bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5751Comparison of side branch dilation techniques after resorbable magnesium scaffold implantation: a bench study
Authors: De Pommereau A , Mogi S , De Hemptinne Q , Adjedj J , Varenne O , Picard F 
Published: October 2019

Abstract

Background
Resorbable magnesium scaffolds (RMS) have demonstrated good safety profile to treat de novo lesions. Nevertheless, bifurcations lesions involving a side branch>2.0mm in diameter were excluded from these studies and such lesions remain technically challenging due to concerns of scaffold deformation or fracture.

Purpose
We sought to evaluate different side branch dilation strategies after provisional T stenting strategy with RMS.

Methods
Using RMS in bifurcations phantoms, three different side branch dilation strategies after provisional T stenting were compared: POT-side-rePOT (rePOT), Kissing-Balloon Inflation (KBI) and Mini Kissing-Balloon Inflation (MKBI) strategies. In vitro experiments were performed under fluoroscopy in the catheterization laboratory. Struts and connectors fractures were evaluated by micro computed-tomography and apposition by optical coherence tomography (OCT). In addition, step by step proximal over-expansion was carried out with different incremental NC balloons and scaffolds were then re-inspected on micro-CT after each over-expansion.

Results
Twelve RMS (n=4 in each group) were successfully implanted. There was no difference on struts and connectors fractures among the 3 techniques as no fracture was visualized. OCT demonstrated that MKBI sequence significantly decreased global malapposition following SB inflation as compared with rePOT or KBI strategies (95.3% vs 88.3% of perfectly apposed struts; p<0,0001 and 93.6%; p=0.004, respectively for MKBI vs. rePOT and KBI). After step by step overexpansion, no strut or connector fracture could be visualized.
Stent strut apposition between in vitro models rePOT, n (%) KBI, n (%) MKBI, n (%) P value rePOT vs KBI P value rePOT vs MKBI P value KBI vs MKBI Overall bifurcation 1702/1928 (88.3%) 2062/2211 (93.6%) 1824/1913 (95.3%) p<0,0001 p<0,0001 p=0.004 MB proximal 376/390 (98.3%) 407/407 (100%) 398/398 (100%) p=0.0001 p=0.0001 p=NS MB bifurcation ostial 210/286 (77.5%) 326/391 (82%) 243/269 (89.8%) p=0.002 p<0,0001 p=0.01 MB bifurcation abostial 421/425 (99.3%) 421/421 (100%) 324/324 (100%) p=0.05 p=0.08 P=NS SB bifurcation ostial 147/227 (62.8%) 321/365 (88.3%) 256/306 (85%) p<0,0001 p<0,0001 p=NS SB bifurcation abostial 98/150 (70.3%) 128/168 (78%) 161/173 (95.5%) p=0.03 p<0,0001 p=0,0005 MB distal 450/450 (100%) 459/459 (100%) 442/443 (99.8%) p=NS p=NS p=NS Comparison between rePOT, KBI and MKBI. Abbreviations: POT, proximal optimization technique; MKBI, mini kissing balloon inflation; KBI, kissing balloon inflation.
Bifurcation exemples

Conclusion
Provisional RMS one stent technique on a bifurcation lesion is technically feasible with these 3 different strategies without scaffold fracture. MKBI strategy resulted in better apposition rates as compared to KBI or rePOT strategies.
P6016His bundle pacing versus biventricular pacing in cardiac resynchronization therapy: acute hemodynamic and electrophysiological effects
Authors: Salden F , Luermans J G , Westra S W , Cornelussen R , Ghosh S , Prinzen F W , Vernooy K 
Published: October 2019

Abstract

Background
Cardiac resynchronization therapy (CRT) is usually performed with a right (RV) and left ventricular (LV) lead. Previous observational studies showed promising results with His bundle pacing (HBP) in patients with left bundle branch block (LBBB) by capturing and recruiting the native His-Purkinje system as an alternative to provide ventricular resynchronization.

Objective
To investigate the effects of HBP as compared to conventional biventricular (BiV) pacing with respect to acute hemodynamic and electrophysiological effects in heart failure patients with LBBB.

