bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2691Excimer laser coronary angioplasty can achieve favorable clinical outocomes for in-stent restenosis lesion with neoatherosclerosis
Authors: Matsuhiro Y , Nishino M , Nakamura H , Yasumoto K , Tanaka A , Nakamura D , Matsunaga Y , Yano M , Yamato M , Egami Y , Shutta R , Tanouti J 
Published: October 2019

Abstract

Background
Recent reports revealed that residual area stenosis (% AS) ≤30% after lesion preparation is a suitable predictor for target lesion revascularization (TLR) after drug-coated balloon (DCB) treatment for in-stent restenosis (ISR). Excimer laser coronary angioplasty (ELCA) can obtain larger lumen area and may be more useful for lesion preparation than plain old ballooning (POBA). On the other hands, it has been reported that in-stent neoatherosclerosis (NA) is major cause of restenosis. It is unclear the correlation between NA of ISR and the effect of ELCA. Thus, we compared the influence of NA which was evaluated by optical coherence tomography (OCT) on % AS for ISR treatment between ELCA and DCB (ELCA) group and POBA and DCB (non-ELCA) group and their clinical outcome.

Methods
We enrolled 58 consecutive ISR lesions which were treated by OCT guidance between July 2014 and July 2018 in our hospital. The lesions were divided into NA and non-NA lesions according to OCT findings. In each lesion, we compared post procedural % AS and % AS change which was calculated by the difference between pre and post procedural % AS between ELCA and non-ELCA groups. In addition, we compared 8-month major advance cardiac events (MACE) defined by composite of binary restenosis and target lesion revascularization (TLR) between ELCA and non-ELCA group in NA lesions.

Results
There were 19 NA (33.3%) and 39 non-NA lesions. In NA lesions, ELCA group can obtain significantly lower % AS (p=0.02) and significantly larger % AS change (p<0.01) than non-ELCA group, but in non-NA lesions, % AS and %AS change were similar between ELCA and non-ELCA groups (table). In 8-month clinical outcome, non-ELCA group experienced MACE twice as much as ELCA group did. (31% vs 17%)
Results of %AS NA lesions (n=19) P value non-NA lesions (n=39) P value ELCA group (n=6) non-ELCA group (n=13) ELCA group (n=17) non-ELCA group (n=22) Post %AS (%) 2±21 26±25 0.02 7±29 23±19 0.07 %AS change (%) 71±15 38±19 <0.01 56±29 44±17 0.11

Conclusion
Although neoatherosclerosis is correlated with refractory restenosis, ELCA can improve residual area stenosis in neoatherosclerosis lesions and can achieve better clinical outcomes for in-stent neoatherosclerosis.
P2695ABSORB bioresorbable scaffold versus Xience metallic stent in acute coronary syndromes with treated with percutaneous coronary intervention. A subanalysis of the COMPARE-ABSORB trial
Authors: Van Geuns R J , Smits P C , Chang C C , Wlodarczyk A , Chevalier B , West N , Gori T , Barbato E , Tarantini G , Kocka V , Achenbach S , Dudek D , Escaned J , Tijssen J , Onuma Y 
Published: October 2019

Abstract

Background
The safety and efficacy of the ABSORB scaffold in ACS patients remain unclear. The COMPARE-ABSORB trial compares the ABSORB to the Xience stent in lesions and patients at high risk for restenosis Patients with STEMI and urgent PCI for non-STEMI were not excluded.

Methods
Patients included in the COMPARE-ABSORB trial undergoing PCI for ACS were eligible. Predefined implantation techniques for ABSORB was mandatory. Primary endpoint is target lesion failure (TLF) at 1 year, defined as a composite of cardiac death, target vessel myocardial infarction and clinically indicated target lesion revascularization.

