bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4661Increased levels of sST2 in patients with mitral annulus disjunction and ventricular arrhythmias
Authors: Scheirlynck E , Dejgaard L , Skjolsvik E , Lie O H , Motoc A , Hopp E , Tanaka K , Ueland T , Ribe M , Collet C , Edvardsen T , Droogmans S , Cosyns B , Haugaa K 
Published: October 2019

Abstract

Background
Mitral annulus disjunction (MAD), a basal displacement of the mitral valve annulus, is described as a possible aetiology of sudden cardiac death. Stretch-induced fibrosis in the sub-valvular apparatus has been suggested as the substrate of arrhythmias.

Purpose
We hypothesized that the stretch related biomarker soluble Suppression of Tumorigenicity-2 (sST2) is a marker of ventricular arrhythmias in patients with MAD.

Methods
We included patients with ≥1 mm MAD on cardiac magnetic resonance imaging, and recorded left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) suggesting papillary muscle fibrosis. Circulating levels of sST2 were assessed by blood sampling. The occurrence of ventricular arrhythmias, defined as aborted cardiac arrest, sustained or non-sustained ventricular tachycardia, was assessed retrospectively.

Results
We included 72 patients with MAD [55 (35–62) years old, 48 (67%) female], of which 22 (31%) had ventricular arrhythmias. Patients with ventricular arrhythmias had lower LVEF (60±6% vs. 63±6%, p=0.04), more prevalent papillary muscle fibrosis [14 (64%) vs. 10 (20%), p<0.001] and higher sST2 levels [31.6±10.1 ng/mL vs. 25.3±9.2 ng/mL, p=0.01] compared to those without. Combining sST2-level, LVEF and papillary muscle fibrosis optimally detected individuals with arrhythmias (area under the curve 0.82, 95% CI 0.73–0.92) and improved the risk model (p<0.05) compared to individual parameters (Figure right panel).

Conclusion
Circulating sST2 levels were higher in patients with MAD and ventricular arrhythmias compared to patients without arrhythmias. Combining sST2, LVEF and LGE may improve risk stratification in patients with MAD.

Acknowledgement/Funding
This work was supported by public grant [203489/030] from the Norwegian Research Council, Oslo, Norway. E. Scheirlynck received an ESC research grant
P4673Macitentan in chronic thromboembolic pulmonary hypertension (CTEPH): combined data from OPUS and OrPHeUS real-world data sets
Authors: Channick R , Chin K , Kim N , McConnell J , Poch D , Flynn M , Leber L , Morganti A , McLaughlin V 
Published: October 2019

Abstract

Introduction
The OPsumit® USers Registry (OPUS) provides real-world data in patients (pts) with pulmonary hypertension newly started on macitentan. The OPsumit® Historical USers cohort (OrPHeUS) study was conducted to supplement OPUS to fulfil the FDA request to characterise the safety of macitentan in clinical practice. Both studies included pts with CTEPH.

Purpose
To describe the characteristics and safety outcomes of CTEPH pts newly treated with macitentan.

Methods
OPUS is a prospective, US, multicentre, long-term, observational drug registry (NCT02126943) ongoing since Apr 2014. OrPHeUS was a retrospective, US, multicentre medical chart review (NCT03197688); data collected Oct 2013-Mar 2017. This subgroup analysis describes CTEPH patient characteristics at macitentan initiation, hospitalisations, survival and liver function tests (LFTs) in the combined OPUS/OrPHeUS data set. LFTs are also provided for the OPUS/OrPHeUS pulmonary arterial hypertension (PAH) population.

