bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1808Routine screening practices for cardiac involvement in patients with sarcoidosis
Authors: Moura D M M , Arimura F E A , Kairalla R A K , Rochitte C E R , Dabarian A D , Feitosa M F , Cafezeiro C R F C , Soares J S , Ramires F J A R , Hotta V T H , Mady C M , Fernandes F F 
Published: October 2019

Abstract

Introduction
Sarcoidosis is a multi-systemic granulomatous disease of unknown etiology. Cardiac sarcoidosis (CS) has proven to be a clinically significant cause of unexplained ventricular dysfunction, atrioventricular block (AVB) and ventricular tachyarrhythmias (VT). Studies have suggested that clinically manifest cardiac involvement occurs in only 5% of patients with sarcoidosis. However, recent imaging studies have shown that cardiac involvement can be observed in up to 54.9% of patients with extracardiac sarcoidosis, mostly clinically silent, but that can eventually manifest into life-threatening arrhythmias.

Purpose
The purpose of this study was to evaluate the routine use of cardiac testing in patients with sarcoidosis. We aimed to evaluate the frequency with which clinical evaluation and cardiac testing are routinely utilized, the results of these tests, and how these results impacted downstream management.

Methods
This study was carried out in a tertiary hospital, assessing referred patients with suspected cardiac sarcoidosis. Clinically manifest CS was defined as the presence of ventricular systolic dysfunction, AVB or sustained VT. The cardiac involvement was evaluated with Late gadolinium-enhanced MRI and PET-CT with FDG. The diagnosis of cardiac sarcoidosis was performed using the criteria of the HRS. All patients had a biopsy with a histopathology suggestive of Sarcoidosis.

Results
Forty-one patients with sarcoidosis were evaluated. CS was confirmed in 46% (N=19), with exclusive cardiac involvement in 10% (N=2). The mean age was 53±9.6 years old and 53% (N=10) were female. Clinically manifest CS was present in 63% (N=12). The most prevalent initial cardiac manifestation was left ventricular dysfunction, in 58% (N=7), usually in the silent form (71%), with VT in 25% (N=3) and AVB in 17% (N=2). All patients with cardiac silent form had PET-CT with FDG or MRI suggestive of CS. The sensitivity of the MRI and PET-CT with FDG was 75% and 82%, respectively, while the concomitant performance of the two methods had a sensitivity of 100%, considering the HRS criteria as gold standard.

Conclusion
Cardiac involvement in patients with sarcoidosis is high and has important prognostic implications. With the enhancement of imaging tests, diagnosis of CS has significantly increased. PET-CT with FDG and MRI are very useful and effective in the evaluation of patients with CS.
P1838Thrombocytopenia under ECMO and Shear-induced shedding of platelet receptor Glycoprotein-(GP)Ialpha
Authors: Vincent F , Rauch A , Desvages M , Spillemaeker H , Rousse N , Dupont A , Jeanpierre E , Delhaye C , Moussa M , Vincentelli A , Verdier B , Debry N , Lassalle F , Susen S , Van Belle E 
Published: October 2019

Abstract

Background
Several mechanisms are suspected to thrombocytopenia under Extracorporeal Membrane Oxygenation (ECMO) such as platelet-consumption or sepsis. Shedding of glycoprotein-(GP)Ibα is a recently identified mechanism of platelet clearance. ECMO generates high shear stress forces that could impact GPIbα-shedding. We hypothesized that ECMO continuous-flow devices could directly induce thrombocytopenia through shear-induced GPIbα-shedding.

Aims
Determine if ECMO induce GpIb-shedding in vitro and in vivo and determinates the kinetic evolution of platelet-count and GpIb-shedding after patient's implantation.

