bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arrhythmias assessed with long-term continuous cardiac monitoring in pulmonary hypertension
Authors: Oerbaek Andersen M.O.E.A , Diederichsen S.Z.D , Hastrup Svendsen J.H.S , Carlsen J.C 
Published: November 2020

Abstract

Background
Arrhythmias are considered a prominent phenomenon in pulmonary hypertension (PH) as the disease progresses. In short-term retrospective studies with up to 24 hours of monitoring, supraventricular tachycardia (SVT) has been found in 8–35% of patients, with significant impact on survival. The incidence of arrhythmias and their clinical role is based on a small number of retrospective studies.

Purpose
Assessment of arrhythmias in PH by continuous long-term cardiac monitoring

Methods
Patients diagnosed with PH were included in this prospective single-centre study where the diagnosis of PAH was established according to international guidelines. Patients received a Reveal LINQ (Medtronic) insertable cardiac monitor (ICM). ICM's continuously monitor the heart rhythm for arrhythmias according to algorithms; and an ECG of the episode will automatically be transmitted whenever an arrhythmia is detected.

Results
Twenty-eight patients were included, of whom 24 patients had pulmonary arterial hypertension (PAH) and four had chronic thromboembolic pulmonary hypertension (table 1) treated according to Table 1. During 168 patient-months of continuous monitoring (median: 206 days per patient) no long-lasting arrhythmias were observed, but only transient SVTs in one patient lasting a total of 2.5 days. Two had SVTs lasting 4.5 hours, and two hours. Five patients had isolated episodes of SVTs lasting 0–10 minutes and two patients had an episode of bradycardia for 10 seconds. The total arrhythmic burden was a period prevalence of less than 0.001%, despite a RVEF of 20.3% and 35.7% in WHO FC IV and III, respectively.

Conclusion
This is the first study with long-term continuous rhythm monitoring in patients with PH. In contrast to earlier observations no long-lasting arrhythmias occurred during 168 patient-months with a period prevalence of arrhythmias as low as less than 0.001% in this cohort of PH patients with WHO FC I-IV and the majority on modern specific PAH therapy.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Actelion
A genome-wide association study identifies novel genetic loci associated with pulmonary embolism
Authors: Krittanawong C , Narasimhan B , Hahn J , Wang Z , Johnson K , Tang W , Baber U , Amos C 
Published: November 2020

Abstract

Background
Pulmonary embolism (PE) is a life-threatening cardiovascular condition. Studies showed that PE patients were associated with disorders of lipid metabolism and had higher triglyceride and lower HDL-C levels compared with healthy. We conducted the genome-wide association study to identify novel loci contributing to PE.

Methods
We conducted a large-scale GWAS of PE in 5,466 PE cases and 461,219 controls of European ancestry from the UK Biobank (466,685 participants total). We used genome-wide summary statistics to test for enrichment of functional annotations using ENRICHR. Example pathways included in Enrichr for testing include membership of genes in pathway databases such as the Kyoto Encyclopedia of Genes and Genomes (KEGG), Wikipathway, PANTHER, BioCarta or NCI-Nature pathways. We analyzed the pathways using combined score and p-values which were well validated by comparing to several methods. For pathway analyses, we considered a nominal P-value threshold of 0.05.

Results
We identified genome-wide significant genetic associations in 63 independent genetic loci for PE (P&lt;5.0x10–7). Our findings for top pathways highlight that lipid metabolism (LIPC, LCAT, NPC2), caffeine metabolism (NAT2), and sudden cardiac death (ABCG8) related genetic loci play an important role in PE alongside genes already associated with coagulation-thrombosis pathway (VWF, THPO, PTPN11, INPP5D, UROS, HMBS) (all p-values p-values &lt;0.05).

Conclusion
Our findings uncovered unexpected novel factors of PE etiology, suggesting novel mechanistic concepts of PE pathophysiology.

