bluuebunny/crossref_metadata_2025 huggingface dataset:
P842Calculated plasma volume status provides additional prognostic value to global registry of acute coronary event (GRACE) score in patients with acute myocardial infarction
Authors: Kawai T , Nakatani D , Yamada T , Morita T , Furukawa Y , Tamaki S , Iwasaki Y , Kawasaki M , Kikuchi A , Seo M , Hikoso S , Sakata Y , Fukunami M
Published: October 2019

Background

Plasma volume status (PVS) has been shown to be a well-validated prognostic indicator which relate to morbidity and mortality in heart failure. However, it remains unclear whether PVS would have the prognostic significance in patients with acute myocardial infarction (AMI). Global Registry of Acute Coronary Events (GRACE) risk score is a powerful predictor of prognosis after acute coronary event, but there is no information available on the additional prognostic value of PVS to GRACE in AMI patients.

Methods

We retrospectively studied 3930 AMI patients. GRACE score and PVS was obtained on the admission. PVS was calculated as follows: actual PV = (1 - hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females); and PVS = [(actual PV - ideal PV)/ideal PV] × 100 (%). The endpoint was All cause of death (ACD) within 5 years.

Results

During a mean follow-up period of 2.4±1.9 years, 406 patients had ACD. PVS was significantly greater in patients with ACD than without ACD (8.1±14.9% vs −1.7±13.3%, p<0.001). Each 5% increase in PVS was linked to a 27% estimated risk of 5-year mortality (p<0.001, HR: 1.05 [1.03–1.08]). PVS was still independently associated with ACD, after adjustment with GRACE score as a potential confounding factor. Kaplan-Meier analysis revealed that patients with PV expansion (PVS>0%) were significantly higher risk of ACD than those without PV expansion in patients both with high risk in GRACE score (>140) (28% (225/803) vs 19% (78/412), p=0.01, HR: 7.5) and with low risk in GRACE score (≤140) (6% (52/894) vs 3% (51/1821), p=0.009, HR: 6.2).

Survival rate curves

Conclusion

PVS, which represents intravascular compartment and congestion, could identify poor prognosis in patients with AMI. In addition, PVS would provide additional prognostic information to GRACE score.
P843Study of the CHA2DS2-VASc score in acute coronary syndrome
Authors: Wadie M , Alhaithami A , Wafa A , Yossof M
Published: October 2019

Background

To predict outcomes, acute coronary syndrome (ACS) can be assessed using GRACE and TIMI risk scores, whereas SYNTAX score is used to assess coronary artery disease (CAD) severity and clarify the management. CHA2DS2-VASc score is used as a predictive tool for stroke prevention in non-valvular atrial fibrillation, and it was studied in ACS in terms of outcome and CAD severity

Methods

Between December 2016 and June 2017, 125 ACS patients (mean age: 57.78 (±9.5) years, 78.4% males) were enrolled in this observational prospective study, 89 patients had been followed-up for six months. Patients were assessed based on history, clinical examination, 12-lead ECG, and coronary angiography.

Results

Subjects with a CHA2DS2-VASc score ≥2 had a higher proportion of multivessel disease (3.9%), left main coronary artery lesions (9.9%), and totally occluded, bifurcational, or long coronary lesions (60%) (All p-values<0.05). We found significant positive associations of the CHA2DS2-VASc score with the SYNTAX score (p<0.001) and the Gensini score (p<0.001). Receiver operating characteristic (ROC) curves were generated and cutoff value determined for the CHA2DS2-VASc score (cutoff>2; 76% sensitivity; 76.8% specificity; p<0.001) in predicting coronary multivessel diseases. Subjects with a CHA2DS2-VASc score ≥2 had a higher in-hospital complications, including heart failure, cardiogenic shock, renal impairment, and AF (all p-values<0.05). The CHA2DS2-VASc score showed significant positive associations with in-hospital (11.9%, p=0.21) and six-month mortality (25%, p=0.042). ROC curves were generated and cutoff value determined for the CHA2DS2-VASc score (cutoff>2; 88% sensitivity; 65.3% specificity; p<0.001) in predicting six-month-mortality. Multivariate logistic regression analysis showed that the CHA2DS2-VASc score (p<0.001 with odds ratio 2.28; 95% CI 1.47–3.53) and the GRACE score (p<0.001 with odds ratio 1.07; 95% CI 1.03–1.09) were predictors of six-month mortality.

Conclusion

CHA2DS2-VASc score is associated with increased CAD severity and in-hospital and six-month outcomes.

Acknowledgement/Funding

None
P844NAS2H score, a novel predictive score of 1-year all cause mortality in Acute Coronary Syndromes
Authors: Faria Da Mota T , Sousa Bispo J , Azevedo P , Fernandes R , Guedes J P , Bento D , Marques N , Santos W , Mimoso J , Jesus I
Published: October 2019

Introduction

In patients admitted for Acute Coronary Syndromes (ACS), mortality is influenced by several clinical and therapeutical factors, and management of these patients should be guided by an estimate of individual risk.

Objective

To develop a simple predictive model of 1-year mortality in patients admitted for ACS.

Methods

The authors present a retrospective, descriptive and correlational study including all patients admitted for ACS in a Cardiology department between the 1st of October 2010 and the 1st of October 2017. A 1-year (1y) follow-up was made through registry consultation and phone call by a Cardiologist. Patients with 1y mortality (1yM) events were studied regarding baseline demographic and clinical characteristics, risk factors and hospitalization data, and a correlational analysis with Chi-square test for categorical variables and t-Student test for continuous variables (confidence level of 95%) was performed. Independent predictors of 1yM were identified through binary logistic regression analysis, using a significance level of 0,05. A discriminatory function was applied, and the Wilks lambda test was used to determine the discriminant score for the studied groups. The authors used SPSS 24,0 for statistical analysis.