Methods
Platelet GPIbα-shedding was first investigated in vitro using a high-shear pump loop model. Plasma with normal platelet count (plasma-NPC) was obtained by dilution of platelet-rich plasma obtained from healthy donors in fresh-frozen-plasma. Samples were collected before and after (5, 30, 60 and 180 min) perfusion at 37°C of plasma-NPC at intermediate and high speed (2.6 and 3.6 L min–1 respectively, n=4 each). Platelet count and GPIbα-shedding were next investigated in 20 ECMO patients before/after implantation (WITECMO trial) and in 20 healthy volunteers. The geometric mean-fluorescence-intensity (gMFI) of platelet GPIbα (PE-staining) and GPIX (FITC-staining) was measured with a Navios flow cytometer (Beckman Coulter, Miami, FL). Results are expressed as GPIbα/GPIX gMFI-ratio.

Results
A significant time-dependent loss of GPIbα/GPIX gMFI-ratio was already apparent after 30 min in vitro and was significantly more pronounced at high-speed compared to intermediate-speed (pANOVA<0.001 and p<0.01 at 180 min respectively). GPIbα/GPIX gMFI-ratio was significantly increased in ECMO patients compared to healthy subjects 1- and 24-hour after implantation (p<0.001). A significantly lower platelet count was observed 1 hour after ECMO implantation (−23% vs baseline, p<0.01) with a further significant decrease at 24-hours (−53% vs baseline, p<0.0001).
Figure 1. A. Significant time-dependent loss of platelet GPIbα/GPIX gMFI-ratio (pANOVA <0.001) assessed by flow-cytometry after 30 min of perfusion at 3.6 L/min with a high-shear continuous-flow device in vitro. B. Representative experiment showing the apparition of a platelet sub-population with loss of GPIbα expression after 30 min of perfusion at 3.6 L/minwith a high-shear continuous-flow device in vitro.
P1841Left cardiac sympathetic denervation in patients with long QT syndrome and catecholaminergic polymorphic ventricular tachychardia: a systematic review and meta-regression
Authors: Lopez Ayala P , Sgro A , Drake T M , Phan K 
Published: October 2019

Abstract

Background
The evidence of benefit and safety of open surgery or Video-Assisted Thoracoscopic Surgery (VATS) for Left Cardiac Sympathetic Denervation (LCSD), for the management of patients with refractory Long QT Syndrome (LQTS) and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), is not consistent.

Purpose
To undertake a systematic review and meta-regression to assess the current evidence for LCSD and to estimate the effects of the open surgery versus the VATS approach on outcomes following LCSD.

Methods
Databases (MEDLINE, EMBASE and Cochrane library) were searched without language or date restriction, from inception to December 2018, for studies reporting the long-term outcomes of LCSD in LQTS and CPVT patients. The number of patients experiencing cardiac events (CEs) before and after surgery, the change in QTc interval in milliseconds (ms), and the incidence of CEs and surgical complications after surgery were pooled to estimate the efficacy of LCSD in both LQTS and CPVT. A meta-regression analysis of outcomes based on the type of surgical approach (open vs VATS) was performed.

Results
Of 557 potentially relevant studies, 27 retrospective case series studies met our inclusion criteria, enrolling 647 patients (VATS, n=408 and Open, n=239). Average follow-up was 32 months. At the end of the follow-up period, 398/585 patients (68.0%) were free of CEs and QTc had decreased from 522±61.6 ms to 494±52.3 ms. Meta-regression analysis (14 studies, n=507) showed no differences between the two approaches in patients' responsiveness to surgery and the incidence of CEs or surgical complications. Open surgery had a statistically significant greater reduction in QTc duration than VATS (β −20.04, 95% CI −36.82 to −3.27, *p=0.019).

Conclusions
LCSD was associated with a reduction in the incidence of cardiac events in LQTS and CPVT patients and in the duration of QTc. Meta-regression analysis showed open surgery to be associated with a greater reduction in QTc. Higher evidence research studies are warranted to fully establish the safety and efficacy of LCSD.

Acknowledgement/Funding
None
P1843Transcatheter aortic valve implantation in patients with uninterrupted vitamin k antagonist
Authors: Robert P , Leclercq F , Lattuca B , Albat B , Maupas E , Robert G , Akodad M , Macia J C , Dubar A , Targosz F , Gandet T , Cayla G 
Published: October 2019

Abstract

Background
Bridging of vitamin K antagonist (VKA) with heparin is usually not promoted during interventional or surgical procedures related to increased risk of bleeding and thrombotic events but this strategy has not been evaluated during TAVI.

