bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6504NETosis is associated with the severity of aortic stenosis
Authors: Kopytek M , Kolasa-Trela R , Zabczyk M , Undas A , Natorska J 
Published: October 2019

Abstract

Background
High hemodynamic forces similar to those observed in aortic stenosis (AS) can trigger neutrophil extracellular traps (NETs) formation.

Purpose
An involvement of NETosis in the AS pathogenesis is unknown.

Methods
We enrolled 25 patients, median age 64.9 [range, 58–69] years with isolated severe AS (transvalvular pressure gradient, PGmean: 53.6±11.3 mm Hg, PGmax: 85.1±17.6 mmHg), after aortic valve replacement and 15 healthy sex/age-matched controls. Autopsy-derived aortic valves from 5 healthy donors served as negative control. Transverse valve sections were taken from the mid and commissural areas of the leaflet and cryosectioned by a Leica CM 1520 cryostat. Valvular expression of citrullinated histone H3 (citH3), together with myeloperoxidase (MPO), and neutrophil elastase (NE) as NETs biomarkers and macrophages (CD68) were evaluated by single- and double- immunostaining. Plasma concentrations of citH3 and interleukin 6 (IL-6) were also determined.

Results
All stenotic and healthy valves expressed citH3 in the leaflets' endothelial and sub-endothelial layers at the aortic side. The in loco expression of citH3-positive cells was higher in AS patients compared with controls (42.3±8.7% vs. 7.2±4.8%, p<0.05) and correlated with disease severity measured as aortic valve area (AVA; r=−0.84, p<0.0001), as well as PGmean (r=0.62, p<0.001), and PGmax (r=0.52, p>0.05). Double-staining revealed that within stenotic leaflets 28.3±8.4% of cells were citH3/MPO- and 25.2±7.1% citH3/NE-positive. None of control valves showed MPO or NE-positivity. Moreover, 6.6±1.9% of valvular cells (17.2±5.4% of citH3-positive cells) showed citH3/CD68 double-positivity and were identified as macrophages. Plasma levels of citH3 were 59% higher in AS patients then in controls (p<0.05), and the concentrations of citH3 correlated with IL-6 levels (r=0.44, p<0.05) and AVA (r=−0.48, p<0.05).

Conclusions
The presence of NETs in stenotic valves and association with AS severity might suggest novel mechanisms involved in the disease progression. This work was supported by the grant from the Polish National Science Center (DEC-2017/01/X/NZ5/02006 to R.K-T.).

Acknowledgement/Funding
This work was supported by the grant from the Polish National Science Center (DEC-2017/01/X/NZ5/02006 to R.K-T.).
P6518Radial artery dilatation to improve access and lower complication rates during coronary angiography (RADIAL): a randomized controlled trial
Authors: Doubell J , Kyriakakis C , Weich H , Herbst P , Pecoraro A , Moses J , Griffiths B , Snyman H W , Kabwe L , Du Toit R , Joubert L , Hassan K , Doubell A 
Published: October 2019

Abstract

Background
Transradial catheterization has become the preferred access site for coronary angiography. The transradial approach is however not without challenges and complications. Cannulation is technically challenging and may require multiple cannulation attempts or access may fail. Local access site complications may occur postprocedurally.

Purpose
To explore the use of prolonged occlusion flow mediated dilatation (PO-FMD) to dilate the radial artery prior to cannulation to reduce puncture attempts, increase cannulation success and reduce access site complications in transradial coronary angiography.

Methods
1156 patients undergoing transradial coronary angiography were randomized into PO-FMD and sham PO-FMD groups. PO-FMD was achieved by a 10 minute inflation of a blood pressure cuff on the arm to above systolic pressure, followed by deflation with resultant radial artery dilation. In the sham PO-FMD group the cuff was not inflated. The operators were blinded to the intervention.

Results
580 patients were randomized to the sham PO-FMD group and 576 to the PO-FMD group. The number of puncture attempts were reduced with the use of PO-FMD, with a median number of attempts of 1 in the PO-FMD group and 2 in the sham PO-FMD group (p<0.001). Cannulation failure was reduced with PO-FMD FMD with cannulation failure rates of 2.7% in the PO-FMD group and 5.8% in the sham PO-FMD group (p=0.01). Radial artery pulsation loss (RAPL) was reduced with PO-FMD with 1.4% in the PO-FMD group and 3.8% in the sham PO-FMD group (p=0.02).

