bluuebunny/crossref_metadata_2025_split huggingface dataset:
P8833-year prognosis of patients with acute coronary syndromes with non-obstructive coronary arteries
Authors: Zandecki L , Sadowski M , Siudak Z 
Published: October 2019

Abstract

Background
More than 10% of patients presenting with symptoms suggestive of acute myocardial ischaemia have no significant atherosclerotic plaques in coronary angiography. The management and longer term prognosis of these patients has been a subject of debate.

Material and methods
The aim of the study was to assess the 3-year prognosis of patients with the diagnosis ACS (acute coronary syndrome) in Swietokrzyskie region of Poland based on data from the Polish National ORPKI Registry. Between 2014–2015, 9771 patients with ACS who underwent coronary angiography entered the registry and were included in the study. Of them, 2141 had no evidence of atherosclerosis or no significant stenosis on coronary angiography. Data on death, myocardial infarction, stroke, heart failure and cardiac hospitalization were compared between ACS patients with and without significant atherosclerotic plaques in coronary angiography.

Results
The results are presented in the table.
Death and cardiovascular events at 3-year follow-up ACS with significant stenosis ACS without significant stenosis p-value Death 14.4% 7.8% <0.001 Myocardial infarction 16.8% 11.6% 0.04 Stroke 6.8% 2.5% 0.01 Heart failure 38.0% 34.0% 0.19 Cardiac hospitalization 50.3% 22.7% <0.001

Conclusion
Patients who have presented with ACS and had no significant stenosis on angiography have had generally better 3-year prognosis that patients with ACS with significant stenosis. However, cardiovascular events, especially heart failure have not been uncommon in this group of patients.
P895Apical sparing in patients without cardiac amyloidosis
Authors: Binder C B , Duca F , Aschauer S , Rettl R , Camuz Ligios L , Dusik F D , Capelle C , Agis H , Hengstenberg C B , Bonderman D 
Published: October 2019

Abstract

Background
Apical sparing describes a reduced longitudinal strain in the basal segments and preserved or supranormal longitudinal strain in the apical segments of the left ventricular (LV) myocardium. This pattern has been described as a typical finding in patients with cardiac amyloidosis (CA) and restrictive cardiomyopathy. However, apical sparing is not a quantitative parameter and is fairly subjective to the echocardiographer's judgement. It is not known, if a certain degree of apical sparing is also present in patients with only mild LV hypertrophy and diastolic dysfunction such as it is present in heart failure with preserved ejection fraction (HFpEF).

Methods
Patients with cardiac transthyretin and light chain amyloidosis and patients with HFpEF were included in a clinical registry at our outpatient clinic. CA was diagnosed according to current guidelines. All patients underwent a comprehensive transthoracic echocardiography (TTE) exam at the time of study inclusion. The TTE protocol included standard and speckle-tracking imaging to assess the presence of apical sparing as well as the basal to apical strain gradient. Patients with known coronary artery disease were excluded.

Results
In total 115 patients were included in this study. Of these, 87 (75.7%) were diagnosed with CA and 28 (24.3%) with HFpEF. Not surprisingly, apical sparing was found in a majority (86.2%) of patients with CA, however mild forms of this phenomenon were also present in 67.9% of patients with HFpEF (p=0.029, Figure 1). Median basal longitudinal strain was significantly more impaired in patients with CA (p<0.001) but there was no difference between longitudinal strain in the apical segments when comparing CA to HFpEF (p=0.443). This resulted in a higher median apical to basal strain gradient in patients with CA (2.3 (IQR 1.7–3.83) versus 1.13 (IQR 1.5–1.8), p<0.001).
Figure 1

Conclusion
Mild forms of apical sparing can be found in patients without CA. Gradual reduction in strain from base to apex could be an unspecific pathophysiologic mechanism which is remarkably pronounced in patients with CA.
P897Diagnostic utility of tissue biopsy in transthyretin cardiac amyloidosis diagnosed by non-invasive diagnostic criteria
Authors: Nishi M , Yamada T , Takashio S , Tsujita K 
Published: October 2019

Abstract

Background
In the recent past, transthyretin cardiac amyloidosis (TTR-CA) is recognized as an important cause of heart failure with preserved ejection fraction, and diagnostic utility of 99mTc-pyrophosphate (99mTc-PYP) scintigraphy in TTR-CA has been established. However, pathological evaluation is still the basis to confirm diagnosis. Subcutaneous tissue and gastrointestinal tract biopsy are useful examinations alternative to endomyocardial biopsy. Nevertheless, the positive ratio of amyloid deposition in these organs is not fully evaluated based on recent non-invasive diagnostic criteria.

