bluuebunny/crossref_metadata_2025 huggingface dataset:
MIDA mortality risk score in patients undergoing percutaneous edge-to-edge mitral repair
Authors: Kavsur R , Iliadis C , Metze C , Spieker M , Tiyerili V , Horn P , Baldus S , Kelm M , Nickenig G , Pfister R , Westenfeld R , Becher M.U
Published: November 2020

Background

Recent studies indicate that careful patient selection is key for the percutaneous edge-to-edge repair via MitraClip procedure. The MIDA Score represents a useful tool for patient selection and is validated in patients with degenerative mitral regurgitation (MR).

Aim

We here assessed the potential benefit of the MIDA Score for patients with functional or degenerative MR undergoing edge-to-edge mitral valve repair via the MitraClip procedure.

Methods

In the present study, we retrospectively included 520 patients from three Heart Centers undergoing MitraClip implantation for MR. All parameters of the MIDA Score were available in these patients, consisting of the 7 variables age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure, left-ventricular end-systolic diameter, left ventricular ejection fraction. According to the median MIDA-Score of 9 points, patients were stratified in to a high and a low MIDA Score group and association with all-cause mortality was evaluated. Moreover, MR was assessed in echocardiographic controls in 370 patients at discharge, 279 patients at 3-months and 222 patients at 12 months after MitraClip implantation.

Results

During 2-years follow-up after MitraClip implantation, 69 of 291 (24%) patients with a high MIDA Score and 25 of 229 (11%) patients with a low MIDA Score died. Kaplan-Meier analysis and log rank test showed inferior rates of death in patients with a low score (p<0.001) and multivariate cox regression revealed an odds ratio of 0.54 (0.31–0.95; p=0.032) regarding 2-year survival in this group. Moreover, one point increase in the MIDA Score was associated with a 1.18-fold increase in the risk for mortality (1.02–1.36; p=0.025). Comparing patients with a high MIDA Score and patients with a low score, post-procedural residual moderate/severe MR tended to be more frequent in patients with a high MIDA Score at discharge (53% vs 43%; p=0.061), 3-months (50% vs 40%; p=0.091) and significantly at 12-months follow-up (52% vs 37%; p=0.029).

Conclusion

The MIDA Mortality Risk Score remained its predictive ability in patients with degenerative or function MR undergoing transcatheter edge-to-edge mitral valve repair. Moreover, a high MIDA score was associated with a higher frequency of post-procedural residual moderate/severe MR, indicating a lower effectiveness of this procedure in these patients.

Funding Acknowledgement

Type of funding source: None
Higher acceleration ejection time ratio predicts impaired prognosis in mild to moderate aortic stenosis
Authors: Einarsen E , Cramariuc D , Bahlmann E , Midtboe H , Chambers J.B , Rossebo A.B , Gerdts E
Published: November 2020

Introduction

Acceleration/ejection time (AT/ET) ratio is a marker of aortic stenosis (AS) severity, and a predictor of outcome in severe AS. The importance of ejection dynamics in mild and moderate AS has been less investigated.

Purpose

To investigate the impact of increased AT/ET ratio on prognosis in patients with mild-moderate AS.

Methods

Data from 1635 patients with asymptomatic mild-moderate AS with preserved ejection fraction enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study was analysed. Covariates of higher AT/ET ratio was identified in linear regression analysis. Outcome was assessed in Cox regression analyses and reported as hazard ratio (HR) and 95% confidence interval (CI) per 1 standard deviation (SD) higher AT/ET ratio. Median follow-up time was 4 years.

Results

The total study population included 38% female, mean age 67 years and average peak aortic jet velocity was 3.02 m/s. Higher AT/ET ratio was significantly associated with lower ejection fraction, higher LV mass, higher aortic jet velocity, lower systolic blood pressure, low stroke volume index and lower stress-corrected midwall shortening (all p<0.05). In Cox regression analyses, adjusting for these confounders including age and gender, 1 SD higher AT/ET ratio predicted a 29% increase in hazard for major cardiovascular events, 25% for cardiovascular death and hospitalization for heart failure and 23% increase in hazards for all-cause mortality (Table).

Conclusion

In asymptomatic mild-moderate AS patients free from diabetes and known cardiovascular disease, higher AT/ET ratio was associated with increased risk for major cardiovascular events, cardiovascular death and hospitalization for heart failure and all-cause mortality independent of traditional risk markers.

Funding Acknowledgement

Type of funding source: None
Is Isolated tricuspid regurgitation different from functional tricuspid regurgitation?
Authors: Vieitez Florez J.M , Monteagudo J.M , Mahia P , Marco I , Gonzalez T , Sitges M , Bouzas A , Gonzalez V , Alonso D , Carrasco F , Adeba A , Hinojar R , Fernandez-Golfin C , Zamorano J.L
Published: November 2020

Introduction

Isolated tricuspid regurgitation (TR) prevalence is increasing in the last decades. Its presence is associated with a worse prognosis when EROA is >40 mm2. Because of high surgery risk and increasing incidence, isolated TR is a challenge in modern cardiology.

Purpose

To evaluate the prevalence and characteristics of isolated TR compared to other TR aetiologies in a large cohort of patients.

Methods

Prospective study where consecutive patients undergoing an echocardiographic study within a three-month period were included. All studies with at least moderate TR were selected. Isolated TR was defined as TR with no likely pulmonary hypertension (>50 mmHg), no overt TR cause (no intrinsic tricuspid disease, LVEF ≥50%, no pacemaker/defibrillator wire across the tricuspid, no other significant valve disease, no disease that may cause TR, no congenital or pericardial heart disease); and no previous valve surgery. Patients with isolated TR and other aetiologies were compared.

