bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3122Complete versus culprit-vessel only revascularization for patients with acute coronary syndromes and multivessel disease
Authors: Ferreira J , Monteiro S , Baptista R , Goncalves F , Monteiro P , Goncalves L 
Published: October 2019

Abstract

Background
Recent randomized clinical trials have suggested that complete revascularization (CR) instead of culprit-vessel only revascularization (CVO) strategies may take a stand in the optimal management of patients admitted for acute myocardial infarction (AMI) with multivessel (MV) disease undergoing primary percutaneous coronary intervention (P-PCI). However, despite the 2017 ST-elevation acute coronary syndrome (STEMI) guidelines update with a new class of recommendation for CR, it remains controversial whether this strategy leads to better outcomes.

Purpose
To compare CR versus CV strategies during hospitalization in patients presenting with AMI with multivessel disease at P-PCI.

Methods
We analyzed data from all patients admitted with non-ST acute myocardial infarction (NSTEMI) and STEMI in a portuguese coronary care unit (CCU), between 2007 and 2016. We then evaluated potential differences of CR versus CVO with PCI during hospitalization in AMI patients with multivessel disease, defined by at least 2 different diseased main coronary vessels, saphenous vein or mammary artery conduits. We used 1:1 ratio propensity score matching to study the impact of CR on patient mortality and adjusted data for relevant risk factors at admission time.

Results
A total of 4758 patients were admitted for AMI, 2690 NSTEMI (56.5%) and 2068 STEMI (43.5%). Access to PCI records was possible in 3162 (66.5%) patients, of which 1707 (54%) underwent CR versus 1455 (46%) who underwent CVO. CVO patients were older (67.9±11.8 vs. 63.5±13.1 years, p<0.001), more diabetic (56.5% vs. 47.1%, p<0.001), hypertensive (78.4% vs. 72.2%, p<0.001), dyslipidemic (82.1% vs. 75%, p<0.001), had greater GRACE score at admission (mean score 143.4±37.2 vs. 131.2±131.2, p<0.001), had more severe coronary disease (mean number of diseased vessels – 2.56±0.6 vs. 2.18±0.4, p<0.004), reached higher Killip class (mean – 1.42±0.9 vs. 1.26±0.7, p<0.001) and had lower left ventricular ejection fraction (48.07±11.6 vs. 51.25±10.5, p<0.001). No significant differences were found in peak troponin-I release between CR and CV (44.7±69 vs. 46.9±76, respectively, p=0.468). After propensity matching, we obtained 130 CR and 133 CVO patients. In this cohort all-cause mortality was lower in CR group at 6-month (RR 0.262, CI 95% 0.071–0.962, p=0.031) and 1-year (RR 0.340, CI 95% 0.119–0.973, p=0.036) follow-up. When comparing STEMI versus NSTEMI all-cause mortality was nonsignificantly lower in CR (RR 0.394 vs. 0.226, p=0.12 vs. p=0.16).

Conclusions
In patients presenting with AMI and MV disease, CR strategy during hospitalization leads to greater 6-month and 1-year survival when compared with CVO strategy. Despite not having found significant differences when STEMI was directly compared to NSTEMI, we believe this was due to the great loss of patient numbers after propensity matching, requiring larger trials to prove the effect.
P3140Burden and the clinical significance of the retained cardiac implantable electronic device components after heart transplantation
Authors: Simsek E , Tamnik F , Demir E , Nalbantgil S 
Published: October 2019

Abstract

Background
Cardiovascular implantable electronic devices (CIEDs) are common in patients undergoing heart transplantation (HT), and complete removal is not always possible at the time of transplantation. Frequency and clinical significance of retained CIED components after HT is not well studied.

Methods
Adult heart failure patients whom had heart transplantation in our institution from date June 2000 to December 2018 were retrospectively evaluated. Pre-post operative chest x-rays and recorded fluoroscopy images of the previous coronary angiograms or endomyocardial biopsies were reviewed by a single observer for retained CIED components. All patients clinical records were also reviewed for adverse outcomes of retained components such as deep venous thrombosis of upper extremity, infection and mortality.