Conclusion
PO-FMD decreases puncture attempts, reduces cannulation failure rates and decreases RAPL during transradial coronary angiography.
P6520Outcomes of the trans radial approach PCI in a single tertiary center over a decade of adoption and
Authors: Perl L , Bental T , Greenberg G , Vaknin-Assa H , Assali A , Kornowski R 
Published: October 2019

Abstract

Background/Introduction
The trans-radial approach (TRA) has been increasingly adopted for the use of percutaneous coronary interventions (PCI), with reported clinical benefits. Little is known regarding the change in outcomes over time.

Purpose
To assess the temporal trends of TRA PCI in a single tertiary center over a decade.

Methods
From a database of 21,763 consecutive PCI's, we analyzed 15,429 patients in 2 periods – 2008 to 2012 (period 1) and 2013 to 2017 (period 2). We examined the proportions of use of TRA, the influence on in-hospital outcomes and adjusted long-term effects.

Results
The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA vs. TFA (1.8% vs. 5.1%, overall, p<0.001), as were rates of additional bleeding events in the following 12 months (1.3% vs. 2.4%, p<0.001). Following multivariate analysis, use of TRA was associated with a lower 30-day and 4-year rate of the composite outcomes of death, myocardial infarction, target vessel revascularization or coronary artery bypass surgery [at 4 years, HR-0.86 (95% CI 0.77–0.96 p=0.007) during period 1 and HR-0.62 (95% CI 0.55–0.7 p<0.0001) during period 2, figure 1]. Interaction analysis showed a stronger effect at the latter period (HR-0.69, 95% CI 0.59–0.81, p<0.001).
Figure 1

Conclusions
Over a decade of follow-up, TRA has gained acceptance for different PCI scenarios, including complex patients- a course which is associated with consistent short and long-term clinical benefits.
P6522Overcoming anatomic challenges to transradial access in STEMI patients
Authors: Campos I , Galvao Braga C , Costa J , Quina Rodrigues C , Costa Oliveira C , Medeiros P , Marques Pires C , Vieira C , Marques J 
Published: October 2019

Abstract

Background
Transradial access is associated with fewer access-related complications, earlier discharge and lower mortality, being the preferred route to perform coronary angiogram and interventions due to its safety and cost effectiveness in STEMI patients. However, the radial artery is smaller, more superficial and thinner than the femoral artery and a percentage of patients ranging from 14% to 27% have a radial artery that is smaller than a 6-French introducer, which sometimes makes angioplasty difficult.

Purpose
This study reports our initial experience with the 5F straight (STR) flush catheter, which can be used as a “child” type rapid exchange catheter inside the 6F guiding catheter, creating a distal tip transition, facilitating angioplasty in transradial coronary interventions when the radial artery is small, tortuous or as severe spasm that impedes advancement of guiding catheter after successful angiography with 5F catheter.

Methods
We analysed, retrospectively, 1510 STEMI patients (pts) admitted in our catheterization laboratory, from August of 2010 to October 2017. Of these patients, 95 (6.3%) pts with problems in advancing a 6F guiding catheter, were submitted to this technique and a direct crossover to a femoral approach was performed in 36 pts (2.4%). This technique consists in the use of longer 5F STR flush catheter in order to overcome the larger distal tip of the 6F guiding catheter through the radial access, employing a 5-in-6 F technique.

Results
In 89 of 95 patients (93.7%), this new technique was successful, with a mean reperfusion time since arrival to the catheterization laboratory of 24.5±9.9 minutes. Of the pts submitted to this technique the majority were female 51 (57.3%) and the mean age was 67±14.3 years. Angioplasties were performed in the left main (2; 2.3%), left anterior descending (36; 40.4%), left circumflex artery (8; 9.0%), right coronary artery (40; 44.9%), right posterior descending artery (1; 1.1%) and obtuse marginal branch (2; 2.3%). No complications in arterial access were seen. Throughout these years of study, the need for crossover to femoral approach has decreased with the learning of this technique. The time until reperfusion since catheterization laboratory arrival was 29.3±9.5 minutes when there was a crossover, being statistically higher than with the radial procedure with the STR technique (p<0.017).