Funding Acknowledgement
Type of funding source: None
Clinical characteristics and prognostic impact of pulmonary hypertension in heart failure with preserved ejection fraction: the PURSUIT HFpEF study
Authors: Sera F , Ohtani T , Nakamoto K , Yamada T , Yasumura Y , Tamaki S , Hayashi T , Yano M , Hikoso S , Yamauchi-Takihara K , Sakata Y 
Published: November 2020

Abstract

Background
Heart failure (HF) with preserved ejection fraction (HFpEF) can develop pulmonary hypertension (PH), which can result from pre-capillary PH as well as post-capillary PH. However, the prevalence and clinical significance of pre-capillary component of PH in HFpEF remain unknown.

Purpose
We aimed to investigate prevalence, clinical features, and prognostic impact of pre-capillary and/or post capillary PH associated with HFpEF.

Methods
From the PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) registry, 204 patients (men: 46%, age: 79±9 years) who were hospitalized with HF and underwent right heart catheterization were divided into 4 groups according to the PH guidelines: non-PH, isolated post-capillary PH (Ipc-PH), pre-capillary PH, and combined pre- and post-capillary PH (Cpc-PH). Patients who had been diagnosed with idiopathic pulmonary arterial hypertension were excluded from the analysis.

Results
The prevalence of PH was 31% (Ipc-PH: 22%, pre-capillary PH: 3%, Cpc-PH: 6%). The prevalence of subcategories of PH was significantly different depending on mean right atrial pressure (RAP) (figure). Echocardiography at discharge showed no significant differences in RV diameter or TAPSE, but smaller LV diameter and higher E/e' in pre-capillary PH and Cpc-PH, which resulted in a higher operant diastolic elastance (Ed). Composite endpoint of all-cause mortality and HF hospitalization at 1 year occurred 13% in non-PH, 25% in Ipc-PH, 49% in pre-capillary PH, and 63% in Cpc-PH, respectively (p=0.001 by log-rank test).

Conclusions
Distinct prevalence of PH was observed in the groups with different RAP levels. Pre-capillary component of PH was associated with impaired LV diastolic function and worse outcomes in HFpEF.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Roche Diagnostics K.K.; Fuji Film Toyama Chemical Co. Ltd
Survival in patients with chronic thromboembolic pulmonary hypertension in the modern management era
Authors: Taniguchi Y , Matsuoka Y , Onishi H , Nakai H , Okada K , Emoto N , Hirata K 
Published: November 2020

Abstract

Background
The management of non-operable chronic thromboembolic pulmonary hypertension (CTEPH) has recently evolved with the availability of balloon pulmonary angioplasty (BPA) and pulmonary vasodilators. We launched BPA program since 2011. The aim was to analyze survival and treatment efficacy in the modern management era.

Method and result
We retrospectively reviewed data from 143 consecutive CTEPH patients diagnosed in our university from January 2011 (i.e. after the availability of BPA) to December 2019. Forty-one patients underwent PEA, in these 25 patients underwent additional BPA (Hybrid group) and other patients were treated with only PEA (PEA group). Ninety patients underwent BPA (BPA group), remaining 12 patients had not undergone any interventional treatments. The 1- and 5-year survival rates of operated patients (n=41) were 97.4% and 90.0%, compared to96.9% and 86.9% in not-operated patients (n=102), respectively (p=0.579) (Figure). There was no death in Hybrid group. Percent decrease of pulmonary vascular resistance in PEA group, Hybrid group, BPA group were −75.4±9.9%, −74.3±11.8%, −56.3±22.2%, respectively (p&lt;0.01, one-way ANOVA). Absolute decrease of mean pulmonary artery pressure in each groups were −20.3±9.5mmHg, −24.5±8.8mmHg, −16.4±9.2mmHg, respectively (p&lt;0.01, one-way ANOVA).

Conclusion
There was no longer significant difference of long-term survival between operated and not-operated CTEPH. Moreover, Hybrid approach might have the potential to lead notable improvement in the prognosis of CTEPH. BPA and PEA would be mutually complementary therapies in the modern management era.
Figure 1

Funding Acknowledgement
Type of funding source: None
Thrombocytopenia as a preoperative risk assessment tool in patients with type B aortic dissection after thoracic endovascular aortic repair
Authors: Xie E.M , Liu J.T , Yang F , Ding H.Y , Hu B.Q , Chen L.F , Yang X.Y , Luo J.F 
Published: November 2020

Abstract

Background
Postoperative thrombocytopenia has been reported to be correlated with adverse events, but the prognostic value of baseline thrombocytopenia is unclear. This study was undertaken to evaluate the relationship between preoperative thrombocytopenia and adverse outcomes in patients with type B aortic dissection who underwent thoracic endovascular aortic repair (TEVAR).

