bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5621Diagnostic accuracy of resting full-cycle ratio in the non-culprit artery of acute patients
Authors: Tamargo Delpon M A , Gutierrez E , Diez-Delhoyo F , Gonzalez-Saldivar H , Rivera A R , Casado A , Vazquez M E , Sanz R , Soriano J , Elizaga J , Fernandez-Aviles F J 
Published: October 2019

Abstract

Introduction
Resting full-cycle ratio (RFR) is a novel non-hyperemic index of coronary stenosis severity, independent of the timing within the cardiac cycle. Recent data has demonstrated good correlation between RFR and Fractional Flow Reserve (FFR) in stable coronary disease (SCD). However, there are no data regarding the reliability of RFR in non-culprit arteries of patients presenting with acute myocardial infarction (AMI).

Purpose
To study the diagnostic accuracy of RFR versus FFR in the non-culprit artery in AMI compared to stable lesions.

Methods
RFR, FFR, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR), and Resistance Reserve Ratio (RRR) were calculated in 67 patients with AMI and an intermediate lesion in a non-culprit artery (median time from primary PCI to study: 48 hours). Data were compared with those of a retrospective group of 66 patients with SCD.

Results
There was a higher proportion of males among patients of the AMI group (85% vs 62%, p=0.0026). Mean age was 64.5±11 years, being AMI cohort younger at presentation [62±11 vs 67±12 years in SCD cohort (p=0.04)]. Patients with AMI had a significantly lower prevalence of hypertension (52% vs 75%, p=0.006), diabetes (10% vs 32%), p=0.002) and hyperlipemia (37% vs 79%, p=0.002).
Coronary physiology parameters showed a non-normal distribution, and are expressed as median [IQR] (Table 1). In patients with AMI, FFR was lower than in patients with SCD. In contrast, RFR showed no significant difference. Both CFR and RRR were higher in the AMI group. No significant differences in IMR were found between cohorts.
Importantly, in the AMI group the correlation between RFR and FFR was 0.84 and the overall agreement 82%, with rates of false positive and negative of 15% and 3%, respectively. In SCD the correlation was 0.81 with a lower overall agreement of 69%, due mostly to a higher rate of false positive RFR (28%) (Figure 1).
Table 1. Microcirculatory parameters in non-culprit artery (AMI) and stable coronary disease (SCD) AMI (N=66) Stable (N=67) p value FFR 0.84 [0.76–0.9] 0.84 [0.76–0.9] 0.006 RFR 0.89 [0.82–0.94] 0,9 [0.84–0.94] 0.24 CFR 2.2 [1.7–3.1] 1.8 [1.1–2.6] 0.011 IMR 17 [14–27] 25 [14–38] 0.051 RRR 2.7 [2.17 - 3.9] 2.1 [1.4–3.1] 0.005 Median [IQR].
Figure 1. Correlation between RFR and FFR valueS

Conclusions
RFR shows a good correlation with FFR in AMI. Surprisingly, overall agreement is higher in the non-culprit artery in an acute setting, with a lower percentage of false positive results.

Acknowledgement/Funding
None
P5629The effect of strut protrusion on local shear stress and neointimal hyperplasia
Authors: Tenekecioglu E , Katagiri Y , Torii R , Pekkan K , Onuma Y , Serruys P W 
Published: October 2019

Abstract

Objective
To evaluate effect of strut protrusion (SP) on wall shear stress (WSS) and neointimal growth (NG) 1 and 5 year after implantation of Absorb scaffold.

Method
8 patients were selected from Absorb Cohort B. After 3-dimensional reconstruction of coronaries, WSS was quantified using Newtonian steady flow simulation (Figure). At 1-year neointimal thickness (NT) was measured by optical coherence tomography and correlated to WSS and SP post-procedure.

Results
Median SP was 112.9 (90.8, 133.1) μm. A logarithmic (log) inverse relationship between SP and post-procedure WSS (r=−0.425 p<0.001 correlation coefficients range: −0.143 to −0.553) was observed whereas a correlation between baseline log transformed WSS and NT (r=−0.451 p<0.001 correlation coefficients range: −0.140 to −0.662) was documented at 1 year. Mixed effects analysis between baseline log transformed WSS and NT at follow up yielded a slope of 30 μm/ln Pascal (Pa) and a y-intercept of 98 μm. As result of NG, flow area decreased from 6.91 (6.53, 7.48) mm2 post-implantation to 5.65 (5.47, 6.02) mm2 at 1 year (p=0.01) and to 5.75±1.37 mm2 at 5 years (p=0.024). Vessel surface with low WSS (<1 Pa) decreased from post-procedure (42%) to 1 year (35.9%) and 5 years (15.2%) (p-overall<0.0001).

