bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5566Prognostic value of quantitative assessment of tricuspid regurgitation. Correlation between echocardiography and cardiac magnetic resonance
Authors: Hinojar Baydes R , Garcia Martin A , Gonzalez-Gomez A , Alonso-Salinas G , Plaza-Martin M , Pascual-Izco M , Lorente A , Hernandez-Jimenez S , Fernandez-Mendez M A , Esteban Peris A , Jimenez-Nacher J J , Zamorano J , Fernandez Golfin C 
Published: October 2019

Abstract

Background
Significant tricuspid regurgitation (TR) is related to poor prognosis independently of the etiology. TR severity and right ventricular (RV) size and function are determinant in the evaluation of patients with RT and are independently related to outcomes. While TR severity is commonly evaluated with echocardiography (echo), cardiac magnetic resonance (CMR) is the gold standard to study the RV. The association between CMR and echocardiographic measures of quantitative TR is unknown.

Purpose
Our aim was to evaluate the association between the most commonly used methods in both techniques: biplane vena contracta (VC) and effective regurgitant orifice (ERO) parameters evaluated by echo and TR volume (TRV) and TR regurgitant fraction (TRF) by CMR; secondly we aimed to evaluate the prognostic value of each parameter.

Methods
Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 with a contemporaneous echo and CMR were included. TR severity was evaluated by VC and ERO method, using EPIQ system and by VRF and TRF using a 1.5 Tesla CMR Philips scanner. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.

Results
A total of 36 patients were included (mean age was 72±7 years, 72% females, 94% functional TR). Both VC and ERO showed moderate to strong and significant correlations with VRF and TRF (table). During a median follow up of 20 months [IQR: 10–29], 38% of the patients reached the combined end point (n=7 developed right heart failure, n=11 underwent tricuspid valve surgery, and n=2 died). Patients with events showed a larger ERO and higher VRF and TRF (p<0.01 for all) and a tendency to larger VC (p=0.06). PISA, VRF and TRF were prognostic factors of the combined endpoint (PISA per 0.1 cm2, HR: 282 [3.9–20362], p=0.01; VC per 1 mm, HR 1.27 [0.98–1.64] p=0.06; VRF per 1ml: HR: 1.02 [1.005–1.025], p=0.003; FRT per 1%, HR: 219.5 [4.8–9897], p=0.06). A value of PISA of 0.42, of VRF of 46 ml and FRV of 43% reached the best accuracy to predicted poor outcomes (p<0.01 for all).
Table 1. Bivariate correlations ERO VC Regurgitant volume by CMR R=0.57, p=0.004 R=0.55, p=0.003 Regurgitant fraction by CMR R=0.61, p<0.001 R=0.56, p=0.01

Conclusion
Validated echocardiographic parameters of TR are significantly correlated with quantitative measures by CMR. PISA by echo, and VRF and FRV by CMR are predictive of impaired prognosis. Further studies confirming our CMR cut-off values of poor outcomes are needed for clinical implementation.
P5582Predicting the clinical outcomes in moderate aortic stenosis: implementation of the newly proposed staging classification
Authors: Amanullah M R , Pio S M , Sin K Y , Ajmone Marsan N , Ding Z P , Delgado V , Ewe S H , Bax J J 
Published: October 2019

Abstract

Background
While symptomatic severe aortic stenosis (AS) carries a worse prognosis and early intervention is favoured, it is always assumed that patients with moderate AS are more stable and their disease progression can be monitored yearly. However, it is known that patients with moderate AS have a higher risk of cardiovascular events but is unclear if other factors may also affect the overall prognosis.

Purpose
In this multicentre registry of patients with moderate AS, the prognostic value of a new staging classification on the extent of cardiac damage was examined.