Results

2121 patients with at least moderate TR were included. Isolated TR was found in 398 patients (18.8%). Basal characteristics are shown in table 1. Patients with isolated TR did not have a higher prevalence of AF (47.5% vs. 48.6% p=0.362). Isolated TR was less severe (20.5% vs. 32.1% of patients with severe TR; p<0.001) and less symptomatic (NYHA ≥ II in 27.8% of patients vs. 69.3%; p<0.001).

After selecting patients with at least severe TR, patients with isolated TR were also less symptomatic (NYHA≥II in 47.8% of patients vs. 70.7%; p<0.001) and they had better RV function (TAPSE <17 mm in 13.4% vs. 35.6%; p=0.001).

We found that patients with isolated severe TR had a larger tricuspid annulus diameter (25.4±0.8 mm/m2 vs. 24.0±0.3 mm/m2; p=0.047).

Conclusions

In this large prospective study, isolated TR is present in 18.8% of significant TR. Isolated TR was less severe, was associated with less RV dilatation (but with larger tricuspid annulus diameter) and patients had a better functional class compared to other TR aetiologies.

Differeces in NYHA and RV function

Funding Acknowledgement

Type of funding source: None
3-Dimensional echocardiographic evaluation of right ventricular function in pediatric sickle cell disease population
Authors: Karsenty C , Guitarte Vidaure A.G.V , Hadeed K , Dulac Y.D , Acar P.A , Blanc A.B
Published: November 2020

Introduction

Sickle cell disease (SCD) is characterized by chronic hemolytic anemia and intermittent vaso-occlusive events associated with cardiac abnormalities.

Aim

To assess 3 dimensional (3D) echocardiographic of right ventricle (RV) volumes and function in a pediatric SCD population.

Methods

Eighteen patients with SCD aged 4 to 17 years old (mean age: 8.0±4 years, 56% male, body surface area (BSA) 1.0±0.35) and 18 healthy controls matched for age, gender and BSA were prospectively included and compared. Echocardiograms were performed using a commercially available ultrasound Philipps EPIQ 9 system using matrix X5–1 transducer. 3D indexed RV volumes and ejection fraction (3D- RVEF) were obtained using full volume acquisitions. RV free wall strain, tricuspid S-wave, tricuspid annular plane systolic excursion (TAPSE), indexed cardiac output, systolic pulmonary pressure (sPAP) and hemoglobin were assessed. Data were analyzed with TomtecArena© software (v2.3, Germany).

Results

Cardiac output was significantly higher in SCD children (4.5 vs 3.6 l/min/m2, p=0.025), as sPAP (24.9 vs 21.9 mmHg, p=0.015), 3D-RV diastolic volume (58.1 vs 47.5 ml/m2, p=0.025) and 3D-RV systolic volume (28.8 vs 21.4 ml/m2, p=0.005). 3D-RVEF and RV free wall strain were significantly lower in SCD compared to control population (respectively 51.9 vs 56.3%, p=0.018; −28.6 vs −32, p=0.017). There were no difference regarding TAPSE and doppler S-wave. Mean hemoglobin in SCD population was 9.6±1.7 g/dl.

Conclusions

Despite normal RV systolic function parameters, 3D-RVEF and RV free wall strain are lower in children with SCD. Chronic anemia generating volume overload and vaso-occlusive events could explain these findings.

3D sickle cell

Funding Acknowledgement

Type of funding source: None
Determinants of pulmonary vascular resistance reduction with upfront oral therapy in idiopathic pulmonary arterial hypertension: relevance in risk assessment
Authors: Badagliacca R , D'Alto M , Ghio S , Greco A , Papa S , Romeo E , Casu G , Corda M , Paciocco P , D'Agostino C , Galgano G , Stolfo D , Correale M , Naeije R , Vizza C.D
Published: November 2020

Background

In pulmonary arterial hypertension (PAH) upfront oral therapy represents the standard of care for naive patients at low and intermediate risk. However little is known about associated changes in risk assessment and prediction of low risk status achievement.

Purpose

To evaluate determinants of PVR reduction in patients treated with upfront oral therapy and to create a score to predict PVR reduction after upfront oral treatment and compared its additive value on top of the European and REVEAL scoring system in predicting treatment response.

Methods

One-hundred-eighty-one consecutive naive PAH patients treated with upfront therapy at 11 italian centers were retrospectively evaluated. Evaluation included clinical, hemodynamic and simple echocardiographic parameters, together with European and REVEAL 2.0 risk scores.

Results

At the time of diagnosis, the majority of the patients was idiopathic PAH (80.6%), female (66.3%), at intermediate risk, 71.8% and 55.2%, respectively, according to the European (average method) and the REVEAL 2.0 risk scores. Ambrisentan-Tadalafil was the most frequent combination used (62%). The median PVR reduction obtained after 180 days (IQR 79–394) was −40.4% (IQR −25.8; −45.3).

Age ≥60 years, male-sex, baseline mPAP 48 mmHg associated with low CI (<2.5 l/min/m2), and RV/LV ratio >1 associated with low TAPSE (<18 mm) emerged as independent predictors of poor PVR reduction, defined as the lower tertile of PVR changes (−25.8%). A treatment response score was created deriving weighted integers from the beta coefficient.

At second evaluation 78 (43.1%) patients achieved or remained at European-derived low risk status, while 63 (34.8%) considering the REVEAL 2.0 score.

Multivariate analysis for the prediction of treatment failure, defined as the absence of low-risk status at follow-up, demonstrated the incremental prognostic power of the models incorporating the treatment response score (≥3) on top of the European and REVEAL 2.0 scores, improving risk discrimination by 63.2% (IDI index 0.056) and 36.8% (IDI index 0.080), respectively.

