bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic utility of genetic testing in restrictive cardiomyopathy a single refferal centre experience
Authors: Szczygiel J A , Michalek P , Franaszczyk M , Truszkowska G , Ziarkiewicz M , Gawor M , Legatowicz-Koprowska M , Walczak E , Mazurkiewicz L , Stawinski P , Jedrzejczak W W , Lutynska A , Ploski R , Bilinska Z T , Grzybowski J
Published: October 2021

Introduction

Restrictive cardiomyopathy (RCM) is considered to have a genetic background in approximately 50–60% of patients (pts) [1,2,3].

Purpose

The aim of the study was to assess the frequency of pathogenic gene variants in Polish patients with RCM.

Methods

Restrictive cardiomyopathy was diagnosed by transthoracic echocardiography. The analysis included all consecutive unrelated pts with RCM admitted to the cardiology department from January 2015 to December 2016. Light-chain (AL) amyloidosis was diagnosed using tissue biopsy, concentration of serum free light chains and bone marrow biopsy. A genetic test was offered to every patient without AL amyloidosis. In 4 pts coding regions of TTR or GLA genes were screened by Sanger sequencing. Next Generation Sequencing (NGS) was performed: a panel covering coding regions of >4800 disease-associated genes in 18 pts and Whole Exome Sequencing (WES) in 2 pts. Classification of rare variants was made according to ACMG criteria [4].

Results

Forty-four pts were enrolled. Eighteen pts were diagnosed with AL amyloidosis. One patient was diagnosed with histologically-proven myocarditis and one patient with transthyretin (ATTR) amyloidosis declined genetic test. The other 24 pts (median age 48 yrs, 6 males) underwent genetic testing, their median values (interquartile ranges) of the following parameters were: NT-proBNP, 2508 (995–5895) pg/mL; hs-TnT, 25 (18–46) ng/L; E/A ratio, 2.5 (1.8–4.5); E wave deceleration time, 135 (98–167) ms; E/e' ratio, 16 (12–19); left ventricular (LV) posterior wall, 13 (12–14.5) mm; interventricular septum, 14 (13–17) mm and LV end-diastolic dimension, 48 (43–49) mm. Pathogenic or likely pathogenic variants were detected in 16 probands: 5 in MYH7 gene, 3 in TNNI3 gene, 2 in MYBPC3 gene, 1 in BAG3 gene, 1 in PRAKG2 gene, 2 in GLA gene and 2 in TTR gene.

Conclusions

Genetic testing is justified in every patient with RCM, in whom AL amyloidosis is excluded. The molecular diagnosis in RCM may result in causal treatment of Anderson-Fabry disease and ATTR amyloidosis or improve disease management in other types of RCM. MYH7 gene is the most common causative gene in Polish patients with RCM.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology
Pericardial disease in patients treated with immune checkpoint inhibitors
Authors: Gong J , Drobni Z D , Zafar A , Quinaglia T , Hartmann S E , Gilman H K , Raghu V K , Gongora C , Alvi R , Zubiri L , Nohria A , Sullivan R J , Reynolds K L , Zlotoff D A , Neilan T G
Published: October 2021

Background

There are limited data on the occurrence, associations and outcomes of pericardial effusions and pericarditis after treatment with immune checkpoint inhibitors (ICIs).

Purpose

To evaluate incidence of pericardial disease in patients treated with an ICI.

Methods

This was a retrospective study at a single academic center that compared 2842 consecutive patients who received ICIs with 2699 age- and cancer-type matched patients with metastatic disease who did not receive ICI (design 1). A pericardial event was defined as a composite outcome of pericarditis and new or worsening moderate or large pericardial effusion. The endpoints were obtained through chart review and were blindly adjudicated. To identify risk factors associated with a pericardial event, in a second analysis, we also compared patients who developed an event on an ICI to patients treated with an ICI who did not develop a pericardial event (design 2). Cox proportional hazard model and logistical regression analysis were performed to study the association between ICI use and pericardial disease as well as pericardial disease and mortality. An additional 6-week landmark analysis was performed to account for lead-time bias.

Results

There were 42 pericardial events in the patients treated with ICI (n=2842) over 193 days (interquartile range 64 to 411) with an incidence rate of 1.57 events per 100 person-years. There was a 4-fold increase in the risk for pericarditis or a pericardial effusion among patients on an ICI compared to controls not treated with ICI after adjusting for potential confounders (hazard ratio [HR] 4.37, 95% confidence interval [CI] 2.09–9.14, p<0.001). Patients who developed pericardial disease while on an ICI had a trend for increased all-cause mortality (HR 1.53, 95% CI 0.99–2.36, p=0.05) compared to those who did not develop pericardial disease. When comparing those who developed pericardial disease after ICI treatment to those who did not, a higher dose of corticosteroid pre-ICI (>0.7 mg/kg prednisone) was associated with increased risk of pericardial disease (HR 2.56, 95% CI 1.00–6.57, p=0.049).

Conclusions

ICI use was associated with an increased risk for development of pericardial disease among cancer patients and a pericardial event on an ICI was associated with a trend towards increased mortality.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health/National Heart, Lung, and Blood Institute; a gift from A. Curt Greer and Pamela Kohlberg
Left ventricular hypertrabeculation in Ebstein anomaly – a clinically significant or irrelevant problem?
Authors: Cieplucha A , Trojnarska O , Rajewska-Tabor J , Katarzynska-Szymanska A , Mitkowski P , Pyda M
Published: October 2021

Background

Ebstein anomaly (EA) is characterized by anomalous tricuspid valve resulting in the whole right heart's distorted anatomy. Heart failure is the most frequent complication in adults with EA. Recently more attention is also paid to the left ventricle. Some limited echocardiographic data suggest a markedly increased occurrence of the left ventricular hypertrabeculation, by some authors called a non-compacted myocardium. Currently, cardiac magnetic resonance (CMR) is a gold standard in the evaluation of hypertrabeculation. However, different diagnostic criteria and discrepancies in the study outcomes make the clinical interpretation of this phenomenon questionable and challenging.

