bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolated exercise-induced pulmonary hypertension is associated with clinical worsening and poorer immunological control in hiv patients
Authors: Madonna R , Fabiani S , Morganti R , Forniti A , Menichetti F , De Caterina R
Published: October 2021

Background and aim

Exercise-induced pulmonary hypertension (Ex-PH), due to impaired pulmonary vascular and right ventricular (RV) contractile reserve on effort, may represent the earliest sign of pulmonary arterial hypertension (PAH), which may develop in Human immunodeficiency virus (HIV) patients with poor disease control. We investigated its association with clinical determinants of immunological status, virological control, and response to antiviral therapy in HIV patients at risk for PAH.

Methods

In 31 consecutive HIV patients with either low (n=29) or intermediate probability (n=3) of PH at rest, we evaluated the association of isolated ExPH with: time to HIV diagnosis, CD4+ T cell count, clinical progression to AIDS, development of resistance to antiretroviral therapy (ART), HIV RNA levels (copies/mL), time to onset of ART, current use of protease inhibitors, combination of ART with boosters (ritonavir e cobicistat), virological response to ART, ART discontinuation. Isolated ExPH at stress echocardiography (ESE) was defined as absence of PH at rest and systolic pulmonary arterial pressure (sPAP) >45 mmHg or a raise of >20 mmHg during low-intensity exercise (while not exceeding a cardiac output of 10 l/min).

Results

20% of the enrolled population developed ExPH. ExPH was inversely associated with CD4+ T cell count (p=0.047), time to HIV diagnosis (p=0.014) and time to onset of ART (p=0.041) compared to patients without ExPH. Patients with ExPH had greater worsening of functional class than patients without ExPH (p<0.001). ExPH and AIDS showed a non-statistically significant trend of direct association (p=0.093). However, AIDS patients had an increase in pulmonary vascular reserve index (PVRI) compared to patients without ExPH (p=0.020) at rest echocardiography. We also observed an inverse correlation between the time to onset of ART with right atrium area (r=−0.411, p=0.022) and indexed right atrial volume (r=−0.102, p=0.009).

Conclusions

Isolated ExPH associates with clinical worsening and poorer immunological control in HIV patients. The assessment of ExPH by ESE may help identify subgroups of HIV patients with a propensity to develop subclinical impairment of pulmonary circulation following poor control of HIV infection.

Funding Acknowledgement

Type of funding sources: None.
Safety and efficacy of percutaneous catheter-directed treatment for intermediate-high risk pulmonary embolism
Authors: Rumiz Gonzalez E , Vilar Herrero J V , Escriva G M , Vidal Urrutia V , Fernandez Cisnal A , Cubillos Arango A , Nunez Villota J , Berenguer Jofresa A , Sanchis Fores J , Valero Picher E
Published: October 2021

Background

Pulmonary embolism (PE) is globally the third most frequent acute cardiovascular syndrome, ranking high among the causes of cardiovascular mortality. Systemic thrombolytic therapy (STT) permits prompt reperfusion after pulmonary obstruction, nevertheless this treatment carries by itself an inherent risk of major bleeding events. Development of new therapies and interventions that allow us to achieve early lung reperfusion along with a reduced risk of bleeding are necessary.

Purpose

The aim of this study was to evaluate the safety and efficacy of percutaneous catheter-directed treatment (PCDT) on intermediate-high risk PE patients with high bleeding risk or contraindication for STT.

Methods

We consecutively included all patients with intermediate-high risk PE undergoing PCDT in two university hospitals. Clinical, echocardiographic and hemodynamic variables (pre and post PCDT) were collected, as well as major adverse cardiac and bleeding events during follow-up.

Results

Between February 2018 and January 2021, we included 30 consecutive patients admitted with intermediate-high risk PE who underwent PCDT. Median age was 60 years, interquartile range (IQR) 51–72, and 41% were women. 14 patients (46.6%) presented an absolute contraindication for STT, which was the main reason for performing PCDT. Catheter-directed local thrombolysis (CDLT) was performed in 27 (90%) patients and mechanical fragmentation-aspiration was performed in 12 (40%) of them. We observed a significant reduction in mean pulmonary artery pressure (mPAP, mmHg) after PCDT: 40±13 vs. 25±12, p<0.001; as well as in NT-proBNP concentrations (pg/ml) 48 hours post-PCDT: 4791±1077 vs. 2311±680, p=0.002, (Figure 1). Echocardiographic parameters of right ventricular (RV) dysfunction also experienced a significant improvement 72 hours post-PCDT: TAPSE (mm) 15±2 vs. 22±3, p=0.001, (Figure 2); basal RV diameter (mm) 51±4 vs. 41±2, p=0.001. During a median follow-up of 13 months, IQR (8–22), 1 patient died from non-cardiac cause and no patient presented a bleeding event.

Conclusions

PCDT for intermediate-high risk PE is safe and effective, producing an early reduction in mPAP, in prognostic biomarkers such as NT-proBNP, as well as an early improvement of classic echocardiographic parameters of RV dysfunction.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Radial versus femoral approach for rotational atherectomy – technical aspects and procedural outcomes
Authors: Bargon S , Achenbach S , Gaede L , Troebs M , Marwan M , Ammon F , Ferstl P , Schacher N
Published: October 2021

Background

Rotational atherectomy (RA) is a well-established therapy for the treatment of heavily calcified coronary lesions. While the radial approach has evolved into the gold-standard for standard percutaneous coronary intervention (PCI), RA is still often performed via a femoral approach. Concerns over guiding size, sheath size, the delivery of the burr as well as the need for a temporary pacemaker play a role in that decision.

Methods

This retrospective analysis includes all patients undergoing RA from 03/2013 to 06/2019 at one institution. We sought to investigate the procedural outcome and the influence of the percutaneous approach.

