bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1821Proximal aorta longitudinal but not circumferential strain predicts aortic events and aortic root dilation rate in marfan syndrome patients
Authors: Guala A , Teixido Tura G , Rodriguez-Palomares J F , Ruiz Munoz A , Granato C , Galian L , Valente F , Servato L , Villalva N , Gutierrez L , Lopez Sainz A , Gonzalez-Alujas T , Sanchez V , Forteza A , Evangelista A 
Published: October 2019

Abstract

Background
The most common cardiovascular complications in Marfan syndrome (MFS) are aortic root dilation and type A aortic dissections. Elective aortic root surgery is indicated when maximum aortic diameter is larger than a defined threshold or in the case of fast-progressing dilation. However, maximum aortic diameter is limited for the prediction of aortic events. Indeed, a large international registry of acute aortic syndromes reported that as much as 40% of aortic dissections happen with maximum aortic diameter lower than 50 mm. Consequently, there is a need for new, non-invasive biomarkers to improve the prediction of aortic complications.

Purpose
The aim of the present study was to assess if proximal aorta circumferential and longitudinal strain and ascending aorta distensibility were associated with progressive aortic dilation and incidence of aortic events in Marfan syndrome patients.

Methods
Eighty seven Marfan syndrome patients free from previous cardiac/aortic surgery or dissection, were prospectively included in a multicenter follow-up. Patients were diagnosed by original Ghent criteria. Proximal aorta longitudinal and circumferential strain and distensibility were computed from baseline cine CMR images by means of feature-tracking. The predictive capacity of each stiffness biomarkers was separately tested with multivariable linear regression analysis (aortic growth) and with Cox logistic regression analysis (aortic events), both corrected for clinical and demographic variables, including baseline maximum aortic diameter.

Results
During a follow-up of 81.6±17 months, mean diameter growth-rate was 0.65±0.67 mm/year and z-score growth rate was 0.07±0.13 / year. Elective aortic root replacement was performed in 11 patients while two patients presented type A aortic dissection.Baseline proximal aorta longitudinal strain was independently related to diameter growth-rate (p=0.001), z-score growth-rate (p=0.018) and aortic events (p=0.018). Conversely, neither circumferential strain nor distensibility were independent predictors of diameter growth-rate (p=0.385 and p=0.381, respectively), z-score growth-rate (p=0.515 and p=0.484, respectively) and aortic events (p=0.064 and p=0.205, respectively).

Conclusions
Proximal aorta longitudinal strain predicts aortic root dilation and major aortic events in Marfan syndrome patients beyond aortic root diameter and clinical and demographic characteristics.

Acknowledgement/Funding
ISCIII PI14/0106, La Maratό de TV3 (20151330) and CIBERCV. Guala A. FP7/People n° 267128
P1839Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study
Authors: Nakashima C A K , Dallan L A O , Lisboa L A F , Hajjar L A , Soeiro A M , Silva B A , Costa M S S , Dornas C J C B , Dalcoquio T F , Furtado R H M , Baracioli L M , Fukushima J T , Gurbel P A , Giugliano R P , Nicolau J C 
Published: October 2019

Abstract

Background
Dual antiplatelet therapy is recommended for patients (pts) with acute coronary syndromes (ACS). However, 10–15% of pts have indication of coronary artery bypass graft (CABG) for the index event and current guidelines recommend stopping clopidogrel at least 5 days prior to CABG. This waiting time could increase hospital length of stay, thus having negative impacts on costs and clinical complications.

Purpose
To evaluate if release to CABG based on platelet aggregability by Multiplate AnalyzerTM would be non-inferior in comparison with common practice (5 days) in terms of 24-hours post-CABG bleeding.

Methods
The PLAT-CABG (NCT 02516267) is a randomized, open label, non-inferiority trial (boundary 25%) testing a strategy of platelet aggregability-guided release to CABG versus standard-of-care on the primary endpoint of chest tube drainage in the first 24 hours post CABG. A total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and with indication for CABG, were assigned to clopidogrel discontinued 5 days prior to CABG (control group) vs. daily measurements of platelet aggregability to ADP using Multiplate AnalyzerTM (intervention group) with CABG occurring after recovering from platelet inhibition (pre-defined as a threshold of 46 AU).

