bluuebunny/crossref_metadata_2025 huggingface dataset:
The novel noninvasive method for prediction of long-term specific therapy efficacy in patients with IPAH and inoperable CTEPH
Authors: Taran I , Valieva Z , Belevskaya A , Saidova M , Martynyuk T
Published: October 2021

Introduction

The main aim of the treatment in patients (pts) with idiopathic pulmonary arterial hypertension (IPAH) is the achivement of low risk of fatal events during the year, that reflecting the complex of nonivasive and invasive parameters presented in the risk stratification scale of ESC and ERS 2015 guidelines. However, in pts with chronic thromboembolic pulmonary hypertension (CTEPH) there is a lack of evidence to use this scale. Also there is some limitation to perform invasive diagnostics in every patient for complex risk assessment. Thus, the searching for the novel noninvasive markers for prediction of treatment efficacy need further investigation.

Purpose

To develop the novel approach for predicting of long-term specific therapy efficacy using noninvasive methods of diagnostic in IPAH and CTEPH pts.

Methods

The study included 88 IPAH and 38 inoperable CTEPH pts. At the time of diagnosis verification and after 1 year of treatment the complex assessment, including 6-minute walking test, cardiopulmonary exercise test, 2D and 3D Echo, right heart catheterization, NT-proBNP level assessment were made. The efficacy of treatment was determined as achievement of cardiac index (CI) equal or more than 2,5 l/min/m2 after 1 year of treatment. To create a model, predicting long-term specific therapy efficacy the classification trees with the full enumeration method for one-dimensional branches C&RT were used. The impact of factors in prediction of the long-term specific therapy efficacy was demonstrated in the ranks of significance of predictors in units (U).

Results

At baseline all pts with IPAH/inoperable CTEPH were out of the low-risk area. Whereas, after 1 year of treatment 27% of IPAH/CTEPH pts achieved a low risk of fatal events.

To develop a model for predicting of the long-term specific therapy efficacy (>1 year) in patients with IPAH/ CTEPH the most significant predictors of achievement of CI equal or more, than 2.5 l/min/m2 were: age (73 U), right ventricular end-diastolic/end-systolic volumes (85 U/84 U) at the time of diagnosis verification, and the dynamics of NT-proBNP (100 U.).

According to the most valuble factors the model of long-term therapy efficacy was created: the value of dynamic (Δ) of NT-proBNP from >−376,4 to <30,4 pg/ml after 12 months of treatment with combination of right ventricular end-diastolic volume <150,5 ml at the time of diagnosis verification predict the therapy efficacy.

Conclusion

The implementation of novel noninvasive method, that predict specific therapy efficacy, allows making a timely decision of therapy escalation in IPAH and CTEPH pts by the first and subsequent years of treatment.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National medical research center of Cardiology, Moscow
Computational fluid dynamics to access the future risk of ascending aortic aneurysms
Authors: Azevedo F S , Almeida G C , Gomes B A A , Kalaoun K , Ibanez I F I , Teixeira P S , Gotlieb I , Melo M M , Oliveira G M M , Nieckele A O ,   Cardiovascular Engineering Team
Published: October 2021

Background

A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk of aortic growth is not completely defined.

Objective

This research seeks to numerically characterize the blood flow and relate resulting stress distribution with AsAA growth.

Methods

Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic Computed Tomography Angiogram (CTA) images of patients with AsAA. Two (CTA) exams with at least one year of difference were obtained. From the CTA-gathered images, three-dimensional models were generated, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to aneurysm growth or non-growth, and thereafter to compare with the clinical data of these patients. Kolmogorov-Smirnov test was used to evaluate the normality distribution and for non-normal distribution, the non-parametric Wilcoxon signed-rank test was applied for comparisons of paired data of the aortic angles. Statistical significance was set at 5%.

Results

The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation, for the group that presented aneurysm growth, leading to an increase of the average pressure at the ascending aortic wall (Fig. 1), between exams. While for the group without aneurysm growth, the average pressure decreased.

Conclusion

This pilot study showed that CFD based upon CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Axialvelocity. Iso-surface-without-growthFigure 2. Isosurface of Q-criterion. Without growth
Plasma desmosine as a biomarker in acute aortic syndrome
Authors: Fletcher A , Syed M B J , Iskander Z , Debono S , Dweck M R , Huang J , Chin C , Newby D E , Choy A M
Published: October 2021

Introduction

Acute aortic syndromes (AAS) include aortic dissection, intramural haematoma and penetrating aortic ulcer, all of which are caused by aortic wall failure and associated with significant mortality. Although, treatment options currently include early surgical intervention or aggressive medical management, disease progression and devastating complications remain commonplace. Early diagnosis of AAS as well as ability to predict those at the highest risk of disease progression would represent significant progress in the care these patients receive. Desmosine is the cross-link component in the elastin molecule and is exclusively released from mature elastin breakdown, thus is a physiologically relevant biomarker of aortic elastin degradation. The aim of the study was to test the hypothesis that plasma desmosine (pDES) concentrations are elevated in AAS and has prognostic value in indentifying those at risk of significant disease progression.

Method

Patients over 25 years old with radiologically confirmed acute aortic syndrome were recruited as part of a prospective observational study (NCT03647566). Demographic details, AAS sub-category, time from index acute aortic syndrome event and pDES concentrations measured by stable isotope dilution LC-MS/MS were recorded at baseline. Baseline and follow up maximal aortic diameters were measured on contrast-enhanced computed tomography (CT) and change in aortic diameter over time was calculated. Control plasma desmosine samples were obtained at a 2:1 ratio control subjects participating in the United Kingdom Aneurysm Growth Study. Data presented as mean±standard deviation or median [interquartile range].

