bluuebunny/crossref_metadata_2025 huggingface dataset:
P5596Something is moving in acute aortic syndrome management and mortality. Results of Spanish registry of acute aortic syndrome (RESA-III)
Authors: Lopez Sainz A , Granato C H , Azqueta M , Barros A J , Mosquera V , Lopez-Ayerbe J , Calvo F , Fernandez Tarrio R , Revilla A , Potocnik M , Fresneda P C , Forteza A , Gil Albarova O , Rodriguez-Palomares J F , Evangelista A
Published: October 2019

Background

The impact of recent advances on the management of acute aortic syndrome (AAS) is usually reported by centres with great experience in aortic diseases. Current data on the management of this specific disease in Spain remains unknown.

Purpose

The Spanish Registry of Acute Aortic Syndrome (RESA-III) was established to assess current results in the management of AAS in a large cohort of hospitals from the same geographical area.

Methods

All patients admitted for AAS to 29 Spanish tertiary hospitals were enroled over 18 months (2017/2018).

Results

574 patients, (68% men; mean age 64±14y; range 18–99) were prospectively and consecutively included. Aortic dissection was the underlying disease in 474 (82.6%) (375 type A, 99 type B), aortic haematoma in 76 (13.2%) (43 type A and 33 type B) and penetrating ulcer in 24 (4.2%) (7 type A and 17 type B). From the subgroup of type A AAS (74% n=425), 81% underwent surgical treatment and medical management was chosen in the remaining 19%. 78 patients did not undergo surgery principally because of severe comorbidities (n=34) or advanced age (n=24), patient refusal (n=7), or presence of an intramural haematoma (n=2). Regarding the cohort of patients with type B AAS (26% n=149), 52% were managed only medically, 37% with endovascular treatment, and 11% underwent open surgery. Endovascular treatment was indicated owing to recurrent pain (n=19), progressive vessel dilation (n=9), dissection expansion (n=5), peripheral (n=5) or visceral ischaemia (n=4), high blood pressure (n=18), peripheral bleeding (n=17) or haemodynamical instability (n=8).

Overall type A mortality during hospitalisation was 36.4%; 26.4% in surgically treated and 79.4% in medically-treated patients (p=0.001). In type B AAS, overall mortality was 19.1%; 21.9% in the treated medically subgroup, 43.8% in those treated with open surgery and 7.8% in the endovascular treatment cohort (p=0.004).

Conclusion

Despite significant advances in acute aortic syndrome diagnosis and management, in-hospital mortality remains high. In type A AAS, medical management rate was too high (19%); however, in type B AAS, endovascular treatment yielded excellent results with less mortality than medical management (7.8% vs 19.1%, respectively). Our data support the need for continued improvement in the management of acute aortic syndrome.
P5598Long term outcome and quality of life following acute type A aortic dissection
Authors: Sbarouni E , Georgiadou P , Manavi M , Analitis A , Beletsioti C , Niakas D , Iliodromitis E , Voudris V
Published: October 2019

Introduction

Acute aortic dissection (AAD) represents surgical emergency and current literature mainly consists of postoperative outcome reports. Long term outcome and quality of life have not extensively been investigated.

Purpose

This is a single center study to assess long term outcome and quality of life of patients who underwent emergency surgery for AAD.

Methods

From January 2007 until December 2009, 74 consecutive patients were operated for AAD type A in our hospital. Seventeen died during hospital stay and 12 died during follow-up. Mean follow up was 108±10 months. Seventeen patients refused to answer the SF-36 questionnaire; therefore our study group consists of 28 patients. The SF-36 Questionnaire was retrospectively obtained by phone calls, the first, fifth and tenth postoperative year and 2 summary scores are reported, physical (PCS) and mental (MCS).

Results

Our in-hospital mortality was 23%, late mortality 21.1% and the overall mortality was 39.2%. Significant differences in both physical and mental score over time were found among the 28 long-term survivors (Table). Both PCS and MCS at 1st, 5th and 10th year did not differ compared to age-matched general population but compared to subjects with one or more chronic diseases both PCS and MCS were both significantly better at 5yrs in our patients vs controls (p=0.0028 and p=0.0259, respectively). Likewise, at 5 years PCS but not MCS was better in comparison to subjects with a history of one hospitalization the preceding year (p=0.035 and p=0.1, respectively).

Descriptive statistics of physical and mental component summary score over time Score 1 year (FU1) 5 years (FU2) 10 years (FU3) p-value Mean (SD) Mean (SD) Mean (SD) PCS 45.4 (7.7) 50.3 (7.0) 46.8 (9.2) 0.008* MCS 42.8 (15.1) 49.7 (12.7) 49.1 (12.3) 0.001** PCS, Physical component summary; *1 vs 5: p=0.003, 1 vs 10: p=0.469, 5 vs 10: p=0.027. MCS, Mental component summary; **1 vs 5: p=0.001, 1 vs 10: p=0.001, 5 vs 10: p=0.939. SD, standard deviation.

Conclusion

Quality of life improves after the 1st post-operative year and is comparable to healthy subjects. Although acute dissection is a catastrophic event with high mortality despite successful and timely repair, long term survival and quality of life on the long term are favorable.
P5608Acute respiratory failure after type A aortic dissection repair: data from the International Registry of Aortic Dissection (IRAD)
Authors: Ballotta A B , Kandil H , Montgomery D G , Ranucci M , Trimarchi S , Myrmel T , Bavaria J E , Sundt T M , Bossone E , Suzuki T , Ota T , Nienaber C A , Isselbacher E M , Eagle K A , Patel H J
Published: October 2019

Background

Acute Respiratory Failure (ARF) has been noted in up to 20% of patients undergoing cardiac surgery and is associated with increased mortality. Cardiopulmonary bypass (CPB) is often followed by pulmonary dysfunction, although literature on the subject in the setting of Type A acute aortic dissection (TAAAD) is limited.

