bluuebunny/crossref_metadata_2025 huggingface dataset:
P3742Transcatheter aortic valve implantation in large annuli: incidence and predictors of specific adverse events with the largest self-expanding device
Authors: Veulemans V , Hellhammer K , Maier O , Klein K , Afzal S , Piayda K , Jung C , Westenfeld R , Kelm M , Zeus T
Published: October 2019

Background

The recently released largest self-expanding transcatheter aortic valve device (STHV-34) is characterized by good results but nevertheless demands an experienced team for the implantation in large annuli.

Purpose

Looking at multi slice computed tomography (MSCT) and procedural data, we tried to identify characteristics that could explain intraprocedural VARC-2 and valve specific non-VARC-2 events.

Methods

We performed a single center retrospective analysis in 80 patients treated with STHV-34. STHV-34 patients were separated into subjects without events (NE, n=43, 54%) and the following adverse events: resheathing/-capture processes (RS/C, n=19, 24%), valve dislodgments (VD, n=21; 26%), infolding (IF, n=6, 8%) and complete dislocation with bail-out valve-in-valve implantation (ViV, n=3, 4%). Events were further categorized in non-VARC-2 and VARC-2. The analysis sought for underlying anatomical conditions and defined risk factors by multivariate analysis.

Results

Primary device success was reached in 96% and immediate postprocedural absence of moderate-to-severe aortic regurgitation was 100%. We identified specific anatomical conditions predisposing for non-VARC-2 and VARC-2 events: RS/C: annular calcium load<1600 AU (OR 47 [CI 1.4–216], p=0.0004). IF: peripheral kinking (RR 5.0 [CI 1.0–24], p=0.0478) and previous RS/C maneuvers (83%). ViV: annular ellipticity index (NS 1.2±0.1 vs. ViV 1.4±0.1, p=0.0049), aortic angulation (AA) angle (NS 54.0±7.0° vs. ViV 61.7±1.5°, p=0.0240) and LVOT-AO angle (NS 149.1±18.9° vs. ViV 130.3±3.5°, p=0.0470).

Conclusion

We confirm high procedural success for the largest currently available STHV-34. The incidence of intraprocedural non-VARC-2 and VARC-2 events are associated with anatomical characteristics that may influence valve selection and implantation strategy.
P3759Comparison of equations for renal function assessment and major adverse outcomes in atrial fibrillation: an analysis from the EORP-AF long-term general registry
Authors: Boriani G , Proietti M , Laroche C , Fantecchi E , Popescu M , Marin F , Maggioni A P , Lip G Y H
Published: October 2019

Background

Several equations exist to estimate creatinine clearance according to serum creatinine values and baseline characteristics. The CKD-EPI equation is usually recommended in general population, while the Cockroft-Gault (CG) equation has been used in atrial fibrillation (AF) clinical trials.

Purpose

To perform a comparison between 6 different equations for evaluation of renal function in AF patients.

Methods

We calculated CKD-EPI, CG, body surface area adjusted CG (CG BSA), MDRD, BIS1 and FAS equations in AF patients enrolled in the EORP-AF Long-Term General Registry. Outcomes at 1-year follow-up were considered.

Results

Renal equations were calculated in 7725 patients. According to CKD-EPI mean (SD) creatinine clearance was 69.14 (21.06) mL/min/1.73 m2. Taking CKD-EPI as reference, the MDRD equation showed the highest agreement (weighted kappa [95% CI]: 0.843 [0.833–0.852]), while CK showed the lowest agreement (weighted kappa [95% CI]: 0.593 [0.580–0.606]. The remaining equations showed moderate agreement. Cox regression analysis showed that all equations were inversely associated with all major adverse outcomes [Figure]. The CKD-EPI equation showed modest predictive ability for the three outcomes (c-statistics: any TE/ACS/CV Death: 0.63379; CV Death: 0.68512; All-Cause Death: 0.67183), with all other equations reporting higher c-statistics (delta-c statistic ranging from +0.01497 for FAS equation for any TE/ACS/CV Death to +0.04547 for CG BSA for all-cause death) for all outcomes (all p<0.0001, for any equation for any outcome). Compared to CKD-EPI, all the other equations showed an improvement in prediction of outcomes, according to IDI and NRI, with the exception of FAS equation for any TE/ACS/CV Death. CG BSA equation showed the greatest improvement in prediction of outcomes compared to CKD-EPI (relative IDI: 21.9% for any TE/ACS/CV Death, 28.8% for CV Death, 34.4% for All-Cause Death).

Cox Regression Analysis

Conclusions

Compared to CKD-EPI equation, all the other equations for creatine clearance has stronger associations with adverse outcomes, with the CG BSA reporting the higher yield for all the outcomes considered.
P3762The impact of type and burden of atrial fibrillation on stroke occurrence in patients with atrial fibrillation: from a prospective cohort of atrial fibrillation patients (CODE-AF Registry)
Authors: Cho S , Kim T , Uhm J , Cha M , Lee J , Park J , Park J , Kang K , Shim J , Kim J , Park H , Choi E , Kim J , Lee Y , Joung B
Published: October 2019

Background and purpose

Although several studies reported that stroke risk in patients with paroxysmal atrial fibrillation (AF) is similar to those with persistent or permanent AF, there is still controversy on the relationship of AF type and stroke occurrence. We investigated the effect of AF type on AF burden and stroke risk in patients with non-valvular AF.

Methods

Within the CODE-AF prospective, outpatient registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation), we identified 8,883 patients ≥18 years of age with non-valvular AF and eligible follow-up visits. We compared AF burden and stroke risk among patients with 3 types of AF: paroxysmal (n=5,808) or persistent (n=2,806) or permanent (n=269).