Results

Plasma desmosine concentrations were measured in 53 patients (64 [53 to 71] years) with acute aortic syndromes and 106 control subjects (53 [44 to 60] years). In patients with AAS, pDES concentrations were almost twice those of control subjects (0.58±0.26 vs 0.27±0.07, p<0.001). In those with AAS, plasma desmosine concentrations were seen to be highest at presentation, and reduced over time from the aortic syndrome event (R=0.51, p=0.003). Plasma desmosine concentration was the only variable associated with increasing aortic diameter over time (R=0.34, p=0.014).

Conclusion

Plasma desmosine concentrations are elevated in patients with AAS, peak at the time of presentation and represents a promising biomarker for early identification and risk stratification in patients with AAS.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): British Heart FoundationTenovus Scotland Major Research GrantChief Scientist Office Catalytic Grant Plasma desmosine, time and expansionBaseline characteristics
Conquering stroke epidemiological statistics in Brazil an innovative initiative from the Brazilian Society of Cardiology
Authors: Machline-Carrion M J , Pontes-Neto O M , Brant L C C , Polanczyk C A , Biolo A , Nascimento B R , Malta D C , Marinho De Souza M F , Soares G P , Xavier G F , Bittencourt M S , Teixeira R , Ribeiro A L P ,   Cardiovascular Statistics Brazil Group
Published: October 2021

Background

Stroke has been the second major cause of death in Brazil in the last decades. A better understanding on epidemiological statistics as well as on the diseases burden is crucial for enabling stakeholders to better tackle the disease.

Purpose

This project aims to continuously monitor and evaluate the data sources on heart disease and stroke in Brazil to provide the most up-to-date information on the epidemiology of these diseases to Brazilian society annually.

Methods

This initiative is based on the Heart Disease & Stroke Statistics Update methodology of the American Heart Association, with the support of the Brazilian Society of Cardiology, the Global Burden of Diseases Brazil network and an international committee. The project incorporates official statistics provided by the Brazilian Ministry of Health and other government agencies, as well as data generated by other sources and scientific studies on heart disease, stroke, and other CVD, including GBD/IHME data.

Results

The age-standardized prevalence rates per 100.000 for ischemic stroke in 1990 was 1327,6 (1151.2 to 1516) and 870.1 (761.1 to 992.8) in 2019 representing a percent change of −34.5 (−36.7 to −0.3). The age-standardized prevalence rates for intracerebral hemorrhage in 1990 was 507.5 (438.9 to584.1) and 315.9 (275 to 361.4) in 2019 representing a percent change of −37.7 (−40.5 to −0.3). The age-standardized incidence rates for stroke in 1990 was 224.6 (201.6 to 251.8) and 127 (113.8 to 142.1) in 2019 representing a percent change of −43.5 (−44.7 to −0.4). the age-standardized mortality rates for stroke in 1990 was 137.8 (127.8 to 144) and 58.1 (52.6 to 61.8) in 2019 representing a percent change of −57.8 (−60.4 to −0.6). The age-standardized DALY rates for stroke in 1990 was 2959 (2829.6 to 3063) and 1219.6 (1142 to 1285.5) in 2019 representing a percent change of −58.8 (−61 to −0.6).

Conclusion

This project represents a fundamental step on a better understanding on the stroke epidemiology in Brazil. While we observed a significant decrease in mortality rates from 1990 to 2019, we also raise a concern on a possible shift for a plateau curve or even increased rates in the next years.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Brazilian Society of Cardiology
Evaluation of the prophylactic role of pethidine in avoiding radial artery spasm during transradial cardiac interventions
Authors: Bouras G , Giannainas N , Lourmpa V , Tsounis D , Adreanides E , Antoniadis D , Lazaridis K , Kalpakos D , Toutouzas K
Published: October 2021

Introduction

Prophylactic use of benzodiazepine and opioids (fentanyl, morphine) is an established method for tackling radial artery spasm, in patients undergoing left cardiac catheterization procedures. Meperidine (Pethidine) is a synthetic opioid with elimination half life of 2–4 hours and duration of action of only 2–3 hours, making it ideal for in-lab administration.

Purpose

We aimed to test primarily the role of pethidine administration in preventing radial artery spasm and secondarily to assess patient discomfort during transradial coronary interventions.

Methods

This is a prospective, randomized, double blinded study. Patients were randomized to either pethidine 0,25mg administration (Group A) or normal saline (Group B) i.v. 10 minutes before the beginning of the procedure. As standard prophylactic measures against spasm, both groups received verapamil 5mg and nitroglycerin 100μg, after sheath introduction in the radial artery. Artery spasm was assessed clinically by the difficulty in advancing or exchanging catheters, as reported by the operator (CHUGH scale). A Visual Analog Scale (VAS) was used to estimate the patient-perceived discomfort, one hour after the end of the procedure.

Results

66 patients were included, 42 in Group A and 24 in Group B. Mean age of the patients was 65.9 years, mean duration of the procedure was 27 minutes and 24% of patients proceeded to PTCA overall. Operators reported no problems in catheter manipulations (CHUGH 0) in 67% of patients from Group A vs 38% of pts from Group B. 64% Group A patients and 21% Group B patients reported no symptoms (VAS 0). Pethidine administration had a negative correlation with VAS (r: −0.418, p: 0.001) and CHUGH Scale (r: −0.295, p: 0.016) scores.

Conclusion

Pethidine low dose administration before radial artery catheterization, shows a positive trend in preventing spasm and reducing procedure-related patient discomfort. Larger studies are required to evaluate the role of pethidine as an alternative prophylactic measure against artery spasm in transradial cardiac interventions.

