bluuebunny/crossref_metadata_2025_split huggingface dataset:
280The impact of epicardial collateral use on the outcomes of retrograde chronic total occlusion percutaneous coronary intervention
Authors: Karacsonyi J , Karmpaliotis D , Alaswad K , Jaffer F A , Yeh R W , Martinez-Parachini J R , Tajti P , Kandzari D E , Krestyaninov O , Jaber W , Choi J , Rangan B V , Ungi I , Banerjee S , Brilakis E S 
Published: October 2019

Abstract

Background
The impact of the type of collateral vessel used on the outcomes of retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.

Methods
We reviewed the baseline clinical and angiographic characteristics and procedural outcomes of 1,501 retrograde CTO PCIs performed in 1494 patients between 2012 and 2019 at 26 centres.

Purpose
We sought to examine the impact of the type of collateral vessel used on the outcomes of retrograde CTO PCI.

Results
Mean patient age was 65.0±10 years and 86% were men. Septal collaterals or bypass grafts were used in 66%, epicardial collaterals in 34% of lesions. Compared with cases in which only septal collaterals and bypass grafts were used, use of epicardial collaterals were associated with larger vessel diameter (3.0 [2.5; 3.0] vs. 3.0 [2.5, 3.2] mm, p=0.005), more moderate/severe tortuosity (55% vs. 42%, p<0.0001), more moderate/severe calcification (73% vs. 65%, p=0.002), and higher Japan chronic total occlusion score (3.34±1.02 vs. 3.11±1.07, p<0.0001). Epicardial collateral use was associated with lower technical (76.3% vs. 80.6%, p=0.053) and procedural (71.9% vs. 77.8%, p=0.011) success rates, but similar incidence of major cardiac adverse events (4.72% vs. 4.56%, p=0.889). Epicardial collaterals were associated with more perforations (10.63% vs. 7.30%, p=0.028). Epicardial collateral use was associated with longer fluoroscopy time (82 [64, 104] 76 [(55, 102] p=0.0003) and higher contrast volume (300 [221; 414] ml vs. 270 [200; 370] ml, p<0.0001).

Conclusion
In a contemporary, multicenter registry epicardial collaterals were used in approximately one-third of retrograde CTO PCIs. Use of epicardial collaterals was associated with lower success but similar major complication rates.

Acknowledgement/Funding
Minneapolis Heart Institute Foundation
286Predictors of atrial fibrillation in patients with embolic stroke of undetermined source: an analysis of the RE-SPECT ESUS trial
Authors: Granger C B , Sacco R L , Easton J D , Meyerhoff J , Cronin L , Kleine E , Grauer C , Bahit M C , Brueckmann M , Diener H.-C 
Published: October 2019

Abstract

Background
A proportion of patients with embolic stroke of undetermined source (ESUS) may have silent atrial fibrillation (AF) or develop AF after the initial evaluation. Better understanding of risk for identification is critical to implement optimal monitoring strategies with the goal of preventing recurrent stroke. The RE-SPECT ESUS trial provides an opportunity to assess predictors for developing AF and associated recurrent stroke.

Methods
RE-SPECT ESUS was a randomized, controlled trial (564 sites, 42 countries) assessing dabigatran versus aspirin for the prevention of recurrent stroke in patients with ESUS. Of 5390 patients enrolled and followed for a median of 19 months, 403 (7.5%) were found to develop AF reported as an adverse event or using cardiac monitoring per standard clinical care. Univariable and multivariable regression analyses for predictors of AF were conducted.

Results
In a multivariable analysis, clinical predictors for developing AF were: older age, history of heart failure, lower heart rate, hypertension, higher body mass index, and being from Western Europe (Table). Using several published predictive models, including HAVOC, C2HEST, AS5F, ARIC, and CHA2DS2-VASc, high scores were associated with increased rates of AF. In patients who developed AF, recurrent stroke occurred in 7.0% per year, versus 4.2% per year in patients who did not develop AF (hazard ratio 1.75; 95% CI 1.30–2.35, p=0.0002).

Conclusion
Besides age as the most important variable, several other factors, including lower heart rate, higher body mass index, and hypertension, are independent predictors of AF after ESUS. Understanding who is at higher risk of developing AF may help identify patients requiring more intense, long-term cardiac monitoring.

