bluuebunny/crossref_metadata_2025_split huggingface dataset:
4070Clinical impact of mitral regurgitation before or following transcatheter aortic valve replacement in patients with aortic stenosis: a nationwide multivariable analysis
Authors: Fauchier L , Bernard A , Bisson A , Lacour T , Herbert J , Ivanes F , Bourguignon T , Clerc J M , Quilliet L , Guillon Grammatico L , Angoulvant D , Saint Etienne C , Babuty D 
Published: October 2019

Abstract

Patients undergoing transcatheter aortic valve replacement (TAVR) may have concomitant mitral regurgitation (MR). The impact of MR at baseline or after TAVR on subsequent prognosis remains to be more precisely determined. We analysed the impact of MR before or after TAVR on prognosis in the systematic analysis of patients treated with TAVR at a nationwide level.

Methods
Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Cox regression was used for the analysis of predictors of events during follow-up.

Results
A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Moderate/severe MR was present at baseline (MRb) in 9.5% of the patients. Few patients (1.6%) revealed moderate/severe MR post-TAVR (MRpt). Mean follow-up was 1.31±1.61 years. MRb was associated with an increased cardiovascular mortality (Hazard ratio 1.29, 95% CI 1.20–1.39) and total mortality (Hazard ratio 1.15, 95% CI 1.10–1.21). However, MRb was not an independent predictor in multivariable analysis, neither for cardiovascular mortality (adjusted HR 1.06, 95% CI 0.98–1.14) nor for total mortality (adjusted HR 1.01, 95% CI 0.96–1.07). MRpt was not a predictor of cardiovascular or total mortality. Older age, male sex, history of pulmonary edema/cardiogenic shock, atrial fibrillation, myocardial infarction, diabetes, renal failure, liver disease, pulmonary disease, previous cancer and anemia at baseline independently predicted mortality during follow-up. All of them (but history of cancer) were also independent predictor of cardiovascular death.

Conclusion
Baseline MR was associated with increased cardiovascular and totality mortality following TAVR but was not an independent predictor of any of them. By contrast, several other predictors of cardiovascular and total mortality were identified. This suggests that MR should not be directly considered to establish the strategy for TAVR decision or for avoiding TAVR-related futility.
4094Microvascular dysfunction in takotsubo syndrome visualized at stress and rest using 82-rubidium PET imaging
Authors: Kildevang Jensen J , Bentsen S , Bang L E , Holmvang L , Ripa R , Hasbak P , Kjaer A 
Published: October 2019

Abstract

Introduction
Takotsubo Syndrome (TTS) is recognized as the acute onset of reversible heart failure, often mimicking acute coronary syndrome with ECG changes and rise in cardiac biomarkers, but with no apparent coronary obstruction. The pathophysiological mechanisms of TTS are not yet fully understood, but it is well established that microvascular dysfunction and constriction plays a crucial role in the pathogenesis of TTS.
Positron emission tomography (PET) using the radioactive tracer Rubidium-82 (Rb-82) is routinely used to asses myocardial perfusion and microvascular function in a wide array of cardiological conditions.

Purpose
The purpose of this study was to evaluate myocardial perfusion and flow reserve in patients with TTS using Rb-82 positron emission tomography (PET) molecular imaging during rest and pharmacologically induced stress, in the acute phase and after 3 months of follow-up.

Methods
A total of 8 patients were diagnosed with TTS due to acute onset of symptoms, rise in cardiac biomarkers, absence of significant coronary obstruction and apical ballooning of the left ventricle. Subsequently the patients underwent Rb-82 PET scan in the acute phase (1–4 days after onset), and again at 3 months of follow-up. Rb-82 PET scans were performed both during resting conditions and during pharmacologically induced stress with infusion of adenosine. Myocardial blood flow (MBF) and total perfusion defect (TPD) were quantified during rest and stress, and the coronary flow reserve (CFR) was calculated. The AHA-17 segment model was used to determine summed rest scores (SRS) and summed stress scores (SSS). Data are presented as means ± SEM