Results

A total of 228 patients were planned to undergo RA. Based on operator preference, RA was attempted via the radial approach (RAD) in 78 (34.2%) patients and via the femoral approach (FEM) in 150 (65.8%) patients. The procedure failed in 2.6% (RAD 1.3% vs. FEM 3.3%, p=0.359) due to crossing failure of either the RotaWire (n=5) or the burr (n=1).

The left anterior descending was the most frequently treated vessel in the radial group and significantly more often targeted in comparison to the femoral group (LAD: RAD 44.6% vs. FEM 26.5%, p=0.004). All other vessels were similarly often treated in both groups (LM: RAD 13.3% vs. FEM 17.3%, p=0.414; LCX: RAD 15.7% vs. FEM 23.5%, p=0.155; RCA: RAD 25.3% vs. FEM 31.5%, p=0.315; Bypass: RAD 1.2% vs. FEM 1.2%, p=0.984). RAD-RA was significantly more often performed with a 6F sheath in comparison to FEM-RA (RAD 47.4% vs. FEM 16.7%, p<0.001). A 7F sheath was used in 52.6% of the cases for RAD-RA (men: 85.4%, women: 14.6%, p=0.176) and is therefore the most frequently chosen sheath size within that group. A 7F or 8F sheath was used in 75.3%, respectively 8.0% of the cases in the FEM group (7F: p<0.001; 8F: p=0.010 compared to RAD). There were no significant differences regarding the burr sizes (RAD 1.43±0.17mm vs FEM 1.41±0.18mm, p=0.442).

Whereas the placement of a temporary pacemaker was equal in both groups (RAD 20.8% vs. FEM 30.8%, p=0.110), the femoral group showed a higher number of patients with any back-up pacing, permanent or temporary (RAD 24.7% vs. FEM 39.0%, p=0.031). There were no significant differences in terms of fluoroscopy time (RAD 00:24:65±00:12:48 vs. FEM 00:28:33±00:17:05, p=0.180) and the volume of contrast medium (RAD 217.2±96.3ml vs. FEM 192.9±86.0ml, p=0.118). Moreover, procedural complications (RAD 17.9% vs. FEM 18.0%, p=0.992) and access site related complications (RAD 6.4% vs. FEM 10.0%, p=0.363) occurred equivalently in both groups.

Conclusion

This analysis shows that RA via radial access is as safe and successful as via femoral access. Despite the more frequent use of 6F sheaths, burr sizes did not differ. Additionally, neither fluoroscopy time nor contrast volume indicated a higher complexity of the RAD approach.

Funding Acknowledgement

Type of funding sources: None.
Frequency and predictors of coronary angiography and percutaneous coronary intervention related stroke
Authors: Staszczak B , Malinowski K P , Siudak Z , Wanha W , Surdacki A , Wojakowski W , Legutko J , Bartus K , Bartus S , Januszek R
Published: October 2021

Background

Acute stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, although potentially life-threatening and often leading to serious disability, characterised by high morbidity and mortality rate. However, particular data on periprocedural complications, predictors, prognosis and the type of coronary intervention has not yet been adequately investigated.

Aim

The aim of the present study was to assess the relationship between the type of coronary procedure [coronary angiography (CA) and PCI] and incidence of stroke as well as predictors of stroke.

Material and methods

This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2019 and included 1,177,161 coronary procedures. Among them, 650,674 patients underwent isolated CA and 526,487 underwent PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) refers to patients admitted for CA and 57 (0.011%) in patients qualified for PCI. Subsequently, the mentioned groups were analysed for similarities and compared. Multivariate analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI.

Results

The amount of patients with periprocedural stroke was higher in a group treated with isolated CA during the analysed time. The mean age of the patients, who developed cerebral stroke, was significantly higher in the overall group (71.4±10.6 vs. 66.7±10.8; p<0.001). Patients with stroke, in comparison to non-stroke group, were treated more often from femoral access for CA (p<0.001) and PCI (p=0.04), they had a history of prior stroke for CA (p<0.001) and PCI (p<0.001) more often, and acute myocardial infarction at admission for CA (p<0.001) and PCI (p=0.01). They were also more frequently transported directly to the catheterisation laboratory for CA (p<0.001) and PCI (p=0.002). Predictors of periprocedural stroke, assessed by multivariate analysis for CA, are presented at Fig. 1 and for PCI at Fig. 2.

Conclusions

Based on the large national registry, PCI is associated with fewer risk factors and lower rate of periprocedural strokes than isolated CA.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
Rapid pacing is an independent predictor for high implantation depth using self-expandable devices in TAVR
Authors: Veulemans V , Maier O , Piayda K , Berning K L , Binneboessel S , Polzin A , Afzal S , Dannenberg L , Horn P , Jung C , Westenfeld R , Kelm M , Zeus T
Published: October 2021

Background/Introduction

Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated.

Purpose

Therefore, we aimed to 1) evaluate the impact of different pacing maneuvers on ID, and 2) identify the independent predictors of deep ID.

Methods

562 TAVR patients with newer-generation self-expandable devices were retrospectively enrolled and further separated into patients undergoing TAVR under FP (n=331; 58.9%) and RP (n=231; 41.1%). The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.

Results

The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification (OR 0.56 [0.37–0.85], p=0.006*), a bicuspid valve (OR 0.34 [0.11–1.0], p=0.049*), valve size 26 mm (OR 0.47 [0.28–0.81], p=0.006*), and RP (OR 0.57 [0.37–0.87], p=0.010*) as independent and highly preventable predictors for deep valve deployment. Independent risk factors for deep ID were the use of a 34 mm device (OR 1.96 [1.22–3.15], p=0.005*) and mild aortic valve calcification (OR 1.62 [0.01–2.61], p=0.046*). In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: −5.6±2.6 mm vs. 3–5 criteria: −4.5±2.0 mm; p<0.0001*).