Methods
Based on the echocardiographic findings at the time of diagnosis of moderate AS (valve area >1.0 and ≤1.5 cm2), they were re-classified into five stages depending on the extra-aortic valvular cardiac damage: no signs of cardiac damage (Stage 0), left ventricular (LV) damage [LV ejection fraction <50%, LV mass index >95 g/m2 for women or >115 g/m2 for men or E/e' >14] (Stage 1), mitral valve or left atrial (LA) damage [LA volume index >34 ml/m2 or mitral regurgitation ≥grade 3 or presence of atrial fibrillation] (Stage 2), tricuspid valve or pulmonary artery vasculature damage [systolic pulmonary arterial pressure ≥60 mmHg or tricuspid regurgitation ≥grade 3] (Stage 3), or right ventricular damage [tricuspid annular plane systolic excursion <17 mm] (Stage 4). The clinical endpoint was all-cause mortality. The association between the extent of cardiac damage and all-cause mortality was assessed by the Kaplan Meier method using log-rank test.

Results
Of the included 522 patients with moderate AS (age 71±11 years, 54% males), 12% (63) of patients were re-classified as Stage 0, 30% (157) in Stage 1, 47% (245) in Stage 2, 6% (31) in Stage 3 and 5% (26) in Stage 4. During follow-up, 43% (226) of patients underwent surgical or transcatheter aortic valve replacement. Over a median follow-up of 6.2 [interquartile range 3.2–9.0] years, 254 (49%) patients died. The cumulative event rates for all-cause mortality increased with increasing stage, particularly for Stages ≥2: 39% for Stage 0, 55% for Stage 1, 67% for Stage 2, 68% for Stage 3 and 57% for Stage 4, respectively (Figure, log-rank test p=0.001).
Cumulative death rates after re-staging

Conclusion
In a real-world registry of patients with moderate AS patients, worsening extra-aortic valvular cardiac damage portends a worse long-term prognosis.
P5585Determinants of the use of direct oral anticoagulants in acute pulmonary thromboembolism in argentina
Authors: Bernal M I , Scatularo C E , Cigalini I M , Jauregui J C C , Ortego J I , Cornejo D , Aboy J M , Burgos L M , Gamarra A L , Visconti M , Garcia Zamora S , Igolnikof D B , Bonorino J M , Zaidel E J , Thierer J 
Published: October 2019

Abstract

Background
In the last decade, direct oral anticoagulants (DOACs) were incorporated as an alternative for anticoagulation in patients with venous thromboembolism. Although they have a better pharmacologic profile than vitamin K antagonists (VKAs), the use of these drugs is not massive.

Purpose
Assess the rate of use of DOACs in acute pulmonary embolism (PE) patients (P) in Argentina and analyze the determinants of their use.

Methods
Based on a registry of 684 P admitted for acute PE in 75 academic centers between October 2016 and November 2017, we performed an analysis of DOACs prescription at discharge. A conventional statistical analysis was performed, to assess the differences between the P that received DOACs or other anticoagulants using univariate and multivariate models.

Results
579 of 601 P who survived were discharged with anticoagulant treatment: 348 (60%) received VKA; 108 (19%) received DOACs (49% Rivaroxaban, 34% Apixaban, 17% Dabigatran) and 123 (21%) received low molecular weight heparins.
Patients who received DOACs had lower severity of PE and less risk of bleeding. The main baseline characteristics are described in table 1. Also, those patients who received DOACs at discharge had fewer in-hospital complications (heart failure, infections or bleeding; all p<0.05).
In the multivariate analysis, health insurance (OR 7.45, 95% CI: 1.74–31.9, p<0.01) was an independent predictor of DOACs prescription at discharge. The history of previous heart failure (OR 0.19, 95% CI: 0.04–0.84, p=0.03) or oncologic disease (OR 0.49; 95% CI: 0.27–0.89; p=0.02) were inversely and independent predictors for DOACs prescription.
Variable DOACs Other anticoagulants P OR CI (95%) Male sex 51 (47.2%) 196 (41.6%) 0.29 – – Age 64.3±17.6 63.3±16.6 0.61 – – Health insurance 106 (98.1%) 402 (85.4%) 0.01 9.1 (2.2–37.7) CKD without dialysis 2 (1.9%) 34 (7.3%) 0.06 0.24 (0.06–1.03) Heart failure 2 (1.9%) 55 (11.7%) 0.01 0.14 (0.03–0.59) Oncology disease 16 (14.8%) 127 (27%) 0.01 0.47 (0.27–0.83) Previous anticoagulation 3 (2.8%) 44 (9.3%) 0.03 0.28 (0.08–0.91) sPESI 1±1.12 1.28±1.11 0.02 0.78 (0.64–0.96) RIETE 1.71±1.17 2.05±1.33 0.02 0.81 (0.68–0.97) CKD: Chronic kidney disease; TIA: Transient ischemic attack.

