bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6451Genetics of recent-onset dilated cardiomyopathy as a predictor of left ventricular reverse remodelling
Authors: Chaloupka A , Krejci J , Piherova L , Grochova I , Binova J , Stranecky V , Kmoch S , Spinarova L , Kubanek M 
Published: October 2019

Abstract

Background
Recent-onset dilated cardiomyopathy (RODCM) is a disease of heterogeneous aetiology including genetic, inflammatory, toxic and metabolic causes. Recognition of the genetic component could improve diagnostic management and risk stratification. Left ventricular reverse remodelling (LVRR) has been identified as a marker of favourable prognosis in RODCM.

Purpose
In this pilot study, we are first to assess the genetic background of RODCM in the Czech Republic by whole-exome sequencing and correlate genotype with LV reverse remodelling.

Methods
In this multi-centre prospective observational study, we enrolled 83 patients with RODCM and a history of symptoms of less than 6 months, for whole-exome sequencing. All patients underwent 12-month clinical and echocardiographic follow-up. LVRR was defined as an absolute increase in left ventricular ejec-tion fraction >10% accompanied by a relative decrease of left ventricular end-diastolic diameter >10% at 12 months.

Results
Whole-exome sequencing identified at least one disease-related variant in 45 patients (54%). As expected, the gene spectrum of identified variants in RODCM was quite wide comprising a total of 28 different genes, with the majority of truncating variants in titin gene which was found in 10 (12%) patients. LVRR occurred in 28 patients (34%), most often in carriers of isolated titin truncating variants, followed by individuals with a negative, or inconclusive results and carriers of other disease-related variants (56% vs. 42% vs. 19%, P 0.041).
Genotype and LVRR Exom negative or non conclusive Isolated titin truncating variant Other variant or combination P-value (n=38) (n=9) (n=36) 12 months ΔLVEF absolute (%) 16 (6–23) 15 (9–34) 6 (3–15) 0.036* 12 months ΔLVEF >10% (n=44; 53%) 24 (63%) 7 (78%) 13 (36%) 0.019* 12 months ΔLVEDD <−10% (n=34; 41%) 18 (47%) 6 (67%) 10 (28%) 0.058 LVRR – 12 months, ΔLVEF >10% and ΔLVEDD <−10% (n=28; 34%) 16 (42%) 5 (56%) 7 (19%) 0.041* n, number; ΔLVEF, change of left ventricular ejection fraction; ΔLVEDD, change of left ventricular end-diastolic diameter; LVRR, left ventricular reverse remodelling. *Statistically significant result.
Gene distribution in RODCM

Conclusion
A substantial proportion of RODCM cases has genetic background. Carriers of titin truncating variants are more likely to reach LVRR at 12 months, which could be seen as a positive prognostic marker of disease development. Genetic testing could contribute to better prognosis prediction and individualised treatment of patients with RODCM.

Acknowledgement/Funding
This study was supported by the research grant of the Ministry of Health, Czech Republic: MZ 15-27682A. All rights reserved.
P6454Antithrombotic therapy and cardiovascular events in patients with left ventricular thrombus
Authors: Lattuca B , Bouziri N , Portal J J , Zhou J , Zeitouni M , Kerneis M , Guedeney P , Legrand L , Hammoudi N , Isnard R , Pousset F , Collet J P , Vicaut E , Montalescot G , Silvain J 
Published: October 2019

Abstract

Background
Left Ventricular Thrombus (LVT) is associated with a high risk of thromboembolic complications such as stroke. Contemporary data are lacking on the management, prognosis and treatment of LVT, particularly with the emergence of the non-vitamin K antagonist anticoagulants (NOACs).

Purpose
To study the time and predictive factors associated with thrombus regression on treatment and its association with survival, embolic and bleeding complications.

Methods
From January 2011 to January 2018, a computerized case sensitive search of LVT was performed on 90 065 consecutive echocardiogram reports. All patients with a confirmed LVT were included in this analysis after imaging review by two independent experts. Repeated echocardiographic data, treatment management and clinical outcomes were collected during follow-up. Major adverse cardiac events (MACE), defined as the composite of death, ischemic stroke or transient ischemic attack (TIA), myocardial infarction (MI) or embolic peripheral artery occlusion were analyzed as well as major bleeding events (BARC ≥3) and the predictive factors and impact of LVT regression.