Conclusion

Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expandable devices.

Funding Acknowledgement

Type of funding sources: None.
Association between fragmented QRS and post-procedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation with CoreValve system
Authors: Duran M , Tezcan H , Ayhan H
Published: October 2021

Background

Transcatheter aortic valve implantation (TAVI) is a less invasive and safe therapeutic alternative in patients who are at very high surgical risk or in whom there are contraindications to open surgery (1,2).On the other hand, life threatening complications including stroke, paravalvular leak, and rhythm disturbances that require permanent pacing still persist (3).Fragmented QRS (fQRS) is defined as RSR' pattern with different morphologies of QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram (ECG) (4).

Purpose

In this study, we examined association between fQRS and post-procedural rhythm disturbances and the need for permanent pacing in patients who underwent TAVI with CoreValve system.

Methods

We analysed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis (MedronicInc; Minneapolis; USA) was implanted. Patients having bundle branch block or QRS duration ≥120 ms in baseline ECG recordings and patients with prior history of permanent pacing were excluded from the study. We examined 12-lead ECGs before and after procedure along with one month and six month follow up. We documented QRS fragmentation and post-procedural rhythm disturbances.

Results

Based on our data, 39 out of 71 patients (54.9%) with fQRS developed temporary rhythm disturbances. However, only 4 out of 29 patients (13.7%) without fQRS developed temporary rhythm disturbances.The difference between two groups in terms of temporary rhythm disturbances was statistically significant (59.4% vs 13.7%, p=0.002). Furthermore, 28 out of 71 patients (39.4%) with fQRS and 1 out of 29 patients (3.4%) without fQRS developed permanent rhythm disturbances, (39.4% vs 3.4%, p<0.001).The difference in permanent rhythm disturbances was also maintained in 1st month and 6th-month follow-ups (37.1% vs 0%, p<0.0001, and 38.7% vs 0%; p<0.0001). According to our data, presence of QRS in anterior derivations was the only independent factor associated with development of post-procedural rhythm disturbances (p<0.05).

Conclusion

Our data showed an increased risk for development of new-onset LBBB and AV blocks following TAVI in patients whose baseline ECG recordings demonstrated fQRS.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Ankara Ataturk Training and Research Hospital
Outcomes of transfemoral-transcatheter aortic valve replacement with Sapien-3 valve in liver cirrhosis patients
Authors: Lak H , Chawla S , Verma B , Vural A , Gad M , Shekhar S , Nair R , Yun J , Burns D , Puri R , Reed G , Harb S , Krishnaswamy A , Kapadia S
Published: October 2021

Background

Little is known about the outcomes of liver cirrhosis patients with severe aortic stenosis (AS) who undergo transcatheter aortic valve replacement (TAVR).

Methods

We undertook a retrospective analysis of consecutive patients with severe symptomatic AS who underwent transfemoral-TAVR with Sapien-3 valve at our Clinic between April 2015 and December 2018, yielding 32 patients with liver cirrhosis on imaging including ultrasound and/or computed tomography. Their baseline characteristics, procedural and long-term outcomes after TAVR with the non-cirrhotic group were compared, along with their management strategies as per the hepatology team.

Results

Among 1028 patients, 32 were assigned to the cirrhosis, and 996 were assigned to the non-cirrhosis (control) group. Compared with the control group cirrhotic patients were slightly younger in age (74.5 vs 81.2 years), had a slightly higher BMI (31.3 vs 29.3), and had a higher incidence of prior history of myocardial infarction (38% vs 33%). Baseline variables including the history of smoking, hypertension, diabetes, and atrial fibrillation were comparable in both groups. Among cirrhotic patients (n=32), the most common etiologies were non-alcoholic steatohepatitis (NASH) (37.5%), Alcoholism (18.75%), and Hepatitis C (12.5%). The mean MELD-NA score was 11.8 and 67% of patients were Child PUGH Class A and 33% were Child PUGH Class B and all patients had a Child PUGH score of ≥5. 53% of patients (n=17) in the cirrhosis group were evaluated by Hepatology and 12.5% (n=4) were evaluated for a liver transplant but only 1 patient had a liver transplant post-TAVR. Compared with the control group cirrhotic patients had similar 1-year mortality (12% vs 12%, p=1), had a lower rate of 30-day new pacemaker post tavr (6% vs 9% p=0.85), had a higher rate of 1-year readmission for heart failure (12% vs 5% p=0.12) and similar 1-year major adverse cardiac and cerebrovascular event (MACCE) rate (15% vs 14% p=0.98)

Conclusion

Patients with severe AS undergoing TAVR with concomitant liver cirrhosis demonstrate comparable outcomes compared with their non- cirrhotic counterparts. NASH followed by alcoholic cirrhosis was found to be most common etiology.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
The effect of MitraClip mitral valve repair on a number of ventricular tachycardia episodes
Authors: Hudec M , Januska J , Jiravsky O , Kala P , Kufova P , Konderlova L , Stepanova R , Muchova T , Kubat T , Sknouril L
Published: October 2021

Background

Mitral valve repair with MitraClip is an established method in the treatment of severe mitral regurgitation. Effect on mitral regurgitation severity, NYHA class and left ventricular function is known, as well as on mortality and number of hospitalizations. Otherwise, there is a lack of evidence, if a successful repair can affect the number of episodes of malignant arrhythmias.

Purpose

To compare the number of ventricular arrhythmias and ICD therapies before and after successful mitral valve repair with MitraClip in retrospective analysis.