Purpose
Our aim was to evaluate the diagnostic sensitivity of tissue biopsy in TTR-CA patients diagnosed by 99mTc-PYP scintigraphy.

Methods
We retrospectively evaluated 124 consecutive TTR-CA patients [wild-type (ATTRwt): 90, hereditary (hATTR): 34] who were diagnosed by positive findings of 99mTc-PYP scintigraphy (visual score 2 or 3) between June 2002 and January 2019 at our institute.

Results
A total of 114 patients underwent tissue biopsy at least one organ. Amyloid was detected on Congo red staining of subcutaneous tissue (43/97: 44%), gastrointestinal tract (52/78: 67%) and heart (78/79: 99%), respectively. Among 70 patients who underwent both subcutaneous tissue and gastrointestinal tract biopsy, amyloid was detected at least one specimen in 57/70 (81%). Compared to hATTR CA patients, ATTRwt CA patients had lower positive ratio of subcutaneous tissue (81% vs. 27%) and gastrointestinal tract (73% vs. 63%) biopsy.

Conclusion
Non-invasive diagnostic criteria of TTR-CA had excellent sensitivity of amyloid deposition in heart. The diagnostic sensitivity of subcutaneous tissue and gastrointestinal tract biopsy was lower in ATTRwt CA compared to hATTR CA. Combination of subcutaneous tissue and gastrointestinal tract biopsy was useful for pathological confirmation of amyloid deposition without endomyocardial biopsy.
P912Outcomes of aortic valve surgery in non-stenotic valves: mechanical replacement versus repair
Authors: Moreira S , Quintal J , Cerqueira R J , Saraiva F A , Ferreira A F , Moreira R , Raimundo R , Amorim M J , Almeida J , Pinho P , Lourenco A P , Leite-Moreira A 
Published: October 2019

Abstract

Background
Considering selected patients and the expertise of the surgical team, aortic valve repair (REPAIR) has been recognized as an alternative to aortic valve replacement.

Aim
To compare mid-term survival, need of reoperation and hemodynamic results after mechanical replacement (MECH) or REPAIR in non-stenotic aortic valve disease.

Methods
Retrospective single-center cohort study including consecutive patients younger than 70 years-old, with non-stenotic aortic valve disease, who underwent 1st aortic valve surgery with MECH or REPAIR (2 experienced surgeons), during a 6-year period. Concomitant procedures were not excluded. First follow-up echocardiogram was performed within 3 months after surgery (median). Mean follow-up time was 4 years, maximum 7. According to the data distribution appropriate statistical tests to compare independent samples were used. Mid-term survival and need of reoperation were studied through Kaplan-Meier curves and Cox regression.

Results
MECH was performed in 94 (56.6%) and REPAIR in 72 patients. Individuals in MECH group were older and presented higher NYHA functional class than REPAIR group (51±11 vs 47±13 years, p=0.048; 30 vs 4%, p<0.001). MECH group presented higher prevalence of rheumatic etiology (17 vs 3%, p<0.001). Although aortic root intervention was more frequent in MECH group (41 vs 17%, p<0.001), there were no differences in cardiopulmonary bypass and cross clamping aortic times (166 vs 148 minutes, p=0.16; and 121 vs 108 minutes, p=0.15 in MECH and REPAIR group, respectively). Left ventricle mass regression was similar (18 vs 21%, p=0.450, in MECH and REPAIR group, respectively). Mid-term survival (REPAIR cumulative survival 97% and MECH 93%, Log-Rank test p=0.752) and reoperation rates were similar between the two groups. REPAIR procedure failed in 3 patients: 2 months (new aortic regurgitation, AR), 7 months (infective endocarditis, IE) and 4 years (AR). MECH failed in 2 patients: 6 months (IE) and 2 months after surgery (prosthesis thrombosis) (Figure 1).