Funding Acknowledgement

Type of funding sources: None.
Optical coherence tomography-defined vulnerable plaque characteristics in relation to functional severity of coronary stenoses stratified by quantitative flow ratio
Authors: Zuo W , Sun R , Zhang X , Qu Y , Ji Z , Su Y , Zhang R , Ma G
Published: October 2021

Background

The functional severity and morphological features of epicardial lesions are both related to plaque vulnerability and adverse coronary events. However, their relationship remains controversial, especially in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Purpose

This study aimed to examine whether quantitative flow ratio (QFR), an angiography-based computation of fractional flow reserve, was associated with optical coherence tomography (OCT)-defined vulnerable plaques such as thin-cap fibroatheromas (TCFAs) in a board spectrum of population, including patients presenting stable angina and NSTE-ACS.

Methods

We identified patients who underwent OCT examinations from 2 prospective cohorts and then assessed interrogated vessels with QFR. Lesions were divided into tertiles: QFR-T1 (QFR <0.85), QFR-T2 (0.85 to 0.93) and QFR-T3 (QFR >0.93).

Results

This post-hoc analysis included 83 lesions from 79 patients (mean age: 61.5±9.8 years, males: 58%). Patients with NSTE-ACS accounted for the majority of the population (67%). The median % diameter stenosis and median QFR value were 42% (36 to 49%) and 0.88 (0.83 to 0.95), respectively. The prevalence of OCT-TCFA was significantly higher in QFR-T1 (50%) than in QFR-T2 (14%) and QFR-T3 (19%) (p=0.003 and 0.018, respectively). Overall significant differences were observed among tertiles in maximum lipid arc, thinnest fibrous cap thickness (FCT), and minimal lumen area (MLA) (p=0.017, 0.040, and <0.001, respectively). The Spearman's correlation analysis showed that QFR was significantly related to MLA (ρ = 0.537, p<0.001), % area stenosis (ρ = –0.512, p<0.001), maximum lipid arc (ρ = –0.360, p=0.002), lipid length (ρ = –0.242, p=0.038), lipid index (ρ = –0.333, p=0.004), and thinnest FCT (ρ = 0.315, p=0.006). In the multivariable analysis, QFR ≤0.80 remained as a significant determinant of TCFAs regardless of the presence of NSTE-ACS and the level of low-density lipoprotein cholesterol (adjusted odds ratio = 4.387, 95% confidence interval: 1.297 to 14.839, p=0.017). In addition, QFR demonstrated moderate predictive ability for OCT-TCFA (area under the curve = 0.72, 95% confidence interval: 0.58 to 0.86, p=0.003) with the best cutoff of ≤0.86 (sensitivity: 65%; specificity: 73%; negative predictive value: 85%; accuracy: 71%).

Conclusions

Lower QFR was related to OCT-TCFA and other vulnerable plaque characteristics in angiographically mild-to-intermediate stable lesions and culprit lesions from NSTE-ACS. The QFR might be a useful tool for ruling out high-risk, rupture-prone plaques without using any pressure wires or vasodilators.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): The Jiangsu Provincial Key Research and Development Program Flow diagram of patient selectionOCT findings according to QFR tertiles
The clinical outcome of fractional flow reserve based coronary revascularization strategy of the patients on hemodialysis
Authors: Hirobe K , Otsuki H , Inagaki Y , Anaka K , Nakao M , Arashi H , Yamaguchi J , Hagiwara N
Published: October 2021

Background

The optimal coronary revascularization strategy for the patients on hemodialysis is yet to be determined. In the real-world practice, we sometimes encounter the rapid deterioration after percutaneous coronary intervention (PCI) to angiographically intermediate but functionally significant stenosis. According to the fractional flow reserve (FFR) based revascularization strategy, the clinical outcome of the deferred lesions is reported to be almost equivalent to that of the lesions received PCI. However, whether the relationship also applies to hemodialysis patients is unclear.

Purpose

To assess the clinical outcome of the lesions for which revascularization strategy was determined by FFR in patients with hemodialysis.

Methods

Consecutive 147 vessels in 120 patients with hemodialysis whose revascularization strategy was decided according to the FFR were enrolled in this study. We compared the clinical outcomes of the deferred group (FFR ≥0.80, 87 vessels, 78 patients) with the PCI group (FFR<0.80, 60 vessels, 42 patients). The primary endpoint of this study was target vessel failure (TVF) defined as a composite of TV revascularization and myocardial infarction evaluated by per-vessel analysis. The secondary endpoint was major adverse cardiovascular events (MACE) defined as all cause death, myocardial infarction, urgent revascularization evaluated by per-patient analysis.

Results

The median follow-up period was 2.3 years (interquartile range, 1.5–4.0 years). The beseline characteristics of the lesions and patients were well balanced between the 2 treatment groups except for the distribution of target vessels and FFR value. The cumulative TVF rate was not significantly different between the deferred group and PCI group (2-year event rate 26.7% vs. 17.7%; Log-rank p=0.23). The risk of MACE was also not significantly different between two groups (2-year event rate 35% vs. 30%; Log-rank p=0.48).

Conclusion

The clinical outcome of the lesions/patients for which received revascularization based on FFR was equivalent to the deferred lesions/patients even in the patients on hemodialysis (2,129/3,000).

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1
Microvascular dysfunction in patients with angina and non-obstructive coronary artery disease – preliminary data from a single center registry
Authors: Banai A , Lupu L , Borohovitz A , Levi E , Banai S , Konigstein M
Published: October 2021

Introduction

About 50% of patients referred for coronary angiography because of angina and/or myocardial ischemia are found to have non-obstructive coronary artery disease (CAD). The role of microvascular dysfunction as the cause of angina or ischemia is becoming increasingly recognized.