Results
MBF during stress was significantly lower in the acute phase than at 3 months follow-up (2.99±0.35 vs. 3.82±0.19 ml/g/min, P=0.016) as opposed to resting MBF, which did not differ significantly (1.33±0.14 vs. 1.45±0.09 ml/g/min, P=0.309). The CFR of the patients was not significantly different in the acute phase compared to 3 months follow-up (2.33±0.25 vs 2.65±0.12, P=0.11), though 4 of the patients had a CFR <2.0 in the acute phase, which was normalized at follow-up. TPD was significantly lower at follow-up compared to the acute phase at both rest (21.6±5.86 vs. 0.75±0.61%, P=0.009) and stress (25.3±6.01 vs. 1.25±0.31%, P=0.006). SRS (12.6±3.24 vs. 0.75±0.59, P=0.01) and SSS (19.9±3.39 vs. 1.38±0.59, P=0.001) was significantly higher in the acute phase compared to follow-up. At follow up, all values were normalized.
Figure 1

Conclusion
These results supports the evidence that TTS is partly caused by microvascular dysfunction and constriction during the acute phase. Further studies are needed to uncover the exact mechanisms behind.
4183New onset atrial fibrillation in acute coronary syndrome: early vs late onset
Authors: Alves Guimaraes J , Goncalves F M , Borges S , Monteiro J J , Mateus P S , Trigo J , Moreira J I 
Published: October 2019

Abstract

Background
The prognostic impact of the timing where new-onset Atrial Fibrillation (AF) occurs in Acute Coronary Syndrome (ACS) patients isn't well studied.

Objective
Evaluate the predictors and prognostic impact of early-onset AF (EAF) and late-onset AF (LAF) in ACS patients.

Methods
We analysed 17016 patients with ACS enrolled in a national multicenter registry from October 2010 to January 2019. Patients with history of valvular disease, valve replacement, AF present at hospital admission or those who died in the first 48 hours were excluded. EAF was defined as AF in the first 48 hours of hospitalization and LAF after 48 hours. The primary endpoint was a composite of death and readmission from cardiovascular causes at 1 year.

Results
The mean age was 65±13 years; 74% were males and 42% had STEMI). 324 (1.9%) had EAF and 344 (2.0%) had LAF.
The predictors of EAF were age ≥75 years (OR 2.04, 95% CI 1.53–2.70, p<0.001); history of heart failure (OR 1.82, 95% CI 1.09–3.02, p=0.022), STEMI diagnosis (OR 2.74, 95% CI 2.06–3.61, p<0.001), admission Killip class (KK)≥2 (OR 2.70, 95% CI 1.98–3.69, p<0.001).
The predictors of LAF were age ≥75 years (OR 3.15, 95% CI 2.36–4.19, p<0.001), history of stable angina (OR 1.42, 95% CI 1.06–1.90, p=0.018), cerebrovascular disease (OR 1.68, 95% CI 1.14–2.46, p=0.008), COPD (OR 2.33, 95% CI 1.58–3.44, p<0.001), STEMI diagnosis (OR 2.31, 95% CI 1.77–3.03, p<0.001), admission KK ≥2 (OR 2.06, 95% CI 1.54–2.76, p<0.001) and stress hyperglycemia (OR 1.54, 95% CI 1.15–2.05, p=0.003)
In STEMI patients only those with LAF had higher symptoms time (245 (IQR 165–400) minutes vs 284 (IQR 200–425) min; p=0.02).
During hospitalization, LAF patients had a worse prognosis with a higher rate of heart failure, re-infarction, stroke, major bleeding and death (Table 1).
In the follow-up, in multivarite analysis, only LAF was a predictor of the primary endpoint (EAF: HR 0.79, 95% CI 0.50–1.25, p=0.314; LAF: HR 1.45, 95% CI 1.05–2.00, p<0.025).
Complications during hospitalization No AF EAF LAF p Death 1.3 6.5 12.5 <0.001 Heart Failure 11.4 38.3 50.3 <0.001 Re-enfarction 1.0 0.9 3.5 <0.001 Stroke 0.5 0.9 3.8 <0.001 Major bleeding 1.3 4.3 4.1 <0.001
Kaplan Meier curve