Results

A total of 3251 patients were included, 826 (25,4%) of which were female, with a mean age of 65,5±13,4 years. In the studied sample, 268 patients (8,2%) died in the year following hospital discharge; this group had a mean age of 65,6±13,2 years, and 80 (29,9%) were female patients. There was a significant association between 1yM and multiple clinical, therapeutical and laboratorial variables, but after multivariate analysis only age greater than 65 years old (yo) [p=0,001], previous stroke [p=0,005], haemoglobin (Hb) <10mg/dL [p<0,001], brain natriuretic peptide (BNP) >100pg/mL [p=0,001], and left ventricular ejection fraction (LVEF) <50% [p <0,001] proved to be independent predictors of the studied outcome. Using these variables, the authors developed a scoring model to predict 1yM in patients admitted for ACS with the following formula = 0,002 + (0,736 x Age >65yo) + (0,91 x previous stroke) + (2,562 x Hb <10) + (0,63 x BNP >100) - (1,207 x FEVE >50%). In this function, variables should be substituted by 1 or 0, depending on wheter they are present or not. The discrimination cutoff was 0,57, with a 70,6% sensibility and 75,9% specificity, and a discriminant power of 75,4%.

Conclusion

Defining the mortality risk of ACS patients after discharge represents a real challenge and demands a careful evaluation of multiple factors in an attempt to achieve an accurate estimation of risk. The authors developed a predicting model for 1yM in ACS patients, with a good discriminant power, based on simple variables. The present score will require validation in a larger cohort of ACS patients before it can be applied in a clinical context.
P850Clinical difference of recent myocardial infarction compared with acute myocardial infarction - Insights from Tokyo CCU network multicenter registry
Authors: Ito R , Takayama M , Yamashita J , Yahagi K , Shinke T , Mase T , Abe K , Miyaji H , Higuchi S , Tanaka H , Yamazaki M , Miyauchi K , Yamamoto T , Nagao K , Chikamori T
Published: October 2019

Background

Although the patient's characteristics and outcome of acute myocardial infarction (AMI) have been sufficiently investigated and primary percutaneous coronary intervention (PCI) has been recognized as established treatment strategy, those of recent myocardial infarction (RMI) have not been fully evaluated.

Purpose

The purpose of the present study was to clarify clinical characteristics and in-hospital outcomes of RMI patients from the database of the Tokyo CCU network multicenter registry.

Methods

In Tokyo CCU network multicenter registry database from 2013 to 2016, 15788 consecutive patients were registered as AMI (within 24 hours from onset) and RMI (within 2–30 days from onset). However 1246 patients were excluded because of inadequate data. And we excluded 66 cases because of out of onset period and 129 cases that strongly suspected of involvement of vasospastic events. Therefore, remaining 14347 patients were categorized to RMI group (n=1853) and AMI group (n=12494), and analyzed.

Results

Compared with AMI group, average age was older (70.4±12.9 vs 68.0±13.4 years, p<0.001), male was less (72.4 vs 76.4%, p<0.001), chest pain as chief complaint was less (75.2 vs 83.6%, p<0.001), prevalence of diabetes mellitus was higher (35.9 vs 31.0%, p<0.001), multi-vessel coronary disease was more (54.7 vs 44.6%, p<0.001), patients undergoing PCI was less (79.0 vs 91.2%, p<0.001), and the incidence of mechanical complication was more in RMI group (3.0 vs 1.5%, p<0.001). Although 30-day mortality was equivalent between 2 groups (5.3 vs 5.8%, p=0.360), the major cause of death in AMI group was cardiogenic shock, while in the RMI group it was a mechanical complication. On Kaplan-Meier analysis, the 2 groups had significantly different cumulative incidence of death due to cardiogenic shock (p=0.006, Log-rank test) and mechanical complication (p=0.021, Log-rank test). Furthermore death due to mechanical complication in AMI group was plateau after about 1 week from hospitalization, whereas in RMI group it continued to increase.

Kaplan-Meier analysis

Conclusions

RMI patients had distinctive clinical features in backgrounds and treatment strategies compared with AMI patients, and the major cause of death of RMI patients was different from that of AMI patients. Furthermore, even though treatment during hospitalization of RMI patients was well done, death due to mechanical complications continued to increase.
P856Incidence and Outcomes of irregular protrusion after stent implantation in patients with acute myocardial infarction: An in in vivo optical coherence tomography study
Authors: Kato T , Higuma T , Yokota T , Kudo N , Yokono Y , Senoo M , Narita N , Endo T , Nishizaki F , Shibutani S , Hanada K , Tomita H
Published: October 2019

Background

Irregular protrusion, a protrusion of material with an irregular surface into the lumen of the vessel after stent implantation, can only be identified by optical coherence tomography (OCT). A previous study demonstrated that irregular protrusion after stent implantation was an independent predictor of 1-year major adverse cardiac events (MACE) in CAD patients. However, the true incidence and prognostic significance of irregular protrusion after stenting in patients with ST-segment elevation myocardial infarction (STEMI) have not previously examined.

Aims

The aims of this study were the following: 1) to evaluate the incidence of irregular protrusion detected by OCT in STEMI patients after stenting; and 2) to compare the long-term outcomes between patients with and without irregular protrusion.

Methods and results

A total of 210 STEMI patients who had post-procedure OCT imaging after coronary stenting within 12 hours after symptom onset were studied. We divided them into two groups: those with irregular protrusion (n=159) and those without (n=51) after stenting. There were no significant differences in baseline characteristics between the 2 groups except that peak CK-MB levels were higher in patients with irregular protrusion than those without (289 (137–563) vs. 260 (63–349) U/L, p<0.05). During mean follow-up period of 298 days, the overall incidence of MACE defined as cardiac death, target vessel-related myocardial infarction, and target lesion revascularization was 15.3%. Kaplan-Meier curve showed that the incidence of MACE did not differ between patients with and without irregular protrusion (14.7% vs. 17.7%, p=0.53 by Log-rank).