Conclusions

A significant proportion of PAH patients treated with upfront oral combination are not able to achieve a low-risk status. The treatment response score helps clinicians in predicting treatment failure at the time of diagnosis.

Funding Acknowledgement

Type of funding source: None
Modeling survival using decision tree analysis in pulmonary hypertension due to left heart disease. the prognostic significance of PVR <3WU when TAPSE <16mm
Authors: Raitiere O , Berthelot E , Fauvel C , Guignant P , Si-Belkacem N , Sitbon O , Bauer F
Published: November 2020

Aims

In 2019, PVR<3 WU was adopted to stratify patients at low risk of pulmonary hypertension due to left heart disease (PH-LHD) as well those with isolated PH-LHD. We sought to evaluate whether the supervised machine learning with Decision Tree analysis that provides more information than Cox Proportional analysis by forming a hierarchy of multiple covariates, confirms this risk stratification.

Methods

202 consecutive patients (mean age: 69±11 y, females 42%) with mean pulmonary artery pressure (mPAP)≥20mmHg and wedge pressure>15mmHg were recruited. Transpulmonary pressure gradient ≥12mmHg, pulmonary vascular resistance (PVR) ≥3WU, diastolic pressure gradient ≥7mmHg, pulmonary arterial capacitance<1.1 ml/mmHg, TAPSE<16 mm, peak systolic tissue Doppler velocity<10cm/s and right ventricular end-diastolic area ≥25 cm2 were the seven categorical values to enter the model. To predict the mortality from the Decision Tree, we used the CHAID method. Each node and branch were compared using survival analysis at 6-year follow-up.

Results

Mean PAP, wedge pressure, cardiac index, and PVR were 40.3±10.0mmHg, 22.3±7.1mm Hg, 2.9±0.8L/min/m2, and 3.6±2.1WU, respectively. Among the seven dichotomous values linked to the prognosis in PH-LHD, only 2 variables entered the model. To predict the mortality, TAPSE was first selected following by PVR. Compared to patients with PVR<3WU and TAPSE ≥16mm, patients with PVR ≥3WU and TAPSE ≥16mm or patients with PVR ≥3WU and TAPSE <16 mm has significant increased mortality (HR=3,0, 95% CI: [1,4–6,4], p=0.006 and HR=3,3, 95% CI: [1,6–6,9], p=0.002, respectively), while patients with PVR <3WU and TAPSE <16 mm exhibiting the worst prognosis (HR=7,2, 95% CI: [3,3–15,9], p=0.0001).

Conclusion

Used for solving regression and classification problems, decision tree analysis indicates that among 7 prognostic factors, TAPSE and PVR have to be interpreted altogether and simultaneously in PH-LHD for mortality assessment. Therefore, in future research, PVR <3 WU should be understood primarily based on right ventricular systolic function assessed by echocardiography whether TAPSE is or not ≥16 mm.

Funding Acknowledgement

Type of funding source: None
Risk stratification of ulcer-like projections in patients with acute type B aortic intramural hematoma
Authors: Chen L.F , Yang F , Liu L , Luo S.Y , Zhu Y , He C.Y , Hu B.Q , Xie E.M , Ma W.T , Liu J.T , Yang X.Y , Xie N.J , Huang W.H , Xue L , Luo J.F
Published: November 2020

Background

Acute type B aortic intramural hematoma (IMH) with ulcer-like projections (ULP) is associated with various adverse aortic-related events (AAE) and recommended for preventive endovascular repair as alternative. However, we have no therapeutic criterion on which to decide preventive treatment.

Objectives

The purpose of this study was to determine the prognostic value and risk stratification of ULP in patients with acute type B IMH for proper treatment.

Methods

A retrospective study was conducted on 61 consecutive patients with acute type B IMH and with present of ULP from January 2015 to December 2018 in our center. All patients were treated medically initially and CT scans were performed on admission and during follow-up period.

Results

During a median follow-up of 4.5 months (range, 0.3 to 49.8 months) from onset, 36 patients (59.0%) had composites of adverse aortic events, including 1 patient died for aortic rupture, 6 patients converted to endovascular repair, 6 progressed into aortic dissection, and 28 developed to aortic enlargement. A cutoff value to estimate risk is 6.0 mm for maximal ULP width (72.2% sensitivity and 84.0% specificity) and 4.0 mm for maximal ULP depth (94.4% sensitivity and 52.0% specificity). Patients with widest (P=0.005) or deepest ULP (P=0.019) in aortic arch and proximal descending thoracic aorta had significant poorer aorta-related event-free survival rates. On multivariate analysis, maximal ULP width ≥6.0 mm [hazard ratio (HR) = 2.569, 95% confidence interval (CI):1.157 to 5.705, P=0.020], maximal ULP depth ≥4.0 mm (HR=5.198, 95% CI: 1.154 to 23.420, P=0.032) and widest ULP in aortic arch and proximal descending thoracic aorta (HR=2.363, 95% CI: 1.012 to 5.517, P=0.047) were independently associated with AAE. ULP with both risk location (widest ULP in aortic arch and proximal descending thoracic aorta) and size (maximal ULP width ≥6.0 mm) were significantly associated with a poorer aortic-related event-free survival rate than others (both P<0.001).

Conclusions

Maximal ULP width ≥6.0 mm, maximal ULP depth ≥4.0 mm and widest ULP in aortic arch and proximal descending thoracic aorta are predictive for progression of acute type B aortic intramural hematoma. For patients with ULP in both risk location and size, preventive endovascular treatment should be considered.