Results
We identified 174 patients with a suspected LVT of whom 159 had confirmed LVT on two different cardiac imaging exams. Ischemic cardiomyopathy was the main cause of LVT (n=125, 78.6%) including 56 (35.2%) patients with an acute ST segment elevation MI. The mean left ventricular ejection fraction was 31.9±12.5% with predominant (98.1%) apical location of the LVT.
Anticoagulation therapy was achieved with vitamin K antagonists, NOACs and parenteral heparins in 48.7%, 22.8% and 27.8% of patients, respectively. Concomitant antiplatelet therapy was prescribed in 67.9% of patients. Total LVT regression was reached in two third of patients (62.3%, n=99) within a median time of 103 [32–392] days. Independent predictors of total LVT regression were an ischemic cardiomyopathy (HR: 0.36 [0.19–0.70], p=0.002), a larger baseline thrombus area (HR=0.66 [0.45–0.96], p<0.031) and a prolonged anticoagulation therapy over 3 months (HR=0.11 [0.05–0.22], p<0.0001).
During a median follow-up of 632 [187–1126] days, MACE occurred in 59 (37.1%) patients with a 18.9% rate of mortality and 13.2% of major bleeding. Patients with a total LVT regression had a non-significant lower rate of MACE as compared with patients without total LVT regression (35.4% vs. 40.0%; HR=0.71 [0.42–1.21]; p=0.20), and a significant lower rate of mortality (15.2% vs. 25.0%; HR=0.48 [0.23–0.98]; p=0.039).
Occurence of mortality (A) and MACE (B)

Conclusions
The prognosis of LVT remains severe with a high risk of major cardiovascular event and mortality. Total LVT regression, mostly reached in 3 months, can be obtained with both vitamin K antagonists and NOACs and is associated with a better prognosis.
P6460The significance of syncope as a presenting symptom in patients with intermediate risk pulmonary embolism
Authors: Natanzon S S , Beigel R , Chernomordik F , Mazin I , Herscovici R , Goitein O , Ben-Zekry S , Grupper A , Matetzky S 
Published: October 2019

Abstract

Background
Intermediate risk pulmonary emboli patients are a challenging group with high risk of recurrent VTE, hemodynamic instability and mortality. A gap of knowledge has emerged regarding predictors of clinical deterioration. The prognostic role of syncope presentation is debatable. We thought to investigate the ability of syncope to predict in-hospital complications and the need of escalation therapy among intermediate risk PE patients admitted to the ICCU.

Methods
Consecutive cohort of all patients hospitalized with a diagnosis of PE, classified as intermediate risk and admitted to the intensive cardiac care unit at the Sheba medical center between the years 2008–2016. Primary outcome: MACE consisting of either one of or a combination of: mechanical ventilation, hemodynamic instability and need for inotropic support, Secondary reperfusion and in-hospital mortality. Secondary outcomes: Each of the individual components including major bleeding and renal failure

Results
213 intermediate risk PE patients were analyzed. 40 patients (19%) presented with syncope. Syncope patients had significant higher RV/LV ratio upon computed tomography (1.7±0.6 vs. 1.4±0.4, p=0.011). The presence of either moderate or severe RV dysfunction was more prevalent, without statistical significance (57.5% vs. 41%, p=0.076).
Syncope patients had higher prevalence of escalation therapy (28.9% vs 9.4%, p=0.003), as well as in the following individual secondary endpoints: mechanical ventilation (10% vs 1.8%, p=0.026), hemodynamic instability (17.9% vs 2.9%, p=0.02), bleeding rates (15% vs 2.4%, p=0.004), and increased need of inotropic support (10% vs 0.6%, p=0.005). There was no significant difference in the need for reperfusion therapy, both surgical (5% vs. 0.6%, p=0.093) and non- surgical (7.5% vs 6.4%, p=0.732), and in-hospital mortality (2.5% vs 0%, p=0.190).
Secondary Outcomes

Conclusion
The presence of syncope as a presenting symptom is associated with more complicated in-hospital clinical course. These patients warrant more aggressive monitoring and assessment for the need of escalation therapy.
P6498Linkage analysis of transvalvular flow patterns, histopathology and target gene expression in aortic valve disease
Authors: Gross T , Lindner D , Ojeda F M , Blankenberg S , Reichenspurner H , Westermann D , Girdauskas E 
Published: October 2019

Abstract

Objectives
Recent studies have shown that shear stress can alter the integrity and gene expression of the aortic wall. We aim to analyze the link between jet dynamic, histological alterations, and gene expression patterns of the proximal aorta in patients with aortic valve disease.