Methods

We analysed patients after a MitraClip mitral valve repair in whom an ICD was implanted at least 1 month before the procedure. Out of 217 patients, there were 47 with ICD, traceable history and successful repair (MR grade ≤2.5 after the procedure). We searched all recorded ICD controls for evidence of ventricular arrhythmias and ICD therapies (ATP or shock). Statistical analysis was performed comparing the number of ventricular arrhythmias and ICD therapies “per month-per patient” before and after the procedure.

Results

We didn't found any statistical difference in number of malignant arrhytmia events before and after the procedure (mean 0.024±0.069 vs 0.029±0.079, p=0.46), neither in ATP therapies (mean 0.038±0.146 vs 0.542±3.249, p=0.39) nor in shocks (mean 0.063±0.225 vs 0.148±0.499, p=0.33). After dividing patients into two groups – with or without previous myocardial infarction, there was also no statistical difference in both groups. In “MI” group: a number of ventricular arrhythmia (mean 0.016±0.036 vs 0.016±0.047, p=0.95), ATP therapies (mean 0.029±0.109 vs 0.073±0.285, p=1.0), shocks (mean 0.049±0.184 vs 0.048±0.172, p=0.77). In “no MI” group: a number of ventricular arrhythmia (mean 0.035±0.098 vs 0.047±0.108, p=0.22), ATP therapies (mean 0.05±0.19 vs 1.203±5.024, p=0.16), shocks (mean 0.083±0.277 vs 0.289±0.733, p=0.17).

Conclusion

Our results don't reflect any influence of MitraClip mitral valve repair on ventricular arrhythmias, ATP therapies or shocks before and after the procedure. Another and deeper analysis should be performed to understand these results.

Funding Acknowledgement

Type of funding sources: None.
Asymmetric leaflet tethering is associated with worse outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation
Authors: Stolz L , Orban M , Braun D , Doldi P , Orban M , Stocker T , Mehr M , Steffen J , Loew K , Hagl C , Massberg S , Naebauer M , Hausleiter J
Published: October 2021

Background

The impact of mitral valve (MV) tethering patterns on outcomes of patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for severe secondary mitral regurgitation (SMR) is unknown.

Purpose

The purpose of this study was to evaluate the impact of asymmetric postero-anterior and medio-lateral MV leaflet tethering on procedural and survival outcomes after TEER for SMR.

Methods

Symmetry of postero-anterior leaflet tethering was defined as the ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in the central MV segment 2. The ratio of the tenting area between MV segments 3 and 1 (S3/S1 ratio) was defined as medio-lateral tethering symmetry. We used receiver operating characteristics and a proportional Cox model to identify cut-off values of asymmetric postero-anterior and medio-lateral tethering for prediction of two-year survival after TEER.

Results

178 patients receiving TEER for SMR were included. Asymmetric postero-anterior tethering was observed in 67 patients (37.6%, PLA/ALA ratio cut-off >1.54). Medio-lateral tethering was asymmetric in 49 patients (27.5%, S3/S1 ratio cut-off >1.49). MR was reduced to MR ≤2+ in 91.6% of patients, while postprocedural MR remained higher in the presence of asymmetric postero-anterior tethering (p=0.01). After adjustment for potential clinical and echocardiographic confounders, multivariable Cox regression analysis confirmed asymmetric postero-anterior tethering (HR=2.77, CI=1.43–5.38, p<0.01) and asymmetric medio-lateral tethering (HR=2.90, CI=1.54–5.45, p<0.01) as independent predictors for two-year survival.

Conclusions

Asymmetric postero-anterior and medio-lateral MV leaflet tethering patterns independently increase two-year all-cause mortality in patients undergoing TEER for SMR. Detailed echocardiographic patient selection might improve outcomes after TEER.

Funding Acknowledgement

Type of funding sources: None. Postero-anterior tetheringMedio-lateral tethering
Impact of leaflet-to-annulus index on residual tricuspid regurgitation following transcatheter edge-to-edge tricuspid valve repair
Authors: Tanaka T , Sugiura A , Kavsur R , Vogelhuber J , Oeztuerk C , Becher M U , Zimmer S , Nickenig G , Weber M
Published: October 2021

Introduction

Edge-to-edge transcatheter tricuspid valve repair (TTVR) is a promising treatment option for tricuspid regurgitation (TR), and it is required to identify anatomical parameters to predict the procedural success of TTVR.

Purpose

In this study, we assessed leaflet-to-annulus index (LAI), a simple tool to evaluate the remodeling of tricuspid annulus in relation to the leaflets, and investigated the association of the LAI with residual TR after edge-to-edge TTVR.

Methods

Consecutive 140 patients with symptomatic TR who underwent edge-to-edge TTVR from June 2015 to July 2020 were enrolled. The LAI was calculated using preprocedural transesophageal echocardiography and was defined as follows: (anterior leaflet length + septal leaflet length)/anteroseptal tricuspid annulus diameter (Figure 1). Primary outcome was residual TR ≥3+ at discharge, and patients were allocated into two groups as follows: residual TR ≥3+ and <3+. Secondary outcome was the composite outcome, consisting of all-cause mortality and heart failure hospitalization, within one year after TTVR.

Results

Of the 140 patients, 43 patients had residual TR ≥3+ after TTVR. The patients with residual TR ≥3+ had lower LAI compared to those with residual TR <3+ (1.06±0.10 vs. 1.13±0.09; p=0.001). Multivariable analysis revealed that LAI was associated with residual TR ≥3+ (odds ratio [by 0.1 increase]: 0.57; 95% confidence interval [95% CI]: 0.35–0.94; p=0.02), independently of baseline TR severity, location of TR jet, and coaptation gap size (Table 1). Patients with residual TR ≥3+ had a higher incidence of the composite outcome within one year after TTVR (34.9% vs. 18.6%; log-rank p=0.04) and residual TR ≥3+ was an independent predictor of the composite outcome within one year (hazard ratio: 2.04; 95% CI: 1.01–4.11; p=0.04).