Methods

This study identified the incidence of ARF after TAAAD, associated risk factors, and the impact of ARF on early and late outcomes. All data have been derived from the International Registry of Acute Aortic Dissection (IRAD).

Results

Postoperative ARF (defined as ventilator support for ≥3 days, tracheostomy, and/or pneumonia) occurred in 434 (24.6%) of 1764 surgically managed TAAAD patients (mean age 60.1±14.2 years) from November 2001 until November 2017. Peripheral vessel procedures (6.4% v 2.8%, p=0.002), cerebral perfusion (89.2% v 82.3%, p<0.001), use of hypothermic circulatory arrest (93% v 87.7%), longer arrest time (median 39 (Q1-Q3 27–128 minutes) v 31 (Q1-Q3 22.0–52.9 minutes)), and lower extremity ischemia (18.8% v 6.7%, p<0.001) were more common in ARF patients.

On multivariable logistic regression analysis, age ≥70 years (OR 1.019, 95% CI 1.005–1.034, p=0.008), current smoking (OR 1.744, 95% CI 1.184–2.570, p=0.005), peripheral vessel procedures (OR 2.457, 95% CI 1.132–5.334, p=0.023), presenting hypotension/shock (OR 2.036, 95% CI 1.336–3.102, p=0.001), lower extremity ischemia at surgery (OR 2.77, 95% CI 1.574–4.875, p<0.001), concomitant coronary artery bypass graft (CABG) (OR 2.982, 95% CI 1.597–5.568, p=0.001), pre-operative acute renal failure (OR 2.532, 95% CI 1.350–4.749, p=0.004), and prolonged circulatory arrest time in minutes (OR 1.005, 95% CI 1.003–1.007, p<0.001) were independently associated with ARF development. Patients with aortic valve replacement (AVR) were less likely to develop ARF (OR 0.497, 95% CI 0.308–0.802, p=0.004).

Post-operative complications were more common in ARF patients. In-hospital mortality was higher in the ARF cohort (16.4% v 4.7%, p<0.001). Multivariable logistic regression identified ARF (OR 2.686, 95% CI 1.647–4.381, p<0.001) as well as pre-operative hypotension (OR 1.89, 95% CI 1.130–3.159, p=0.015), lower extremity ischemia (OR 2.77, 95% CI 1.545–4.998, p=0.001), pre-operative myocardial infarction (OR 3.141, 95% CI 1.058–9.33, p=0.039), and CABG (OR 1.988, 95% CI 1.011–3.909, p-value 0.047) as independent predictors of death.

Conclusions

Post-operative ARF is common after TAAAD repair; in-hospital complications and death are higher in this cohort.

Acknowledgement/Funding

W.L. Gore & Associates, Inc.; Medtronic; Varbedian Aortic Fund; Hewlett Foundation; Mardigian Foundation; UM Faculty Group Practice; Ann & Bob Aikens
P5614The association between tissue morphology assessed with optical coherence tomography and mid and late-term results after percutaneous coronary intervention for in-stent restenosis lesions
Authors: Tada T , Miura K , Ohya M , Shimada T , Murai R , Amano H , Kubo S , Habara S , Tanaka H , Fuku Y , Kadota K
Published: October 2019

Background

It was reported that tissue morphology of in-stent restenosis (ISR) lesions assessed with optical coherence tomography (OCT) had an effect on midterm results including ISR and target lesion revascularization (TLR) rates after percutaneous coronary intervention (PCI). However, little was known about the association between tissue morphology assessed with OCT and late-term results.

Methods

We performed PCI treated with paclitaxel coated balloon (PCB) or drug-eluting stent (DES) for 452 ISR lesions (260 lesions with fibrous plaque and 192 lesions with lipid-laden plaque) using OCT between May 2008 and July 2016. Six- to eight-month (midterm) angiographic follow-up was performed on 422 of the 452 ISR lesions (follow-up rate: 93.4%). Furthermore, eighteen- to twenty-month (late-term) angiographic follow-up was performed on 337 of the 361 ISR lesions (follow-up rate: 93.4%) which were free from midterm TLR. We examined the association between tissue morphology, midterm-results and late-term results including ISR and TLR rates. Fibrous plaque was defined as homogeneous, signal-rich regions with low attenuation. Lipid-laden plaque was defined as diffuse border, signal poor regions with high attenuation.

Results

The patients were 353 men and 69 women, and the mean age was 68.8±9.6 years. PCI were performed with PCB in 285 lesions (PCB group) and DES in 137 lesions (DES group). The figure shows the angiographic midterm results of the 422 lesions and late-term results of the 337 lesions with respect to each tissue morphology and each PCI device. There was no difference in ISR and TLR rates of lesions with both fibrous and lipid-laden plaque at midterm between the two groups. ISR and TLR rates of lesions with lipid-laden plaque at late-term were significantly higher in the PCB group than in the DES group, while there was no difference in ISR and TLR rates of lesions with fibrous plaque at late-term between two groups.

Figure 1

Conclusion

Tissue morphology of ISR lesions might have an impact on outcomes after PCI. Morphological assessment of ISR tissue using OCT might suggest favorable types of PCI for ISR lesions.
P5620Clinical and hemodynamic determinants of coronary flow reserve in non-obstructed coronary arteries - A patient level pooled analysis of the DEBATE and ILIAS studies
Authors: Stegehuis V E , Wijntjens G W M , Bax M , Meuwissen M , Chamuleau S A J , Voskuil M , Di Mario C , Vrints C , Haude M , Boersma H , Serruys P W , Piek J J , Van De Hoef T P
Published: October 2019

Aim

Coronary Flow Reserve (CFR) is a valuable physiological index for the assessment of myocardial flow impairment due to focal or microcirculatory coronary artery disease (CAD). Coronary flow capacity (CFC) is another flow-based concept in diagnosing ischemic heart disease (IHD), based on hyperemic average peak velocity (hAPV) and CFR. We evaluated clinical and hemodynamic factors which potentially influence CFR and CFC in non-obstructed coronary arteries.