Methods
We prospectively identified a total of 139 consecutive patients who were referred for aortic valve replacement (AVR) from January 2012 through December 2015. All patients underwent pre-operative MRI assessment to determine the maximal shear stress area of the proximal aorta. Depending of the aorta diameter we subdivided our study population in three subgroup (i.e., patients with a diameter ≤40mm, 41–49mm and ≥50mm). Based on the MRI results, two aortic wall tissue samples were collected during surgery. One sample were acquired from an area of low wall shear stress (WSS) and the second from the area of maximal WSS. The samples were graded in seven histopathologic features.
For RNA isolation the tissue was disrupted using a Tissue Lyser II (Qiagen). For the gene expression analysis of h18S, hCCL2, hCOL1A1, hVCAM1, and hELN reverse transcription of RNA was carried out using the High-capacity cDNA kit (life-technologies,USA). Therefore, 125 ng total RNA from tissue samples were reversely transcribed into cDNA.

Results
Regardless of the aortic valve functional lesion (i.e., stenosis or regurgitation), the maximal area of WSS was in the major curvature of the proximal aorta (73%, n=102). We observed that in both tissue samples just the orientation of vascular smooth muscle cell was strongly related to the diameter of the ascending aorta (p=0.004 vs. p=0.0032). In the whole study population any significant correlation was found between maximal cross-sectional aortic diameter and genes expression. However, in the subgroup analysis we identified that the tissue samples who were exposed to higher wall shear stress and presented a diameter ≥50mm, showed a statically significant gene over-expresion of COL1A1 (p=0.041) and ELN (p=0.01). In the tissue samples with a low WSS we also identified a significant over-expression of CCL2 (p=0.005) and COL1A1 (p=0.01).

Conclusions
Tissue samples from the slow WSS area with a proximal aortic diameter ≥50mm presented elevated levels of inflammatory response genes (i.e, CCL2). On the other hand, samples that were exposed to higher WSS demonstrated more relation to changes in the architecture of the connective fibres (i.e., elastin and collagen).

Acknowledgement/Funding
None
P6506Circulating microparticles preceding endothelial dysfunction and inflammatory process in patients with pseudoexfoliative glaucoma
Authors: Oikonomou E , Bourouki E , Moschos M , Siasos G , Siasou G , Gouliopoulos N , Paraskevopoulos T H , Papageorgiou N , Miliou A , Zacharia E , Mistakidi C V , Tousoulis D 
Published: October 2019

Abstract

Background
Pseudoexfoliative glaucoma (PEX) is a type of glaucoma characterized by the secretion of a grey-white, fibrogranular material in several tissues. Microparticles are shed membrane vesicles released from a variety of cell types in response to cellular activation or apoptosis and correlate with the pathogenesis of cardiovascular diseases. Endothelial MPs may be used as biomarkers of endothelial function.

Purpose
To evaluated the role of endothelial dysfunction, arterial stiffness and systemic inflammation in patients with PEX compared to patients with Primary open angle glaucoma (POAG) and control subjects as well as the possible pathophysiologic role of a specific microparticle profile associated with endothelial damage.

Methods
We enrolled 29 subjects with PEX, 57 subjects with POAG and 44 control subjects. Endothelial function was evaluated by flow-mediated dilation (FMD). Pulse wave velocity (PWV) was measured as an index of aortic stiffness and augmentation index (AIx) as a measure of arterial wave reflections. Growth differentiation factor-15 (GDF-15) and intercellular adhesion molecule1 (ICAM1) were measured to evaluate systemic inflammatory status. Total circulating MPs and EMPs were isolated and analysed by flow cytometry, utilizing specific labels for EMPs (CD 144+) and Annexin V staining for phospatidylserine bearing-MPs (AnnexinV + MPs).

Results
There was a linear impairment in FMD (p=0.005), PWV (p=0.007) and Aix (p=0.02) and a stepwise increase in GDF-15 (p=0.001) and sICAM-1 levels (p=0.08) between the three study groups (control, POAG, PEX). Interestingly, the PEX subjects expressed greater levels of total circulating MPs (Annexin V+) [1698 (1199–5894) MPs/μL vs. 1641 (1470–2705) MPs/μL. vs 493 (417–1512) MPs/μL, p=0.004] and EMPs (CD144+)[1412 (645–1760) MPs/μL3 vs 1380 (498–2496) MPs/μL vs 34 (184–870) MPs/μL, p<0.001] compared to POAG and control subjects.

