bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1761Distal transradial approach for primary percutaneous coronary intervention for patients with acute myocardial infarction: a multicentre study
Authors: Izumikawa T , Takeshita S , Yamada T , Mizuguchi Y , Taniguchi N , Nakajima S , Hata T , Takahashi A 
Published: October 2019

Abstract

Background
The distal transradial approach (dTRA) for coronary catheterisation is a newly introduced alternative to the conventional transradial approach. This technique is expected to decrease the incidence of haemorrhagic complications and improve patient comfort. However, limited data are available regarding the application of this technique in patients with acute myocardial infarction (AMI). This study investigated the feasibility and safety of the dTRA for primary percutaneous coronary intervention (PCI) in patients with AMI.

Methods
This study included patients with AMI who underwent primary PCI via the distal radial artery across 3 Japanese hospitals between January 2018 and January 2019. Patients' background, procedural characteristics, and clinical outcomes including the incidence of haemorrhagic complications were analysed.

Results
This study enrolled 95 consecutive patients with AMI, including 68 patients (71.6%) with ST-segment elevation myocardial infarction (STEMI), in whom distal radial artery puncture was attempted for primary PCI. The patients included 70 men (73.7%), and the mean age was 72.2±12.4 years. Among these patients, cannulation was successfully performed in 89 patients (93.7%). A 5-, 6-, or 7-French sheath (conventional or slender) was used in this study. Cannulation was performed using a forearm radial artery approach in patients in whom dTRA failed.
PCI was successfully performed in all patients. The meantime to achieve haemostasis was 6.3±5.3 hours, and no major bleeding complications occurred. Based on The Early Discharge After Transradial Stenting of Coronary Arteries trial haematoma scale, grade I, II, and III subcutaneous haemorrhages were observed in 16 (16.8%), 4 (4.2%), and 1 patient (1.1%), respectively. No patient developed a haematoma > grade IV.
In patients with STEMI, the mean door-to-balloon time was 39.4±31.9 min, and the mean puncture-to-balloon time was 19.7±14.2 min.

Conclusions
The distal radial approach is feasible and safefor primary PCI in selected patients with AMI.The application of the dTRA may serve as a less invasive strategy for the treatment of patients with AMI.
P1764Quality criteria for STEMI care - a national perspective
Authors: Da Conceicao Pedro Pais J A , Picarra B C , Carrington M , Santos A R , Guerreiro R A , Carvalho J , Bras D , Congo K , Neves D , Aguiar J 
Published: October 2019

Abstract

Introduction
The definition of quality criteria in health care is essential to implement structural organization strategies that ensure that patients (P) receive the best care according to the most updated recommendations available at the time they are treated. Quality indicators have recently been defined with regard to the approach and treatment of STEMI in the European Guidelines published in 2017.

Objective
The authors intend to characterize the level of care provided to P with STEMI inserted into a national multicenter registry since 2011 in order to establish a relationship with international recommendations.

Population and methods
Descriptive study based on a national multicenter registry. A total of 2051 P admitted to the hospital with the diagnosis of STEMI were included, 1266 P for the year 2011 and 785 P for the year 2016.

Results
The P of the year 2011 and 2016 presented similar age (64±14 vs 63±13). There was a higher percentage of P admitted by STEMI fast track managed care system in 2016 (36.9% vs 22.2%, p<0,001) and less from the Emergency Department (31.6% vs 56.8%; p<0,001). Regarding the transport to the Hospital, there was an increase in patients transported by prehospital medical teams (28% vs 21%; p<0,001) and less by own means (35.7% vs 45.6%; p<0,001). Regarding in-hospital therapy, it was found that in 2016 more patients received loading doses of P2Y12 inhibitors – Clopidogrel (78.1% vs 70.3% P<0,001) and Ticagrelor (54.7% vs 0.7% P<0,001). In post-discharge therapy, there was also a slight improvement in care in 2016, with more P being treated with P2Y12 inhibitor (96.2% vs 92.4%; p=0.03) and beta-blocker (84.4% vs 78.7%; p<0,001). Regarding the type of reperfusion, there was an increase in angioplasty (95.5% vs 92.2%; p<0,001) and a decrease in fibrinolysis (4.5% vs 7.8%; p=0.03) in 2016. There was a slight worsening of the prehospital delay in 2016 (median 163min vs 120min) and an improvement in door to reperfusion time (median 60min vs 70min). There was also an increase in angioplasties performed in 2016 (87.1% vs 85.1%; p<0,001) as well as an increase in the percentage of left ventricular function evaluation before discharge (98.2% vs 93.9%; p<0,001).