Conclusions
The rate of use of DOACs in survivors of an acute PE in Argentina was 19%, and this P present lower clinical risk, fewer co-morbidities and greater access to health coverage.
P5590Temporal trends in first-line anticoagulation therapy for cancer-associated venous thromboembolism
Authors: King J M , Delate T , Charlu M , Zhu S , Pai A , Clark N P , Witt D M , King J B 
Published: October 2019

Abstract

Background
Knowledge of the comparative safety and efficacy of anticoagulant classes for the treatment of cancer-associated venous thromboembolism (VTE) has evolved over the past 20 years with recent evidence from randomized trials suggesting that direct oral anticoagulants (DOACs) may be a safe and effective oral alternative therapy to low-molecular-weight heparin (LMWH).

Purpose
To characterize the temporal trends in first-line outpatient anticoagulation therapy for cancer-associated VTE.

Methods
We conducted a retrospective cohort study of patients who were hospitalized for a cancer-associated VTE between 2000 and 2017. Patients were identified from the cancer registries of two regions of a large, integrated healthcare system in the United States. The primary outcome was the age- and sex-adjusted incidence rates of first-line anticoagulant therapy according to the year in which the VTE occurred. We determined each patient's anticoagulant regimen according to her/his outpatient pharmacy dispensing records during the first 30 days post-hospital discharge. Regimens were categorized as 1) LMWH, 2) warfarin ± an injectable anticoagulant, 3) fondaparinux, or 4) DOAC ± an injectable anticoagulant. Patients were excluded if they had history of VTE prior to cancer diagnosis, used an anticoagulant during the 6-months pre-hospitalization, did not initiate an anticoagulant after hospital discharge, or had a skin carcinoma.

Results
Overall, 9,816 patients were included with a mean age of 66±13 years and 5,238 (54%) were female. From 2000 to 2003, prior to publication of the first randomized controlled trial demonstrating LMWHs were superior to vitamin K antagonists for cancer-associated VTE, warfarin was first-line anticoagulant in ≈90% of cases (Figure). After 2003, there was a slow, steady decline in warfarin use corresponding with an increased use in LMWH: from 11% in 2003 to 55% in 2017. Since 2012, fondaparinux has accounted for <1% of first-line anticoagulant therapies. DOACs, which first became commercially available in the United States in 2010, have seen exponential growth since 2014, accounting for 20% of first-line anticoagulant therapies in 2017.
First-line anticoagulant use in cancer

Conclusion
From 2000 to 2017, first-line anticoagulant therapy for cancer-associated VTE has seen significant changes characterized by an increase in LMWH and DOAC use, and a decline in warfarin use.

Acknowledgement/Funding
Kaiser Permanente Northern California Community Benefit Grant, Agency for Health Research and Quality R18HS026156
P5610Inflammatory response after ExoVasc personalized external aortic root support (PEARS) procedure in patients with Marfan syndrome or non-Marfan genetic aortopathy
Authors: Kockova R , Maly J , Krebsova A , Labos M , Pirk J 
Published: October 2019

Abstract

Background
External aortic root support (PEARS) is a novel prophylactic aortic root surgery.

Purpose
The study aimed to determine the severity of inflammatory response after the personalized external aortic root support (PEARS) procedure in comparison to after the standard prophylactic aortic root surgery (SPARS).