Results
As of Oct 2018, OPUS/OrPHeUS included 144 CTEPH pts with follow-up data. At macitentan initiation, median (Q1, Q3) age was 66 (56, 73) years; of the 53 pts with a WHO functional class (FC) assessment, 35.8%, 49.1% and 15.1% were in FC II, III and IV, respectively. Median (Q1, Q3) time from CTEPH diagnosis was 18.6 (7.4, 56.4) months (n=141). At macitentan initiation, 32.6% of pts had no PAH therapy, 63.9% were receiving one and 3.5% were receiving two PAH therapies. Median (Q1, Q3) exposure to macitentan was 15.9 (4.3, 30.4) months. There were 43 (29.9%) CTEPH pts who discontinued treatment; 23 due to an adverse event (AE), 0 due to a hepatic AE (HAE) and 20 not due to an AE/HAE. There were 58 (40.3%) CTEPH pts who experienced ≥1 hospitalisation and 9 (6.3%) pts died. LFTs are presented in the table.
LFTs CTEPH follow-up pts PAH follow-up pts (N=144) (N=4072) ALT or AST ≥3x ULN   Pts with ≥1 event, n (%) 1 (0.7) 132 (3.2)   Incidence rate per 1 person-year (95% CI) 0.005 (0.001, 0.035) 0.024 (0.020, 0.029) ALT or AST ≥3x ULN and total bilirubin ≥2x ULN   Pts with ≥1 event, n (%) 1 (0.7) 27 (0.7)   Incidence rate per 1 person-year (95% CI) 0.005 (0.001, 0.035) 0.005 (0.003, 0.007) ALT: alanine aminotransferase; AST: aspartate aminotransferase; CI: confidence interval; ULN: upper limit of normal.

Conclusions
Analysis of OPUS/OrPHeUS data provides further insight into real-world use of macitentan in CTEPH pts. The observed hepatic safety profile in CTEPH pts is in line with that of PAH pts.

Acknowledgement/Funding
Actelion Pharmaceuticals Ltd
P4692Pronostic factors after arterial switch operation for transposition of the great arteries in children
Authors: Blondel De Joigny C , Metton O , Ninet J , Galoin Bertail C , Bakloul M , Perouse De Montclos T , Leconte C , Mulatier C , Di Filippo S 
Published: October 2019

Abstract

The objective of this study was to assess long-term outcome and factors associated wih mortality in children after arterial switch operation (ASO) for transposition of the great arteries (TGA).

Material and methods
Retrospective analysis of all ASO performed from 2000 to 2016 in patients with TGA. Demographics, clinical and biological data, surgical techniques, echocardiographic measurements, and outcomes were collected. Pronostic factors for mortality were assessed.

Results
364 patients were included (263 males). Antenatal diagnosis was made in 60,4%. Birth weight was 3207,5±511.2g, gestational age was 39.1±1.6weeks. Intramural coronary artery was present in 24 cases (6.6%). Long term follow-up was 9.2±4.8 years. Rashkind procedure was performed in 88.7% of the cases. Ventilatory support was needed in 56% and prostaglandins in 85% preoperatively. ASO occurred at the age of 7.44±6.26 days (1 to 56) and 5.6±4.6 days after admission. Bypass duration was 123.1±33.3mn. Overall and postoperative hospital stay were respectively 19.9±8.6 and 14.4±7.3 days. Survival rates were 95.3% at 1 month, 94.8% at 3, 6 and 12 months and 94.5% at 2.5 years and up to 18 years after surgery. Twenty patients died (5.5%): 17 early postoperatively (4.7%). Time from surgery to death was 64.2±207.9 days (0 to 919). Long-term events occurred in 49.6% of the patients: pulmonary stenosis, aortic or mitral regurgitation, residual shunt, coronary lesions (1.7%), arrhythmias (5.5%), cardiac failure. Freedom from late reintervention was 99.7%, 97.4%, 96.2% at 1, 3 and 6 months, 95.9%, 95%, 92.3% and 90.3% at respectively 1, 2, 5 and beyond 8 years after ASO. No Rashkind, postoperative ECMO support, delayed chest closure, bypass duration, troponine level and small birth weight were significant predictive factors of mortality (respectively p=0.006, p<0.0001, p=0.0007, p<0.0001, p=0.001 and p=0.044). Antenatal diagnosis, gender, gestational age, preoperative ventilatory support, prostaglandin infusion, and SpO2, coronary arteries anatomy or age at surgery were not associated with death.

Conclusion
This study showed that Rashkind procedure may have a favourable impact on prognosis of neonates with TGA. Postoperative ECMO support and troponine level, and small birth weight were associated with worse outcome.
P4695Pulmonary hypertension in grown-up congenital heart disease, 2018 Nice classification. Impact on mortality. GUCH Registry data
Authors: Nicolosi L N , Moros C G , Rubio M C , Pacheco Otero M , Cazalas M , Faliva G , Sosa Liprandi A , Grippo M 
Published: October 2019

Abstract

Background
Pulmonary hypertension (PH) is a serious complication of grown-up congenital heart (GUCH) diseases. Its onset is associated with a marked increase in mortality in these patients.