Acknowledgement/Funding
Funded by Boehringer Ingelheim
298Change in respiratory muscle strength predicts clinical events in patients with chronic heart failure
Authors: Hamazaki N , Masuda T , Kamiya K , Matsuzawa R , Nozaki K , Ichikawa T , Tabata M , Maekawa E , Noda C , Yamaoka-Tojo M , Matsunaga A , Ako J 
Published: October 2019

Abstract

Background
Respiratory muscle weakness, frequently observed in patients with chronic heart failure (CHF), has been documented as a predictor for poor prognosis. Several studies have reported that respiratory muscle training increases respiratory muscle strength and consequently improves exercise tolerance and quality of life in these patients. However, the relationship between the change in respiratory muscle strength and prognosis is still unclear.

Purpose
We aimed to investigate whether the change in respiratory muscle strength following cardiac rehabilitation predicts the incidence of clinical events in CHF patients.

Methods
We studied 348 patients with CHF who were hospitalized because of decompensated heart failure and received 5-month cardiac rehabilitation during hospitalization and after hospital discharge. Clinical characteristics including aetiology of heart failure, comorbidity conditions, medications, blood examination and echocardiographic variables were obtained from clinical records. We also measured maximal inspiratory pressure (PImax) as respiratory muscle strength at hospital discharge and 5 months later. The change of PImax (ΔPImax) between the 5-month observation period was examined. We followed up the patients after the observation period and investigated the incidence of all-cause mortality or all-cause unplanned readmission. In statistical analysis, patients were divided into two groups based on the median value of ΔPImax. We compared the event-free survival rate between the two groups using the Kaplan-Meier method with a log-rank test. We also performed the Cox proportional hazard model to clarify whether the ΔPImax was an independent predictor for the incidence of clinical events.

Results
Over a median follow-up of 1.6 years, 121 patients (34.8%) died or readmitted, and their rate of incidence was 21.7/100 person-years. The higher ΔPImax was associated significantly with a higher rate of event-free survival (Log-rank: 8.085, P=0.004, Figure 1). In univariate Cox proportional hazard model, ΔPImax was a significant predictor for the all-cause mortality/readmission (unadjusted hazard ratio for PImax increase of 10 cmH2O: 0.842, 95% CI: 0.763 - 0.931, P=0.001). Even after adjustment for clinical confounding factors including baseline PImax, ΔPImax remained significant and independent predictor for the all-cause mortality/readmission (adjusted hazard ratio for PImax increase of 10 cmH2O: 0.862, 95% CI: 0.763 - 0.974, P=0.017, Figure 2).

Conclusion
This study is the first to demonstrate that the change in respiratory muscle strength following cardiac rehabilitation independently predicts the incidence of clinical events in patients with CHF. The increase in PImax of 10 cmH2O was associated significantly with a 14% decrease in the rate of all-cause mortality or readmission.

Acknowledgement/Funding
JSPS KAKENHI JP16K16442
404Impact of cardiovascular risk factors for the development of cardiovascular disease: Results from MORGAM and BiomarCaRE consortia
Authors: Magnussen C 
Published: October 2019

Abstract

Background
Knowledge about the impact of modifiable risk factors for cardiovascular disease (CVD) onset is essential to improve CVD prevention.

Purpose
We estimated population-attributable fractions (PAFs) of body-mass-index (BMI), systolic blood pressure (SBP), diabetes, blood lipids (non-high-density lipoprotein cholesterol; non-HDL-C) and daily smoking for CVD.

Methods
Harmonized data from MOnica Risk, Genetics, Archiving and Monograph (MORGAM) and Biomarkers for Cardiovascular Risk Assessment in Europe (BiomaCaRE) consortia were used to calculate hazard ratios (HRs; 95% CI) and PAFs for incident CVD (myocardial infarction or coronary death, unstable angina, cardiac revascularization, ischemic stroke). PAFs for single risk factors or any combination of them were estimated using methods by Laaksonen 2011.