Conclusion

Lower LAI is associated with residual TR ≥3+ after edge-to-edge TTVR, which itself was a significant predictor of the one-year composite outcome. Our findings suggest that LAI is a useful tool to identify patients to be successfully treated with edge-to-edge TTVR.

Funding Acknowledgement

Type of funding sources: None. Figure 1Table 1
Transesophageal echocardiography versus intracardiac echocardiography-guided left atrial appendage occlusion: a comparative analysis
Authors: Grazina A , Fiarresga A , Ramos R , Sousa L , Cacela D , Bernardes L , Branco L M , Galrinho A , Viegas J M , Cardoso I , Teixeira B , Teixeira A R , Jacinto S , Cruz Ferreira R
Published: October 2021

Introduction

The left atrial appendage occlusion (LAAO) procedure is a therapeutic option for stroke prevention in patients with atrial fibrillation (AF) which have contraindication to oral anticoagulants or still develop embolic events despite therapeutic anticoagulation. Transesophageal echocardiography (TEE) has been the gold standard to guide this procedure, with the intracardiac echocardiography (ICE) emerging as an alternative because of the advantage of reducing the general anesthesia burden compared to TEE.

Objectives

This study aims to compare the safety, procedure-related parameters and outcomes between TEE-guided LAAO and ICE-guided LAAO.

Methods

In a tertiary center, patients who underwent TEE-guided LAAO and ICE-guided LAAO were compared retrospectively regarding technical success, procedure-related events, procedure-related parameters (fluoroscopy time, dose of radiation and contrast volume), 45 days-transthoracic echocardiography (TTE) and 1-year outcomes (mortality, stroke and major bleeding).

Results

88 patients underwent LAAO between 2009 and 2020 (n=43 with TEE, n=45 with ICE). Baseline characteristics were similar. Success was achieved in 95.3% (n=41) and 95.6% (n=43) of the patients in the TEE and ICE groups, respectively (OR 0.95, p=0.96). Procedure-related complications (major vascular complications, perforation, device embolization) didn't show significant differences (14.0% vs 8.9%, OR 1.66, p=0.46) in the TEE and ICE groups, respectively. Fluoroscopy time was inferior in the TEE group (29.1±13.6 vs 44.1±17.4 minutes, p=0.001), while radiation dose (2761±1555 vs 3397±2118 mGy, p=0.113) and contrast volume (220.3±104.1 vs 204.0±100.9mL, p=0.469) showed no significant differences. 45 days-TTE showed no significant differences between the TEE and ICE groups regarding peri-device leaks (14.0% vs 24.4%, p=0.212), device thrombus (2.3% vs 0%, p=0.990) and iatrogenic atrial septal defects, all mild (4.7% vs 13.3%, p=0.174). 1-year outcomes showed no significant differences regarding stroke (9.3% vs 4.4%, p=0.186), major bleeding (9.3% vs 2.2%, p=0.78) and all-cause mortality (9.3% vs 11.1%, p=0.38) between the TEE and ICE groups, respectively.

Conclusions

ICE-guided LAAO is associated with similar results, procedure-related events, procedure related-parameters (fluoroscopy time being the only exception) and 1-year outcomes, compared with TEE-guided LAAO.

Funding Acknowledgement

Type of funding sources: None.
Twelve months results from a prospective real-world multicenter clinical practice of CAS using the CGuard Embolic Prevention System (EPS): the IRONGUARD 2 study
Authors: Sirignano P , Stablie E , Taurino M , Speziale F
Published: October 2021

Objectives

When compared to carotid endarterectomy, carotid artery stenting (CAS) has been associated to a higher rate of post procedural neurologic events, potentially related to plaque's debris prolapsing through stent's mesh. Consequently, the need for increased plaque coverage has resulted in the development of dual layered mesh covered carotid stent systems (DLS). However, recent reports demonstrated that these devices are also associated with a not-negligible restenosis rate among the studies. Aim of this registry was to evaluate 1-year safety and efficacy of DLS for CAS in the clinical practice.

Methods

From January 2017 to June 2019 a physician-initiated, prospective, multispecialty, registry enrolled 733 consecutive patients undergoing CAS using the CGuard Embolic Prevention System (EPS) in 20 centres. The primary endpoint was the occurrence of death and stroke at 1 year; secondary endpoints were transient ischemic attack (TIA), acute myocardial infarction (AMI), restenosis rate and in-stent thrombosis, ECA occlusion at 1 year.

Results

Among all enrolled subjects, late results were collected for 726 patients (99.04%). Dual antiplatelet therapy was maintained for at least 30 days post-procedurally in all patients, and for 3 months in 295 (40.63%), according with each center routine practice. After 30th post-operative day, new neurological adverse event was detected in 5 patients (0.68%), accounting for 1 minor stroke (0.13%), and 4 (0.55%) transient ischemic attacks. Eight patients (1.10%) died during the study period: 2 fatal acute myocardial infarctions (0.27%), 4 malignancies (0.55%), 1 suicide (0.13%), 1 undefined complication in Guillain-Barré Syndrome (0.13%). At duplex ultrasound examination, internal carotid artery was found patent in all but two patients (0.27%), and 2 asymptomatic in-stent restenosis (0.27%) were judged to be severe (>70%, peak systolic velocity >450cm/sec) and successfully treated by stent-in-stent. External carotid artery patency rate was 98.8% (718/726). At univariate analysis, post-dilatation (p=0.62; OR: 0.67; CI95%: 0.13–3.34), and dual antiplatelet therapy duration (p=0.97; OR: 0.96; CI95%: 0.11–8.31) were found to be not statistically related to occlusion and/or restenosis occurrence.