Methods

We analysed CFR and CFC of 396 non-obstructed vessels of patients from two large multi-center trials (DEBATE and ILIAS) with stable CAD who were scheduled for percutaneous coronary intervention (PCI). Doppler flow measurements were performed after inducing hyperemia with either intracoronary or intravenous infusion of adenosine.

Results

Akaike's Information Criterion (AIC) revealed the parameters age, female gender, a history of myocardial infarction, hypercholesterolemia, current or previous smoking and rate pressure product (RPP) as independent predictors in the best model of fit for CFR in an angiographically non-obstructed vessel. After multivariate regression analysis age, female gender and RPP remained as determinants of CFR in angiographically non-obstructed vessels. Subsequently, ordered logistic regression analysis revealed that age is associated with a worse CFC.

Conclusion

Clinical and hemodynamic parameters are associated with CFR and to a lesser extent CFC in an angiographically non-obstructed coronary artery. CFC is less sensitive to variations in clinical and hemodynamic parameters than CFR and therefore a promising tool in contemporary clinical decision making in the cardiac catheterization laboratory.

Acknowledgement/Funding

DEBATE: Cardiometrics INC. ILIAS: Dutch Health Insurance Board; RADI Medical Systems, Uppsala, Sweden; and Endosonics, Rancho Cordova, CA.
P5621Diagnostic accuracy of resting full-cycle ratio in the non-culprit artery of acute patients
Authors: Tamargo Delpon M A , Gutierrez E , Diez-Delhoyo F , Gonzalez-Saldivar H , Rivera A R , Casado A , Vazquez M E , Sanz R , Soriano J , Elizaga J , Fernandez-Aviles F J
Published: October 2019

Introduction

Resting full-cycle ratio (RFR) is a novel non-hyperemic index of coronary stenosis severity, independent of the timing within the cardiac cycle. Recent data has demonstrated good correlation between RFR and Fractional Flow Reserve (FFR) in stable coronary disease (SCD). However, there are no data regarding the reliability of RFR in non-culprit arteries of patients presenting with acute myocardial infarction (AMI).

Purpose

To study the diagnostic accuracy of RFR versus FFR in the non-culprit artery in AMI compared to stable lesions.

Methods

RFR, FFR, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR), and Resistance Reserve Ratio (RRR) were calculated in 67 patients with AMI and an intermediate lesion in a non-culprit artery (median time from primary PCI to study: 48 hours). Data were compared with those of a retrospective group of 66 patients with SCD.

Results

There was a higher proportion of males among patients of the AMI group (85% vs 62%, p=0.0026). Mean age was 64.5±11 years, being AMI cohort younger at presentation [62±11 vs 67±12 years in SCD cohort (p=0.04)]. Patients with AMI had a significantly lower prevalence of hypertension (52% vs 75%, p=0.006), diabetes (10% vs 32%), p=0.002) and hyperlipemia (37% vs 79%, p=0.002).

Coronary physiology parameters showed a non-normal distribution, and are expressed as median [IQR] (Table 1). In patients with AMI, FFR was lower than in patients with SCD. In contrast, RFR showed no significant difference. Both CFR and RRR were higher in the AMI group. No significant differences in IMR were found between cohorts.

Importantly, in the AMI group the correlation between RFR and FFR was 0.84 and the overall agreement 82%, with rates of false positive and negative of 15% and 3%, respectively. In SCD the correlation was 0.81 with a lower overall agreement of 69%, due mostly to a higher rate of false positive RFR (28%) (Figure 1).

Table 1. Microcirculatory parameters in non-culprit artery (AMI) and stable coronary disease (SCD) AMI (N=66) Stable (N=67) p value FFR 0.84 [0.76–0.9] 0.84 [0.76–0.9] 0.006 RFR 0.89 [0.82–0.94] 0,9 [0.84–0.94] 0.24 CFR 2.2 [1.7–3.1] 1.8 [1.1–2.6] 0.011 IMR 17 [14–27] 25 [14–38] 0.051 RRR 2.7 [2.17 - 3.9] 2.1 [1.4–3.1] 0.005 Median [IQR].

Figure 1. Correlation between RFR and FFR valueS

Conclusions

RFR shows a good correlation with FFR in AMI. Surprisingly, overall agreement is higher in the non-culprit artery in an acute setting, with a lower percentage of false positive results.

Acknowledgement/Funding

None
P5629The effect of strut protrusion on local shear stress and neointimal hyperplasia
Authors: Tenekecioglu E , Katagiri Y , Torii R , Pekkan K , Onuma Y , Serruys P W
Published: October 2019

Objective

To evaluate effect of strut protrusion (SP) on wall shear stress (WSS) and neointimal growth (NG) 1 and 5 year after implantation of Absorb scaffold.

Method

8 patients were selected from Absorb Cohort B. After 3-dimensional reconstruction of coronaries, WSS was quantified using Newtonian steady flow simulation (Figure). At 1-year neointimal thickness (NT) was measured by optical coherence tomography and correlated to WSS and SP post-procedure.