Purpose

To determine the frequency of the left ventricular hypertrabeculation among adults with EA; to assess its association with the ventricular size and function and the markers of heart failure.

Methods

Study group consisted of 35 unoperated adults (mean age 41.9±14.8 years) with Ebstein anomaly. The study protocol included: a) cardiac magnetic resonance (CMR) with the assessment of the left ventricle (LV) and functional right ventricle (fRV), including ejection fraction (EF), end-diastolic, end-systolic, and stroke volumes indexed by body surface area (respectively: EDVind, ESVind, SVind), and presence of hypertrabeculation defined according to Jacquier (1) as trabeculation mass >20% of the LV mass; b) cardiopulmonary tests with the assessment of peak oxygen consumption (peak VO2, % of predicted peak VO2), ventilation/carbon dioxide slope (VE/VCO2 slope) c) brain natriuretic peptide (BNP).

Results

Left ventricular hypertrabeculation was present in 13 (37.1%) patients.

We demonstrated no difference between patients with and without LV hypertrabeculation regarding: s

Conclusions

Left ventricular hypertrabeculation demonstrated by cardiac magnetic resonance is a phenomenon frequently occurring among adults with Ebstein anomaly. However, its presence is not associated with both ventricles' worse function nor with reduced exercise capacity. Therefore, the clinical relevance of left ventricular hypertrabeculation in this population remains questionable and requires further prospective studies.

Funding Acknowledgement

Type of funding sources: None.
Association between non-O blood group and spontaneous abortion in women with inherited thrombophilia
Authors: Poretto A , Spiezia L , Turatti G , Marobin M , Borella E , Campello E , Simioni P
Published: October 2021

Background

Spontaneous abortion is reported to be one of the most frequent pregnancy complications reaching a prevalence up to 15%. The association between congenital thrombophilia and pregnancy loss has been debated in several studies with conflicting results. We aimed to retrospectively evaluate the prevalence of inherited thrombophilia (i.e antithrombin, protein S and C deficiencies, factor V Leiden and prothrombin variant) in a group of women with a personal history of miscarriage. The prevalence non-O blood group, considered the most common thrombophilic condition, was concomitantly considered.

Materials and methods

A group of n. 566 women with a personal history of spontaneous abortion recruited among caregivers of patients admitted to the Medical Department of our University Hospital between December 2011 and December 2019 were enrolled. Women under 18 yrs, those with a personal history of venous and/or arterial thrombosis and with an acquired thrombophilic condition were excluded. An equally number of healthy women without a personal history of pregnancy loss acted as controls. The Odds Ratios (ORs) and 95% confidence intervals (CIs) were calculated as an estimate of pregnancy loss developing.

Results

Out of n. 566 enrolled women, n. 127 (22.4%) had an inherited thrombophilic condition. The prevalence of congenital thrombophilia was significantly higher in women with miscarriage than controls (OR 2.12; CI 95% 1.51–2.92). Non-O blood type was observed in n. 325 (57.4%) women. The prevalence of non-O blood group was significantly higher in women with pregnancy loss (p 0.01) and the association of thrombophilia and non-O blood type further increased the risk of pregnancy loss (OR 3.28; CI 95% 2.01–5.36).

Conclusions

Both inherited thrombophilia and non-O blood type should be considered risk factors for pregnancy loss. The knowledge of this information may help the clinician to better manage women with pregnancy loss. Further studies are required to confirm our findings.

Funding Acknowledgement

Type of funding sources: None.
Non-invasive risk prediction based on right ventricular function in patients with pulmonary arterial hypertension
Authors: Qaderi V , Weimann J , Harbaum L , Schrage B , Knappe D , Sinning C , Schnabel R , Blankenberg S , Kirchhof P , Klose H , Magnussen C
Published: October 2021

Background

Individual risk assessment in patients with pulmonary arterial hypertension (PAH) is fundamental to improve their outcome. Although right ventricular (RV) dysfunction is a major determinant of outcome in PAH, echocardiographic measures of RV function are poorly represented by current risk models.

Objective

The objective of this study was to identify echocardiographic measures of RV function, which are associated with adverse outcome and to develop a non-invasive, echocardiography-based risk score for PAH patients.

Methods

In 254 patients with PAH we analyzed functional status, laboratory results, pulmonary function and echocardiographic measures. Echocardiographic measures comprised RV chamber diameters, right atrial area, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), 2D RV strain and pericardial effusion. We used Cox regression models to assess the association with the composite endpoint of 5-year all-cause death or lung transplantation. The analyses included a conventional model using only guideline-recommended variables and a model adding significant echocardiographic measures. Based on the final multivariable model a point risk score was derived, indicating the association with the primary outcome.