Conclusion

This real-world registry suggests that use of EPS in clinical practice is safe and associated to a minimal occurrence of adverse neurological events up to 12 months follow up.

Funding Acknowledgement

Type of funding sources: None.
Smoking habit does not differentiate young patients with first diagnosed and never treated hypertensive disease regarding blood pressure levels and hypertension mediated organ damage
Authors: Triantafyllidi H , Benas D , Schoinas A , Trivilou P , Varoudi M , Kosteli G , Birmpa D , Ikonomidis I
Published: October 2021

Background

Early onset hypertension is associated with a considerably greater risk for CVD mortality compared with hypertension that begins later in life. Aim of this study is the evaluation of cardiovascular risk (CV) factors and hypertension mediated organ damage (HMOD) in young patients with first diagnosed and never treated hypertensive disease regarding smoking habit.

Methods

From a cohort of 520 non-diabetic and first diagnosed and never treated hypertensive patients, we studied those patients aged <50 years (n=216, age=42±7, 149 males). Ambulatory blood pressure monitoring (24-h ABPM), cardiovascular risk factors [smoking, obesity (BMI), hyperlipidemia (HDL-C, LDL-C)] and HOMD [aortic stiffness (PWV), left ventricular diastolic dysfunction (E/Ea), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (IMT), endothelial function (PBR5–25)] were estimated in each young patient before treatment initiation.

Results

Young patients' population was divided regarding smoking habit in Group A (smokers, n=89, age=42±7, 64 males) and Group B (non-smokers, n=127, age=42±6, 85 males). While increased LDL-C (p=0.002), decreased HDL-C levels (p<0.001) and augmented 24-h systolic and diastolic BP variability (p=0.001 and p=0.03, respectively) were revealed in Group A, no other differences were found between groups regarding BMI, 24-h ABPM and HMOD.

Conclusion

In early phases of arterial hypertension disease, young people have similar BP and HMOD burden despite the pre-existence of smoking habit and hyperlipidemia. Subsequently, there is still time for combined treatment of these three risk factors (smoking, hyperlipidemia, arterial hypertension) and prevention of future CV adverse events.

Funding Acknowledgement

Type of funding sources: None. Young hypertensives and smoking
Cerebrovascular disorders in diabetic patients with resistant hypertension and factors associated with their severity
Authors: Falkovskaya A Y U , Mordovin V F , Sukhareva A E , Manukyan M A , Zyubanova I V , Lichikaki V A , Tsoi E I , Gusakova A E
Published: October 2021

Introduction

Diabetes mellitus (DM) and hypertension (HTN) are associated with accelerated brain damage that often precedes the development of stroke and dementia. However, little is known about the features of silent brain damages and possible mechanisms of their development in patients with resistant hypertension (RHTN) and type 2 DM.

Objective

To study the features of MRI- sings of silent brain damage in patients RHTN with type 2 DM and to establish the factors associated with their development.

Methods

We studied 46 with RHTN and type 2 DM (mean age 60.3±7.9 years; 27 females (59%), mean 24-hour (systolic/diastolic) BP 169.0±16.4/89.0±14.7 mmHg, HbA1c 7.4±1.3%). On average, patients were taking 4.3±1.0 antihypertensive drugs. Patients were subjected to brain MRI (1.5 T), 24-hour BP monitoring, lab tests (HbA1c, TNF-α, hsCRP, leptin, resistin, aldosterone, basal end postprandial serum glucose, insulin, C-peptide). According to MRI linear dimensions of liquor spaces (subarachnoidal spaces (SAS), lateral ventricles, III and IV ventricles), white matter lesions (WMLs), basal ganglia and thalamus abnormalities were assessed. In addition, severity of periventricular WMLs (PWMLs) was evaluated semi-quantitatively on a scale of 0 to 4.

Results

The frequency of ventricular dilatation was 45%, expansion of SAS – 65%, lacunar infarctions – 25%, focal WMLs (diameter <3 mm) – 52%, PWMLs – 89%. According to the correlation analysis, an increase in density of the MR signal of PWMLs was associated with an increase in levels of TNF-α (r=0.55 p=0.01) and hsCRP (r=0.64 p=0.045). The increase in density of the MR signal from basal ganglia and thalamus correlated with postprandial levels of glucose (r=0,48 p=0,025; r=0.46 p=0.04, respectively), insulin (r=0.54 p=0.011; r=0.52 p=0.017, respectively) and C-peptide (r=0.54 p=0.011; r=0.46 p=0.037, respectively), as well as with basal level of insulin (r=0.52 p=0.007; r=0.48 p=0.012, respectively) and the leptin (r=0.40 p=0.027; r=0.36 p=0.048, respectively). The severity of PWMLs depended on the level of basal glycaemia (r=0.35, p=0.020) and HbA1c (r=0.37, p=0.04). The transverse size of the chiasmal cistern had a relationship with of the resistin level (r=0.43, p=0.03), and the transverse size of the III ventricle correlated with the serum aldosterone level (r=0.51, p=0.13). There were no direct correlations between MRI- sings of silent brain damage and blood pressure levels.

Conclusion

Thus, diabetic patients with resistant hypertension have a high frequency of white matter lesions and of liquorodynamics dysturbanses. The severity of these changes depends on a complex of metabolic, pro-inflammatory and neurohormonal factors in the absence of a direct relationship with the blood pressure level.

Funding Acknowledgement

Type of funding sources: None.
Longitudinal association between serum uric acid level and carotid atherosclerotic plaques in patients with new cases of hypertension
Authors: Podpalova O , Kaliadka M , Mrochek A
Published: October 2021

Objective

To reveal the relationship between uric acid level and carotid atherosclerotic plaques in hypertensive subjects in randomized urban population according to 10-years prospective study.