Methods
A total of 825 patients with acute and sub-acute type B aortic dissection undergoing were TEVAR at a multidisciplinary aortic center were enrolled between January 2010 and December 2017. Patients were stratified on the basis of presence (n=149) or absence (n=676) of thrombocytopenia (platelet count, &lt;150x109/L), according to preprocedural platelet counts. The primary outcome of interest was in-hospital mortality. Secondary outcomes of interest was long-term death.

Results
In the enrolled cohort, thrombocytopenia occurred in 149 (18.1%) patients. Patients with thrombocytopenia were older, were more commonly acute stage of TBAD, higher D-dimer level and had higher rates of abdominal vessel involvement and pericardial effusion. During the hospitalization period, 26 patients (3.2%) died, which was significantly higher in the thrombocytopenic group (8.1% versus 2.1%; P=0.001) Multivariate analyses revealed that thrombocytopenia was independently associated with in-hospital mortality (Table). During long-term follow-up (median duration 44.2 months), A total of 62 deaths were reported after discharge, including 40 (64.5%) aortic-related and unknown deaths, of which 12 and 50 patients for thrombocytopenia and non-thrombocytopenia group, respectively. Kaplan-Meier estimated rates of long-term all-cause mortality were higher for thrombocytopenia (log-rank test, P=0.014). Similar results were observed in a subset of aortic-related death (P=0.004) as well as aortic-related and unknown death (P=0.006), not non-aortic related death (P=0.878) (Figure 1).

Conclusion
Platelet counts, as simple and inexpensive indexes, were reliable to be used as a preoperative risk assessment tool for patients with type B aortic dissection undergoing thoracic endovascular aortic repair.
Figure 1. Long-term Mortality

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): This research was supported by grant DFJH201807 from High-level Hospital Construction Project of Guangdong Provincial People's Hospital.
Aortic invovement in fibromuscular dysplasia. 3-dimensional CT, case-control study. THE ARCADIA-POL BIS study
Authors: Szkamruk K , Kruk M , Kepka C , Adlam D , Persu A , Canning C , Pappaccogli M , Van Der Niepen P , Januszewicz M , Kabat M , Warchol-Celinska E , Prejbisz A , Jozwik-Plebanek K , Dobrowolski P , Januszewicz A 
Published: November 2020

Abstract

Background
Fibromuscular dysplasia (FMD) is a non-atherosclerotic arterial disease that manifests as the presence of beaded or focal lesions in medium or small-sized arteries and may also include arterial dissection, aneurysm, and tortuosity. FMD could be revealed in various manifestations, however limited data on the involvement of the thoracic aorta is reported.

Purpose
To measure and evaluate involvement of thoracic aorta in patients with FMD.

Methods
We analysed aortas of 144 consecutive patients (mean age 50.2±14.0, 116 women) with confirmed FMD in at least one vascular bed. The control group consisted of 144 (mean age 50.5±14.0, 116 women) age and sex matched individuals. All patients underwent detailed clinical evaluation including angio-CT scan including aortic valve, thoracic aorta and coronary arteries. We measured the aortic valve annulus, sinus of valsalva, sinotubular junction, the diameters of ascending and descending aorta, aortic unfolding, the height of ostium of RCA and LCA and diameter of right and left coronary artery ostia in patients with fibromuscular dysplasia and compared them to matched controls.