Purpose

Our aim was to describe coronary physiology and microvascular function in patients with angina and ischemia and non-obstructive CAD (ANOCA/INOCA).

Methods

Patients with angina, referred for coronary angiography and found to have non-obstructive CAD enter a prospective registry and undergo invasive coronary physiology evaluation. Fractional flow reserve (FFR), coronary flow reserve (CFR), index of myocardial resistance (IMR) and resistive reserve ratio (RRR) are recorded. Patients with obstructive CAD (≥50% diameter stenosis and/or FFR≤0.8), acute coronary syndrome and/or hemodynamic instability are excluded. Microvascular dysfunction is considered significant if either CFR<2.5, IMR≥25 and/or RRR≤3.5.

Results

58 patients with ANOCA or INOCA were studied. Mean age was 64.8±10.4 and 65.5% were females. Hyperlipidemia, hypertension, and obesity were the most frequent cardiovascular risk factors (65.5%, 55.1% and 39%, respectively), and approximately 25% had known ischemic heart disease with a previous percutaneous coronary intervention. Microvascular dysfunction was found in 29 (52.7%) of the patients. 10 (18.2%) had CFR<2.5, 20 (34.5%), had IMR≥25, and 27 (50%) had RRR≤3.5. Among patients with IMR≥25, mean CFR and RRR were 2.1±0.5 and 2.4±6.8, respectively.

Conclusion

Microvascular dysfunction is present in approximately half of the patients with angina and/or ischemia referred for coronary angiography and found to have non-obstructive CAD.

Funding Acknowledgement

Type of funding sources: None.
Antithrombotic strategies in elderly patients with atrial fibrillation revascularized with drug-eluting stents: PACO-PCI (EPIC-15) registry
Authors: De La Torre Hernandez J M , Ferreiro J L , Lopez Palop R , Ojeda S , Marti D , Avanzas P , Linares J A , Diego A , Amat I J , Telleria M , Cid B , Otaegui I , Lozano I , Pinar E , Perez De Prado A ,   PACO-PCI (EPIC-15) registry
Published: October 2021

Background

The strategy of antithrombotic therapy in patients with atrial fibrillation (AF) after revascularization with drug-eluting stents continues to be debated. The evidence in elderly population in this scenario is particularly scarce.

Purpose

We sought to investigate the antithrombotic regimens applied and their prognostic effects in patients over 75 years old with AF after revascularization with drug-eluting stents.

Methods

Retrospective registry in 20 centers including consecutive patients over 75 years with AF treated with drug-eluting stents. A primary endpoint of MACCE and a co-primary endpoint of major bleeding by ISTH criteria were considered at 12 months.

Results

Out of 41,000 patients undergoing PCI 1,249 patients (81.1±4.2 years, 33.1% women, 66.6% ACS, 30.6% complex PCI) were included. Triple antithrombotic therapy (TAT) was prescribed in 81.7% and dual antithrombotic therapy (DAT) in 18.3%. TAT was based on direct oral anticoagulants (DOAC) in 48.4% and maintained for only 1 month in 52.2%, and DAT included DOAC in 70.6%. Primary endpoint of MACCE was met in 9.6% and primary endpoint of major bleeding in 9.4%. TAT was significantly associated with more bleeding (10.2% vs. 6.1%, p=0.04) but less MACCE (8.7% vs. 13.6%, p=0.02) than DAT and the use of DOAC was significantly associated to less bleeding (8% vs. 11.1%, p=0.03) and similar MACCE (9.8% vs. 9.4%, p=0.8). TAT over 1 month or with VKA was associated with more major bleeding but comparable MACCE rates.

Conclusions

Despite advanced age TAT prevails, but prolonged durations or use of VKA are associated with increased bleeding without additional MACCE prevention. DAT reduces bleeding but with a trade-off in terms of ischemic events. DOAC use was significantly associated to less bleeding and similar MACCE rates.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bristol-Myers-Squibb/Pfizer
Utility and safety of the MANTA device for access site closure after removal of the mechanical hemodynamic support device Impella on the intensive care unit
Authors: Burkart P , Bossard M , Moccetti F , Hess S , Jeyarasa M , Madanchi M , Cioffi G , Seiler T , Wolfrum M , Hakimi M , Seelos R , Toggweiler S , Attinger-Toller A , Kobza R , Cuculi F
Published: October 2021

Background

The percutaneously implanted hemodynamic mechanical support devices Impella are commonly used in patients at risk for or with cardiogenic shock (CS). Impella removal after hemodynamic stabilization on the intensive care unit (ICU) remains a major challenge and is prone to high rates of bleeding and vascular complications.

Purpose

It is unknown if the use of the novel large-bore access closure device MANTA® is safe and facilitates access management compared to manual compression.

Methods

Between January 2017 and December 2020, 172 CS patients were treated with an Impella® device at our centre. Of those, in 89 patients the Impella® was removed on the ICU and access site management occurred with either MANTA® device or manual compression. The criteria for MANTA® 14 french device deployment included: (i) femoral artery Diameter >6mm and (ii) absence of significant peripheral arterial disease (PAD). Bleeding and vascular access site complications were assessed and adjudicated according to the Valve Academic Research Consortium-2 (VARC-2) criteria.