Results

The median age of the overall population was 68.0 (interquartile range, 60.0–75.0); 36.0% were female. Patients with persistent and permanent AF were older and had higher CHA2DS2-VASc scores and anticoagulation rate than those with paroxysmal AF. Compared with permanent AF (5.2±16.4%), the arrhythmic burden of AF on 24hrs Holter monitoring was significantly lower in paroxysmal AF (2.1±7.2%, p<0.001) and persistent AF (2.0±7.5%, p<0.001). During median follow-up period of 1.38 years (interquartile range: 0.96–1.67), total 82 (0.92%) patients experienced ischemic stroke with incidence rates of 0.51, 1.04 and 1.69 events per 100 person-years for paroxysmal, persistent and permanent AF, respectively. Compared with paroxysmal AF, the risk of ischemic stroke was increased in persistent AF with clinical variable adjusted hazard ratio (aHR) of 1.94 (95% confidence intervals [CI], 1.23–3.07; P=0.005) and permanent AF with aHR of 2.64 (95% CI, 1.09–6.41; P=0.03).

AF type and HR of stroke occurrence Paroxysmal (n=5,808) Persistent (n=2,806) Permanent (n=269) Stoke events 39 37 6 Person years (PYs) 7673 3544 356 /100 PYs 0.51 1.04 1.69 HR (95% CI), p-value HR (95% CI), p-value HR (95% CI), p-value Unadjusted HR 1 (Reference) 2.05 (1.27–3.31), 0.003 3.32 (1.15–7.90), 0.02 Clinical variables adjusted HR 1 (Reference) 1.94 (1.23–3.07), 0.005 2.64 (1.09–6.41), 0.03 PYs: Person years; HR: Hazard ratio.

Conclusion

Persistent and permanent AF was associated with the increased risk of stroke than paroxysmal AF, after adjustment of clinical variables including age, sex, comorbidities and anticoagulation rate. These results suggest that AF type and burden might be related with the risk of ischemic stroke and should be considered in the stroke prevention of AF.
P3766New-onset peri-operative atrial fibrillation is associated with increased mortality in patients undergoing total knee and hip replacements
Authors: Varon B , Kandel L , Rivkin G , Leibowitz D
Published: October 2019

Background

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgeries performed in elderly patients with osteoarthritis. Limited data address the clinical significance of peri-operative atrial fibrillation (AF) in these patients.

Purpose

This study aimed to determine whether pre-existing or new onset AF is associated with increased 1-year mortality rates.

Methods

280 patients over the age of 60 undergoing THA or TKA with peri-operative AF and 280 control matched patients were retrospectively identified, and their files reviewed. The primary endpoint was 1-year mortality from the date of the surgery.

Results

Of the 280 patients with peri-operative AF, 37 had new onset AF with a 1-year mortality rate of 10.8%. This mortality was significantly higher in patients with new-onset AF compared to patients without AF or patients with previous AF (10.8%, vs. 1.1% and 2.5%, respectively; p=0.005). On multivariate analysis, this difference remained significant after adjustment for risk factors associated with mortality.

Variables associated with mortality Characteristic P value Adjusted Odds Ratio 95% confidence interval When AF type is included:   Chronic renal failure 0.004 7.64 1.91–30.64   Timing of AF (New onset) 0.005 9.95 1.99–49.77 When AF timing is included:   Chronic renal failure 0.005 7.47 1.83–30.40   Timing of AF (post-op) 0.0.1 7.59 1.62–35.62 AF, atrial fibrillation.

Conclusion

One-year mortality in elderly patients undergoing TKA or THA is significantly increased in patients with new postoperative AF. These patients warrant increased clinical surveillance following surgery.
P3775Income level is associated with risk of adverse events in patients with atrial fibrillation
Authors: Liao J.-N , Chao T F , Chen S A
Published: October 2019

Background

Atrial fibrillation (AF) increases the risk of cardiovascular events, major bleeding, and all-cause mortality. Risk factors for adverse events in AF patients have been identified, but data regarding the effect of income level were limited.

Methods

From the year 2010 to 2015, a total of 185,052 patients with AF aged ≥20 years were identified from the “National Health Insurance Research Database” in Taiwan and 169,450 of them had a CHA2DS2-VASc score ≥1 (for males) or ≥2 (for female). Among them, income data were available in149,489 patients and these subjects constituted our study population. Patients were classified into low-, intermediate- and high-income group. The baseline characteristics were analyzed. Subgroup analysis (low income versus high income; intermediate versus high income) was done using matched populations. The end-points include all-cause mortality, ischemic stroke, intracerebral hemorrhage (ICH), major bleeding and composite outcomes (any of mortality, ischemic stroke or ICH)

Results

Compared to the low-income group, patients in intermediate- and high-income groups were younger and had less underlying diseases. Besides, the percentage of anticoagulant use increased with income levels. The annual incidences of mortality, stroke, ICH, major bleeding and composite outcome increase with the decrease of income. Multi-variate Cox regression analysis showed that higher income was significantly associated with a lower risk of adverse events. The observations that high income conveys a lower risk remained consistent after matched subgroup analysis. (Figure) Compared to low-income group, the high-income group had a decreased risk of ischemic stroke by 18%, ICH by 22.5%, major bleeding by 16.4%, mortality by 44.4%, and composite outcome by 33.7%.