Conclusions

Irregular protrusion after stent implantation was detected in three-fourth of STEMI patients. Although patients with irregular protrusion had a greater myocardial damage, it did not influence clinical outcomes.

Acknowledgement/Funding

Donation course from Abbott Japan
P858High endothelial shear stress and local Reynolds number are associated with lipid growth of coronary plaques
Authors: Thondapu V , Poon E K W , Tacey M , Zhu S , Dijkstra J , Revalor E , Serruys P , Ooi A , Barlis P
Published: October 2019

Background

Local haemodynamic disturbances in coronary blood flow are associated with abnormal endothelial shear stress (ESS) and progressive atherosclerosis. However, standard techniques to estimate ESS lack the diagnostic specificity necessary for future clinical utility. Possible improvements include use of a more realistic non-Newtonian model of blood, which may provide more accurate ESS measurements and is further able to detect local variations in blood viscosity.

Purpose

To compare accuracy of ESS generated by Newtonian versus non-Newtonian rheological models to detect coronary plaque progression. To investigate local Reynolds number (ReL), a viscosity-based haemodynamic metric calculated by the non-Newtonian model, as an independent marker of plaque progression.

Methods

Sixteen patients with non-culprit plaques completely visualised in serial optical coherence tomography (OCT) imaging were identified. Plaques were analysed in 0.2mm intervals at each timepoint for lipid and calcium arc. Computational fluid dynamic simulations were performed using Newtonian and non-Newtonian models to calculate ESS, whereas ReL was calculated by the non-Newtonian simulations. Each haemodynamic index was compared to interval changes in lipid and calcium using multivariate regression.

Results

In total, 894 matched arterial segments from baseline and follow up imaging were analysed. In the Newtonian results, baseline segments exposed to ESS>1.7Pa had a 12.5° increase in lipid arc (95% CI 2.2° to 22.8°, p=0.018) while segments exposed to ESS<1.1Pa had an 8.1° decrease in calcium (95% CI −14.0° to −2.2°, p=0.007). In the non-Newtonian results, baseline regions exposed to ESS>2.2Pa had a 14.4° increase in lipid (95% CI 4.2° to 24.7°, p=0.006) while areas with ESS<1.4Pa had an 8.7° decrease in calcium (95% CI −14.6° to −2.8°, p=0.004). Baseline regions exposed to ReL<34 showed an average 11.9° increase in lipid arc (95% CI 0.6° to 23.2°, p=0.039). Regions exposed to ReL>55 had an average increase in lipid arc of 26.6° (95% CI 14.5° to 38.6°, p<0.001).

Conclusions

Both Newtonian and non-Newtonian rheological models show that high ESS is associated with increased lipid while low ESS is associated with decreased calcium. ReL is independently associated with interval increases in lipid arc, suggesting a mechanistic role of local blood viscosity in lipid accumulation. ReL may serve as a novel haemodynamic marker of plaque progression.
P862Hypoxemia during sleep in patients with vasospastic angina
Authors: Nakagawa Y , Sairyo M , Nozaki S
Published: October 2019

Background

Previous studies have shown the associations between sleep-disordered breathing (SDB) and vasospastic angina (VSA). However the characteristics of SDB related to VSA have been unknown.

Purpose

We investigate the characteristics of SDB in VSA patients, with focus on the role of nocturnal hypoxemia, which may trigger nocturnal ischemic attacks, typical attacks occurred during sleep in early morning.

Methods

We studied 33 patients who were diagnosed with VSA, based on diagnostic algorithm in the Japanese Circulation Society guidelines 2013 for VSA. All patients underwent polysomnography. Twenty one patients with moderate-severe SDB [apnea-hypopnea index (AHI) of at least 15/hour] diagnosed with polysomnography, but without cardiovascular diseases, were served as controls.

Results

Only 3 patients with VSA were free of SDB (AHI less than 5/hour). Moderate to severe SDB was found in 25 of 33 patients with VSA. These 25 patients were further studied. Daytime sleepiness assessed by the Epworth sleepiness scale, was lower in SDB patients with VSA than those without it (4.8±4.2 vs. 8.9±4.0; p=0.02). There were no differences in AHI between SDB patients with and without VSA (41.2±17.2/hour vs. 39.9±14.4/hour), but hypoxemic burden (time with oxygen saturation <90%) was higher in those with VSA than those without it [(median 20.7minitutes, interquartile range 6.4–48.0minitues) vs. median 5.9minitutes, interquartile range 3.9–11.0minitues); p=0.01]. In VSA patients, 39% of hypoxemia was observed in rapid eye movement (REM) periods of sleep, which accounts for only 18% of total sleep.

Conclusions

A high prevalence of moderate-severe SDB was found in VSA patient, although the symptoms were mild. Hypoxemia is a characteristic of SDB associated with VSA, which may be a target for therapeutic intervention in addition to drug therapy.
P867Detecting cholesterol crystals in coronary artery disease
Authors: Komatsu S , Takahashi S , Yutani C , Takewa M , Ohara T , Kodama K
Published: October 2019

Background

Cholesterol crystals (CCs) have been recognized as only ghost images. Recently, free monolayer and multilayer CCs besides atheromatous materials from aortic ruptured plaque, obtained using nonobstructive angioscopy, were demonstrated using polarized light microscopy.

Purpose

The aim of the study was to detect free CCs from coronary slow flow.