Results
We included 150,190 participants (77,801 men and 72,389 women) without CVD at baseline. Strongest associations were seen for SBP ≥160 mmHg (HR 1.79, 1.67–1.92 men; HR 1.93, 1.75–2.14 women), diabetes (HR 2.02, 1.86–2.20 men; HR 2.29, 2.06–2.55 women), non-HDL-C ≥220 mg/dL (HR 3.11, 2.49–3.88 men; HR 2.27, 1.68–3.05 women), daily smoking (HR 1.82, 1.73–1,90 men; HR 2.16, 2.0–2.33 women). Table 1 provides PAFs for incident CVD. Overall PAFs for men and women were 73.7% (67.7–79.1) and 73.3% (64.9–80.9).
Table 1. PAFs (%) for 5-year incident CVD Risk factor/category PAFs (95% CI), men PAFs (95% CI), women Underweight 0.1 (−0.1, 0.3) 0.2 (−0.1, 0.6) Pre-obesity 6.6 (4.3, 8.9) 4.3 (1.5, 6.9) Obesity 3.9 (2.7, 5.3) 8.0 (5.3, 10.5) SBP 130 to <140 mmHg 2.8 (1.7, 4.0) 2.7 (1.3, 4.0) SBP 140 to <160 mmHg 9.7 (8.1, 11.3) 9.3 (6.7, 11.6) SBP ≥160 mmHg 11.3 (9.7, 12.8) 18.9 (16.2, 21.8) Diabetes 5.2 (4.5, 6.2) 7.8 (6.5, 9.4) non-HDL-C 100 to <145 mg/dL 4.3 (1.8, 6.4) 3.3 (0.5, 6.5) non-HDL-C 145 to <185 mg/dL 13.9 (9.8, 17.5) 11.3 (6.0, 16.2) non-HDL-C 185 to <220 mg/dL 15.8 (12.8, 18.4) 12.8 (8.8, 17.0) non-HDL-C ≥220 mg/dL 16.7 (14.6, 18.5) 17.0 (12.5, 21.1) Daily smoking 16.5 (15.0, 18.3) 12.3 (10.7, 13.7) The N CVD events/N used was 8,302/77,801 for men and 4,071/72,389 for women.

Conclusion
Uncontrolled risk factors, especially non-HDL-C and SBP in the highest category, daily smoking and diabetes had the highest impact for incident CVD. All risk factors combined accounted for a PAF of 73%. Targeting risk factors would lead to a substantial reduction of CVD onset.

Acknowledgement/Funding
BiomarCaRE: EU Seventh Framework Programme (FP7/2007-2013), No. HEALTH-F2-2011-278913. MORGAM: EU FP 7 CHANCES (HEALTH-F3-2010-242244).
406Phenotyping acute decompensated heart failure by intrarenal venous flow and right ventricle-pulmonary circulation uncoupling
Authors: Labate V , Vella A , Carenini M , Losito M , Caracciolo M M , Rovida M , Bandera F , Guazzi M 
Published: October 2019

Abstract

Background
Intrarenal venous blood flow (IRVF) has recently been used to assess renal haemodynamics in heart failure (HF).Different IRVF patterns have been described, with discontinuous IRVF related to a worse outcome compared to the continuous one.

Purpose
We aimed at studying the interaction between IRVF and the right heart dynamics thorough the study of right ventricular (RV) to pulmonary circulation (PC) coupling in acute decompensated (AD) HF patients.

Methods
92 ADHF patients underwent a transthoracic echocardiography followed by renal ultrasonography and laboratory tests. The IRVF was evaluated by Venous Impedance Index (VII)