Results

Among the 89 included patients, Impella® removal was performed using the MANTA® device in 31 cases and manual compression in 58 cases. Mean age was 66±11 years, and 50 (56.2%) patients had a CS classified as Society for Cardiovascular Angiography and Interventions (SCAI) D or higher due to myocardial infarction. Median support time was 40 (IQR 24; 69) hours. Baseline characteristics are displayed in Table 1. Immediate haemostasis was more frequently achieved by MANTA® device compared to manual compression (p=0.034). Moreover, we observed significantly less overall (2 (6.5%) vs. 22 (37.9%), p=0.001) and minor bleedings (1 (3.2%) vs. 15 (25.9%), p=0.006) with the MANTA® device when compared to manual compression. Of note, there were no significant differences in vascular complications between the two groups (Table 2).

Conclusions

In patients requiring Impella® support and residing on ICU, the MANTA® device, compared to standard of care manual compression, seems to be a safe and effective option for access site management, especially with regards to the reduction of bleeding events. However, physicians should carefully assess the vascular anatomy and degree of calcification prior to deployment of the MANTA® device. Nevertheless, more prospective data is necessary for evaluating the optimal access closure among CS patients treated with a percutaneously implanted Impella® device.

Funding Acknowledgement

Type of funding sources: None. Table 1. Baseline demographicsTable 2. Outcomes
Clinical outcomes in percutaneous coronary interventions with polymer-free vs. durable-polymer stents: a metanalysis of randomized clinical trials
Authors: Escribano D , Cordero A , Bertomeu-Gonzalez V , Moreno-Arribas J , Monteagudo M , Lopez Ayala J M , Perez-Berbell P , Quintanilla M , Zuazola P
Published: October 2021

Background

Polymer-free (PF) stents were designed as an alternative to durable-polymer (DP) drug-eluting stents to minimize the time on dual antiplatelet treatment for patients at high-risk of bleeding. Nonetheless, the efficacy and safety of PF vs. DP stents in patients undergoing percutaneous coronary intervention (PCI) remain controversial.

Methods

We performed a metanalysis with currently available studies that assessed the effect of PF-stents vs. DP-stents after performing a systematic search. The endpoints analyzed were all-cause death, myocardial infarction, target lesion revascularization (TLR) and probable or definite stent thrombosis. The raw numbers of incident end-points reported in each study were used. We performed analyses in short and long term (<1 or >1 year follow-up) studies.

Results

We included 12464 patients from 8 studies (5 short-term and 3 long-term): 6723 treated with PF-stents and 5741 with DP stents. Females represented 23.3% (n=3284) and 33.7% (n=4202) were included in the setting of acute coronary syndromes. As shown in the figure, PF-stents were associated to lower incidence of all-cause mortality (HR: 0.91 95% CI 0.84–0.98; p=0.016) and TLR (HR: 0.88 95% CI 0.80–0.96; p=0.003). No differences were observed in the risk of cardiovascular death (HR: 0.96 95% CI 0.86–1.06 p=0.415), myocardial infarction (HR: 0.90 95% CI 0.80–1.01; p=0.061) or probable-definite stent thrombosis (HR: 0.92 95% CI 0.74–1.14; p=0.447). Finally, no differences in the primary end-point (HR: 0.92 95% CI 0.83–1.03; p=0.143) were detected with PF-stents vs. DP-stents. No significant heterogenicity was observed in any of the endpoints, except for the incidence of stent thrombosis.

Conclusions

Under current PCI techniques the use of PF-stent might be associated to better outcomes, especially in terms of all-cause mortality and TLR.

Funding Acknowledgement

Type of funding sources: None.
Localization of the femoral artery bifurcation: hips don't lie – in at least 97% of cases
Authors: Uehlein S , Smolka S , Arnold M , Marwan M , Achenbach S
Published: October 2021

Background

The most common vascular access for structural cardiac interventions such as transcatheter aortic valve implantation (TAVI) is the common femoral artery (CFA). Depending on the procedure CFA puncture has to be performed not only unilaterally, but also bilaterally. Since incorrect localization of femoral access can lead to severe vascular complications, specific knowledge about the exact position of the CFA bifuraction is helpful. Such information might be systematically obtained from pre-TAVI CT scans.

Methods

We performed a retroperspective analysis of consecutive contrast-enhanced pre-TAVI CT angiography data sets (n=1000) to determine the CFA bifurcation localization relative to the femoral head and the correlation to contralateral CFA bifurcation location.

Results

The site of the CFA bifurcation was in 67.2% below the femoral head (−−), in 24.3% within the lower third of the femoral head (−), in 7.4% in the mid (0) and in 1.2% within the upper third (+) of the femoral head. Bifurcations above (++) the femoral head were not detected. CFA bifurcations below the femoral head showed the highest prevalence within men and women in all age groups (50–59, 60–69, 70–79, 80–89, 90–99 years). Bilateral agreement of CFA bifurcations was observed in only 69.3% and was independent of one-sided hip replacement (agreement 72.7%) or two-sided hip replacement (agreement 78.7%). A congruent contralateral left CFA bifurcation below the femoral head could be predicted in 80.6%, whereas CFA bifurcations within the lower and upper margins of the femoral head were congruent in only 65.7% (of these, 49.2% for the lower third, 29.7% for the mid and 36.4% for the upper third).

Conclusion

In conclusion, punctures within the upper third of the femoral head will provide an ideal puncture site in at least 97% of cases, independent of age, sex, or previous hip replacement.

Funding Acknowledgement

Type of funding sources: None.
Impact of doppler velocity index after transcatheter aortic valve replacement using Sapien-3 valve – a single centre experience
Authors: Lak H , Sammour Y , Chawla S , Svensson L G , Yun J , Harb S , Reed G W , Puri R , Jaber W , Krishnaswamy A , Kapadia S
Published: October 2021

Background

Little is known about the hemodynamic performance of Edwards Sapien-3 (S3) valve after Transcatheter Aortic Valve Replacement (TAVR). Doppler velocity index (DVI) is a better indicator of prosthetic valve function as it is independent of valve size and flow, unlike mean gradient and peak velocity which are flow-dependent.

