bluuebunny/crossref_metadata_2025 huggingface dataset:
P5749Haemodynamical effects o fleft ventricular assistance during high-risk percutaneous coronary interventions with a pneumatic left ventricular assist device
Authors: Bastos M B , Schreuder J J , Daemen J , Den Uil C A , Van Mieghem N M
Published: October 2019

Background

Referral for high-risk percutaneous coronary intervention (PCI) is a progressively growing trend. Percutaneous Mechanical Circulatory Support (MCS), may protect the myocardium and reduce the risk of major adverse events. Clinical data on Left Ventricular (LV) unloading by pneumatically driven Percutaneous Left Ventricular Assist Devices (pVAD's) is currently scarce.

Purpose

Describe the unloading pattern produced by a pneumatically driven pulsatile pVAD on LV haemodynamics through real-time Pressure-volume (PV) analysis with a conductance catheter positioned in the left ventricle.

Methods

19 patients undergoing high-risk PCI treated with MCS were monitored with PV loops and pulmonary artery catheterization throughout the intervention.

Results

When activated on 1:1 assist ratio, the mean output produced by the pVAD was 1.36±0.13L/min. Compared to pre-implantation, 1:1 support produced a significant reduction in End-systolic Wall Stress (ΔWSes: −11.95%, p<0.01) and PV area (ΔPVA: −16.67%, p<0.01). Contractility did not significantly change (ΔV100: +29.48%, p=0.073; End-systolic Elastance, ΔEes: 1.24%, p=0.86). Effective Arterial Elastance (Ea), representing afterload, decreased (ΔEa: −12.05%, p<0.05). Total Arterial Compliance (ΔTAC: +31.59, p<0.01) increased and Ventricular-arterial Coupling (ΔEa/Ees: −9.79%, p=0.06) non-significantly improved. Mean arterial pressure non-significantly decreased (ΔMAP: −6.66%, p=0.06) and global Cardiac Output remained stable (ΔCO: −0.06%, p=0.37). When the pVAD was removed after the PCI these changes were reversed (Figure 1).

Image 1

Conclusion

High-risk PCI with pneumatic MCS may result in LV unloading and reduced myocardial oxygen consumption. Further insights will be released in the PULSE trial (Clinicaltrials.gov NCT03200990).
P5982Transcatheter aortic valve replacement in elderly patients with severe symptomatic aortic stenosis
Authors: Antunez Muinos P J , Alvarez Rodrigez L , Lopez Pais J , Lopez Otero D , Sanmartin Pena X , Cid Menendez A , Gonzalez Ferreiro R , Trillo Nouche R , Cid Alvarez B , Gonzalez Juanatey J R
Published: October 2019

Introduction

TAVR has proven to be a safe technique for high-risk patients. The objective of our work is to know the results of TAVR in patients older than 90 years; which are the riskiest and had more complications during the admission.

Methods

Observational retrospective analysis based on all a single-center registry of all consecutive TAVR (N=518) during the last 10 years (2008–2018). Patients older than 90 years old represent 5.8 of the procedures (N=30). We performed a descriptive analysis of the baseline characteristics of our patient cohort, and the development of events during follow-up.

Results

Our population, as reflected in TABLE 1, had a median age of 91,32 years old, and the majority were women (57.58%). The procedures were mostly elective, unless in 4 patients (12.12%) that were urgent. None valvuloplasty was done before TAVR in this cohort, neither Valve-in-valve. Stratification scores had a wide range, from 1.45 to 28.8% for EurSCORE II and from 4.19 to 17.19% for STS, with a median of 5.53 and 8.49% respectively.

Mortality in the first 30 days and in the first year was 0.00%. Mortality after the first year was 71.40% due to non-cardiovascular events (median time of follow-up of 34.34 months).

Finally, we would also like to remark that the incidence of heart failure during the first year was 14.29%, taking into account all the follow-up, the incidence was 37.04%. Despite these data, in our registry, the need for pacemaker after the valve implantation was higher than in younger populations (40.62%), probably due to the age-related fibrosis of the cardiac conduction system.

Conclusions

TAVR is a very safe procedure with very successful results in elderly patients, nevertheless, due to the frailty of this population, individualization is mandatory in order to optimize the resources.

Acknowledgement/Funding

None
P6009Poor outcomes in pulmonary arterial hypertension as a member of RNF213-associated vascular diseases
Authors: Hiraide T , Kataoka M , Suzuki H , Aimi Y , Chiba T , Isobe S , Katsumata Y , Goto S , Kanekura K , Satoh T , Sano M , Gamou S , Kosaki K , Fukuda K
Published: October 2019

Background

A variant of c.14429G>A (p.Arg4810Lys, rs112735431) in the ring finger protein 213 gene (RNF213; NM_001256071.2) has been recently identified as a risk allele for pulmonary arterial hypertension (PAH), suggesting that PAH can be added as a new member of RNF213-associated vascular diseases including Moyamoya disease and peripheral pulmonary stenosis.

Purpose

Our aim was to identify the clinical features and outcomes of PAH patients with RNF213 p.Arg4810Lys variant.

Methods

Whole-exome sequencing was performed in 139 idiopathic (or possibly heritable) PAH patients. Hemodynamics and prognosis were evaluated in the patients with RNF213 p.Arg4810Lys variant and the patients with bone morphogenic protein receptor type 2 (BMPR2) mutations.

Results

The RNF213 p.Arg4810Lys variant was identified in a heterozygous state in 11 patients (7.9%). Time-course changes in hemodynamics after combination therapy in the patients with the RNF213 p.Arg4810Lys variant were significantly poorer compared with those in BMPR2 mutation carriers (n=36) (comparison of changes in mean pulmonary arterial pressure, P=0.007). The event-free rate of death or lung transplantation was significantly poorer in RNF213 p.Arg4810Lys variant carriers than in BMPR2 mutation carriers (5-year event-free rate since the introduction of prostaglandin I2 infusion, 0% vs. 93%, P<0.001) (Figure).

