA: 0.33 and 0.72 mgFEU/L, dabigatran: 0.12 and 0.30 mgFEU/L, p<0.001 non anticoag. vs. dabigatran, p<0.01 VKA vs. dabigatran). PAP complex values were increasing parallel with D-dimer levels and only in the dabigatran group did not increase significantly. VWF antigen and FVIII activity increased significantly in all three groups after ablation, but there was no significant difference between the groups.

Conclusions

the safest anticoagulation strategy for patients undergoing PVI was uninterrupted dabigatran therapy. The extend of endothelial damage was not affected by anticoagulation.
P1909Cryobaloon pulmonary vein isolation without pulmonary venography
Authors: Mengel C , Lee X W , Betts J , Ingram R , Haqqani H M
Published: October 2019

Introduction

Cryoballoon pulmonary vein isolation (PVI) has been shown to be non-inferior to radiofrequency PVI and have several advantages including shorter procedure times. Cryoballoon PVI traditionally requires the use of occlusive pulmonary venography to assess for balloon position and contact however, some patients have contraindications to the use of iodinated radiocontrast.

Purpose

We assessed the feasibility of performing cryoballoon PVI without pulmonary venography.

Methods

Thirty-five initial consecutive patients with paroxysmal or persistent atrial fibrillation underwent cryoballoon PVI as a primary procedure under conscious sedation by a single operator. None had a contraindication to radiocontrast administration. Left atrial CT was obtained the day prior in all patients to assess pulmonary vein anatomy. Transeptal puncture was performed using 1–5 ml of contrast given the non-routine availability of intracardiac echocardiography. CT images obviated the requirement for pre-balloon deployment venography and pulmonary vein balloon occlusion was assessed by tactile feedback as well as the fluoroscopic appearance of balloon deformation (Fig 1.). If adequate temperature was not obtained with initial cooling during ablation, application was discontinued and the balloon repositioned. If repeated ablation did not result in sufficient cooling and vein isolation, pulmonary venography was utilised to assess adequacy of vein occlusion and sites of leak.

Results

The median age was 57 yrs with 69% male and 63% having paroxysmal AF. 137/138 pulmonary veins were successfully isolated with mean 1.77 ablations per vein. Median nadir ablation temperature was −45°C (range −62 to −30°C) with a median time to isolation of 36.5 seconds. 120/138 (87%) of veins were isolated without the use of contrast, however 18/138 required venography. Overall, 63% of patients had successful PVI without requiring any pulmonary venography. Average procedure time was 104 minutes. One patient sustained a mediastinal hematoma that resolved with conservative management. Median follow up was 3.6 months, with 74% of patients being free from atrial fibrillation at last follow up.

Conclusion

This study demonstrates that it is feasible to perform cryoballoon PVI without pulmonary venography in 87% of targeted veins. In this series, 63% of patients had successful 4 vein isolation without pulmonary vein contrast administration. This technique combined with imaging guided transeptal puncture can allow for truly contrast-less PVI in patients with severe contrast allergy or severe renal dysfunction.
P1929A randomized controlled trial evaluating outcome impact of cilostazol in patients with coronary artery disease and at a high risk of cardiovascular disease
Authors: Chao T.-H , Tseng S.-Y , Liu P.-Y , Li Y.-H
Published: October 2019

Background

We and others have previously found that cilostazol has a favorable effect on glucose and lipid homeostasis, endothelial function, anti-atherosclerosis, and vasculo-angiogenesis. However, it is poorly understood that if this compound can provide better clinical outcome.

Purpose

This study investigated the outcome effect of cilostazol in patients with coronary artery disease (CAD) or at a high risk of cardiovascular (CV) disease.

Methods

We conducted a randomized, double-blind, placebo controlled trial involving 266 patients to receive cilostazol 200 mg/day (n=134) or dummy placebo (n=132). The primary endpoint was a composite of CV death, non-fatal myocardial infarct, non-fatal stroke, hospitalization for congestive heart failure or unplanned coronary revascularization. Pre-specified secondary endpoints include the composite major coronary event (MCE) and major adverse CV and cerebrovascular event (MACCE) on long-term follow-up. The mean duration of follow-up was 2.9 years.

Results

Relative to placebo, cilostazol treatment had a borderline effect on risk reduction in the primary endpoint (hazard ratio [HR], 0.67; 95% confidence interval (CI), 0.34–1.33), whereas the beneficial effect in favor of cilostazol was significant in patients with diabetes mellitus or a history of percutaneous coronary intervention (P for interaction, 0.02 and 0.06, respectively). Use of cilostazol, but not placebo, significantly reduced the risk of the MCE (HR, 0.38; 95% CI, 0.17–0.86) and MACCE (HR, 0.47; 95% CI, 0.23–0.96). A significantly lower risk of angina pectoris (HR, 0.38; 95% CI, 0.17–0.86) and unplanned revascularization (HR, 0.13; 95% CI, 0.02–1.09) was also observed in the cilostazol group. After multi-variable adjustment, cilostazol treatment independently predicted a lower risk of the MCE and MACCE.