Conclusion
The results presented demonstrate a slight improvement in the quality of the care provided to STEMI P. However, there are areas for improvement, in accordance with international recommendations, in particular with regard to reperfusion times.
P1767Prevalence and clinical significance of sleep-disordered breathing in patients with hypertrophic cardiomyopathy
Authors: Potratz M , Fox H , Fox H , Faber L , Faber L , Oldenburg O , Oldenburg O , Rudolph V , Rudolph V , Bitter T , Bitter T 
Published: October 2019

Abstract

Background
Despite major advances in knowledge on hypertrophic cardiomyopathy (HCM) at the genetic and molecular levels, the understanding of essential clinical aspects remains limited. The aim of this study is to identify the prevalence and clinical significance of Sleep-disordered Breathing (SDB) in a large patient population.

Methods
201 patients (78 women, age 64±15 years) with HCM were screened for obstructive (OSA) or central (CSA) sleep-disordered breathing using multichannel cardiorespiratory polygraphy. Additionally, patients received a spiroergometric examination and echocardiography. SDB was defined as apnea-hypopnea index (AHI) ≥5/h and OSA/CSA differentiated after the majority of events.

Results
SDB was documented in 60% of all patients. OSA was diagnosed in 71 patients (35.3%) and CSA in 44 (21.9%) patients. SDB requiring treatment was found in 106 (52.7%) patients. In patients with AHI ≥15/h NYHA class was increased (2.1 vs. 2.39, p=0.04) and maximal O2 uptake during exercise was lower (20.1 vs. 16.1 p<0.001). Also left atrial diameter was significantly larger (46.9 mm vs. 50.41 mm, p=0.01) and rate of atrial fibrillation was increased (0.5 vs. 0.72 p=0.03). CSA pts had a larger left atrial diameter compared to pts with OSA (52.13 mm vs. 47.82 mm, p=0.02).

Conclusion
There is a high prevalence of SDB in HCM patients. Patients with moderate to severe SDB showed increased atrial fibrillation incidence and reduced cardiopulmonary performance. Whether the SDB has an independent prognostic relevance in patients with HCM needs to be elucidated.
P1769Microvascular resistance increases with left ventricular mass in hypertrophic cardiomyopathy
Authors: Bakar S , Hayman S , McCarty D , Thain A , McLellan A , Wagner C , Lavi S 
Published: October 2019

Abstract

Introduction
Hypertrophic cardiomyopathy is often associated with myocardial ischemia despite lack of focal epicardial coronary stenoses and this is partially attributable to microvascular dysfunction. The index of microvascular resistance (IMR) is a hemodynamic index that is independent of epicardial stenoses and reflects coronary microvascular function.

Purpose
To investigate the relationship between microvascular dysfunction and the degree of hypertrophy in hypertrophic cardiomyopathy patients.

Methods
We performed a prospective study to assess epicardial and microvascular coronary hemodynamics in 12 subjects with hypertrophic cardiomyopathy undergoing diagnostic coronary angiography. A pressure-temperature sensor coronary guidewire was used with intracoronary injections of room-temperature saline to measure mean coronary transit time during rest and hyperemia induced with intravenous adenosine. IMR was calculated by multiplying mean coronary transit time during hyperemia by distal coronary pressure in each subject. Left ventricular mass was calculated from baseline echocardiographic studies using established methods. Continuous variables are shown as mean ± standard deviation.

Results
Six subjects were male; mean age was 59.8±11.6 years. Baseline body mass index was 30.5±6.1 kg/m2 and left ventricular ejection fraction was 76.7% ± 11.0% with mean left ventricular mass 230.1±76.6 grams by echocardiography. Ten subjects had asymmetric septal hypertrophy; one subject had marked apical hypertrophy and one subject had asymmetric septal and inferolateral hypertrophy. Resting left ventricular outflow tract gradient was 59.4±37.8 mmHg and increased to 90.0±54.1 mmHg with Valsalva maneuver. Systolic anterior motion of the mitral valve was present in 10 subjects. Hemodynamic variables included coronary flow reserve (2.1±1.2); hyperemic mean transit time (0.29±0.15 sec.), and IMR (21.7±10.2). Index of microvascular resistance was strongly positively correlated with left ventricular mass (Figure 1; Pearson r=0.68, p=0.021).
Figure 1. IMR is correlated with LV mass