Incidence and hazard ratio

Conclusions

Income levels were associated with the risk of adverse events in AF patients and should be taken into account when taking care of AF patients.
P3779NT-proBNP adds incremental predictive information on incident atrial fibrillation in patients with asymptomatic aortic stenosis
Authors: Bang C N , Greve A M , Boman K , Egstrup K , Olsen M H , Kober L , Nienaber C A , Ray S , Rossebo A M , Nielsen O W , Willenheimer R , Wachtell K
Published: October 2019

Background

Incident atrial fibrillation (AF) marks an adverse shift in the prognosis of patients with aortic stenosis (AS). Identifying risk factors for AF is therefore of paramount importance for timely intervention in patients with AS. In patients without AS, brain natriuretic peptides (BNP) is a well-established biomarker for left ventricular pressure overload on the pathway to heart failure and atrial fibrillation. However, a potential role of NT-proBNP to predict risk of new-onset AF in asymptomatic patients with mild to moderate AS is not well studied.

Methods

We included 1,434 patients with mild to moderate AS from the SEAS Study (Simvastatin and Ezetimibe in Aortic Stenosis) without AF or clinically overt heart failure at baseline. The primary endpoint for this substudy was time to incident AF, as determined by the first annual in-study 12-lead ECG with AF. Multivariable Cox model were adjusted for other important predictors of incident AF as selected by Bayesian statistics. Fine and Gray competing risk regression was used to evaluate the influence of all-cause mortality on selected predictor variables of incident AF.

Results

During a median follow-up of 4.3 years (range 0.1–6.9 years), incident AF occurred in 114 (6.1%) patients (13.8 per 1,000 person-years of follow-up), who at baseline were older (69±10 vs. 67±10 years, p<0.001), had larger systolic left atrial diameter (46±24 vs. 34±18 mm, p<0.001) and higher NT-proBNP level (286 [132; 613] vs. 154 [82; 297] pg/ml, p<0.001); but same left ventricular ejection fraction (66±6 mm vs. 67±6, p=0.4). In multivariable Cox regression, adjusted for age, circumferential end-systolic stress, left atrial volume and ECG PR interval, Ln(NT-proBNP) was associated with higher risk of new-onset AF (HR: 1.9 [95% CI: 1.6–2.3], p<0.001). Similar results were found when using Fine and Gray estimates with all-cause mortality (HR: 2.0 [95% CI: 1.7–2.4], p<0.001 (Figure, panel A). NT-proBNP level added incremental predictive information on incident AF over the other important, as selected by Bayesian statistics, predictor variables (C-index 0.81, p<0.001, Figure, panel B). There was no interaction with aortic valve area (p>0.05).

Figure 1

Conclusions

In patients with asymptomatic aortic stenosis and sinus rhythm at baseline, NT-proBNP levels were significantly higher in patients who subsequently developed AF. NT-proBNP significantly improved prognostic information of incident AF over other important predictor variables. This supports the notion that incident AF is a marker of left ventricular pressure overload and possibly a novel marker of timely intervention with aortic valve replacement.
P3792The impact of elective cardioversion for atrial fibrillation in heart failure patients
Authors: Graby J , Carpenter A , Medland R , Brown S , Sowerby C , Priestman L , Dayer M , Furniss G
Published: October 2019

Introduction

Severe left ventricular systolic dysfunction (LVSD) is associated with worse outcomes in heart failure (HF) patients. Persistent atrial fibrillation (AF) is common in this patient group. As part of a nurse-led cardioversion service at a district general hospital we assessed the impact of elective cardioversion (DCCV) for AF in patients with LVSD on their ejection fraction (EF), and compared outcomes in patients selectively pre-treated with amiodarone for their DCCV.

Methods

A retrospective analysis was undertaken of DCCV for AF over 5 years, recording demographic, medication, serial echocardiogram (TTE), and outcome data. Significant LVSD was classified as moderate (ejection fraction [EF] 35–45%) or severe (EF<35%). All patients treated with amiodarone had baseline and serial thyroid, liver, renal function monitored, were counselled on side effects and followed up.

Results

103 patients with significant LVSD and follow-up TTE underwent DCCV, with a median age of 66 (IQR 58–73) and mean CHA2DS2-VASc 2.5. Overall mean baseline EF was 30% (SD ±11), overall follow-up EF (regardless of repeat TTE rhythm) was 42% (SD ±12), and the mean delta EF +12% improvement (SD ±11). At follow-up TTE, 66% (68/103) of patients were in sinus rhythm (SR) and 34% (35/103) in AF. 62/68 (91%) patients in SR at follow-up TTE were also treated with HF medications, vs 33/35 (94%) of those in AF. 61/68 (90%) of patients in SR at follow-up TTE had any improvement in EF vs 21/35 (60%) patients in AF (p=0.0007). For patients in SR the mean baseline EF was 31% (SD ±10) and mean follow-up EF 47% (SD ±9), vs the AF at repeat TTE patients' mean baseline EF 27% (SD ±12) and mean follow-up EF 35% (SD ±13). The mean delta EF of patients still in SR at follow-up scan was 15% (SD ±10) vs 8% (SD ±11) for patients who had reverted to AF (p=0.0004). Prior analysis of our data-set including patients awaiting repeat TTE demonstrated a significant improvement in 6 month AF recurrence rate.