Time to death or lung transplantation

Conclusions

PAH patients with the RNF213 p.Arg4810Lys variant were associated with a poor reactivity to vasodilator drugs and poor clinical outcomes even in the recent era. Earlier consideration of lung transplantation might be required for RNF213 p.Arg4810Lys variant carriers developing PAH. Documentation of the RNF213 p.Arg4810Lys variant, as well as already known pathogenic genes, can provide clinically relevant information for therapeutic strategies, leading to a personalized approach for the treatment of PAH.
P6013Evidence for ANTXR2 as a therapeutic target on systemic-to-pulmonary shunt induced pulmonary arterial hypertension
Authors: Liu X Y , Meng L K , Yuan W , Zheng M L , Chi H J , Yang X C , Li J , Zhong J C
Published: October 2019

Introduction

Pulmonary arterial hypertension secondary to congenital heart disease (CHD-PAH) with systemic-to-pulmonary shunt is characterized by proliferative vascular remodeling. Excessive proliferation and resistance to apoptosis of pulmonary artery smooth muscle cells (PASMCs) are the primary cellular bases of vascular remodeling. Anthrax toxin receptor 2 (ANTXR2) exhibits anti-proliferative properties. The effects of ANTXR2 on vascular remodeling and systemic-to-pulmonary shunt induced PAH remain unexplored.

Purpose

The purpose of this study was to determine the possible roles of ANTXR2 in the pathogenesis of systemic-to-pulmonary shunt induced PAH and explore its possible mechanisms.

Methods

Lung tissue sections from CHD-PAH patients, systemic-to-pulmonary shunt induced PAH rat model, ANTXR2−/− rats, and PASMCs were used. Immunohistochemistry, real time polymerase chain reaction, Western blot, proliferation, apoptosis, and next generation sequencing (NGS) were performed in this study.

Results

ANTXR2 expression was reduced in severe CHD-PAH patient lung tissue and pulmonary arterioles, as well as in lung tissues from rats with systemic-to-pulmonary shunt induced PAH. Over-expression of ANTXR2 in cultured PASMCs inhibited cell proliferation and promoted apoptosis, while knockdown of ANTXR2 promoted cell proliferation and inhibited apoptosis. Male ANTXR2−/− rats showed more severe percent medial thickness and muscularization of pulmonary arterioles than wild type (WT) rats in basal conditions, and exhibited heavier PAH following exposure to systemic-to-pulmonary shunt. To further determine the underling mechanism, NGS was performed in ANTXR2−/− rat lungs and that of WT littermates. A total of 1319 genes were found to be dysregulated, and biological processes influenced by these differentially expressed genes include negative regulation of blood vessel diameter,vasoconstriction, regulation of blood vessel diameter, regulation of blood vessel size, vascular process in circulatory system, etc.

Conclusion

Our work identifies a novel role for ANTXR2 in systemic-to-pulmonary shunt induced PAH based on the findings that ANTXR2 deficiency could exacerbate systemic-to- pulmonary shunt induced vascular remodeling in the development of PAH. ANTXR2 may be a potential target for CHD-PAH treatment.

Acknowledgement/Funding

Beijing Natural Science Foundation (7172078 and 7172182), the National Major Research Plan Training Program of China (91849111)
P6146Atmospheric front patterns and acute cardiovascular diseases, a new perspective in the cardiovascular threat of global climate change
Authors: Boussoussou N , Boussoussou M , Rakovics M , Entz L , Nemes A
Published: October 2019

Background

There is substantial evidence that the health threat of global climate change is real and it could be a medical emergency. The impact of climate change on health is mediated through atmospheric parameters which are direct environmental stressors on the human body and have a potential cardiovascular (CV) morbidity and mortality effect. Acute cardiovascular diseases (ACVDs) are already major public health issues and in the future unfavourable atmospheric situations, such as increasingly volatile fronts and their negative effects can further increase this problem. Despite evidence about the importance of different atmospheric parameters on health outcomes, there have been few results for atmospheric front patterns' CV effects. Weather fronts are the most complex atmospheric phenomena therefore these atmospheric parameters might have the greatest influence on ACVDs.

Purpose

We aimed to explore the effects of atmospheric front patterns on ACVDs.

Methods

A time series Poisson-regression analysis was used to analyse 6499 ACVD hospital admissions, during a five-year period (2009–2013), in light of front patterns. Covariates were three-day (target day and the two previous days) front sequence patterns comprised of the five major front types (no front, warm front, occluded front, cold front, stationary front). Relative risk (RR) estimates for front effects were adjusted for seasonality. The relationship on all ACVDs combined and separately on patient groups by major CV risk factors (hypertension, hyperlipidaemia, diabetes, previous CV diseases) was examined.

Results

We found that in general, front patterns containing warm front days had a detrimental effect. A warm front, when followed by two days with no fronts present, increased RR by 46% (CI: 4–89%, p=0,015). Cold fronts however were protective. A no front – cold front – occluded front pattern corresponded to a 28% (CI: 8–49%, p=0,037) decrease in RR, with this pattern being present in 1.1% of all days of the study period. Out of the group specific results an occluded front, following days with no fronts present, showed to have the largest effect on hyperlipidaemic patients, increasing RR by 144% (CI: 51–295%, p<0.001).

Conclusions

This work provides both independent evidence of front patterns' CV effects and a novel tool to investigate and help the understanding of complex associations between atmospheric fronts and ACVDs. The importance of our findings is growing in the context that extreme atmospheric conditions and changes are likely to become more common in the future as a result of climate change. Medical meteorology may open up a new horizon and become an important field of preventive cardiology in the future. In conclusion, a better understanding of atmospheric front effects is of particular importance in order to help identify possible targets for future prevention strategies.
P6154Association between n-3 and n-6 polyunsaturated fatty acids and plaque vulnerability by optical coherence tomography in acute myocardial infarction patients
Authors: Kanehama N , Kimura S , Kawakami T , Tateishi R , Tachibana S , Hayasaka K , Arai H , Hiroki J , Yoshioka K , Kuroda S , Ueshima D , Iwatsuka R , Hayashi T , Mizukami A , Matsumura A
Published: October 2019

Background

The values of n-3 and n-6 polyunsaturated fatty acids (PUFAs) like low eicosapentaenoic acid (EPA) /arachidonic acid (AA) ratio are known to be associated with cardiovascular events, however their relationship with coronary plaque vulnerability in acute myocardial infarction (AMI) is not revealed.