Conclusion
Patients with EAF and LAF have different characteristics and outcomes with LAF patients having a worse in-hospital and long term prognosis.
4283Exercise right heart catheterization before and after balloon pulmonary angioplasty in inoperable patients with chronic thromboembolic pulmonary hypertension
Authors: Liebetrau C , Kriechbaum S , Rieth A , Ghofrani H A , Haas M , Rolf A , Hamm C W , Guth S , Mayer E , Wiedenroth C B 
Published: October 2019

Abstract

Background
Balloon pulmonary angioplasty (BPA) is an evolving treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The main indicator for success is improvement in pulmonary hemodynamics, but outcome data are heterogeneous.

Purpose
The aim of the present study was to evaluate pulmonary hemodynamics not only at rest, but also during exercise before and 6 months after BPA.

Methods
We report a prospective series of 64 consecutive patients with inoperable CTEPH who were treated interventionally with BPA. All patients underwent standardized assessment prior to the first BPA and 6 months after the last intervention. Assessment included WHO FC, Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR), 6-minute walking distance (6MWD), serum levels of the N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP), and exercise RHC.

Results
The mean number of sessions per patient was 5.6 (± 1.3) and the mean number of pulmonary segments targeted in all interventions was 11 (± 3). BPA treatment led to improvements in pulmonary hemodynamics and exercise capacity (6MWD: 416±94 m vs. 463±96 m; p<0.0001) except for CO and CI during RHC at rest; these parameters showed improvements only during exercise RHC. MPAP at rest showed a reduction from 41±9 to 31±9 mmHg (p<0.0001) and PVR at rest decreased from 6.8±2.3 WU to 4.3±1.9 WU (p<0.0001). Further decreases were observed for systolic pulmonary arterial pressure, TPG, PVR, and TPR. Cardiac output (7.0±2.0 L/min vs. 8.3±2.0 L/min; p<0.0001) and cardiac index during exercise RHC (3.8±1.1 L/min/m2 vs. 4.4±1.1 L/min/m2; p<0.0001) improved significantly. Median NT-proBNP concentrations decreased from 741 ng/L (IQR 192–1425 ng/L) to 139 ng/L (IQR 60–266 ng/L) during BPA treatment (p<0.0001). Results from the CAMPHOR questionnaire showed significant improvements in symptoms (11±5.8 vs. 5.5±4.9, p<0.0001), activity limitations (9.2±5.6 vs. 5.2±4.5, p<0.0001), and quality of life (6.4±5.7 vs. 3.5±3.7, p<0.0001).

Conclusion
Significant improvements in pulmonary hemodynamics at rest and during exercise were observed 6 months after BPA. Exercise right heart catheterization offers a more discriminating evaluation of the changes in pulmonary hemodynamics after BPA.
4314Cardiac involvement of Wilsons disease
Authors: Quick S , Reuner U , Weidauer M , Heidrich F M , Mues C , Hempel C , Sveric K , Ibrahim K , Linke A , Speiser U 
Published: October 2019

Abstract

Background
Wilson's disease (WD) is an inherited autosomal recessive disorder resulting from abnormal copper metabolism. Relatively little is known about the effects of copper accumulation on the heart.

Objective
We aimed to determine if patients with Wilson's disease show signs of cardiac involvement and structural heart disease.

Methods
In this prospective trial, we studied 61 patients with Wilson's disease and compared them to 61 age- and gender-matched healthy controls.