Table 1. Comparing outcomes with amiodarone pre-treatment for patient with follow-up EF data Acute DCCV Success Mean Baseline EF Mean Repeat EF Mean Delta EF AF Recurrence to 6 months Amiodarone 17/17 (100%) 29% (SD 11) 45% (SD 11) 15% (SD 13) 6/17 (35%) No Amiodarone 80/86 (93%) 30% (SD 11) 42% (SD 12) 12% (SD 10) 50/86 (58%) P value 0.59 0.22 0.11

Conclusion

Restoration of SR in a cohort of patients with AF, severe LVSD, on good medical therapy significantly improves left ventricular EF. This reinforces the importance of maintaining SR for HF patients. There was also a trend towards improved medium term outcomes in patients pre-treated with amiodarone. Further study into long-term rhythm control and ablation outcomes is needed.
P3833Low heart rate variability is associated with future arrhythmic events in hypertension
Authors: Terentes-Printzios D , Vlachopoulos C , Korogiannis L , Christopoulou G , Xydis P , Ioakeimidis N , Aznaouridis K , Dima I , Georgakopoulos C , Tousoulis D
Published: October 2019

Background/Introduction

Cardiac autonomic dysfunction and target organ damage are associated with increased cardiovascular mortality and arrhythmias.

Purpose

The aim of the study was to investigate the effect of heart rate variability (HRV) and markers of target organ damage in the prognosis of future arrhythmic events.

Methods

We studied 292 untreated at baseline hypertensives (mean age 53±13, 153 males). Cardiac autonomic function was evaluated by analysis of short-term HRV measures over 24-h using 24-h ambulatory blood pressure monitoring and the standard deviation of the measurements. Echocardiography was also performed and left ventricular mass index (LVMI) was estimated with the Demereux formula. Aortic stiffness was assessed with carotid-femoral pulse wave velocity (cfPWV) and wave reflections with aortic augmentation index corrected for heart rate (Alx@75). Patients were followed up for a median period of 13 years. The primary endpoint was a composite of atrial/ventricular tachycardias, symptomatic multiple premature ventricular contractions, second and third-degree heart blocks and pacemaker/defibrillator placement.

Results

In comparison without events, patients with the primary endpoint (n=37, 13%) had lower 24-h daytime HRV (9.6 beats per minute vs. 11.1 beats per minute, p=0.005), higher systolic blood pressure (168 mmHg vs. 163 mmHg, p=0.003), higher cfPWV (8.4 m/s vs. 7.7 m/s, p=0.005), higher LVMI (133 g/m2 vs. 122 g/m2, p=0.002) and higher AIx@75 (29.0% vs. 26.3%, p=0.043). In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of HRV, cfPWV, LVMI and AIx@75 to discriminate subjects with arrhythmic events. The area under the curve (AUC) and 95% CIs of the ROC curves were AUC=0.35 (95% CI: 0.26–0.44, p=0.003) for HRV, AUC=0.64 (95% CI: 0.54–0.73, P<0.006) for cfPWV, AUC=0.67 (95% CI: 0.58–0.75, P=0.001) for LVMI and AUC=0.55 (95% CI: 0.47–0.64, P=0.298) for AIx@75 (Figure). In Cox regression analysis, only HRV was associated with increased risk of arrhythmic events (Hazard ratio per 1 unit =0.87, 95% Confidence intervals 0.76 to 0.995, p=0.043) when adjusted for age, gender, cfPWV, LVMI and AIx@75.

ROC curves of HRV & target organ damage

Conclusions

Low heart rate variability is associated with increased risk of future arrhythmic events suggesting an early sympathovagal imbalance that could lead to future events in hypertension.
P3846The association between statin prescription, recurrent venous thromboembolism and bleeding events: from the COMMAND VTE Registry
Authors: Yoshikawa Y , Yamashita Y , Mabuchi H , Morimoto T , Amano H , Takase T , Hiramori S , Kim K , Oi M , Kobayashi Y , Toyofuku M , Tada T , Murata K , Sakamoto J , Kimura T
Published: October 2019

Background

Statin prevents occurrence and recurrence of atherosclerotic events. With regard to venous thromboembolism (VTE), a randomized controlled trial suggested that statin reduced occurrence of VTE, whereas its usefulness as secondary prevention of VTE remains to be elucidated.

Purpose

This study aimed to assess the association between statin prescription, recurrent VTE and bleeding events in patients with VTE.

Methods

The COMMAND VTE Registry is a multicentre registry enrolling consecutive 3027 patients with acute symptomatic VTE among 29 centres in Japan. We divided the cohort into the patients who were prescribed statin (N=437) and those not (N=2590), and compared the two groups. We assessed hazard ratios (HRs) of those with statin relative to those without for long-term clinical outcomes (recurrent symptomatic VTE and International Society of Thrombosis and Hemostasis [ISTH] major bleeding). Because the durations of anticoagulation therapy were widely different between the two groups, we constructed Cox's proportional hazard model incorporating status of anticoagulation during the follow-up period as a time-varying covariate. Also, because the incidences of death were strikingly different between the two groups due to the difference in the prevalence of active cancer, we used Fine-Gray's subdistribution hazard model in the presence of competing risks. We incorporated clinically relevant factors into these two models as covariates (10 factors for recurrent VTE and 11 for major bleeding).

Results

The statin group was significantly older than the non-statin group (statin 71.2±11.8 vs. non-statin 66.5±15.8, P<0.001). The prevalence of active cancer in the statin group was less than one-half of that in the non-statin group (12% vs. 25%, P<0.001), and the cumulative 3-year incidence of death was significantly lower in the statin group than in the non-statin group (12.8% vs. 26.1%, log-rank P<0.001). The table shows the adjusted HRs of the statin group relative to the non-statin group. The HRs of the statin group relative to non-statin group for recurrent VTE were significantly low, but those for major bleeding were insignificant.