Purpose

We evaluated the relationship between n-3 and n-6 PUFAs and coronary plaque vulnerability assessed by optical coherence tomography (OCT) in AMI patients.

Methods

We investigated 79 AMI lesions (51 ST elevated myocardial infarction (STEMI) lesions and 28 non-STEMI lesions) that had undergone emergency percutaneous coronary intervention using OCT. Coronary plaque characteristics by OCT were compared with n-3 and n-6 PUFAs values which were measured on admission.

Results

Of all AMI lesions (n=79), 43 thin-cap fibroatheroma (TCFA) and 35 plaque rapture (PR) were detected by OCT. Lesions with TCFA had no significant relationship with n-3 and n-6 PUFAs values, whereas lesion with PR had significantly lower EPA values than those without (55.8±29.5 vs 74.3±37.1 μg/ml, p=0.018). Median low-density lipoprotein (LDL) cholesterol value was 117 (98–137) mg/dl and sub-analysis in patients who had lower LDL cholesterol values than median (n=39) revealed that EPA values were significantly lower in lesions with TCFA (56.3±30.9 vs 85.3±47.7 μg/ml, p=0.03). In STEMI patients, the values of EPA and EPA/AA ratio were significantly lower in lesions with TCFA (EPA: 55.5±22.8 vs 80.8±46.1 μg/ml, p=0.01; EPA/AA ratio: 0.34±0.16 vs 0.50±0.36, p=0.03). STEMI patients who had lower LDL cholesterol values <114 mg/dl of median (n=26), the values of EPA, EPA/AA ratio, and EPA+ docosahexaenoic acid (DHA) /AA ratio were significantly lower in lesions with TCFA (EPA: 51.4±20.7 vs 93.1±53.0 μg/ml, p=0.01; EPA/AA ratio: 0.37±0.16 vs 0.67±0.41, p=0.01; EPA+DHA/AA ratio: 1.13±0.41 vs 1.63±0.76, p=0.04). In STEMI patients with lower LDL cholesterol values, EPA/AA ratio positively correlated with fibrous cap thickness (Spearman, ρ=0.35, p=0.08). The cutoff value of EPA/AA ratio predicting the existence of TCFA was 0.52 (area under the curve 0.78, sensitivity 93.8%, specificity 70.0%, p=0.02).

Conclusion

This study demonstrated that n-3 and n-6 PUFAs values were associated with coronary plaque vulnerability by OCT in AMI patients, especially in STEMI. These results suggest that n-3 and n-6 PUFAs may be residual risk markers of severe acute cardiovascular events in patients with low LDL cholesterol values.
P6159The efficacy of heart rate reduction with bisoprolol transdermal patch prior to coronary computed tomography angiography
Authors: Misawa T , Utsugi Y , Matoba T , Koura K , Nakashima E , Onishi K , Ishimaru G , Okada H , Toshida N , Inagaki H
Published: October 2019

Background

Oral or intravenous beta-blockers have commonly been used to control the heart rate (HR) prior to coronary computed tomography angiography (CCTA). However, the administration after arrival at the hospital was time-consuming, and could not achieve the target heart rate in several cases. Moreover, the efficacy of transdermal beta blockers in HR control for patients who underwent CCTA have not been fully reported.

Purpose

The purpose of this study was to clarify the usefulness of the bisoprolol patch prior to the arrival at the hospital in HR control for patients who underwent CCTA.

Methods

A total of 282 consecutive patients (160 male, age 64±12 years) who underwent CCTA were included in this study. The bisoprolol transdermal patch (8mg) was administered before arrival at the hospital in 191 patients (beta group), and no additional medication was administered in 91 patients (control group). Intravenous landiolol hydrochloride was administered when HR remained over 65 bpm on arrival at the hospital. The HR on arrival, during and after CCTA was evaluated.

Results

The baseline HR was significantly higher in the beta group (80±15 vs. 72±15, P<0.0001). However, the achievement rate of HR ≤65 bpm on arrival was significantly higher in the beta group (56.5% vs. 44.0%, P=0.047). Thus, additional treatment with intravenous landiolol hydrochloride was administered to 43.5% of the patients in the beta group and 56.0% of those in the control group. There were no significant differences in the HR during and after CCTA between the 2 groups. Multivariate analysis revealed that the use of bisoprolol transdermal patch (OR, 3.54; 95% CI 1.67–7.51, P=0.001) and the baseline HR (OR, 0.91; 95% CI 0.89–0.94, P<0.0001) were significant predictors of the achievement rate of HR ≤65 bpm on arrival. There were no serious adverse effects throughout CCTA in all patients.

Conclusions

The administration of bisoprolol transdermal patch before arrival at the hospital was useful for HR control and reduced the rate of additional intravenous treatment in patients who underwent CCTA.
P6166Radiomics-based machine learning versus histogram analysis and visual assessment to identify advanced atherosclerotic lesions on coronary computed tomography angiography
Authors: Kolossvary M , Karady J , Kikuchi Y , Ivanov A , Schlett C L , Lu M T , Foldyna B , Merkely B , Aerts H J , Maurovich-Horvat P , Hoffmann U
Published: October 2019

Background

Currently used coronary CT angiography (CTA) plaque classification and histogram-based methods have limited accuracy to identify advanced atherosclerotic lesions. Radiomics-based machine learning (ML) could provide a more robust tool to identify high-risk plaques.