Conclusion
Aortic valve repair seems to be safe and effective in this single-center study showing similar results comparing with mechanical aortic valve replacement. We should reinforce the need of judiciously select patients for this complex surgical technique and the specialized training of the surgical team. Further studies are needed to provide reliable recommendations on this theme.
P923Feasibility of the transcatheter mitral valve repair as the rescue therapy for patients with severe mitral regurgitation and endangered heart failure
Authors: Huang W M , Lee C W , Sung S H , Chang H C 
Published: October 2019

Abstract

Background
For those who carry high or prohibitive surgical risk, the transcatheter edge-to edge mitral valve repair using MitraClip has been a safe and effective treatment for severe mitral regurgitation (MR). In patients with severe MR and cardiogenic shock under hemodynamic supporting devices, emergent surgical mitral valve interventions carry extremely high risk for peri-operative morbidities and mortalities. The feasibility and efficacy of emergent MitraClip to rescue patients in critical conditions remains elucidate.

Methods
Patients with severe MR were evaluated by the heart team and those with high or prohibitive surgical risks were referred to receive MitraClip procedures. Emergent MitraClip were conducted in patients with unstable hemodynamics and under mechanical or inotropic support. The hemodynamic measures, transthoracic echocardiography, transesophageal echocardiography, and blood tests were performed before MitraClip procedures. Procedural success was defined as having mild mitral regurgitation immediately after MitraClip, and patients were free from in-hospital mortality. Clinical and echocardiographic outcomes were followed by telephones and clinics.

Results
Among 50 consecutive patients (74.7±11.2 years, 74% male), 8 emergent MitraClip procedures were conducted to rescue patients with cardiogenic shock. Extracorporeal membrane oxygenation were used in 2 patients and intra-aortic balloon pump were applied in 4 patients (50%). The rest of 4 patients received continuous inotropic agent administration. Compare to those who underwent elective procedures, patients underwent emergent MitraClip had higher surgical risk profile (Euroscore II 34.8% vs 5.1% and STS score 19.7% vs 5.1%), poorer renal function and higher right atrial pressure. There was no peri-procedural death, myocardial infarction, stroke or any adverse events requiring emergent cardiac surgery in both groups. Mild mitral regurgitation was achieved in 87.5% patients from the emergent group and 95.2% patients in the elective group (P=0.514). In follow up, there were 5 deaths (three in the emergent group), including 2 non-cardiovascular deaths. The Kaplan-Meier analysis showed patients who underwent emergent procedures have poorer long-term survival rate as compare to those who received elective procedures. (P value = 0.008).

Conclusions
When open-heart surgery is not feasible and deferred due to excessive risk, trans-catheter mitral valve repair is an alternative way to rescue patients in cardiogenic shock status. The emergent MitraClip procedure may provide comparable safety and efficacy in treating patients with severe MR and unstable hemodynamics.
P924Prognostic significance of moderate primary mitral regurgitation and atrial fibrillation
Authors: Hayashi H , Abe Y , Kuriyama T , Mu X , Hamaguchi T , Inoko M 
Published: October 2019

Abstract

Background
Severe primary mitral regurgitation [degenerativeMR (DMR)] is associated with poor outcome, including cardiac death and admission due to worsening heart failure. Whereas little information is available regarding the characteristics of moderate DMR and their impact on prognostic outcome.
The aim of the present study was to investigate the prognosis and its determinant in patients with moderate DMR.

Methods
From 13,700 consecutive patients who underwent transthoracic echocardiography. We selected moderate DMR but without other underlying cardiac diseases. Characteristics and event free rate as compared with age- and gender-matched patients with none to mild MR.

Results
Of a total of our cohort, 185 (1%) patients had moderate DMR, and we compared with 185 age- and gender-matched patients with none to mild MR. During the follow-up period of 1372±655 days, 30 patients (8%) met the composite endpoint defined as cardiac death and admission due to worsening heart failure. Kaplan-Meier analysis showed patients with moderate DMR was significantly associated with a poor outcome compared to patients with none to mild MR (log-ranktest P<0.0001). Cox proportional hazard ratio revealed thatmoderate MR and atrial fibrillation (AF) were the independent predictors of the composite endpoint.
Prgnostic outcome: AF and moderate DMR

Conclusions
Patients withmoderate DMR and concomitant AF had a significant poor outcome. An activesurveillance and some intervention for AF and moderate MR may be required.
P927Long-term mortality in patients with paradoxical low-flow low-gradient versus normal-flow high-gradient aortic stenosis undergoing transcatheter aortic valve implantation
Authors: Fusini L , Muratori M , Tamborini G , Ghulam Ali S , Gripari P , Salvi L , Roberto M , Trabattoni P , Agrifoglio M , Bartorelli A L , Alamanni F , Pepi M 
Published: October 2019