Results

Median SP was 112.9 (90.8, 133.1) μm. A logarithmic (log) inverse relationship between SP and post-procedure WSS (r=−0.425 p<0.001 correlation coefficients range: −0.143 to −0.553) was observed whereas a correlation between baseline log transformed WSS and NT (r=−0.451 p<0.001 correlation coefficients range: −0.140 to −0.662) was documented at 1 year. Mixed effects analysis between baseline log transformed WSS and NT at follow up yielded a slope of 30 μm/ln Pascal (Pa) and a y-intercept of 98 μm. As result of NG, flow area decreased from 6.91 (6.53, 7.48) mm2 post-implantation to 5.65 (5.47, 6.02) mm2 at 1 year (p=0.01) and to 5.75±1.37 mm2 at 5 years (p=0.024). Vessel surface with low WSS (<1 Pa) decreased from post-procedure (42%) to 1 year (35.9%) and 5 years (15.2%) (p-overall<0.0001).

Conclusion

SP disturbs laminar flow, creates region of low WSS that is mechanistically associated with NG and lumen area reduction. This observation would suggest thin strut with effective embedment would reduce NG and improve WSS towards physiological values.
P5633Diagnostic impact of resting full-cycle ratio as newly developed non-hyperemic indices for physiological lesion assessment
Authors: Takashima H , Suzuki A , Sakurai S , Ando H , Nakano Y , Watanabe A , Mukai K , Wakabayashi H , Kojima H , Sawada H , Saka Y , Fujimoto M , Tanabe S , Ohashi H , Amano T
Published: October 2019

Background

Although fractional flow reserve (FFR) is a gold standard method to evaluate functional lesion severity in the catheterization laboratory, the need of hyperemic condition limits the widespread adoption of FFR. Recently, the resting full-cycle ratio (RFR) which was newly developed resting indices was launched. It is unclear whether RFR as resting condition could assess physiological lesion severity of coronary artery stenosis. The aim of this study was to evaluate the diagnostic impact of RFR compared to FFR in entire range of coronary artery stenosis.

Method

A total of 53 patients with 70 lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis.

Results

In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.3±0.8mm, 44±12%, 14.6±7.2mm, 0.90±0.11, and 0.83±0.11, respectively. Functional significance was observed in 24 lesions (34%) of all lesions. The RFR showed a significant correlation with FFR (y = 0.800x + 0.239, R = 0.817, p<0.001). The Bland-Altman plot demonstrated a good agreement with a mean difference of 0.07 and a standard deviation of 0.06 between RFR and FFR across entire range of coronary artery stenosis. ROC curve analysis showed an excellent accuracy of RFR cut-off of ≤0.90 in predicting FFR ≤0.80 which had 78% sensitivity and 87% specificity (AUC 0.87, diagnostic accuracy 84%).

Conclusion

The RFR as newly resting indices is reliable to the assessment of functional lesion severity. This physiology-based approach may be a possible alternative method for FFR measurements in daily practice.
P5655Efficacy of new-generation atrial antitachycardia pacing for atrial tachyarrhythmias in patients with left ventricular dysfunction
Authors: Kamakura T , Nakajima K , Kataoka N , Wada M , Yamagata K , Ishibashi K , Inoue Y , Miyamoto K , Nagase S , Noda T , Aiba T , Yasuda S , Kusano K
Published: October 2019

Background

The progression to persistent atrial fibrillation (AF) is associated with a worse clinical outcome in patients with previous atrial tachyarrhythmias. New-generation atrial antitachycardia pacing (ATP) (Reactive ATP) reduced the progression to persistent AF in patients with pacemaker and preserved left ventricular (LV) function. However, little is known about the efficacy of Reactive ATP in patients with cardiac implantable electronic devices (CIED) and LV dysfunction.

Purpose

We aimed to investigate the efficacy of Reactive ATP for atrial tachyarrhythmias in patients with LV dysfunction (LV ejection fraction [LVEF] <40%).

Methods

This study included 423 patients with CIED and previous atrial tachyarrthythmias. Reactive ATP was programmed in 284 patients (ATP group) and 139 were implanted with a dual-chamber device without ATP function (control group). The differences in the success rate of ATP and incidence of progression to persistent AF (≥7 days) between the ATP and control groups were evaluated in 108 patients with LVEF <40% (reduced LVEF) and 315 with LVEF ≥40% (preserved LVEF). Patients with persistent AF were excluded from this study.

Results

During 710±337 days of follow-up period, 16 patients (15%) with reduced LVEF and 51 (16%) with preserved LVEF progressed to persistent AF (p=0.88). The mean ATP success rate was lower in patients with reduced LVEF than in those with preserved LVEF, although not statistically significant (reduced LVEF: 27.2±19.4% and preserved LVEF: 35.1±29.2%, p=0.12). The incidence of progression to persistent AF was significantly lower in the ATP group than in the control group both in patients with reduced and preserved LVEF (log-rank, reduced LVEF: p=0.0070 and preserved LVEF: p<0.0001) (Figure). Multivariate analysis showed that use of Reactive ATP and smaller left atrium were associated with lower incidences of persistent AF, while LVEF was not predictive of progression to persistent AF (Reactive ATP: hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.17–0.46, p<0.0001, left atrium diameter: HR 1.03, 95% CI 1.00–1.07, p=0.030).

Figure 1

Conclusions

Reactive ATP was effective in preventing AF progression in patients with LV dysfunction.
P5658Incorporation of severity of left atrial enlargement in clinical risk factors improves identification of patients at risk for development of atrial fibrillation
Authors: Chawla D , Olet S , Mortada M E , Zilinski J , Ammar K A , Nangia V , Bhatia A , Niazi I , Sra J , Tajik A J , Jahangir A
Published: October 2019

Background

Early identification of patients at risk for atrial fibrillation (AF) is desirable to prevent its development and complications. Clinical predictors have been recognized but need refinement to improve predictability. We evaluated whether severity of left atrial enlargement (LAE) added to a scoring system (CHA2DS2VASC) in an unselected non-AF population improves risk stratification for incident AF.