Results
Of 1670 patients, 842 were treated for ACS. At 1-year, TLF occurred in 22 patients (5.0%) of the ABSORB group and in 14 patients (3.5%) of the Xience group (HR 1.44%; 95% CI 0.74%-2.82%, P=0.284). Definite device thrombosis occurred in 9 patients (2.0%) of the ABSORB group and in 2 patients (0.5%) of the Xience group (HR 4.10%; 95% CI 0.89%-18.9%, P=0.071).
Baseline characteristics ABSORB (n=442) XIENCE (n=400) Age, years (SD) 60.7 (9.6) 61.3 (9.1) Male 350/442 (79.2%) 313/400 (78.3%) Current smoker 159/439 (36.2%) 126/397 (31.7%) Diabetes mellitus 152/440 (34.5%) 138/399 (34.6%) Hypertension 298/442 (67.4%) 266/400 (66.5%) Hypercholesterolemia 255/442 (57.7%) 232/400 (58.0%) Family history of coronary artery disease 147/442 (33.3%) 103/400 (25.8%) Previous MI 61/442 (13.8%) 67/400 (16.8%) Established Peripheral Vascular Disease 27/442 (6.1%) 15/400 (3.8%) Previous PCI 83/442 (18.8%) 86/400 (21.5%) Previous CABG 1/442 (0.2%) 4/400 (1.0%) Previous stroke 15/442 (3.4%) 21/400 (5.3%) Renal Insufficiency 9/442 (2.0%) 13/400 (3.3%) Clinical presentation   Unstable angina 149/442 (33.7%) 141/400 (35.3%)   Non-ST elevation myocardial infarction 183/442 (41.4%) 156/400 (39.0%)   ST elevation myocardial infarction 110/442 (24.9%) 103/400 (25.7%)
KM plot for target lesion failure

Conclusion
The COMPARE-ABSORB trial showed no difference in the primary endpoint at one year for the ACS subgroup. The signal for increased thrombosis remained, even with the optimized implantation protocol

Acknowledgement/Funding
Maasstad Hospital, Rotterdam, the Netherlands
P2717Type-II MI and chronic myocardial injury rates, invasive management and 4 year mortality among consecutive patients undergoing high sensitivity troponin T testing in the emergency department
Authors: Etaher A , Gibbs O , Saad Y M , Frost S , Nguyen T , Ferguson I , Juergens C , Chew D , French J K 
Published: October 2019

Abstract

Background
In emergency departments (EDs), assessment of patients with suspected acute coronary syndromes (ACS) represents a major workload and high sensitivity troponin (HsTn) T and I levels are frequently measured. A minority of patients have final diagnosis of myocardial infarction (MI).

Methods and results
Among 2738 consecutive patients with suspected ACS presenting to ED at Liverpool Hospital, Australia, between March and June 2014, we determined the relative frequencies of 3 patient groups: type-I MI, type-II MI including chronic myocardial injury (CMI), and assessed the use of invasive and pharmacological therapies and 4-year outcomes. Adjudication of MI was according to the 4th universal definition of MI as follows: 1) type-I MI; 2) type-II MI (including acute myocardial injury), and 3) CMI. Of 995 patients (36%) median age 76 years [IQR 65–83]), with at least 2 HsTnT measurements and one >14ng/l, 727 (73%) had chronic myocardial injury, 171 (17%) had type-II MI; and 97 (9.7%) had type-I MI. Patients with type-I MI (mean age 63 years) were younger than those with type-II MI or chronic myocardial injury by 12 and 14 years respectively. The main triggering factors for type-II MI/acute injury included: sepsis (21.1%), acute heart failure (18.3%), tachyarrhythmia (16.9%), anaemia (8.6%) and a combination of factors (16%). In-hospital angiography (62% had PCI) rates were 95% for patients with type-I MI, 24% (7% PCI) for those with type-II MI and 3.4% for CMI. Mortality at 4 years was 55% for type-II MI, 44% for CMI and 18% for type-1 MI (P<0.001; Figure), though after Cox modelling adjusting for age, gender, renal function and COPD, compared to type 1 MI, type-II MI (hazard ratio 1.61 [95% CIs 0.90–2.86]; p=0.106) and CMI (hazard ratio 1.01 [95% CIs 0.59–1.74]; p=0.963) were not independently associated with increased late mortality, largely because patients with type 1 MI were a decade younger.

Conclusion
Among unselected patients undergoing HsTnT testing in EDs, type-II MI including acute myocardial injury was more common than type-I MI. Chronic myocardial injury, which occurred in 3 of 4 patients. While patients with type-II MI acute myocardial injury had higher late mortality rates than type-I MI, though after multivariable analyses mortality rates were not different.
P2726Extremely boosted prediction of cardiac amyloidosis by routine laboratory paramaters
Authors: Agibetov A , Seirer B , Aschauer S , Dalos D , Rettl R , Duca F , Agis H , Kain R , Binder C , Mascherbauer J , Hengstenberg C , Samwald M , Dorffner G , Bonderman D 
Published: October 2019

Abstract

Background/Introduction
Cardiac amyloidosis (CA) is a rare and complex condition with poor prognosis. Novel therapies have been shown to improve outcome, however, most of the affected individuals remain undiagnosed, mainly due to a lack in awareness among clinicians. One approach to overcome this issue is to use automated diagnostic algorithms that act based on routinely available laboratory results.