Figure 1

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): This research was supported by grant DFJH201807 from High-level Hospital Construction Project of Guangdong Provincial People's Hospital.
Sex-dependent association between day-by-day morning blood pressure variability and common carotid artery intima-media thickness: the J-HOP study
Authors: Nagai M , Hoshide S , Kario K
Published: November 2020

Background

Day-by-day home systolic blood pressure variability (BPV) was shown to be associated with increased common carotid artery (CCA) intima-media thickness (IMT) in the hypertensives. Recently, 24 hour ambulatory BPV was revealed to serve as an indicator of higher CCA-IMT only in males. However, there have been no studies that reported the sex-dependent relationship between day-by-day BPV and CCA-IMT.

Purpose

We assessed the hypothesis that day-by-day BPV was associated with higher CCA-IMT in the Japanese males at high-risk of cardiovascular disease.

Methods

Among 4310 patients with one or more cardiovascular risks recruited for the Japan Morning Surge-Home Blood Pressure Study, carotid ultrasound in CCA was performed in the 1365 patients (mean age 65.6 years old, male 52%). The home blood pressure (BP) readings during mean 11.2 days were used to calculate home mean levels and variability in morning systolic BP (SBP). Day-by-day BPV was measured as standard deviation [SD] and delta (maximum-minimum) in SBP.

Results

Average mean CCA-IMT of left and right side was 1.046±0.4mm. Mean (r=0.118, p<0.0001), SD (r=0.120, p<0.0001) and delta (r=0.149, p<0.0001) in morning SBP were significantly correlated with CCA-IMT. In the multiple regression analysis adjustment for confounders including age, gender, body mass index, total cholesterol, high density lipoprotein and mean morning SBP, SD (B: 0.008, 95% CI: 0.001–0.015, p<0.05) or delta (B: 0.004, 95% CI: 0.002–0.006, p<0.001) in morning SBP each had a significant association with CCA-IMT. According to the gender, SD (p<0.01) or delta (p<0.01) in morning SBP each was significantly associated with CCA-IMT only in the male group while neither SD (p=0.4) nor delta (p=0.4) in morning SBP was associated with CCA-IMT in the female group.

Conclusions

In addition to the conventional risk factors, day-by-day morning SBP variability was a significant indicator of increased CCA-IMT in the high-risk Japanese population. The significant relationship between day-by-day morning SBP variability and CCA-IMT was observed only in the males. Gender specific impact of day-by-day morning home systolic BPV on carotid artery atherosclerosis should be taken into account in the high-risk elderly at cardiovascular disease.

Funding Acknowledgement

Type of funding source: None
PRediction and detection of Occult Atrial fibrillation in patients after acute Cryptogenic stroke and Transient Ischemic Attack (PROACTIA)
Authors: Skrebelyte-Strom L , Steine K , Ronning O.M , Dahl F , Kjekshus H
Published: November 2020

Background

Studies with implantable cardiac rhythm monitors (ICRM) have shown that a 1/3 of patients with cryptogenic stroke/transitory ischemic attack (TIA) have episodes of subclinical atrial fibrillation (SCAF) as one of the potential risk factor for cerebral embolism. However, ICRM are costly and resource demanding.

Purpose

The PROACTIA study seeks to test a pre-specified scoring system to assess individual risk of SCAF in order to offer tailored therapy to patients after cryptogenic stroke/TIA.

Methods

Patients admitted with first time cryptogenic stroke or TIA were eligible for the study and underwent blood sampling, cerebral CT/MRI, carotid Doppler ultrasound, ECG, 24h-HolterECG, transthoracic transesophageal echocardiography, registration of medical history and implantation of ICRM during the index hospitalization

The scoring system was composed of variables that have previously been found associated with AF occurrence: CHA2DS2-VASc, P-wave duration (P-dur), premature atrial contractions (PAC)/24h, supraventricular runs (SVR)/24h, left atrial end-systolic volume index (LAVI), and the biomarkers TnT, NT-proBNP and D-dimer.

Data are presented as median (inter quartile range).

Results

Within 25 months, 434 patients screened and 251 patients were included in the present study and had an ICRM implanted. Eleven patients were later excluded yielding a study cohort of 176 patients with cerebral infarction and 61 with TIA that were followed for 833 (633–1028) days. AF was detected in 36%. It took 113 (25–336) days to detect AF, and 5 (2–14) days from AF-detection to initiation of NOAC. All variables were significantly increased in AF patients: no-AF vs AF: CHADS-VASC: 4 (3–5) vs 5 (4–6)*, LAVI mL/m2: 35 (28–40) vs 40 (35–50)**, PAC/24h: 69 (29–211) vs 347 (59–1917)**, SVR / 24-h: 1 (0–3) vs 3 (1–17)**, P-dur ms: 100 (100–120) vs 120 (100–120)**, D-dimer mg/L: 0,3 (0,2–0,6) vs 0,5 (0,3–0,9)**, TnT ng/L: 10 (7–16) vs 15 (9–27)**, NT-proBNP ng/L: 103 (49–283) vs 245 (102–774)**. *p<0.01, **p<0.001.

Multivariate analysis yielded the following model: −8.524 + 0.057*LAVI (p<0.001) + 0.035*P-dur (p<0.001) + 0.873*LogPAC/24h (p<0.001). ROC analysis using leave-one-out cross validation: AUC=0.77. Applying the model to our population, it would identify a high-risk group (>80% true positive) consisting of 17 true positive and 4 false positive, and a low-risk group (<5% false negative) consisting of 17 true negative and 1 false negative.

Conclusions

ICRM detected SCAF in 36% of cryptogenic stroke/TIA patients within 27 months. LAVI, PAC/24h and P-duration were strong independent predictors of SCAF enabling a meaningful risk stratification that can be used for tailoring therapy in cryptogenic stroke/TIA patients.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Stiftelsen Dam
Comparison of neointimal coverage between biodegradable-polymer everolimus-eluting stent and durable-polymer everolimus-eluting stent using angioscopy for the patients with acute coronary syndrome
Authors: Umemoto T , Matsuda J , Hatano Y , Lee T , Yonetsu T , Sasano T
Published: November 2020

Background

New-generation biodegradable-polymer platinum chromium everolimus-eluting stent (BP-PtCr-EES) is available, which has different polymer and alloy compare to more established stent design, a durable-polymer cobalt-chromium everolimus-eluting stent (DP-CoCr-EES).