Design and methods

A 10-years prospective study included 3,500 randomized individuals living in the district of Vitebsk (2007/2008 - 2017/2018). The coverage of the survey was 97,9% (3427 participants). There was revealed 2170 persons with normal blood pressure. 1862 of them were examined on the second stage in 2012/2013 (coverage of the survey was 85,8%). 286 new cases of hypertension were revealed and they had significant positive relationship with the IV quartile of uric acid level (≥339 μmol/l). A 10-years prospective analysis was provided in 2017/2018 and included 145 randomized subjects with hypertension diagnosed on the second stage of the study. Specially developed registration form was filled in for all the participants and it included socio-demographic data, standard questionnaires for detection of cardiovascular risk factors, anthropometry, blood pressure measurements, electrocardiography, blood chemistry, ultrasound examination of brachiocephalic arteries and echocardiography.

Results

According to the results of 10-years prospective study serum uric acid level ≥339 μmol/l, revealed at the start of the study, is a predictor of the detection of carotid atherosclerotic plaques in 2017/2018 in subjects with new cases of hypertension (df=1; χ2 Wald=6,63; p<0,05) adjusted for age and gender. Cross-sectional analysis of these subjects showed that the level of uric acid, regardless of age and gender, is associated with the level of triglycerides (p<0,001), apo B (p<0,001), apo A1 (p<0,05), LDL (p<0,05), VLDL (p<0,05), HDL (p<0,05), non-HDL-C (p<0,05), total cholesterol (p<0,05), high-sensitivity CRP (p<0,05), TNF-α (p<0,05), apoB/apoA1 ratio (p<0,05), glycated hemoglobin percentage (p<0,05), body mass index (p<0,001), waist circumference (p<0,05), metabolic syndrome (p<0,05) and alcohol abuse (p<0,05). In stepwise multiple linear regression model the most significant of these factors were the level of triglycerides (β=0,23, p<0,05), alcohol abuse (β=0,18, p<0,05), body mass index (β=0,18, p<0,05), apoB/apoA1 ratio (β=0,17, p<0,05) and level of high-sensitivity CRP (β=0,15, p<0,05).

Conclusions

Serum uric acid level ≥339 μmol/l predicted detection of carotid atherosclerotic plaques in patients with new cases of hypertension in 10-years prospective study. The most significant factors, regardless of age and gender, associated with serum uric acid levels in these patients were level of triglycerides, alcohol abuse, body mass index, apoB/apoA1 ratio and level of high-sensitivity C-reactive protein.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Republican Scientific and Practical Centre of Cardiology
Home blood pressure monitoring detects unrevealed hypertension in women with a history of preeclampsia: results of the BP-PRESELF study
Authors: Muijsers H E C , Wu P , Van Der Heijden O W H , Wijnberger L D E , Van Bijsterveldt C , Buijs C , Pagels J , Toennies P , Heiden S , Roeleveld N , Maas A H E M
Published: October 2021

Background/Introduction

The risk of cardiovascular disease more than doubles after hypertensive disorders of pregnancy. As early onset chronic hypertension contributes to cardiovascular risk, implementation of screening strategies, using home blood pressure monitoring (HBPM), may help to improve long-term cardiovascular health.

Purpose

We evaluated whether HBPM among women with a history of preeclampsia/HELLP syndrome is feasible for early detection and management of hypertension.

Methods

The Blood Pressure after PREeclampsia by SELF monitoring (BP-PRESELF) is a multicenter randomized controlled trial. We recruited 198 women with a mean age of 45 years, approximately 12 years after the index pregnancy. Participants were randomized to intervention group with HBPM for the duration of one year or the control group with 'usual care' (Figure 1). The primary outcome was feasibility of HBPM during 1 year of follow-up, defined as protocol adherence, protocol persistence and patient acceptance. Secondary outcomes were blood pressure levels and prevalence of hypertension.

Results

The baseline characteristics did not show statistically significant differences between groups, except for years since index pregnancy. Especially blood pressure levels were very similar at time of inclusion.

Protocol adherence decreased during the first 6 months, after which it stabilized (Figure 2A). Protocol persistence remained high throughout follow-up (Figure 2B). During the study period, 33 women (34%) in the intervention group were diagnosed with hypertension versus only 10 women (11%) in the control group. At 1-year follow-up, mean systolic blood pressure (SD) was 120.4 (11.6) mm Hg in the intervention group versus 126.1 (14.3) mm Hg in the control group, P=0.003. Mean diastolic blood pressure (SD) values were 77.2 (8.0) mm Hg versus 81.7 (9.4) mm Hg, P<0.001, respectively. Adjusted systolic and diastolic differences (95% confidence interval) were −6.81 (−10.17, −3.45) and −4.93 (−7.26, −2.61) mm Hg, with 80% less hypertension at 1-year follow-up in the intervention group.

Conclusion(s)

HBPM appears to be feasible for follow-up of blood pressure in women after preeclampsia/HELLP syndrome, while it detected hypertension and reduced blood pressure levels after intervention in one-third of women in this group.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): INTERREG-V-A program Germany-The Netherlands “Zorg Verbindt”, co-financed by the European Union (EU), Ministry for Economy, Innovation, Digitalization and Energy of the Federal State of Nordrhein-Westfalen (Germany), and the Province of Gelderland (The Netherlands). CONSORT flowchartProtocol adherence (A) and persistence (B)
Accuracy of a cuffless blood pressure measurement with a single-channel electrocardiogram monitor with photoplethysmography
Authors: Sagirova Z H N , Kuznetsova N O , Gogiberidze N A , Gognieva D G , Chomakhidze P S H , Kopylov P H Y U
Published: October 2021

Introduction

The accurate assessment of the blood pressure (BP) allows to diagnose of the cardiovascular diseases and correct their treatment timely. Cuff-less BP measurement can be more convenient to use and can also provide the blood pressure monitoring using with telemedicine. In this study, we evaluated the cuff-less BP measurement method based on photoplethysmography.