Purpose

To assess the incremental benefit of LAE severity added to CHA2DS2VASc in predicting future AF in non-AF patients.

Methods

From 2012–2017, consecutive adult patients with an echocardiogram and no prior AF were identified. CHA2DS2VASc was used to define baseline AF risk, and the incremental risk of AF with addition of LAE was assessed through increased LA volume index (LAVI; moderate 42–48 ml/m2, severe >48 ml/m2). To quantify improvement in risk prediction, logistic regression model was fitted and odds ratios (OR) and ROC curves obtained.

Results

Out of 155,597 patients with no prior AF, 13.8% developed AF over 1.5±1.3 years. OR for AF with CHA2DS2VASc was 1.68 (95% CI 1.66–1.69). With addition of moderately or severely increased LAVI to the model, OR for AF increased to 2.3 (2.2–2.5) and 3.8 (3.6–4.0), respectively. ROC analysis showed c-statistics of 0.66 with CHA2DS2VASc, 0.63 with LAVI, and 0.71 with incorporation of both (Fig).

AF CHAD score

Conclusion(s)

In non-AF patients, predictability for future AF can be improved by using clinical factors (CHA2DS2VASc) and increased LAVI. This information may guide closer monitoring and initiation of therapies to prevent progression to AF or stroke.

Acknowledgement/Funding

None
P5659Atrial fibrillation causes cognitive impairment-which cognitive domains are affected?
Authors: Pal T , German-Sallo M , Preg Z , Szentendrey D , Tripon R G , Nemes-Nagy E
Published: October 2019

Introduction

Hypertension is an important modifiable risk factor related to cognitive dysfunction. Data suggest that atrial fibrillation (AF) is also associated with an increased risk of cognitive decline, independent of stroke history. Few studies focus on the effect of AF on specific cognitive domains.

Purpose

We aimed in this study to investigate the prevalence of cognitive dysfunction among hypertensive patients with atrial fibrillation and to evaluate the impact of atrial fibrillation on the affected cognitive domains.

Methods

In the present paper, we included 488 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 37–93 years (mean age: 68±10 years; 51.84% female; 48.15% male). Diagnosis of AF was based on 12 lead ECG. All types of AF (paroxysmal, persistent and permanent) were included. The prevalence of atrial fibrillation in our sample was 23.77% (n=116), on admission mean heart rate was 76±16 bpm and mean blood pressure 137/82 mmHg (±19/11 mmHg). After routine clinical assessment all participants completed the Montreal Cognitive Assessment (MoCA) test used for the detection of mild cognitive impairment. Depression as a confounding factor on cognitive performances was detected with the shortened 13 items form of Beck Depression Inventory (BDI-13). We compared MoCA scores of the group of patients with atrial fibrillation with scores from the group in sinus rhythm. Statistical analysis was performed with the IBM SPSS v.20 program.

Results

Impairment in cognitive functions was revealed among hypertensive patients in sinus rhythm vs. with atrial fibrillation according to MoCA in 66.1% (n=246) vs. 81.9% (n=95). Cognitive scores were significantly lower in the atrial fibrillation group vs. patients in sinus rhythm: MoCA: 21.74 vs. 22.97 (p=0.016). The prevalence of depression in the two groups was not statistically different, AF 52.58% vs. 55.34% patients in sinus rhythm (p=0.89). Analysing MoCA's cognitive domains, patients with atrial fibrillation had significantly lower scores in visuospatial/executive (3.09 vs. 3.52 p=0.005), language (1.59 vs. 1.85 p=0.019) and abstraction (1.18 vs. 1.41 p=0.005) domains.

Conclusions

The prevalence of cognitive impairment is higher in patients with atrial fibrillation. Atrial fibrillation may have an impact on the most complex cognitive functions as visuospatial/executive, language and abstraction.

Acknowledgement/Funding

Funding for the study was provided by the Hungarian Academy of Science, contract nr. 0346/26.02.2016.
P5675Ischemic stroke in patient with sinus node disease in comparison to atrial fibrillation, bradycardia-tachycardia syndrome and other cardiac conditions: a nationwide cohort-study
Authors: Bodin A , Bisson A , Clementy N , Pierre B , Herbert J , Gaborit C , Guillon Grammatico L , Babuty D , Fauchier L
Published: October 2019

Atrial fibrillation (AF) may be associated with sinus node disease (SND) presenting as a brady-tachy syndrome (BTS), known to be at risk for embolic ischemic stroke (IS). It remains unclear whether the risk of IS is increased in patients with isolated SND.

Methods

This French longitudinal cohort study was based on the national database covering hospital care from for the entire population (PMSI) from 2010 to 2015. We compared incidences of IS in patients with a diagnosis of AF or SND to that in a control group of patients with a main diagnosis of cardiac condition (excluding those with AF or SND, history of stroke and mechanical valve or mitral stenosis).

Results

Of 1,732,412 patients included in the cohort, 1,601,435 (92.44%) had isolated AF, 102,849 (5.94%) had isolated SND and 28,128 (1.62%) had BTS. The control group with cardiac condition included 479,108 patients. Incidence of IS progressively increased when considering patients from the control population, patients with isolated SND, with BTS or with isolated AF (0.67%/yr, 1.95%/yr, 3.03%/yr and 5.48%/yr respectively). These differences were seen in all strata of CHA2DS2VASc score (table). SND patients with a CHA2DS2-VASc score ≥3 had a yearly incidence of IS >2%, comparable to AF population with a CHA2DS2-VASc score ≥1.