Results
The main results are depicted in the table
Main results of PLAT-CABG study Variables Control Group (n=95) Intervention Group (n=95) P-value for superiority P-value for non-inferiority Chest tube drainage (mL), Median (25th–75th) 350 (250–500) 350 (250–500) 0.680 0.001 Time symptom to CABG (hours), Median (25th–75th) 191 (150–281) 166 (119–225) <0.001 NA Time surgery indication to CABG (hours), Median (25th–75th) 136 (112–161) 112 (66–142) <0.001 NA CABG = coronary artery bypass graft.

Conclusion
Platelet-aggregability guided release to CABG is non-inferior to standard of care in ACS patients awaiting CABG in terms of peri-operative bleeding and significantly shortens the time to CABG.

Acknowledgement/Funding
Roche Diagnostica Brazil
P1858Meta-analysis of performance of risks scores for predicting outcomes after percutaneous Mitraclip implantation
Authors: Wang T K M , Wang M T M 
Published: October 2019

Abstract

Background
The Mitraclip is the most established percutaneous mitral valve intervention indicated for severe mitral regurgitation at high or prohibitive surgical risk. Risk stratification plays a critical role in selecting the appropriate treatment modality in high risk valve disease patients but have been rarely studied in this setting. We compared the performance of risk scores at predicting mortality after Mitraclip in this meta-analysis.

Methods
MEDLINE, Embase and Cochrane databases from 1 January 1980 to 31 December 2018 were searched. Two authors reviewed studies which reported c-statistics of risk models to predict mortality after Mitraclip for inclusion, followed by data extraction and pooled analyses.

Results
Amongst 494 articles searched, 47 full-text articles were evaluated, and 4 studies totalling 879 Mitraclip cases were included for analyses. Operative mortality was reported at 3.3–7.4% in three studies, and 1-year mortality 11.2%-13.5% in two studies. C-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.66 (0.57–0.75), EuroSCORE II 0.72 (0.60–0.85) and STS Score 0.64 (0.56–0.73). Respective Peto's odds ratios (95% confidence interval) to assess calibration were EuroSCORE 0.21 (0.14–0.31), EuroSCORE II 0.43 (0.24–0.76) and STS Score 0.36 (0.21–0.61). C-statistics (95% confidence interval) for 1-year mortality were EuroSCORE II 0.64 (0.57–0.70) and STS Score (0.58–0.64).

Conclusion
All scores over-estimated operative mortality, and EuroSCORE II had the best moderate discrimination while the other two scores were only modestly prognostic. Development of Mitraclip-specific scores may improve accuracy of risk stratification for this procedure to guide clinical decision-making.
P1861Influence of thermal conductivity on esophageal protection with a cooling device during high-power short-duration radiofrequency ablation
Authors: Kulstad E , Mercado-Montoya M , Shah S 
Published: October 2019

Abstract

Introduction
Recent clinical data show that high-power, short-duration (HPSD) radiofrequency (RF) ablation can result in a similar esophageal injury rate as traditional low-power, long-duration (LPLD) ablation. Existing methods to prevent esophageal injury have yielded mixed results and can result in prolonged procedure time, potentially increasing the incidence of post-operative cognitive dysfunction. A new esophageal cooling device currently available for whole-body temperature modulation is being studied for the prevention of esophageal injury during LPLD RF ablation and cryoablation. We sought to develop a mathematical model of HPSD ablation in order to quantify the capability of this new esophageal cooling device to protect from esophageal injury under high-power conditions.

Methods
Using a model we developed of HPSD RF ablation in the left atrium, we measured the change in esophageal lesion formation and the depth of lesions (measured as percent transmurality) with the esophageal cooling device in place and operating at a temperature from 5°C to 37°C. Tissue parameters, including thermal conductivity, were set to average values obtained from existing literature, and energy settings were evaluated at 50W for between 5 and 10 seconds, and at 90W for a duration of 4 seconds.