Purpose

To compare neointimal coverage (NIC) between BP-PtCr-EES and DP-CoCr-EES by using coronary angioscopy (CAS).

Methods

A total of 36 patients (44 stents) with BP-PtCr-EES or DP-CoCr-EES who underwent CAS at 1 year after stenting were investigated. We compared angioscopic findings assessed by angioscopy between BP-PtCr-EES (n=18) and DP-CoCr-EES (n=26). NIC grade and yellow plaque grade (YPG) was adopted from earlier reports from grade 0 to 3. We determined maximum (max-) and minimum (min-) NIC grade and heterogeneity score (HGS = max NIC grade minus min NIC grade). We also assessed YPG and the presence of thrombus (TH).

Results

Six lesions (33.3%) in BP-PtCr-EES group and 7 (26.9%) lesions in DP-CoCr-EES group were culprit lesions of acute coronary syndrome, which did not statistically differ between the two groups (p=0.74). And there were no significant differences in stent diameter (BP-PtCr-EES: 2.97±0.39 mm vs DP-CoCr-EES: 3.14±0.45 mm, p=0.22) and length (BP-PtCr-EES: 26.9±7.9 mm vs DP-CoCr-EES: 28.4±8.0 mm, p=0.54). In terms of CAS findings, BP-PtCr-EES group has better neointimal coverage than DP-CoCr-EES group (max NIC grade: 2.6±0.7 vs 2.0±0.9, p=0.01. min NIC grade: 1.1±0.8 vs 0.5±0.5, p<0.01), but HGS was almost same (1.6±0.7 vs 1.5±0.9, p=0.70). YPG of BP-PtCr-EES group showed significantly lower than DP-CoCr-EES group (1.0±1.0 vs 1.7±1.0, p=0.02). The rate of TH was significantly lower in BP-PtCr-EES group than DP-CoCr-EES group (25%, n=6, vs 75%, n=18, p=0.03). There were no clinical events such as stent thrombosis or restenosis during the observation period in both stent groups.

Conclusion

Superior neointimal coverage and less YPG or TH were observed by CAS in the BP-PtCr-EES group at 1 year after stenting. Clinical significance was still unknown because of no clinical events in both groups. Prospective and large populations studies may be required.

Funding Acknowledgement

Type of funding source: None
Coronary circulatory indices in non-infarct related vascular territories in a porcine acute myocardial infarction model
Authors: Lee S.H , Kim H.K , Lee J.M , Hong Y.J , Choi K.H , Shin E.S , Nam C.W , Doh J.H , Yang J.H , Song Y.B , Hahn J.Y , Choi S.H , Jeong M.H , Samady H , Escaned J
Published: November 2020

Background

There has been debate on the reliability of fractional flow reserve (FFR) or resting pressure-derived indices in non-IRA of patients with acute ST-segment elevation myocardial infarction.

Purpose

This study aimed to evaluate temporal changes of coronary hemodynamic and physiologic indices in non-infarct related artery (non-IRA), which might be affected by adjacent infarcted myocardium, using an experimental animal model of acute myocardial infarction (AMI).

Methods

In Yorkshire swine, acute myocardial infarction was simulated with selective balloon occlusion at left circumflex artery (LCX) as IRA for 30 minutes. Non-IRA stenosis was created using bare metal stent implantation in left anterior descending artery (LAD) 4 weeks before the experiments. Serial changes of systemic hemodynamics, coronary pressure, and Doppler-derived coronary flow velocity were measured in a non-occluded LAD as non-IRA from baseline, balloon occlusion of LCX, and 15 minutes after reperfusion of LCX.

Results

Among the 6 experimental subjects, the median diameter stenosis of non-IRA was 33.9% (Q1-Q3: 21.7%-46.1%). During balloon occlusion of IRA, there were transient significant changes in both resting and hyperemic aortic pressure (Pa), distal coronary pressure (Pd), averaged peak velocity (APV), trans-stenotic pressure gradient (PG), and microvascular resistance of non-IRA (all P values<0.020). After reperfusion of IRA, the resting APV (P=0.002) and resting trans-stenotic PG (P=0.004) were significantly increased and resting microvascular resistance (P=0.004) was significantly decreased than those in baseline phase. However, the hyperemic APV (P=0.479), hyperemic trans-stenotic PG (P=0.778), and hyperemic microvascular resistance (P=0.816) were not significantly different compared with those in the baseline phase. After reperfusion, the FFR in non-IRA was not significantly different (0.94±0.01 vs. 0.93±0.01, P=0.353), while the CFR (1.93±0.07 vs. 1.36±0.07, P=0.025) and resting Pd/Pa (0.98±0.01 vs. 0.94±0.01, P=0.017) were significantly lower than baseline values.

Conclusions

In a porcine AMI model, occlusion of IRA induced significant changes of systemic hemodynamics and coronary circulatory indices of non-IRA. However, after reperfusion of IRA, FFR did not change significantly, while resting

Summarizing Figure

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): 1. Philips/Volcano, 2. Bio & Medical Technology Development Program of the National Research Foundation of the Korean government
Association between bleeding avoidance and outcomes: Japanese coronary intervention registry report in collaboration with ACC-NCDR
Authors: Sawano M , Numasawa Y , Spertus J.A , Kennedy K , Inohara T , Miyata H , Fukuda K , Rumsfeld J.S , Masoudi F.A , Kohsaka S
Published: November 2020

Background

Bleeding avoidance strategies (BASs) such as radial access and closure device use for femoral access have been increasingly being implemented but its association with bleeding events among East Asians with reported higher bleeding risk remains unclear.