Conclusions

Cilostazol treatment significantly reduced the risk of CV events in patients with CAD or at a high risk of CV disease.

Acknowledgement/Funding

MOST 106-2314-B-006-044, MOHW106-TDU-B-211-113003, MOHW107-TDU-B-211-113003, and MOST107-2314-B-006-076-MY2
P2243CTCA alone demonstrates superior diagnostic accuracy, prognostic utility and is less expensive than CTCA combined with subsequent multi-modality functional imaging in patients with ischaemic symptoms
Authors: MacLean E , Sehmi J , Kanaganayagam G S , Ngee T , Nicol E
Published: October 2019

Background

The evaluation of suspected ischaemic symptoms incorporates multi-modality anatomical and functional imaging tests. The 2016 update to the UK's NICE guidelines recommends CT coronary angiogram (CTCA) first line in patients without known coronary artery disease. Additive multi-modality functional imaging may provide synergistic diagnostic and prognostic information.

Purpose

To investigate the diagnostic accuracy, prognostic utility and cost of CTCA combined with subsequent multi-modality functional testing versus (vs) CTCA alone.

Methods

772 consecutive patients were referred to a single UK tertiary centre with symptoms suggestive of ischaemia. 657 individuals (“CTCA group”) underwent CTCA alone, and 115 individuals (“Combined group”) underwent CTCA and then either perfusion cardiac MRI (n=25), stress echocardiogram (n=16), or myocardial perfusion scintigraphy (n=74). Patients underwent invasive angiography (n=79) +/− revascularisation at the discretion of the referring clinician. All readers and operators were aware of previous imaging findings. Revascularised patients (n=52) were excluded from long term follow-up. The remaining patients were followed-up for a mean of 38.1±17.4 months and the incidence of major adverse cardiovascular events (MACE) recorded. Costs were derived from the NICE guidelines.

Results

Baseline characteristics were similar between groups. The Combined group underwent significantly more invasive angiograms than the CTCA group (29.6% vs 6.8%, p=0.0001) with no significant difference in the rate of revascularisation (73% vs 67%, p=0.72). Mean time from CTCA to angiogram was significantly longer in the Combined group (81.2 vs 38.1 days, p=0.0001). Both sensitivity and specificity were lower in the Combined group than in the CTCA group (sensitivity: 70% vs 93%, specificity: 75% vs 100%). The rate of long term MACE was significantly higher in the Combined group (8.7% vs 2.6%, p=0.0026). Multivariate analysis of CTCA and functional imaging findings found that CTCA-derived four vessel aggregate stenosis score (0–12) was the strongest predictor of MACE for the whole cohort (OR 4.4, p<0.0001), and also for those with negative functional tests (OR 3.9, p<0.0001). Per patient, a combined strategy was more expensive than CTCA alone (£1551 vs £368, p=0.0001).

CTCA and functional data vs outcomes

Conclusions

Combining multi-modality functional testing with CTCA increased costs but did not improve diagnostic accuracy or long term outcomes. Further reductions in both MACE and unnecessary invasive angiography are desirable; CT-derived functional data such as FFRCT may be implicated.
P2466The impact of circumferential pulmonary vein isolation on global and regional left atrial function in patients with paroxysmal atrial fibrillation
Authors: Blendea D , Istratoaie S , Pop S , Mansour M
Published: October 2019

Introduction

The effect of circumferential pulmonary vein isolation (PVI) for atrial fibrillation (AF) on left atrial (LA) function has not been well defined.

Purpose

The aim of this study was to evaluate the immediate impact of ablation on parameters of global and regional LA function using intracardiac echocardiography (ICE)

Methods

We studied 26 consecutive patients (age 56±10 years, 19 men) with paroxysmal AF using ICE before and immediately after circumferential PVI. All pulmonary veins were isolated in all patients. ICE measurements included LA fractional area shortening, peak A wave on transmitral Doppler flow, peak emptying velocity on the left atrial appendage (LAA) Doppler flow, as well as tissue Doppler myocardial velocities at the level of the posterior LA wall, interatrial septum, and lateral wall, which were used as parameters of regional LA function.