Conclusion(s)
Microvascular dysfunction as assessed by IMR is strongly correlated with left ventricular mass and may contribute to symptoms in patients with hypertrophic cardiomyopathy.
P1770A MYBPC3 founder splicing mutation with high penetrance and early onset of Hypertrophic Cardiomyopathy in men
Authors: Mendez Fernandez I , Fernandez Avila A , Espinosa Castro M A , Lorca Gutierrez R , Cuenca Parra S , Tamargo Delpon M , Rodriguez Crespo J F , Vazquez Aguilera N , Yotti Alvarez R , Bermejo Thomas J , Fernandez Aviles F 
Published: October 2019

Abstract

Introduction
MYBPC3 is the most frequently affected gene in Hypertrophic Cardiomyopathy (HCM). This study aimed to analyze the founder origin and clinical phenotype of the MYBPC3 c.2149–1G>A pathogenic variant, which had been previously described in only one HCM proband.

Methods
HCM probands who underwent genetic test at our institution were reviewed. Clinical data from carriers were collected retrospectively. In order to identify the haplotypes sharing MYBPC3 c.2149–1G>A variant, six markers covering from 46 to 62 Mb of HSA11 were genotyped in 11 carriers and 6 non-carriers. Genotype information for those markers was extracted for Iberian population (n=107) from the 1000 Genomes Browser database. Haplotypes were reconstructed with Phase 2.1 software and phylogenetic analysis with MEGA7 software.

Results
MYBPC3 c.2149–1G>A was identified in 7 of 523 HCM probands and 23 family members. Penetrance in carriers older than 30 years was 80% (100% men, 55% women, p=0.03). Men were significantly younger at diagnoses, with larger left atrium. One patient had an aborted sudden death. The haplotype reconstruction showed the existence of 53 haplotypes. The most probable segregation for MYBPC3 c.2149–1G>A carriers was estimated in two haplotypes, H52 and H53. The phylogeny reconstruction estimated that both H52 and H53 haplotypes may come from common ancestor H16. In fact, H52 comes from one recombination event in H53 haplotype that has recently occurred in one of our families.
Characteristics of affected carriers All (n=16) Men (n=11) Women (n=5) p Age at diagnoses (years) 44 (19) 38 (22) 48 (14.5) 0.036 Maximal LVWT (mm) 19 (4) 19 (3) 17 (6) 0.209 Ejection Fraction (%) 61 (5) 61 (4) 68 (17) 0.131 Left atrium (mm) 42 (13) 44 (15) 35 (11) 0.05 Outflow Tract Obstruction 2 (12.5%) 2 (18.2%) 0 (0%) 0.524 Late Gadolinium Enhancement† 13 (92.9%) 9 (90.0%) 4 (100%) 0.714 Dyspnea (NYHA ≥2) 4 (25%) 4 (36.4%) 0 (0%) 0.242 NSVT 6 (37.5%) 4 (36.4%) 2 (40%) 0.538 Atrial Fibrillation 4 (25%) 3 (27.3%) 1 (20%) 0.635 ICD primary/secondary prevention 7 (43.8%)/1 (6.3%) 5 (45.5%)/1 (9.1%) 2 (40%)/0 (0.0%) 0.750 Data are expressed as median (interquartile range) or number (%). LVWT: left ventricular wall thickness; NSVT: non sustained ventricular tachycardia. †14 man and 4 women underwent cardiac magnetic resonance.
MYBPC3 haplotype tree.

Conclusions
MYBPC3 c.2149–1G>A is a founder pathogenic variant that shows a high penetrance and an early onset of HCM, specially in men.
P1773Predictors of arrhythmic events in patients with non-compaction cardiomyopathy
Authors: Vaikhanskaya T , Kurushka T V , Sivitskaya L N 
Published: October 2019

Abstract

The phenotypic expression of non-compaction cardiomyopathy (NCM) ranges from subclinical arrhythmias to sudden cardiac death.

Objective
Search of identifying predictors of life-threatening ventricular tachyarrhythmias (ltVTA) and analysis arrhythmic risk stratification capacity of ECG (heart rate turbulence – HRT, microvolt T-wave alternans – mTWA, QT interval corrected - QTc, and fragmented QRS - frQRS), Echo and MRI features in pts with NCM was the goal of this study.