Results
Dividing the population according to the different IRVF patterns allowed to phenotype the HF population. Patients with the worst IRVF pattern (monophasic) showed significantly higher prevalence of pulmonary hypertension and RV dysfunction with a lower TAPSE/PASP ratio. Patients with continuous IRVF pattern showed normal pulmonary pressures and RV function with a higher TAPSE/PASP ratio. A strong logarithmic correlation between VII and TAPSE/PASP ratio was observed (R2=0,5406).
At multivariate linear regression analysis, RV to PC uncoupling was identified as independent determinant of VII. TAPSE/PASP was inversely associated with VII (−0.55±0.16, p=0.0011). LVEF was not associated with VII (p=0.08).
No difference in renal function laboratory test was found while NT-proBNP was significantly higher in the IRVF monophasic group.
Patients characteristics Total (92) Continuous (32) Pulsatile (19) Biphasic (15) Monophasic (26) P value VII 0.49±0.36 0.11±0.06 0.38±0.12 0.74±0.05 0.95±0.02 <0.0001 LVEF (%) 43.9±16.1 51.4±13.4 41.6±15 43±15.3 34±16.3 0.002 TAPSE (mm) 16.7±5.5 20.1±5.1 13.9±2.7 17±6.5 13.7±4.3 <0.0001 PASP (mmHg) 41.6±14.5 30.9±6.9 42.9±9.3 52.6±12.6 50.3±16.3 <0.0001 TAPSE/PASP 0.46±0.26 0.69±0.24 0.33±0.08 0.34±0.14 0.29±0.11 <0.0001 Creatinine (mg/dL) 1.25±0.52 1.25±0.59 1.17±0.49 1.26±0.52 1.31±0.48 0.6 GFR (ml/min/1.73sqm) 58.9±2.2 59.6±22.9 60.2±17.8 61.6±23.5 55.4±16.9 0.7 NT-proBNP (ng/L) 5511±7764 2231±2463 6365±10318 7257±8173 7509±8380 0.004 VII = Venous impedance index; LVEF = left ventricle ejection fraction; TAPSE = Tricuspid annular plane systolic excursion; PASP = Pulmonary artery systolic pressure; IVC = Inferior vena cava; GFR = Glomerular filtration rate.

Conclusions
The identified correlation between RV to PC uncoupling and the IRVF pattern provides new evidence regarding the pathophysiological mechanisms of cardio-renal syndrome paving the way to interventions with proven effectiveness on the RV to reverse the unfavorable kidney hemodynamics and failure.
429Impairment in arterial-ventricular coupling and its prognostic value in patients with decompensated heart failure
Authors: Lukina O , Soloveva A , Troitskaya E , Soseliya N , Meray I , Villevalde S , Kobalava Z 
Published: October 2019

Abstract

Objective
The interaction of the left ventricle (LV) with the arterial system, termed ventricular-arterial coupling (VAC), is a central determinant of cardiovascular performance and cardiac energetics. Heart failure (HF) modify the structure and function of LV. The aim of the study was to assess VAC parameters and their prognostic value in patients with different phenotypes of decompensated HF.

Methods
Parameters of VAC were assessed by 2-dimentional echocardiography in 355 patients admitted with decompensated HF (198 male, 72±11 years (M±SD), arterial hypertension 94%, previous myocardial infarction 42%, HF with preserved ejection fraction (HFpEF) 36%, reduced EF (HFrEF) 44%, mid-range EF (HFmrEF) 20%, diabetes 40%, NTproBNP 3763 (1801; 5486) pg/ml, eGFR 51 (41; 64) ml/min/1.73 m2) on the admission. VAC was expressed as the ratio arterial elastance (Ea)/ end-systolic LV elastance (Ees) and was considered optimal at range of 0.6–1.2. Patients received standard therapy (334 (94%) beta-blockers, 312 (88%) iv diuretics, 170 (48%) – iv nitrates, 280 (79%) and 57 (16%) ACEI and ARB, 270 (76%) MRA). Hospital length of stay was 10 (8; 12) days. P<0.05 was considered statistically significant.