Purpose
The aim of this study was to evaluate the rate of major bleeding and vascular complications after TAVI performed in patients with uninterrupted VKA.

Methods
From January 2016 to October 2017, consecutive patients who underwent TAVI with uninterrupted VKA (INR between 1.5 and 3.5) were prospectively included in a monocentric registry. TAVI were performed according to current guidelines and a 50UI/kg bolus of heparin was injected at the beginning of the procedure for all patients. Vascular and bleeding complications were assessed using the Valve Academic Research Consortium 2 (VARC2) and the Bleeding Academic Research Consortium (BARC) definitions at 30 day follow-up.

Results
A total of 88 patients were included with a median age of 84 years [81.8–87], 42% being female, the median STS score was 5.1 [4.1–7.5], the median CHADS2-VASc was 5.5 [5–6] and 60.2% had a chronic kidney failure. Median INR at time of implantation was at 2.1 [1.8–2.6]. VKA were used for atrial fibrillation (89.8%), mechanic mitral prosthesis (5.7%) or venous thromboembolic disease (4.5%). Trans femoral access was used in 88.6% of the patients. Major bleeding (BARC ≥3b) occurred in 5 patients (5,7%) and major vascular complications occurred in 7 patients (8%). Peripheral arterial disease (RR = 10.95; 95% CI: 1.63 to 73.75; p=0.014) and carotid access (RR=8.56; 95% CI: 1.19 to 61.51; p=0.033) were significantly associated with major bleeding. INR >2.5 was significantly associated with vascular complications (RR=7.14; 95% CI: 1.29 to 39.63; p=0.025). In multivariate analysis, Body mass index (OR=1.26; 95% CI: 1.02 to 1.57; p=0.032) and INR >2.5 (OR=18.91; 95% CI: 1.62 to 221.26; p=0.010) were independent factor significantly associated with vascular complications or major bleeding. Mortality rate at 30 days follow-up was 2.3%, there was no myocardial infarction and stroke rate was 4.5%.
Figure 1. Study flowchart

Conclusion
TAVI with uninterrupted VKA treatment seems to be feasible and safe with low risk of bleeding and vascular complications in this first single centre experience. Particular caution is advocated in low BMI patients and to keep INR<2.5.
P1851Long-term outcomes of transcatheter versus surgical aortic valve replacement in low risk, elderly patients with severe aortic stenosis
Authors: Kang D.-H , Oh J K , Lee S.-A , Lee S , Kim D.-H , Park D.-W , Song J.-M , Choi K.-J , Song J.-K , Zo J.-H , Park S.-J , Park S.-J 
Published: October 2019

Abstract

Background
Although surgical aortic valve replacement (SAVR) is recommended for symptomatic severe aortic stenosis (AS) patients at low surgical risk, there is a growing need for an expansion of transcatheter aortic valve replacement (TAVR) as an alternative to SAVR for elderly AS patients at low operative risk.

Purpose
We tried to compare the long-term clinical outcomes of TAVR versus SAVR in elderly AS patients (≥80 years old) at low surgical risk.

Methods
We consecutively enrolled 261 elderly patients (131 men; 83±3 years of age) with symptomatic severe AS and EuroSCORE II <4%, who underwent SAVR or TAVR from 2010 to 2018. Heart Team made the decision between SAVR and TAVR according to the individual patient's preference and characteristics. SAVR was performed on 93 patients (SAVR group), whereas TAVR was chosen for 168 patients (TAVR group). The primary end point was cardiac mortality including procedure-related death, and the secondary end point was all-cause death and cardiovascular event.