Results
A total of 226 patients had bicaval orthotopic heart transplantation during study time. 73 (32%) of the patients had CIED before transplantation and 24 (32.8%) of the patients had retained lead components after HT. (Table 1) All of the components were part of a superior vena cava coil of the right ventricular ICD lead. Mean follow up time was 46.6±49.8 months and only 1 (1.3%) adverse event (right subclavian DVT) occurred in a patient with retained lead. There were not any statistical significance for mortality and infection between patients with and without lead fragments. Patients were also compared for history of any cardiac surgery before HT, especially ventricular assist device procedures and no differences were observed between groups.
For history of any cardiac surgery p=0.748, for assist device surgery, p=0.269). Patient's medical records reviewed for a history of magnetic resonance imaging (MRI). Two patients with retained lead fragments had non-thorocic (abdominal and cranial) MRI and any clinical pathology did not observed after MRI.
Table 1 All Patients With Retained CIED comp. Without Retained CIED comp. p (n=226) (n=24) (n=49) Age ± sd 42.91±12.2 44.88±12.6 41.59±13 0.290 Ischemic etiology 65 (28.8%) 8 (33.3%) 13 (26.5%) 0.546 CIED type   CRT-D 5 (20.8%) 5 (%10.2) 0.215   DR-ICD 5 (20.8%) 8 (16.3%) 0.636   VR-ICD 14 (58.3%) 35 (71.4%) 0.263 Dual coil ICD lead 24 (100%) 48 (97%) 1 Mortality (%) 96 (42.5) 7 (37%) 20 (40.8%) 0.463

Conclusion
Retained CIED components were seen 32.8% of the HT patients with CIED prior to transplantation. According to our data retained leads are not associated with severe adverse clinical outcomes. Also non cardiac MRI could be safe in patients with retained lead fragments.
P3348Prevention of stroke in intracerebral haemorrhage survivors with atrial fibrillation (PRESTIGE-AF): a retrospective cohort study
Authors: Nielsen P B , Soegaard M S , Skjoeth F S , Andersen S D , Larsen T B L , Lip G Y H L 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) patients surviving an intracerebral haemorrhage (ICH) present a clinical challenge. The PRESTIGE-AF trial is an ongoing trial designed to investigate the optimal stroke prevention strategy in AF patients who have suffered an ICH.

Purpose
To describe baseline clinical characteristics of a study population similar to the expected PRESTIGE-AF trial.

Methods
The patient population was identified from the Danish Stroke Registry, linked with additional registries to obtain information on comorbidities and medication. Specific incl/excl criteria from the PRESTIGE-AF trial were applied, including indication for OAC treatment due to AF and the ICH was not related to trauma.

Results
From 2003–2015 a total of 1405 patients with AF and ICH were included, mean age of 79.4 years [Table]. 40% had suffered a “mild” index ICH, and approximately 25% had a “moderate” or a “severe” index event based on the SSS score. Hypertension (75%) and prior thromboembolic events (33%) were common comorbidities. In the year before the index ICH, 27% recieved antiplatelet therapy, 34% OAC, and 22% receiving both treatments.
Table 1 Demographics and clinical characteristics Percent (number) Number of patients 1,405 Females 695 (49.5) Age, mean (SD) 79.4 (8.8) Scandinavian Stroke Scale*, median (IQR) 40.0 (22.0–50.0) “Mild” intracerebral haemorrhage (43–58) 563 (40.1) “Moderate” intracerebral haemorrhage (26–42) 377 (26.8) “Severe” intracerebral haemorrhage (<26) 361 (25.7) Hypertension 1067 (75.9) Prior thromboembolism 460 (32.7) CHA2 DS2 -VASc score, mean (SD) 4.2 (1.3) Antiplatelet therapy (mono) 377 (26.8) VKA treatment 436 (31.0) NOAC treatment 40 (2.9) OAC and antiplatelet treatment 311 (22.1) *Scale from 0–58; lower score indicates more severe stroke; 7% missing information.

Conclusion
The identified study population using the criteria for the PRESTIGE-AF trial were generally elderly and had a high prevalence of hypertension and prior stroke. The PRESTIGE-AF trial is required to determine optimal stroke prevention treatment in a population of AF patients presenting with ICH.