Purpose
To classify GUCH patients with pulmonary hypertension (PH) according to PH subgroups, and explore association between PH and mortality during follow up.

Methods
An observational retrospective study was conducted on patients on the GUCH database. Overall data were analyzed. Patients diagnosed with PH were selected and classified according to the 2018 Nice HT guidelines on pulmonary arterial hypertension secondary to congenital heart disease: Group 1 (PAH1) and its 4 subgroups (SG1: Eisenmenger's syndrome; SG2: left to right shunts; SG3: PAH associated with congenital heart disease; SG4: post-operative PAH); Group 2 (PH2), Group 3 (PH3), Group 4 (PH4), Group 5 (PH5). Statistical analysis: Kaplan Meier Log Rank test using SPSS 20 software.

Results
The database included 2073 patients (P), mean age 31.8±12.9 years, 54.2% (1123 P) were women. Overall mortality: 4.2% (88 P). Follow up: 44.1±37 months. Results showed 5.1% of patients (105 P) had PH, 3.8% (79 P) of whom corresponded to group PAH1, and 1.3% (26 P) to the remaining groups. Analysis of P with PH showed that 67.6% (71 P) were women, mean age was 41.3±14.7 years, mortality during follow up was 25.7% (27 P). Classification according to group showed 75.2% (79) corresponded to PAHG1, 9.5% (10) to PH2, 0% to PH3, 1% (1) to PH4, and 14.3 (15) to PH5. Analysis of P in PAHG1 showed a 43% (34 P) prevalence of SG1, 27.8% (22 P) of SG2, 8.9% (7 P) of SG3, and 20.3% (16 P) of SG4. Mortality per group was 22.8% (18 P) in PAH1, 20% (2 P)in PH2, 0% in PH 3, 0% in PH 4, and 46.7% (7 P) in PH 5. Kaplan Meier survival curves showed significant association between PH and mortality, Log Rank=0.000, and worst survival in groups PH2, PAH1 and PH5. No differences in mortality were observed among PAH1 subgroups, Log Rank= 0.458.
Survival curves

Conclusions
PH negatively affected survival of GUCHpatients. Analysis of mortality during follow up showed patients in group PH5 to have the worst outcomes, possible because patients with a single ventricle were included in this group. Group PAH1 comprised 75% of PH patients, with a greater predominance of patients with Eisenmenger's syndrome, but no significant differences in mortality during follow-up among the 4 subgroups.
P4701Impact of statin therapy on EVT for PAD with decreased low-density lipoprotein cholesterol
Authors: Noto T 
Published: October 2019

Abstract

Background
The benefits of treating patients with peripheral artery disease (PAD) with statins are well established. Purpose
This study investigated the effects of statins on patients who presented with low levels of low-density lipoprotein (LDL) cholesterol, were diagnosed with PAD, and subsequently underwent endovascular treatment (EVT).

Methods
We evaluated 115 cases with PAD underwent EVT, 115 cases with LDL choresterol of 100 or less. The primary outcome was Low Limb event (LLE). LLE was defined as all cause death and amputation.

Results
We divided into two groups. Statin grous N=67, non-Statin group n=48. There were no significant significant differences prevalence of male gender, diabetes mellitus, hypertension, hemodialysis and critical limb ischemia between two groups. LLE of one year in statin group was significantly lower in non-statin group. (22.5% vs 40.5% P<0.05). Kaplan-Meier curve was shown in the Figure.
Kaplan-Meier curve

Conclusion
Statin treatment in patients with PAD demonstrated beneficial effects such as less amputation, even though both groups presented with low LDL cholesterol levels.
P4703Distal radial artery access using slender technique for superfitial femoral artery intervention
Authors: Ruzsa Z , Nemes B , Orias V , Csuhajda A , Sotonyi P , Merkely B 
Published: October 2019

Abstract

Purpose
The purpose of this pilot study was to evaluate the acute success and complication rate of the distal radial artery access for femoral artery intervention.