Results
Baseline characteristics were similar between the two groups, but the TAVR group was significantly older than the SAVR group (83±3 vs 82±2 years; p<0.01). Device was successfully implanted in all the patients and there was 1 in-hospital mortality in the TAVR group and 3 in-hospital mortalities in the SAVR group (p=0.13). During a median follow-up of 24 months (IQR, 9–45 months), there were 22 deaths (13.1%) including 8 cardiac deaths (4.8%) in the TAVR group and 16 deaths (17.2%) including 9 cardiac deaths (9.7%) in the SAVR group. The rates of the primary and secondary end points were similar between two groups in the overall cohort and the propensity score-matched cohort (table). On subgroup analysis according to the presence of coronary artery disease (CAD), the only independent variable associated with cardiac mortality, the SAVR group had a significantly higher cardiac mortality rate than the TAVR group (15±7% vs 7±6% at 5 years, p=0.048) in 185 (71%) patients without CAD, whereas there was no significant difference among those with CAD.
Harzard ratio for clinical outcomes TAVR (n=168) SAVR (n=93) Overall cohort TAVR (n=76) SAVR (n=76) PS-matched cohort HR (95% CI) p value HR (95% CI) p value Cardiac mortality 8 9 0.65 (0.25–1.71) 0.386 2 7 0.34 (0.07–1.61) 0.173 All-cause mortality 22 16 1.08 (0.56–2.08) 0.831 6 12 0.86 (0.30–2.43) 0.774 Cardiovascular event* 18 12 1.09 (0.52–2.28) 0.826 6 10 0.72 (0.26–1.98) 0.525 *Cardiovascular event was defined as the composite of cardiac mortality, hospitalization for heart failure, stroke, myocardial infarction, and reoperation.

Conclusion
In elderly AS patients at low surgical risk, TAVR was similar to SAVR with respect to long-term clinical outcomes. TAVR should be considered a treatment option for elderly patients who refuse to undergo surgery despite low risk.
P1852The clinical experience of J valve transapical transcatheter aortic valve replacement system in high-risk patients with severe pure aortic regurgitation
Authors: Liu W , Zhou Y J , Zhang H B , Meng X U , Gao Y N 
Published: October 2019

Abstract

Objective
Patients with severe pure aortic regurgitation (PAR) undergoing transcatheter aortic valve implantation (TAVI) is still under controversial. J valve™, a China Food and Drug Administration (CFDA) certified device, has specific positioning and anchoring system, which makes this device indicated in PAR patients. We aim to introduce the clinical experience of J valve in the treatment of PAR in high risk patients.

Methods
A total of 53 severe PAR patients (STS score 6,3±1.8, mean age, 76.4±5.2 years) who underwent TAVI using J valve™ in our Hospital from June 2017 to December 2018 were retrospectively enrolled. All patients underwent echocardiography and contrast-enhanced computed tomography to evaluate their baseline and follow-up characteristics. The 30 days outcomes were reported according to the Valve Academic Research Consortium-2 (VARC) definitions.

Results
All patients underwent transapical TAVI, and J valve was in implanted successfully in 51 patients (96,2%). J valve was dislodged in two patients, one patient was successful implanted with another J valve and the dislodged valve placed in descending aorta. The other patient was converted to urgent surgery for aortic valve replacement. One patient was converted to surgery due to severe aortic regurgitation after J-valve placement. The 30 days mortality was 9.2% (n=5), 1 patient died of acute heart failure and 2 patients died of infection. During the hospitalization, none of the patients had stroke or transient ischemic attack (TIA) and periprocedural myocardial infarction (MI). There were 5 (n=14.3%) patients presenting with bleeding complications (BARC 4 definition of major bleeding). 1 (2.9%). Pacemaker implantation was performed in 2 (5.7%) patients. Paravalvular regurgitation was none or trace in 90.7% (n=49), mild to moderate in 5.6% (n=3), and moderate to severe 1.8% (n=1) after the procedure. Mean intensive care unit stay was 29.30±15.30 h.
Working illustration of J valve

Conclusion
TAVI by J valve™ can be an alternative option for high risk patients with PAR, but more evidences are still needed to further prove its safety and feasibility.
P1855Multiple and posterior location of moderate paravalvular leaks are associated with worse long-term outcome after successful TAVR
Authors: Kalinczuk L , Chmielak Z , Zielinski K , Mintz G S , Dabrowski M , Kumor M , Jastrzebski J , Skowronski J , Motyl D , Siodmiak A , Pregowski J , Michalowska I , Demkow M , Hryniewiecki T , Witkowski A 
Published: October 2019

Abstract

Background
Posterior location of a paravalvular leak (PVL) affects left ventricle fluid dynamics in a more unfavorable way than leaks of the other locations.