Purpose
We tested the performance of flexible machine learning and traditional statistical prediction models for non-invasive CA diagnosis based on routinely collected laboratory parameters. Since laboratory routines vary between hospitals or other health care providers, special attention has been taken to adaptive and dynamic parameter selection, and to dealing with the frequent occurrence of missing values.

Methods
Our cohort consisted of 376 clinically accepted patients with various types of heart failure. Of these, 69 were diagnosed with CA via endomyocardial biopsy (positives), and 307 had unrelated cardiac disorders (negatives). A total of 63 routine laboratory parameters were collected from these patients, with a high incidence of missing values (on average 60% of patients for each parameter). We tested the performance of two prediction models: logistic regression, and extreme gradient boosting with regression trees. To deal with missing values we adopted two strategies: a) finding an optimal overlap of parameters and deleting all patients with missing values (reduction of parameters and samples), and b) retaining all features and imputing missing values with parameter-wise means. To fairly assess the performance of prediction models we employed a 10-fold cross validation (stratified to preserve sample class ratio). Finally, area under curve for receiver-operator characteristic (ROC AUC) was used as our final performance measure.

Results
A complex machine learning model based on forests of regression trees proved to be the most performant (ROC AUC 0.94±4%) and robust to missing values. The best regression model was obtained with the 25 most frequent variables and patient deletion in case of missing values (ROC AUC 0.82±0.8%). While progressive inclusion of predictor variables worsened the performance of the logistic regression, it increased that of the machine learning approach.

Conclusions
Extreme gradient boosting of regression trees by routine laboratory parameters achieved staggering accuracy results for the automated diagnosis of CA. Our data suggest that implementations of such algorithms as independent interpreters of routine laboratory results may help to establish or suggest the diagnosis of CA in patients with heart failure symptoms, even in the absence of specialized experts.
P2731Genetic ancestry analysis of the Italian founder population carrying the cardiac amyloidosis-causing variant Val122Ile in the transthyretin gene
Authors: Cappelli F , Mazzarotto F , Frusconi S , Contini E , Polimanti R , Buxbaum J , Martone R , Morini S , Taborchi G , Bartolini S , Olivotto I , Pelo E , Di Mario C , Perfetto F 
Published: October 2019

Abstract

Background
Transthyretin amyloidosis is a life-threatening disorder caused by the deposition of TTR amyloid in various tissues and organs. The most common worldwide pathogenic variant with almost exclusive cardiac involvement is Val122Ile (rs76992529), with an allele frequency of 3.5% in the U.S. African-American population, but rare in Caucasians. Unexpectedly, we identified 23 Caucasian individuals with Val122Ile in our amyloidosis referral center (9 affected patients, 14 carriers), belonging to 9 unrelated families.

Purpose
To determine the ancestral origin of the Tuscan founder population of TTR Val122Ile carriers.

Methods
A total of 24 individuals were included in the analysis (our 23 probands and relatives from Val122Ile families and the Caucasian reference sample NA10851 (CEU – Utah resident with European ancestry). All samples were genotyped using the EUROFORGEN Global AIM-SNP array1, inclusive of 127 highly informative SNPs to infer genetic ancestry. We have performed a principal component analysis (PCA) of the 9 unrelated probands and NA10851, compared with the Phase 3 of the 1000 Genomes Project data, comprising 2504 unrelated individuals from >20 distinct populations.(Figure 1).

Results
As shown in Figure 1, all our samples but one (from Argentina) cluster very close to the super-cluster of European populations, and distant from the populations of African ancestry. The proband from Argentina and the Caucasian reference sample NA10851 cluster close to Mexicans and Peruvians, and the super-cluster of European populations, respectively, confirming the robustness of the analysis.

Conclusion
Based on this result, we can confidently conclude that our samples from Tuscan families in which the TTR Val122Ile variant segregates are of ancestral European origin, with no mixed African ancestry, implying that the same variant originated in Africans and Europeans independently and not as result of genetic admixture. These findings suggest the presence of a mutational hot spots in TTR, with potential impact on the epidemiology of amyloidosis worldwide.