Adjusted hazard ratios Outcome measures Model 1 P value Model 2 P value Adjusted HR [95% CI] Adjusted HR [95% CI] Recurrent VTE 0.59 [0.36–0.98] 0.042 0.53 [0.32–0.89] 0.02 Major bleeding 0.87 [0.60–1.24] 0.43 0.997 [0.69–1.43] 0.99 Model 1 derived from Cox's model with time-varying covariate of anticoagulation status. Model 2 derived from Fine-Gray's model.

Study flowchart

Conclusions

Prescription of satin was associated with significantly low risks for recurrent VTE, whereas that was not for major bleeding events. Statin could be a potential treatment option for secondary prevention of VTE.
P3849Baseline profile of patients treated for acute venous thromboembolism in routine clinical practice according to age and renal function in the RE-COVERY DVT/PE global cohort study
Authors: Ageno W , Casella I B , Han C K , Schellong S , Schulman S , Singer D E , Desch M , Tang W , Voccia I , Zint K , Goldhaber S Z
Published: October 2019

Background

Observational studies provide the opportunity to evaluate routine practice without the selection and treatment criteria imposed in randomized clinical trials (RCTs).

Purpose

Using data from the RE-COVERY DVT/PE global observational study (enrolment January 2016 to May 2017), we describe the baseline profile of patients treated for acute venous thromboembolism (VTE) in routine clinical practice according to age and renal function.

Methods

Baseline patient characteristics, clinical features (comorbidities/medical history), and anticoagulant therapy were tabulated descriptively for the subgroups of age (<75, ≥75 years) and creatinine clearance (<30, 30 to <50 [moderate impairment], 50 to <80 [mild impairment], ≥80 mL/min). Anticoagulant therapy at baseline and at hospital discharge or 14 days after diagnosis (whichever was later) was recorded.

Results

In this observational study of 6122 patients with acute deep vein thrombosis, the proportions of patients at baseline who were ≥75 years of age (25.2%) or who had mild to moderate renal impairment (38.1%) were higher than in RCTs of non-vitamin K antagonist oral anticoagulants (NOACs) for acute VTE treatment (∼12–13% elderly and ∼26–29% with mild or moderate renal impairment) (from analyses of the RE-COVER trials; Hokusai-VTE and AMPLIFY). Older patients and those with renal impairment were more often female and were more likely to have comorbidities than the younger or normal renal function groups (Table). At the time of hospital discharge or 14 days after diagnosis, whichever was later, the majority was treated with NOACs (54%). Vitamin K antagonists were prescribed to approximately 1 in 5 patients. The use of NOACs decreased with worsening renal function, whereas the proportions treated with parenteral anticoagulation alone increased in the moderate renal impairment group compared with patients with normal renal function.

Conclusion

The population treated for acute VTE in routine clinical practice includes more elderly and renally impaired patients than represented in RCTs. These baseline data provide a snapshot of patient characteristics and patterns of anticoagulant therapy.

Acknowledgement/Funding

Funded by Boehringer Ingelheim
P3859Stroke after transcatheter aortic valve implantation: an unpredictable risk?
Authors: Maier O , Bosbach G , Hellhammer K , Zeus T , Kelm M , Veulemans V
Published: October 2019

Background

Transcatheter aortic valve implantation (TAVI) has become the preferred alternative to surgical valve replacement in high risk patients with severe symptomatic aortic stenosis. Stroke is still a feared complication following TAVI, associated with increased mortality and severe impact on patients' daily living. Despite technological development and knowledge improvement, cerebrovascular events (CVE) are still not predictable so far and simple risk scores are lacking. The expansion of TAVI therapy towards younger and lower risk populations will force us to discover the mechanisms determining stroke after TAVI.

Purpose

This study aimed to evaluate different patient and procedure related factors for prediction of stroke after TAVI, especially regarding severity of aortic calcification.

Methods

From May 2011 to January 2018 a total of 1365 patients underwent TAVI with a balloon-expandable (32.4%) or self-expandable (67.6%) valve at our institution. 60 patients (4.4%) suffered from new neurological impairment in terms of CVE after TAVI during hospital stay (mean 11.2±6.7 days). We performed propensity score matching (1:10) to balance baseline characteristics between patients with and without stroke following TAVI, resulting in 56 patients with in-hospital stroke and 521 patients without neurological disorder. Stroke was defined according to the Valve Academic Research Consortium recommendations (VARC-2).

Results

Body surface area (stroke vs. control: 2.73±0.27 vs. 2.81±0.29 m2; p=0.0451) and prior stroke (stroke vs. control: 17.86% vs. 8.64%; p=0.0256) were patient related predictors of stroke after TAVI during in-hospital stay. While aortic valve Agatston score (stroke vs. control: 2475±1593 vs. 2060±1344 AU; p=0.0383) and ascending thoracic aorta Agatston score (stroke vs. control: 986.5±1989 vs. 505.2±1018 AU; p=0.0045) showed to be good predictors, peripheral vascular diseases were not associated with stroke (stroke vs. control: 35.7% vs. 31.3%; p=0.4986). A procedural predictor of acute CVE was extended procedure time (stroke vs. control: 101.8±39.6 vs. 90.0±31.3 hours; p=0.0105). Finally, stroke after TAVI resulted in clearly prolonged hospital stay (stroke vs. control: 16.1±9.0 vs. 10.7±6.2 days; p<0.0001).