Results

Median age was 65.5 years, 33.9% were females. During a median follow-up time of 4.18 years 74 patients died (n=63) or underwent lung transplantation (n=11). In univariable analyses low systolic blood pressure (Hazard ratio [HR] 0.99, 95% Confidence Interval [CI] 0.98,1.00), NYHA functional class IV (HR 3.23, 95% CI 1.48,7.07), 6-minute walk distance (HR 1.00, 95% CI 1.00,1.00), NT-proBNP concentrations (HR 1.00, 95% CI 1.00,1.00), renal impairment (HR 0.99, 95% CI 0.98,1.00), reduced diffusion capacity for carbon monoxide (HR 0.99, 95% CI 0.98,1.00), reduced TAPSE (HR 0.90, 95% CI 0.85,0.96) and reduced FAC (HR 0.97, 95% CI 0.94,1.00) were associated with the endpoint. A multivariable, conventional risk model, including NYHA functional class, 6-minute walk distance, NT-proBNP concentrations, pericardial effusion and right atrial area, resulted in a C-Index of 0.539. Adding TAPSE and FAC to this model improved the performance significantly (C-index 0.639, p-value 0.017). This model was translated to a 12-point score with the highest weighting assigned to TAPSE, FAC, pericardial effusion and 6-minute walk distance (Figure).

Conclusion

An easily applicable score integrating non-invasive, echocardiographic parameters of RV function improves prediction of adverse outcome in PAH patients.

Funding Acknowledgement

Type of funding sources: None. Risk prediction chart
Prognostic significance of polyvascular disease in patients admitted with acute decompensated heart failure: the ARIC Study Community Surveillance
Authors: Chunawala Z , Qamar A , Arora S , Pandey A , Fudim M , Vaduganathan M , Mentz R , Caughey M
Published: October 2021

Introduction

The prevalence and outcomes of polyvascular disease (PVD) in patients admitted with acute decompensated heart failure (ADHF) have not been previously reported, nor is it known whether associations differ for heart failure (HF) with reduced vs. preserved ejection fraction (HFrEF vs HFpEF, respectively).

Purpose

To investigate the relationship between atherosclerotic involvement of multiple arterial territories and mortality in patients hospitalized with ADHF.

Methods

The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of adjudicated heart failure in 4 US areas from 2005–2014, with events verified by physician review. Medical histories were abstracted from the hospital record. PVD was defined by coexisting disease in ≥2 arterial beds, identified by prevalent coronary artery disease, peripheral arterial disease, and cerebrovascular disease. Mortality hazards of PVD vs. no PVD were analyzed separately for HFpEF and HFrEF, with adjustment for age, race, sex, year of admission and geographic region. All analyses were weighted by the inverse of the sampling probability.

Results

Of 24,936 ADHF hospitalizations (52% female, 32% Black, mean age 75 years), 19% had PVD (22% among HFrEF hospitalizations, 17% among HFpEF hospitalizations), Figure 1. There was an increasing trend in 1-year mortality with 0, 1 and ≥2 arterial bed involvement, both for patients with HFrEF (29% to 32% to 38%; P-trend=0.0006) and HFpEF (26% to 32% to 37%; P-trend <0.0001). After adjustments, PVD was associated with a 20% higher hazard of 1-year mortality in patients with HFrEF (HR=1.23; 95% CI: 1.06–1.44) and a 30% higher hazard in patients with HFpEF (HR=1.33; 95% CI: 1.09–1.63), with no significant interaction by HF type (P-interaction = 0.5).

Conclusion

Patients hospitalized with ADHF and coexisting PVD have an increased risk of death, irrespective of HF type. Clinical attention should be directed toward PVD, with secondary prevention strategies enacted to improve the prognosis of this vulnerable population.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health Distributions of arterial diseaseTrends in 1-year mortality outcomes
The effect of doxycycline on abdominal aortic aneurysm growth: a meta-analysis
Authors: Patel M M
Published: October 2021

Introduction

There have been many studies on the benefits of chronic doxycycline therapy on slowing down the rate of abdominal aortic aneurysm (AAA) expansion by decreasing matrix metalloproteinase (MMPs) levels in AAA, known contributors to AAA growth. However, there have been few studies performed on the clinical effect of doxycycline on reducing the rate of AAA expansion.

Purpose

The objective of this meta-analysis was to evaluate the effect of doxycycline on the expansion of AAA.

Methods

We performed a comprehensive literature search using PubMed, Embase, and Cochrane Libraries from inception to October 2020 for all studies evaluating the effect of chronic doxycycline therapy on AAA growth. The primary outcome was the effect doxycycline therapy on AAA growth rate compared to the placebo. The mean difference and 95% confidence intervals (CI) were obtained by the Inverse Variance method within a random effect model.

Results

A total of three randomized control trials (485 total patients) were included in the final analysis. The analysis showed that there was no significant benefit of chronic doxycycline therapy in reducing AAA dilation rate compared to placebo [Mean difference of 0.03; 95% CI −0.05 to 0.11, P=0.43, I2=90%].

Conclusion

This is the first meta-analysis evaluating the effects of chronic doxycycline therapy on the growth rate of AAAs. The current data suggests that there is no significant decrease in rate of expansion of AAA diameter in patients treated with chronic doxycycline vs. placebo.

Funding Acknowledgement

Type of funding sources: None.
Hybrid vascular interventin for multilevel peripheral arterial disease
Authors: Puzdriak P D , Ivanov M A , Gusinskiy A V , Shlomin V V , Bondarenko P B , Chizhova K A , Novikova N Y U , Shvarts E Y U
Published: October 2021

Objective

To increase the effectiveness of intervention for the lower limb arteries multilevel lesion (MPAD) in patients with type C and D lesions by TASC II classification.