Methods

In this study, we compare outcomes based on differences in DVI among a consecutive series of patients who underwent S3 TAVR between April 2015 and December 2018. Our institutional review board approved the study and informed consents were obtained from the subjects.

Results

Among 921 patients who had follow-up echocardiograms within 30 days after TAVR, 60.8% had DVI ≤0.5, while 39.2% had DVI >0.5. The median 30-day DVI was 0.47 with a standard deviation of 0.11 and mean 0.49 and interquartile range 0.41–0.55. The baseline clinical and procedural characteristics were similar between both groups with the exception of less post-dilation (36.8% vs. 47.4%; p=0.001) and greater implantation depth (2.59±1.99 vs. 2.31±1.9mm; p=0.031) with DVI ≤0.5. The rates of aortic valve calcification, pre dilation, pre-TAVR aortic regurgitation (AR) were similar. At baseline, there were no differences between both groups in mean or peak gradients or aortic velocity time integral (VTI). At 1 year, mean gradients were higher with DVI ≤0.5 (12.7±5.6 vs. 11.1±4.6 mmHg; p=0.001). DVI ≤0.5 was associated with higher peak gradients (24.2±10.2 vs. 21.4±8.7 mmHg; p=0.002), and aortic VTI (51.4±13.5 vs. 46.8±12.2 cm; p<0.001) at 1 year, especially with the 26mm and 29mm prostheses. Compared with DVI>0.5 group, patients in DVI<0.5 group had lower baseline left ventricular ejection fraction (LVEF) (54.5±12.2% vs. 58.9±11.2%; p<0.001), higher left ventricular end-diastolic volume index (LVEDVi) (54.3±20.9 vs. 49.4±17.4 ml/m2; p=0.001), higher LV end-systolic volume index (LVESVi) (25.2±16.5 vs. 21.3±12.7 ml/m2; p=0.001), and similar LV mass index (110.7±31.9 vs. 106.9±32.7 g/m2; p=0.134). 1-year mortality rates among patients who had DVI ≤0.5 compared to DVI >0.5 were lower (6.6% vs. 10.6%; log-rank p=0.033), however no difference was noted at both 2 years (17.3% vs. 20.1%; log-rank p=0.151), and 3 years after TAVR (30.7% vs. 31.2%; log-rank p=0.333).

Conclusions

DVI<0.5 was associated with higher peak gradients and lower baseline LVEF. DVI <0.5 group patients had lower 1-year mortality but similar mortality at 2 and 3-years of follow up.

Funding Acknowledgement

Type of funding sources: None. Figure 1. All-cause SurvivalFigure 2. Hemodynamic Data
Clinical and echocardiographic parameters associated with left ventricular recovery after TAVI
Authors: Tiosano S , Maor E , Berkovitch A , Fefer P , Feinberg M , Vatury O , Barbash I M , Guetta V , Segev A
Published: October 2021

Introduction

The relationship between severe Aortic Stenosis (AS) and Left Ventricular (LV) dysfunction is well established. However, there is a paucity of data regarding LV functional recovery after TAVI.

Purpose

To study the clinical and echocardiographic parameters associated with LV functional recovery after TAVI.

Methods

We evaluated all patients who underwent TAVI between 2009–2020 in a tertiary medical center. We included patients with pre-procedural LV Ejection Fraction (LVEF) of 40% and below. All patients had baseline and in-hospital post-procedural echo, and their clinical characteristics were recorded in a designated TAVI registry. LV functional recovery was defined as an absolute increase in at least 10% in LVEF post-procedurally. No LV recovery was defined as an absolute change of up to ±10% in post-procedure LVEF, and LVEF deterioration was defined as an absolute decrease of more than 10% in post-procedural LVEF compared to baseline. Univariate analysis consisting clinical and echocardiographic factors for LV functional recovery was performed, followed by logistic regression adjusting for confounders.

Results

Out of 1,349 consecutive TAVI patients, 100 (7.4%) had LVEF of 40% or less. There were 69 (69%) men with a mean age of 82±8 years, and average BMI of 27±4 kg/m2. Prior coronary artery disease and hypertension were present in 34 (34%) and 21 (21%) of patients, respectively. Out of these 100 patients, 32 (32%) had achieved LV functional recovery and no patient had experienced LVEF deterioration (FIGURE). Mean Left Ventricular End Systolic Diameter (LVESD) was 3.79 and 4.43 in the LV functional recovery and no LV recovery groups, respectively. Mean aortic pressure gradient was higher among patients who had LV functional recovery compared to no LV recovery (45.9 vs. 31.5 mmHg, respectively). Multivariable analysis revealed parameters that were independently associated with LV functional recovery: Coronary artery disease – OR 5.29 (95% CI 1.59–20.44), LVESD – OR 0.87 (95% CI 0.8–0.95) for each 1 mm increment and mean aortic pressure gradient – OR 1.91 (95% CI 1.21–3.28) per each 10 mmHg increment.

Conclusion

In patients with severe AS and LV dysfunction undergoing TAVI, the presence of coronary artery disease, increased aortic pressure gradient and reduced LVESD were associated with early LV functional recovery.

Funding Acknowledgement

Type of funding sources: None. Figure 1
National prevalence and outcomes of different mitral valve interventions for mitral regurgitation among patients with cardiogenic shock: an analysis of the national readmission database 2010–2018
Authors: Aldrugh S , Kakouros N , Qureshi W
Published: October 2021

Background

Prevalence and outcome data of mitral valve (MV) interventions for severe mitral regurgitation (MR) in the setting of cardiogenic shock (CS) is limited.