Materials and methods
The study was a single-centre, retrospective, based on hospital record analysis of patients who underwent the PEARS procedure (PEARS group) or SPARS (SPARS group) during 1998–2017. C-reactive protein (CRP), white blood count (WBC), and echocardiography were routinely obtained. Fever was defined as body temperature ≥38°C. Diagnosis of pericarditis included a minimum of three signs from chest pain, pericardial effusion, ST elevation, elevated CRP, and body temperature.

Results
PEARS and SPARS groups consisted of 13 and 14 patients, respectively, scheduled for prophylactic aortic root surgery. A majority of patients in both groups had Marfan syndrome with causal mutation in the fibrillin 1 (FBN1) gene (62% vs 79%). Patient baseline characteristics were similar in the two groups, except aortic root was significantly larger in the SPARS group than in the PEARS group (60±12 mm vs 48±5 mm; P=0.003). All surgical procedures were successful and without major complications. The peak values of CRP and WBC were significantly higher in the PEARS group (264.5±84.4 mg/L vs 184.6±89.6 mg/L; P=0.034 and 15.2±3.8 109/L vs 11.9±3.3 109/L; P=0.029). Early and recurrent fever requiring hospital readmission was significantly more frequent in the PEARS group (77% vs 36%; P=0.032 and 46% vs 7%; P=0.020). Early and recurrent pericarditis requiring hospital readmission was also more frequent in the PEARS group (31% vs 0%; P=0.024 and 31% vs 0%; P=0.024).
Inflammatory characteristics Postprocedural inflammatory characteristics PEARS group SPARS group P value (N=13) (N=14) Peak level of CRP (mg/L) 264.5±84.4 184.6±89.6 0.034 Peak WBC (109/L) 15.2±3.8 11.9±3.3 0.029 ST elevation (N) 11 (85) 6 (43) 0.024 Early fever (N) 10 (77) 5 (36) 0.032 Recurrent fever (N) 6 (46) 1 (7) 0.020 Early pericarditis (N) 4 (31) 0 (0) 0.024 Recurrent pericarditis (N) 4 (31) 0 (0) 0.024 CRP, C-reactive protein; WBC, white blood count.
Echocardiography-signs of inflammation

Conclusions
The PEARS procedure is an extremely promising surgical technique, but the postoperative inflammatory response occurs frequently and more severely in comparison to SPARS. Clearly, these findings warrant further investigation.
P5612In vivo histological and clinical evaluation of layered culprit plaque by optical coherence tomography in stable angina patients
Authors: Okamoto H , Kume T , Yamada R , Neishi Y , Uemura S 
Published: October 2019

Abstract

Background
In patients with stable angina pectoris (SAP), exact mechanism of plaque progression overtime is still unclear due to lack of histological evaluation. Directional coronary atherectomy (DCA) allows for the differential cutting of atherosclerotic lesions and for the histological examination.

Purpose
The aims of this study were to compare the histological features obtained by DCA and layered pattern (LP) by OCT, and to establish the prevalence and clinical characteristics of LP in culprit lesion form SAP patients.

Methods
SAP patients who underwent OCT imaging guide PCI in our medical school hospital between June 2016 and June 2018 were included into this study. This was two-fold histological and clinical studies. In a histological study, we evaluated histological features of 42 specimens from 18 patients who underwent DCA and compare OCT findings. Lesions were classified into the following categories based on the OCT finding before DCA cutting; homogeneous or heterogeneous group. Furthermore, lesions in heterogeneous group were classified into 2 categories; LP or non-LP group. In a clinical study, 205 target lesions form 205 patients were categorized as shown above at minimum lumen area (MLA) sites. Plaque characteristics were compared among these groups.