Methods

A total of 86 patients with coronary artery disease underwent angioscopy with coronary artery sampling. Blood in the coronary artery with and without temporary slow flow was sampled. The blood sample was spread onto a filter paper, and the filter paper was rinsed with distilled water (filter paper-rinse method). The rinse water was scanned using polarized light microscopy, and CCs were detected. The dimensions of CCs from the coronary artery and aortic ruptured plaques were measured for 100 randomly selected samples. The lengths and widths of the CCs were measured.

Results

CCs were obtained in 31 of 86 patients (36.0%). CCs were detected in 38.4% of patients with acute coronary syndrome and in 31.9% of patients with stable angina. CCs were detected 47.1% with slow flow and in 25% without slow flow.

Cholesterol Crystals in Coronary Artery

Conclusions

CCs from the coronary artery can be successfully obtained by using our original method. CCs were detected in patients with clinically stable angina and in those without coronary artery slow flow.
P868Temporal remodeling of coronary arteries during progression of atherosclerosis with serial coronary CT angiography using 3D metrics: results from the PARADIGM study
Authors: Van Den Hoogen I J , Lin F Y , Van Rosendael A R , Gianni U , Al Hussein Alawamlh O , Lee S E , Berman D S , Shaw L J , Bax J J , Min J K , Chang H J
Published: October 2019

Aim

To determine compensatory enlargement and luminal reduction of coronary arteries during the progression of atherosclerosis with serial coronary computed tomography angiography (CCTA) by using volumetric measurements. To date, the impact of coronary plaque progression on temporal remodeling, as opposed to the static remodeling, has only been studied with invasive imaging modalities and primarily two-dimensional areas rather than three-dimensional volumes.

Methods

In total, 1,245 patients with suspected coronary artery disease (CAD) at 13 sites (61±9 years, 39% women) underwent serial CCTA with interscan interval of ≥2 years. The primary objective was to assess volumetric temporal remodeling, defined as the linear association between the change in coronary plaque, lumen and vessel volume at follow-up CCTA on a per-segment level. Temporal remodeling was determined in strata of low and high baseline plaque burden as well as different coronary segments at baseline. Linear regression analysis and Pearson's correlation coefficients were calculated to assess associations.

Results

Amongst 1,245 patients with 19,920 segments, the median interscan interval was 3.3 (IQR 2.6–4.8) years. For each 1 mm3 increase in plaque volume, the increase in vessel volume was 0.72 mm3 and the decrease in lumen volume was 0.28 mm3 (Figure 1, both p<0.001). Volumetric temporal remodeling was similar in low versus high PAV [0.70 mm3 vs 0.73 mm3 (p for interaction=0.491)] and left-main arteries versus all other segments [0.78 mm3 vs. 0.72 mm3 (p for interaction=0.336)], but not in proximal versus distal segments at baseline [0.75 mm3 vs. 0.61 mm3 (p for interaction=0.020)].

Figure 1. Volumetric temporal remodeling

Conclusion

In general, coronary plaque grows approximately 70% outward and 30% into the coronary lumen during the progression of atherosclerosis. Volumetric temporal remodeling is not limited by baseline plaque burden, but is potentially dependent on its location within the coronary artery tree.

Acknowledgement/Funding

NRF of Korea (Grant No. 2012027176); Dalio Institute of Cardiovascular Imaging and Michael J. Wolk Foundation
P869Predictive value of the endothelial shear stress distribution in three-dimensional quantitative coronary angiography models in detecting vulnerable plaques
Authors: Zanchin T , Bourantas C , Torii R , Serruys P W S , Karagiannis A , Ramasamy A , Onuma Y , Mathur A , Baumbach A , Windecker S , Lansky A , Maehara A , Stone P H , Raeber L , Stone G W
Published: October 2019

Background

Low Endothelial shear stress (ESS) is a well-known instigator of coronary atherosclerosis. Prospective intravascular ultrasound (IVUS)-based imaging studies with computational fluid dynamic analysis revealed its predictive merit in-vivo. However, whether coronary modelling derived from quantitative coronary angiography (QCA) is equally effective in detecting high-risk plaques remains to be established.

Purpose

To examine the value of endothelial shear stress (ESS) estimated in three-dimensional (3D) QCA models in detecting plaques that are likely to progress and cause events.

Method

We analysed the baseline intravascular ultrasound virtual histology (IVUS-VH) and angiographic data from 28 non-culprit lesions with a vulnerable phenotype (i.e., fibroatheroma or thin cap fibroatheroma) that caused major adverse cardiac events or required revascularization (nc-MACE-R) at 5-year follow-up and from a control group of 119 vulnerable plaques that remained quiescent. The segments studied by IVUS-VH at baseline were reconstructed using 3D-QCA software and in the obtained geometries blood flow simulation was performed and we estimated the resting Pd/Pa across the vulnerable plaque and the mean ESS values in 3mm sub-segments. A propensity score was built by the baseline plaque characteristics and the hemodynamic indices and its efficacy in detecting nc-MACE-R lesions was examined.

Results

Nc-MACE-R lesions were longer (32.5mm [18.0, 41.6], vs. 19.6mm [12.7, 31.3], p=0.03), had smaller minimum lumen area (MLA) (3.65mm2 [3.26, 4.36] vs. 5.03mm2 [3.98, 6.66], p<0.01), increased plaque burden (PB) (69.4% [63.5, 72.0] vs. 60.8% [53.7, 66.5], p<0.01), were exposed to higher ESS (9.40Pa [6.3, 12.5] vs. 4.1Pa [3.0, 6.9], p<0.01), and exhibited a lower resting Pd/Pa (0.97 [0.95, 0.98] vs. 0.98 [0.97, 0.99], p<0.01]. In multivariable analysis the only independent predictor of nc-MACE-R was the maximum 3mm ESS value (hazard ratio: 1.08 [1.02, 1.16], P=0.016). Lesions exposed to high ESS (>4.95Pa) with a high-risk anatomy (MLA<4mm2and PB>70%) had a higher nc-MACE-R rate (53.8%) than those with a low-risk anatomy exposed to high ESS (31.6%) or those exposed to low ESS that had high (20.0%) or low-risk anatomy (7.1%, P<0.001).