Results
The FMD group had significantly smaller dimensions of aortic valve annulus and sinus of Valsalva than control group (2.3 [2.1–2.6] vs 2.9 [2.7–3.1] p&lt;0,0001; 2.9 [2.7–3.2] vs 3.1 [2.8–3.3] p=0,0011 respectively). In addition the FMD group had a significantly greater mean diameter of the ascending and the descending aorta than the control group (3.1 [2.7–3.3] vs 3 [2.9–3] p=0,0436; 2.4 [2.2–2.7] vs 2.3 [1.8–2.5] p&lt;0,0001 respectively). The height of the ostium of the left and of the right coronary artery was smaller in FMD than in the control group (1.2 [1.1–1.4] vs 1.3 [1.2–1.4] p=0,0001; 1.1 [1–1.3] vs 1.3 [1.1–1.4] p&lt;0,0001 respectively). There was no difference in the diameter of sinotubular junction and the right and the left coronary artery ostias between the FMD and control groups (2.7 [2.5–2.9] vs 2.7 [2.5–2.9]; 0.3 [0.2–0.3] vs 0.3 [0.2–0.3]; 0.3 [0.3–0.3] vs 0.3 [0.3–0.4] respectively).

Conclusions
Patients with fibromuscular dysplasia display smaller dimensions of aortic valve and larger diameter of ascending and descending aorta as compared to control subjects. Despite the predominant clinical significance of focal pathologies in FMD patients, the disease may display a specific, pan-vascular phenotype.

Funding Acknowledgement
Type of funding source: None
Are aortic root and ascending aorta echocardiographic diameters by adult vs paediatric guidelines recommendations interchangeable?
Authors: Servato M.L , La Mura L , Lopez Sainz A , Granato C , Teixido G , Galian L , Gutierrez L , Gonzalez Alujas M.T , Casas G , Valente F , Rodriguez Palomares J.F , Evangelista A 
Published: November 2020

Abstract

Background
Both aortic root size and ascending aorta are clinical parameters with significant therapeutic implications which can be easily assessed by transthoracic echocardiography (TTE). However, measurement values may vary according to cardiac cycle and the edge convention used.

Purpose
This study aimed to compare the aortic diameter values measured using the lastest recommendations of two different guidelines, adults and children, to determine the influence of these methods on echocardiographic measurements.

Methods
Two hundred and fifty adult patients (56% male, 63±15 years of age) and 67 children (65% male, 10.04±4.5 years of age) in whom TTE was clinically indicated were included. Aortic diameters were measured twice at 2 levels (sinuses of Valsalva and ascending aorta): leading edge to leading edge during diastole, (L-L in D) following the 2015 American Society of Echocardiography (ASE) adults guidelines and inner edge to inner edge during systole (I-I in S) following the 2010 ASE paediatric guidelines.

Results
Mean aortic diameters obtained by L-L in D and I-I in S are shown in Table 1. Correlation coefficient was 0.990 (CI95% 0.988–0.992) for sinuses of Valsalva measurements and 0.991 (CI95% 0.989–0.993) for ascending aorta in adult patients and 0.983 (CI95% 0.975–0.973) and 0.970 (CI95% 0.956–0.952) in childrens respectively. When both populations were analysed together, concordance correlation coefficients were 0.991 (CI95% 0.989–0.993) and 0.970 (CI95% 0.991–0.994), respectively. Bland- Altman analysis for each level measured (A: aortic root; B: ascending aorta) in the total cohort of 317 patients is shown in Figure 1. Mean aortic diameters and differences in the whole group are shown in Table 1.

Conclusions
Measurement of aortic root and ascending aorta showed a significantly larger diameters by L-L in D than by I-I in S. However, these differences had subclinical significance and management implications. These similar diameter values may be used indifferently but systematically during follow-up. Systolic diameter expansion has a similar value to that of anterior aortic wall thickness; however, it is more vulnerable to changes in haemodynamic conditions.
Figure 1

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Vall d'Hebron Research Institute
Role of estimated aortic pulse wave velocity in the prediction of future thoracic aortic aneurysm expansion
Authors: Boczar K , Boodhwani M , Beauchesne L , Dennie C , Chan K.L , Wells G.A , Coutinho T 
Published: November 2020

Abstract

Background
Thoracic aortic aneurysm (TAA) is a deadly disease in critical need of novel strategies for risk assessment and medical management. To address this need, we have previously shown that directly measured carotid-femoral pulse wave velocity (cfPWV), a marker of aortic stiffness and health, independently predicts future TAA expansion. Since aortic pulse wave velocity can be estimated from age and mean arterial pressure (MAP), in the present study we sought to determine whether estimated aortic pulse wave velocity (e-aPWV) also predicts TAA expansion.