Results
Esophageal injury as measured by percent transmurality was considerably higher at 50W and 10s duration than at 90W of power with 4s duration, although both settings showed potential for esophageal injury. The protective effect of the esophageal cooling device was evident for both cases, with a greater effect when using 50W for 10s (Figure 1). At the coldest device settings, using a 5 min pre-cooling period also reduced the transmurality of the intended atrial lesions.
Esophageal protection in HPSD ablation

Conclusions
Esophageal cooling with a new patient temperature management device shows protective effects against thermal injury during RF ablation across a range of tissue thermal conductivity, using a variety of high-power settings, including 90W applied for 4 seconds. Adjusting the cooling power by adjusting the circulating water temperature in the device allows for a tailoring of the protective effects to operating conditions.

Acknowledgement/Funding
Attune Medical
P1863Establishing safe working parameters for radio frequency catheterization along with acoustic sensing
Authors: Refaat M , El Khoury W , Rmeity N , Mahmasani A , Al Aaraj J , Akiki M , Gebran A , Abbas R , Hajjar M , Oweis G 
Published: October 2019

Abstract

Background
Studies comparing angles of application in Radio Frequency (RF) catheter ablation other than 0 and 90 degrees are absent from the literature. Likewise, using acoustics to predict steam pop occurrences and prevent a catastrophic rupture of the myocardium has not been examined previously.

Purpose
Evaluate the effect of various parameters on the ablated volume and the probability of creating a boiling pop.

Methods
A low-cost testing and educational platform to work with generic RF catheters was set up. The in-vitro system allows controlling the blood flow surrogate over the cardiac tissue, the catheter contact force, electric power, and ablation time. Acoustic transducers have been employed with the setup to detect preliminary acoustic signals.

Results
Obtained results show a positive correlation between variations of the ablated surface geometry and power intensity changes. Generated figures provide percentages of a boiling pops for any given set of parameters fig1 (Top left: Probability of popping vs power and time). The probability of a boiling pop occurring increased if the ovine specimen is non-irrigated. The ratio of the burn correlates with the power and the angle of the catheter (30°, 45°, 60°, and 90°). However, the probability of the popping mostly depends on the power fig1 (Top right: Burn ratio vs power for 30°, 45°, 60°, and 90°) and fig1 (Bottom right: Cross sectional view of the corresponding lesions -same scale used for all images). Benign precursory bubbles detected by acoustics preceded the occurrence of catastrophic boiling pops fig1 (Bottom left: Acoustic signal showing a precursory pop before the major cavitation).
Figure 1

Conclusion
The established parameters for power intensity and exposure time should be respected to maintain a safe procedure. Acoustics can be further implemented to provide a warning for electrophysiologists before the occurrence of a boiling pop.

Acknowledgement/Funding
The funding for this project was provided from the URB and the MPP at the AUBMC and the AUB.
P1884Low lipid levels and high variability correlate with the risk of new-onset atrial fibrillation
Authors: Lee H , Lee S R , Choi E K , Han K D , Oh S 
Published: October 2019

Abstract

Background
High levels of lipids and lipid variability are established risk factors for atherosclerotic cardiovascular disease. We investigated their roles in the development of atrial fibrillation (AF). This is the largest cohort study yet on the association between lipid levels and AF, and the first study on the association between lipid variability and AF.

Methods
A nationwide population-based cohort of 3,828,652 adults (mean age 43.9 years) from the Korean National Health Insurance Service database without prevalent AF, not on lipid-lowering medication, and with at least 3 measurements of each lipid parameter at 1–2 year intervals over a 4-year period were included. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were measured, and lipid variability was calculated using variability independent of mean. The cohort was divided into quartiles by baseline lipid levels and lipid variability, and followed up for incident AF.

Results
During median 3.4 years of follow-up, AF was newly diagnosed in 13,240 (0.35%). AF development was inversely associated with TC and LDL-C levels (for top vs. bottom quartile; TC, hazard ratio [HR] 0.76, 95% confidence interval [95% CI] 0.72–0.80); LDL-C, HR 0.78, 95% CI 0.74–0.82) in both sexes, and with TG levels in men (HR 0.85, 95% CI 0.80–0.90). Meanwhile, AF development was associated with higher LDL-C and HDL-C variability (for top vs. bottom quartile; LDL-C, HR 1.16, 95% CI 1.10–1.22; HDL-C, HR 1.08, 95% CI 1.03–1.14) in both sexes, and with TC variability in men (HR 1.16, 95% CI 1.10–1.22).