Results
While left ventricular function assessed by global longitudinal and global radial strain did not differ significantly between the groups, Wilson's disease patients had significantly reduced global radial strain (table 1).
Wilson's disease patients demonstrated significantly more late gadolinium enhancement than the control patients (4.9±1.4 vs. 1.1±0.2% p<0.001).
The severity of Wilson's disease, based on the Unified Wilson's Disease Rating Scale, was significantly correlated with the extent of late gadolinium enhancement (r=0.53, P=0.001), cardiac troponin (r=0.56, P=0.001), the number of premature ventricular contraction (r=0.66, P=0.001).
Table 1. Myocardial strain and CMR characteristics of patients and controls Parameter Patients (n=61) Controls (n=61) p value Left ventricular parameters   GLS, % −22.8 (4.8) −21.8 (5.1) 0.124   GRS, % 43.2 (13.2) 51.6 (13.8) 0.002   GCS, % −29.2 (5.2) −28.6 (4.7) 0.534 Late gadolinium enhancement   LGE, %* 4.9 (1.4) 1.1 (0.2) 0.003   LGE at RVIP, n (%) 58 (95) 3 (5) <0.001   Midwall LGE, n (%) 11 (18) 0 <0.001 Right ventricular parameters   GLS, % −23.6 (4.9) −26.1 (5) 0.01 Data are presented as mean (SD), median (IQR)*, or n (%) unless otherwise stated. GLS, global longitudinal strain; GRS, global radial strain; GCS, global circular strain; LGE: late gadolinium enhancement; RIVP, right ventricular insertion point.

Conclusion
Our data demonstrate that cardiac involvement in Wilson's disease is possible and those patients who are severely affected by the disease carry a higher risk of developing structural heart disease.
4323Detection of early inflammation in myocarditis by molecular magnetic resonance imaging of activated platelets
Authors: Maier A , Jakob K , Von Elverfeldt D , Braig M , Bienert T , Peter K , Klingel K , Bode C , Von Zur Muehlen C 
Published: October 2019

Abstract

Introduction
A noninvasive imaging strategy for diagnosis and localization of early myocarditis would be of great clinical interest. However, resolution of current imaging techniques is limited. Platelets play an important role in inflammatory processes but the role in myocarditis is unknown. Therefore, the aim of this project was to examine the role of platelets in myocarditis and establish a sensitive non-invasive molecular MRI in-vivo imaging strategy for diagnosis of myocarditis with a contrast agent against activated platelets in mice.

Methods
Myocarditis was induced by subcutaneous injection of an emulsion of porcine cardiac myosin and complete freud's adjuvant (CFA) in Balb/c mice. Inflammatory activity was targeted with a contrast agent against activated platelets consisting of microparticles of iron oxide (MPIO) conjugated to a single chain antibody directed against ligand-induced binding sites (LIBS) on activated glycoprotein IIb/IIIa (=LIBS-MPIO). In comparison, we applied an unspecific control antibody linked to microparticles of iron oxide (control-MPIO) and injected LIBS-MPIO to mice subjected to incomplete freud's adjuvant (iCFA). All imaging results were correlated to immunohistochemistry findings.

Results
Histological evaluation showed significantly higher binding of LIBS-MPIOs to platelet enriched, CD41-positive inflamed myocardium two days after induction of myocarditis in comparison to later time points (7d, 14d, 21d) (p<0.05) and control-MPIO (p<0.05) injection. In iCFA injected mice no significant LIBS-MPIO binding was found (p<0.05). In 3D in-vivo MRI we could specifically detect focal signal effects in LIBS-MPIO injected mice 2 days after induction of myocarditis, whereas in control-MPIO injected mice no signal effect was visible. Quantification of the myocardial MRI signal confirmed a signal decrease after LIBS-MPIO injection and significant fewer signals in comparison to control-MPIO injection (p<0.05).
As a perspective, we also found CD41 positive areas in histology of human myocarditis specimens.