Conclusion

In the present study, 3D-QCA-derived local hemodynamic variables provided useful prognostic information and in combination with lesion anatomy enabled more accurate identification of nc-MACE-R lesions. Further research in a larger number of patients is need to confirm these findings before the conduction of large scale prospective studies that will combine intravascular imaging and 3D-QCA modelling to more accurately detect vulnerable plaques.
P884Short-term exposure to asian dust is associated with myocardial infarction with nonobstructive coronary arteries
Authors: Ishii M , Seki T , Kaikita K , Nakai M , Sumita Y , Nishimura K , Miyamoto Y , Noguchi T , Yasuda S , Tsutsui H , Komuro I , Saito Y , Ogawa H , Tsujita K , Kawakami K
Published: October 2019

Background

Asian dust (AD) is considered as one of air pollution that increases risk of acute myocardial infarction (AMI). However, it has not been elucidated whether AD might increase the risk of myocardial infarction with nonobstructive coronary arteries (MINOCA).

Methods

A time-stratified case-crossover design and conditional logistic regression models was used to investigate the association between short-term exposure to AD and admission of AMI during the spring months in a nationwide administrative Diagnostic Procedure Combination (DPC) database, the Japanese Of All cardiac and vascular Diseases (JROAD)-DPC, between April 2012 through March 2016. MINOCA was defined as AMI having angiography without revascularization and coronary atherosclerosis, whereas myocardial infarction with obstructive coronary artery disease (MI-CAD) was AMI with revascularization and/or coronary atherosclerosis. Data for AD events, air pollutants (PM2.5, Ox, NO2, SO2), and meteorological variables were obtained from the nearest monitoring station of the hospital.

Results

During the study period, 3,233 MINOCA and 27,202 MI-CAD patients were identified from 30,435 AMI patients. Although the occurrence of AD events 2 days before the admission was not associated with the admission of AMI and MI-CAD, the AD events was significantly associated with the admission of MINOCA with adjustment for meteorological variables and each air pollutant. In subgroup analysis of MINOCA, patients without low ADL was associated with higher risk of the admission due to AD exposure than those with low ADL, with significant interaction.

Conclusions

AD events might be more likely to trigger onset of MINOCA than MI-CAD.

Acknowledgement/Funding

None
P885Cardiovascular events in patients with suspected ST-elevation myocardial infarction and no obstructive coronary artery disease
Authors: Andersson H , Laustsen L S , Laustsen A , Pedersen F , Bang L E , Bates E R , Nallamothu B K , Blankenberg S , Grande P , Clemmensen P , Holmvang L
Published: October 2019

Background

Patients with suspected ST-elevation myocardial infarction (STEMI) and no obstructive coronary artery disease (CAD) comprise a heterogeneous group with varying prognoses.

Purpose

To evaluate the prognostic value of cardiac troponin T (cTnT) in patients with suspected STEMI and no obstructive CAD.

Methods

Patients with suspected STEMI and no obstructive (<50% diameter stenosis) CAD were consecutively included from 2009–2014. Patients were classified as having normal cTnT, dynamic cTnT elevation, or stationary cTnT elevation. All patients were followed with respect to major adverse cardiovascular events (MACE), cardiovascular readmission, and repeat coronary procedures, until 1 year after discharge.

Results

The study included 502 patients with suspected STEMI and no obstructive CAD: 165 (33%) had normal cTnT, 293 (58%) had dynamic cTnT elevation and 44 (9%) had stationary cTnT elevation. Within one year after admission, 40 (8%) had MACE, 81 (16%) had cardiovascular readmission, and 8 (2%) underwent repeat coronary procedures. The risk of MACE was elevated in patients with stationary cTnT elevation compared with normal cTnT (OR 13.6, 95% CI 2.3–80.2, p=0.004). There was no statistically significant difference between those with dynamic cTnT elevation and normal cTnT (OR 2.9, 95% CI 0.6–14.0, p=0.189). Adding cTnT pattern to a conventional risk model, area under the receiver operating curve for predicting the 1-year risk of MACE improved significantly (80% vs. 85%, p=0.004, Figure 1).

Figure 1

Conclusion

In patients with suspected STEMI and no obstructive CAD, cTnT pattern during acute hospitalization is associated with the 1-year risk of MACE and improves risk prediction for the individual patient.

Acknowledgement/Funding

The Danish Heart Foundation, the A.P. Møller Foundation, the Foundation of Reinholdt W. Jorck and Wife, Rigshospitalet's Research Foundation
P899Long-term evolution of Fabry cardiomyopathy under enzyme replacement therapy in the Swiss Fabry cohort. An echocardiographic study
Authors: Monney P , Namdar M , Schmied C , Gruner C , Dormond O , Krayenbuhl P A , Barbey F , Nowak A
Published: October 2019

Introduction

Fabry cardiomyopathy may present with left ventricular hypertrophy (LVH) and enzyme replacement therapy (ERT) aims to slow its progression in affected patients. LVH progression may be observed despite ERT and the aim of this study was to identify predictors of adverse LV remodeling under treatment.

Methods

This multicentric study included consecutive Fabry patients receiving ERT and for whom a clinical follow-up (FU) with echocardiography (TTE) of at least 5 years was available. The first TTE was performed at the time of ERT start and disease progression was defined as an increase in LV mass index between the first and the last available FU TTE.

