bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2678Performance of the European society cardiology 0/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T: meta-analysis
Authors: Burgos L M , Battioni L , Costabel J P , Trivi M 
Published: October 2019

Abstract

Introduction
A rapid rule-out or rule-in protocol based on the 0-hour/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) is recommended by the European Society of Cardiology (ESC), and recently multiple studies have validated it in their settings. We conducted a systematic review and meta-analysis with the aim of assess the diagnostic accuracy of the 2015 ESC guidelines for management of acute coronary syndrome (ACS) in patients without ST-segment elevation's 0-/1-hour algorithm using hs-cTnT for the early rule-out and rule-in of acute myocardial infarction (AMI) on presentation. For the secondary analysis we evaluate cumulative mortality at 30 days.

Methods
We carried out a systematic review and meta-analysis of prospective studies involving adults presenting to the emergency department with possible ACS in which hs-cTnT measurements were obtained according to the ESC algorithm and AMI outcomes were adjudicated during the initial hospitalization. We searched MEDLINE, EMBASE, Cochrane database and LILACS, and unpublished abstracts presented in international congresses from 2015 to November 2018.To obtain estimates of sensitivity and specificity, with corresponding 95% confidence intervals (CI), we used a bivariable random-effects model. Summary receiver operating characteristic curves were drawn, plotting individual studies as well as the summary estimate.

Results
Seven studies involving 9251 patients were identified. The summary sensitivity of these tests in diagnosing acute MI at presentation to the emergency department was estimated to be 99.1% (95% CI 97.2–99.7%) and the summary specificity was 92.5% (95% CI 86.6–95.9%). With a false positive rate of 0.075 (95% CI 0.041–0.134), diagnostic odds ratio (DOR) of 1293.1 (95% CI −52.48 to 2638.5), and Likelihood Ratio (LR) +13.193 (95% CI 5.3–21, and LR −0.010 (95% CI −0.001 to 0.021). Cumulative mortality at 30 days in the rule-out group was 0,08% (4 studies; n=3715).

Conclusion
The European Society Cardiology 0-Hour/1-Hour Algorithm using High-Sensitivity Cardiac Troponin T has high diagnostic accuracy, it allows safe rule-out as well as accurate rule-in of acute myocardial infarction. With low cumulative 30-day mortality in patients assigned the rule-out zone.
P2682Long-term effects of enhanced external counterpulsation treatment on symptom burden, usage of nitrates, physical capacity and health-related quality of life in patients with refractory angina pectoris
Authors: Wu E , Desta L , Brostrom A , Martensson J 
Published: October 2019

Abstract

Background
Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimized medical therapy. Recurrent angina symptoms are strongly associated with psychological distress and cardiac anxiety (i.e., a subtype of anxiety related to cardiac sensations). Enhanced external counterpulsation (EECP) is an alternative non-invasive treatment for these patients. An EECP course includes 35 1-hour sessions over 7 weeks. No previous study has explored long-term EECP effects on cardiac anxiety in patients with RAP.

Objective
To evaluate the effects of EECP treatment in patients with RAP regarding usage of nitrates, physical capacity, cardiac anxiety and HRQoL.

Methods
A quasi experimental design with long-term follow-up (6 months) involving 50 patients (men=37, 47–91 years) who had finished one course of EECP. Assessment of average use of nitrates, six-minute walk test, functional class with Canadian Cardiovascular Society (CCS) classification and questionnaires for cardiac anxiety and HRQoL were collected pre and post treatment. In addition, the questionnaires were collected 6 months after completion of EECP.

Results
Patients used significantly less nitrates (p<0.001) compared to at the start of treatment. They enhanced the walking distance on average by 46 m after EECP (p<0.001) and CCS class also improved (p<0.001). All subscales except for one in cardiac anxiety were significantly reduced (p<0.05). All dimensions in HRQoL improved significantly (p<0.01). The positive effects in both cardiac anxiety and HRQoL were maintained 6 months after the treatment.