Results

The mean radiofrequency ablation time was 37±22min. Post ablation there was a significant reduction of the LA fractional area shortening from 27±8% to 22±6% (p<0.01). The tissue Doppler velocity of atrial contraction at the posterior wall decreased significantly post ablation: from 8.9±1.8 cm/s to 6.9±1.4 cm/s (p<0.01). There were no significant differences between the pre and post ablation values for tissue Doppler velocities at the level of the interatrial septum or LA lateral wall. The post ablation peak transmitral A wave and peak LAA Doppler velocities did not differ significantly from the pre ablation values.

Conclusion

In patients with paroxysmal atrial fibrillation, circumferential PVI results in an immediate decrease in LA function without a significant change in LAA function.
P2485Cardiac abnormalities and vascular damage in young adults with type 1 diabetes mellitus: incidence and associations with kidney dysfunction
Authors: Medvedev D , Mahamat K , Soseliya N , Efimova V , Safarova A , Kobalava Z
Published: October 2019

Background

In contrast to type 2 diabetes mellitus (DM), cardiac and vascular abnormalities in type 1 DM (T1DM) are not well investigated. We aimed to evaluate occurrence of cardiac remodeling, arterial stiffness and blood pressure (BP) phenotypes in T1DM patients.

Methods

The cross-sectional study consecutively included T1DM patients 18–44 y.o. without known CVD, in whom 24-hour monitoring of peripheral and central BP (ABPM) with BPLab Vasotens, applanation tonometry and conventional and speckle tracking echo were performed. BP phenotypes were determined according to current guidelines, PWV and CBP - according to individual reference values. Presence of systolic dysfunction was defined as global longitudinal strain (GLS) <20%, left ventricular hypertrophy (LVH) as LV myocardial mass index (LVMI) >95/>115 g/m2 for women/men, LV remodeling (LVR) as RWT ≥0.43. P<0.05 was considered significant.

Results

A total of 125 patients with T1DM (mean age 29,2±7,6 years, 60% male, median duration of DM 6,9 [2; 11] years, HbA1c 9.9 [6; 12] %, mean BMI 23±3 kg/m2, smoking 39%, median GFR 100 [86; 117] ml/min/1.73 m2, GFR <60 ml/min/1.73 m2 – in 8.8%, median albuminuria 19 [8; 24] mg/g (moderate and high albuminuria in 14.6% and 2.2%) were investigated.

According to office BP and ABPM hypertension (HTN) was diagnosed in 28% patients (true and masked in 4.8 and 23.2%, respectively) and true normotension in 72%.

Isolated nocturnal HTN was observed in 14.4%. Majority of the patients were dippers (51.2%), non-dippers and night-peakers profiles were registered in and 43.2% and 5.6%, respectively. Central SBP and PWV elevation were observed in 17.6% and 57.6% (PWV >10 m/s - only in 2.4%). Cardiac abnormalities were revealed in 72.4% of patients: GLS<20%, LVH, LVR and diastolic dysfunction (DD) in 71.2, 12, 39.2 and 16.8% patients, respectively. Isolated GLS <20% was detected in 30%, combination of GLS<20% with LVH (or LVR) and DD in 47.2%.

Patients with vs without HTN were characterized by higher PWV (7.8±1.5 vs 6.9±1.2, p<0.001), LVMI (89.9 [75; 96] vs 71.5 [64; 77] p<0.001), incidence of DD (29.6 vs 12.2%, p=0.03), LVH (28 vs 6%, p=0.002), trend towards higher rate of central SBP increase (32.7% vs 17.4%, p=0.08), lower incidence of LVR (26 vs 44%, p=0.002) and similar GLS (p=0.16).

Groups with vs without nocturnal HTN did not differ by PWV, central SBP, GLS and LVMI. PWV increase was associated only with higher LVMI (88.2 [69; 95] vs 77.6 [68; 83], p=0.042).

Correlations (p<0.05) with albuminuria were observed for GLS (r=−0.26), DD (r=0.22) and non-dipping state (r=−0.34). GFR correlated (p<0.05) with GLS (r=−0.32) and PWV (r=−0.32).

Conclusion

Incidence of prognostically unfavourable phenotypes of HTN, cardiac remodeling and arterial stiffness (even in patients without HTN) were relatively high in T1DM population. GLS and non-dipping state correlated with albuminuria, GLS and PWV with GFR
P2583Endothelial cell-derived extracellular vesicles promote M2 polarization of THP-1 cells
Authors: Fruehwald D , Zietzer A , Nickenig G , Werner N , Jansen F
Published: October 2019

Introduction

The intercellular transfer of biologically active molecules in extracellular vesicles (EVs) has recently been discovered as an important mechanism, which regulates cardiovascular health and disease. In the context of atherosclerosis, endothelial cell-derived EVs have been shown to modulate the phenotype of EV recipient cells in a relevant manner. Under pro-atherogenic conditions e.g. hyperglycemia, the export of numerous signal molecules in EVs is altered and so are EV-dependent effects on recipient cells. While the effect of endothelial-cell derived EVs on other endothelial cells and vascular smooth muscle cells is well characterized, little is known about the vesicle-based interaction of endothelial cells and monocytes under pro-atherogenic conditions. This is particularly relevant as monocytes are crucial modulators of vascular regeneration and inflammation. Our aim was therefore to investigate, whether EVs from endothelial cells have a significant effect on the differentiation and polarization of monocytes and how this process is affected by pathologic conditions as mentioned above.