Methods and results
The clinical and angiographic data of 195 consecutive cases with symptomatic superficial femoral stenosis, treated via distal radial (DR) or proximal radial (PR) access using 6F sheathless guiding between 2014 and 2018, were evaluated in a pilot study. Secondary access was achieved through the pedal artery. Primary endpoint: major adverse events (MAE), rate of major and minor access site complications. Secondary endpoints: angiographic outcome, procedural factors, cross-over rate to femoral access site, and duration of hospitalization. Overall technical success was achieved in 186 patients (95.4%) with 25/26 (96.1%) success in DR and 161/169 (95.2%) success in PR group (ns). The cross over rate to femoral access site was 3.8% in DR and 4.7% in PR group (ns), while dual (transradial and transpedal) access was used in 9/26 (34.6%) patients in DR and 39/169 (23%) patients in PR group (p<0.05). Stent implantation was necessary in 8/26 (30.7%) cases in DR and in 42/169 (24.8%) cases in PR group (ns). CTO recanalization was performed in the DR and PR group with 94.1% (16/17) and 92.6% (79/81) technical success rate. The mean contrast consumption, fluoroscopy time and procedure time was in the DR and PR group was: 93.4 [78–108]ml vs 120 [108–131]ml, 662 [501–822]vs 769 [671–866]min, and 33.4 [27–39]vs 36.5 [32–40]min (ns), respectively. The rate of access site complications in the DR and PR group was 0% and 4.7% (0% major, 4.7% minor) (p p<0.001), respectively. The cumulative incidence of MAE at 3 months in the DR and PR group was 3.8% vs 10.6% (p<0.05).

Conclusion
Femoral artery intervention can be safely and effectively performed using distal transradial access and distal radial access is associated with lower access site complications.
P4736The Prognostic Impact of Volume Substitution on Cardiac Strain and the Development of Postoperative Atrial Fibrillation after Cardiac Surgery
Authors: Sulzgruber P , Pilz A , Schnaubelt S , Koller L , Kazem N , Hammer A , Laufer G , Steinlechner B , Fleck T , Toma A , Wojta J , Niessner A 
Published: October 2019

Abstract

Background
Postoperative atrial fibrillation (POAF) represents a common complication after cardiac valve or coronary artery bypass surgery. Etiologically, multifactorial causes such as the patients' age, weight, comorbidities or local remodeling proved a strong association with this common arrhythmia. While strain of atrial tissue is known to induce atrial fibrillating impulses, less attention has been paid to potentially strain-promoting values during the peri- and post-operative period. Therefore, we aimed to determine the association of peri- and post-operative volume substitution on markers of cardiac strain and subsequently its impact on the promotion and development of POAF.

Methods
In this prospective observational study 271 patients undergoing elective cardiac surgery in our Medical University were enrolled (median age: 69 years [IQR: 60–75 years]; 195 [72%] male gender). Intra- and post-operative data was collected from anesthesiologic and intensive care unit protocols. Multivariate binary logistic regression analysis was used to identify the prognostic value of volume substitution on the development of POAF.

Results
A total of 123 (45.4%) individuals developed POAF. The average intra-operative transfusion volume was significantly elevated in the POAF subgroup (605.6ml [POAF] vs. 227.1ml [non-POAF]; p<0.001). Moreover, the fluid balance within the first 24 hours after surgery was significantly higher in patients developing POAF (+1129.6 ml [POAF] vs. +544.9 ml [non-POAF]; p=0.044). We found that N-terminal pro brain natriuretic peptide (NT-proBNP) values were significantly elevated in patients that received any volume substitution (2860.0 pg/mL [Transfusion] vs. 1486.5 pg/mL [no-Transfusion]; p=0.002). In line with those results, the postoperative fluid balance was also found to have a direct and significant correlation with postoperative NT-ProBNP values (r=0.287, p=0.002). Of note, the amount of substituted volume proved to be a strong and independent predictor for POAF with an adjusted odds-ratio (OR) per one standard deviation (1-SD) of 2.49 (95% CI: 1.25–4.96; p=0.009).

Conclusion
Within the present analysis we were able to demonstrate that substitution of larger transfusion volumes presents a strong and independent predictor for the development of POAF. Via the observed distinct association with NT-proBNP values, it can reasonably be assumed that post-operative atrial fibrillating impulses are triggered via volume-induced cardiac strain.
P4737Complete surgical revascularization: the impact of the different definitions on mortality
Authors: Veiga Oliveira P , Madeira M , Ranchordas S , Brizido C , Nolasco T , Boshoff S , Marques M , Almeida M , Teles R , Calquinha J , Sousa-Uva M , Ventosa A , Abecassis M , Neves J P 
Published: October 2019

Abstract

Introduction
The concept of complete revascularization arises from the early stages on coronary artery bypass grafting (CABG). There are several different definitions applied across the literature, promoting a difficult comparison between studies. Despite the established importance of complete revascularization, there is no agreement which definition has the most impact on mortality.