Purpose

Our aim is to study the national prevalence, mortality, and outcomes of three mitral valve interventions (transcatheter mitral valve (MitraClip), surgical mitral valve repair (sMVR), and surgical mitral valve replacement (sMVr)) in patients with severe MR and CS, and how they compare to a non-invasive medical approach to management.

Methods

Patients with concomitant severe MR and CS were included for the years 2010 - 2018 from the national readmission database. We compared the national prevalence, in hospital mortality, readmission rate, and outcomes of patients who were treated either medically (non-invasive), or underwent an invasive approach with MitraClip, sMVR, or sMVr using one-way ANOVA and logistic regression.

Results

A total of 106,015 patients (68±13 years, 42% women) with severe MR and CS were identified. Of these, 88,696 (84%) were treated medically, while 607 (0.6%) underwent MitraClip, 4,528 (4%) underwent sMVR, and 12,184 (12%) underwent sMVr. Majority of patients in all four groups had a high Elixhauser comorbidity score of >6. In-hospital mortality rate was 31% in the medical therapy group, 14% and 17% in the sMVR and sMVr groups subsequently, and 26% in the MitraClip group (p<0.001). The median cost of hospitalization was significantly higher in the MitraClip group ($400,087) compared to the other groups (medical=$140,282, sMVR =$290,456, and sMVr =$353,688, p<0.001). Readmission rates were significantly lower in the sMVR (0.7%) and sMVr (1%) groups compared to the medical therapy (4%) and MitraClip (6%) groups (p<0.001). MitraClip was associated with a higher use of Impella (Odds Ratio (OR) 2.6; 95% Confidence Interval (CI) 1.8–3.8, p<0.001), intra-aortic balloon pump (IABP) (OR 3.8; 95% CI 2.9–5.1, p<0.001), and vasopressors (OR 1.6; 95% CI 1.1–1.7, p<0.001) than sMVR or sMVr. Extracorporeal membrane oxygenation (ECMO) use was more common in sMVR (OR 2.9, 95% CI 2.5–3.4, p<0.001) and sMVr (OR 2.0,95% CI 1.8–2.2, p<0.001) than in MitraClip. In terms of complications, MitraClip was associated with a higher rate of vascular complications (OR 4.2; 95% CI 1.4–12.8, p<0.001); while both sMVR and sMVr had higher association with significant post-operative bleeding (OR 2.3; 95% CI 1.9–2.8, p<0.001) and (OR 2.1; 95% CI 1.9–2.4, p<0.001) respectively.

Conclusion

Majority of patients in this cohort with severe MR and CS were treated either medically or underwent surgical MV replacement. Although MitraClip improved hospital mortality over medical therapy, it was associated with a higher mortality risk, readmission rate, and cost of hospitalization when compared to sMVR and sMVr.

Funding Acknowledgement

Type of funding sources: None.
Right ventricular longitudinal strain on cardiovascular magnetic resonance imaging predicts outcome in patients undergoing transcatheter mitral valve repair
Authors: Koschutnik M , Dona C , Nitsche C , Dannenberg V , Koschatko S , Beitzke D , Loewe C , Huelsmann M , Schneider M , Bartko P E , Goliasch G , Hengstenberg C , Kammerlander A A , Mascherbauer J
Published: October 2021

Background

The prognostic value of left and right ventricular global longitudinal strain (LV and RV GLS) derived from cardiovascular magnetic resonance (CMR) feature tracking in patients with severe mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) is unknown.

Methods

Consecutive patients scheduled for TMVR underwent pre-procedural and follow-up CMR imaging including feature tracking strain analysis. Kaplan-Meier estimates and multivariate Cox-regression analyses were used to identify the prognostic impact of LV and RV GLS on CMR using a composite of heart failure hospitalization and death.

Results

A total of 62 patients (78.3±7.0y/o, 45% female, EuroSCORE II: 9.7±7.2%) with severe MR underwent CMR prior to TMVR. 23 (37%) patients presented with right ventricular dysfunction (RVD) defined by RV GLS >−20% on CMR. At baseline, RVD was associated with NT-proBNP levels (9510 vs. 4064pg/mL, p=0.030). On CMR, RVD was associated with reduced left and RV ejection fraction (LVEF: 39.2 vs. 48.7%, p=0.011, RVEF: 35.1 vs. 46.7%, p<0.001), as well as increased LV GLS (−14.0 vs. −19.5%, p=0.003).

A total of 18 events (12 deaths, 6 hospitalizations for heart failure) occurred during follow-up (mean 11.4±9.1months). While LV GLS was not significantly associated with outcome (HR 0.95, 95% CI: 0.90–1.01, p=0.082), RV GLS showed a strong and independent association with event-free survival by multivariate Cox-regression analysis (adj.HR 0.91, 95% CI: 0.83–0.99, p=0.033) after adjustment for relevant baseline and procedural data (EuroSCORE II, post-procedural residual MR), imaging parameters (TAPSE, LV and RVEF on CMR), and cardiac biomarkers (NT-proBNP). When compared with the “gold standard” RVEF on CMR (RVEF <45%: adj.HR 0.86, 95% CI: 0.23–3.20, p=0.825) and TAPSE on echo (TAPSE <17mm: adj.HR: 2.77, 95% CI: 0.72–10.70, p=0.140), only RVD (RV GLS >−20%: adj.HR 5.05, 95% CI: 1.23–20.63, p=0.024) was significantly associated with the composite endpoint (Figure 1). Follow-up CMR was performed in 21 (34%) patients. RV GLS significantly improved after TMVR (−20.6 to −25.2%, p=0.016, Figure 2).