Purpose

To demonstrate the performance of the National Cardiovascular Data Registry (NCDR) CathPCI bleeding risk score, 10-year trend of BAS utilization rate and its relationship with observed bleeding within a Japanese PCI quality improvement initiative established in collaboration with the American College of Cardiology-NCDR.

Methods

A cohort of 19,656 consecutive Japanese patients undergoing PCI was included. First, we assessed the discrimination of the validated NCDR CathPCI bleeding score in the study population. We then assessed temporal trends in the implementation of BAS for PCI and calculated the observed versus expected bleeding rate [O/E ratio] in four time periods (T1: 2008–2011, T2: 2012–2013, T3: 2014–2015, T4: 2016–2018). In multivariable logistic models, we calculated the correlation between BAS use and bleeding rates in individual time frames.

Results

During the study period, the application of BAS increased from 42.2% (T1) to 90.3% (T4) and observed bleeding rate declined from 10.2% (T1) to 7.3% (T4). The discrimination of the NCDR CathPCI bleeding risk score was acceptable in the Japanese population (c-statistics 0.760–0.845). The calculated O/E ratio declined from 1.34 (T1) to 1.14 (T4). The use of radial access and vascular closure devices after transfemoral access use was associated with 46.7–56.6% and 25.6–47.5% bleeding reduction rates, respectively. The correlation between greater BAS adoption and the decline in bleeding rates was greater among elective cases than urgent/emergent cases.

Conclusion

Our findings support the positive impact of the adoption of BAS in Japanese patients undergoing PCI. This study demonstrates the value of common data standards and risk adjustment developed in registries to support high quality care.

Trends in BAS use & Bleeding Rate

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science
The long-term impact of transcatheter aortic valve implantation on arterial stiffness and central hemodynamics
Authors: Gardikioti V , Terentes-Printzios D , Aznaouridis K , Latsios G , Siasos G , Drakopoulou M , Oikonomou E , Christoforatou E , Tsigou V , Xanthopoulou M , Toutouzas K , Vavuranakis M , Tousoulis D , Vlachopoulos C
Published: November 2020

Background/Introduction

The study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal.

Purpose

We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections opting for a global approach.

Methods

We enrolled 90 patients (mean age 80.2±8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by both carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate (AIx@75), an index of wave reflections, and central pressures were assessed with arterial tonometry. Measurements were conducted at baseline, after the procedure and at 1 year.

Results

Immediately post-TAVI there was a statistically significant increase in arterial stiffness (7.5±1.5 m/s vs 8.4±1.9 m/s, p=0.001 for cfPWV and 1,773±459 cm/s vs 2,383±645 cm/s, p<0.001 for baPWV) despite no change in systolic blood pressure. At 1-year follow-up, TAVI was still associated with an increase in arterial stiffness compared to pre-TAVI (7.5±1.5 m/s vs 8.7±1.7 m/s, p<0.001 for cfPWV and 1,773±459 cm/s vs 2,286±575 cm/s, p<0.001 for baPWV) but not to post-TAVI values. We also observed a decrease in AIx@75 (32.2±12.9% vs 27.9±8.4%, p=0.016) post-TAVI that was attenuated at 1 year (32.2±12.9% vs 29.8±9.1%, p=0.38).

Conclusions

Our study shows that after TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term. Our findings further elucidate the immediate and long-term hemodynamic changes of TAVI to the aorta that may entail prognostic role in this growing population.

Change of vascular biomarkers post-TAVI

Funding Acknowledgement

Type of funding source: None
Is high-normal blood pressure a more important risk factor for cardiovascular disease in women than in men? The Hordaland Health study
Authors: Kringeland E.A , Tell G.S , Midtbo H.B , Haugsgjerd T.R , Igland J , Gerdts E
Published: November 2020

Background

Hypertension is a major risk factor for cardiovascular disease (CVD), but the definition of hypertension is currently debated. Little is known about whether high-normal blood pressure (BP) carries a different risk for CVD in women and men.

Purpose

The aim of the current study was to test associations of high-normal BP with CVD in women and men participating in the community-based Hordaland Health Study (HUSK).

Methods

Data from 8252 participants aged 40–43 years (52% women) participating in the HUSK survey in 1992–93 were coupled with hospitalization or death from CVD documented by ICD codes in national registries in the period 1994–2009. Attended BP was measured in accordance with current guidelines. The average of the two last measurements was taken as the clinic BP measure. The cohort was grouped into normal BP (BP<130/85 mmHg), high-normal BP (BP 130–139/85–89 mmHg) and hypertension (BP≥140/90 mmHg or use of antihypertensive drugs). CVD was defined as hospitalization or death from any CVD diagnosis. The association between BP category and CVD was tested in sex-specific Cox regression analyses, using normal BP as the reference group and adjusting for diabetes, smoking, body mass index and total cholesterol.

Results

At baseline, 17% women and 27% men had high-normal BP and 16% women and 32% men had hypertension (both p<0.001 between sexes). During 16 years follow-up, 15% of women and 22% of men experienced hospitalization or death from CVD (p<0.001). A significant sex-interaction of BP group and outcome was found (p<0.05). In multivariable analyses in women, both hypertension and high-normal BP were associated with incident CVD (both p<0.01) independent of confounders (Table). In men, only hypertension was associated with incident CVD in the same model, while high-normal BP was not (p<0.001 and p=0.53, respectively) (Table).