Methods
RV apical and BiV pacing, using the implanted leads, and temporary HBP, using an electrophysiology catheter, was performed in 13 patients (QRS duration 168±16 ms) undergoing CRT implantation. Hemodynamic response (relative to baseline AAI pacing) was assessed as change in LVdP/dtmax. Multi-electrode body-surface mapping, what has been used previously to characterize electrical dyssynchrony in CRT patients, was evaluated using the standard deviation of activation times (SDAT) (figure, right panel).

Results
HBP resulted in a significant LV dP/dtmax increase, that was comparable to the increase during BiV pacing and significantly larger than RV pacing (figure, left panel). HBP resulted in a more homogenized electrical activation and larger reduction in SDAT than both conventional BiV pacing and RV pacing (figure, middle panel).

Conclusions
Acute HBP results in hemodynamic improvement and electrical resynchronization that is as good as conventional BiV pacing. These results suggest that HBP may serve as an alternative for conventional BiV pacing in LBBB patients, however prospective studies are needed to prove chronic clinical outcomes.

Acknowledgement/Funding
Medtronic is a subsidising party.
P6018Can chronic his bundle pacing be safely started in centers with lack of experience of this technique? Data from a multicentric registry
Authors: Chaumont C , Popescu E , Auquier N , Milhem A , Viart G , Savoure A , Godin B , Mirolo A , Eltchaninoff H , Anselme F 
Published: October 2019

Abstract

Introduction
Right ventricular pacing (RVP) induces ventricular asynchrony in patients with normal QRS and increases the risk of heart failure and atrial fibrillation on long term. His bundle pacing (HBP) is a physiological alternative to RVP. Interest in HBP has been hampered in part by technical challenges and limited implantation tool set. Recent studies assessed feasibility and safety in expert centers with a vast experience of HBP. These results may not apply to less experienced centers.

Purpose
To evaluate feasibility and safety of permanent his bundle pacing in hospitals with limited technical training to this technique and to evaluate stability of his bundle capture thresholds at 3 months follow up.

Methods
We included all patients who underwent pacemaker implantation with attempt of HBP in three hospitals between September 2017 and December 2018. All the 5 operators were novice for HBP at the beginning of the study. Selective his bundle capture (HBC) was defined as concordance of QRS and T waves complexes with the native ECG (patients with underlying bundle branch block may normalize), presence of a delay between spike and QRS complex, absence of widening of the QRS at a low pacing output, and recordable his bundle electrogram. At 3 months follow-up, his bundle capture thresholds, R-wave amplitudes and pacing impedances were recorded.

Results
HPB was successful in 51 of 58 patients (87.9%); selective HBC was obtained in 40 patients while nonselective HBC occurred in 11 patients. Indication for pacemaker implantation was atrioventricular conduction disease in 31 patients (53%), sinus node dysfunction in 5 patients (9%) and AV nodal ablation for non-controlled atrial arrhythmias in 22 patients (38%). AV nodal ablation was performed during the same procedure in 14 patients. The mean procedure duration was 75±8 min, and mean fluoroscopy duration was 10±2 min. The mean HBP threshold was 1.47±0.27 V and did not increase after a 3 months follow-up (1.12±0.18 V). Only 7 patients (14%) had HBP threshold >2V/0.5ms. The mean impedance was 477±37 Ω and slightly decreased at 3 months (364±24Ω). The mean R-wave amplitude was 4.1±1 mV at implantation and 3.2±0.6 mV at 3 months. Bundle branch block correction was achieved in 5 of 7 patients with underlying left bundle branch block. There was no pericardial effusion, no pneumothorax and no device infection. Ventricular lead revision was required at 3 months in one patient for sudden threshold increase, without obvious dislodgement.
LBBB correction after HBP

Conclusion
His bundle pacing performed by novice operators to this technique appeared feasible and safe. The mean HBP threshold did not increase at 3 months follow-up.
P6141Associations between atmospheric parameters and haemostatic factors: a case control study
Authors: Boussoussou M , Boussoussou N , Rakovics M , Entz L , Nemes A 
Published: October 2019

Abstract

Background
One of the biggest health challenges in the 21st century is global climate change. The health effect of climate change is partly mediated through atmospheric parameters. There is a growing concern that atmospheric parameters might increase cardiovascular (CV) morbidity. Increased levels of haemostatic factors are predictors of CV events. The associations between CV diseases and atmospheric parameters have been widely reported, however there are few studies of atmospheric parameters' effects on markers of haemostasis.