Conclusions

RV rather than LV GLS, as determined on CMR, is an important predictor of outcome in patients undergoing TMVR. At 1 year follow-up, RV function significantly improved, and thus might add useful prognostic information on top of established risk factors.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2
An evaluation of patient outcomes following transcatheter pulmonary valve implantation: a meta-analysis
Authors: Saluja S , Contractor H , Wiltshire R , Mannan F , Hussain N , Abidin N , Tin L , Ali S , Saluja S , Khan K , Sobolewska J , Sood P , Anderson S
Published: October 2021

Background

Transcatheter pulmonary valve implantation has emerged as an effective alternative to surgery in patients with congenital Right Ventricular Outflow Tract Dysfunction (RVOT). There is demonstrable evidence that Percutaneous Pulmonary Valve Implantation (PPVI) effectively restores conduit graft viability with a consequent improvement in right ventricular pressures.

Aim

The objective of this study was to perform a meta-analysis of all previously published studies examining the outcome of PPVI and the associated early and late peri-procedural factors in patients with RVOT dysfunction. Data from procedures performed within our own centre have also been included.

Methodology

We performed a meta-analysis of all observational studies investigating early and late outcomes following PPVI. Risk ratios and risk differences were pooled in a random-effects model. The I2 statistic was used to quantify heterogeneity between studies. We searched EMBASE, MEDLINE, CINAHL, PsychInfo and Cochrane databases from their inception until 2021. Studies were included if they reported any comparative data regarding study endpoints. Primary endpoint was mean RVOT gradient. Secondary end points include pulmonary regurgitation fraction, left and right ventricular end-diastolic and systolic volume indexes, and left ventricular ejection fraction. Complication rates were considered a safety endpoint.

Results

A total of 23 studies with 1501 participants enrolled were included in the final meta-analysis. The RVOT gradient decreased significantly [weighted mean difference (WMD) = −20.32 mmHg; 95% confidence interval (CI): −22.15, −19.11; p<0.001]. Mean right ventricular (RV) systolic pressures fell significantly [(WMD)= −18.4 mmHg; 95% CI: −16.4, −20.2; p<0.001) and RV diastolic pressures decreased significantly [(WMD) = −6.3 mmHg, 95% CI: −4.3, −8.9; p<0.001). Pulmonary regurgitation fraction (PRF) also decreased notably (WMD = −24.38%, 95% CI: −28.27, −17.32; p<0.001).The incidence of infective endocarditis was 1.8% (95% CI: 0.7–3.8).

Conclusion

PPVI is an effective and safe strategy in relieving right ventricular remodelling and improving haemodynamic and clinical outcomes in patients with RVOT dysfunction. Multi-centre collaborations are essential to further determine the long-term effects of PPVI on cardiac function, exercise tolerance and quality of life in RVOT dysfunction.

Funding Acknowledgement

Type of funding sources: None.
Early results of multiple coronary artery bypass grafting on arteries less than 1.5 mm in diameter
Authors: Zaikovskii V Y , Shiryaev A A , Vasiliev V P , Galyautdinov D M , Vlasova E E , Akchurin R S , Mykimov S D
Published: October 2021

The widespread using of coronary artery (CA) stenting has led to the fact that nowadays coronary artery bypass grafting (CABG) is the method of choice for patients with multiple occlusions and diffuse lesions, who can be refused in surgery due to “small”, not specified in the guidelines, CA (diameter less than 1.5 mm). The use of microsurgical technique makes it possible to reconstruct small-caliber vessels, however, no detailed comparative data has been published yet.

Aim

To analyze the efficacy of CABG using microsurgical techniques for multiple CA bypass with arteries less than 1.5 mm and compare the results with coronary surgery of larger vessels in the early postoperative period.

Methods

We studied the early results of CABG in two groups of patients. The study group was represented by 100 patients with multiple coronary artery lesions with d<1.5 mm, who underwent control MSCT-shuntography in the postoperative period. We formed a control group of 100 patients who underwent CABG with a target artery d>1.5 mm. In all cases cardiopulmonary bypass and microsurgical technique were used.

Results

All patients underwent complete revascularization of CA, the average number of distal anastomoses was 4,3±0,5 in the study group versus 3.6±0,3 in the comparison group, p<0,001. Intraoperatively in the study group significantly more often performed complex anastomoses to arteries <1,5mm (47 patients vs 18, p<0,001), onlay-flap anastomoses (23 vs 1, p<0,001), single and multiple endarterectomies (19 vs 1, p<0,001). The need for long-term inotropic support (15 cases vs 13, p=0,684), as well as prolonged artificial lung ventilation (2 vs 3, p=0,651), in hospital stage was similar in both groups. Patients from the study group more often underwent reexploration for bleeding in the early postoperative period, which was explained by a large number of complex reconstructions and prolonged on pump time, nevertheless, the difference did not reach statistical significance (4 vs 2, p=0,407). Perioperative myocardial infarction (MI) were registered in 3 (3%) and 1 (1%) cases in the study and control groups, respectively, p=0,621. All patients in the study group underwent MSCT-shuntography in the early postoperative period, according to which 8 patients (8%) had occlusion of the autovenous coronary grafts to the CA<1.5mm and 4 patients (4%) - occlusion of the bypasses to CA>1.5 mm.

Conclusion

CABG in patients with coronary arteries less than 1.5 mm in diameter requires complex reconstructive techniques significantly more often. Nevertheless, in the early postoperative period, it is possible to achieve comparable results in the patient groups with and without CA<1,5mm in the anastomotic sites.

Funding Acknowledgement

Type of funding sources: None.