Conclusion

The severity of aortic valve and ascending thoracic aorta calcification predicts stroke after TAVI as well as extended procedure time, possibly due to increased mechanical intravascular manipulation by prolonged catheterisation. These correlations could guide us in identifying those patients who are most likely to benefit from transcatheter cerebral embolic protection devices.
P4126Safety of magnetic resonance imaging in patients with non-conditional cardiac implantable electronic devices: A systematic review and meta-analysis
Authors: Padmanabhan D , Farwati M , Izath A , Al-Masry A , Kella D , Gamero S , Barout A , Assaf Y , Shetty D , Asirvatham S , Felmlee J , Watson R , Cha Y.-M , Friedman P
Published: October 2019

Recent guideline statements approve the performance of magnetic resonance imaging (MRI) in patients with non-conditional cardiac implantable electronic devices (CIEDs) under certain closely monitored conditions. Data from current registries may have lower power to discern changes that may occur in the CIED after the MRI.

Objective

We aimed to systematically review the literature to identify the adverse events and significance of changes in device function associated with performing MRI in patients with CIEDs

Methods

A comprehensive literature search of the databases was performed between 1980- 2017. Two independent reviewers selected studies and extracted data. A random-effects model was used for meta-analysis.

Results

A total of 7,422 patients underwent 8,865 MRI studies. No death occurred post MRI. Clinical adverse events were extremely rare (mostly less than 1%) and are summarized in Table 1. No significant changes in the pooled mean effect size estimate was noted for the changes in the lead parameters (pacing threshold, sensing and impedance)

Binary outcomes post magnetic resonance imaging in patients with non-conditional cardiac implantable electronic devices Outcome Sample size Number of patients Rate SE LL of CI UL of CI Death 7401 0 0 0 0 0 Atrial arrhythmia 7173 10 0.001 0.0004 0.0007 0.0024 Ventricular arrhythmia 7371 9 0.0012 0.0004 0.0006 0.0022 Oversensing 4981 17 0.0034 0.0008 0.0020 0.0053 Inhibition of pacing 7371 6 0.0008 0.0003 0.0003 0.0016 Lead Failure/Generator Failure 7475/7475 2/8 0.0002/0.0011 0.0001/0.0004 0.0001/0.0005 0.0009/0.002 Power on Reset 1388 105 0.0131 0.0014 0.0107 0.0161 Did not complete scan 6851 13 0.0019 0.0005 0.0011 0.0031 Chest pain 7080 11 0.0021 0.0004 0.0008 0.0027. Lead threshold rise (>0.5v/>50%-A/V) 5076/6246 12/16 0.0024/0.0026 0.0007/0.0006 0.0013/0.0015 0.0040/0.0041 Change in Battery voltage >0.04V 7132 42 0.0061 0.0009 0.0043 0.0079 Sensing decrease >50%-A/V 5087/5834 17/9 0.0033/0.0015 0.0008/0.0005 0.0020/0.0008 0.0052/0.0028 Impedance changes >50ohms/>50% 5810 22 0.0038 0.0008 0.0024 0.0057 Rise in cardiac enzymes 1703 26 0.0152 0.0030 0.0102 0.0219 A, atrial; V, ventricular; SE, standard Error; LL, lower limit; UL, upper limit; CI, Confidence intervals.

Conclusions

MRI in patients with non-conditional CIEDs can be performed with high degree of safety and low rate of clinical events when performed under standardized protocols

Acknowledgement/Funding

None
P4130Age-related changes in pulmonary artery flow measured by non-invasive cardiac magnetic resonance imaging
Authors: Agoston Vas Coldea L N , Muresan I , Mocan T
Published: October 2019

Background

Ageing, a major cardiovascular risk factor, is associated with increased arterial stiffness. The evaluation of physiological changes of the pulmonary artery (PA) wall in healthy subjects of different ages may be relevant in clinical practice. The aim of the present study was to investigate age-related changes of PA flow and elasticity by phase-contrast cardiovascular magnetic resonance (PC-CMR) in a population of patients without cardiovascular disease.

Methods

Nightly, apparently healthy subjects (20 to 70 years old, 58 males), underwent velocity-encoded CMR of the PA using a 1.5T system. The assessment of the PA flow and the arterial stiffness, using phase-contrast cardiovascular magnetic resonance (PC-CMR), was made non-invasively, by subtracting simultaneous forward flow and reversed flow velocity in the main PA. Data were divided in 2 groups, one with the subjects <45 years and the other >45 years. Comparisons were made between the young one (≤45 years, n=49) and the older subjects (>45 years, n=41).

Results

PA area increased significantly with age. Reversed flow volume and peak velocity also increased; the time until the start of reversed flow was shortened as age increased (p<0.01), while global flow and forward flow parameters remained unchanged. Ratio of peak velocity reversed flow to forward flow was strongly related to both age and arterial stiffness. A multivariate analysis was performed, in order to establish the correlation between PA stiffness and reversed flow parameters, adjusted for age, gender and body surface area. The independent variables of the peak velocity reversed flow reversed flow were age, PA diameter, right ventricular ejection fraction and right ventricular mass.

Conclusion

PA reversed flow parameters, including peak velocity flow and volume, measured by PC-CMR, increase significantly and show up earlier with ageing. Therefore, this assessment could be used in finding relevant markers of subclinical vascular aging.
P4138Clinical differences between methamphetamine and non-methamphetamine associated non-ischemic dilated cardiomyopathy
Authors: Reddy P , O'meara K , Patel S , Chau E , Banayan A , Ng T , Elkayam U
Published: October 2019

Background

Methamphetamine associated cardiomyopathy (MACM) is an increasingly recognized form of dilated cardiomyopathy around the globe which remains poorly characterized.

Purpose

To compare the clinical characteristics of MACM to those of non-MA associated dilated CM (NMACM).

Methods

Consecutive patients with MACM presenting to our institution between Jun 2018 and Jan 2019 were prospectively studied and compared to an age and gender-matched cohort of dilated non-ischemic CM cases.