Conclusions
Lower cholesterol levels (TC, LDL-C) and higher cholesterol variability (LDL-C, HDL-C) were associated with higher risk for AF. Low TG levels and high TC variability were also associated with AF incidence in men. These findings support the “cholesterol paradox” in AF, and suggest that cholesterol variability is also a risk factor for AF development.
P1886Validation of the MB-LATER score prediction ability for recurrent atrial fibrillation after electrical cardioversion
Authors: Marinkovic M , Mujovic N , Kovacevic V , Mihajlovic M , Vajagic L , Kocijancic A , Olafsson U , Andersen K , Arnar D O , Lip G Y H , Potpara T 
Published: October 2019

Abstract

Introduction
The MB-LATER score (Male, Bundle brunch block, Left atrium ≥47 mm, Type of AF [paroxysmal, persistent or long-standing persistent], and ER-AF=early recurrent AF during first three months) was originally developed for prediction of late AF recurrences post AF catheter ablation (CA-AF). Subsequently, the score has been internationally validated in multiple AF cohorts, showing a good prediction ability for recurrent AF post AF-CA. We assessed prediction ability of the MB-LATER score for recurrent AF after successful electrical cardioversion (ECV) of AF.

Methods
The retrospective study included a Serbian and Icelandic centre, enrolling patients post successful ECV of AF in the period between January 2014 and February 2016. Of 580 patients, 136 (23.4%) were excluded because incomplete data needed for the MB-LATER score calculation. AF episodes lasting ≤7 days before ECV were classified as paroxysmal AF, and the ER-AF component of the MB-LATER score was excluded from the analysis because of different clinical implications in the setting of ECV. The study outcome was defined as the time to first recurrence of AF post successful ECV. Patients post successful ECV were seen at 1 and 6 months post ECV and every 12 months thereafter.

Results
Among 444 patients (median age 68 years [IQR 60.0–74.6], 289 males [65.2%], 200 [45.0%] with non-paroxysmal AF. AF re-occurred in 283 patients (63.7%) after a median of 233.5 [IQR 44–366]) days post successful ECV. Patients with recurrent AF had significantly higher median MB-LATER score than those without (1 [IQR 1–2] vs. 2 [IQR 1–2], p<0.001). On univariate analysis, the MB-LATER score was significantly associated with time to AF recurrence post ECV (Hazard Ratio 1.20; 95% CI 1.07–1.35, p=0.003), showing modest but statistically significant prediction ability for recurrent AF post successful ECV (c-statistic 0.61; 95% CI 0.56–0.66, p<0.001). The Kaplan-Meyer survival free from AF post successful ECV was significantly better for patients with a MB-LATER score of <2 than for those with a score of ≥2 (log-rank p=0.005) (Fig 1.).
Figure 1

Conclusion
In our analysis of an international cohort of AF patients post successful ECV, the MB-LATER score showed a modest but statistically significant prediction ability for recurrent AF post ECV. Reliable prediction of recurrent AF post ECV could inform patient selection and treatment decision-making. Further prospective validation of the MB-LATER score prediction ability for recurrent AF post ECV is underway.
P1894Serum light-chain neurofilament is associated with brain atrophy in patients with atrial fibrillation
Authors: Aeschbacher S , Meyre P , Sinnecker T , Ammann P , Auricchio A S , Kobza R , Shah D , Sticherling C , Ehret G , Kuhne M , Osswald S , Conen D , Bonati L H , Kuhle J , Wurfel J 
Published: October 2019

Abstract

Background and aims
There is emerging evidence that atrial fibrillation (AF) is associated with cognitive dysfunction, increased risk for dementia and reduced brain volume independent of stroke, but the underlying mechanisms of these associations remain unclear. Here, we investigated the association of serum light-chain neurofilament (sNfL), a neuroaxonal injury biomarker, with brain atrophy in AF patients.