Results

Sixty-one patients (median age 35 years [23–48] and 40 (66%) men) were included with a median FU of 10.5 years [7.2–12.2]. Progression was seen in 33 (54%) patients with an annual increase in LV mass index of 1.8 g/m2/year [0.7–3.2] (vs −0.8 g/m2/year [−1.6 to 0.4] in the non-progression group). Presence of LVH (>95 g/m2 in women or >115 g/m2 in men) at the start of ERT was the only morphological baseline parameter significantly associated with progression after adjustment for age, gender and baseline arterial hypertension (OR 22.5, 95% CI 2.7–188.3, p=0.004). Over the FU duration, patients with baseline LVH (n=22) had higher increase in LV diastolic diameter (2.3±4.9 mm vs 0.9±4.1, p=0.009), a lower increase in relative wall thickness (−1.7±14.1% vs 4.6±9.8%, p=0.04), and a higher increase in LV mass index (22±22 g/m2 vs 0±17 g/m2, p=0.001), as compared with patients with no baseline LVH. While no difference was seen in the evolution of the LV ejection fraction, a faster decline in diastolic function was observed in patients with baseline LVH, with a higher increase in E/e' ratio (5.9±7.4 vs 1.1±2.8, p=0.001) and in left atrial diameter (4.7±5.4 mm vs 1.8±5.2 mm).

Baseline characteristics All (n=61) No LVH (n=39) LVH (n=22) p Age (years) 35 [23–48] 17 [21–36] 50 [44–54] <0.001 Male gender 40 (66%) 22 (56%) 18 (82%) 0.79 Arterial hypertension 10 (17%) 3 (8%) 7 (31%) 0.03 LV mass index (g/m2) 105±43 79±18 150±38 <0.001 Mitral E/e' ratio 7.8±5.0 6.7±2.0 9.9±7.8 0.02

Conclusion

Over a median FU of over 10 years, LV wall thickness, LV mass and LV diastolic function remained stable under ERT, providing the treatment was started, early, i.e. before development of LVH. If LVH is already present at baseline, ERT appears to be less effective, with significant progression in LV mass and significantly faster decrease in diastolic function.
P906Impact of aortic valve calcification severity on device success after trans catheter aortic valve replacement
Authors: Larroche J , Panh L , Lhermusier T , Lairez O , Bataille V , Marachet M.-A , Chollet T , Petermann A , Bouisset F , Boudou N , Marcheix B , Rousseau H , Galinier M.-A , Carrie D , Lavie-Badie Y
Published: October 2019

The aim of this study was to determine whether CS, measured on the preoperative contrast enhanced multislice computed tomography (MSCT), is associated with Device Success (DS), Major Adverse Cardiac Events (MACE) and paravalvular leaks (PVL) after TAVR.

Methods

We included 352 consecutive patients who underwent TAVR with a preoperative standardized contrast enhanced MSCT. Valvular calcifications detection was defined by adding +100 Hounsfield Unit (HU) to mean HU determined by a Region Of Interest placed in the contrast enhanced ascending aorta. CS was then indexed to the aortic annulus surface (CSi). Endpoints were DS and 30-days MACE according to Valve Academic Research Consortium-2 consensus document, and PVL greater than or equal to grade 2.

Results

DS was obtained for 305 patients. In multivariate analysis, CS and CSi were negatively and independently associated with DS: OR=0.88, 95% CI 0.81–0.96, p=0.004; and OR=0.94, 95% CI 0.91–0.98, p=0.002 respectively. There was no association between MACE and CS (p=0,953) and CSi (p=0,757). PVL was positively associated with CS (p<0.001) and CSi (p<0.001).

Multivariate analysis for device success Multivariate analysis for device success procedure Initial Model Final Model OR (95% CI) p OR (95% CI) p Age (years) 1.06 (1–1.12) 0.058 Size (cm) 1.02 (0.98–1.07) 0.26 Hypertension 0.35 (0.13–0.92) 0.033 0.34 (0.13–0.87) 0.024 Diabete mellitus 1.72 (0.68–4.34) 0.249 Mean gradient 0.99 (0.97–1.02) 0.517 Mitral regurgitation 0.6 (0.28–1.27) 0.18 Valve size   ≤23 1 (REF)   26 1.85 (0.8–4.27) 0.152   29 4.08 (1.32–12.59) 0.015 4.72 (1.62–13.78) 0.004   31 1.42 (0.32–6.38) 0.647 CS (for an increase of 1000 pts) 0.89 (0.81–0.98) 0.017 0.88 (0.81–0.96) 0.004 CSi (for an increase of 100 pts) 0.94 (0.9–0.99) 0.013 0.96 (0.91–0.98) 0.002

Example of CS measurement

Conclusion

In TAVR, the aortic valvular CS, measured on preoperative contrast enhanced MSCT, is significantly associated with DS and PVL, but not with 30-days MACE. Its routine use could be relevant to appreciate success chances of TAVR.
P909Echocardiographic Assessment of Left Ventricular Function in Patients with Aortic Stenosis and the short-term effects after intervention
Authors: Alfarih M , Leu C , Moon J , Hughes A , Nihoyannopoulos P , Captur G
Published: October 2019

Introduction

Aortic stenosis (AS) is the most prevalent form of acquired valvular heart disease, it affects ∼2% of people aged over 75. Series of compensatory mechanisms occur, in order for LV to adapt to high pressure overload. Aortic valve replacement has been the mainstay AS treatment either surgically or percutaneously. The evaluation of myocardial strains after Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) is still underexplored and there is no single study to date scouting the difference between TAVI and SAVR.

Aim

To assess the impact of unloading LV after TAVI and SAVR on LV remodelling.

Methods

In this prospective study, we have recruited 111 patients (75±11 years, 63% were females) with varying degrees of aortic stenosis. Of the 111 patients, 43 patients and 11 patients underwent TAVI and SAVR respectively between November 2017 and May 2018. Demographics, clinical and echocardiographic measurements along with speckle tracking parameters were recorded for all participants and again 4±2 weeks after intervention.