Conclusion

High-normal BP was a more important risk factor for CVD in middle-aged women than men. Our findings challenges whether hypertension-associated CVD risk is optimally detected in women by the current hypertension definition in European guidelines.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): University of Bergen
Clinical features and predictors of masked uncontrolled hypertension: from Korean ambulatory blood pressure monitoring (Korabp) registry
Authors: Lee Y , Kim H.J , Shin J.H , Shin J , Lim Y.H , Park J.K , Heo R , Park S , Ihm S.H , Pyun W.B
Published: November 2020

Background

Clinical characteristics of patients with masked uncontrolled hypertension (MUCH) are poorly defined, and few studies have reported on clinical predictors of MUCH. We investigated demographic, lifestyle, clinical and blood pressure (BP) characteristics in patients with MUCH and proposed a prediction model for MUCH.

Method

We analyzed 2044 subjects taking antihypertensive medication enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, who were categorized into controlled hypertension (n=481, normal office BP, normal 24-hour ABP), pseudo-uncontrolled hypertension (n=131, high office BP, normal 24-hour ABP), MUCH (n=380, normal office BP, high 24-hour ABP), and sustained uncontrolled hypertension (n=1,052; high office BP and high 24-hour ABP).

Result

The prevalence of MUCH increased with office systolic BP (SBP) and diastolic BP (DBP), whereas it was not associated with the numbers of antihypertensive drugs. But in patients with a high office SBP (≥130 mmHg), the prevalence of MUCH increased with decreasing numbers of antihypertensive drugs (interaction p=0.008; Figure 1A). Multiple logistic regression analysis identified high office SBPs and DBPs, prior stroke, dyslipidemia and single anti-hypertensive agent use as independent predictors of MUCH (Table 1). A prediction model using these predictors showed a high diagnostic accuracy (C-index 0.833) and a goodness of fit for the presence of MUCH (Figure 1B).

Conclusion

MUCH is associated with the borderline increase in office BP and the underuse of anti-hypertensive drugs as well as dyslipidemia and prior stroke, which underscores the importance of achieving the optimal BP control level in the high risk patients. The proposed model would accurately predict MUCH in patients with controlled office BP.

Figure 1

Funding Acknowledgement

Type of funding source: None
Genetically, dietary sodium intake is causally associated with salt-sensitive hypertension risk in a community-based cohort study: a Mendelian randomization approach
Authors: Choi J.R
Published: November 2020

Excessive dietary salt intake is associated with an increased risk of hypertension. Salt sensitivity, i.e., an elevation in blood pressure in response to high dietary salt intake, has been associated with a high risk of cardiovascular disease and mortality. We investigated whether a causal association exists between dietary sodium intake and hypertension risk using Mendelian randomization (MR). We performed an MR study using data from a large genome-wide association study comprising 15,034 Korean adults in a community-based cohort study. A total of 1,282 candidate single nucleotide polymorphisms associated with dietary sodium intake, such as rs2960306, rs4343, and rs1937671, were selected as instrumental variables. The inverse variance weighted method was used to assess the evidence for causality. Higher dietary sodium intake was associated with salt-sensitive hypertension risk. The variants of SLC8E1 rs2241543 and ADD1 rs16843589 were strongly associated with increased blood pressure. In the logistic regression model, after adjusting for age, gender, smoking, drinking, exercise, and body mass index, the GRK4 rs2960306TT genotype was inversely associated with hypertension risk (OR = 0.356, 95% CI = 0.236–0.476). However, the 2350GG genotype (ACE rs4343) exhibited a 2.11-fold increased hypertension risk (OR = 2.114, 95% CI = 2.004–2.224) relative to carriers of the 2350AA genotype, after adjusting for confounders. MR analysis revealed that the odds ratio for hypertension per 1 mg/day increment of dietary sodium intake was 2.24 in participants with the PRKG1 rs12414562 AA genotype. Our findings suggest that dietary sodium intake may be causally associated with hypertension risk.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (2017R1D1A3B03034119, 2014M3C9A3064552), and the KRIBB Initiative program. This research was also supported by the Medical Research Center Program (2017R1A5A2015369). This work was supported (in part) by the Yonsei University Research Fund 2017. Bioresources for this study were provided by the National Biobank of Korea and the Centers for Disease Control and Prevention, Republic of Korea (2017-009).
Associations of sodium intake with central hemodynamics and changes in vascular structure and function at high altitude localities
Authors: Zhang Z , Chen X
Published: November 2020

Objectives

To investigate the associations of sodium intake with central hemodynamics and changes in vascular structure and function at high altitude localities.

Methods

A total of 383 Buddhists were enrolled in four temples with an average elevation of 3,800 meters from December 2018 to January 2019. Estimated 24-hour urinary sodium excretion was measured by the Kawasaki formula using the urinary sodium/creatinine ratio of the second fasting spot urine in the morning. Central hemodynamics, including central systolic blood pressure (CSBP), central diastolic blood pressure (CDBP), central pulse pressure (CPP), central mean arterial pressure (CMAP), augmentation pressure (AP), augmentation index (AI), were evaluated by applanation tonometry using the SphygmoCor analyzer. Vascular structure and function were quantified by carotid intima media thickness (cIMT) and brachial ankle pulse wave velocity (BaPWV), respectively. Pearson correlation and multiple linear regression were used to analyze the associations between 24h urinary sodium with central arterial hemodynamic parameters, cIMT and BaPWV.