Incidence (%/year) of ischemic stroke CHA2DS2-VASc AF population SND population “Control” population Women Men Women Men Women Men All scores 6.72% 4.37% 1.93% 1.96% 0.67% 0.68% Score = 0 – 1.960% – 1.211% – 0.217% Score = 1 2.337% 3.046% 0.538% 1.486% 0.166% 0.345% Score = 2 3.917% 4.499% 0.879% 1.541% 0.298% 0.580% Score = 3 7.572% 4.733% 2.207% 2.084% 0.541% 0.907% Score = 4 7.016% 4.820% 2.363% 2.305% 0.930% 1.278% Score = 5 6.725% 5.345% 2.845% 2.849% 1.249% 1.553% Score = 6 7.637% 7.543% 3.319% 4.109% 1.737% 2.031% Score = 7 10.196% 13.927% 4.663% 7.708% 2.346% 4.089% Score = 8 17.654% 12.607% 8.519% 11.904% 2.446% 2.355%

Conclusion

Patients with isolated SND had a lower risk of IS than patients with AF or BTS. However, SND patients had a non-neglectable risk of IS during follow-up which was higher than in a “control” population. Whether oral anticoagulation may bring a significant clinical benefit might be studied in patients with SND at highest risk of IS.
P5680One-year outcomes of heart failure patients undergoing cardiac resynchronization therapy using adaptivCRT algorithm
Authors: Briongos Figuero S , Estevez A , Perez M L , Martinez-Ferrer J B , Alvarez-Costa L , Anguera I , Garcia E , Perez-Lorente F , Porres J M , Perez-Villascastin J M , Rodriguez J C , Munoz-Aguilera R
Published: October 2019

Background

Adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular (LV) only pacing and ambulatory optimization of the intrinsic atrioventricular and interventricular conduction intervals. Studies reporting morbidity and mortality outcomes of aCRT carriers in daily clinical practice are lacking.

Purpose

To determine in a real-life setting, whether 1-year outcomes were different among CRT carriers undergoing aCRT pacing and those under conventional biventricular (biV) pacing.

Methods

Symptomatic heart failure (HF) patients with sinus rhythm undergoing first CRT-defibrillator implant were selected from the UMBRELLA nationwide registry (2012–2017). The primary endpoint was the composite of all-cause mortality or HF hospitalization at 12-month follow-up. HF admission was defined as hospitalization due to symptoms requiring intravenous diuretic treatment. Primary healthcare records were used to prospectively collect all data.

Results

Two hundred and six patients were collected (66.1±8.7 years; 73.3% male). Eighty-seven out of 206 patients were implanted with an aCRT capable device, but this algorithm was activated at implant and remained enabled at 1-year in 59 patients (aCRT group). The other 147 patients composed the non-aCRT group. At implant left bundle branch block was present in 93% of patients, 69.6% of population was in functional class III or IV and mean left ventricle ejection fraction was of 26.5±5.6%. Non-ischemic cardiomyopathy was present in 63.1% of patients and optimal medical treatment was achieved in majority of population (92% of patients with beta-blockers; angiotensin-converting enzyme inhibitorsor angiotensin II receptor blockersin 89%). The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). In aCRT patients, LV-only pacing accounted for a mean of 53.3±37.6% of all ventricular pacing.

After 12-month follow-up period, 25 patients (12.1%) met the primary composite endpoint of death or HF hospitalization. Nine patients died and nineteen patients were admitted due to worsening HF. There was no difference in the risk of all-cause death or HF hospitalization between aCRT and non-aCRT patients (10.2% vs. 12.9% respectively; OR=0.76, CI: 0.29–2.01, p=0.585)

Conclusions

In this contemporary cohort of HF patients undergoing CRT with high percentages of ventricular pacing, clinical performance of aCRT algorithm was adequate. The risk of death or HF hospitalization was low and no differences were observed at one-year follow-up. Future randomized studies will clarify the role of this algorithm in CRT carriers.

Acknowledgement/Funding

None
P5689First intention epicardial VT ablation: what are the results?
Authors: Graca Rodrigues T E , Cortez-Dias N , Silva G L , Agostinho J R , Aguiar-Ricardo I , Rigueira J , Nunes-Ferreira A , Santos R , Cunha N , Morais P , Pereira S , Silverio-Antonio P , Carpinteiro L , Pinto F J , Sousa J
Published: October 2019

Introduction

Ventricular tachycardia (VT) endocardial mapping and ablation may not be sufficient in several arrhythmogenic contexts, because ventricular myocardium may comprise intricate endocardial, intramural and epicardial substract. Thus, epicardial ablation has lately become a complementary and necessary tool to approach some VTs in different types of cardiomyopathies.

Purposes

To evaluate the clinical characteristics of patient most suitable for first intention epicardial VT ablation and to describe our centre experience.

Methods

Single-centre prospective study of consecutive patients (pts) undergoing isolated first intention epicardial VT mapping and ablation since August 2015. All pts had clinical assessment, electrocardiogram (ECG), echocardiogram and cardiac magnetic resonance when feasible. Pts with a previous endocardial ablation were excluded. Epicardial subxiphoid access utilizing a tuhoy needle was performed under fluoroscopic guidance. High-density mapping was performed using CARTO® V4 and EnSite PrecisionTM systems and multipolar catheters. Radiofrequency energy was applied with an irrigated-tip catheter.