Conclusion
Pseudoexfoliative glaucoma is associated with impaired endothelial function, arterial wall properties and vascular inflammation with a parallel increase in EMPs. Our findings indicate the significant role of endothelial damage in the progress of glaucomatous disease especially in subjects with pseudoexfoliative glaucoma.
P6519Transulnar approach vs. left radial access in STEMI patients: experiences from a single high volume center
Authors: Zafirovska Taleska B , Petkoska D , Jovkovski A , Vasilev I , Kitanovski D , Kedev S 
Published: October 2019

Abstract

Background
Transulnar and left radial artery approach are alternative wrist access sites from right TRA for coronary diagnostic and interventional procedures. Using wrist approach in all STEMI patients can decrease access site bleeding and vascular complications, improve patient outcomes and reduce MACCE, allowing rapid ambulation.

Purpose
To compare the results of the two most common wrist access crossover sites from right TRA in a large single center registry of consecutive STEMI PPCI patients.

Methods
From March 2011 until December 2017, 5048 consecutive STEMI patients that underwent catheterization were included in a single center prospective registry. Right radial access was used in 97% (4891) of patients. From the total number of STEMI patients, Transulnar approach was used in 95 (1.9%) patients. LRA was used in 43 (0.8%), TFA in 8 (0.1%) and TBA in 11 (0.2%). We compared two groups of patients with TUA and LRA by analyzing access site complications, procedural characteristics, procedural and fluoroscopy time.

Results
All procedures were successfully performed through TUA and LRA. Procedural time was slightly longer in STEMI patients with LRA transfer (41±16 vs. 38±16 min), but there was no significant difference between patients with TUA and LRA transfer in terms of fluoroscopy time (10±9.3 vs. 10±6.8 min), procedural success and vascular complications. Patients with TUA had significantly smaller number of anomalies 1% vs. 14% in LRA and were less prone to high degree spasm 1% vs. 4,6%. Both access sites had similar number of patients with multiple access site punctures 7.3% vs. 6.9%. Hand ischemia was not observed in any patient on day 1 after procedure and on 1 month follow-up. None of the patients showed nerve injury. Minor access site hematomas were similar with 2% EASY type 1 hematoma present in both groups.
TUA vs. LRA STEMI STEMI (n=5048) LRA TUA P value ACCESS 43 (0,8%) 95 (1,9%) Anomalies 7 (14%) 1 (1%) P<0,0001 Multiple punctures >3 3 (6,9%) 7 (7,3%) NA High grade spasm 2 (4.6%) 1 (1%) P<0.0001 Procedure time 41±16 min 38±16.4 min 0.0250 Fluoroscopy time 10±6.8 10±9.3 NA STEMI = ST segment elevation myocardial infarction; LRA = Left Radial Access; TUA = Transulnar Access.
TUA vs.LRA STEMI

Conclusion
Both transulnar and left radial access are safe and feasible alternatives to the default right radial approach, decreasing the need of TFA crossover in STEMI patients.
P6524The comparison of radial artery occlusion rate after distal radial artery puncture between hemodialysis and non-hemodialysis patients
Authors: Yokota S , Tobita K , Hayashi T , Mashimo Y , Miyashita H , Yokoyama H , Nishimoto T , Shishido K , Yamanaka F , Mizuno S , Murakami M , Tanaka Y , Takahashi S , Saito S 
Published: October 2019

Abstract

Background
In recent years it has been attempted to use a distal radial artery (DRA) as a puncture site for cardiac catheterization and intervention. A patency of radial artery is important in hemodialysis patients because the radial artery is source as an arteriovenous shunt. However, the incidence of radial artery occlusion (RAO) is not known after DRA puncture.

Purpose
To compare RAO rates after DRA puncture between dialysis and non-dialysis patients.

Method
This was retrospective, observational and single center study. All consecutive 1,533 patients undergoing DRA puncture were analyzed. The primary endpoint is RAO rates. The secondary endpoint is composite bleeding adverse event rates. These endpoints were evaluated by a vascular echocardiography several hours or the next day after the procedure.

Result
Among 1,533 patients, 26 were dialysis patients and 1,504 were non-dialysis patients. 1,386 people (90.5%) succeeded in puncture. Radial artery occlusion occurred in 7 patients (0.4%), all of whom were non-dialysis patients. There was no significant difference of RAO rate in dialysis patients and non-dialysis patients.