Conclusion
SP disturbs laminar flow, creates region of low WSS that is mechanistically associated with NG and lumen area reduction. This observation would suggest thin strut with effective embedment would reduce NG and improve WSS towards physiological values.
P5633Diagnostic impact of resting full-cycle ratio as newly developed non-hyperemic indices for physiological lesion assessment
Authors: Takashima H , Suzuki A , Sakurai S , Ando H , Nakano Y , Watanabe A , Mukai K , Wakabayashi H , Kojima H , Sawada H , Saka Y , Fujimoto M , Tanabe S , Ohashi H , Amano T 
Published: October 2019

Abstract

Background
Although fractional flow reserve (FFR) is a gold standard method to evaluate functional lesion severity in the catheterization laboratory, the need of hyperemic condition limits the widespread adoption of FFR. Recently, the resting full-cycle ratio (RFR) which was newly developed resting indices was launched. It is unclear whether RFR as resting condition could assess physiological lesion severity of coronary artery stenosis. The aim of this study was to evaluate the diagnostic impact of RFR compared to FFR in entire range of coronary artery stenosis.

Method
A total of 53 patients with 70 lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis.

Results
In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.3±0.8mm, 44±12%, 14.6±7.2mm, 0.90±0.11, and 0.83±0.11, respectively. Functional significance was observed in 24 lesions (34%) of all lesions. The RFR showed a significant correlation with FFR (y = 0.800x + 0.239, R = 0.817, p<0.001). The Bland-Altman plot demonstrated a good agreement with a mean difference of 0.07 and a standard deviation of 0.06 between RFR and FFR across entire range of coronary artery stenosis. ROC curve analysis showed an excellent accuracy of RFR cut-off of ≤0.90 in predicting FFR ≤0.80 which had 78% sensitivity and 87% specificity (AUC 0.87, diagnostic accuracy 84%).

Conclusion
The RFR as newly resting indices is reliable to the assessment of functional lesion severity. This physiology-based approach may be a possible alternative method for FFR measurements in daily practice.
P5655Efficacy of new-generation atrial antitachycardia pacing for atrial tachyarrhythmias in patients with left ventricular dysfunction
Authors: Kamakura T , Nakajima K , Kataoka N , Wada M , Yamagata K , Ishibashi K , Inoue Y , Miyamoto K , Nagase S , Noda T , Aiba T , Yasuda S , Kusano K 
Published: October 2019

Abstract

Background
The progression to persistent atrial fibrillation (AF) is associated with a worse clinical outcome in patients with previous atrial tachyarrhythmias. New-generation atrial antitachycardia pacing (ATP) (Reactive ATP) reduced the progression to persistent AF in patients with pacemaker and preserved left ventricular (LV) function. However, little is known about the efficacy of Reactive ATP in patients with cardiac implantable electronic devices (CIED) and LV dysfunction.

Purpose
We aimed to investigate the efficacy of Reactive ATP for atrial tachyarrhythmias in patients with LV dysfunction (LV ejection fraction [LVEF] <40%).

Methods
This study included 423 patients with CIED and previous atrial tachyarrthythmias. Reactive ATP was programmed in 284 patients (ATP group) and 139 were implanted with a dual-chamber device without ATP function (control group). The differences in the success rate of ATP and incidence of progression to persistent AF (≥7 days) between the ATP and control groups were evaluated in 108 patients with LVEF <40% (reduced LVEF) and 315 with LVEF ≥40% (preserved LVEF). Patients with persistent AF were excluded from this study.

Results
During 710±337 days of follow-up period, 16 patients (15%) with reduced LVEF and 51 (16%) with preserved LVEF progressed to persistent AF (p=0.88). The mean ATP success rate was lower in patients with reduced LVEF than in those with preserved LVEF, although not statistically significant (reduced LVEF: 27.2±19.4% and preserved LVEF: 35.1±29.2%, p=0.12). The incidence of progression to persistent AF was significantly lower in the ATP group than in the control group both in patients with reduced and preserved LVEF (log-rank, reduced LVEF: p=0.0070 and preserved LVEF: p<0.0001) (Figure). Multivariate analysis showed that use of Reactive ATP and smaller left atrium were associated with lower incidences of persistent AF, while LVEF was not predictive of progression to persistent AF (Reactive ATP: hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.17–0.46, p<0.0001, left atrium diameter: HR 1.03, 95% CI 1.00–1.07, p=0.030).
Figure 1