Results

Pre-TAVI LV-GLS mean was −10.8±3.5% and after implantation of aortic prosthesis immediate improvement of the myocardial deformation to −13.98±2.9% was observed after one month of the intervention, mean difference of −3.16% following procedure. There was an evidence of significant improvement in LV-GRS after TAVI (44.86±12.9% to 49.77±10.8%, P value= 0.047). Per contra, when comparing pre and post TAVI LV-GCS, no statistical evidence was noted. However, a difference of −2.4% in GCS following the intervention might be clinically important, but no previous evidence can support this. This is attributed to the poor reproducibility and yet not available standardisation.

Table 1 Variables TAVI (n=43) SAVR (n=11) P value† Pre Post P* value Pre Post P* value GLS (%) −10.82±3.5 −13.98±2.9 <0.001 −12.75±4.3 −16.1±2 0.021 0.152 GCS (%) −30.1±8.1 −32.49±9.2 0.134 −27±9.8 −33.9±4.69 0.063 0.062 GRS (%) 44.86±12.9 49.77±10.8 0.047 36.6±13.3 44.97±4.9 0.074 0.058 Data are expressed as mean ± SD. Comparisons were performed using paired Student's t tests. *Pre and post intervention. †Post TAVI vs. post SAVR. Comparison done using unpaired t test of the differences.

Conclusion

Significant improvement was evident in myocardial deformation parameters – in particular GLS – after weeks of the intervention demonstrating a strong evidence of reversed remodelling following SAVR and TAVI.
P910An Asian perspective on left ventricular outflow tract cut-offs and the resulting discrepancy in severity grading of aortic stenosis
Authors: Chew N , Ngiam N , Tan B Y Q , Sim H W , Kong W K F , Tay E L W , Yeo T C , Poh K K
Published: October 2019

Objectives

Inconsistencies in grading of aortic stenosis (AS) severity have been reported based on measurement of left ventricular outflow tract diameter (LVOTd), but this remains to be studied in an Asian population. We investigated consistency of grading AS severity at various LVOTd, and subsequently postulated alternative cut-offs for more consistent grading of AS severity.

Methods

350 consecutive patients with index echocardiographic diagnosis of severe AS were divided them into three groups based on LVOTd: “small” (<20mm), “average” (20–22mm), “large” (>22mm). In each group, the consistency of flow-dependent (transaortic mean pressure gradient (MG)) and flow-independent parameters (AVA) were used for classification of AS severity.

Results

Of 350 patients, 51.7% had small LVOTd, while 30.8% and 17.5% had average and large LVOTd respectively. Consistent grading by LVOTd based on AVA and MG, was seen in 33.7% of patients with small, 47.6% with average, 57.7% with large LVOTd. When the hypothetical AVA cut-off of 0.9cm2 was used, consistent grading improved to 38.0% in small, 56.5% in average and 70% in large LVOTd. At an AVA cut-off of 0.8cm2, there was further incremental improvement in the small LVOTd group to 54.1% (p<0.05).

Table 1. Consistent grading by LVOTd based on current guidelines Small LVOTd (<20mm, n=181) Average LVOTd (20–22mm, n=108) Large LVOTd (>22mm, n=61) Consistent grading AVA < cut-off MG >40 Consistency (%) Consistent grading AVA < cut-off MG >40 Consistency (%) Consistent grading AVA < cut-off MG >40 Consistency (%) n=61 33.7 n=51 47.6 n=35 57.7 n=69 38 n=61 56.5 n=43 70* n=98 54.1*+ n=70 65.1* n=43 70.8* *p-value <0.05 when compared with AVA cut-off 0.8cm2 for each LVOTd category; +p-value <0.05 when compared with AVA cut-off 0.9cm2 for each LVOTd category.

Figure 1

Conclusion

Current severe AS guidelines are most consistent with those in the large LVOTd group. However, the majority of the study's Asian population is in the small LVOTd group, which is the group most susceptible to discrepancy in AS grading. Improved consistency in echocardiographic grading may be attained with a lower AVA cut-off in this Asian cohort.
P916The effect of a novel, user-friendly, transcatheter edge-to-edge mitral valve repair device in a porcine model of mitral regurgitation
Authors: Ge Z , Pan C , Shu X , Pan W , Zhou D , Li W , Chen H , Wei L , Ge J
Published: October 2019

Objective

A new technique has been devised to treat mitral regurgitation (MR) through the transapical route by replicating the edge-to-edge repair surgery. This system encompasses an easy-to-use leaflet clamp and a smaller-sized delivery system (14F–16F). We aimed to evaluate the effectiveness of this device in a porcine model of acute MR.

Methods

Acute MR was induced in 36 anesthetized porcine subjects by severing the major chordae supporting the corresponding segment of the leaflet. This device was then transapically implanted on the prolapsing segment under 3D epicardial echocardiographic guidance. All of the animals were killed 30 days after the procedure to verify the proper location of the implanted devices.

Results

Cutting the major chordae induced an eccentric MR jet (MR grade: 3+, 27.8%/4+, 72.2%) in all of the animals. Every single pig was then successfully implanted with one clamp. The duration of catheterization ranged from 18 to 40 minutes. Overt MR reduction was observed following the procedure through echocardiography; residual MR was mild in 8 cases, trivial in 19 cases, and absent in 9 cases. In terms of hemodynamic parameters, the mean and maximum mitral valve pressure gradients were increased significantly (p<0.01), but these values were less than 4 mmHg in all of the cases. Autopsy demonstrated that all but one device were precisely placed to clip the prolapsing segment of the mitral valve, and there was no evidence of thrombosis, thromboembolism or impairment of the cardiac structure.