Results

First intention epicardial VT ablation was attempted in 12 pts (mean age 57.6±14.6 years, 91% male). The majority had non-ischemic dilated cardiomyopathy, of unknown aetiology in 59%, hereditary dilated cardiomyopathy in 17% ethanolic origin in 8% and post-myocarditis in 8%. Right Ventricular Arrhythmogenic Cardiomyopathy was present in 1 patient. As expected, our population presented a mean ejection fraction of 29% and 11 pts (92%) had an implantable cardioverter defibrillator - ICD (55% as primary prevention, 45% as secondary prevention). All pts had experienced symptomatic VT, with all ICD carriers receiving appropriate shocks. Only 4 pts had an available 12 lead ECG of the VT, and all of them had a QS pattern in lead aVL and a slurred initial QRS complex. The majority of patients presented low voltage areas and local abnormal ventricular activities at the epicardial surface, with the exception of 2 pts in whom ablation was not performed (one non-ischemic cardiomyopathy of ethanolic aetiology and the other of unknown origin). Mean ablation application time was 68 minutes, with an average maximum power of 39.9 watts. Mean overall procedure and fluoroscopic time was 132 and 24 minutes, respectively, with no major intraprocedural complications. During a mean follow-up of 307±328 days, 3 pts died (mean 121 days after procedure), 3 had recurrent VT episodes and ICD shocks, and 2 received heart transplant.

Conclusion

In selected pts, with non-ischemic dilated cardiomyopathy and ECG with QS pattern in aVL and slurred QRS, epicardial VT mapping and ablation may be used as first approach, preventing unnecessary endocardial mapping. This procedure demonstrated to be safe.
P5706Finding predictors and causes of cardiac surgery ICU readmission using machine learning and causal inference
Authors: Lee J , Ahmidi N , Srinivasan R , Alejo D , Dinatale J , Schena S , Whitman G , Sussman M , Shpitser I
Published: October 2019

Background

“Bounce-back” to the intensive care unit (ICU) occurs when patients return to the ICU for critical changes in clinical status within the same hospital admission. Bounce-backs post-cardiac surgery increase resource utilisation, total cost of care, are associated with higher mortality and morbidity. However, prediction of bounce-back has proved to be challenging. Previous work addressed the feasibility of predicting bounce-back, but these models required significant physician input to design and calibrate the predictive variables.

Purpose

We aimed to develop an automated machine learning model that would identify patients at risk of bounce-back by selecting the most relevant variables from those available before onset of bounce-back. Additionally, we highlight the differences between predictive and causal inference, to demonstrate that purely associative methods of prediction can mislead clinical decision-making.

Methods

Clinical records of adult cardiac surgery patients between 2011 to 2016 were collected from our institutional Society for Thoracic Surgeons (STS) database and our institutional electronic health record (EHR) system. For bounce-back prediction, an L1 regularised logistic regression model was applied, which also automatically determined important variables with highest prediction effect from the initial 151 variables. For causal inference, the g-computation algorithm was used to compare the differences between causal and predictive regression effects. We quantified the performance of our system on clinically relevant metrics such as specificity, sensitivity, and area under the ROC curve (AUC).

Results

Of the 6189 patients, 357 (5.7%) bounced back to the ICU. The prediction model achieved an AUC score of 0.75 (0.03) and 22% specificity at 95% sensitivity, Further analysis showed 79% of the false positive patients had faced other severe postoperative complications but none of the false negative patients had downstream complications. Subsequent causal analysis revealed that the actual causal effects of treatments differed from the predictive model estimates, e.g. administration of intra-operative tranexamic acid increased the probability of bounce-back by 13% but its causal effect on bounce-back after removing confounders was negligible (an increase of only 0.5%).

Conclusions

Our predictive machine-learning model can successfully predict patients at risk of ICU bounce-backs, using linked STS registry data with the comprehensive electronic health record. The prediction model automatically detects important subset of variables. In addition, we note that causal and predictive model estimates of the same parameters differed, indicating that reliance on predictive models for interventional clinical decision-making may not be appropriate.

Acknowledgement/Funding

National Institutes of Health, Office of Naval Research, Defense Advanced Research Projects Agency
P5712Research Network in Africa (RNA): quality assessment of antihypertensive generic drugs in 10 African countries
Authors: Macquart De Terline D , Zabsonre P , Balde D , Ikama S , N Guetta R , Tchabi Y , Sidi Aly A , Damourou J M F , Takombe J L , Bernard M , Do B , Diop B I , Jouven X , Antignac M , Ali Toure I
Published: October 2019

Introduction

Hypertension results in more deaths than any other risk factor and has been on the rise in Sub-Saharan Africa over the past few decades. Generic drugs have helped improve accessibility and affordability of antihypertensive therapy in developing countries. However, assessment of quality standards of these products is important.

Purpose

We performed a quality assessment of five commonly used antihypertensive generic drugs in ten Sub-Saharan African countries and studied the impact of price on quality.

Methods

Drug samples were prospectively collected using standardized methods between 2012 and 2014. We developed a validated reversed-phase liquid chromatography with tandem mass spectrometry method to accurately quantify the active ingredient in a certified public laboratory. Quality was defined based on the percentage ratio of measured to expected dosage of active ingredient.

Results

A total of 1185 samples were assessed, of which 70.0% were generic (n=830). Among the generic drugs, the percentage of poor quality drugs was 24.3% (n=202/830). The percentage ratio of measured to expected dosage of active ingredient ranged from 49.2% to 111.3%; the majority (81.7%) of the poor quality samples had insufficient quantity of the active ingredient. Moreover, poor quality was not associated with purchase price of the drug.

Conclusion

In this study from ten Sub-Saharan African countries, nearly one-quarter of the available generic antihypertensive drugs were found to be of poor quality. Concerted measures to improve the quality of antihypertensive drugs could lead to major improvements in hypertension control with attendant reduction of its deleterious consequences in low and middle income countries.