Materials and methods

87 hybrid vascular reconstructions (74 male and 13 female, 59% (n=52) smokers) for MPAD were performed from 2017 to 2020. The average age was 64,6±8,1y. CLI was diagnosed in 47% (n=41) by Fontaine- Pokrovsky classification. Following concomitant disease were diagnosed: stage 2–3 of CHF by HYHA classification 33% (n=29), COPD 23% (n=20), arterial hypertension stage 2–3 54% (n=47), CAD 66% (n=58), postinfarction cardiosclerosis 29% (n=26). Registered lesion of iliac-femoral segment type A/B=44 (51%) and C/D=43 (49%); registered lesion of femoro-tibial segment A/B=14 (16%), C/D=73 (84%) by TASC-II classification. Common femoral artery (CFA) bifurcation was most important to perform hybrid intervention. Through CFA with patented method (RU 2621395C) we performed remote endartherectomy from external iliac or superficial femoral arteries, that allowed us to remove a total prolonged occlusion (>15–20 cm), reducing the time and complexity of the endovascular stage. The key note is that we perform CFA plasty with using an autovenous patch with a “trunk” through which we provide endovascular stage of hybrid intervention on natural blood flow, restored after open endartherectomy. This technique allows you to change the direction of introducer in both distal and proximal direction without the need for extra punctures or temporary clamping of the arteries.

Results

Technical success rate was 98%. Local aneurysm of EIA was found in one case that restricted to provide the loop endarterectomy. The average duration of hybrid operation was 223,7±88,2 min (134,2±72,3 min for open and 89,9±52,9 for endovascular stages). Average blood loss was 225,3±130,7 ml. ICU staying duration was 20,6±2,8 hours. 30-days patency was 98,8%, 12 and 36 months primary patency was 98% and 88,5% respectively. There were no deaths within 30 days after hybrid operation. The following complications occurred: bleeding n=2 (2,3%), acute thrombosis n=1 (1,2%), surgical site infection n=1 (1,2%) but cured safely. Limb salvage in critical ischemia was in 100% of patients for 20 months.

Conclusion

Hybrid surgery of MPAD is highly effective, reduces operation trauma, improves its results and limb salvage. By reducing trauma of surgical intervention reduces admition in ICU, postoperative risks, especially in patients with severe concomitant pathology.

Funding Acknowledgement

Type of funding sources: None.
Elevated lipoprotein(a) level predicts repeated peripheral revascularization
Authors: Tmoyan N , Ezhov M , Afanasieva O , Chubykina U , Klesareva E , Tyurina A , Afanasieva M , Pokrovsky S
Published: October 2021

Background

Despite high-intensity lipid-lowering therapy, there is a residual risk of cardiovascular events that could be associated with lipoprotein(a) [Lp(a)]. Data about the role of Lp(a) in the development of significant stenosis after carotid and lower extremity artery revascularization are lacking.

Purpose

To evaluate the relationship of Lp(a) level with repeated revascularization due to restenosis or de novo stenosis after endovascular or surgery repair of carotid and lower limb arteries.

Methods

The study included 258 patients (209 men and 49 women, mean age 67 years) who underwent revascularization of carotid and/or arteries of lower extremities for symptomatic stenotic atherosclerosis. Restenosis or de novo stenosis has been assessed by ultrasonography or angiography. History and physical examination have been performed to identify atherosclerosis risk factors. Lipids, C-reactive protein, Lp(a) concentrations were measured in blood serum.

Results

During 3 years follow-up, repeated revascularization due to restenosis or de novo stenosis was registered in 111 patients. Hyperlipoproteinemia(a) [Lp(a) ≥30 mg/dL] was associated with an increased risk of repeated revascularization with hazard ratio 2.9; 95% confidence interval 2.0–4.2, p<0.01 (figure). C-reactive protein and other clinical and laboratory variables did not differ in patients with and without repeated peripheral revascularization. According to Cox regression analysis adjusted for all risk factors, hyperlipoproteinemia(a) remained an independent predictor of severe restenosis or de novo stenosis of carotid and lower extremity arteries and was associated with a threefold increased risk of repeated revascularization.

Conclusions

In a three-year prospective study of patients after peripheral revascularization, Lp(a) level ≥30 mg/dL was shown as an independent risk factor for repeated revascularization.

Funding Acknowledgement

Type of funding sources: None. Survival analysis
Intravascular lithotripsy in calcified peripheral lesions: the real-world single-center JEN-experience
Authors: Kretzschmar D , Aftanski P , Thieme M , Schulze P C , Moebius-Winkler S
Published: October 2021

Objective

Peripheral vascular disease (PVD) is a major cause of morbidity and mortality with increasing need for interventional therapies. Vascular calcification increases risk of complications and may impair the effect of antiproliferative therapy. Intravascular lithotripsy (IVL) using pulsatile sonic pressure waves to modify intimal and medial calcium is a promising approach for those patients to overcome the drawbacks of vascular calcification.

Purpose

A single-center, prospective registry of patients undergoing peripheral lithotripsy was established. Periprocedural safety events as well as short and long term follow-up clinical data were evaluated.

Methods

A prospective review of cases using IVL was performed for the period from December 2018 to January 2021 at our center. Angiographic images were quantified by using the QVA 8.0 module, Medis Suite Version 3.2.60.4 developed by Medis Imaging Systems.

Results

61 cases of IVL were performed in 51 patients with Rutherford class 3. Mean age was 71 years with 78% (28) of the patients being men. Diabetes was present in 80% and renal insufficiency in 47% of the cases. The median calcified lesion length treated was 82 mm (10; 390 mm) with a PACCS sore of 3 (1; 3), indicating a highly calcified status. In 41% (n=25), predilation was necessary. We treated 8 iliac-, 19 common femoral-, 52 superficial femoral-, 5 deep femoral-, 29 popliteal- and 2 crural- lesions with balloon sizes ranging from 4.0 to 7.0 mm. In 35 (57%) cases IVL was used as a stand-alone therapy, in the remaining 26 an adjunctive therapy (DCB and/or stent) was used. We were able to reach an acute luminal gain of 2.5 mm. A ballon rupture occurred in 6 (10%) cases. There were no other complications. Mean ABI improved from 0.6 to 0.8 (p<0.0001) immediate after the intervention. Follow-up after 6 months again demonstrated an improved ABI of 0.8 (p<0.0001 vs. baseline).