Results
In the histological study, 9 (21.4%) specimens were classified in homogeneous group and 33 (78.6%) in heterogeneous group. In 33 heterogeneous group, LP group were observed in 12 specimens (36.3%). Of 12 LP group, 10 LP group consisted of intramural thrombosis. In clinical study, 39 (19.0%) lesion were classified in homogeneous group and 166 (81.0%) in heterogeneous group. In 166 heterogeneous group, LP group were observed in 75 lesions (45.2%). Of heterogeneous group, LP group had significantly smaller MLA (1.5±0.9 mm2 vs 1.9±1.0 mm2, p<0.05) and higher rate of microchannels (57.3% vs 15.4%, p<0.05) than non-LP group.
A representative layered pattern case

Conclusions
LP in culprit lesion with SAP was significantly associated with intramural thrombosis. MLA sites in LP was significantly smaller than in non-LP group. These data suggest that thrombus formation and subsequent their organization overtime might contribute to the plaque progression even in SAP patients.
P5613Proportional relationship between early mobilization of bone marrow progenitor cells and the extent of vascular injury during coronary stenting: insights on the role of systemic mechanisms of vascular
Authors: Jimenez-Quevedo P , Bernardo E , Del Trigo M , Otsuki S , Nombela Franco L , Brugaletta S , Ortega Pozi A , Salinas P , Nunez Gil I , Megia Renteria H , Fernandez Ortiz A , Macaya C , Escaned J , Sabate M , Gonzalo N 
Published: October 2019

Abstract

Background
The role of circulating progenitor cells (CPCs) on vascular repair after everolimus-eluting stent (EES) implantation is largely unknown.

Objectives
The aim of the study was to investigate the quantitative and temporal variations of CPCs levels after EES implantation, and its relationship with the degree of peri-procedural vascular damage, stent healing and neointimal hyperplasia, as measured by optical coherence tomography (OCT).

Methods
In a consecutive series of patients with stable coronary artery disease undergoing stent implantation CPC subpopulations (CD34+/CD45low, CD133+/CD45low, CD34/KDR/CD45low, CD133/KDR/CD45low) were evaluated using a flow cytometry technique at baseline, 1 and 4 weeks. OCT evaluation was performed immediately after stent implantation to quantify stenting-related injury, and at 9-month follow-up to assess mid-term vascular response.

Results
Twenty patients (mean age 66±9 years; 80%male) with 24 stenoses treated with EES were included in the study. Vascular injury score was associated with the increase of CD133+/KDR/CD45 low at 1-week (β0.28 [95% CI0.15; 0.41], p<0.001) and with the maximum neointimal thickness at 9-month follow-up (β0.008 [95% CI-0.0004; 0.002]:p=0.04). Mean neointimal area at 9-month was associated with the increase in the number of CD34+/CD45low at 1 week (β0.029 [95% CI0.025;-0.033]; p<0.0001). Inverse relationships between the number of uncoated and apposed struts at 9-month and the 1-week delta values of CD34/KDR/CD45low and CD133/KDR/CD45low (β-4.49 [95% CI-8.17;-0.82]; p=0.017 and β −12.53 [95% CI: −22.17; −2.90]; p=0.011, respectively) were also found.

Conclusion
Long-term vascular healing after EES implantation is modulated by early changes in levels of CPC subpopulations. This systemic response is proportional to the extent of vessel wall injury. Early mobilization of CPCs influences mid-term strut coverage and the development of neointimal hyperplasia.

Acknowledgement/Funding
Dr Jimenez-Quevedo is a recipient of the ISCIII (Instituto de Salud Carlos III) grant “Fondo de Investigaciόn Sanitaria” (PI11/00299) to perform this
P5617Repeatability of instantaneous wave-free ratio in comparison with fractional flow reserve
Authors: Horie T , Hoshino M , Hirano H , Kanno Y , Ohya H , Sumino Y , Hada M , Yamaguchi M , Kanaji Y , Sugiyama T , Yonetsu T , Kakuta T 
Published: October 2019

Abstract

Background
Instantaneous wave-free ratio (iFR) has been recently introduced as an adenosine free alternative for fractional flow reserve (FFR) to assess the functional significance of epicardial coronary stenosis. Little is known, however, regarding the repeatability and stability of iFR in comparison with FFR.

Purpose
The aim of this study was to evaluate the repeatability of iFR and compare it to that of FFR.