Purpose

Our objective was to compare the diagnostic performance of radiomics-based ML against histogram-based methods and visual assessment of ex-vivo coronary CTA cross-sections to identify advanced atherosclerotic lesions as defined by histology.

Methods

Overall, 21 coronaries of seven hearts were imaged ex vivo with coronary CTA. From 95 coronary plaques 611 histological cross-sections were obtained and classified based-on the modified American Heart Association scheme. Histology cross-sections were considered advanced atherosclerotic lesions if early, late fibroatheroma or thin-cap atheroma was present. Corresponding coronary CTA cross-section were co-registered and classified into homogenous, heterogeneous, napkin-ring sign plaques based on plaque attenuation pattern. Area of low attenuation (<30HU) and average CT number was quantified. In total, 1919 radiomic parameters describing the spatial complexity and heterogeneity of the lesions were calculated in each coronary CTA cross-section. Eight different radiomics-based ML models were trained on randomly selected cross-sections (training set: 75% of the cross-sections) to identify advanced atherosclerotic lesions. Plaque attenuation pattern, histogram-based methods and the best ML model were compared on the remaining 25% of the data (test-set) using area under the receiver operating characteristic curves (AUC) to identify advanced atherosclerotic lesions using histology as a reference.

Results

After excluding sections with heavy calcium (n=32) and no visible atherosclerotic plaque on CTA (n=134), we analyzed 445 cross-sections. Based on visual assessment, 46.5% of the cross-sections were homogeneous (207/445), 44.9% heterogeneous (200/445) and 8.6% were with napkin-ring sign (38/445). Radiomics-based ML model incorporating 13 parameters significantly outperformed visual assessment, area of low attenuation and average CT number to identify advanced lesions (AUC: 0.73 vs. 0.65 vs. 0.55 vs. 0.53; respectively; p<0.05 for all).

Conclusions

Radiomics-based ML analysis may be able to improve the discriminatory power of CTA to identify high-risk atherosclerotic lesions.
P6178The optimal point of CT-FFR measurement in comparison with invasive FFR
Authors: Miyajima K , Motoyama S , Sarai M , Kawai H , Takahashi H , Muramatsu T , Naruse H , Ishii J , Ozaki Y
Published: October 2019

Background

Currently, invasive fractional flow reserve (FFR), has become a gold standard to select patients requiring revascularization. Coronary computed tomography angiography (CTA) -derived FFR (FFRCT/CT-FFR) can be used for the management of coronary artery disease, which would be a gatekeeper of invasive coronary angiography. In most of the previous report to evaluate the diagnostic performance of FFRCT/CT-FFR, FFRCT/CT-FFR value was measured at the same point as the invasive FFR. Clinically, FFRCT/CT-FFR should be measured without the information of invasive FFR. However, optimal measurement point for CT-FFR has not been established yet.

Purpose

To assess the optimal measurement point of CT-FFR in comparison with invasive FFR as a gold standard.

Methods

CTA images scanned at 70–99% of R-R interval with 320 slice CT were screened. In the de-novo lesions with invasive FFR data were included in this study. Since calcified lesions could affect CT-FFR value, severe calcified lesions on CTA were excluded from the analysis. The CT-FFR analysis was performed by 2 cardiologists blinded to the results of the invasive FFR using a standard desktop computer and dedicated software. CT-FFR values could be provided at any point from ostium of coronary artery to the distal with vessel diameter of 1.8mm. To determine the optimal point for measurement of CT-FFR, CT-FFR values were obtained at 3 points in each coronary artery; 1) at the same point as invasive FFR; 2) lowest CT-FFR at distal point of coronary artery; 3) at 2.0 cm distal to the lesion. The diagnostic performance at each point was compared with invasive FFR.

Results

Fifty vessels of 44 patients (average age 68 years, male were 32) were included. Average Agatston score was 279.4. There was significant correlation between CT-FFR at each point and invasive FFR. CT-FFR at the same point as invasive FFR showed the good correlation with invasive FFR (R=0.641, 95% CI= 0.041–0.127, p<0.0001). Compared to the lowest CT-FFR at distal (R=0.608, 95% CI= 0.069–0.160, p<0.0001), CT-FFR at 2.0 cm distal to the lesion (R=0.604, 95% CI= 0.007–0.061, p<0.0001) revealed better correlation with invasive FFR. Sensitivity, specificity, positive and negative predictive value at each point were 92.8 / 93.3 / 81.8; 75.0 / 57.1 / 94.2; 61.9 / 48.2 / 60.0; and 96.0 / 95.2 / 84.6, respectively. Diagnostic accuracy showed that CT-FFR at 2cm distal to the lesion (0.84) was similar to CT-FFR at the same point as invasive FFR (0.80), and it was better than far distal (0.68) to detect invasive FFR derived ischemia.

Conclusions

CT-FFR was feasible to detect invasive FFR derived ischemia at the same point.

CT-FFR at 2.0 cm distal to the lesion showed higher diagnostic performance compared with CT-FFR measured at the far distal. CT-FFR measurement at 2.0 cm distal to the lesion would be a optimal position clinically.
P6181The association of coronary lumen volume to left ventricle mass ratio with myocardial blood flow and fractional flow reserve
Authors: Van Diemen P A , Schumacher S P , Bom M J , Driessen R S , Everaars H , Stuijfzand W J , Raijmakers P G , Van De Ven P M , Min J K , Leipsic J A , Knuuti J , Boellaard P R , Van Rossum A C , Danad I , Knaapen P
Published: October 2019

Background

A low coronary lumen volume to left ventricle mass ratio (V/M) derived from coronary computed tomography angiography (CCTA) has been proposed as a factor contributing to impaired myocardial blood flow (MBF) even in the absence of obstructive coronary artery disease (CAD).

Objective

To elucidate the association of V/M with non-invasively obtained MBF parameters by means of [15O]H2O positron emission tomography (PET), as well as its correlations with invasively measured fractional flow reserve (FFR), overall and specifically in vessel with non-obstructive CAD.

