bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3678Pulmonary artery ablation during open mitral valve surgery for pulmonary artery hypertension: a prospective randomized study
Authors: Bogachev-Prokophiev A V , Zalesov A , Afanasyev A V , Sharifulin R M , Ovcharov M A , Karaskov A M 
Published: October 2019

Abstract

Purpose
Recent investigations of pulmonary artery (PA) ablation into the treatment of idiopathic pulmonary artery hypertension (PAH) have suggested improvement of functional capacity, and hemodynamics. We investigated the impact of PA ablation in patients with PAH due to left heart disease (Dana Point, 2008) scheduled for open-heart mitral valve surgery.

Methods
Fifty patients aged 52±10 with mitral valve disease complicated severe PAH (mean PAP >40mm Hg) were randomly assigned to mitral valve surgery with or without PA ablation procedure. Eligible criteria: positive reactive test with nitric oxide inhalation (decrease of mean PAP more than 10 mm Hg without decrease of cardiac output). There were no between group differences in preoperative characteristics.

Surgical procedure
After bypass is establishedthe fibrous fold of pericardiumand the ligamentum arteriosum are dissected out, and the branches of the right and left pulmonary artery are mobilized well out into the hilum of the lungs bilaterally. PA ablation was performed epicardially at the bifurcation of the main PA, and 10 mm distal to the right and left PA's using AtriCure Isolator®multifunctional pen.
Serial assessment of echocardiography, right heart catheterization (catheter Swan-Ganz), and 6-min walk test (6MWT) were performed during hospital stay. The primary endpoints were the change of meanpulmonary artery pressure (PAP)and 6MWT. The secondary endpoints were hospital mortality, freedom from PADN-related complication: PA perforation, PA dissection, and PA thrombosis (MDCT assessment).

Results
There were no early deaths. No procedure-related complications were observed.
On first day after surgery patients from ablation group showed significant reduction of mean PAP (from 50.6±5.3to 34.6±9.9 mm Hg, p<0.001), and significant improvement of 6MWT at discharge (from 229±34 m to 475±21 m, p<0.001). On first day after surgery patients from control group also showed significant reduction of mean PAP (from 51.3±6.3to 47.2±8.5 mm Hg, p=0.011), and significant improvement of 6MWT at discharge (from 249±32 m to 335±18 m, p<0.001). Nevertheless, there was significant between group difference in mean PAP on first day after surgery (34.6±9.9 mm Hg, vs 47.2±8.5 mm Hg, p=0.005). Moreover there was significant differences in 6MWT at discharge (475±21 m vs 335±18 m, p=0.002) with benefit to ablation group.
Epicardial pulmonary artery ablation

Conclusions
We report for the first time the effect and superiority of PA ablation on functional capacity and hemodynamics in patients with mitral valve disease complicated PAH. Epicardial PA ablation for the treatment PAH can be effectively and safely performed during open heart surgery.

Acknowledgement/Funding
None
P3685Can 3D echocardiography give a contribute to the diagnosis of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)?
Authors: Mazzanti A , Addetia K , Maragna R , Yamat M , Pagan E , Monti L , Bagnardi V , Priori S G 
Published: October 2019

Abstract

Background
The diagnosis of ARVC is based on the structural assessment of the heart with 2D echocardiography (2DE) and cardiovascular MRI (CMR) to detect the presence of global and segmental right ventricular (RV) abnormalities. Little is known about the diagnostic value of 3D echocardiography (3DE) in ARVC. The aim of this study was to assess whether a combination of 2DE and 3DE could replace 2DE and CMR combination with similar diagnostic accuracy in patients with suspected ARVC.

Methods
Thirty-nine subjects (59% males, 47±15 years, 41% with desmosomal mutations) with suspected or confirmed diagnosis of ARVC underwent evaluation of the RV with the use of CMR, 2DE, 3DE.
3DE and CMR were independently used to obtain RV volumes, ejection fraction and presence of segmental RV abnormalities. These studies were blindly classified as meeting none, minor, or major criteria for ARVC in accordance with the 2010 TFC. Kappa statistics were used to assess the concordance between 2DE-CMR and 2DE-3DE diagnostic approaches.