Methods and results

Human Coronary Arterial Endothelial Cells (HCAECs) were cultured in high-Glucose-medium (30 mM) for 72h. PBS was used as a control. Large EVs were isolated from the culture supernatant by differential centrifugation (1 x 1500 g / 15 min + 2 x 2ehz748.0909 g / 40 min). The harvested large EVs were characterized by Immunoblotting, Nanoparticle Tracking Analysis as well as Transmission electron microscopy and were shown to be mostly between 80 and 500 nm in size. Specific surface markers including Annexin V and Flotillin-1 were highly enriched in the isolated EVs. The EVs were used for co-culture with THP-1 cells with and without previous phorbol-12-myristate-13-acetate (PMA) stimulation. After 4h as well as after 24 h of incubation with EVS, total RNA was isolated from the THP-1 cells and qPCR was performed to assess polarization towards M1 by TNF-α gene expression or M2 by IL-10 expression. While EV treatment of THP-1 cells without previous PMA-stimulation showed no measurable effect, a significant decrease in the expression of TNF-α was detected after 4 h of treatment from Glucose injured HCAECs. Similar results were obtained without glucose stimulation, the most significant reduction of TNF-α expression however was seen at 24 h. In regard to IL-10 no significant expression changes were detected in EV treated THP-1 cells.

Conclusion

We showed that glucose injury does not relevantly affect vesicle release or size. Furthermore, endothelial cell derived EVs cause a reduction of TNF-α expression, which indicates a polarization towards an M2 macrophage phenotype, irrespective of prior hyperglycaemic injury. As the M2 phenotype has been described as pro-regenerative, we conclude that endothelial cell derived EVs can exert a protective function during the invasion of monocytes in cardiovascular disease and remodeling.
P2597Heart failure and atrial tachyarrhythmia on abiraterone: a characterization using pharmacovigilance databases
Authors: Salem J E , Lebrun-Vignes B , Pariente A , Shaffer C M , Malouf G G , Dureau P , Potey C , Funck-Brentano C , Roden D M , Moslehi J J , Bretagne M
Published: October 2019

Background

Abiraterone and enzalutamide are recently approved androgen deprivation therapies (ADT) for metastatic prostate cancer. The cardiac safety profile for the two drugs is unknown.

Methods

Using French and World Health Organization (WHO) pharmacovigilance databases, we performed a disproportionality-analysis of suspected adverse-drug-reactions (ADR) to evaluate the reporting-odds-ratio (ROR) of cardiac ADR associated with abiraterone compared to enzalutamide, other ADT used in prostate cancer, and entire database. Clinical and demographic characterization of patients with ADT-induced cardiac ADR was performed.

Results

In the 5,759,781 ADR reports in men, 55,070 pertained to ADT. The ROR of AT for abiraterone was of 4.1 [3.1–5.3] vs. enzalutamide, 3.7 [3–4.5] vs. other ADT, and 3.2 [2.7–3.7] vs. entire database. The corresponding ROR for HF were of 2.5 [2–3], 1.5 [1.3–1.7], and 2 [1.7–2.3], respectively. Mean time to AT and HF onset was shorter on abiraterone (5.2±0.8 and 4.5±0.6 months, respectively) vs. other ADT (13.3±3.2 and 9.2±1.1 months; p<0.05). Cases on abiraterone vs. other ADT were more frequently associated with ≥2 ADR-terms including AT, HF, hypokalemia, hypertension and edema (13.6% vs. 6%, p<10–4). For abiraterone, age but not dose was associated to reporting of AT/HF vs. any other ADR.

Table 1 Number (available data) AT HF Hypokalemia Edema Hypertension Age (y) 5989 r: 0.03, p: 0.02 r: 0.05, p≤0.0001 r: 0.06, p≤0.0001 r: 0.04, p≤0.01 ns Dose of hydrocortisone equivalent (mg/day) 3828 ns ns ns r: −0.07, p≤0.001 r: −0.12, p≤0.0001 Dose of abiraterone (mg/day) 6285 ns ns ns ns ns Details concerning correlation (r) between clinical covariates and reporting for AT, HF, hypokalemia, edema and hypertension within overall adverse drug reaction on abiraterone (n: 9203) extracted from VigiBase (through 08/2017).