Methods
Patients with stable coronary artery disease who underwent physiological assessment twice within 90 days were enrolled. Repeated measurements were performed at diagnostic and therapeutic catheterization in about 70% of studied population. The remaining patients were measured twice for non-culprit lesion assessment at primary PCI and subsequent non-culprit and ischemia-documented lesion PCI. The calculation of iFRmatlab from DICOM pressure tracing data of resting state was performed using a fully automated off-line software algorithm in a blind fashion. FFR values were also measured by a fully automated algorithm in the same core laboratory by using hyperemic pressure tracing data. The repeatability of the two indices were evaluated and compared. The inter-rater agreement between iFRmatlab and FFR values of two measurements was assessed by κ coefficient. The pressure rate product during each assessment was also documented and evaluated.

Results
Ninety-three lesions from 92 patients were included in the study. The time interval between the two assessments was 38.4±19.0 days. iFRmatlab and FFR both showed significant correlation within the two assessments (iFRmatlab: r=0.75, 95% confidence interval, 0.64 to 0.83; mean difference, −0.006 [−0.18 to −0.01], FFR: r=0.86, 95% confidence interval, 0.79 to 0.90; mean difference, 0.004 [−0.07 to 0.03]). The inter-rater agreement of functional ischemia for iFRmatlab and FFR were κ=0.449 and κ=0.732, respectively. Although the prevalence of functional ischemia during the first and second assessment were consistent for both indices (iFRmatlab: 70.0%/67.7%, FFR: 86.0%/ 86.0%), significant difference was observed in the prevalence of clinical disagreement on the diagnosis of functional ischemia (FFR=0.80, iFR=0.89 used as cut-off values, respectively) between the first and second assessment among the two indices (iFRmatlab: 6.5%, FFR: 23.7%, p=0.002). iFRmatlab was significantly associated with pressure rate product during the examination compared to FFR (iFRmatlab: r= −0.25, 95% confidence interval, −0.43 to −0.04, P=0.018, FFR: r=−0.08, 95% confidence interval, −0.28 to −0.13, p=0.467).

Conclusion
Our results suggested that iFRmatlab showed lower repeatability and reliability for decision making compared to FFR. The instability of iFRmatlab potentially derives at least in part from its association with heart rate and blood pressure product.
P5622Clinical significance of late-acquired malapposition observed by serial optical coherence tomography after second-generation drug eluting stents
Authors: Nakamura T , Yonetsu T , Nakao M , Nakagama S , Niida T , Matsuda Y , Hirasawa K , Hatano Y , Sasaoka T , Umemoto T , Lee T 
Published: October 2019

Abstract

Background
Previous studies have demonstrated that the presence of late-acquired stent malapposition after stent implantation may be a risk of late and very late stent thrombosis and myocardial infarction, which is however still controversial.

Purpose
We sought to investigate the incidence and prognosis of late acquired stent malapposion after second-generation drug eluting stents (2G-DES) implantation.

Methods
A total of 199 lesions in 139 patients who underwent optical coherence tomography (OCT) at both immediately after implantation (Baseline) and 6–12 months after 2G-DES implantation (follow-up) were investigated. We excluded lesions with stent failure before follow-up examination. We evaluated presence or absence of malapposed strut at 1mm interval of OCT images and stents with one or more cross-sections with >30% malapposed strut was defined as stents with malapposition (MP), otherwise well-apposed (WA). We divided the lesions into 4 groups according to the presence of malapposition at baseline and follow-up; WA and WA, persistent well-apposed; MP and WA, resoloved malapposition; WA and MP, late acquired malapposition (LAMP); and MP and MP, persistent malapposition. We compared the target lesion failure (TLF) rate after follow-up examination among 4 groups with Kaplan–Meier analysis.

Results
Median follow-up period was 469 (IQR 71–1416) days. follow-up OCT examination was performed at median 9 months (IQR 7.6–10.5). There were no significant differences in patient's and procedural characteristics among the 4 groups. TLF rate in LAMP group was 12.0% and Kaplan–Meier analysis showed no significant differences among the 4 groups in TLF rate.
TLF-free suvival curves (Kaplan-Meier)

Conclusion
LAMP was observed by OCT at 6–12 months in 12.0% of lesions after 2G-DES implantation, which was not associated with TLF at 5 years.