Conclusions
Patients with RAP received beneficial effects from EECP. Reduced symptom burden and improved physical capacity enable engagement in physical activities. Furthermore, less cardiac anxiety and improved HRQoL may enhance life satisfaction for these patients. EECP treatment should be considered to a greater extent to improve the life situation for these patients.
P2690Safety and effectiveness of thin-strut DES for bifurcated coronary lesions not involving left main: a RAIN (veRy thin stents for patients with left mAIn or bifurcatioN in real life) sub-analysis
Authors: Angelini F , De Filippo O , D'Ascenzo F , Cerrato E , Omede' P , Escaned J , Sheiban I , Cortese B , Trabattoni D , Helft G , Mattesini A , Lusher T F , Biole' C , Giustetto C , Rinaldi M 
Published: October 2019

Abstract

Background
Thinner stent struts of new DES (drug eluting stent) are associated with shorter time of reendothelialization, a reduction of shear stress and inflammation of coronary walls. Despite this great innovations their clinical safety and efficacy in challenging scenarios as non left main bifurcation coronary lesions has not been tested.

Methods
RAIN is a multicenter registry enrolling patients treated on bifurcated coronary lesions and left main with thin-strut DES. Baseline characteristics and procedural data were recorded. Target lesion revascularization (TLR) was the primary endpoint, whereas major adverse clinical events (MACE; composite of all-cause death, myocardial infarction (MI), target vessel revascularization (TVR), TLR and stent thrombosis (ST)) along with its single components were the secondary endpoints. A multivariate analysis to identify predictors of TLR and sub-analysis according to stenting strategy (provisional vs 2-stent technique), use of final kissing balloon (FKB) and IVUS/OCT optimization were performed.

Results
Data from 1803 patients (59% ACS, 61% stable CAD) treated on bifurcations were retrospectively evaluated. Follow up was available for 1685 (94%) patients for a median of 12 months (IQR 7–18). TLR occurred globally in 2.5% of cases (2.2% in provisional stenting, 3.5% in 2-stent technique). The rate of MACE was 9.4%, whereas all-cause death and MI, occurred in 4.1% and 3.2% of cases respectively. TVR and definite ST incidence were 3.7% and 1.1%. At multivariate analysis, chronic kidney disease (CKD) negatively influenced the main endpoint (HR 1.95, 95% CI 1.06–3.6, p=0.03), whereas post-dilatation (HR 0.56, 95% CI 0.3–0.93, p=0.04) and provisional stenting resulted being protective factors. FKB reduced TLR occurrence at FU only in 2-stent technique (p=0.03), whereas intracoronary imaging (performed in 29% of patients) were uninfluential.

Conclusion
Very thin-strut DES represents a highly effective solution in bifurcation lesions. The risk of TLR is reduced by post-dilatation and provisional stenting. FKB is recommended in 2-stent technique, whereas further studies are required to address the impact of intracoronary imaging in this setting.
P2696Clinical characteristics of late catch-up phenomenon after implantation of 2nd generation drug eluting stent
Authors: Saigusa T , Miura T , Taki M , Kobayashi M , Kanai M , Okuma Y , Yanagisawa T , Hashizume N , Otagiri K , Shoin K , Kato T , Ebisawa S , Motoki H , Kuwahara K 
Published: October 2019

Abstract

Introduction
Late catch-up phenomenon (LCU) of 1st generation drug eluting stent (DES) has been increasing yearly despite the rate of restenosis in 1 year has reduced compared with bare metal stent (BMS). 2nd generation DES was more improved than 1st generation DES and suggested more benefits about clinical outcome.

Purpose
To investigate the incidence and predictor of LCU after implantation of 2nd generation DES and to evaluate the association between LCU phenomenon and adverse events.

Methods
Between August 2012 and July 2013, a total of 1665 consecutive patients (1956 lesions with elective/urgent PCI) were enrolled in SHINANO 5 years Registry (a prospective observational multicenter cohort study) from 13 institutions in Nagano, Japan. 711 patients that were treated with 2nd generation DES and 576 patients with BMS were selected. Exclusion criterias were cases of 1st DES, only POBA, only aspiration and chronic total occulusion.