Purpose

To evaluate the accuracy of cuffless blood pressure measurement using with the single-channel electrocardiogram (ECG) monitor with photoplethysmography pulse wave registration.

Methods

The study included 500 patients aged from 32 to 88 years (mean 64±7,9 years) with arterial hypertension. We used the single-channel electrocardiogram monitor with photoplethysmography, this device looks like a phone case and records electrocardiogram (I standard lead) and photoplethysmogram (PPG) simultaneously. For each patient, blood pressure was measured using a sphygmomanometer with a cuff (3 times and the mean value was calculated). Then within 1 minute after blood pressure measurement, an electrocardiogram and photoplethysmogram were recorded for 3 minutes using the single-channel electrocardiogram monitor with photoplethysmography. ECG and PPG were recorded from the patient's fingers in a sitting position. According to the combination of the electrocardiogram signal and the photoplethysmogram signal, using a special algorithm based on machine learning, the levels of systolic and diastolic blood pressure were calculated. We compared measurement of blood pressure obtained using with the sphygmomanometer and the single-channel electrocardiogram monitor with photoplethysmography.We used the Bland-Altman method for statistical data analysis.

Results

In total of 1000 blood pressure measurements were obtained from 500 patients. According to the Bland-Altman analysis of systolic pressure the average discrepancy was 3,49 mmHg, the standard deviation was 4,21, the standard error of the average was 0,61. One-sampled 2-sided t-test was −0,477 (confidence interval −2.83; −4.33). The average discrepancy for diastolic blood pressure was 3,1 mm Hg, the standard deviation was 3,61 mm Hg, standard error of the average 0,52, One-sampled 2-sided t-test was −0,455 (95% confidence interval −2,64; −4,18). The correlation of the systolic and diastolic pressure using with two measurement methods was 0,89 (p=0,001) and 0.87 (p=0,002), respectively.

Conclusion

There is not significant difference between the results of cuffless measurement of the blood pressure by the single-channel electrocardiogram monitor with photoplethysmography and cuff-based sphygmomanometer measurement in patients with cardiovascular diseases.

Funding Acknowledgement

Type of funding sources: None.
Single pill combinations present a proven fast track in practice to reach the target blood pressure
Authors: Brguljan J , Chazova I E , Gaciong Z , Simic D , Vajer P , Zelveian P , Jelakovic B
Published: October 2021

Objective

To assess the efficacy of ambulatory blood pressure (BP) lowering with perindopril/amlodipine (dual SPC arm) and perindopril/amlodipine/indapamide (triple SPC arm) in newly diagnosed and uncontrolled hypertensive patients. Design and method: 450 adults with essential hypertension were assessed in the interventional, open-label, prospective, international, multicentre PRECIOUS trial. Treatment duration was 16 weeks, divided into four treatment periods. ABPM was performed at the baseline and end of the study (prior to the visit 1 and 5), with a validated automated portable BP-measuring device (Mobil-O-Graph PWA) worn on the non-dominant arm for a 24-hour period, measuring BP in 20 minutes interval during the day and 30 minutes interval during the night. At inclusion, naïve or patients uncontrolled on previous mono or dual therapy (other than perindopril/amlodipine (P/A)) were assigned to dual SPC arm with initial dose of 4/5 mg P/A. Those uncontrolled on previous dual or triple therapy were assigned to triple SPC arm with initial dose of 4/5/1.25 mg perindopril/amlodipine/indapamide (P/A/I). If office BP control was not reached, the initial dose was up titrated in 4-week intervals to 8/5 mg, 8/10 mg P/A or 8/10/2.5 mg P/A/I in dual SPC arm and to 8/5/2.5 mg, or 8/10/2.5 mg P/A/I in triple SPC arm.

Results

After 16 weeks of treatment the decrease in average ambulatory BP was −16.1/−10.8 mmHg (from 142.8/92.6 mmHg to 125.1/80.8 mmHg) in dual SPC arm and −21.8/−13.5 mmHg (from 147.3/93.3 mmHg to 124.2/79.0 mmHg) in triple SPC arm. The relative reductions in ambulatory BP were −11.1%/−11.3% in dual and −14.5%/−14.2% in triple SPC arm. The absolute as well as relative ABPM reductions were higher for the awake-time BP. All ambulatory BP reductions were statistically significant in both arms (p<0.001). 71% of patients reached the normal 24h SBP levels and 45.6% the normal 24h DBP levels. At the end of the trial, the mean dose of perindopril was 6.4±2.0 mg and of amlodipine 6.5±2.3 mg in dual SPC arm. In triple SPC arm, the mean dose of perindopril was 6.66±1.89 mg, of amlodipine 6.51±2.30 mg, and of indapamide 2.08±0.59 mg. Treatment tolerability was good. 85% of patients experienced no adverse events; the recorded ones were clinically irrelevant.

Conclusions

Applying dual (perindopril/amlodipine) and triple (perindopril/amlodipine/indapamide) SPC treatment strategy resulted in a significant and fast BP reduction, measured by ABPM, in naïve and in patients uncontrolled on previous therapy. In even 71% of patients normal 24h SBP was reached. It seems that adding long acting diuretic in triple SPC enhanced drug efficacy even though the patients in the triple SPC arm had a more resistant hypertension.

Funding Acknowledgement

Type of funding sources: None.