Acknowledgement/Funding
The present study was supported by an Investigator-Initiated Research to Azienda Ospedaliero Universitaria Careggi from Pfizer Srl.
P2732Prevalence of electrocardiographic abnormalities in patients with cardiac amyloidosis
Authors: Martone R , Taborchi G , Bartolini S , Morini S , Lossi A , Perlini S , Mussinelli R , Sabena A , Palladini G , Gabriele M , Vignini E , Di Mario C , Olivotto I , Perfetto F , Cappelli F 
Published: October 2019

Abstract

Background
Electrocardiographic (ECG) abnormalities are common in patients presenting with Light-Chain (AL) or Transthyretin (ATTR) related Cardiac Amyloidosis (CA). Type of amyloid may differently affect electrical properties of the heart being responsible for variable patterns of ECG anomalies at presentation.

Purpose
In this retrospective, observational study we sought to compare prevalence of ECG abnormalities between AL and ATTR patients with CA.

Methods
Clinical files from two Referral Centres were reviewed; ECG recordings were analysed by trained cardiologists and relevant findings were reported about rhythm (sinus vs atrial fibrillation [AF]), grade I or grade II atrio-ventricular (AV) delays, intra-ventricular (IV) conduction abnormalities, low-voltage QRS and pseudo-necrosis pattern. Presence of pace-maker (PM) and stimulated QRS were regarded to as clinical equivalents for AV block, after review of indications to implantation.

Results
Two hundred and fifty-one patients were identified (127 ATTR vs 124 AL; among ATTR, 27 patients had mutation in TTR gene: 10 Val142Ile, 11 Ile88Leu, 6 other). As expected, most ATTR patients were male (89% vs 56% in AL, p: <0.001), and AL patients were younger (mean age 64 [53–70] vs 79 [73–83]; p: <0.001).
Pathological ECG findings were common in both subgroups, involving more than three-quarters of the overall population (82% in ATTR, vs 72% in AL, p: 0.06). Atrial fibrillation was more common in ATTR, prevailing in 39% vs 5.6% (p: <0.001). ATTR had a higher burden of AV block (53% vs 13%, p: <0.001) and IV conduction delays (43% vs 21%, p: <0.001), and consistently presented a higher prevalence of PMs (24 patients vs 1). Low-voltage QRS was more prevalent in AL patients (52% vs 28%, p: <0.001), while no significant difference was found in prevalence of pseudo-necrosis patterns (ATTR: 29%, AL: 40%; p: ns).
Due to imbalance in age and gender and relative possible confounding effect on rhythm disturbances, adjusted odds ratios (OR) were calculated. It resulted that ATTR was independently associated with a higher prevalence of AF and AV conduction delays when compared to AL (adjusted OR: 4 [95% CI: 1.4–11.2], p: 0.008, and 6.2 [95% CI: 2.6–14.9], p: <0.001; respectively), while being inversely associated with low-voltage QRS (adjusted OR: 0.4 [95% CI: 0.2–0.9], p: 0.026).

Conclusions
ECG abnormalities are common in CA. Rhythm disturbances are more prevalent in ATTR, while AL more often results in low-voltage QRS. Such differences remain relevant after adjustment for age and gender imbalance, thus suggesting an aetiology-specific link.
P2733Prognostic value of cardiac dysautonomia in AL amyloidosis
Authors: Nicol M , Cescau A , Baudet M , Harel S , Royer B , Sarda L , Cohen Solal A , Arnulf B , Logeart D 
Published: October 2019

Abstract

Introduction
Cardiac involvement is the major prognostic factor in patients with light chain amyloidosis (AL). Cardiac dysautonomia can occur early in amyloidosis and can be assess by Iodine-123-metaiodobenzylguanidine (123I-MIBG) scintigraphy. Its prognostic value has been shown in TTR amyloidosis but is unknown in AL amyloidosis. We aimed to evaluate the prognosis impact of cardiac dysautonomia in patients with AL amyloidosis.

Methods
We carried out a prospective study in consecutive patients with biopsy-proven AL amyloidosis. All patients underwent clinical examination, EKG, echocardiography, cardiac MRI and biological tests. The 2012 Mayo clinic prognostic classification was calculated by using blood levels of NT-proBNP, cardiac T troponin and the differential of free light chains as recommended. The sympathetic cardiac innervation was assessed by using 123I-MIBGscintigraphy and measurement of the heart-to-mediastinum uptake ratio (late H/M) in the anterior view of the chest. A cardiac denervation was defined by late H/M <1.8 4h after injection of 3 MBq/kg of 123I-MIBG. The primary end-point was all-cause mortality during follow-up.