Results
There were significant difference about patients background between BMS and 2nd generation DES groups. Those groups were matched with propensity score. After matching, 822 patients (BMS group 411 patients, 2nd generation group 411 patients) were analyzed. The rates of 2nd DES and BMS restenosis 5 years after initial PCI were 9.2% and 8.5% (p=0.572), those of LCU were 2.6% and 5.6% (p=0.043) by 1 year landmark analysis. Cox proportional hazards analysis revealed that the DES in-stent restenosis (ISR) lesion and higher HbA1c were independent predictors for LCU from 1year to 5year (HR 5.304, p=0.009, HR 1.254, p=0.015), but 2nd generation DES was not. Kaplan Meier curve showed no association between LCU phenomenon and all cause death (p=0.446). Cox regression analysis showed LCU was not independent predictor for all cause death (p=0.414).

Conclusions
Implantation to DES-ISR lesion with 2nd generation DES was associated with higher LCU. Despite of more complex lesions with 2nd generation DES, there were no differences of LCU incidence between 2nd generation DES and BMS.

Acknowledgement/Funding
None
P2697Percutaneous coronary intervention with 2nd generation drug eluting stent versus coronary artery bypass grafting in patients with unprotected left main disease: clinical outcome from a referral center
Authors: Scudiero F , Migliorini A , Stefano P L , Marcucci R , Pennesi M , Carrabba N , Muraca I , Vitale R , Marchionni N , Valenti R 
Published: October 2019

Abstract

Background
Percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease is currently recommended as an alternative to coronary artery bypass grafting (CABG) in patients with low and intermediate SYNTAX score.

Purpose
We sought to compare clinical outcomes of unprotected left main coronary artery disease by PCI or CABG in a “real world” population referred to high volume center.

Methods
All consecutive patients with unprotected left main coronary artery disease treated by PCI with second-generation drug-eluting stent were compared to those treated by CABG. The primary endpoint was the composite of death, non-fatal myocardial infarction (MI) or stroke at 2 years follow-up.

Results
A total of 558 patients were included. The mean age was 71±9 years, diabetes was present in 29%, and 56% of the patients presented with acute coronary syndrome. The distal left main coronary artery was involved in 84.6% of the lesions, the rate of Syntax score >32 was 50%. At 2 years, the primary end-point occurred in 10% of the patients in the PCI group and in 9.6% in the CABG group (p=0.862). The rates of death, non-fatal MI or stroke at 2 years were comparable; conversely the rate of ischemia driven revascularization at 2 years was higher in PCI group than CABG (5.5% and 1.5% p=0.010, respectively in PCI and CABG group).
Kaplan-Meier curves of MACCE

Conclusions
In a “real world” population with unprotected left main coronary artery disease, PCI with second generation stent, as compared to CABG, showed similar rates of the composite end point of death, non-fatal MI or stroke at 2 years, irrespective of coronary anatomy complexity.
P2736Hemodynamic and clinical impact in adult patients with anomalous aortic origin of the coronary artery evaluated with quantitative flow reserve
Authors: Adjedj J , Hyafil F , Aminfar F , Farnoud A , Rubimbura V , Fournier S , Ferrag W , Wijns W , Muller O , Aubry P 
Published: October 2019

Abstract

Background
Anomalous origin of the right coronary artery (ARCA) represents the most frequent form of abnormal coronary origin and may potentially increase the risk for sudden cardiac death. Evaluation of ARCA in adult patients referred for invasive coronary angiograms (ICA) is difficult, and clinical impact is unknown. Quantitative flow reserve (QFR) is an available method able to virtually calculate fractional flow reserve using 3-dimensional quantitative coronary angiography (3D-QCA) based on ICA.

Objectives
To evaluate the feasibility of QFR analysis in patients with ARCA and its clinical impact.

Methods
Using the registry of proximal anomalous connections of coronary arteries (ANOCOR registry), a multicentric observational registry including 472 adult patients with ANOCOR between 2010 and 2013, we retrospectively performed QFR analysis from ICA and evaluated the rate of death, myocardial infarction, unplanned revascularization and hospitalization in cardiology at 5 years.

Results
Among 128 patients with ARCA, 41 (32%) could have QFR analysis with median clinical follow-up of 8.3 years. The mean QFR value was 0.90±0.10, and 3D-QCA analysis showed preserved lumen area despite the elliptical shape of the proximal part of the ARCA which in the worst cases appeared on ICA as a significant narrowing. The event rate was 14.6% (n=6), including three deaths (one due to cancer, one due to stroke, and one cause remains unknown), two unplanned revascularizations, and one hospitalization for heart failure at 5 years. No myocardial infarction was reported.