Methods
The study enrolled and followed up 59,7±16,2 months 72 pts (family – 13; sporadic – 59; aged 39.2±14.1 years; 43/59.7% male; LVEF 44.7±13.2%) with morphological signs of non-compaction myocardium, confirmed by any three of the four standart criteria: Echo (Jenni, Stöllberger), MRI (Petersen, Jacquier). For analysis as primary end-points the following ltVTA events were accepted: SCD, successful resuscitation, stVT/VF/syncope, appropriated ICD discharges.

Results
As a result of the rank correlation Spearman analysis positive correlations (p<0.0001) of an MRI markers of myocardial fibrosis were revealed with ECG parameters; thus, leads (n) with frQRS (frQRSn: r=0.65) and QT interval corrected (QTc: r=0.66) correlated with T1 native relaxation time (ms) and the LGE myocardial segments (n). Significant correlations (p<0.0005) are found between LGE (%) and frQRS(n): r=0.61; QTc: r=0.56; VTA (r=0.48); systolic dysfunction (LVEF: r=−0.59; GLS: r=0.58; TAPSE: r=−0.55; RVEF: r=−0.54) and biventricular non-compaction (r=0.60). Positive correlations of the frQRS(n) with the pathological mTWA test (mTWA mean: r=0.55; p<0.001), VTA (r=0.61; p=0.0008) and negative correlations with systolic/contractile function (LVEF: r=−0.56, p=0.001; TAPSE: r=−0.51, p=0.003; LV GLS “–”%: r=−0.57, p<0.001) were determined. Surprisingly, significant correlations between NC/C ratio (one of the main diagnostic criteria of LVNC) and other phenotypic signs or clinical complications were not identified.
As a result of step-by-step multiple regression analysis, a predictive model was constructed (R=0.53; F=8.50; p<0.ehz748.05257) and 3 independent predictors of ltVTA were revealed: HRT slope (TS: β=−0.36; p=0.002), QRS fragmentation (nQRSfr: β=0.32; p=0.001), and myocardial fibrosis (LGE%: β=0.27; p=0.02). As a result of ROC analysis following cut-off value were detected: fibrosis (LGE ≥22.5%; AUC 0.742; 95% CI: 0.594–0.889; sensitivity 77%; specificity 78%), pathological HRT (TS ≤2.5 ms/RR; AUC 0.771; 95% CI: 0.629–0.912; sensitivity 67%, specificity 87%), and fragmented QRS (frQRSn ≥5 leads; AUC 0.721; 95% CI: 0.559–0.883; sensitivity 80%, specificity 87%).

Conclusion
These markers (frQRSn along with LGE) reflect pathophysiological substrate triggering fatal arrhythmias; association of higher number of leads with frQRS, expressed LGE and pathological TS-HRT may be used as independent predictors of ltVTA for NCM pts
P1794Futility risk model development and validation among patients with aortic stenosis treated with transcatheter aortic valve replacement
Authors: Fauchier L , Bisson A , Herbert J , Lacour T , Ivanes F , Bourguignon T , Clerc J M , Quilliet L , Lantelme P , Angoulvant D , Babuty D , Guillon Grammatico L , Bernard A , Saint Etienne C 
Published: October 2019

Abstract

Risk-benefit assessment for transcatheter aortic valve replacement (TAVR) is still a matter of debate. A sizeable group of patients do not fully benefit from intervention despite a technically successful procedure. We therefore sought to identify patients with a bad outcome early after the procedure, and to develop a prediction model and calculator for identification of these patients.

Methods
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Multivariate logistic regression was used to select the risk factors of early all-cause death in first year after TAVR procedure (considered as futility) for the overall population. Score points were assigned to each risk factor using the β coefficient. Internal validation was performed by a bootstrap method. Calibration was assessed with the Hosmer-Lemeshow goodness of fit test and accuracy with the C-statistic.

Results
A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Mean follow-up was 1.31±1.61 years and 9,338 deaths were recorded (yearly rate 14.9%), among which 4,562 (49%) occurred in first year after TAVR procedure. The final logistic regression model included older age, male sex, history of hospital stay with heart failure, history of acute pulmonary oedema, atrial fibrillation, previous stroke, vascular disease, diabetes, renal disease, liver disease, pulmonary disease, anemia, history of cancer, metastasis and denutrition,. The area under the curve (AUC) for the score was 0.696 (95% CI 0.688–0.704). This score outperformed frailty index and Charlson comorbidity index for identifying futility. AUC was 0.677 (95% CI 0.669–0.86) for internal validation. The Hosmer–Lemeshow goodness of fit test had a p-value of 0.10 suggesting that the model was accurate. We further divided the model into 4 groups with 5%, 12%, 19% and 30% futility, respectively. The low-risk group consisted of 60% of the patients and the high-risk group consisted of 4% of these patients.