Purpose
We examined the possible association between atmospheric parameters and several haemostatic markers.

Methods
The study consisted of 3800 hospitalized patients with acute CV diseases (ACVDs) and 260 healthy blood donors. We examined the relationship of haemoglobin (Hgb), white blood cells (WBC), thrombocytes (THR) and local atmospheric parameter conditions (temperature, atmospheric pressure, humidity, wind speed, atmospheric front) on a day-to-day basis in a 5-year period (2009–2013) using a General Additive Model with cubic splines of covariates, regularized by a ridge penalty, and employing generalized cross validation. Atmospheric parameters were allowed to have a lagged effect by up to 21 days.

Results
Among blood donors, the average of daily temperature lagged by 8–14 days had a significant effect on Hgb, exhibiting a U-shaped relationship, where higher Hgb values were associated with extremities of the observed temperature interval. For ACVD patients, all examined blood test variables has a significant association with at least some of the atmospheric parameters. Hgb was shown to have a negative linear relationship with mean daily humidity, and the average of daily temperature lagged by 15–21 days, while the average of daily temperature variation lagged by 2–7 days had highly non-linear effect. The relative strength of the association with Hgb was largest for daily temperature variation. WBC values had a slightly non-linear positive relationship with atmospheric pressure lagged by 1 day, with WBC being significantly increased above 1030 hPa. THR values decreased linearly with an increase in mean daily temperature averaged for days lagged 15–21. Atmospheric pressure lagged by 1 day also had a significant effect on THR, with a positive linear effect under 1010 and over 1020 hPa but no effect between. The relative effect of atmospheric pressure on THR was twice as large compared to temperature.

Conclusions
Our study showed that exposure to certain atmospheric parameters is associated with significant changes in haemostatic marker levels. In the context of global climate change, the importance of focusing on atmospheric parameters as minor CV risk factor is substantially growing. A better understanding of the fluctuation of the examined markers, in light of atmospheric parameters, appears to be of particular importance for future studies and could help establish new CV prevention strategies.
P6148Visually assessed coronary and cardiac calcium outperforms perfusion data during scintigraphy in the prediction of adverse outcomes
Authors: Suma S , Garibaldi S , Sartorio D , Pressman G , Gaibazzi N 
Published: October 2019

Abstract

Background
The presence and amount of calcium in the coronary arteries, but also in the heart valves and aorta, has been clearly associated with cardiovascular and all-cause mortality and this information might be prognostically useful during SPECT-CT examinations, where CT images are co-registered for attenuation correction of myocardial perfusion, but then discarded.

Objectives
This study sought to determine whether the assessment of calcifications of the coronary arteries, cardiac valves and thoracic aorta in the computed tomography images co-registered for attenuation correction during stress-scintigraphy (SPECT-CT) is associated with long-term mortality and cardiac events on top of other available data.

Methods
Baseline data were collected prospectively on 353 consecutive patients, referred for suspected coronary artery disease (CAD) with no previously known CAD who underwent stress SPECT-CT between Sept 2010 and Oct 2012. Retrospective analysis was performed on follow-up data for outcomes.

Results
Patients (mean age 72 years. 58% males) had a mean follow-up of 6.4 years, during which 48 died (15 from cardiovascular causes) and 10 had a non-fatal myocardial infarction (MI). Reversible myocardial perfusion defects were detected in 55 patients (15.6%), 39 of whom (11%) had more than mild defects. The presence of an overall visual calcium score >1 in the attenuation correction images was the most strong univariable (hazard ratio 8.99, p<0.0001) and multivariable (hazard ratio 4.76, p<0.0001) predictor of all-cause death or non-fatal MI on top of age, gender, irreversible myocardial perfusion defects and revascularization after the test.
Multivariable models Clinical + SPECT + Overall Calcium Ischemic Cardiac Events HR CI (95%) p-value χ2 Age 1.058 1.0234 to 1.093 0.0008 Male gender 1.63 0.88 to 3.024 0.1183 Fixed perfusion defect 3.924 1.63 to 9.426 0.0022 Overall Calcium >1 4.765 2.2 to 10.32 <0.0001 71.69
Kaplan-Meier