Abstract

Background
Controversial data exist on clinical outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG) undergoing valve replacement. This entity is a combination of a small aortic valve area (AVA<1cm2), a preserved left ventricular ejection fraction (LVEF≥50%), and a “paradoxical” low mean gradient due to the presence of low LV stroke volume (≤35 mL/m2). The low flow state is explained by the presence of a high afterload and pronounced LV concentric remodeling, with impaired LV filling. Currently, poorer outcomes have been reported after surgical aortic valve replacement in patients with PLF-LG AS compared with the normal-flow high-gradient (NF-HG) AS.

Purpose
The aim of this study was to determine the clinical outcomes in patients with PLF-LG AS undergoing transcatheter aortic valve implantation (TAVI) compare to NF-HG patients.

Methods
A total of 609 patients (age 81±6 years) with symptomatic severe AS and preserved LVEF who underwent TAVI, was enrolled and divided in two groups: group A included patients with NF-HG (542 patients) and group B including those with PLF-LG (66 patients). At 1-year follow-up, death and clinical events were reported.

Results
TAVI was feasible in all patients. A significant reduction in mean aortic pressure gradient was observed after TAVI both in PLF-LG (baseline, 30±5 mmHg; 1-year, 11±4 mmHg; p<0.001) and in NF-HG (baseline, 53±11 mmHg; 1-year, 12±4 mmHg; p<0.001) together with an increase in AVA (PLF-LG: baseline, 0.74±0.16 cm2, 1-year: 1.83±0.41 cm2, p<0.001; NF-HG: baseline, 0.65±0.16 cm2, 1-year: 1.84±0.35cm2, p<0.001). Perioperative mortality at 30-days was similar in group A (17/542, 3%) and in group B (2/66, 3%). Figure shows the survival curves up to 5 years follow-up according to the two groups. PLF-LG and HG-AS had similar survival rate throughout the long-term follow-up. Similarly, rehospitalization rate was not different in the two groups (PLF-LG: 12% vs NF-HG: 7%, p=0.121).
Kaplan-Meier analysis

Conclusions
Differently from surgical series, TAVI patients with PLF-LG AS had showed similar mortality and rehospitalization rates compared to NF-HG.
P942Impact of left ventricular ejection fraction in patients with critical limb ischemia: from I-PAD registry
Authors: Fujimori K , Nagae A , Miura T , Katoh T , Hirabayashi M , Kashiwagi D , Yokota D , Yanagisawa T , Sakai T , Senda K , Saigusa T , Ebisawa S , Okada A , Motoki H , Kuwahara K 
Published: October 2019

Abstract

Introduction
In patients with critical limb ischemia (CLI) it is known that malnutrition, low BMI, inflammation and so on are prognostic factors. But, it is unclear whether left ventricular ejection fraction (LVEF) affects prognosis of CLI patients. So we investigated that LVEF affects prognosis of CLI patients.

Methods
From July 2015 to July 2016, 371 consecutive peripheral artery disease patients who performed endovascular treatment (EVT) were enrolled in I-PAD registry. 179 of them were patients with CLI. We could conduct follow up survey about 126 (age 75.5±11.1, men 63.5%) and divided two groups according to their LVEF (group with LVEF≤40%, n=13, group without LVEF≤40%, n=113). The primary end point was major adverse limb events (MALE: TLR, TVR, major amputations) and secondary end point was all-cause death.

Results
The median follow-up period was 11.5±6.7 months. The 18 months MALE rate was significant higher in the group with low LVEF than group without low LVEF (76.9% vs 37.2% p<0.05). The 18months all-cause death tended to be higher in the group with low LVEF, however there was not statistical significance in the two groups (53.8% vs 24.8% p=0.09).

Conclusion
LVEF was associated with MALE in patients with CLI.
P955Assessment of coronary and myocardial reperfusion as well as left ventricular infarct size and function following streptokinase administration immediately after Primary coronary intervention
Authors: Ammar A , Al-Daydamony M M , Amin M I , Nagieb A M , Ammar M A S 
Published: October 2019

Abstract

Background
Reperfusion injury might be considered a consequence of insufficient myocardial perfusion (MP) due to microthrombi (MT) embolization into the microcirculation. Streptokinase (SK) a fibrinolytic agent, if injected into the culprit artery immediately after primary percutaneous coronary intervention (PPCI) might tackle and dissolve these MT resulting in better MP and function.