Methods

This is a substudy of the PACIFIC trial, in which 208 patients underwent CCTA, and [15O]H2O PET prior to invasive coronary angiography (ICA) in conjunction with 3 vessel FFR measurements. Patient specific V/M was calculated for 152 patients. Matched vessel specific hyperemic MBF (hMBF), coronary flow reserve (CFR), FFR, and patient specific V/M were available for 431 vessels. The median V/M (20.71 mm3/g) was used to divide the study population into a group with a low V/M (<20.71 mm3/g) and a high V/M (≥20.71 mm3/g). Non-obstructive CAD was defined as a ≤50% stenosis grade on ICA.

Results

Overall, a higher percentage of vessels with an abnormal hMBF (34% vs. 19%, p=0.009), lower FFR values (0.93 [interquartile range: 0.85–0.97] vs. 0.95 [0.89–0.98], p=0.016), and a higher number of positive FFR values (20% vs. 9%, p=0.004) were observed among vessels in the low V/M group. Furthermore, a weak correlation between V/M, global hMBF (R=0.179, p=0.027), and global CFR (R=0.163, p=0.045) as well as a weak significant association with vessel specific hMBF (p=0.027), and FFR (p<0.001) was observed (figure 1). V/M was not independently predictive of vessels specific MBF parameters or FFR. Among vessels with non-obstructive CAD (361 vessels), an abnormal hMBF tended to be more frequently observed in vessels with a low patient specific V/M (21% vs. 13%, p=0.056). Globally, there was no correlation between V/M and hMBF nor CFR. Patient specific V/M tended to be weakly associated with vessel specific hMBF (p=0.083) and was associated with FFR (p=0.027) (figure 1). Lastly, patient specific V/M tended to be independently predictive of FFR in this specific group.

Conclusion

Overall, vessels with an abnormal hMBF, and positive FFR measurements were more frequently observed in patients with a low V/M compared to those with a high V/M. Furthermore, V/M weakly correlated with global hMBF as well as with CFR and was associated with vessel specific hMBF and FFR. However, there was no correlation between V/M and global nor vessel specific blood flow parameters in the absence of obstructive CAD, notwithstanding a weak association of V/M with FFR within this group was noted.
P6183Diagnostic performance of coronary computed tomography angiography-derived fractional flow reserve in patients with acute myocardial infarction and moderate non-culprit coronary stenosis
Authors: Jablonkai B , Ahres A , Ruboczky G , Nagybaczoni B , Oze A , Balogh Z S D , Schrancz A , Astrid A , Szilveszter B , Kolossvary M , Simon J , Merkely B , Maurovich-Horvat P , Andrassy P
Published: October 2019

Background

Revascularisation of significant non-culprit coronary lesions (NCL) may improve clinical outcome in patients with myocardial infarction and multi vessel disease, however management of moderate NCLs is still controversial. Dobutamine stress echocardiography (DSE) and invasive fractional flow reserve (FFR) are accepted methods to detect myocardial ischemia, nevertheless coronary CT angiography-derived fractional flow reserve (CT-FFR) is a new modality, which has not been widely investigated to date in patients with NCLs.

Purpose

Our aim was to determine the diagnostic performance of CT-FFR compared to DSE and invasive FFR.

Methods

In this prospective trial, DSE, FFR and CT-FFR were performed in every patient with MI and at least one moderate NCL (30–70% diameter stenosis by visual assessment). New or worsening wall motion abnormality in at least two contiguous myocardial segments on DSE, and FFR value<0.8 in invasive FFR and CT-FFR as well were determined as abnormal. In comparison, DSE and FFR were regarded as reference standard methods.

Results

Between March of 2017 and December of 2018, 51 patients (58.2±10.4 years, 74.5% male) were enrolled and 71 NCLs (40 LAD, 13 LCx, 18 RCA) were investigated. Dobutamine stress echocardiography, FFR and CT-FFR were positive in 30.9%, 32.3% and 22.5% of all lesions, respectively. FFR values were higher with CT-FFR compared to invasive FFR (0.85±0.11 vs. 0.83±0.08, p<0.05). Compared to DSE, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of CT-FFR were 40.9%, 85.7%, 56.2%, 76.3% and 71.8%, respectively. The same values were 39.1%, 85.4%, 56.2%, 74.5% and 70.4% compared to invasive FFR, respectively. Correspondence of CT-FFR with DSE (k=0.29) and with FFR (k=0.27) was weak.

Conclusion

This is the first study that compares the three modalities in the evaluation of moderate NCLs. Our results demonstrated moderate diagnostic accuracy, excellent specificity, poor sensitivity and PPV and acceptable NPV of CT-FFR compared to DSE and FFR. At this stage, CT-FFR is probably not accurate enough to determine revascularisation strategy of moderate NCLs as a single non-invasive method.
P6187Multicentre diagnostic performance of on-site workstation CT derived fractional flow reserve
Authors: Ihdayhid A R , Fujimoto S , Motoyama S , Comella A , Kato E , Miyajima K , Isa M , Kamo Y , Sarai M , Kawai H , Arakita K , Hislop-Jambrich J , Cameron J , Seneviratne S , Ko B
Published: October 2019

Background

On-site workstation based computed tomography derived fractional flow reserve (CT-FFR) is an emerging method to assess vessel specific ischaemia in coronary artery disease (CAD). Global data on its diagnostic performance when compared with CT coronary angiography (CTA) is limited.

Purpose

To evaluate the on-site multicentre diagnostic performance of reduced-order CT-FFR at detecting vessel specific ischaemia.

Method

This is a retrospective pooled analysis of 141 patients (204 vessels) with suspected CAD enrolled from 3 global centres who underwent CTA, onsite CT-FFR and invasive FFR. On-site CT-FFR was performed using a reduced order model on a standard desktop computer with dedicated software. The per vessel diagnostic performance of CT-FFR (≤0.8) for vessel specific ischemia (FFR≤0.8) was compared with CTA (≥50% stenosis).