Methods
Explorative analysis from the Swiss-AF cohort study, a multicenter prospective observationalstudy which recruited patients aged ≥45 years with documented AF (NCT02105844). In baseline blood samples, sNfL concentrations were measured in duplicates using a single-molecule array assay. Brain MRI was obtained at baseline and at two years using a standardized protocol including a 3D T1-weighted MPRAGE sequence, on which Structural Image Evaluation using Normalization of Atrophy (SIENA) with optimized parameters for brain extraction was applied to calculate the two-year percentage whole brain volume change (PBVC).

Results
We included 245 Swiss-AF patients (median age 73, 73% male). Two-year PBVC was significantly associated with baseline sNfL in linear regression, with a 0.09% whole brain volume decrease per 10 pg/ml sNfL increase (95% CI [0.05–0.13], p<0.001). This association remained significant after adjustment for age, history of stroke and other vascular risk factors.
Neurofilament and brain atrophy

Conclusion
Increasing baseline sNfL was predictive of higher two-year brain atrophy rates independent of stroke history in AF patients. This association might reflect a chronic neurodegenerative process in AF.

Acknowledgement/Funding
Swiss National Science Foundation
P1907Propensity score matched analysis of antazoline mesylate vs. amiodarone or propafenone for pharmacological cardioversion of short-duration atrial fibrillation
Authors: Wybraniec M , Wrobel W , Wilkosz K , Wrona K , Bula K , Kolasa J , Mizia-Stec K 
Published: October 2019

Abstract

Background
Former studies corroborated promising quinidine-like properties of antazoline mesylate facilitating rapid cardioversion atrial fibrillation (AF). Still, paucity of data exists concerning direct comparison of antazoline to other antiarrhythmic agents.

Purpose
The study aimed to verify the hypothesis that intravenous antazoline is non-inferior to amiodarone and/or propafenone in terms of rhythm conversion rate and safety among patients with AF.

Methods
After reviewing 2344 consecutive medical records with I48 code of international classification of diseases (ICD), 505 eligible patients (21.5%) with paroxysmal or persistent AF who underwent emergent pharmacological cardioversion in the real-world setting of emergency department were enrolled in retrospective observational analysis. The choice of antiarrhythmic drug was left to the discretion of attending physician. Antazoline group was separately matched with corresponding amiodarone (n=218) and propafenone (n=90) cohort using propensity score matching (PSM) with nearest neighbor algorithm (ratio 1:1), adjusting for age, sex, arterial hypertension, diabetes, depressed left ventricular ejection fraction, coronary artery disease, history of stroke, AF ablation, CHA2DS2-VASc score, chronic kidney disease and duration of AF episode. The primary endpoint was restoration of sinus rhythm in the emergency department.

Results
The study population (mean age of 67 (59; 74) years; 53.7% females) was characterized by median AF episode duration of 10.5 (5; 24) hours. Antazoline alone was administered in 23.4% of patients (n=118); amiodarone in 47.5% (n=240); propafenone in 9.9% (n=50); while 19.2% (n=97) received ≥2 antiarrhythmic drugs. Before PSM adjustment, antazoline had comparable rhythm conversion rate to propafenone (85.6% vs. 80.0%; P=0.367) and higher than amiodarone treatment (vs. 66.7%, P=0.0002), and greater than combined amiodarone/propafenone group (68.6%; RR 1.25; 95% CI: 1.12–1.39, P=0.0001). After PSM, the use of antazoline was associated with the efficacy similar to propafenone (82.2% vs. 80.0%, RR 1.03; 95% CI: 0.84–1.25, P=0.788) and superior to amiodarone (85.3% vs. 67.0%, RR 1.27, 95% CI: 1.09–1.48, P=0.0019, number needed to treat 5.5; Figure). No major adverse actions were reported in the antazoline group.

Conclusion
Antazoline appears to be an efficacious and safe drug for pharmacological cardioversion of AF in real-life setting, which is at least non-inferior to existing antiarrhythmic drugs.

Acknowledgement/Funding
None