Conclusion
This futility prediction score established from a large nationwide cohort of patients treated with TAVR may provide a relevant insight for optimizing healthcare decision. It may facilitate identification of patients who, despite an apparently successful procedure, have risk of death that may outweigh the benefit of an anticipated TAVR.
P1799Importance of the parietal band in normal subjects and in patients with repaired tetralogy of Fallot: the unknown muscle of the forgotten ventricle
Authors: Nedaei F , Vejlstrup N G , Madsen P L 
Published: October 2019

Abstract

Introduction
The parietal band (PB) is little acknowledged. The PB traverses the basal part of the right ventricle (RV) with myocardial fibres circumscribing the inlet portion of the RV, anatomical studies suggest the PB may be of significant importance for RV contraction. RV dysfunction is of particular concern in patients with repaired Tetralogy of Fallot (ToF pts.).

Purpose
To study the importance of the PB for RV function in a retrospective cohort study by comparison of normal subjects with ToF pts. with and without resected PB.

Methods
The PB function was compared to RV volume and function by echocardiography and magnetic resonance imaging (CMR) in 89 normal subjects (echo and CMR) and 106 ToF pts. (CMR).

Results
A PB was identified in all normal subjects. In these, the PB shortened by 41±5% (mean±SD) during systole, and correspondingly, the septum-to-free wall distance was shortened by 47±17%. In ToF pts., the PB had been resected in 57.5% of cases. Resection of the PB was not of any consequence for RV dilatation or pulmonary and tricuspid valve regurgitation fraction (all ns), but resection was associated with a lowered RV free-wall to inter-ventricular septum approximation (21±13% vs. 39±9%) and consequently a lowered RV ejection fraction (RVEF; 45±8% vs. 54±8%) (both p<0.001). 84% vs. 48% (p<0.0001) had reduced RVEF if the PB had been resected.

Conclusions
The two groups of ToF pts. may differ in other aspects than presence of the parietal band, but taken together our findings in normal subjects and ToF pts. do suggest that the parietal band is significant importance for right ventricle contraction.
P1800The benefit of atrial septal defect closure in patients with borderline shunt
Authors: Komar M , Przewlocki T , Sobien B , Prochownik P , Gancarczyk U , Libiszewska N , Olszowska M , Podolec P 
Published: October 2019

Abstract

Objective
Closure of atrial septal defect in patients with borderline shunt is controversial. The aim of the study was to evaluate the outcomes of transcatheter closure of secundum atrial septal defect (ASD) in the patients with the borderline shunt.

Methods
215 pts (126 F,89 M) with a mean age of 31.9±18.2 (16–58) years with a small ASD who underwent transcatheter closure were analyzed. All patients had an isolated secundum ASD with pulmonary to systemic blood flow Qp:Qs ratio≤1.5, mean 1.2±0.6 (1.1–1.5).
A symptom-limited treadmill exercise test with respiratory gas exchange analysis, transthoracic color Doppler echocardiographic study and Quality of life (QoL) (using the SF36 questionnaire (SF36q)) were repeated in all pts before and 36 months after the procedure.

Results
The device was successfully implanted in all pts (procedure time 19.1±5.2 (8–38) minutes, fluoroscopy time 8.1±4.4 (6–13) minutes). There were no major complications. The defect echo diameter was 7.7±3.9 (5 - 15) mm. The diameter of the implanted devices ranged from 6 to 18 mm.
After 36 months of ASD closure, all the pts showed a significant improvement of exercise capacity. 7 QoL parameters (except mental health) improved at 36 months of follow-up compared with baseline. The mean SF36q scale increased in 168 (78.1%) pts of mean 40.2±20.1 (9–72). The right ventricular dimension decreased in 173 pts (80.4%) (Table 1).
Table 1 Parameter Before ASD closure 36 months after ASD closure p value Time of exercise (min) 12.1±5.2 18.6±4.3 <0.001 VO2 peak (ml/kg/min) 10.2±4.7 14.8±4.2 <0.001 SF36q scale 0–100 37.3±22.3 79±29.5 <0.001 Right atrial area (cm2) 20.1±1.7 14.7±1.5 <0.001 Right ventricular area (cm2) 18.1±1.4 12.2±1.5 <0.001

Conclusions
ASD closure in patients with borderline shunt resulted in a significant and long-term clinical and hemodynamic improvement after percutaneous treatment.