Results

Mean age was 65.8±9.9, 70.7% were male. FFR significant stenosis was present in 34.3% (70/204) of vessels. Pearson correlation of CT-FFR for invasive FFR was 0.52, P<0.001. Bland Altman analysis demonstrated a mean difference of 0.06±0.15 (95% limits of agreement −0.22 to 0.35). Per vessel diagnostic accuracy, sensitivity and specificity of CT-FFR and CTA were 79.9% vs 53.5%; 78.6% vs 85.7%; 80.6% vs 35.9% respectively. Diagnostic performance as assessed by area under the receiver operator curve (AUC) for CT FFR was superior to CTA (0.82 [95% CI 0.76–0.88] vs 0.61 [0.55–0.67]; P<0.001).

Conclusion

On-site workstation CT-FFR demonstrated high per vessel diagnostic performance and was superior when compared with CTA in assessment of vessel specific ischaemia as assessed by invasive FFR in a multicentre setting.
P6202Serum sitosterol levels and ABCG5 and ABCG8 genetic mutations among Japanese dyslipidemic subjects
Authors: Kojima N , Tada H , Kawashiri M , Takamura M
Published: October 2019

Background

Sitosterolemia, which is caused by ABCG5 or ABCG8 genetic mutations, is involved with marked increased concentrations of cholesterol as well as non-cholesterol plant sterols including sitosterol. Assessments of serum sitosterol level is critical to discriminate this disease from familial hypercholesterolemia (FH), which exhibits similar phenotypes except for elevated sitosterol levels. However, no prior data exist regarding the optimal cutoff value of serum sitosterol predicting the presence of sitosterolemia with double pathogenic mutations in ABCG5 or ABCG8 genes.

Methods

We retrospectively investigated consecutive 253 Japanese dyslipidemic subjects (mean age = 47.02 yr, male = 48.6%) with the assessments of serum sitosterol level as well as the presence of ABCG5 or ABCG8 genetic mutations in our institute since 2009 to 2018. Exome lesions of those 2 genes were sequenced, and pathogenicity of the identified genetic variants were determined using standard variant filtering schema, including minor allele frequency, in silico annotation tools. We divided the subjects into 3 groups based on the number of pathogenic mutations in ABCG5 or ABCG8 genes. We compared serum lipid values, including LDL cholesterol as well as serum sitosterol among those groups, and tried to determine the optimal cutoff value discriminating patients of sitosterolemia with double mutations from others.

Results

We identified 11 individuals with sitosterolemia with double mutations, 27 individuals with a single mutation, and 215 individuals without any mutations. Distribution of serum sitosterol exhibited skewed to the right (Figure). There was no significant correlation between serum sitosterol and other lipids, including LDL cholesterol. As expected, serum sitosterol level of patients with sitosterolemia exhibited significantly higher than those of any other groups (52.0 vs. 7.9 μg/ml, p=2.22×10–6, 52.0 vs. 2.8 μg/ml, p=2.275×10–8). 15 μg/ml was the optimal cut-off value, the sensitivity and specificity of which were 100%, and 99.6%, respectively.

Histgram of serum sitosterol

Conclusion

We suggest the cutoff sitosterol value of 15 μg/ml predicting the presence of sitosterolemia with double pathogenic ABCG5 or ABCG8 genetic mutations.
P6207Polypill to improve adherence in cardiovascular secondary prevention: a real challenge in real practice
Authors: Merino Argos C , Dalmau Gonzalez-Gallarza R , Velez Salas A , Castro Conde A , Martinez Marin L A , Caro Codon J , Rodriguez Sotelo L , Marco Clement I , Martin Polo L , Rosillo Rodriguez S O , Lopez-Sendon Hentschel J L
Published: October 2019

Background

Poor adherence is a barrier to optimal secondary cardiovascular prevention. The need for a polymedication, the cost of some drug therapies and the silent evolution of some cardiovascular conditions are often related to poor adherence. A fixed-dose polypill strategy (AAS, ACEi and statin) has emerged as a possibility to improve adherence in cardiovascular prevention and therefore improve outcomes. Nevertheless, the complexity of cardiovascular disease patients' drug therapy regimes and the need for titration of doses in order to reach the goals, makes it difficult to introduce a fix-dose polypill.

Methods

We performed a prospective study of consecutive patients attending a secondary prevention consultancy. In order to find out whether they were amenable to a polypill regime, we analyzed their drug therapy scheme and the level of control of blood pressure and LDL cholesterol.

Results

We included 302 patients, and their treatment is shown in table 1. Of the total of patients, we found that only 25 patients (8.3%) were optimal candidates for receiving a fixed-dose polypill. The reasons for not being eligible are summarized in figure 1, highlighting the need for higher statin dose or statin intolerance as the most frequent cause (79.5%), or the need for titration or combination of drugs according to the blood pressure levels.

Patients' characteristics and therapy Patients (n=392) Sex (male) 252 (83.4%) Age (mean ± SD) 60.82 (±11,33) Event (STEMI, NSTEMI, angina) 155 (51.3%), 123 (40,7%), 24 (7.9%) ACEi/ARBs 279 (72.5%) ASA 279 (92.4%) Statins (Atorvastatin 80mg, atorvastatin 40mg, rosuvastatin, other statin) 221 (73.2%), 37 (12.3%), 25 (8.3%), 17 (5.6%) Anti-arterial hypertensive combination pill 51 (16.9%) Number of drugs (mean±SD) 6.61 (±2.47) Optimal blood pressure control (<140/90 mmHg) 197 (65.2%) Optimal LDL control (<70 mg/dl) 208 (69.8%)

Causes of non-eligibility for polypill

Conclusion

Despite the fact that polypill could bring the opportunity to improve cardiovascular drug therapy adherence, the complexity of secondary prevention patients and the common need for a high dose statin makes it difficult to implement a polypill scheme in the real practice.
P6220The non-invasive coronary flow reserve predicts exercise capacity in patients undergoing cardiac rehabilitation
Authors: Meimoun P , Ghannem M , Clerc J
Published: October 2019

Background

The benefit of exercise on peripheral muscles is established but the exact role of the coronary microcirculation in exercise capacity after cardiac rehabilitation (CR) is unclear. Objective: Our aim was to test the relationship between non-invasive coronary flow reserve (CFR) and exercise capacity in patients undergoing CR after acute myocardial infarction (AMI).