Purpose
To assess impact of the PVL location and its grade on subsequent long term mortality after successful TAVR.

Methods
Out of 445 consecutive patients treated between 8/2009 and 10/2017 within the single-center, prospective TAVR Registry, there were 432 pts [median 83.0 years of age, 63.4% female] with device success (97.1%) as per VARC-2. Post-procedural TTE studies done within 7 days post-TAVR were analyzed for PVL location (anterior vs posterior vs medial vs lateral) and grade (none/trace/mild vs moderate). Long-term mortality was assessed.

Results
Median follow-up was 29.3 (15.8–53.1) months with 1-year follow-up in all pts. The 30-day and 1-year mortality rates were 3.0% (n=13) and 13.4% (n=58) with an estimated 4-year mortality of 35.5%. Moderate PVL was reported in 28.5% (n=123) of pts, with 12.0% (n=52) having multiple locations (>1 PVL). Among moderate PVLs (n=184), most were of anterior (33.2%), 29.3% were posterior, 25.2% were lateral, and the least common location was medial (12.0%). Whereas moderate PVL alone was not associated with worse long-term outcome, the 1-year mortality rates tended to be higher for pts with PVL found at multiple or posterior locations (19.2% vs 12.6% among the rest of the subjects, p=0.20, and 18.5% vs 12.7%, p=0.28, respectively). The KM curves suggest mid-term clinical importance of multiple or posterior PVLs (Fig 1A and 1B).
Figure 1

Conclusions
Moderate PVL found in multiple locations or recognized in the posterior location tend to be associated with worse midterm (1–2 years) prognosis after successful TAVR.
P1856Percutaneous mitral edge-to-edge valvuloplasty in end-stage heart failure as a bridge to heart transplant: a case series from a single tertiary referral center
Authors: Montalto C , Crimi G , Mandurino-Mirizzi A , Frassica R , Gazzoli F , Covi R , Moschella M , Ghio S , Magrini G , Raineri C , Pelenghi S , Ferrario M , De Ferrari G M , Oltrona-Visconti L 
Published: October 2019

Abstract

Background
Improved outcomes after percutaneous edge-to-edge mitral valvuloplasthy with MitraClip implantation were recently observed in patients with heart failure (HF) and functional severe mitral regurgitation (MR). Nonetheless, its efficacy in end-stage heart failure (HF) are lacking.

Purpose
Our aim was to investigate feasibility, preliminary efficacy on hemodynamics and follow-up of MitraClip implantation in a cohort of patients with very advanced HF.

Methods
Patients were retrospectively included in the present analysis if already in HT list, unsuitable for HT despite optimal medical and device therapy, or if implantation was a “bridge-to-candidacy”.

Results
Baseline and procedural characteristics are listed in Table 1; MR etiology was predominantly functional (n=7). No major complications were observed in the peri-operative period. At 6-month follow-up, invasive hemodynamics was available for 8 patients. A significant increase in cardiac index was observed (Least Square Mean Difference, LSMD = +0.47 L/min/m2; p=0.03; Figure 1), in conjunction with a numerical reduction in pulmonary vascular resistance (LSMD = −1.02 WU; p=0.3), a trend towards lower mean pulmonary arterial pressure (LSMD = −6.5 mmHg; p=0.053) and lower ejection fraction (LSMD = −6.5%; p=0.053). At a median follow-up of 772 days (IQR 156–1,578), all three patients unsuitable for HT at baseline could be eligible to HT list and one of them received LVAD. Moreover, two patients were transplanted, four experienced unplanned rehospitalization for HF, and one died of non-cardiac cause.
Table 1. Baseline clinical evaluation (n=10) Age (y) 53.67±8.43 HF Etiology – post ischemic 4 (40) Male sex 6 (60) HF Etiology – no CAD 4 (40) Body Surface Area (m2) 1.76±0.22 HF Etiology – other 2 (20) Chronic Resynchronization Therapy 5 (50) Euroscore II 6.00±2.74 Baseline MR grade (+) 4 (40) STS mortality 1.71±2.65 Residual MR grade (+) 1.71±0.49 Clips implanted (number) 1.78±0.67 Data are expressed as mean ± SD or count (valid %). MR scored on a scale from 0+ to 4+. STS, Society of Thoracic Surgeons.
Figure 1