Conclusions
Reactive ATP was effective in preventing AF progression in patients with LV dysfunction.
P5658Incorporation of severity of left atrial enlargement in clinical risk factors improves identification of patients at risk for development of atrial fibrillation
Authors: Chawla D , Olet S , Mortada M E , Zilinski J , Ammar K A , Nangia V , Bhatia A , Niazi I , Sra J , Tajik A J , Jahangir A 
Published: October 2019

Abstract

Background
Early identification of patients at risk for atrial fibrillation (AF) is desirable to prevent its development and complications. Clinical predictors have been recognized but need refinement to improve predictability. We evaluated whether severity of left atrial enlargement (LAE) added to a scoring system (CHA2DS2VASC) in an unselected non-AF population improves risk stratification for incident AF.

Purpose
To assess the incremental benefit of LAE severity added to CHA2DS2VASc in predicting future AF in non-AF patients.

Methods
From 2012–2017, consecutive adult patients with an echocardiogram and no prior AF were identified. CHA2DS2VASc was used to define baseline AF risk, and the incremental risk of AF with addition of LAE was assessed through increased LA volume index (LAVI; moderate 42–48 ml/m2, severe >48 ml/m2). To quantify improvement in risk prediction, logistic regression model was fitted and odds ratios (OR) and ROC curves obtained.

Results
Out of 155,597 patients with no prior AF, 13.8% developed AF over 1.5±1.3 years. OR for AF with CHA2DS2VASc was 1.68 (95% CI 1.66–1.69). With addition of moderately or severely increased LAVI to the model, OR for AF increased to 2.3 (2.2–2.5) and 3.8 (3.6–4.0), respectively. ROC analysis showed c-statistics of 0.66 with CHA2DS2VASc, 0.63 with LAVI, and 0.71 with incorporation of both (Fig).
AF CHAD score

Conclusion(s)
In non-AF patients, predictability for future AF can be improved by using clinical factors (CHA2DS2VASc) and increased LAVI. This information may guide closer monitoring and initiation of therapies to prevent progression to AF or stroke.

Acknowledgement/Funding
None
P5659Atrial fibrillation causes cognitive impairment-which cognitive domains are affected?
Authors: Pal T , German-Sallo M , Preg Z , Szentendrey D , Tripon R G , Nemes-Nagy E 
Published: October 2019

Abstract

Introduction
Hypertension is an important modifiable risk factor related to cognitive dysfunction. Data suggest that atrial fibrillation (AF) is also associated with an increased risk of cognitive decline, independent of stroke history. Few studies focus on the effect of AF on specific cognitive domains.

Purpose
We aimed in this study to investigate the prevalence of cognitive dysfunction among hypertensive patients with atrial fibrillation and to evaluate the impact of atrial fibrillation on the affected cognitive domains.

Methods
In the present paper, we included 488 consecutive hypertensive patients admitted to a Cardiovascular Rehabilitation Clinic aged between 37–93 years (mean age: 68±10 years; 51.84% female; 48.15% male). Diagnosis of AF was based on 12 lead ECG. All types of AF (paroxysmal, persistent and permanent) were included. The prevalence of atrial fibrillation in our sample was 23.77% (n=116), on admission mean heart rate was 76±16 bpm and mean blood pressure 137/82 mmHg (±19/11 mmHg). After routine clinical assessment all participants completed the Montreal Cognitive Assessment (MoCA) test used for the detection of mild cognitive impairment. Depression as a confounding factor on cognitive performances was detected with the shortened 13 items form of Beck Depression Inventory (BDI-13). We compared MoCA scores of the group of patients with atrial fibrillation with scores from the group in sinus rhythm. Statistical analysis was performed with the IBM SPSS v.20 program.

Results
Impairment in cognitive functions was revealed among hypertensive patients in sinus rhythm vs. with atrial fibrillation according to MoCA in 66.1% (n=246) vs. 81.9% (n=95). Cognitive scores were significantly lower in the atrial fibrillation group vs. patients in sinus rhythm: MoCA: 21.74 vs. 22.97 (p=0.016). The prevalence of depression in the two groups was not statistically different, AF 52.58% vs. 55.34% patients in sinus rhythm (p=0.89). Analysing MoCA's cognitive domains, patients with atrial fibrillation had significantly lower scores in visuospatial/executive (3.09 vs. 3.52 p=0.005), language (1.59 vs. 1.85 p=0.019) and abstraction (1.18 vs. 1.41 p=0.005) domains.