Methods

CFR was performed by transthoracic Doppler echocardiography in the left anterior descending artery 24 h after angioplasty (CFR1) and after 20 sessions of CR program (at 4±1 months) (CFR2) in 60 consecutive patients (57±11 years, 30% women) with an anterior AMI successfully treated by primary coronary angioplasty. CFR was performed in a modified parasternal view using intravenous adenosine infusion (0.14 mg/kg/min within 2 minutes). CR program consisted of a half hour of fractioned exercise added of a half hour session of general gymnastics and body building. To test the exercise capacity, symptom limited exercise echocardiography was performed just after the CFR2, in a semi-supine position, starting at 25 watts, with 20–25 watts increments of workload every two minutes.

Results

CFR was measured successfully in all patients, and CFR2 was significantly higher than CFR1 (2.9±0.65 vs 1.9±0.4, p<0.001). Though CFR1 was correlated to left ventricular systolic function and its improvement at follow-up (all, p<0.01), CFR2 was independently related to exercise capacity (mean workload 100±30 watts, percent maximal heart rate 83±12%, no ischemia, no new wall motion abnormalities in all tests) after adjusting for age, sex, and body mass index (r=0.6, p<0.01).

Conclusion

CFR predicts exercise capacity in patients undergoing a CR program after AMI. The improvement of CFR contributes to cardiac performance.
P6239Late adverse effects of residual platinum concentrations on cardiac function in testicular cancer survivors: a 30-year follow-up study
Authors: Bjerring A W , Fossa S D , Haugnes H S , Haugaa K H , Edvardsen T , Sarvari S I
Published: October 2019

Background

Cisplatin-based chemotherapy (CBCT) is essential in the treatment of testicular cancer (TC), and platinum can be detected in TC survivors decades after cessation of treatment. CBCT has been implicated as a risk factor in cardiovascular morbidity and mortality.

Purpose

Our study aimed to assess the relationship between residual serum platinum concentrations and changes in cardiac function and morphology in TC survivors 30 years after CBCT.

Methods

Seventy TC survivors diagnosed and treated with CBCT (1980–1994) were recruited from the longitudinal Norwegian Cancer Study in Testicular Cancer Survivors. Serum platinum concentration was measured twenty years after CBCT. Patients were then allocated to either a high or low platinum concentration group. Echocardiography was performed in all subjects.

Results

The participants were on average 60±9 years old. There was a trend towards smaller left ventricular (LV) volumes in the high residual platinum concentration group (Table). No intergroup difference in cardiac function was found. Six (9%) participants had reduced EF (<52%) and 14 (20%) participants had reduced LV global longitudinal strain (> −18.0%), however, there was no intergroup difference. Neither cumulative cisplatin dose nor residual serum platinum concentration showed any correlation with LV or right ventricular functional parameters.

Table 1 Low residual Pt concentration >85 ng/L (n=35) High residual Pt concentration <85 ng/L (n=35) p-value Cumulative cisplatin dose, mg/m2 680±249 814±271 <0.05 Residual Pt concentration, ng/L 44±22 136±44 <0.001 3D LV end-diastolic volume, ml/m2 66±17 60±8 0.07 3D LV end-systolic volume, ml/m2 29±15 24±5 0.08 3D ejection fraction, % 57±9 59±6 0.24 LV global longitudinal strain, % −19.2±3.3 −20.0±2.0 0.26 LV global circumferential strain, % −21.1±4.2 −22.1±1.8 0.30 E/e' 10.6±4.4 9.2±2.2 0.10 TAPSE, mm 2.2±0.4 2.3±0.4 0.22 RV fractional area change, % 40±7 41±7 0.67 Data are presented as mean ± SD. The P-values were derived from the Student's t-test. LV, left ventricle; MV, mitral valve; Pt, platinum; RV, right ventricle; TAPSE, tricuspid annular plane systolic excursion.

Conclusion

Our 30-year follow-up study of testicular cancer patients could not demonstrate impact on cardiac function caused by cumulative cisplatin dose or residual serum platinum concentrations.

Acknowledgement/Funding

South-Eastern Norway Regional Health Authority
P6243Impact of coronary flow reserve as an important predictor for major adverse cardiac and cerebrovascular event in hemodialysis patients even in patients without myocardial perfusion abnormality
Authors: Umemoto N , Ooshima S , Ooshima S , Itou R , Itou R , Iio Y , Iio Y , Kajiura H , Kajiura H , Shimizu K , Shimizu K , Sakakibara T , Sakakibara T , Ishii H , Ishii H , Murohara T , Murohara T
Published: October 2019

Background

In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13N-ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic test for IHD. We have reported about the predictability of coronary flow reserve (CFR) in poor prognosis in HD population. Some prior studies show that low CFR predicts poor prognosis for not only cardiovascular event but also all-cause mortality. Although it is well-known that CFR is an important predictor, there are limited data about CFR of patients without myocardial perfusion (MP) abnormality. We investigated the prognostic predictability of adverse cardiac and cerebrovascular event (MACCE) in HD patients without MP abnormality.

Methods

A total 438 of HD patients who underwent 13NH3PET for suspected IHD were enrolled. All patients were underwent 13NH3PET at our facility. After we excluded patients whose summed stress score (SSS) >3, we identified 182 eligible patients. Patients were divided into two group according to the median value of CFR; low CFR group (≤2.405) and high CFR group (>2.405). We followed up them up to 4.2 years (median 2.4 years) and collected their data. We evaluated their major adverse cardiac cerebrovascular event. We performed Kaplan-Meyer analysis and multivariable cox regression models. Furthermore, we evaluated the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when CFR added into a model with established risk factors.