Conclusions
Visual assessment of coronary or overall coronary, cardiac and aortic calcium in the CT images used for attenuation correction during SPECT-CT is feasible, reproducible and strongly associated with hard cardiac events and all-cause death, beyond clinical variables and myocardial perfusion data. This incredibly easy visual calcium assessment does not require additional costs or radiation and may heavily impact on better risk-assessment of patients with suspected CAD undergoing SPECT-CT.
P6158Prognostic value of non-obstructive coronary artery disease detected on coronary computed tomography angiography among subjects with suspected coronary artery disease
Authors: Aljizeeri A , Alali Alfaris M , Ahmed D , Farea J , Elneama A , Suliman I , Ahmed A , Alharthi M , Alsaileek A , Al-Mallah M 
Published: October 2019

Abstract

Introduction
Coronary Computed Tomography Angiography (CTA) is an established technique for the detection of coronary artery disease (CAD). However, the prognostic value of non-obstructive CAD is not well defined. Thus, the aim of this analysis is to determine the prognostic value of non-obstructive CAD detected on CTA.

Methods
In the Multi-Center Multi-Ethnic Coronary Computed Tomography Angiography (MECCA) Study, 3209 subjects without known CAD underwent CTA. Patients with obstructive CAD were excluded from this analysis. Patients with ≤70% luminal coronary artery stenosis in vessels other than the left main were classified to have non-obstructive CAD while patients without any plaque were considered to have normal CTA. Patients were followed up for a median duration of 3.4 years for all-cause mortality (ACM). Multivariable Cox models were used to determine the independent predictors of event-free survival.

Results
A total of 1455 subjects had non-obstructive CAD and 1382 subjects had normal coronary arteries. Subjects with non-obstructive CAD were older (55.9±11 vs 46.2±11 years, p<0.001) and more likely to be males (56.8% vs 50.5%, p=0.001) and had more prevalent traditional risk factors. A total of 83 ACM were observed (4.4% in the non-obstructive group and 1.3% in the normal group, p<0.001). Patients with clinical events were older (61.8±14 vs 50.9±12 years, p<0.001) and have more prevalence of DM (42.2% vs 31.4%, p=0.031) and HTN (72.3% vs 54.3%, p=0.001). In Multivariable Cox models, non-obstructive CAD was associated with increased event rate (Hazard ratio 1.75, 95% CI 1.01–3.01, p=0.45).
Kaplan-Meier Survival Curves

Conclusions
Patients with non-obstructive CAD on CTA have a higher rate of all-cause mortality. Non-obstructive CAD on CTA enhances risk stratification among subjects suspected with CAD and should call for more aggressive guidelines directed medical therapy.

Acknowledgement/Funding
None
P6162Difference in progression to obstructive lesions according to the presence of high-risk plaque features
Authors: Lee S E , Pontone G , Gottlieb I , Hadamitzky M , Leipsic J A , Raff G , Stone P H , Samady H , Virmani R , Berman D S , Shaw L J , Narula J , Bax J J , Min J K , Chang H J 
Published: October 2019

Abstract

Background
It is still debatable whether the so-called high-risk plaque (HRP) simply represents a certain phase during the natural history of coronary atherosclerotic plaques or the disease progression would differ according to the presence of HRP.

Purpose
We determined whether the pattern of non-obstructive lesion progression into obstructive lesions would differ according to the presence of HRP.

Methods
Patients with non-obstructive coronary artery disease, defined as % diameter stenosis (%DS) ≥50%, were enrolled from a prospective, multinational registry of consecutive patients who underwent serial coronary computed tomography angiography at an inter-scan interval of ≥2 years. HRP was defined as lesions with ≥2 of positive remodelling, spotty calcification, and low-attenuation plaque. The total and compositional percent atheroma volume (PAV) at baseline and annualized PAV change were compared between non-HRP and HRP lesions.