Methods
Sixty four patients presenting within 24 hours by their first ST elevation myocardial infarction, underwent PPCI, then equally divided into 2 groups; G1 received 250 kU of intracoronary SK (ICSK) vs saline in G2. Successful coronary perfusion was defined as corrected TIMI frame count (cTFC) <28 frames, and successful MP as TIMI myocardial blush grade (TMBG) 3. Evaluation of left ventricular (LV) function was done by comparing the baseline LV global longitudinal strain (GLS) before and 1-month after PPCI. Assessment of infarct size was done by measuring peak CK-MB, CK-MB area under the curve and ST segment resolution (STR) 90 min after PPCI.

Results
Thirty minutes after ICSK, cTFC (fig) was significantly lower (P≤0.05), while TMBG (fig) was significantly higher (P≤0.02) in G1 vs G2. Peak CK-MB, CK-MB area under the curve were significantly lower (P≤0.015 & P≤0.001 respectively) while STR≥70%was significantly higher in G1 (P≤0.045). Multivariate logistic regression analysis showed that the likelihood of achieving successful MP post-PPCI is associated with ICSK administration [OR=0.123, 95% CI (0.02–0.75), P≤0.024] and total ischemic time (ROC curve). Multivariate linear regression analysis showed that each of, immediate ICSK administration post-PPCI and TMBG were independent predictors for LV GLS improvement after one month. No significant difference in bleeding risk between G1&2 (p=1).

Conclusion
ICSK given immediately after primary PCI was an independent predictor of successful coronary and myocardial reperfusion. It significantly led to reduction of infarct size and improvement of LV GLS.
P957Survival benefits of routine glycoprotein IIb/IIIa inhibitors during primary PCI in ST-segment elevation myocardial infarction: A meta-analysis of randomised controlled trials
Authors: Karathanos A , Lin Y F , Dannenberg L , Parco C , Schulze V , Brockmeyer M , Krieger T , Jung C , Heinen Y , Perings S , Zeymer U , Kelm M , Polzin A , Wolff G 
Published: October 2019

Abstract

Background
Cardiovascular guidelines recommend adjunct glycoprotein IIb/IIIa inhibitors (GPI) only in selected patients with acute ST-segment elevation myocardial infarction (STEMI).

Purpose
This study aimed to evaluate routine GPI use in STEMI treated with primary PCI.

Methods
Online databases were systematically searched for randomised controlled trials (RCTs) of routine GPI vs. control therapy in STEMI. Data from retrieved studies were abstracted and evaluated in a comprehensive meta-analysis using Mantel-Haenszel estimates of risk ratios (RR) as summary statistics.

Results
After systematic review, twenty-one RCTs with 8,585 patients were included: ten trials randomized tirofiban (T), nine abciximab (A), one eptifibatide (E), one trial used A+T; only one trial used DAPT with prasugrel/ ticagrelor. Routine GPI were associated with a significant reduction in all-cause mortality at 30 days (2.4% (GPI) vs. 3.2%; risk ratio (RR) 0.72; p=0.01) and 6 months (3.7% vs. 4.8%; RR 0.76; p=0.02), and a reduction in recurrent MI (1.1% vs. 2.1%; RR 0.55; p=0.0006), repeat revascularization (2.5% vs. 4.1%; RR 0.63; p=0.0001), TIMI flow <3 after PCI (5.4% vs. 8.2%; RR 0.61; p<0.0001) and ischemic stroke (RR 0.42; p=0.04). Major (4.7% vs. 3.4%; RR 1.35; p=0.005) and minor bleedings (7.2% vs. 5.1%; RR 1.39; p=0.006) but not intracranial bleedings (0.1% vs. 0%; RR 2.7; p=0.37) were significantly increased under routine GPI.

Conclusions
Routine GPI administration during primary PCI in STEMI resulted in mortality reduction, driven by reductions in recurrent ischemic events – however predominantly in trials pre-prasugrel/ticagrelor. Trials in contemporary STEMI management are needed to confirm these findings.