Results
Using the 2DE-CMR approach, patients were classified as follows: 5 not affected, 8 with possible, 9 with borderline and 17 with definite ARVC diagnosis. The evaluation of TFC criteria with the 2DE-3DE approach yielded a high degree of concordance with the standard of care (2DE-CMR approach, K=0.93 with 95% CI: 0.84–1.0). There was complete agreement between the 2DE-CMR and 2DE-3DE approaches for individuals with definite ARVC diagnosis (n=17) and in individuals not affected by ARVC (n=5). Two patients with possible and borderline ARVC diagnosis using the 2DE-CMR approach were confirmed as definite ARVC with 2DE-3DE approach.
Contribution of 3D echo to ARVC

Conclusions
The use of 2D and 3D echocardiography allows bedside evaluation of patients with suspected ARVC, which is diagnostically comparable to that obtained using the traditional combination of 2DE-CMR. This information is particularly relevant for patients who cannot undergo CMR such as patients with ICD.
P3706Atrial fibrillation with CHA2DS2-VASC =0. Really no need for anticoagulation?
Authors: Cosmi D , Mariottoni B , Cosmi F 
Published: October 2019

Abstract

Background
Based on the ESC guidelines on Atrial Fibrillation, oral anticoagulation is recommended in male patients with CHA2DS2-VASC score ≥1, in females if CHA2DS2-VASC is ≥2. In our research, we evaluated if there are patients at risk of significant thromboembolic events among those whose CHA2DS2-VASC score is apparently = 0, that could benefit of anticoagulant therapy.

Methods
Over the last 12 years, 20,154 outpatients were evaluated in our clinics. We found the presence of non valvular atrial fibrillation in 3.043 (15.1%) patients. In 176 (5.7%) of them the CHA2DS2-VASC was = 0. None of them, as suggested in the guidelines, received oral anticoagulants or antiplatelet drugs. In these patients, we evaluated the presence of other two important cardiovascular risk factors, not included in CHA2DS2-VASC score: cigarette smoking and hypercholesterolemia.

Results
Smoking patients were 70, of whom heavy smokers (≥20 cigarettes/day) were 32. Patients with LDL cholesterol>115 mg/dl were 55. During one year follow-up, 3 of 176 patients (1.7%) with CHA2DS2-VASC score = 0 had a stroke. These patients were all heavy smokers and one of them also had high LDL values; they didn't show significant carotid stenosis or carotid dissection. None of the patients was found to have thrombophilic disorders.
Transthoracic echocardiogram was performed, resulting negative for patent foramen ovale, ventricular dysfunction, or masses.
All patients underwent 24 hours blood pressure monitoring, and it was found that all of them had masked hypertension; lower extremity arterial evaluation revealed mild, asymptomatic peripheral arterial disease, with ABI <0.9. No events occurred in patients with elevated LDL, not heavy smokers.
The risk of stroke in the population of heavy smokers, even if CHA2DS2-VASC score was apparently = 0, was 9.3%, with a clear indication for anticoagulation.

Conclusions
In heavy smokers patients with atrial fibrillation, CHA2DS2-VASC score could apparently be =0, when they are only clinically evaluated. In fact, these patients often have asymptomatic peripheral arterial disease of the lower limbs and masked hypertension.
Our research highlights how in some subgroups of patients there could be some “hidden” risk factors, that we should keep in mind and closely search for when evaluating the risk of cardioembolic stroke, that remains high.
P3715Impact of sleep-disordered breathing on short-term functional outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis using holter-monitoring
Authors: Kang D O , Kim C K , Park Y , Jang W Y , Kim W , Choi J Y , Choi C U , Na J O 
Published: October 2019

Abstract

Background
Sleep-disordered breathing (SDB) assessed by conventional polysomnography is reported to have close association with worsened clinical outcomes in patients with ischemic stroke. The cardiopulmonary coupling (CPC) analysis using Holter-monitoring is an easily assessable method to evaluate SDB. However, its prognostic impact needs to be investigated.

Purpose
The present study investigated the prognostic impact of SDB defined by CPC analysis using Holter-monitoring at early stage of ischemic stroke on the functional disability at 3-month follow-up.

Methods
Total 692 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. We investigated the association between SDB and functional disability at 3-month measured by modified Rankin scale (mRS).