Methods
One hundred and five consecutive, unoperated subjects with TAA were recruited. e-aPWV was estimated from validated equations based on age and MAP. cfPWV was measured with arterial tonometry according to guidelines. TAA size was measured at baseline and at the latest follow-up using available imaging modalities according to guidelines. Stepwise multivariable linear regression (P≤0.25 to enter, P≤0.10 to stay in the model) assessed independent associations of e-aPWV and cfPWV with future TAA growth. Variables considered in the models were: age, sex, BSA, MAP, TAA etiology and location, baseline TAA size, follow-up time, imaging modality, history of hypertension, diabetes and smoking.

Results
Seventy eight percent of subjects were men. Mean±SD age, baseline aneurysm size and follow-up time were 62.6±11.4 years, 46.2±3.8 mm and 3.0±1.0 years, respectively. e-aPWV and cfPWV were moderately correlated (Pearson's correlation coefficient = 0.61). Results of the linear regression analyses showed that both measured (cfPWV) and estimated (e-aPWV) independently predicted future TAA expansion (β±SE: 0.032±0.011, P=0.048 and 0.240±0.085, P=0.006, respectively). The base model's R-squared value of 0.39 was increased to 0.44 with addition of either cfPWV or e-aPWV to the model, confirming that each parameter of aortic stiffness enhances prediction of TAA growth.

Conclusion
Aortic stiffness is relevant for assessment of TAA disease activity. Similar to cfPWV, e-aPWV is also independently associated with future TAA expansion. Thus, e-aPWV represents a tool to improve TAA risk stratification that is simple, free of cost, and obviates the need for specialized equipment or dedicating training, which leads to excellent potential for widespread incorporation into clinical practice.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research
IL6 trans-signalling associates with atherothrombotic but not with cardioembolic stroke
Authors: Ziegler L , Wallen H , Aspberg S , De Faire U , Gigante B 
Published: November 2020

Abstract

Background
Pro-inflammatory processes underlie ischemic stroke, albeit it is largely unknown if they selectively associate with the risk of atherothrombotic and cardioembolic ischemic stroke. Here we analyse whether the pro-inflammatory interleukin (IL) 6 trans-signalling, associates with the risk of ischemic stroke and underlying atrial fibrillation (AF).

Method
During a 20-year follow-up, 203 incident ischemic strokes were recorded from national registers in the cohort of 60-year-old men and women from Stockholm (n=4232).
For each study participant, we have estimated the activity of the IL6 trans-signalling through the calculation of the ratio between the circulating pro-inflammatory binary IL6:sIL6R complex and the circulating inactive ternary IL6:sIL6R:sgp130 complex, the so called B/T ratio. An excess of the binary complex, mirrored by a high B/T ratio, is associated with an increased risk of cardiovascular events. The B/T ratio has been dichotomized at the median. The risk of ischemic stroke associated with B/T ratio &gt; median was estimated by Cox regression and expressed as hazard ratio (HR) with a 95% confidence interval (CI) in the presence and absence of AF. Risk estimates were adjusted for cardiovascular risk factors and anticoagulant treatment. In a secondary analysis, the association of IL6 trans-signalling with the risk of incident AF (n=279) was analysed.

Results
B/T ratio &gt;median was associated with the risk of ischemic stroke only in study participants without AF diagnosis (adjusted HR 1.49; 95% CI 1.08–2.06). No association was observed with ischemic stroke in study participants also diagnosed with AF. Moreover, the B/T ratio was not associated with the risk of AF (HR 0.96; 95% CI 0.75–1.24).

Conclusions
IL6 trans-signalling, estimated by the B/T ratio, is associated with atherothrombotic but not cardioembolic stroke. Consistently, the B/T ratio did not associate with the risk of incident AF. Our results support the relevance of IL6 trans-signalling in atherosclerosis related ischemic stroke.

Funding Acknowledgement
Type of funding source: None