Results

The estimated 24h urinary sodium excretion of the Buddhists in such area was (5.26±1.61)g and the estimated salt intake was (13.36±4.09)g. There was no significant correlation between 24h urinary sodium with CDBP, AP and cIMT (P>0.05). After adjusting for gender, age, CSBP, body mass index (BMI), fasting blood glucose (FBG), estimated glomerular filtration rate (eGFR), triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL), the estimated 24h urine sodium was positively correlated with CSBP (β=1.313, P=0.018) and CPP (β=1.311, P<0.001), the estimated 24h urinary sodium was significantly negatively correlated with AIX75 and BaPWV (β=−1.124, P=0.028 and β=−37.530, P<0.001, respectively). The line graph of means across the 24h urinary sodium quartiles and the cubic fitting curve showed that the associations between 24h urinary sodium excretion with AIX75 and BaPWV presented an approximate “J” shape.

Conclusions

24h urinary sodium was positively correlated with CSBP and CPP and negatively correlated with AIX75 and BaPWV in the Buddhists in this high altitude area. The associations between 24h urinary sodium with AIX75 and BaPWV resembled a “J” shape.

Funding Acknowledgement

Type of funding source: None
Assessment of cardiovascular risk in patients with chronic periodontitis
Authors: Lipatova T.E , Eremin A.V
Published: November 2020

Introduction

To effective prevention of cardiovascular morbidity and mortality in populations with an unfavorable cardiovascular profile, it is important to analyze the occurrence and severity of traditional risk factors and the calculated risks of cardiovascular events.

Aim

Estimation of cardiovascular risk in patients with chronic periodontitis (CP) different severity.

Methods

We examined 2400 person (65.6% male, aged from 40 to 64 years), of these 466 had health periodontium (HP), 1934 had CP different severity. Considered exclusion criteria were known diabetes and cardiovascular diseases. The 10-year risk of a cardiovascular event was calculated using SCORE (Systematic Coronary Risk Evaluation) and Reynolds Risk Score (RRS).

Results

There were no differences between the groups with HP and mild CP in the incidence of calculated 10-year risk of a cardiovascular event. Severity of periodontitis was associated with a higher cardiovascular risk on the SCORE. High risk on the SCORE in the group with HP was found in 10.3%, and in patients with moderate and severe CP-in 34.1%, 48.5% respectively. Using the RRS among 538 patients with moderate risk on the SCORE was showed the results: 48 (8.9%) patients were classified as low risk, 258 (48%) - the moderately low risk category (5% to 10%), 192 (35.7%) patients -a moderately high risk (10% to 20%) and 40 (7.4%) - high risk (≥20%). There was an association between SCORE index with the number of missing teeth (Spearman's R=0.591) and the loss of periodontal bone according to panoramic x-ray (R = 0.46). RRS index correlated with the severity of periodontal inflammation: the periodontal index (R=0.43), and the depth of periodontal pockets (R=0.38).

Conclusion

The relationship between the results of severe CP as missing teeth, loss of periodontal bone and the risk of fatal cardiovascular events is important for clinical use and can be an additional cardiovascular risk marker for patients with CP.

Funding Acknowledgement

Type of funding source: None
Thromboxane metabolite excretion is associated with serious vascular events in diabetes mellitus: a sub-study of the ASCEND trial
Authors: Rocca B , Buck G , Petrucci G , Parish S , Pagliaccia F , Baigent C , Mafham M , Bowman L , Armitage J , Patrono C
Published: November 2020

Background

Platelet activation plays a major role in the atherothrombotic complications of diabetes. Thromboxane (TX)A2 is a pro-thrombotic prostanoid, synthesized via cyclooxygenase-1 and released by activated platelets. The metabolism of TXA2 in vivo leads to a major stable end-product, 11-dehydro-TXB2 (TXM), measurable in urine and reflecting the whole-body rate of TXA2 biosynthesis. In two large trials of high-risk, aspirin-treated (mostly, without diabetes) patients, (CHARISMA and HOPE trials), the baseline rate of urinary TXM excretion was an independent predictor of future cardiovascular events.

Purpose

The aim of the ASCEND (A Study of Cardiovascular Events in Diabetes) TXM sub-study was to investigate the association between baseline urinary TXM and future serious vascular events or revascularization (SVE-R), major bleeds and incident cancer independent of other risk factors and treatment, in people with diabetes and no manifest cardiovascular disease at trial entry.

Methods

Urinary TXM was measured by a previously GC/MS-validated, immunoassay in 6,487 participants with eligible baseline samples. Analyses excluded 539 participants using NSAIDs. TXM appeared log-normally distributed, so analyses were by quintiles and per SD (=0.622) of continuous loge TXM. The association of loge TXM with outcome was adjusted by basic factors (age, sex, sample volume and randomized treatment allocation) and by the predictors of log TXM (smoking, type 2 diabetes treated with insulin or oral hypoglycaemics, HDL cholesterol, body mass index, urinary albumin/creatinine ratio, eGFR). The association of log TXM with non-vascular, non-cancer MedDRA outcomes was investigated to determine whether TXM had a general effect on outcome. During a mean of 6.6 years follow-up there were 618 SVE-Rs, 206 bleeds and 700 cancers among these patients.

Results

Log TXM correlated significantly with SVE-R, hazard ratio (HR) per 1 SD of log TXM: 1.13 (1.04–1.23), p=0.003 (Figure 1, panel a), non-significantly with major bleeds [HR 1.15 (1.00–1.32), p=0.055] (Figure 1, panel b), and marginally significantly with cancer [HR 1.09 (1.01–1.17), p=0.03] (Figure 1, panel c). There was no association of log TXM with non-vascular non-cancer MedDRA outcomes (HR per 1 SD, 0.99; 99% CI, 0.94–1.05).

Conclusion

The rate of urinary TXM excretion, a non-invasive biomarker of TXA2-mediated platelet activation in vivo, is log-linearly associated with serious vascular events independent of other risk factors in people with diabetes. Its potential association with cancer must be viewed as hypothesis-generating and needs confirmation.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): IMI1: Surrogate markers for micro- and macro-vascular hard endpoints for innovative diabetes tools (SUMMIT).