Conclusions
The prevalence of cognitive impairment is higher in patients with atrial fibrillation. Atrial fibrillation may have an impact on the most complex cognitive functions as visuospatial/executive, language and abstraction.

Acknowledgement/Funding
Funding for the study was provided by the Hungarian Academy of Science, contract nr. 0346/26.02.2016.
P5675Ischemic stroke in patient with sinus node disease in comparison to atrial fibrillation, bradycardia-tachycardia syndrome and other cardiac conditions: a nationwide cohort-study
Authors: Bodin A , Bisson A , Clementy N , Pierre B , Herbert J , Gaborit C , Guillon Grammatico L , Babuty D , Fauchier L 
Published: October 2019

Abstract

Atrial fibrillation (AF) may be associated with sinus node disease (SND) presenting as a brady-tachy syndrome (BTS), known to be at risk for embolic ischemic stroke (IS). It remains unclear whether the risk of IS is increased in patients with isolated SND.

Methods
This French longitudinal cohort study was based on the national database covering hospital care from for the entire population (PMSI) from 2010 to 2015. We compared incidences of IS in patients with a diagnosis of AF or SND to that in a control group of patients with a main diagnosis of cardiac condition (excluding those with AF or SND, history of stroke and mechanical valve or mitral stenosis).

Results
Of 1,732,412 patients included in the cohort, 1,601,435 (92.44%) had isolated AF, 102,849 (5.94%) had isolated SND and 28,128 (1.62%) had BTS. The control group with cardiac condition included 479,108 patients. Incidence of IS progressively increased when considering patients from the control population, patients with isolated SND, with BTS or with isolated AF (0.67%/yr, 1.95%/yr, 3.03%/yr and 5.48%/yr respectively). These differences were seen in all strata of CHA2DS2VASc score (table). SND patients with a CHA2DS2-VASc score ≥3 had a yearly incidence of IS >2%, comparable to AF population with a CHA2DS2-VASc score ≥1.
Incidence (%/year) of ischemic stroke CHA2DS2-VASc AF population SND population “Control” population Women Men Women Men Women Men All scores 6.72% 4.37% 1.93% 1.96% 0.67% 0.68% Score = 0 – 1.960% – 1.211% – 0.217% Score = 1 2.337% 3.046% 0.538% 1.486% 0.166% 0.345% Score = 2 3.917% 4.499% 0.879% 1.541% 0.298% 0.580% Score = 3 7.572% 4.733% 2.207% 2.084% 0.541% 0.907% Score = 4 7.016% 4.820% 2.363% 2.305% 0.930% 1.278% Score = 5 6.725% 5.345% 2.845% 2.849% 1.249% 1.553% Score = 6 7.637% 7.543% 3.319% 4.109% 1.737% 2.031% Score = 7 10.196% 13.927% 4.663% 7.708% 2.346% 4.089% Score = 8 17.654% 12.607% 8.519% 11.904% 2.446% 2.355%

Conclusion
Patients with isolated SND had a lower risk of IS than patients with AF or BTS. However, SND patients had a non-neglectable risk of IS during follow-up which was higher than in a “control” population. Whether oral anticoagulation may bring a significant clinical benefit might be studied in patients with SND at highest risk of IS.
P5680One-year outcomes of heart failure patients undergoing cardiac resynchronization therapy using adaptivCRT algorithm
Authors: Briongos Figuero S , Estevez A , Perez M L , Martinez-Ferrer J B , Alvarez-Costa L , Anguera I , Garcia E , Perez-Lorente F , Porres J M , Perez-Villascastin J M , Rodriguez J C , Munoz-Aguilera R 
Published: October 2019

Abstract

Background
Adaptive cardiac resynchronization therapy (aCRT) algorithm provides synchronized left ventricular (LV) only pacing and ambulatory optimization of the intrinsic atrioventricular and interventricular conduction intervals. Studies reporting morbidity and mortality outcomes of aCRT carriers in daily clinical practice are lacking.

Purpose
To determine in a real-life setting, whether 1-year outcomes were different among CRT carriers undergoing aCRT pacing and those under conventional biventricular (biV) pacing.

Methods
Symptomatic heart failure (HF) patients with sinus rhythm undergoing first CRT-defibrillator implant were selected from the UMBRELLA nationwide registry (2012–2017). The primary endpoint was the composite of all-cause mortality or HF hospitalization at 12-month follow-up. HF admission was defined as hospitalization due to symptoms requiring intravenous diuretic treatment. Primary healthcare records were used to prospectively collect all data.