Time to onset

Conclusion

Compared to other ADT, abiraterone was associated with a higher reporting of AT and HF associated with hypokalemia, hypertension and edema. These findings are consistent with the hyper-mineralocorticism induced by abiraterone and not with other ADT.
P2614Comparison of global longitudinal strain and ejection fraction in correlation to NT-proBNP in ischemic and non-ischemic heart failure
Authors: Ablasser K , Von Lewinski D , Kolesnik E , Gangl M , Kattnig L , Habenicht V , Manninger M , Scherr D , Schmid J , Fruhwald F , Zirlik A , Verheyen N
Published: October 2019

Background

In chronic heart failure (CHF) NT-proBNP and left ventricular ejection fraction (LVEF) by echocardiography are standard diagnostic as well as follow-up markers and are known to correlate with prognosis. Speckle-tracking echocardiography is a more recent technique to quantify myocardial deformation as a measurement of left ventricular function with potential benefits over LVEF.

Purpose

The purpose of this investigation was to analyse the cross-sectional relationship between 2D speckle tracking-derived global longitudinal strain (GLS) and NT-proBNP plasma levels in a prospective cohort of ischemic and non-ischemic CHF patients.

Methods

We enrolled 205 patients with chronic heart failure. Major inclusion criteria were age over 18 years, stable disease with absence of unplanned hospitalization or change in medication or device therapy in the previous month or major surgery in the previous 3 months. CHF treatment had to be according to the recommendations of the ESC CHF guidelines 2016 and LVEF had to be below 50%.

Patient history, physical examination and an extensive echocardiography exam were performed. Lab results included NT-proBNP. Manual longitudinal strain was calculated using EchoPAC (General Electric Medical Systems, Horten, Norway) by a single and blinded examiner. LVEF was measured using Simpson's biplane method.

Results

205 patients included in the study. The baseline characteristics included mean age 65.0 years and 75% male. Mean GLS was −9.6% (SD ±4.5%) and median NT-proBNP 1269.5 (IQR 379.5–2759.5) ng/ml. The CHF aetiology was 70.0% ischemic vs 30.0% non-ischemic.

There was a significant negative correlation between GLS and NT-proBNP (Pearson r=0.239, p=0.029), this was not significant for LVEF and NT-proBNP (Pearson r=0.149, p=0.228).In a multivariate regression analysis adjusted for age, sex, NYHA classification and HF aetiology, GLS remained significantly correlated with NT-proBNP (adjusted beta-coefficient= 0.289, p=0.011). Furthermore, in contrast to LVEF, GLS showed a significant correlation to NT-proBNP in patients with ischemic (Pearson r=0.266, p=0.049) as well as non-ischemic aetiology of heart failure (Pearson r=0.434, p=0.034).

Conclusion

Global longitudinal strain, not LVEF, was significantly correlated with NT-proBNP in patients with CHF, independently of age, sex, symptoms or heart failure aetiology. This shows that speckle-tracking might be superior to LVEF for the assessment of left ventricular function in CHF.
P2647Impact of hypertension on extent of non-obstructive coronary artery disease (The NORIC registry)
Authors: Berge C , Eskerud I , Almeland E B , Larsen T H , Pedersen E R , Rotevatn S , Lonnebakken M T
Published: October 2019

Background

In non-obstructive coronary artery disease (CAD), increasing extent of disease is associated with a worse prognosis. Statin therapy has been suggested to improve the prognosis. Whether hypertension, a modifiable CV risk factor, affects the extent of non-obstructive CAD in patients with stable angina is less explored.

Purpose

To assess the association between hypertension and extent of non-obstructive coronary artery disease.

Methods

We identified 1117 patients (mean age 62±10 years, 48% women) from the Norwegian Registry for Invasive Coronary angiography (NORIC). All subjects had stable angina and non-obstructive CAD defined as 1–49% stenosis in any coronary artery segment by coronary computed tomography angiography (CCTA). The extent of non-obstructive CAD was assessed as coronary artery segment involvement score (SIS) on CCTA. Extensive non-obstructive CAD was defined as SIS≥4.

Results

Hypertension was present in 44% and patients with hypertension were older with a higher prevalence of diabetes, obesity, smoking and statin therapy (all p<0.05). Coronary artery SIS and calcium score were higher in patients with hypertension compared to those without hypertension, (3.1±2.0 vs. 2.6±1.7, p<0.001 and 41 (116) vs. 32 (91) HU, p<0.05), respectively. There was no significant sex difference in the prevalence of hypertension. In univariable analysis, hypertension, age, calcium score and statin treatment were significantly associated with extensive non-obstructive CAD (Table). Hypertension remained a strong, independent predictor of extensive non-obstructive CAD after adjusting for other known covariables (Table).