Acknowledgement/Funding
This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 754517
P3359Myocardial flow reserve using 13N ammonia PET for detection of cardiac allograft vasculopathy in heart transplant patients
Authors: Kikuchi N , Yamamoto E , Nagao M , Momose M , Hattori H , Suzuki A , Shiga T , Niinami H , Hagiwara N , Nunoda S 
Published: October 2019

Abstract

Purpose
Risk stratification and early detection of cardiac allograft vasculopathy (CAV) are essential in heart transplantation patients. CAV is associated with poor outcome in the chronic phase after heart transplantation. CAV presents a diffuse vascular involvement and has been difficult to noninvasively diagnose by the lack of a sensitive method to detect developing vascular pathology in the allograft. The present study investigates the ability of 13N-ammonia PET for detection of CAV in heart transplant patients.

Methods
Data of adenosine-stress 13N-ammonia PET imaging for thirty-one patients (mean age, 39 years-old) after 11 + 7 years from transplant was analyzed. Five patients had undergone percutaneous coronary intervention (PCI), and the remaining 26 patients had no history of definite myocardial ischemia. Myocardial flow was generated from the time activity curve of left ventricle input and myocardial uptake using 3-compartment model and the first 2 minutes' dataset of list-mode acquisition. Global - myocardial flow reserve (MFR) was calculated by stress to rest flow ratio. Patient with global-MFR <2.0 was defined as significant decrease. Summed difference score (SDS) was used as an estimate for the extent of ischemia, and the patient showing SDS >2 was identified as those having significant ischemia.

Results
The mean Global-MFR of our subjects were 2.3 (1.2 to 3.9). MFR using 13N-ammonia PET significantly decreases in one third of heart transplant patients in chronic stage. Eleven patients with Global-MFR <2.0 (35%) were observed, and eight of them had no history of clinical myocardial ischemia. The proportion of patients with a history of PCI is 18% in patients with Global-MFR <2.0 (vs 5%, p=0.210). Moreover, there were eight patients with SDS >2 (26%) including three patients having a history of PCI. The proportion of patients with a history of PCI tends to be high with SDS >2 (38% vs 9%, p=0.056).

Conclusion
This modality using 13N ammonia PET is useful for easily detection of CAV before manifestation of symptomatic myocardial ischemia in heart transplant patients.
P3361Pathophysiology measured with positron emission tomography is equally impaired in hypertrophic and non-hypertrophic regions in hypertrophic cardiomyopathy
Authors: Nordstrom J , Magnusson P , Harms H , Lubberink M , Morner S , Sorensen J 
Published: October 2019

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease with regard to clinical manifestations. It is characterized by an asymmetric pattern of hypertrophy of the left ventricle. However, less is known about pathophysiological distribution of the abnormalities. Positron emission tomography (PET) provides quantitative assessment of myocardial blood flow (MBF), oxidative metabolism, and sympathetic innervation using the following tracers: 15O-water, 11C-acetate, and 11C-HED.

Purpose
The purpose of the present study was to investigate if physiological parameters measured with PET are more impaired in hypertrophic regions compared to non-hypertrophic regions.

Methods
We examined 25 HCM patients using a Discovery MI PET/CT with 15O-water, 11C-acetate, and 11C-HED. Wall thickness (WT) was calculated from the 11C-acetate scan for basal and mid segments (n=12) in the 17-segment model and hypertrophic regions were defined as segments >15 mm. 15O-water PET was performed during rest and adenosine induced stress. Quantification of MBF, oxygen consumption (MVO2) and retention index of 11C-HED (RIHED) was done in aQuant software. Comparison of parameters in hypertrophic regions to non-hypertrophic regions was done using Mann-Whitney U- test and Bland-Altman analysis with repeatability coefficient defined as 2 times the standard-deviation of differences.

Results
One patient had all segments >15mm and one patient had all segments <15mm and were therefore excluded from analysis. WT was 18.2±1.9 mm in hypertrophic regions and 12.2±1.5 mm in non-hypertrophic regions. None of the PET-parameters showed a significant difference between hypertrophic and non-hypertrophic regions, see table 1.
Table 1 MBFREST MBFSTRESS MVO2 RIHED Hypertrophic segments (mm) 0.70±0.20 1.74±0.92 0.092±0.026 0.12±0.037 Non-hypertrophic segments (mm) 0.68±0.18 1.71±0.87 0.094±0.025 0.12±0.036 p-value 0.767 0.851 0.956 0.684 Repeatability coefficient (%) 25.4 35.4 13.3 16.2 Mean ± standard deviation for PET-parameters in hypertrophic and non-hypertrophic segments. Relative repeatability coefficient (%) between regions and p-value for Mann-Whitney U-test.