Conclusion
When performing DRA puncture, the probability of radial artery occlusion is not higher in dialysis patients than non-dialysis patients. The DRA puncture may be one of the option as puncture site even in dialysis patients.
P6527Patients discharged on the same day following elective PCI report equal satisfaction using health related quality of life instruments as compared to usual care: results from a randomized trial
Authors: Bogale N B , Melberg T M , Skadberg M S , Aasen G A , Nilsen D N , Barvik S B , Ogne C O , Bader M B , Bonarjee V B , Larsen A L 
Published: October 2019

Abstract

Background
Earlier observations in the era of femoral procedures using warfarin as the anticoagulant agent have shown safety following same day discharge after elective percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD). Procedures have evolved with most European centres adopting radial procedures with corresponding improvement in technique and equipment. Adoption of “radial lounges” has improved and simplified the observation routines with early ambulation. Antiplatelet therapy has also become more efficacious. The safety of same day discharge has been demonstrated. The economic benefit of such a strategy is significant with reported cost reductions of approximately 50%. Patient reported satisfaction is also shown to be comparable to standard care.
The current bed availability in health care facilities has made it a necessity to explore measures to reduce bed occupancy rates. Reduction in bed occupancy can further permit health personell to focus on other duties and obligations in wards with patients requiring hospitalization. Early discharge may cause anxiety and dissatisfaction among patients.

Purpose
The aim of our study was to evaluate safety and patient satisfaction of same discharge following uncomplicated elective radial access PCI.

Methods
Randomized controlled single center study. Eligible patients scheduled for elective PCI with radial access were prescreened following predefined inclusion and exclusion criteria. Health related quality of life instruments (HRQOL), Seattle Angina Questionnaire (SAQ), Short form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) were completed by the patients and received at base line and at 30 days post-procedure. All same day discharged patients were contacted by phone by a specialized study nurse the day after the procedure.

Results
517 patients were screened between November 2015 and November 2018 and 82 patients with mean age of 65 years were block randomized post-procedure. 38 patients were randomized to same day discharge after 6 hours of observation and 44 patients to standard care group which necessitated an overnight hospitalization. 11 female patients and 71 male patients were included.
No adverse events were registered in either group. No significant difference between groups were observed in the SAQ (treatment satisfaction score p=0.48, angina frequency scale p=0.58), SF-36 (SF vitality p=0.93) or HADS (HADS anxiety + depression p=0.15).
Changes of HADS score

Conclusions
Discharge on the same day following uncomplicated PCI for stable angina is safe and patient health related quality of life instruments confirm that patients are equally satisfied with this new care strategy when compared to usual care.

Acknowledgement/Funding
Stavanger University Hospital
P6541Wrist band photoplethysmography pulse morphology-based autocorrelation analysis enables atrial fibrillation detection without the need of pulse detection
Authors: Valiaho E.-S , Kuoppa P , Lipponen J A , Martikainen T J , Jantti H , Rissanen T T , Kolk I , Castren M , Halonen J , Tarvainen M P , Hartikainen J E K 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is often asymptomatic and intermittent making its detection a major clinical challenge. A photoplethysmography (PPG) wrist band with algorithm-based detection of AF provides a promising solution for screening of AF. However, the shapes of individual pulse waveforms vary in AF decreasing pulse detection accuracy.

Purpose
The purpose of this study was to evaluate the utility of PPG wrist band pulse morphology in detection of AF.

Methods
A 5-minute PPG was recorded with a PPG wrist band from patients with AF or sinus rhythm. A simultaneously registered ECG served as the golden standard for the rhythm analysis and was interpreted by two cardiologists. In addition to using the inter-beat-interval (IBI) based AFEvidence algorithm in comparison, we extracted a feature straight from the PPG signal, without the need of pulse detection. This feature was calculated as the average of absolute autocorrelation values over different lags. The feature describes the regularity of the PPG signal and is decreased if the shape and periodicity of pulse waves vary. The performance of this PPG morphology-based method in detection of AF was evaluated and compared to the AFEvidence.

Results
The study population consisted of 213 patients (106 AF, 107 sinus rhythm). The sensitivity and specificity of PPG morphology-based autocorrelation AF detection method were 98.1% and 94.4%. For AFEvidence, the sensitivity and specificity were 96.2% and 98.1%, respectively (p=0.146 between the methods, McNemar test).
PPG samples of AF and sinus rhythm

Conclusions
The PPG morphology-based autocorrelation method detects AF with good accuracy without the need of pulse detection. The method seems promising in detection of AF and should be studied further.

Acknowledgement/Funding
None