Conclusion
This new technique may be a simple and useful approach to perform primary PCI through transradial access in patients with small diameter radial arteries, allowing a reduction of crossover to femoral access, which translates into a lower risk of vascular complications and shorter reperfusion time, that may influence the prognosis of STEMI patients.
P6525Impact of acute arrhythmias on in-hospital mortality in patients undergoing angioplasty
Authors: Karrthik A , Gad M , Ahuja K , Bazarbashi N , Abderrehman K , Ahmed H 
Published: October 2019

Abstract

Introduction
Arrhythmia is one of the most common complications in patients undergoing percutaneous coronary interventions (PCI). Prior attempts to address these arrhythmias “aggressively” did not show improvement in survival. This study aims to investigate the impact of acute arrhythmias on in-hospital mortality in patients undergoing angioplasty in the United States.

Methods
Data about patients undergoing PCI between January 2010 and December 2014 on the Nationwide Readmission Database (NRD) was queried from the Healthcare Cost and Utilization Project (HCUP). All patients undergoing PCI were identified with the appropriate ICD-9 procedure codes. Binominal logistic regression testing was utilized to perform a multivariate analysis and different patient baseline characteristics were adjusted for including age, gender, LOS, diabetes mellitus, hypertension, renal failure, and cancer diagnosis. Odds Ratio (OR) of in-hospital mortality following acute arrhythmia were reported alongside 95% Confidence Intervals (CI).

Results
A total of 2,712,078 patients underwent PCI during hospitalization from January 2010 to December 2014. Out of those, 56,985 (2.1%) patients died while hospitalized. Most of the patients who died were older (mean age 70.73±12.9) and males (59.3%). After adjusting for age, female gender, hypertension, diabetes, heart failure, anemia, malignancy, psychiatric disorder, and longer length of stay; ventricular and supraventricular arrhythmias were found to be predictors of in-hospital mortality. Atrial fibrillation had an OR of 1.588 (95% CI: 1.551–1.626), ventricular tachycardia an OR of 2.191 (95% CI: 2.133–2.250), and ventricular fibrillation an OR of 4.143 (95% CI: 4.031–4.258).

Conclusions
Ventricular and supraventricular arrhythmias are independent predictors of in-hospital mortality following angioplasty. Further studies are warranted to evaluate the optimal management for patients with acute arrhythmia following PCI.
P6532Trimetazidine and nicorandil decrease the increment of serum creatinine in patients with normal or slightly decreased renal function after undergoing elective percutaneous coronary intervention
Authors: Li X , Wang X , Liu D , Zhang M , Liu M , An F 
Published: October 2019

Abstract

Background
Contrast-induced nephropathy (CIN) is a serious complication of percutaneous coronary intervention which can cause serious adverse outcomes. There is still no effective treatment for it.

Aims
To evaluate and compare the protective effect of trimetazidine and nicorandil on renal function in patients undergoing percutaneous coronary intervention.with estimated glomerular filtration (eGFR) >60 ml/min/1.7 m2.

Method
161 patients who met the inclusion criteria were recruited and divided into control group (n=41), trimetazidine group (n=40), nicorandil group (n=40) and trimetazidine combined with nicorandil group (n=40). Both TMZ and nicorandil were administered orally 72 hours before and 48 hours after the procedure. All patients in the four groups were given intravenous saline (0.9%) at a rate of 1 ml/kg/h 6 hours before and 12 hours after the procedure. Serum creatinine (SCr), GFR were measured before and 48 hours after the procedure. An increase of 44mmol/L (0.5mg/dL) in SCr or 25% higher than basal levels at 48 hours after administered iodinated CM was diagnosed as CIN.

Results
(1) The baseline characteristics of the four groups were similar. (2) The SCr levels increased in control group (baseline 73.07±15.69 VS. after PCI 91.71±23.10 mmol/L), TMZ group (baseline 71.90±17.30 VS. after PCI 82.00±17.19 mmol/L), nicorandil group (baseline 72.23±15.95 VS. after PCI 81.45±18.30 mmol/L)and TMZ plus nicorandil group (baseline 71.13±13.50 VS. after PCI 73.35±12.64 mmol/L) at 48 hours after the procedure, all p values <0.05. (3) The increment of SCr after PCI in control group (ΔScr=18.63±9.21 mmol/L) is higher than TMZ group (ΔScr=10.10±5.62 mmol/L) and nicorandil group (ΔScr=9.23±5.60mmol/L), and is higher than TMZ plus nicorandil group (ΔScr=2.23±1.42 mmol/L), all p values <0.001. There was no statistical difference of increment of SCr between TMZ group and nicorandil group. (4) Contrast-induced nephropathy developed in 14.6% (6/41) in control group, 2.5% (1/40) in TMZ group and 2.5% (1/40) in nicorandil group (p<0.05), none in TMZ plus nicorandil group.