Table 1. Covariables of extensive non-obstructive CAD in univariable and multivariable logistic regression analysis Univariable analysis Multivariable analysis OR 95% CI p-value OR 95% CI p-value Hypertension 1.57 1.21–2.04 0.001 1.47 1.03–2.10 0.035 Age 1.06 1.05–1.08 <0.001 1.04 1.01–1.06 0.001 Calcium score 1.02 1.01–1.02 <0.001 1.01 1.01–1.02 <0.001 Statin treatment 1.34 1.03–1.75 0.029 1.20 0.83–1.70 0.341 Smoking 1.33 1.00–1.77 0.052 1.24 0.86–1.78 0.251 Diabetes mellitus 1.34 0.86–2.12 0.191 1.10 0.57–2.09 0.781 Obesity 1.03 0.76–1.41 0.839 1.19 0.79–1.80 0.425

Conclusions

Hypertension is associated with extensive non-obstructive CAD in patients with stable angina, suggesting that early and aggressive antihypertensive treatment may impact disease progression.
P2681The impact of modifiable life style risk factors on inflammation in patients with coronary artery disease: modelling a target population for anti-inflammatory treatment
Authors: Blaum C , Brunner F J , Braetz J , Kroeger F , Gossling A , Lorenz T , Karakas M , Schnabel R , Westermann D , Blankenberg S , Seiffert M , Waldeyer C
Published: October 2019

Introduction

Modifiable lifestyle risk factors (modRF) of coronary artery disease (CAD) such as smoking, lack of physical activity (PA) and poor diet are associated with high inflammatory burden. An optimisation of modRF might significantly affect the target population for pharmacological anti-inflammatory treatment (AIT) as determined by a hsCRP ≥2 mg/l.

Aim

To analyse the influence of modRF on hsCRP in a contemporary CAD cohort and model the effect of modRF optimisation on hsCRP in a target population with high inflammatory burden.

Methods

We included all patients with angiographically documented CAD from an observational cohort study ongoing since 2015 and excluded patients with recent myocardial infarction, malignancy, infectious disease, and immunosuppressive medication. ModRF were assessed by questionnaire at enrolment. Lack of PA was defined as PA <1.5 h/week and poor diet as ≤12 points of an established Mediterranean diet score (MDS, range 0–28 points). The Kruskall-Wallis Test was used to compare hsCRP levels depending on the number of modRF. We performed univariate and multivariate linear regression with log(hsCRP) as the dependent variable. Based on the latter we recalculated hsCRP for each patient assuming optimisation of individual modRF.

Results

Of the 1003 patients (mean age 69 years, 72% male) included, 48% (N=479) had a hsCRP ≥2 mg/l. HsCRP increased with the incremental number of modRF (median hsCRP-values for 0–3 modRF: 1.1, 1.6, 2.1, 2.7 mg/l, p<0.001). Univariate and multivariate linear regression showed a significant association between log(hsCRP) and each of PA ≥1.5 h/week, MDS >12, and smoking (Table 1). Recalculation of hsCRP levels identified 21% (N=102/479) of patients with hsCRP ≥2 mg/l who could achieve a hsCRP <2 mg/l assuming optimisation of present modRF.

Table 1. Linear regression results Univariate Multivariate exp(β) (95% CI) p-value exp(β) (95% CI) p-value PA ≥1.5 h/week 0.63 (0.54, 0.72) <0.001 0.76 (0.66, 0.88) <0.001 MDS >12 0.74 (0.65, 0.86) <0.001 0.83 (0.73, 0.96) <0.010 Smoking 1.16 (1.01, 1.34) <0.040 1.19 (1.03, 1.36) <0.017 Impact of modifiable lifestyle risk factors on hsCRP in 1003 CAD patients. Multivariate analyses are adjusted for age, sex, diabetes, body mass index and intake of cholesterol lowering drugs.

Conclusion

Modifiable lifestyle risk factors are independently associated with hsCRP levels in CAD patients. A relevant portion of patients with high inflammatory burden might achieve a hsCRP <2 mg/l by lifestyle changes alone. This should be considered in view of the cost and side-effects of pharmacological AIT and for the design of future intervention studies in this field.
P2685Improving myocardial perfusion in refractory angina: extracorporeal shockwave myocardial revascularization in a monocentric cohort
Authors: D'Amico S , Alunni G , D'Amico M , Fu M , Celentani D , Pidello S , Brustio A , Campana M , Baccega M , Giustetto C , Marra S , Rinaldi M
Published: October 2019

Background

The incidence of patients with refractory angina (RA) is increasing. Medical therapy for RA is limited and prognosis is poor. Experimental data and small clinical studies suggest that the use of Extracorporeal shockwave myocardial revascularization (ESMR) may contribute to angiogenesis and improve symptoms in patients with RA.