Figure 1. Percentage of poor quality in generic antihypertensive drugs according to the country of purchase.

Acknowledgement/Funding

Grant AAP-2014-042, ANSM (Agence Nationale Sécurité du Médicament
P5739Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock: exploring prognostic variables and risk prediction tools
Authors: Goncalves Teixeira P M , Passos Silva M , Mbala D , Ana Canelas M , Varela M , Raquel Barbosa A , Guerreiro C , Mosalina A , Dias T , Queiros P , Fontes-Carvalho R , Ponte M , Dias A , Caeiro D , Braga P
Published: October 2019

Introduction

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to support patients in cardiogenic shock has been increasing in Portugal over the past few years. Nonetheless, epidemiologic, prognostic and clinical outcome data are scarce.

Purpose

We aim to identify clinical variables with prognostic significance in this challenging population, as well as the performance of various risk scores in mortality prediction.

Methods

All patients that underwent VA-ECMO support at our Cardiac ICU between 2011 and 2018 were included in the analysis. Logistic regression analysis was used to assess the relationship between clinical variables and outcomes.

Results

Short-term mechanical support with VA-ECMO was given to 40 patients, with a mean age of 52±11 years. At the time of the implant, the mean SOFA score was 11.2±4.0, and mean SAVE score was −4.75±4.6. Mean ECMO support duration was 116±96 hours. In 70% (N=28) of patients, VA-ECMO was successfully weaned. In-hospital mortality was observed in 52.5% of patients, which was in accordance with the predicted mortality by SOFA score (22.5% to 82% in our population risk range) and by SAVE score (60 to 70%). Those who placed the VA-ECMO as a bridge to transplant or to long-term mechanical LV assist device had greater in-hospital mortality rates (91.6 vs 41.9%, p=0.013), as well as those under ≥2 inotropic/vasopressors (69.2 vs 21.4%, p=0.012) or when adrenaline use was needed (100% vs 44.1%, p=0.01). No other between-group differences were observed in what concerns short-term mortality. After logistic regression analysis, independent predictors of in-hospital mortality included AMI setting, number of vasoactive amines used, and necessity of a LV venting device. SAVE score had the greater predictive ability in these patients (AUC = 0.638) among the most utilized clinical risk scores (SOFA score AUC = 0.37; APACHE II score AUC = 0.59; SAPS II score AUC = 0.54).

Conclusion

In our analysis, patients in profound cardiogenic shock on VA-ECMO support had slightly better survival rates than predicted by classical Risk Scores. The SAVE score may be the most accurate tool to predict in-hospital mortality in this specific, and yet heterogeneous, clinical subset. Other well recognized clinical markers of severity may also help refine short-term prognosis, and potentially improve organ transplant or other destination therapy prioritization.
P5746Human induced pluripotent stem cell-derived mesenchymal stem cell therapy effectively reduced brain infarct volume and preserved neurological function in rat after acute intracranial hemorrhage
Authors: Li Y C , Lee F Y , Chua S , Yip H K
Published: October 2019

Intracerebral hemorrhage (ICH) causes 10%-20% of all strokes and results in higher morbidity compared to other subtypes of cerebral stroke. Although early surgical intervention can clear the expanding hematoma, clinical outcomes following ICH have not significantly improved over the decades. Since ICH elicits neuroinflammation to exacerbate brain edema, damage the blood-brain barrier (BBB), lead to secondary neuronal injury, anti-inflammation may be a critical therapeutic strategy. Mesenchymal stem cell (MSC) therapy processes anti-inflammatory, immunomodulatory and tissue regenerative properties, suggesting that MSC therapy could be an effective therapy for ICH. Therefore, this study tested the hypothesis that human induced pluripotent stem cell-derived mesenchymal stem cell (iPSC-MSC) therapy could effectively reduce brain-infract volume (BIV) and improve neurological function in rat after acute ICH induced by a weight-drop device. Adult-male SD rats (n=40) were equally divided into group 1 (sham-operated control), group 2 (ICH), group 3 (ICH + hyaluronic acid (HA)/intracranial injection/3h after ICH), group 4 [ICH + HA + iPSC-MSC (1.2x106 cells/intracranial injection/3h after ICH)] and euthanized by day 28 after ICH procedure. In vitro study showed that hemorrhagic-brain tissue augmented protein expressions of inflammation (HMGB1/MyD88/TLR-4/TLR-2/NF-κB/TNF-α/iNOS/IL-1β) in cultured neurons that were significantly inhibited by iPSC-MSC treatment (all p<0.001). By days 7/14 after ICH procedure, circulating inflammatory levels of TNF-α/IL-6/MPO expressed were lowest in group 1, highest in group 2 and significantly lower in group 4 than in group 3 (all p<0.0001). By day 14 after ICH procedure, neurological function and BIV expressed an opposite pattern, whereas protein expressions of inflammation (HMGB1/MyD88/TLR-4/TLR-2/NF-κB/I-kB/TNF-α/iNOS/IL-1β/MMP-9), oxidative stress (NOX-1/NOX-2/oxidized protein) and apoptosis (mitochondrial-Bax/cleaved-caspase-2/PARP) in brain exhibited an identical pattern to circulating inflammation among the four groups (all p<0.001). Microscopy demonstrated that the number of vascular remodeling/GFAP+/53BP1+/γ-H2AX+ cells displayed an identical pattern of inflammation, whereas the NeuN+ cells displayed an opposite pattern of inflammation among the four groups (all p<0.001). In conclusion, iPSC-MSC therapy markedly reduced BIV and preserved neurological function mainly by inhibiting inflammatory/oxidative-stress generation.

Acknowledgement/Funding

Kaohsiung Chang Gung Memorial Hospital, Taiwan Society of Stem Cell Research