Results

Seventy patients were studied (35 MACM and 35 NMACM). Mean age was similar between groups (49±9 vs. 48±10 years, p=0.465) and 97% of patients were male. Median duration of MA use prior to cardiomyopathy diagnosis was 5 years (range 0–30). Patients were predominantly Hispanic in both groups (48% vs. 62%, p=0.229), but with a greater proportion of Caucasians in the MACM group compared to NMACM (26% vs 6%, p=0.045).MACM was characterized by lower left ventricular ejection fraction (LVEF) and greater left ventricular end diastolic volume (LVEDV) compared to NMACM. RV dilation was present more often in MACM cases (Table). Years of MA use was associated with greater LA volumes (R2= 0.13, p=0.048). Association with larger LVEDV and incidence of RV dilation were borderline significant (R2= 0.11, p=0.054 and p=0.058 respectively). The amount of MA used per week correlated with higher RVSP (R2=0.317, p=0.004). Polysubstance abuse was associated with greater LVEF (p=0.028), lower LVEDV (p=0.037) and lower LV mass (p=0.004).

Echocardiographic parameters MACM Non-MACM p-value LVEDV (ml) 215 (62) 181 (40) 0.009* LVESV (ml) 166 (63) 133 (41) 0.017* LVEF (%) 20 (8) 26 (10) 0.006* LV Mass (g) 311 (109) 285 (81) 0.286 LA Volume (ml) 88 (26) 85 (29) 0.670 RV Dilation (no.) 23 (65.7%) 14 (40.0%) 0.027* Reduced RV Function (no.) 21 (60.0%) 21 (60.0%) 0.596 RVSP (mmHg) 40 (14) 44 (12) 0.671 RAP (mmHg) 9 (5) 10 (5) 0.682 Intracardiac Thrombus (no.) 3 (8.6%) 2 (5.7%) 0.500 Mean values are reported with standard deviation. *p<0.05.

Conclusion

MACM is associated with higher degree of LV and RV dilatation as well as LV systolic dysfunction when compared to matched NMACM cases. Years of MA use and amount of MA consumed appear to influence severity of disease.

Acknowledgement/Funding

None
P415330-Day readmission after hospitalization for heart failure in china
Authors: Li J , Bai X K , Zhang L H , Masoudi F A , Spertus J A , Krumholz H M
Published: October 2019

Background

Hospital readmission after heart failure (HF) is common, costly, and potentially preventable. Current patterns of 30-day readmission rates after HF discharge and patient characteristics associated with these readmissions in China are unknown.

Purpose

To calculate the rates and timing of all-cause readmissions within 30-day after HF hospitalization and to identify patient characteristics associated with readmissions.

Methods

We included consecutive patients who were hospitalized primarily for HF and discharged alive from 52 geographically diverse hospitals in China followed for 30 days after discharge. Patients were invited for face-to-face interviews to collect information about any readmission. If a patient was unwilling or unable to attend, information was obtained by telephone contact with the patient, his or her relatives, or physicians. We fit mixed models with a logit link function accounting for patient clustering by hospital to identify patient factors associated with 30-day readmission. To estimate the variability in hospital-level, we calculated the median odds ratio (OR) from the fully adjusted hierarchical model, which represents the average likelihood of a statistically identical patient readmitted at one random hospital versus another.

Results

Among 4649 eligible patients, 4542 (97.7%) had 30-day follow-up. the median (IQR) age was 67 (57, 75) years; 62.5% were men. The length of index hospital stay was 9 (7, 13) days. Readmissions for any cause within 30 days of discharge occurred in 562 patients (12.4%), of which 30.1% occurred within 7 days of discharge and 58.9% 15 days. Half of readmission diagnosis within 30 days were HF (283, 50.4%). Prior HF (OR 1.3, 95% CI 1.09–1.55), valvular heart disease (OR 1.64, 95% CI 1.26–2.1), chronic obstructive pulmonary disease (OR 1.35, 95% CI 1.05–1.73), diabetes (OR 1.44, 95% CI 1.19–1.74) and longer length of index hospitalization stay (HR 1.02, 95% CI 1.01–1.03 per day) were associated with higher risks of 30-day readmission. The C-statistic was 0.615. The median odds ratio was 1.32 (1.05–1.48).

Conclusion

In China, one in eight patients hospitalized for HF are readmitted within 30-days, with the majority occurring within 2 weeks of discharge. Both patient characteristics and variability across hospitals accounted for the variability in readmissions, suggesting an important opportunity for improving the transitions of care in HF.
P4164Transcatheter pulmonary valve implantation versus surgical pulmonary conduit replacement in corrected tetralogy of Fallot with pulmonary atresia: a propensity matched comparison
Authors: Dorobantu D M , Taliotis D , Turner M , Parry A , Tulloh R , Stoica S
Published: October 2019

Background

Tetralogy of Fallot with pulmonary artesia (PA-VSD) complete repair includes the placement of a right ventricle to pulmonary artery conduit. As more and more patients survive past childhood, the need for conduit replacement has increased. Transcatheter pulmonary valve implantation (TPVI) has emerged as an alternative to the surgical pulmonary valve replacement (SPVR) in conduit failure, but comparative data are lacking.

Purpose

We aim to use data from a national procedural audit database to compare TPVI and SPVR in operated PA-VSD with conduit failure.

Method

All patients with surgically corrected PA-VSD undergoing TPVI or SPVR between 2006–2012 were included (SPVR n=103, TPVI n=31). A propensity score matching algorithm based on age, gender, known genetic mutations, MAPCAs presence of endocarditis, preoperative mechanical support, operation year and follow-up time was used and resulted in balanced groups.