Conclusion

This first real-world data of IVL reports compelling safety of IVL in a complex, difficult-to-treat patient cohort. For the first time, clinical follow-up data were presented and demonstrated a sustained improved ABI after 6 months. This innovative approach will gain more interest in the future, especially since long term effects of paclitaxel eluting devices are controversially discussed.

Funding Acknowledgement

Type of funding sources: None. ABI initial follow-up
Temporal course of vascular response after fluoropolymer paclitaxel-eluting stent implantation for femoropopliteal artery lesions
Authors: Tomoi Y , Kuramitsu S , Hiramori S , Soga Y , Ando K
Published: October 2021

Background

Limited data is available regarding the vascular response after fluoropolymer paclitaxel-eluting stent (FP-PES) implantation. We sought to assess the vascular response at 6- and 12-month after FP-PES implantation for femoropopliteal artery lesions using serial optical coherence tomography (OCT) examination.

Methods and results

From the IMPERIAL trial, this study evaluated 10 de novo femoropopliteal lesions treated with FP-PES. The primary study endpoint was neointimal tissue coverage at 6- and 12-month follow-up as assessed by serial OCT examination. The incidence of peri-strut low-intensity area (PLIA) and extra-stent lumen (ESL) was also assessed. A total of 203 matched cross-sectional images were evaluated at 6- and 12-month (5,615 and 5,763 struts, respectively). From 6 to 12 months, the mean neointimal thickness tended to increase from 198 μm to 233 μm with a significant reduction in the incidence of malapposed struts (0.59% vs. 0.28%, p=0.039). Conversely, uncovered struts and PLIA were more frequently observed at 12 months (4.4% vs. 7.8%, p=0.01; 12.7% vs. 21.0%, p<0.001, respectively). The ESL area significantly increased over time without any difference in its incidence (0.24±0.32 mm2 vs. 0.38±0.36 mm2, p=0.009).

Conclusions

Neointimal proliferation was markedly inhibited from 6 to 12 months after FP-PES implantation, whereas the incidence of uncovered struts and PLIA significantly increased over time with the enlargement of ESL.

Funding Acknowledgement

Type of funding sources: None.
Quantitative flow ratio for the functional assessment of extracranial internal carotid artery stenosis
Authors: Franzese M , Di Serafino L , Stabile E , Giugliano G , Leone A , Ilardi F , Strisciuglio T , Esposito G
Published: October 2021

Background

In asymptomatic patients at high surgical risk presenting with significant extracranial internal carotid artery stenoses, a selective invasive angiography is performed before carotid artery stenting (CAS). Sometimes, the angiographic findings of the stenosis could be discordant from those observed at the non-invasive imaging evaluation and the use of a pressure-wire to evaluate the hemodynamic potential of the stenosis, might be dangerous for the higher risk of cerebrovascular events.

Purpose

The Quantitative Flow Ratio (QFR), by estimating the contrast flow velocity and based on a 3-dimensional quantitative angiography, might be of value as an online angiography-based functional assessment of internal carotid stenoses, in order to guide the physicians in the decision-making process to proceed or not to revascularization.

Methods

We prospectively enrolled 14 asymptomatic patients with an indication for invasive treatment of internal carotid artery stenosis. The echo-colour-Doppler was performed in 28 vessels and the Peak Systolic Velocity (PSV, cm/sec) was used to identify functionally significant stenoses (PSV >120cm/sec). At the angiography, internal carotid artery stenosis degree was obtained according to NASCET criteria (%DSNASCET) and the lesion considered angiographically significant if >60%. After the exclusion of 4 vessels, QFR, Area Stenosis (AS, %) and Minimal Lumen Area (MLA, mm2) were obtained in the remaining 24 vessels (Figure 1, Panel A and B).

Results

At the linear regression analysis, QFR values significantly correlated with PSV (r2=0.71, p<0.001) as well as with %DSNASCET (r2=0.81, p<0.001). In addition, using the PSV as reference, QFR showed good accuracy to predict the presence of a functionally significant stenosis (AUC=1.00, p<0.001) with a cut-off value of 0.90. Similarly, the MLA significantly correlated with both the PSV and %DSNASCET (respectively, r2=0.61 and r2=0.60, p<0.001) as well as the AS (respectively, r2=0.68 and r2=0.87, p<0.001) (Figure 2).

Conclusion

This study suggests the possibility to adopt QFR for the functional assessment of extracranial internal carotid artery stenoses and should be considered as hypothesis generating to design a larger validation trial.

Funding Acknowledgement

Type of funding sources: None.
Comparison of outcomes between imaging guided versus angiography guided percutaneous coronary intervention in patients with acute coronary syndrome: insights from the national inpatient sample
Authors: Akuna E A , Asemota I A , Elbermawy M E , Almani U A , Soon-Shiong R S , Kang C K , Bharosa B S , Usman M U , Li L L , Vij A V
Published: October 2021

Objective

Coronary intravascular imaging allows visualization and characterization of vessel wall. Percutaneous coronary intervention (PCI) using intravascular ultrasound or optical coherence tomography has optimized stent deployment techniques, reduced periprocedural outcomes and reduced long-term major cardiovascular events. We sought to investigate the outcomes of imaging guided to conventional angiography guided PCI with reference to in-hospital mortality, hospital length of stay (LOS) and total hospital charge.