Results
A total of 1,115 non-obstructive lesions were identified from 327 patients (61.1±8.9 years old, 66.0% male). There were 690 non-HRP and 425 HRP lesions. HRP lesions possessed greater PAV and %DS at baseline compared to non-HRP lesions. However, the annualized total and non-calcified PAV change were greater in non-HRP lesions than in HRP lesions. On multivariate analysis, addition of baseline PAV and %DS to clinical risk factors improved the predictive power of the model (Table). When clinical risk factors, PAV, %DS, and HRP were all adjusted on Model 3, only baseline PAV and %DS independently predicted the development of obstructive lesions (hazard ratio (HR) 1.046 [95% confidence interval (CI): 1.026–1.066] and HR 1.087 [95% CI: 1.055–1.119], respectively, all p<0.001), while HRP did not (p>0.05).
Comparison of C-statistics of per-lesion analysis to predict progression to obstructive lesion C-statistics (95% CI) P Model 1: Baseline PAV 0.880 (0.879–0.884) – Model 2: Model 1 + baseline %DS 0.938 (0.937–0.939) vs. Model 1: <0.001 Model 3: Model 2 + HRP 0.935 (0.934–0.937) vs. Model 2: 0.004 Adjusted for age, male sex, hypertension, diabetes mellitus, hyperlipidemia, family history of coronary artery disease, smoking, body mass index, and statin use.

Conclusion
The pattern of individual coronary atherosclerotic plaque progression differed according to the presence of HRP. Baseline PAV was the most important predictor for lesions developing into obstructive lesions rather than the presence of HRP features at baseline.

Acknowledgement/Funding
This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).
P6165Sex differences in compositional plaque volume progression in patients with stable coronary artery disease: observations from a serial CCTA registry
Authors: Lee S E , Andreini D , Budoff M J , Cademartiri F , Hadamitzky M , Marques H , Leipsic J A , Stone P H , Samady H , Narula J , Berman D S , Shaw L J , Bax J J , Min J K , Chang H J 
Published: October 2019

Abstract

Background
It is unclear whether sex impacts the plaque volume (PV) progression in patients with stable coronary artery disease (CAD).

Purpose
To explore whether the total and compositional PV progression rate differ according to sex.

Methods
We performed a prospective multinational registry of consecutive patients who underwent serial CCTA at ≥2-year interval. Total and compositional PV at baseline and follow-up were quantitatively analysed and normalized using the analysed total vessel length. Multivariate linear regression models were constructed for each women and men.

Results
Of the 1,255 patients included (median CT interval 3.8 years), 543 were women and 712 were men. Women were older (62±9 years vs. 59±9 years, p<0.001) and had higher total cholesterol level (195±41mg/dL vs. 187±39mg/dL, p=0.002). Prevalence of hypertension, diabetes, and family history of CAD were not different (all p>0.05).
At baseline, men possessed greater total PV (131.5±230.5mm3 vs. 97.7±193.6mm3, p=0.005) and a higher prevalence of high-risk plaques (HRP) than women (31% vs. 20%, p<0.001). Annual total PV progression rate was greater in men, driven by the greater non-calcified PV progression (TABLE).
In multivariate analysis (TABLE), although total PV progression rate was not different, women were associated with greater calcified PV progression (β=2.83, p=0.004) but slower non-calcified PV progression (β=-3.39, p=0.008) and less development of HRP (β=-0.18, p=0.049) than men.
CCTA findings according to sex Univariate analysis Female Sex in Multivariable Analysis Women (n=543) Men (n=712) P β SE P Agatston CACS, /year 0.44±0.7 0.4±0.7 0.332 0.106 0.04 0.006 Total PVnormalized, mm3/year 14.7±23.4 17.8±26.2 0.026 -0.56 1.33 0.677 Calcified PVnormalized, mm3/year 10.5±21.5 10.0±19.1 0.670 2.83 0.98 0.004 Non-calcified PVnormalized, mm3/year 4.2±17.3 7.8±21.2 0.001 -3.39 1.28 0.008 Development of high-risk plaque*, n (%) 86 (15.8) 139 (19.5) 0.092 -0.18 0.09 0.049 In linear multivariate regression analysis adjusted with age, race, HTN, DM, family history, smoking, LDL, statin, anti-platelets, beta-blockers, and PV at baseline, women were associated with greater calcified PV progression and slower non-calcified PV progression. (High-risk plaque was defined as ≥2 of low-attenuation plaque, spotty calcification, and positive remodelling.)

Conclusion
In this large CCTA cohort, we found that the compositional PV progression differs according to sex. These findings, which are hypothesis generating, suggest that comprehensive plaque evaluation may contribute to further refine risk stratification according to sex.

Acknowledgement/Funding
This work was supported by the National Research Foundation of Korea funded by the Ministry of Science and ICT (Grant No. 2012027176).