Results

Median age at TPVI and SPVR were 23 years (11–51) and 12 years (0.3–55) respectively. Median follow-up was 3.7 years (1 day-12.5 years) in SPVR and 2 years (0.3–10.6) in TPVI. There were slightly more females in the TPVI group (64% vs 49% in SPVR p=0.1). There were no significant differences in procedure era (77% after 2005), MAPCAs (31%) or known genetic conditions (17%). All cases of preoperative endocarditis (n=6) and mechanical support (n=4) were in the SPVR group.

Survival, freedom from pulmonary valve replacement (PVR) and PVR free survival before and after matching at 5 years are shown in Table. After matching survival tended to be lower in TPVI (p=0.4), but without reaching statistical significance, while freedom from PVR (p=0.004, Figure) and PVR free survival (0.02) were significantly lower after TPVI, compared to SPVR.

Relative mortality by age increments Before matching After matching TPVI SPVR TPVI SPVR p value Survival at 5 years (%) 87 92 87 94 0.4 Freedom from PVR at 5 years (%) 83 96 83 100 0.004 PVR free survival at 5 years (%) 72 88 72 94 0.02

Conclusions

In our study TPVI showed comparable midterm survivable with SPVR, but significantly lower freedom from PVR, resulting in a lower PVR free survival. Further studies with longer follow-up and a prospective design are needed to investigate the factors influencing these outcomes.
P4334Effects of Asian dust on blood pressure and blood cell counts: a cross-sectional study of health check-up data
Authors: Ishii M , Seki T , Sakamoto K , Kaikita K , Miyamoto Y , Tsujita K , Masuda I , Kawakami K
Published: October 2019

Introduction

Asian dust (AD) is one of the health care problems because AD increases risk for mortality, respiratory, and cardiovascular disease. Previous animal studies showed that particulate matter from AD induced oxidative stress and systemic inflammation, increased blood pressure and heart rate, and decreased cardiac contraction. However, few reports show association of AD with increased blood pressure in human healthy subjects.

Purpose

The aim of this study was to investigate effects of AD on blood pressure and blood cell counts in human.

Methods

Using generalized linear models, we estimated the association between short-term exposure to AD and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and white blood cell (WBC) count in 296,168 participants aged 20 and older (men n=168,579, 56.9%) who underwent medical check-ups and had no anti-hypertensive agents between April 2005 and March 2015 in a health check-up center in Japan. AD days were the days on which AD events occurred, which were defined as decreased visibility (<10km) due to AD monitored by local meteorological observatory. Propensity score matching analysis was performed to reduce the effects of possible confounders such as age, sex, mean temperature, humidity. In multivariable generalized linear models, data of other air pollutant such as SO2, NO2, Ox or suspended particulate matter was used as covariate.

Results

During study period, 61 AD days were observed, and there were 4,670 participants undergoing medical check-ups on AD days. In the propensity score matched population (n=4,670, each), short-term exposure to AD was significantly associated with an increased risk of higher SBP, DBP, HR, or WBC count [β=1.303, 95% confidence interval (CI) 0.577 to 2.029 for SBP, β=0.630, 95% CI 0.122 to 1.138 for DBP, β=0.987, 95% CI 0.410 to 1.563 for HR, β=150.0, 95% CI 64.9 to 235.1 for WBC]. These significant associations were also observed in two-pollutant models. In subgroup analysis according to age, AD exposure had greater impact on SBP, DBP, and HR in younger people (20 to 40 years old), but WBC count in middle-high age (51 years and older).

GLM analysis according to age category

Conclusions

The present study showed that short-term exposure to AD was associated with higher SBP, DBP, HR and WBC count. Short-term exposure to AD may exacerbate sympathetic nervous system for the young and immune system for the elderly.
P4348Early assessment of left ventricular function by layer-specific strain and its relationship to pulsatile arterial load in patients with coronary slow flow
Authors: Shi J , Xing Y M , Qian J , Yang H , Luo L , Kong D H , Pan C Z , Shu X H , Ge J
Published: October 2019

Background

Previous studies reported controversial Left ventricular (LV) function impairment and pathophysiology in patients with coronary slow flow (CSF). Greater arterial load has been shown to increase aortic impedance and endothelial shear stress, potentially affecting coronary anatomy and function. We investigated LV systolic function by a new layer-specific strain technology and assessed the association between pulsatile arterial load and contractility.

Methods and results

A total of 70 patients with CSF and 50 controls with normal coronary angiography were included in the study. Layer-specific longitudinal and circumferential strains were assessed from endocardium, mid-myocardium and epicardium (GLS-endo, GLS-mid, GLS-epi and GCS-endo, GCS-mid, GCS-epi) by two-dimensional speckle tracking imaging (2D-STI). Pulsatile arterial load was estimated by indexed arterial compliance (ACI). Layer-specific GLS showed a decreasing gradient from the endocardium to the epicardium in both controls and CSF group. GLS-endo and GLS-mid in CSF group were significantly lower than the control group (all P<0.05). Layer-specific longitudinal strain showed a good correlation with the number of affected coronary arteries (all P<0.05) and the mean thrombolysis in myocardial infarction frame count (TFC) (all P<0.05). ACI was lower in CSF patients (P=0.005) and ACI was correlated negatively with layer-specific GLS (all P<0.05).

Conclusion

Layer-specific evaluation of the LV provides an understanding of the layer-specific properties of the LV wall and the possible process of the LV impairment in patients with CSF. Greater pulsatile arterial load, as manifested by a lower ACI, is coupled with worse LV longitudinal function in CSF patients.