Conclusions
QFR analysis of ARCA is feasible and non-significant QFR values are associated with good clinical outcome at 5 years. QFR of ARCA could be the evaluation of choice to help in clinical decision-making during ICA, when applicable.
P2737Changes of the amount of myocardial fibrosis after cardiac surgery in adult congenital heart disease patients: a cardiovascular magnetic resonance T1 mapping study
Authors: Tangcharoen T , Thirawut V , Prasertkulchai W , Yamwong S 
Published: October 2019

Abstract

Background
Myocardial fibrosis is not uncommon in patients with adult congenital heart disease (ACHD). Whether myocardial fibrosis can be resolved after cardiac surgery is questionable.

Purpose
We aimed to investigate the change of myocardial fibrosis after cardiac surgery in ACHD patients using T1 mapping CMR technique. The amount of myocardial fibrosis and cardiac function including myocardial strain were compared between non-ACHD and surgically-corrected ACHD patients.

Methods
All patients underwent cardiovascular magnetic resonance (CMR) on a 1.5T system before and after cardiac surgery. The protocol was approved by the local ethnic review board, and informed consent was obtained from each participant. Pre- and post-contrast T1 mapping were performed in the mid-cavity short-axis level with a 5(3)3 MOLLI scheme and ECG-gated acquisition. Myocardial fibrosis was expressed by the percentage of ECV. Ventricular and clinical parameters including 6-minute walk distance (6MWD), ejection fraction and myocardial strain were also analyzed. Mean ± standard deviation (SD) was reported. Paired t-test and independent sample t-test were used.

Results
Total 13 ACHD patients underwent CMR before and after surgery (34±16 years old, 9 female, 5 cyanotic, 5 underwent second operation). Median duration between CMR scanning and surgery was 308 days. Despite of increased 6 minutes-walk distance after surgery, the myocardial ECV did not significantly change (table 1). Compared with non-ACHD patients, the ECV in ACHD patients after surgery remained significantly higher (figure 1) although ventricular function including myocardial strain was not significantly different in both group (p=0.15 and 0.78 for ventricular function and strain rate respectively).
Table 1. Comparison of clinical and imaging parameter before and after surgery in ACHD patients Before surgery After surgery p LVEDVi (ml/m2) 77.5±29.1 70.8±10.4 0.34 LVEF (%) 61.0±8.3 61.8±7.5 0.72 RVEDVi (ml/m2) 122.2±74.4 80.6±26.4 0.02 RVEF (%) 60.4±13.6 56.9±10.8 0.14 6 minutes walk distance (meter) 287.3±93.0 350.4±61.6 0.05 ECV (%) 27.2±5.7 26.2±4.3 0.59
Figure 1

Conclusions
The amount of myocardial fibrosis, as expressed by percentage of the ECV, remained unchanged after surgery despite of clinical improvement. Compared with non-ACHD patients, the amount of fibrosis was significantly higher in ACHD patients after surgery.
P2744Age distribution of valvular heart disease in China: from a national multicenter prospective cohort study
Authors: Zhang B , Zhang H T , Xu H Y , Wu Y J 
Published: October 2019

Abstract

Background
Valvular heart disease (VHD) has been caught in two important cross-currents in recent decades: aging demography and the rise of multimodality imaging and transcatheter valve therapy. In this setting, we aim to identify the distribution, characteristics, and management of Chinese VHD patients according to age.

Methods
China Valvular Heart Disease Cohort Study (China-VHD) was conducted from March to September 2019 in 46 centers over China. It included prospectively 12331 adults with native moderate or severe VHD, of which we described the distribution, management, and in-hospital events according to age (18–44, 45–54, 55–64, 65–74, ≥75). Multivariate Logistic regression was employed to investigate the impact of age on in-hospital events composed of in-hospital mortality, acute heart failure, and stoke.