Methods

We performed a retrospective cohort study using data from the 2016–2017 Nationwide Inpatient Sample (NIS) which is the largest collection of inpatient hospitalization data in the United States. Patients admitted with a principal diagnosis of acute coronary syndrome (ACS) who underwent PCI with and without intravascular imaging was determined using the International Classification of Diseases, Tenth revision codes. The primary outcome was inpatient mortality while secondary outcomes are showed in table 1. STATA software was used for the analysis. Multivariate logistic and linear regression models were used to adjust for confounders.

Results

There were over 71 million hospital discharges in the combined 2016 and 2017 NIS database. Admission for ACS in adult patients (aged ≥18 years) who underwent PCI yielded 622,855 results. Among this group, 27, 520 (4.4%) had imaging guided PCI while 595,335 (95.6%) had PCI without imaging.

Patients with imaging guided PCI had lower inpatient mortality (3.2% vs 2.3%, AOR: 0.74, 95% CI 0.60–0.90, p=0.004) compared to PCI with angiographic data alone. Imaging guided PCI had an adjusted increased mean LOS of 0.16 days (3.8 vs 3.7 days, CI: 006–0.26, p=0.002) with an adjusted increased mean total hospital charge of $13, 206 ($120,203 vs $104,916, p= <0.0001).

Conclusion

Patients hospitalized for ACS who had imaging guided PCI had reduced inpatient hospital mortality compared to those who had PCI without imaging guidance. Overall utilization of imaging was less than 5% in 2016–2017, however it is expected to be higher in recent years with improvements in clinical practice, training and available scientific evidence.

Funding Acknowledgement

Type of funding sources: None.
Impact of wire sensor location on coronary physiological measurement
Authors: Lotfi A L , Haider A H , Pervaiz A P , Kadado A J K , Bachman M B , Rodriguez Arciniega J R A , Visintainer P V
Published: October 2021

Background

The location of the wire sensor to measure FFR and dPR has not been systemically studied. Therefore, we hypothesize that the coronary physiological measurements will vary with the location of the sensor. This exploratory study is to assess whole cycle pressure distal/pressure aorta (Pd/Pa) ratio, FFR, and dPR at different sensor position within the vessel to evaluate the impact of pressure drop and measurements based on sensor position.

Methods

54 patients who had an indication for coronary angiography were screened and 30 consecutive patients were enrolled. The OptoWire 2 or 3 generation fiberoptic pressure wire was used to assess Pd/Pa, dPR, and FFR. Our primary goal is to test if those measurements vary with the FFR wire sensor placed at 10mm (proximal), 35–45mm (mid), and greater than or equal 60–70mm (distal) distal to the target lesion respectively. We used a multilevel linear regression approach.

Results

Of 30 patients enrolled, 23 (76.6%) were males, mean age was 64.7 years (± 11.0 yrs), and mean stenosis was 61.6% (±13.4%). Adjusting for age, gender, and severity of stenosis, results showed that for all three measures (Pd/Pa, DPR, and FFR) (Figure 1), pressure decreased in a linear fashion the further the sensor was from the target lesion (p values <0.001). Further, pairwise comparisons of the measurements at adjacent locations similarly showed significant declines in pressure (p values <0.001).

Conclusions

This is first study to demonstrate that the location of the pressure wire can impact the results of both resting and hyperemic pressures which can cause a false negative result. This is especially important where the values are near the cut-off.

Funding Acknowledgement

Type of funding sources: None.
Intracoronary pharmacological therapy versus aspiration thrombectomy in patients presenting with ST-segment elevation myocardial infarction (IPAT-STEMI): a systematic review and meta-analysis
Authors: Kaddoura R , Mohamed Ibrahim M I , Al-Badriyeh D , Omar A , Al-Kindi F , Arabi A
Published: October 2021

Background

Large thrombus load remains a challenge in the interventional cardiology practice. It precludes direct stent implementation and aggravates coronary obstruction leading to impaired myocardial perfusion, worsened cardiac function, and adverse clinical outcomes. Thus, various strategies have been advocated such as aspiration thrombectomy (AT), and/or localized or intracoronary (IC) treatment with thrombolytic agents and/or glycoprotein IIb/IIIa inhibitors (GPI).

Purpose

To evaluate the effectiveness of IC-administered pharmacological agents alone or combined with AT compared with AT alone as an adjunct to percutaneous coronary intervention (PCI) in STEMI patients with large thrombus burden.

Methods

The method was conducted according to the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A systematic search strategy using MEDLINE, EMBASE, CENTRALE, Scopus, ProQuest Public Health, Web of Science databases was performed on February 22, 2020 and updated on February 13, 2021. Eligible trials were randomized controlled trials (RCT) comparing IC-administered thrombolytic agents and/or GPI with or without AT to AT alone in patients presenting with STEMI who underwent PCI. The primary outcomes included coronary reperfusion indices e.g., thrombolysis in myocardial infarction (TIMI) flow grade 3 (G3), TIMI myocardial perfusion grade (TMPG) 3, Myocardial blush grade (MBG) 2/3, ST-segment resolution (STR). Others included clinical outcomes e.g., major adverse cardiovascular events (MACE).