Conclusions
TMZ and nicorandil exerted similar protective effect on renal function by decreasing SCr level and CIN incidence after PCI. The efficacy of TMZ combined with nicorandil on renal protection was greater than TMZ or nicorandil alone.
P6537Screening for Atrial Fibrillation in Native Americans using iPhone ECG
Authors: Stavrakis S , Elkholey K , Lofgren M , Freedman B 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is a major risk factor for stroke. Screening for silent AF, with subsequent initiation of anticoagulation in at-risk individuals, may decrease the risk of stroke. Native Americans (NA) have a high prevalence of diabetes and higher incidence of stroke than whites and blacks. Indigenous Australians, and Maori in New Zealand develop AF on average 10–20 years earlier than Europeans and Asians living in the same country. We hypothesized that screening for AF using a single time point, 30-second iPhone-based ECG recording will result in identification of silent AF in a significant number of NA compared to routine care, and that the age profile of those detected may be younger than non-NA.

Purpose
To determine the prevalence of AF, and incidence of unknown AF in NA seen at a tribal clinic using opportunistic screening with a single-lead iPhone-based ECG device (Kardia Mobile).

Methods
A database study was carried out in NA patients aged ≥50 followed to determine the prevalence of AF. Consecutive patients aged ≥50 with no prior history of AF were approached when attending the AST clinic for a primary care visit for opportunistic screening. Following consent, a 30-second ECG was recorded. A cardiologist overread all tracings to confirm the diagnosis of AF. Those confirmed to have AF were referred to a cardiologist for further management.

Results
The AF prevalence in 2952 NA patients aged ≥50 (1256 male, 1696 female), was 2.2%. Prevalence increased significantly with age (age 50–59, 0.9%; age 60–69, 2.6%; age 70–79, 3.6%; age ≥80, 7.8%; p for trend <0.0001). There were significant sex differences in AF prevalence (males 3.6% vs. females 1.2% p<0.0001). The mean age of those with AF was significantly older than for those without AF (69±10 vs, 63±6 respectively, p<0.0001). In the first month following study commencement in Jan 2019, 157 eligible patients without AF were approached and 142 (90%) agreed to receive screening for AF. The mean age of those enrolled was 62±8 years (66% women), and mean CHA2DS2-VASc score was 2.3±1.4.The age and sex distribution of those screened was similar to the overall clinic population without AF. Two of 142 patients (1.4%; age 59 and 61, respectively) screened were diagnosed with AF and were referred to a cardiologist. Enrollment is planned to reach 1500 patients by August 2019.

Conclusions
Opportunistic screening for AF using iPhone ECG in NA is feasible and well accepted by the patients when attending a tribal clinic. Our preliminary data suggest that NA, like other first nation peoples, may develop AF at a younger age compared to non-NA populations and would be likely to benefit from AF screening. In light of the high prevalence of risk factors for development of AF in NA, this novel approach for AF screening in tribal clinics has the potential to improve health outcomes among a large number of individuals.
P6547The energy cost of His bundle pacing can be curtailed
Authors: Zanon F , Marcantoni L , Pastore G , Baracca E , Picariello C , Lanza D , Maddalozzo A , Giatti S , Carraro M , Roncon L , Barbetta A , Di Gregorio F 
Published: October 2019

Abstract

Introduction
His bundle pacing (HBP) allows physiological ventricular activation and prevents the electrical and mechanical desynchronization generally induced by myocardial stimulation, which can increase the risk of atrial fibrillation and heart failure. On the other hand, reliable HBP capture often requires higher energy than conventional myocardial pacing. This reduces the expected life of the stimulator and might limit the diffusion of HBP in the clinical practice.

Purpose
Decreasing HBP current drain by careful management of stimulation safety margin and pulse duration.