Conclusions
Percutaneous edge-to-edge mitral valvuloplasty with MitraClip appears safe and effective in end-stage patients, impacts on clinical decision-making and therefore might be considered as a “bridge” towards a more definite strategy.

Acknowledgement/Funding
None
P1888Autoantiboides to Muscarinic M2 cholinoceptors in patients with paroxysmal atrial fibrillation
Authors: Mironova E S , Mironova N A , Mironov N Y U , Layovich L Y U , Golitsyn S P , Zykov K A , Sharf T V , Efremov E E , Azmuko A A , Molokoedov A V 
Published: October 2019

Abstract

Introduction
Atrial fibrillation (AFib) is the most frequenly encountered arrhythmia. In the majority of cases AFib occurs in patients with cardiovascular diseases such as arterial hypertension (AH). In 10–15% of cases AFib occurs in the absense of comorbidities in structurally normal heart. It is reffered to as “lone AFib” and the cause of this arrhythmia remains unknown. Activation of cardiac M2-actylcholinoreceptors (M2-CR) leads to decrease in duration of atrial refractory periods that may contribute to development of AFib. Autoantibodies against M2-CR has cholinomimetic properties, but role of these autoantibodies in development and maintenance of AFib has not been studied.

Purpose
To assess autoantibodies against M2-CR in patients with paroxysmal lone AFib, in patients with AFib and AH and healthy people.

Methods
100 patints with lone Afib, 100 patients with Afib and AH and 25 healthy people were included. Patients underwent clinical blood and urinlysis, assessment of biochemistry blood panel, 12-lead ECG, 24-hour Holter monitoring, echocardiography and stress-testing (treadmill or stress-echocardiography). Assesment of IgM and IgG autoantibodies to M2-CR was performed by indirect immunoenzyme assay. The following peptide molecules were used as epitopes for detection of autoantibodies: M1-amino acid sequence YTVIGYWPLGVVCDL (83–98) of the first extracellular loop of M2-CR; M2-sequence VRTVEDGECYIQFFSNAAVTFGTAI (168–192) of the second extracellular loop of M2-CR; M3-sequence NTFCAPCIPNTV (410–421) of the third extracellular loop of M2-CR, M4-short sequence VEDGECYIQFFS (171–182) of the second extracellular loop of M2-CR; M1+M4-chimeric molecule formed by sequences of the first and the second extacellular loops of M2-CR connected by disulfide bound YTVIGYWPLGVVCDL+VEDGECTIQFFS (83–98+171–182).

Results
IgG to M2-CR were found in 32% of patients with AFib and in 12% of healthy subjects (p<0,05). IgM to M2-CR were found in 25% of patients with AFib and in 32% of healthy subjects (p<0,05). In patients with lone AFib prevalence of IgG to M2-CR were greater than in patients with AFib and AH (39% vs 25%; p<0,05). Patients with lone AFib and AFib and AH had higher prevalence of IgG to all amino-acid sequences and difference was statistically significant for M2, M4, M1+M4 epitopes (see fig.).
Prevalence of IgG to M2-CR epitopes

Conclusion
Higher prevalence of IgG to M2-CR in patients with AFib than in healthy subjects may suppose an active role of autoimmune processes in arrhythmogenesis.