Result
The NB coupling was present in 216 (31.2%) of 692 patients with mean age of 64.2±12.8 years. The NB group showed significantly higher proportion of severe functional disability (mRS ≥3; 45.3% vs. 12.3%, p<0.001) and persistent disability (ΔmRS≤0; 42.6% vs. 56.4%, p<0.001) after 3-month. In multivariate analysis, the presence of NB coupling was an independent predictor of higher risk of both severe and persistent functional disability (HR: 3.97; 95% CI: 2.37–6.64; p<0.001; and HR 1.92; 95% CI: 1.34–2.77; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 175 patient pairs (C-statistics=0.759).
Parameters of functional disability Overall population (n=692) PSM population (n=350) no NB (n=476) NB (n=216) OR (95% CI) p-value no NB (n=175) NB (n=175) OR (95% CI) p-value Initial NIHSS ≥5 89 (18.6) 81 (37.5) <0.001 52 (29.7) 52 (29.7) >0.999 Discharge mRS ≥3 146 (30.6) 126 (58.3) <0.001 90 (51.4) 89 (50.8) 0.915 3-month mRS ≥3 59 (12.3) 98 (45.3) 5.86 (4.00–8.60) <0.001 38 (21.7) 72 (41.1) 2.52 (1.57–4.02) <0.001 3-month ΔmRS ≤0 (persisent disability) 203 (42.6) 122 (56.4) 1.74 (1.26–2.41) 0.001 77 (44.0) 100 (57.1) 1.69 (1.11–2.58) 0.014 Data are expressed as n (%). mRS = modified Rankin's scale; NB = narrow-band; NIHSS = National Institutes of Health Stroke Scale; OR = odds ratio; PSM = propensity-score matched.
Functional disabilities after 3-month

Conclusion
SDB assessed by CPC analysis at early phase of ischemic stroke was able to predict both greater and persistent functional disability at 3-month. The CPC analysis using Holter-monitoring is a useful modality for predicting functional disabilities in acute ischemic stroke.
P3719Myocardial injury during TAVI with self-expanding prosthesis is not associated with patient-prosthesis features, hemodynamics or clinical outcome
Authors: Johnsen M S , Kelly I E , Askevold E T , Hoffmann P , Opdahl A , Al-Ani A , Von Lueder T G 
Published: October 2019

Abstract

Background
Transcatheter aortic valve implantation (TAVI) has been associated with increases in markers of myocardial injury but underlying mechanisms as well as relevance for prosthesis hemodynamics, cardiac function and clinical outcome remain unclear.

Purpose
To study the trajectory of high-sensitivity troponin T (hs-TnT) during TAVI and elucidate putative associations with demographics, anatomical and procedural features, as well as clinical and echocardiographic outcome.

Methods
This prospective real-world registry study included all patients (n=275) undergoing transfemoral TAVI using a self-expanding or balloon-mounted system at a large tertiary university hospital over the most recent three-year period. Plasma levels of hs-TnT (reference level 0–14 ng/l) at 24 hours (h) before TAVI and at 9h, 18h, 30h, 42h and 72h after TAVI were analyzed. Patients with ongoing myocardial ischemia and acute coronary syndrome were excluded. We studied the association between hs-TnT values and patient characteristics, echocardiographic and CT findings at baseline as well as procedural features including the use of pre- and postdilatation. Moreover, we studied the association between hs-TnT and and echocardiography and clinical outcome at 1 year after TAVI.

Results
In this real-world TAVI cohort (median age 83.2±0.2 years; 48.7% women; 5.2±0.2 comorbidities; eGFR 58.0±6.0 ml/min/1.73m2; mean±standard error), 100% of patients exhibited significant elevations of hs-TnT at approximately 9-fold (207.0±11.0) compared to baseline (23±0.2 ng/L, median±SE). Peak hs-TnT values were reached at 9 h post-TAVI (207±11 ng/L) with subsequent gradual decline (figure). Myocardial injury was confirmed by elevated creatin kinase (CK) and CKMB isozyme. No significant association was found between peak hs-TnT, delta hs-TnT (peak minus baseline values) or area under the curve (AUC) of hs-TnT on the one hand, and patient demographics including renal dysfunction, comorbidity, age and gender on the other side. Moreover, no significant association between hs-TnT and anatomical features, prosthesis sizing, or use of pre- and postdilatation was found. No association between hs-TnT during TAVI and NYHA functional class, transvalvular pressure gradient, cardiac function or survival at 1 year was found. In subjects with at least one year of follow-up after TAVI (n=138), NYHA functional class (1.7 vs 2.7) and NT-proBNP plasma levels (1126±316 vs 1581±563 ng/L) were significantly lower compared to pre-TAVI.