Conclusions
Platelets are involved in the inflammation of myocarditis. Molecular MRI with LIBS-MPIO can image them at an early time point. This noninvasive imaging strategy is of clinical interest for both diagnostic and prognostic purposes, and highlights the potential of molecular MRI for characterization of cardiovascular pathologies such as myocardial inflammation.
P3100Anti-thrombin nanoparticles limit ischemia-reperfusion injury and no-reflow in myocardial infarction
Authors: Pan H , Lindon A , Grabau R , Dominguez W , Wickline S 
Published: October 2019

Abstract

Introduction
Persistent microvascular thrombosis and thrombin signaling in cardiac ischemia reperfusion injury (IRI) combine to promote infarct expansion and heart failure. We have reported previously that treatment of acute ischemic kidney injury (AKI) in rodents with anti-thrombin perfluorocarbon nanoparticles (PFC NP) limits damage to endothelium, reduces “no reflow”, and hastens recovery of kidney function. In cardiac IRI, we hypothesized that thrombin continues to exert deleterious effects well after reperfusion, but whether this strategy is effective in preserving vascular barrier function and preventing no reflow in cardiac IRI is not known. Accordingly, we postulated that sustained local thrombin inhibition with long acting anti-thrombin nanoparticles might limit vascular damage and barrier disruption that otherwise leads to hemorrhage and no reflow.

Methods
14 Sprague Dawley rats undergoing LAD occlusion for 45 min were pretreated with i.v. injection of anti-thrombin PPACK (D-phenylalanyl-L-prolyl-L-arginine chloromethyl ketone)-conjugated PFC NP (∼13,000 PPACK per PFC NP), or saline (control) followed by 2 hours of reperfusion. Sham controls (no LAD ligation) were compared. Simultaneous to treatments, a different and unique nontargeted CE PFC NP (CE: Crown Ether core) was injected for subsequent tracking and spectroscopic quantification of the relative distributions and amounts of PFC NP trapped in non-reperfused myocardium. Hearts were perfused with saline in situ, then extracted for ex vivo 19F (fluorine) MRI and spectroscopy at 7T (Bruker). T2* images were acquired for hemorrhage/edema in the area at risk. 19F MRI was acquired for PFC NP trapping (spin echo: TR 2000ms, TE 4.51 ms, FOV 20x20, 64x64 slice 1mm), along with whole heart 19PFC CE spectroscopy.

Results
Fluorine MRI of an intact heart illustrates the trapping of PFC NP in areas of nonreperfusion (Figure) amidst infarct scar region. Quantification of total heart CE PFC NP signal emanating from trapped NP revealed reduced accumulation (−49%) in the hearts of treated rats (0.47±0.09 vs 0.92±0.19, treated vs control; p<0.05). For sham occlusions, minimal deposition of CE PFC NP was observed irrespective of PPACK PFC NP treatment (n=10 per group). Areas of T2* signal indicative of vascular leakage extended beyond that of the 19F signals (Figure T2*), indicating more severe damage and trapping in central infarct zones than in more peripheral border zones after 2 hours.

Discussion
Continued inhibition of thrombin in cardiac IRI with locally-acting PPACK PFC NP preserved vascular integrity, and limited hemorrhage and No Reflow (less trapping). Because these PPACK PFC NP do not prolong bleeding times or coagulation parameters beyond ∼30–60 min after injection, yet maintain prolonged local surveillance against activated thrombin, they represent a potentially useful therapeutic strategy for cardiac IRI.
P3107Effect of cardiac rehabilitation predicts event-free survival
Authors: Mikkelsen N , Rasmusen H , Reeh J , Cardarso-Suarez C , Lado-Baleato O , Diaz-Louzao C , Prescott E 
Published: October 2019

Abstract

Background
Participation in cardiac rehabilitation (CR) improves prognosis. Whether more effect of exercise training also affects prognosis is unknown.