Results

Twelve RCT enrolled 1,466 patients were included in the final analysis. The trials were categorized into 3 groups: (1) Thrombolytics [4 RCT], (2) GPI [3 RCT], and (3) GPI+AT [7 RCT]. Groups 2 and 3 included two mutual studies with multiple arms. In comparison with AT alone, thrombolytic therapy, as presented in four RCT, significantly improved TIMI flow G3 (OR = 3.71, 95% CI: 1.85–7.45; P overall effect = 0.0002; heterogeneity = 0%), complete STR (OR = 3.64, 95% CI: 1.60–8.26; P overall effect = 0.002; heterogeneity = 34%) and MACE (OR = 0.47, 95% CI: 0.22–0.99; P overall effect = 0.05; heterogeneity = 46%), but not TMPG 3. Pooling the data of the two studies with similar intervention i.e., thrombolytics + AT further refined the results with statistical improvement of TMPG 3 as well (OR = 5.44, 95% CI: 2.61- 11.34; P overall effect <0.ehab724.211201; heterogeneity = 0%) (Fig. 1). Pooled results for GPI and GPI+AT groups did not show statistical improvement in TIMI flow G3, MBG 2/3, nor complete STR (Fig. 2).

Conclusion

The findings of this meta-analysis showed that IC-administered thrombolytic agents improved myocardial reperfusion and MACE compared with AT alone in STEMI patients undergoing PCI.

Funding Acknowledgement

Type of funding sources: None.
CHA2DS2 -VASc score as a predictor for contrast-induced nephropathy in patients with acute coronary syndrome undergoing percutaneous coronary intervention
Authors: Hamdy Elkholy M O N , Shehata H , Abu Arab T
Published: October 2021

Background

Contrast induced nephropathy (CIN) is one of the most important complications of PCI, resulting in increased medical resources, longer hospital stay and higher mortality so it is important to detect early high risk patients for CIN and provide them with preventive measures. In recent years, several studies have demonstrated an association of CHA2DS2-VASc score with cardiovascular prognosis and adverse outcomes in different populations including heart failure, SCAD and ACS beyond the original AF field. The predictive value of the CHA2DS2-VASc score on CIN still remains unclear although all of the components of the CHA2DS2-VASc score are important risk factors for CIN. For this reason, the present study was designed to evaluate the predictive value of preprocedural CHA2DS2-VASc score on the development of CIN in patients with ACS who underwent PCI.

Objective

To assess the predictive value of the CHA2DS2-VASc Score for contrast induced nephropathy among acute coronary syndrome patients who underwent percutaneous coronary intervention.

Material and methods

This study is a prospective study conducted over 300 patients with myocardial infarction underwent primary coronary intervention. It took place from February 2020 till September 2020. We analyzed patient's demographic data, clinical data, laboratory data, angiographic data and CHADSVASC score and followed up patients daily for 72 hour after PCI for development of CIN then compared these data in CIN versus non CIN patients trying to find out which of these factors can predict occurrence of CIN and find CHADSVASC score cutoff value for prediction of CIN.

Results

CIN was developed in 89 patients. A significant relationship existed between CIN and female gender, DM, HTN, door to needle time, killip class above one, contrast volume (p<0.000), previous intervention using contrast (p<0.001), anemia (p<0.014), duration of procedure (p<0.074) and number of coronary vessels affected (p<0.031). However, non-significant relationship existed between CIN and Stroke, TIA, previous thromboembolism (p<0.446), ejection fraction (p<0.155), culprit vessel (p<0.317), TIMI grade (p<0.278) and antiplatelet type (p<0.934). Receiver operating characteristic curve analysis showed good predictive value of CHA2DS2-VASc score for CIN (area under the curve 0.801, sensitivity 69.66% and specificity 80.75%). Patients with a CHA2DS2-VASc score cutoff value ≥4 had a higher liability for CIN (p<0.000).

Conclusion

CHA2DS2-VASc score is a simple bedside risk score for preprocedure CIN risk stratification among ACS patients who underwent primary PCI.

Funding Acknowledgement

Type of funding sources: None.
Identifying predictive risk factors for permanent pacemaker implantation up to 30 days post-TAVI
Authors: Li J , Christodoulidou A , Cranley J , Ara F , Costopoulos C.H.A.R.I.S , Costanzo P , Osullivan M , Davies W , Densem C , Martin C A
Published: October 2021

Background

Conduction system abnormalities, including AV block, are amongst the most common complications of transcatheter aortic valve implantation (TAVI). Post-TAVI high degree AV block necessitates permanent pacemaker (PPM) implantation.

Purpose

To assess the ability of standardly available pre-, intra- and post-TAVI factors to predict PPM implantation within 30-days post procedure.

Methods

Demographic and clinical (pre-, intra-, and post-procedural) data including ECG parameters were collected from all patients who underwent TAVI at our centre from August 2017 to November 2020. Patients with pre-existing PPM were excluded from the study. Predictive factors were selected through univariate analysis, and selected characteristics were incorporated into a multivariate binomial logistic regression model, in order to create a 30-day PPM risk-prediction model. The Akaike information criterion (AIC) and area under receiver operating curve (AUC/C-statistic) were used to assess discriminative performance.

Results

In total, data from a total of 446 patients were analysed. Of these, 40 (8.97%) received PPM implantation within 30 days of the procedure. The mean age of the patients was 81.5 (±7.3 SD) years; 99 (22.2%) had pre-existing first degree AV block, 55 (12.3%) had pre-existing left bundle branch block (LBBB) and 50 (11.2%) had pre-existing right bundle branch block (RBBB). Intra-procedurally 40 (9.0%) developed LBBB, 21 (4.7%) developed 3rd degree AV block, and 95 (21.3%) patients required temporary pacing wire (TPW) pacing. Post-procedurally, 138 (30.9%) exhibited AV block, 107 (24.0%) LBBB and 50 (11.2%) RBBB.