Purpose

The aim of this study was to assess the efficacy of ESMR in the improvement of myocardial perfusion and symptoms in patients with RA.

Methods

Patients with RA despite optimal medical therapy and not suitable for further myocardial revascularization were enrolled and underwent ESMR. Characteristics such as angina class scores (CCS class score), nitroglycerin consumption and hospitalization rate among cases (patients with RA who received ESMR) and controls (patients with RA who did not receive ESMR) were compared at baseline and 6 months after ESMR therapy. In patients receiving ESMR the effect of on cardiac perfusion was assessed at six months.

Results

Among screened patients, 159 met the inclusion/exclusion criteria. 151 patients were enrolled in the present study and 121 treated with ESMR. There were 121 patients in the treatment group and 29 patients in the control group. The mean age of the patients was 70±8.8 years in the case group and 71±5.3 years in the control group. Other characteristics were similar in both groups. After ESMR myocardial perfusion by SPECT significantly improved: mean SSS was reduced from 21.2±9.42 to 14.2±10, with a 33% relative reduction (p=0.0001). Clinical follow up of both group demonstrated a significant improvement CCS class score at six months (1.5±0.6 in treatment and 1.92±0.69 in controls; p 0.0013) a significant improvement NYHA class score (1.4±0.6 in cases and 1.73±0.59 in controls; p 0.008); also, nitroglycerin consumption (29% in case cases, and 44.8% in controls; P 0.15) and hospitalization rate were reduced in the treatment group compared to control (16% vs. 37.9%; P 0.02).

Clinical outcome of two groups at 6 months follow up Treatment group (n=121) Control group (n=29) p CCS class 1.5±0.6 1.92±0.7 <0.001 NYHA class 1.4±0.6 1.7±0.6 <0.008 Nitrates uptake 35 (29%) 13 (45%) <0.15 Admission to emergency department 20 (16%) 11 (38%) <0.02

SPECT results after 6 months follow up

Conclusion

ESMR therapy is a non-invasive safe and potentially effective new option for patients with refractory angina. This study confirms the beneficial effect of ESMR therapy on cardiac symptoms, myocardial perfusion and hospitalizations in patients with refractory angina.
P2769Racial differences in outcomes among acute pulmonary embolism patients: a nationwide analysis
Authors: Shi T
Published: October 2019

Background

Limited data is available regarding racial disparities in patients admitted for acute pulmonary embolism.

Purpose

We aimed to examine the impact of racial differences on outcomes in patients admitted for acute pulmonary embolism.

Methods

We used the Nationwide Inpatient Sample, which represents 20% of community hospital discharges in the US, to identify adult patients who were discharged with the primary diagnosis of acute pulmonary embolism in 2016 with ICD-10 codes. Logistic regression analysis and linear regression analysis were used to compare patients with different races. Outcomes were focused on in-hospital mortality, total cost, length of stay and disposition, adjusting gender, age, Charlson comorbid index and socioeconomic variables.

Results

In 2016, 35,526 patients were admitted with a primary diagnosis of acute pulmonary embolism. White patients were more likely to be older and with higher income. After adjusting for the above variables, white patients had lower total cost of hospitalization (p<0.0001), shorter length of stay (p<0.0001), lower in-hospital mortality (adjusted odds ratio = 0.79, p=0.001), and more likely to be discharged to rehabilitation facilities compared to being discharged home.

Outcomes in white vs non-white patients

Conclusion

Among acute pulmonary embolism hospitalizations, white patients generally had better outcomes despite being older in age, and were more likely to be transferred to rehabilitation facilities after discharge.
P2814The long-term patterns of red blood cell transfusion and outcome in patients undergoing percutaneous coronary intervention - a Korean nationwide longitudinal cohort study
Authors: Choi J.-M , Choi J.-H , Jang Y.-J , Song N.-R , Lee S.-H , Lee J.-M , Park T.-K , Yang J.-H , Song Y.-B , Hahn J.-Y , Choi S.-H , Gwon H.-C , Lee S.-H , Kang M.-R
Published: October 2019

Aims

Transfusion long after percutaneous coronary intervention (PCI) may pose a significant risk but is not sufficiently understood. We investigated the long-term patterns and impact of transfusion on the clinical outcome of patients undergoing PCI.