Results
The median values of Ea, Ees and VAC were 2.2 (1.7; 2.9) mmHg/ml, 1.8 (1.0; 3.0) mmHg/ml and 1.32 (0.75; 2.21). Impairment of VAC was revealed in 63% of patients: VAC >1.2 – in 55% (predominantly patients with HFrEF), VAC<0.6 – in 8% of patients (all with HFpEF). Normal VAC was observed in 78% of patients with HFpEF, 42% of patients with HFmrEF and only in 1% with HFrEF. There was significant correlation between VAC and levels of NTproBNP (r=0.35), hematocrit (r=−0.29), hemoglobin (r=−0.26), systolic pulmonary artery pressure (sPAP) (r=0.18), diameters of left atrium (r=0.32) and right ventricle (RV) (r=0.32).
In-hospital mortality was 1.5%. After 6 months of follow-up 72 (20.3%) patients were readmitted with decompensated HF and 42 (11.8%) patients died. Patients with vs without worse prognosis had lower Ea (2.1 (1.7; 2.8) vs 2.3 (1.9; 3.0) mmHg/ml, Ees (1.5 (0.7; 2.5) vs 1.9 (1.0; 3.1) mmHg/ml, systolic blood pressure (130 (115; 150) vs 140 (130; 160) mmHg), higher level NTproBNP (4687 (3277; 6220) vs 3396 (1555; 5052) pg/ml), RV diameter (3,3 (3,0; 3,7) vs 3,0 (2,8; 3,5) cm), p<0.05 for all. There was increased risk of re-hospitalizations with decompensated HF and all-cause death in patients with decrease of Ea <2.2 mmHg/ml (OR 2.5, 95% CI 1.39–4.34, p<0.05), increase sPAP >45 mmHg (OR 3.7, 95% CI 1.74–7.45, p<0.05).

Conclusion
Impairment of VAC was revealed in 63% of patients with decompensated HF. Decrease of arterial elastance <2.2 mmHg/ml and increase of sPAP >45 mmHg are associated with risk of all-cause death and decompensated HF re-admissions in 6 month follow-up.
430Non-invasive estimation of right atrial pressure by IVC measurement differently predicts long-term prognoses in acute heart failure patients with reduced and preserved LVEF
Authors: Saito C , Jujo K , Abe T , Kametani M , Arai K , Minami Y , Ashihara K , Hagiwara N 
Published: October 2019

Abstract

Introduction
Inferior vena cava (IVC) measurement by bed-side echocardiography is a non-invasive, reproducible and feasible estimation of right atrial pressure (RAP). However, the effect of left ventricular systolic functions on the clinical efficacy of estimation of RAP using IVC parameters in hospitalized patients with acute heart failure (AHF) has not been fully discussed.

Purpose
We aimed to investigate the prognostic impact of RAP evaluation by IVC measurement in AHF patients, focusing on left ventricular ejection fraction (LVEF).

Methods
This observational study initially included 1,350 consecutive patients who were urgently hospitalized due to AHF. After the exclusion of patients receiving hemodialysis, those died in hospital, and those without full information of echocardiography during the index hospitalization, 507 patients with reduced (<40%; HFrEF) and 482 patients with preserved (≥40%; HFpEF) LVEF who discharged alive were respectively analyzed. In accordance with ESC guidelines, HFrEF and HFpEF patients were respectively divided into three groups depending on maximum IVC diameter and collapse; Normal-RAP group (IVC diameter ≤2.1cm and collapse >50%), High-RAP group (IVC diameter >2.1cm and collapse <50%), and Intermediate-RAP group (others). The endpoints of this study were cardiovascular (CV) death after the discharge, and hospitalization due to heart failure recurrence (HHF).

Results
During the observation period, 70 HFrEF patients (13.8%) and 51 HFpEF patients (10.5%) died by CV cause, and 223 HFrEF patients (43.9%) and 158 HFpEF patients (32.8%) were rehospitalized due to HF. In HFrEF patients, Kaplan-Meier analysis showed a low CV mortality rate only in the Normal-RAP group (Log-rank trend: P=0.001, Figure), but no significant difference in HHF rate among RAP groups (p=0.35, Figure). In multivariate Cox regression analysis, RAP classification was an independent predictor of CV mortality in HFrEF patients (adjusted hazard ratio (AHR) 1.90 [95% confidence interval (CI) 1.12–3.21)), even after the adjustment of diverse covariants. On the other hand, in HFpEF patients, Kaplan-Meier analysis showed the high mortality rate and HHF rate only in the High-RAP group (Log-rank trend: both p<0.001, Figure). Multivariate Cox regression analysis revealed that RAP classification independently predicted both prognoses (CV mortality: AHR 2.23 [95% CI 1.10–4.52]; HHF: AHR 1.34 [95% CI 1.03–1.74]) in HFpEF patients.
Figure 1