Conclusions
Modest transient elevations of hs-TnT occur in all patients undergoing TAVI and are consistent with subtle myocardial injury. The lack of significant association between the extent of myocardial injury during TAVI and clinical and hemodynamic outcome as well as all-cause mortality is reassuring for current real-world practice.
P3720Cerebral near-infrared spectroscopy monitoring during transcatheter aortic valve implantation
Authors: Seppelt P C , Mas S , Lotz G , Meybohm P , Zacharowski K , Fichtlscherer S , Zeiher A M , Vasa-Nicotera M 
Published: October 2019

Abstract

Introduction
Stroke and transient ischemic attack (TIA) are important periprocedural cerebrovascular complications of transcatheter aortic valve implantation (TAVI). Regional cerebral O2 saturation is an indicator for cerebral perfusion and can be measured in real-time and noninvasively by near-infrared spectroscopy (NIRS). In this pilot study we evaluated the feasibility and utility of NIRS during TAVI.

Methods
Regional cerebral O2 saturation (rScO2, bihemispheric) was measured by near-infrared spectroscopy during 32 transfemoral TAVI procedures (female 56.3%, mean age 81.8 years). All patients received conscious sedation and O2-supplement if peripheral oxygen saturation (SpO2) was below 95%. Baseline rScO2 was measured at the beginning of the procedure, as well as before, during and 5min after rapid pacing for valve deployment.

Results
Mean preoperative mini mental state examination score was 26.5 points (theoretically max. 30 points, >24 points no severe cognitive impairment). Two-third of the patients (n=21) required oxygen supply (mean 4.0 l/min) during the TAVI procedure. Mean baseline rScO2 was 59.3% with no differences between both cerebral hemispheres (left 60.3% vs. right 58.7% p=0.23). Compared to baseline rScO2 and rScO2 assessed immediately before rapid passing, rScO2 dropped significantly during rapid pacing (59.3% vs. 51.8%, p<0.01 and 60.9% vs. 51.8%, p<0.01 respectively). Five minutes after rapid pacing rScO2 values had normalized again (post rapid pacing 60.9% vs. 51.8% during rapid pacing, p<0.01; baseline 59.3% vs. post rapid pacing 60.9%, p=0.51). Intraprocedural cerebrovascular events were observed in two cases. One patient developed a left-sided hemiplegia (stroke, later verified by cerebral CT scan) and one patient a transient tremor of the left upper extremity (TIA, new hemorrhagic or ischemic event ruled out by cerebral CT scan). In both cases we observed an abnormal sudden rScO2 decrement by the corresponding right hemispheric NIRS sensor (left-right hemisphere sensor: 60% vs. 44% and 63% vs. 48% respectively).

Conclusion
Regional cerebral O2 saturation, an indicator for cerebral perfusion, decreases significantly during rapid pacing of TAVI procedure. Furthermore, rScO2 measurement by NIRS may be helpful to detect cerebrovascular complications early during TAVI procedure.
P3722Platelet reactivity changes following transcatheter aortic valve implantation
Authors: Ostojic Z , Samardzic J , Reskovic Luksic V , Pavasovic S , Skoric B , Separovic Hanzevacki J , Milicic D , Bulum J 
Published: October 2019

Abstract

Introduction
Although recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI), precise time course and duration of these changes have not been fully investigated.

Purpose
To investigate PR changes during and after TAVI.

Methods
Study included 42 consecutive patients with severe and symptomatic aortic stenosis undergoing TAVI procedure in our institution. Patients' clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses for next three months. PR was measured in six time points: just before induction of anaesthesia (T1), after heparin administration (T2), at the end of procedure (T3), and on 3rd, 6th and 30th postoperative day (T4–6). PR was measured using impedance aggregometer (Multiplate® analyzer, Roche, Munich, Germany) in response to three platelet aggregation agonists: arachidonic acid (ASPItest), ADP (ADPtest) and thrombin receptor activating peptide-6 (TRAPtest).