Methods and results

Five-year clinical outcomes of all Korean undergoing PCI using stent in year 2011 (n=48786) were investigated. Primary outcome was the incidence density of transfusion. The association of transfusion with major adverse clinical event (MACE) consisting all-cause death, revascularization, critically ill cardiovascular status, or stroke was assessed after reflecting the propensity of each patient for transfusion and adjusting transfusion frequency and intervals. The 5-year incidence density of transfusion was 4.74 (95% confidence interval [CI] = 4.70–4.79) per 100 person-year. Patients who received transfusion were older, were more often women, and had overall higher frequency of clinical risk factors (p<0.001, all). Transfusion was associated with MACE (hazard ratio [HR] = 3.0, 95% CI = 2.9–3.1, p<0.001) and with death, revascularization, critically ill cardiovascular status, and stroke (HR from 1.6 to 6.5, p<0.001, all). The period of transfusion coincided with the period of highest MACE incidence density and all other clinical events. Subgroup analyses classified by clinical characteristics showed consistent results.

Year of transfusion and outcome

Conclusions

One out of every 4 Koreans undergoing PCI received transfusion within 5 years, and had 3-fold higher risk of MACE compared to patients without transfusion. These observational findings may warrant the establishment of transfusion strategies for patients undergoing PCI.
P2827Different views of sudden cardiac arrest characteristics according to the assessed population
Authors: Karam N , Bougouin W , Waldmann V , Dumas F , Jost D , Lamhaut L , Beganton F , Gandjbakhch E , Algalarrondo V , Aissaoui N , Geri G , Loeb T , Cariou A , Jouven X , Marijon E
Published: October 2019

Background

Survival rate remains extremely low in sudden cardiac arrest (SCA) and death may occur at all stages of its management. We hypothesized that different medical care providers have different visions of the SCA population characteristics.

Purpose

To assess SCA characteristics among four groups: all-comers SCA, resuscitated SCA, SCA admitted alive to intensive care unit (ICU), and SCA admitted to cardiology.

Methods

Data was taken from the Paris Sudden Cardiac Death Expertise Center prospective registry that includes all adults presenting SCA in Paris and suburbs (6.7 millions). We compared SCA characteristics according to the management phase where the population was assessed.

Results

Of 18,622 out-of-hospital cardiac arrests occurring between 2011 and 2016, 15,207 fulfilled SCA criteria and had known resuscitation status. Among them, 9,721 SCA (63.9%) underwent resuscitation, leading to 3,349 SCA (22.0%) admitted to ICU, then 735 (4.8%) admitted to Cardiology. Mean age was highest in the global population (70.7yrs), and decreased progressively throughout the phases to 57.0yrs in cardiology (P<0.001). Ratio of male victims and rates of witnessed SCA and bystanders' cardiopulmonary resuscitation and automated external defibrillator use increased gradually (all P<0.001). No flow duration decreased by a third (9.1min overall to 3.0min in cardiology, P<0.001). The rate of shockable initial rhythm increased drastically, from 19.5% overall to 26.8% in resuscitated patients, 48.9% in ICU-admitted SCA, and 89.4% in cardiology-admitted (Table).

Sudden cardiac arrests characteristics Entire SCA population SCA with attempted resuscitation SCA admitted to ICU SCA admitted to Cardiology P value n=15,207 n=9,721 n=3349 n=735 Age (years ± SD) 70.7±16.9 65.8±16.1 59.7±15.7 57.0±14.5 <0.001 Male sex, n (%) 9,353 (61.6) 6607 (68.0) 2395 (71.5) 599 (81.5) <0.001 Home location, n (%) 12,297 (81.1) 7075 (73.0) 1906 (56.9) 269 (36.6) <0.001 Bystander, n (%) 10,546 (71.2) 7545 (78.7) 3037 (90.7) 715 (97.3) <0.001 Bystander CPR, n (%) 5,684 (39.1) 4504 (47.7) 2120 (63.5) 583 (81.2) <0.001 Public AED use, n (%) 155 (1.0) 142 (1.5) 116 (3.5) 51 (6.9) <0.001 No flow, (min ± SD) 9.1±12.5 7.5±10.4 5.3±6.6 3.0±3.8 <0.001 EMS call-to-arrival delay, (min ± SD) 10.2±5.8 10.1±5.7 10.1±6.1 9.6±6.4 0.068 Initial Shockable rhythm, n (%) 2,643 (19.5) 2529 (26.8) 1635 (48.9) 657 (89.4) <0.001 SCA: sudden cardiac arrest; AED: automated external defibrillator; CPR: cardiopulmonary resuscitation; EMS: emergency medical service; ICU: intensive care unit.

Conclusion

Characteristics of SCA change considerably according to the assessed population, leading to different views on SCA reality. Keeping in mind the SCA population considered is paramount for a non-biased view of SCA.