The following factors met significance at multivariate logistic regression analysis: pre-TAVI RBBB (OR 6.62 [95% CI, 1.37–36.51]), intra-TAVI 3rd degree AV block (OR 12.80 [95% CI, 3.44–53.34]), intra-TAVI LBBB (OR 4.02 [95% CI, 1.28–12.53]), use of TPW pacing (OR 8.58 [95% CI, 3.19–25.12]) and post-TAVI LBBB (OR 7.84 [95% CI, 2.75–24.46]) (Table).

Finally, variables were incorporated into a multivariate logistic regression model with the outcome variable of 30-day PPM implantation (Figure 1a). A model incorporating five factors (pre-TAVI RBBB, intra-TAVI 3rd degree AV block, intra-TAVI LBBB, use of TPW pacing and post-TAVI LBBB) demonstrated excellent discriminative ability (accuracy 0.925 and an AUC of 0.952) at predicting PPM implantation (Figure 1b).

Conclusions

Following variable selection, the best performing model incorporated five factors including pre-TAVI RBBB, intra-TAVI AV block (3rd degree), intra-TAVI LBBB, use of TPW pacing and post-TAVI LBBB. We aim to validate this model using an external cohort.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1
Long-term survival benefit of SAVR over TAVR in low-risk elective patients
Authors: Kowalowka A , Kowalewski M , Wanha W , Kolodziejczak M , Mariani S , Li T , Stefaniak S , Los A , Hudziak D , Gocol R , Suwalski P , Rogowski J , Jemielity M , Wojakowski W , Deja M
Published: October 2021

Background

Aortic valve (AV) stenosis can be treated either by surgical AV replacement (SAVR) or since 2002 by transcatheter aortic valve implantation (TAVI). Due to lower invasiveness, TAVI is a preferred approach in high- and prohibitive risk surgical candidates, yet outcome data is conflicting when lower risk patients are considered and in particular at long-term.

Purpose

Our study evaluates long-term survival in elective low-risk patients after AV replacement with severe AV stenosis.

Methods

We conducted a registry data analyses of patients scheduled for elective isolated AV with AV stenosis between 2015 and 2019 and underwent TAVI or SAVR. Urgent, emergent and salvage procedures were excluded. In TAVI group only transfemoral access was considered. Propensity score matching to determine SAVR controls for TAVI group in 1:3 ratio with caliper 0.2 of standardized deviation (figure 1).

Results

Study group included 2393 elective AVR patients 1765 was in SAVR group and 628 in TAVI group. Median follow-up was 2.72 years ([IQR: 1.32–4.08], max 6.0). Propensity matching with replacement returned 329 TAVI cases and 593 SAVR controls with median age 76 (Interquartile range [IQR:71–73]) and EuroScore II 1.81 [IQR:1.36–2.53]). 30-day mortality was 11/329 (3.32%) vs 18/593 (3.03%) in the TAVI vs SAVR respectively (RR 1.10 [0.52–2.37]; p=0.801). At two years, there was no difference between SAVR and TAVI in terms of mortality (HR 1.23 [0.83–1.83] P=0.309). At 6 years, overall survival analysis favored SAVR which was associated with 30% lower mortality (HR 0.70 [0.496–0.997]; p=0.048, see figure 2).

Conclusions

TAVI as compared to SAVR is equally safe in elective low-risk patients up to 2 years post-op. After that time survival is better in surgically managed patients. Extended observations from randomized trials in low-risk patients are warranted to draw definite conclusions regarding long-term safety of TAVI in this population.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The work was supported by the research non-commercial grant from Medical University of Silesia Figure 1Figure 2
Clinical outcomes following isolated transcatheter tricuspid valve repair: a meta-analysis and meta-regression study
Authors: Bocchino P P , Angelini F , Vairo A , Andreis A , Fortuni F , Franchin L , Frea S , Raineri C , Pidello S , Conrotto F , Montefusco A , Alunni G , De Ferrari G M
Published: October 2021

Background

Significant tricuspid regurgitation (TR) is a common valvular heart disease worldwide.

Purpose

We aimed to assess the pooled clinical and echocardiographic outcomes of different isolated transcatheter tricuspid valve repair (ITTVR) strategies for significant (≥ moderate) TR.

Methods

We systematically searched the literature for studies evaluating the efficacy and safety of ITTVR for significant TR in adult. The primary outcomes were the improvement of New York Heart Association (NYHA) functional class and 6-minutes walking distance (6MWD) and the presence of severe or greater TR at the last available follow-up of each individual study. Random-effect meta-analysis was performed comparing outcomes before and after ITTVR.

Results

14 studies with 771 patients were included. Mean age was 77±8 years and mean EuroScore II was 6.8%±5.4%. At a weighted mean follow-up of 212 days, 209 (35%) patients had a NYHA III to IV functional class compared to 586 (84%) patients at baseline (risk ratio: 0.23, 95% CI 0.13 to 0.40, P-value<0.001). 6MWD significantly improved from 237±113 meters to 294±105 meters (mean difference: +50 meters, 95% CI +34 to +66 meters, P-value<0.001). 147 (24%) patients showed severe or greater TR after ITTVR compared to 616 (96%) at baseline (risk ratio: 0.29, 95% CI 0.20 to 0.42, P-value<0.001).

Conclusion

Patients undergoing ITTVR for significant TR experienced a significant improvement in NYHA functional status and 6MWD and a significant reduction in TR severity at mid-term follow-up.

Funding Acknowledgement

Type of funding sources: None.