Results
Mean patient age was 82.1 years with majority of patients being male 57.1% (N=24). Mean valve area and mean transvalvular gradient prior to procedure were 0.71±0.21 cm2 and 49.1±18.7 mmHg, respectively. All patients underwent successful TAVI procedure using either self-expandable (N=25, 59.5%) or balloon-expandable valve. Two patients (4.7%) underwent transapical TAVI, while transfemoral approach was used in all other patients. Mean postimplantation gradient was 10.2±7.1 mmHg.
Mean PR on T1 was 24.3±23.1 U for ASPItest, 41.6±26.5 U for ADPtest and 90.1±33.3 U for TRAPtest. There was no significant difference in PR on T2. However, on T3, ignificant reduction of PR in all 3 tests was observed (ASPI 9.4±10.1 U (p=0.001), ADP 23.1±15.0 U (p<0.001) and TRAP 64.5±27.3 U (p<0.001)). Lowest PR values for all tests were reached on T4, after which incline in PR has been observed. On T5, value of ASPItest reached levels not significantly different to those on T1 (15.1±17.2 U, p=0.13), while ADPtest and TRAPtest remained significantly lower (27.3±18.5 U, p=0.007 and 68.6±33.2 U, p=0.003, respectively). All PR values returned to initial levels on T6 (figure 1).

Conclusions
Our results show that successful TAVI procedure induces transient decrease in PR regardless of the platelet activation pathway. These findings add new knowledge in understanding complexed relations in intravascular milieu following TAVI. Further research on a larger number of patients is needed to confirm and asses clinical significance of these results.

Acknowledgement/Funding
Croatian Science Foundation
P3736Predictors of access site complication in transfemoral transcatheter aortic valve implantation
Authors: Potratz M , Kramer N , Mohemed K , Scholtz S , Scholtz W , Rudolph V , Bleiziffer S , Rudolph T K 
Published: October 2019

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is an increasing common treatment option for patients (pts) with symptomatic severe aortic stenosis (AS). Despite its proven effectiveness and decreasing complication rate, vascular access site complications still occur in 5–7% of the cases and are associated with increased mortality and morbidity.

Purpose
The aim of this study was to analyze pts with vascular complications during TAVI procedure to better understand underlying mechanisms and aid future risk stratification.

Methods
From our ongoing single center TAVI registry encompassing over 1600 pts, we recruited 200 pts with vascular complications. By using propensity score 1:2 matching 400 controls without vascular complications were identified. Matching was done for peripheral vascular disease, age, gender, sheath size and BMI using the nearest neighbor algorithm. In the femoral artery, a localized, upward calcium scoring over 10 cm starting from the bifurcation was conducted in all pts using the 3mensio structural heart software ver. 8.0 (Pie Medical Imaging BV). Comparison between groups was done using the t-test. Multiple regression analysis was used to identify risk factors independently associated with vascular complication.

Results
Using VARC-2 definitions 22 (11%) pts classified as major and 178 (89%) as minor vascular complications. Patients with vascular complications had a significantly longer duration of hospitalization 17.1 days vs. 14.4 days (p=0.001), were more often on oral anticoagulation in 22.3% vs. 15.1%, (p=0.03) and had low preprocedural hemoglobin (11.8 vs. 12.1 (p=0.03). Vascular complications resulted in significantly higher 30 day mortality (7.4% vs. 3.2%, p=0.02). Detailed analysis of the femoro-iliacal vessels showed a higher percentage of kinking (50.5% vs. 33%, p = <0.001) in pts with vascular complications, however the calcium score was not significantly different (269.57 vs. 267.18, p=0.94). Of interest, pts with major vascular complications had a significantly higher calcium score as compared to controls (500.3 vs. 267.2, p=0.002). Major complications also translated in an even higher mortality after 30 days (18.2% vs. 3.2% (p = <0.001) and hospitalization time (days): 27.7 vs. 14.5 (p = <0.001) Multiple regression analysis identified vascular kinking (p = <0.001) and oral anticoagulation (p=0.04) at admission to be independent risk factors for vascular complication in the overall cohort whereas calcium score was only predictive for major vascular complications (p=0.04)

Conclusion
This study confirms that vascular complications during TAVI are associated with increased 30 day mortality and longer hospitalization. Patient dependent factors are the main predictors for vascular complications and should be considered thoroughly.