Purpose
To investigate whether change in VO2peak after CR is a predictor of future cardiovascular disease and/or mortality

Methods
Retrospective analysis on 1237 cardiac patients completing a CR program in Copenhagen in 2011–2017 with a cardiopulmonary exercise test performed at baseline and end of CR. The association between change in VO2peak and future risk of morbidity and mortality through registry linkage was assessed by Cox regression analysis adjusting for age, sex, cardiac diagnosis, comorbidities and baseline VO2peak.

Results
1237 patients were included, mean was age 64 (±11) years and 75% were males. 30% of the patients did not improve in VO2peak. There were 166 events and 76 deaths during a median follow-up of 2.3 years. Both baseline VO2peak and change in VO2peak were significantly associated with risk after multivariable adjustment.
Change in VO2peak: MACE and mortality

Conclusion
Improvement in VO2peak during a CR program is a strong predictor of subsequent prognosis in cardiac patients.
P3124Predictive value of the residual SYNTAX score following primary PCI in multivessel patients with MI-related cardiogenic shock - a CULPRIT SHOCK sub-analysis
Authors: Barthelemy O , Rouanet S , Brugier D , Vignoles N , Bertin B , Zeitouni M , Guedeney P , Overtchouk P , Hage G , Hauguel-Moreau M , Akin I , Desch S , Vicaut E , Thiele H , Montalescot G 
Published: October 2019

Abstract

Background
Complete revascularization (CR) – assessed by the residual SYNTAX score (rSS) – following PCI is associated with a better prognosis – in stable coronary disease, acute coronary syndrome and myocardial infarction (MI). Whether, the completeness of revascularization impacts the prognosis of patients in cardiogenic shock (CS) remains unclear.

Aim
Assess the prognosis value of rSS following primary PCI in multivessel patients undergoing MI-related CS.

Methods
The CULPRIT SHOCK trial – the largest randomized trial (n=706) to date in CS – compared an immediate multivessel PCI (MVPCI) strategy to a culprit lesion only PCI (with possible staged revascularization) strategy in multivessel patients with MI-related CS. The rSS were retrospectively assessed following last PCI (either index or staged) by a central core laboratory and patients were allocated in 4 different groups according to rSS: CR (rSS=0), 0< rSS ≤5, 5< rSS ≤14, rSS >14. The prognostic impact of rSS on the 30-day composite endpoint (mortality and/or severe renal failure) and 30-day and 1-year mortality were assessed using multivariate logistic regression.

Results
Among the 604 patients with last rSS available, aged 68.2±11.4, the median rSS was 9.0 [4.0–17.0]. CR was achieved in 75 (25%) patients in the MVPCI strategy and in 31 (10.2%) in the culprit lesion only PCI strategy. One hundred and six (17.5%), 102 (16.9%), 198 (32.8%) and 198 (32.8%) patients had a rSS=0, 0< rss ≤5, 5< rSS ≤14 and rSS >14, respectively. Patients with a higher rSS were older, less active smoker, had more triple vessel disease, chronic total occlusion, post-PCI culprit coronary TIMI flow <3 and require more mechanical circulatory support and catecholamine. Univariate analysis shows a stepwise increase in adverse events according to rSS: patients with 5< rss ≤14 and rSS >14 had higher rates of 30-day primary endpoint (OR [95% CI]: 2.02 [1.24; 329] and 2.75 [1.69; 4.49]), 30-day mortality (OR [95% CI]: 2.13 [1.29; 3.51] and 3.14 [1.90; 5.18]) and 1-year mortality (OR [95% CI]: 2.39 [1.46; 3.90] and 3.47 [2.11; 5.71]) compared to patients with CR. After multiple adjustment, rSS – tested as continuous variable – was independently associated with 30-day primary endpoint, 30-day and one-year mortality (Figure)

Conclusion
Among multivessel patients with MI-related cardiogenic shock, 1) complete revascularization is achieved only in one fourth of the patients using a MVPCI strategy and, 2) the residual SYNTAX score is independently associated with early and late mortality.

Acknowledgement/Funding
Funded by the European Union 7th Framework Program and others