Results
Fifty consecutive patients with AL amyloidosis were included. The median age was 68 years old [58–73]. By using both echocardiography and MRI, cardiac involvement was diagnosed in 33 patients (66%) and thirteen of these patients were NYHA class III or IV. By using Mayo clinic classification, patients were I, II, III and IV classes in 9 (18%), 14 (28%), 16 (32%) and 11 (22%) cases respectively. According to echocardiographic data, the median wall thickness of left ventricle was 13 mm [12–15]. The late H/M was 1.51 [1.33–1.67]. Cardiac denervation was found in 44 patients (88%). The 6 patients (12%) with a normal late H/M had no cardiac amyloidosis involvement.
During a median follow-up of 24 months, 9 patients (18%) died. The area under the ROC curve of late H/M for predicting death was 0.74 (CI 95% 0.58–0.86). According to this curve, the best threshold was 1.44 and 7 of the 9 patients who died had late H/M ≤1.44. The figure shows the 2 year-survival according to late H/M. Late H/M ≤1.44 predicted all-cause death irrespective of the Mayo clinic classification: HR 8.0 (CI 95% 2.1–63) after adjustment on the Mayo clinic score (p=0.005). In addition, unplanned hospitalization for heart failure occurred in 8 patients with late H/M ≤1.44 versus 3 patients with late H/M >1.44 (p=0.03).
Survival according to late H/M

Conclusion
Late H/M ≤1.44 is predictive of adverse outcomes in patients with AL amyloidosis, independently of the Mayo Clinic prognostic classification.
P2748Lipoprotein(a) and autotaxin in patients with stenotic atherosclerosis of coronary arteries and aortic valve stenosis
Authors: Afanasieva O , Tmoyan N , Razova O , Klesareva E , Afanasieva M , Burdeynaya A , Ezhov M , Pokrovsky S 
Published: October 2019

Abstract

Background
Lipoprotein(a) [Lp(a)] is an independent risk factor of coronary heart disease (CHD) and calcific aortic valve stenosis (CAVS). It has been recently shown that autotaxin (ATX), which breaks down lysophosphatidylcholine, derived from oxidized phospholipids, to lysophosphatidic acid, was strongly associated with CAVS.

Purpose
The aim of the study was to investigate the role of Lp(a) and ATX in CHD patients with and without CAVS.

Methods
The study included 438 patients (average age 66±11 years, men 310), 332 had CHD with ≥50% stenosis in at least one coronary artery according to angiography. CAVS was diagnosed with ultrasound. The control group consisted of 106 patients without CHD and CAVS. The concentrations of Lp(a), ATX, lipids and blood cells were measured for all the patients.

Results
CHD without CAVS (group I) was diagnosed in 287 patients, 45 patients had CHD and CAVS (group II). Patients in both groups were older than patients in the control group (75±8, 66±10 and 61±13 years respectively). ATX level was lower in group I (median [25; 75%]: 493 [406; 583] ng/ml) than in control group (544 [412; 655] ng/ml, p=0.02) or group II (553 [475; 609] ng/ml, p=0.003). Lp(a) was lower in control group (14.5 [5.5; 36.0] mg/dl) than in group I (25.6 [9.7; 58.5] mg/dl, p=0.0004) and group II (23.8 [9.9; 79.1] mg/dl, p=0.02). Elevated level of ATX was positively associated with CAVS in CHD patients, but negatively with CHD in patients without CAVS. We have shown that age, glucose level and neutrophil-lymphocytes index (NLI) could be predictors of CAVS in patients with CHD according to results of logistic regression analysis.
Odds ratio of high (QIV) vs. low (QI) Odds ratio (95% confidence interval) Groups Autotaxin Lipoprotein(a) Neutrophil-lymphocytes index I vs. control 0.5 (0.3–0.9)* 2.7 (1.3–5.2)** 2.4 (1.3–4.6)* II vs. control 8.6 (1.1–70.1)* 3.4 (1.2–9.4)* 6.2 (2.2–16.9)** II vs. I 16.6 (2.1–131.1)** 1.3 (0.5–3.2) 2.5 (1.0–6.37)* *p<0.05, **p<0.005.

Conclusion
Elevated Lp(a) level is a predictor of CHD regardless of calcific aortic valve stenosis, whereas elevated concentration of autotoxin in CHD patients was associated with calcific aortic valve stenosis.