Results
In Chinese VHD population, overall percentage peaked in 55–64 year olds. The frequency of multivalvular heart disease (MVHD) saw an increasing trend with age (p for trend <0.001). Of single valvular heart disease, mitral regurgitation (MR) was the most frequent left-sided VHD followed by aortic regurgitation (AR), aortic stenosis (AS), and mitral stenosis (MS). AS frequency significantly grew with age (p for trend = 0.02) while AR peaked in 18–44 year olds and fluctuated at a lower level in the older population. In contrast, mitral valve disease (MS, MR, and mixed mitral valve disease) was most frequent in 45–54 year olds and dropped with age (p for trend all <0.001). Noteworthily, all aortic valve disease was notably frequent in men whereas mitral valve disease and MVHD more common in women. Similar to developed countries, degenerative etiology rose steeply while rheumatic and congenital origin fell with age. Regarding management, surgical valve replacement rate was similar in age groups lower than 75 years old with increasing frequency of concomitant CABG. No matter aortic or mitral, the percentage of bio-prosthesis rocketed after 65 years (aortic: 74.7%, mitral: 70.6%). In multivariate logistic regression, covariables included age, sex, BMI, hypertension, diabetes, coronary heart disease, aortic disease, cardiomyopathy, COPD, NYHA class and valvular intervention. Compared to patients younger than 45, in-hospital events significantly higher in patients over 75 only (OR: 1.69 [95% CI: 1.07–2.66], p<0.02). Moreover, women showed a lower risk of in-hospital events (OR: 0.78 [95% CI: 0.63–0.96], p<0.01).
Age distribution of VHD

Conclusion
Age plays a crucial role in valvular heart disease, best illustrated in AS. Unlike the western world, AR and MR are more frequent than AS but show a slightly decreasing trend with age. As expected, degenerative etiology is becoming more prevalent whereas rheumatism decreases. Age over 75 and male are associated with growing in-hospital events. Degenerative VHD thus present an important public-health burden.

Acknowledgement/Funding
Innovation project of Chinese academy of medical science
P2746Survival of people with valvular heart disease in the community (OxValve-Survive)
Authors: Taylor C , Ordonez-Mena J M , Roalfe A K , Wilson J , Myerson S , Prendergast B , Hobbs F D R 
Published: October 2019

Abstract

Background
Valvular heart disease (VHD) occurs commonly in older patients (>65 years) but the majority is mild disease, which is of uncertain importance. Understanding the impact of VHD on mortality in this older group of patients would help determine its relevance and aid the appropriate use of healthcare resources. OxValve is a cohort study in Oxfordshire screening people aged 65 and over for VHD. Over 4,009 participants were recruited between August 2009 and May 2016 and screened using echocardiography to establish the presence and severity of VHD.
AIMS To report survival in the OxValve cohort, and to investigate whether people with VHD are at increased risk of death.

Methods
The OxValve cohort was linked to Office for National Statistics mortality data to obtain date and cause of death. Cox regression was used to investigate the association of any VHD, VHD of significant severity, and VHD subtypes with all-cause and cause-specific mortality, adjusting for potential confounders including age, sex, socioeconomic status, smoking, and comorbidities.

Results
Linked mortality data was available for 3,511 OxValve participants up to September 2018 (median 5.85 years follow-up). VHD was present in 2,645 (75.3%) participants and of these 288 (8.2%) had significant VHD. In total, 311 (8.9%) participants had died. Cancer was the commonest cause of death (n=135), followed by cardiovascular disease (n=75) and respiratory disease (n=35). After adjustment for age and other covariates, mild to moderate VHD was not associated with increased all-cause mortality (HR 1.16, 95% CI: 0.89 to 1.50). However, VHD of significant severity (moderate or severe disease) was associated with a nearly two-fold higher risk of death overall (HR 1.92, 95% CI: 1:38 to 2.67) including increased CVD mortality (HR 2.25, 95% CI: 1.21 to 4.18).
DISCUSSION Mild to moderate VHD was very common, but was not associated with increased mortality. Significant VHD was however associated with a two-fold reduction in survival. Further research is required to understand the natural history of VHD, how to identify those with progressive disease and when to intervene.

Acknowledgement/Funding
NIHR Biomedical Research Centre, Oxford