Objectives
Evaluate the impact of the different definitions of complete surgical revascularization in late mortality.

Methods
Single center retrospective study of all consecutive patients submitted to isolated CABG with previous myocardial viability assessment (myocardial perfusion scintigraphy) from 2011 to 2016. Exclusion criteria: emergent procedures and previous cardiac surgery. The primary end-point was follow-up mortality (n=20). The population of study was162 patients with 22,2% female gender and a mean age of 66 years. The follow-up was complete in 98,8%, median time of 4,1 (IQR 3,0–5,5) years.
The completeness of revascularization was classified in all patients according to four different definitions (n=162 for each definition): Numerical (the number of stenotic vessels must equal the number of distal anastomoses applied); Functional (all ischemic myocardial territories are reperfused; areas of old infarction with no viable myocardium are not required to be reperfused); Anatomical Conditional (all stenotic main-branch vessels are revascularized) and Anatomical Unconditional (all stenotic vessels are revascularized, irrespective of size and territory supplied).
For each definition, statistical analysis was performed using the Kaplan-Meier method with log rank test and Cox proportional analysis (EuroSCORE II and revascularization definition).

Results
On univariate analysis, there was no significant statistical association between each definition of complete revascularization and follow-up mortality: numerical (p=0,694); anatomical unconditional (p=0,294); but a trend was found on functional (p=0,063) and anatomical conditional (p=0,084).
On multivariate analysis, incomplete functional revascularization increased the risk of follow-up mortality in 2,89 folds and anatomical conditional in 3,28 folds (Figure 1). The other definitions were not statistically associated with late mortality.

Conclusion
According to this study, complete functional and anatomical conditional revascularization definitions are determinants of follow-up mortality in a multivariate model including EuroScore II. The revascularization of all stenotic main-branch vessels (anatomical conditional) seems to have the highest impact, fact that we should be taken in consideration on daily work.
P4753Impact of renal function on bleeding risk in patients with non-valvular atrial fibrillation treated with direct oral anticoagulants: Subanalysis of the DIRECT registry
Authors: Hirata A , Sotomi Y , Kobayashi T , Amiya R , Hirayama A , Higuchi Y 
Published: October 2019

Abstract

Background
Renal dysfunction is one of the high bleeding risk factors in patients with atrial fibrillation as presented in the HAS-BLED score. The impact of renal function on bleeding risk is, however, still to be investigated in the era of direct oral anticoagulants (DOAC).

Methods
We conducted a single-center prospective observational registry of NVAF patients with DOACs: the DIRECT registry (UMINehz745.112933283). All patients with NVAF (N=2216) who were users of dabigatran (N=648), rivaroxaban (N=538), apixaban (N=599), or edoxaban (N=431) from 2011 to 2017 were enrolled (71.6±10.8 years, mean follow-up duration: 407.2±388.3 days). In the present substudy, all patients were stratified by renal function. Creatinine clearance (CCr) was estimated with the Cockcroft-Gault equations with available creatinine at baseline. Patients were divided into 4 groups based on CCr. (CCr>80, CCr50–80, CCr30–50, and CCr<30). The primary endpoint was major bleeding according to the ISTH criteria. Clinical endpoints were compared between the groups (Kaplan-Meier analysis, Log-rank test). The influence of DOAC type in patients with renal dysfunction was also assessed for the primary endpoints of major bleeding.

Results
Kaplan-Meier estimated 2-year major bleeding rate significantly increased as renal function decreased (CCr>80 2.5%, CCr50–80 4.2%, CCr30–50 4.2%, CCr<30 7.8%, Log-rank test p<0.001). However, in patients with apixaban (low CCr 59.6±25.9ml), major bleeding does not appear to increase as renal function decreased.(CCr >80 9.2%, CCr 50–80 8.0%, CCr 30–50 10.3%, CCr<30 7.3%, Log-rank test p=0.97).
Kaplan-Meier Analysis

Conclusions
Renal dysfunction increased bleeding risks in NVAS patients with DOACs. Apixaban might be safely used for patients with renal dysfunction.