Methods
In 28 patients undergoing DDD pacing with HBP, a third lead was implanted in RV apex to provide back-up pacing on demand. HBP and apical leads were connected, respectively, to the V1 and V2 channels of a 3-chamber stimulator. When HBP was effective, apical sensing occurred within the VV delay and prevented V2 stimulation. In contrast, in case of HBP failure, V2 sensing was missing and apical back-up pacing was promptly delivered at the end of the VV delay. The availability of a back-up pulse on demand allowed reducing the HBP safety margin with no risk. Furthermore, the individual HBP strength-duration curve was derived in the aim of optimizing the Hisian pulse parameters, which are the major determinants of the device current drain.

Results
Correct back-up inhibition by successful HBP and stimulation in the event of capture loss was achieved in all the patients. The latency from Hisian pacing to apical sensing averaged 96±14 ms. According to the pacemaker counters, no back-up pulse was delivered in daily life in 59% of patients. In the remaining, the prevalence of back-up stimulation never exceeded 15% of paced ventricular cycles. The high HBP threshold was essentially due to an increased rheobase (1.2±0.6 V), while the chronaxie ranged from 0.30 to 0.53 ms in 71% of patients (median 0.44 ms), exceeding 0.6 ms only in 29% of the cases. An average current saving of 5.4±3.0 μA was obtained at the expense of a mild reduction in HBP safety margin (from 1.6±0.2 to 1.4±0.1 times).
HBP and apical back-up

Conclusions
Back-up stimulation on demand is a reliable option to decrease HBP current drain and prolong the stimulator service life with full safety. In most of the cases, significant saving can be achieved by pulse shortening, as the chronaxie time is in the same range as with myocardial stimulation and longer pulses are not required. A pulse duration exceeding 0.6 ms is indicated in less than 1/3 of the implants.
P6550Right ventricular apical pacing vs. non-right ventricular apical pacing induced tricuspid regurgitation: implication of 3D echocardiographic location of leads
Authors: Yu Juan Y , Chen Y , Wu M , Zhen Z , Yao Q 
Published: October 2019

Abstract

Background
Pacemaker, device leads have been reported to cause tricuspid regurgitation (TR) of variable degrees. It is different between RVA pacing and None-RVA pacing in device-related TR. Few articles indicate this area. Objectives: We sought to evaluate (1) TR degree in patients with right ventricular apical (RVA) pacing vs. none-RVA pacing; (2) the relationship of lead-position between RVA vs. none-RVA pacing associated with TR undergo 3-dimensional echocardiography (3DE).

Methods
Conventional echocardiography performed in 458 patients after pacemaker implantation. In addition, 284 patients with pre-pacemaker implantation echocardiography available were included to evaluate the development of significant TR prospectively.

Results
RVA pacing patients had a higher frequency of significant TR (degree≥2) compared to none-RVA pacing (63% vs. 42%, p-value <0.01). For RVA pacing, the lead was more likely to position at the anterior, posterior and septal compared to none-RVA pacing (51% vs. 33%, p-value <0.01). Importantly, leads were more likely to be positioned in the central portion with none-RVA pacing compared to RVA pacing (30% vs. 13%, p-value <0.01). Among 284 patients with pre-& post-implantation echocardiography, RVA pacing is associated with the development of significant TR compared to none-RVA pacing (59% vs. 41%, P=0.012).
Factors Associated with Significant TR Univariate p-value Multivariate p-value Age 1.035 (1.016–1.055) <0.01 1.025 (1.005–1.047) 0.02 Duration 1.003 (1.001–1.006) 0.02 1.001 (0.998–1.004) 0.62 Male 0678 (0.468–0.980) 0.04 0.657 (0.436–0.991) 0.05 Pre-AF 2.623 (1.740–3.955) <0.01 1.162 (0.588–2.295) 0.67 Post-AF 3.529 (2.329–5.346) <0.01 2.671 (1.566–4.556) <0.01 DDDR 0.428 (0.236–0.777) 0.01 0.724 (0.336–1.563) 0.41 RVA 2.451 (1.673–3.589) <0.01 1.962 (1.266–3.042) <0.01
3D TTE view of the device leads in TVs

Conclusions
The study demonstrates that RVA pacing is more likely to develop significant TR compared to none-RVA pacing. Significantly, this study is the first details to demonstrate that lead impingement is one of the possible mechanisms that could explain the higher frequency of TR in RVA pacing compared to none-RVA pacing by 3DE.

Acknowledgement/Funding
This manuscript is partially supported by the Summit Grant from the University of Hong Kong and Queen Mary Hospital.