Conclusion
Non-invasive and easy classification of AHF patients by maximum IVC size and collapse may predict CV mortality after the discharge in HFrEF and HFpEF; while, it failed in HHF of HFrEF patients.
444Plasma levels of microfibrillar associated protein type 4 (MFAP4) are predictive for aortic dissection in patients with Marfan Syndrome
Authors: Van Andel M M , Wanga S , Yin X , Skroblin P , Koolbergen D R , Groenink M , Zwinderman A H , De Vries C J , Mulder B J M , Mayr M , De Waard V 
Published: October 2019

Abstract

Aim
Marfan syndrome is a disorder with mutations in the fibrillin-1 gene, leading to elastic fiber degradation and increased TGF-beta signaling. The life-threatening feature of Marfan is aneurysm formation with a risk of fatal aortic dissections. In a proteomics screen, we identified MFAP4, a protein involved in fibrillin-1 and elastic fiber formation, to be increased in the Marfan aorta. We aim to study the role of MFAP4 in Marfan aortic disease.

Methods and results
MFAP4 co-localizes in the aorta with elastin and collagen fibers.
In vitro experiments show that MFAP4 expression is upregulated by TGF-beta, which could explain the increased MFAP4 protein levels in the Marfan aorta.
In a substudy of 96 Marfan patients from the COMPARE trial, MFAP4 levels correlate with aortic root diameter (r=0.30, p=0.01). Patients previously enrolled in the COMPARE trial were retrospectively analyzed. Cardiovascular events, including aortic dissection, were assessed. Plasma samples were prospectively collected at time of inclusion in the study and analyzed retrospectively on MFAP4. In the 7 years of follow up, 5 Type B dissections occurred, all of them in patients in the upper tertile of plasma MFAP4. High plasma MFAP4 associates with poor dissection-free survival (Figure 1).
Moreover, the aortic distensibility as measure for aortic stiffness and damage, was calculated throughout the aorta from available MRI images of these patients. Interestingly, in the descending thoracic aorta where type B dissections occur, the aortic distensibility is significantly lower (indicating decreased aortic elasticity) in Marfan patients with high plasma MFAP4, thus associating with aortic damage.
Figure 1

Conclusion
MFAP4, a protein involved in extracellular matrix assembly, is elevated in the Marfan aorta. High plasma MFAP4 seems to reflect aortic damage and predicted type B aortic dissections in up to 7 years follow up.
459Direct oral anticoagulants are an effective therapy for left ventricular thrombus formation
Authors: Gama F , Freitas P , Trabulo M , Ferreira A , Andrade M J , Matos D , Strong C , Ribeiras R , Ferreira J , Mendes M 
Published: October 2019

Abstract

Background and aim
Left ventricular thrombus is a frequent complication of myocardial infarction (MI) and heart failure with severely depressed ejection fraction. Once diagnosed, anticoagulation for up to 6-months is recommended, but clinical experience with direct oral anticoagulation (DOAC) is limited to a few case reports. Our aim is to test DOAC LV thrombus resolution efficacy against warfarin.

Methods
Single-centre retrospective cohort study of consecutive patients with recently diagnosed LV thrombus, either after acute myocardial infarction or heart failure with reduced ejection fraction, from January 2009 till December 2018. Thrombus diagnosis and subsequent assessments were performed with echocardiography and complemented with cardiac magnetic resonance, when appropriate. Decisions regarding the type, dose and duration of anticoagulation and any concomitant antiplatelet therapy were left to physician's judgement.

Results
In a population of 66 patients (51 male, mean age 69±12 years), 13 received DOAC therapy, with the remainder receiving vit. K antagonists. One from each group was lost to follow up. The DOAC subgroup had higher prevalence of atrial fibrillation, higher left ventricular end-diastolic volumes and worse wall motion severity score index (WMSI). The duration of anticoagulant therapy, concomitant single or dual antiplatelet therapy and overall follow up were similar between strategies. Thrombus remission was observed in 91.7% (n=11) and 59.6% (n=31) patients within DOAC and warfarin group, respectively. Risk of unsuccessful resolution was reduced by 35% relative to the warfarin group (RR 0.65; 95% CI [0.491–0.862]; p-value 0.035) (figure).
figure

Conclusion
DOAC seems to be an effective alternative to vitamin-K antagonists in patients with LV thrombus.