Table 1. Changes in hemodynamic parameters, cardiac size, and functional parameters after the procedure Preoperation Postoperation P value MR-maxA (mm2) 7.27±2.13 1.54±1.29 0.000 MVPG-max (mmHg) 1.95±0.47 3.66±0.62 0.000 MVPG-mean (mmHg) 0.87±0.31 1.7±0.28 0.000 LVEDD (mm) 46.08±2.85 46.44±3.53 0.239 LVESD (mm) 29.11±3.44 29.08±3.62 0.940 LVEF (%) 66.53±6.4 67.14±4.93 0.256 LAD (mm) 35.75±2.24 36.42±1.99 0.057 LAA (mm2) 12.95±2.22 12.64±1.55 0.301

Figure 1

Conclusions

Transapical implantation of the novel mitral valve repair device is effective and safe in reducing acutely induced MR in pigs; thus, suggesting that it has great potential for clinical benefit in patients with MR.

Acknowledgement/Funding

Shanghai Science and Technology Committee
P920The impact of tricuspid regurgitation on patient outcome in early and late heart failure
Authors: Fang J X , Tse H F , Yiu K H
Published: October 2019

Background

Severe tricuspid regurgitation (TR) is associated with poor outcome, but TR remains poorly understood and under-treated.

Purpose

To examine the impact of TR at different stages of heart failure.

Methods

3275 patients with outpatient echocardiogram done at our Hospital in 2013–15 with a mean follow-up of 1092 days were analyzed retrospectively. TR was graded by a semi-quantitative approach using jet-area on multiple views and inferior vena cava (IVC) flow pattern. Multivariate Cox proportional hazard model assessed for mortality, time-to-first heart failure hospitalization, and major adverse cardiovascular event in 3 years. Results were adjusted for age, sex, left ventricular ejection fraction (LVEF), left atrial enlargement, pre-existing cardiovascular, peripheral vascular and cerebrovascular disease, moderate-to-severe aortic or mitral valve disease, pulmonary hypertension, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, malignancy, and heart failure stages (0=no heart failure, A=risk factor present, B=structural abnormality, C=symptomatic D=advanced). Subgroup analysis stratified by heart failure stage 0, stage A/B and stage C/D was done. Kaplan-Meier function, log-rank test, logistic regression, AURUC, and goodness-of-fit test were done.

Results

In patients with stage A-B heart failure, severe TR had a hazard ratio of 2.93 for death in 3 years compared to no TR (95% CI 1.11–7.73, p=0.03) and moderate TR had a hazard ratio of 2.35 (95% CI 1.28–4.31, P=0.006). In stage C/D, severe TR had a hazard ratio of 2.17 (95% CI 1.12–4.16, p=0.02) and moderate TR had no significant effect (hazard ratio 1.09, p=077). For heart failure hospitalization, severe TR had no significant association in stage A/B but had a hazard ratio of 3.74 in stage C/D (95% CI 1.81–7.7, p<0.001). TR had no impact on major adverse cardiovascular event in this model. No significant interaction was found between TR and heart failure stage, ejection fraction, and valvular heart disease. The model had C-statistics of 0.82 for 3-year mortality, 0.90 for heart failure hospitalization, and 0.81 for MACE, with insignificant Hosmer-Lemeshow goodness-of-fit test p for each, indicating good fit.

Conclusion

The association between TR and increased mortality in heart failure is apparent early and attenuated later, whereas that of TR and heart failure symptom decompensation appears late.

Acknowledgement/Funding

None
P922Presentation and outcomes of mitral valve surgery in France in the recent era
Authors: Messika Zeitoun D , Enriquez-Sarano M E S , Candolfi P C , Gilard M G , Iung B I , Vahanian A V , Mesana T M
Published: October 2019

Background

Contemporary and unbiased information regarding the surgical management of patients with mitral regurgitation (MR) at the Nationwide level are scarce. The PMSI, a mandatory administrative database, offers the unique opportunity to assess the presentation and outcomes of all consecutive mitral valve (MV) surgeries performed in France in the contemporary era.

Methods

We collected all (isolated or combined) MV surgeries performed for MR in France both in public and private hospitals between 2014 and 2016. Based on an algorithm we developed, MR etiology was classified as degenerative (DMR), secondary (SMR) or OTHER (rheumatic, congenital, infective endocarditis or unknown).

Results

Between January 2014 and December 2016, 18,167 mitral valve surgeries were performed in France (55% repair and 45% replacement; 52% isolated MV surgery). Mean age was 66±12 years and 59% were male. Etiology was DMR in 42%, SMR in 16% and OTHER in 42%. Among DMR, repair rate was 68% overall and 72% in the subset who underwent an isolated MV surgery (70% of all DMR). Repair rates decreased with age, Charlson index and sex (female) (all P<0.0001). Among SMR, a repair was performed in 39% and a combined surgery in 51%. In-hospital mortality and rate of death / readmission for CHF at one year were 3.4% and 13% respectively for DMR (2.4% and 5.5% respectively for isolated DMR) and 7.8% and 17.8% respectively for SMR (5.5% and 12.4% respectively for isolated SMR). Center volume was associated with a lower in-hospital mortality (p=0.002) but not with higher DMR repair rate (P=0.85).

Conclusion

In this large administrative contemporary nationwide database, 1) DMR surgery was twice as frequent as SMR and more frequently performed isolated; 2) Repair rates in DMR were suboptimal overall but more critically in the elderly and women subsets. 3) Operative mortality and one-year rate of death and readmission were approximately twice as high in SMR than in DMR and overall considerable even for isolated DMR surgery; and 4) In DMR, center volume had no impact on repair rate but an independent impact on outcome. These results underline the need to develop strategies to improve management and outcomes of patients with both degenerative and secondary MR.