Results

There were intergroup difference in baseline characteristics: age, gender, prior CVD and diabetes. Kaplan-Meyer analysis shows statistically intergroup difference [log rank p=0.04, hazard ratio (HR) 0.54, 95% confidential interval (CI) 0.30–0.97]. Multivariable cox regression model for MACCE shows CFR is an independent risk factor (p=0.04, HR 0.54, 95% CI 0.30–0.97). As regarding model discrimination, all of C-index (0.82 vs 0.80, p=0.23), NRI (0.51, p<0.01) and IDI (0.03, p=0.03) were greatest in a predicting model with established risk factors plus CFR.

Conclusions

The low CFR group had poor prognosis in MACCE comparing to the high CFR group. CFR would be an independent risk factor for MACCE. Adding CFR on conventional risk factors could more accurately predict MACCE in HD patients, even in patients without MP abnormality.
P6251Prognostic value of ACEi/ARBS in elderly patients with heart failure with reduced ejection fraction with and without chronic kidney disease
Authors: Martinez Milla J , Cortes M , Lopez-Castillo M , Devesa A , Rivero-Monteagudo A L , Martin-Mariscal M , Briongos S , Taibo M , Franco-Pelaez J A , Tunon J
Published: October 2019

Introduction

Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers therapy (ACEI/ARB) have shown to reduce mortality in patients with heart failure and reduced left ventricular ejection fraction (HFrEF). However, there is lack of information about the benefit of these drugs in patients with chronic kidney disease (CKD), and even less in elderly patients. Our aim is to compare the prognostic impact of ACE/ARB if CKD is present or not

Methods

From January 2008 to July 2014, we consecutively enlisted 802 patients aged >75 years that had ejection fraction ≤35%. Clinical, echocardiographic and ECG data were taken from hospital records. Follow-up was made via telephone and hospital records as well. We analyzed the relationship between treatment with ACEi/ARBs (with different doses) and occurrence of mortality or MACE (major adverse cardiovascular events: composite of death from any cause or hospitalization for heart failure).

Results

From the total population 410 (51%) patients that had not CKD (glomerular filtration rate (GFR) >60ml/min/1,73m2) and 390 (49%) patients had CKD (with GFR ≤60ml/min/1,73m2). We analyze the population according the presence or not of CKD. Both groups had similar characteristics except the age: 81.5±4.5 years vs. 82.6±4.1 (p<0.05) and the percentage of use of ACEi/ARB 78.8% of the total vs 66.9% of the total (p<0.05). The mean ejection fraction was 27.9±6.5% vs 28.12±6.5% (p>0.05). The mean follow up was 33±22 vs 32±23 months (p>0.05). In patients with no CKD 170 (42%) patients died and 239 (58%) patients had a MACE. In the CKD group 211 (54.1%)patients died and 257 (65.9%)patients had a major cardiovascular event. In the univariate analysis in both groups the use of ACEi/ARB reduced the mortality and the MACE. After a multivariate analysis ACEi/ARB appear to be beneficial in the CKD group (OR 0.71 [0.50–0.98]) but not in no CKD group

Conclusions

According to our data, treatment with ACEI/ARB in elderly patients HFrEF and CKD should be encouraged even more than in those without CKD.
P6255Impact of whole grain consumption on arterial stiffness. Results of the Corinthian cross-sectional survey
Authors: Vavouranaki G , Oikonomou E , Vogiatzi G , Lazaros G , Tsalamandris S , Siasos G , Chasikidis C , Theofilis P , Mistakidi C V , Anastasiou M , Galiastatos N , Santouri M , Tousoulis D
Published: October 2019

Introduction

The benefits of certain dietary patterns on cardiovascular diseases has been questioned over the last years. Whole grain consumption has been one of the controversial issues regarding the effect on cardiovascular disease. In Greek rural population consumptions of bread is part of the daily meal and a possible source of whole grain.

Purpose

To investigated the effect of whole grain bread consumption on arterial stiffness in Mediterranean population.

Methods

In a cross-sectional survey (Corinthia study) volunteers subjects completed a food frequency questioner (FFQ), including a question of consumption of bread on regular basis, whole grain (group I) or not (group II). Medical history, lifestyle habits, anthropometric and vital signs, as well as, laboratory blood test were performed. All patients underwent carotid-femoral pulse wave velocity (C-F PWV) measurements which were obtained noninvasively by SphygmoCor devise.

Results

Among the 2043 volunteers 1389 patients had adequate quality of pulse wave velocity recordings and were regular consumers of bread. Whole grain bread was consumed by 473 subjects (male 37%, female 63%,) but 916 (male 43.1%, female 56.9%) did not consume. Subjects consuming whole grain bread were younger compare to those who were not (group I: 62±11 years vs. group II: 64±12 years, p=0.02), have lower C-F PWV (group I: 9.04±2.93 m/sec vs. group II: 9.57±2.76 m/sec, p=0.01) but no other statistical difference were observe among other parameters (i.e. hypertension, diabetes mellitus, BMI, smoking etc). Hierarchical multiple regression showed that whole grain consumption predicted pulse wave velocity statistically significantly (b=−0.33, 95% CI: −0.62, −0.17, p=0.03) in addition to age (b=0.09, 95% CI 0.08–0.10, p<0.001), systolic blood pressure (b=0.02, 95% CI 0.01, 0.03, p<0.001) beta=0.157) and diabetes mellitus (b=0.75, 95% CI 0.40, 1.09, p<0.001).

Conclusion

Whole grain bread consumption has a beneficial effect on arterial stiffness as detected by better carotid femoral pulse wave velocity. This may have a positively effect on cardiovascular diseases.