Results
Two hundred and six patients were collected (66.1±8.7 years; 73.3% male). Eighty-seven out of 206 patients were implanted with an aCRT capable device, but this algorithm was activated at implant and remained enabled at 1-year in 59 patients (aCRT group). The other 147 patients composed the non-aCRT group. At implant left bundle branch block was present in 93% of patients, 69.6% of population was in functional class III or IV and mean left ventricle ejection fraction was of 26.5±5.6%. Non-ischemic cardiomyopathy was present in 63.1% of patients and optimal medical treatment was achieved in majority of population (92% of patients with beta-blockers; angiotensin-converting enzyme inhibitorsor angiotensin II receptor blockersin 89%). The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). In aCRT patients, LV-only pacing accounted for a mean of 53.3±37.6% of all ventricular pacing.
After 12-month follow-up period, 25 patients (12.1%) met the primary composite endpoint of death or HF hospitalization. Nine patients died and nineteen patients were admitted due to worsening HF. There was no difference in the risk of all-cause death or HF hospitalization between aCRT and non-aCRT patients (10.2% vs. 12.9% respectively; OR=0.76, CI: 0.29–2.01, p=0.585)

Conclusions
In this contemporary cohort of HF patients undergoing CRT with high percentages of ventricular pacing, clinical performance of aCRT algorithm was adequate. The risk of death or HF hospitalization was low and no differences were observed at one-year follow-up. Future randomized studies will clarify the role of this algorithm in CRT carriers.

Acknowledgement/Funding
None
P5689First intention epicardial VT ablation: what are the results?
Authors: Graca Rodrigues T E , Cortez-Dias N , Silva G L , Agostinho J R , Aguiar-Ricardo I , Rigueira J , Nunes-Ferreira A , Santos R , Cunha N , Morais P , Pereira S , Silverio-Antonio P , Carpinteiro L , Pinto F J , Sousa J 
Published: October 2019

Abstract

Introduction
Ventricular tachycardia (VT) endocardial mapping and ablation may not be sufficient in several arrhythmogenic contexts, because ventricular myocardium may comprise intricate endocardial, intramural and epicardial substract. Thus, epicardial ablation has lately become a complementary and necessary tool to approach some VTs in different types of cardiomyopathies.

Purposes
To evaluate the clinical characteristics of patient most suitable for first intention epicardial VT ablation and to describe our centre experience.

Methods
Single-centre prospective study of consecutive patients (pts) undergoing isolated first intention epicardial VT mapping and ablation since August 2015. All pts had clinical assessment, electrocardiogram (ECG), echocardiogram and cardiac magnetic resonance when feasible. Pts with a previous endocardial ablation were excluded. Epicardial subxiphoid access utilizing a tuhoy needle was performed under fluoroscopic guidance. High-density mapping was performed using CARTO® V4 and EnSite PrecisionTM systems and multipolar catheters. Radiofrequency energy was applied with an irrigated-tip catheter.

Results
First intention epicardial VT ablation was attempted in 12 pts (mean age 57.6±14.6 years, 91% male). The majority had non-ischemic dilated cardiomyopathy, of unknown aetiology in 59%, hereditary dilated cardiomyopathy in 17% ethanolic origin in 8% and post-myocarditis in 8%. Right Ventricular Arrhythmogenic Cardiomyopathy was present in 1 patient. As expected, our population presented a mean ejection fraction of 29% and 11 pts (92%) had an implantable cardioverter defibrillator - ICD (55% as primary prevention, 45% as secondary prevention). All pts had experienced symptomatic VT, with all ICD carriers receiving appropriate shocks. Only 4 pts had an available 12 lead ECG of the VT, and all of them had a QS pattern in lead aVL and a slurred initial QRS complex. The majority of patients presented low voltage areas and local abnormal ventricular activities at the epicardial surface, with the exception of 2 pts in whom ablation was not performed (one non-ischemic cardiomyopathy of ethanolic aetiology and the other of unknown origin). Mean ablation application time was 68 minutes, with an average maximum power of 39.9 watts. Mean overall procedure and fluoroscopic time was 132 and 24 minutes, respectively, with no major intraprocedural complications. During a mean follow-up of 307±328 days, 3 pts died (mean 121 days after procedure), 3 had recurrent VT episodes and ICD shocks, and 2 received heart transplant.

Conclusion
In selected pts, with non-ischemic dilated cardiomyopathy and ECG with QS pattern in aVL and slurred QRS, epicardial VT mapping and ablation may be used as first approach, preventing unnecessary endocardial mapping. This procedure demonstrated to be safe.