Conclusion
Pathophysiology in terms of myocardial blood flow at rest and stress, oxygen consumption and sympathetic innervation are not significantly different in hypertrophic segments compared to non-hypertrophic segments in patients with HCM. Thus, the disease is not confined to hypertrophied areas but spread throughout the left ventricle.

Acknowledgement/Funding
Selanders stiftelse, Regionala forskningsrådet
P3375The parasternal long axis ultrasound view does not allow the maximum diameter of the aortic root to be measured in atypical BAV
Authors: Milleron O , Masi P , Paul J F , Arnoult F , Ould Ouali N , Tchitchinadze M , Lansac E , Jondeau G 
Published: October 2019

Abstract

Background
Following guidelines, maximal aortic root diameter have to be measured in parasternal long axis view (PLA TTE) in trans-thoracic echocardiography (TTE). However, asymmetry of the aortic root is common in BAV and the larger diameter might be missed when using PLA TTE, depending on the asymmetric root orientation.

Purpose
Assess whether the maximum aortic diameter measured with PLA TTE and CT differs according to the type of BAV.

Methods
86 patients with BAV without significant valvulopathy (aortic regurgitation <2 and no more than mild stenosis with mean gradient <10mmHg) referred for aortic aneurysm assessment and who had benefited from TTE and CT were studied.
Definition: Typical BAVs have a horizontal valve opening (type I L-R and type 0 anteroposterior) while atypical BAVs have a vertical valve opening (type I N-R and type 0 lateral). (Figure) We compared: – using CT, the orientation of the largest diameter of the aortic root in typical and atypical BAVs using the sagittal plane as a reference (Figure). – the difference of the maximal aortic root diameter measured with PLA TTE and CT in typical and atypical BAVs.

Results
Patients with typical and atypical BAVs were comparable for age, sex, weight, height, aortic root surface area and maximum diameter of the aoric root.
When comparing maximal aortic root diameter measured in PLA TTE and CT:
– in the whole cohort, PLA TTE underestimates the maximal aortic root diameter with a mean difference of 3 mm.
– in atypical BAVs, the difference between CT and PLA TTE is 6,0 mm significantly different from the 2,3 mm found in typical BAVs p=0.0008 (Figure)
The orientation of the maximal aortic diameter is correlated with the type of BAV: Using the sagittal plan as a reference, this angle is 64.3° for the typical BAV and 143,1° for the atypical BAV p<0.0001 (Figure).
The use of a blue arrow (figure) to show the ultrasound beam direction in PLA ETT helps to understand that, in typical BAVs, the maximal aortic root diameter has the same direction that ultrasound beam while in atypical BAVs, the ultrasound beam direction is perpendicular to the direction of the maximum aortic diameter.
Figure 1

Conclusion
The difference in maximal diameter of the aortic root measured with CT and PLA TTE is significantly greater in atypical BAVs than in typical BAVs (6.0 mm vs 2.3mm). This difference can be explained by the fact that in the atypical BAV, the orientation of the maximal diameter of the aortic root differs from the typical BAV: using the sagittal plane as a reference, in the atypical BAV, the mean angle is around 140° and this orientation is perpendicular to the direction of the ultrasonic beam, explaining the inability to measure the maximum aortic diameter in PLA TTE for the atypical BAVs.
P3377MDCT-derived left ventricular global longitudinal strain and left ventricular ejection fraction in patients with aortic stenosis: a comparative analysis with echocardiographic measurements
Authors: Gegenava T , Bijl P , Vollema M , Kley F , Weger A , Hautemann D , Reiber J , Ajmone-Marsan N , Bax J , Delgado V 
Published: October 2019

Abstract

Introduction
Known predictors of poor outcome in aortic valve stenosis patients include older age, significant valvular calcification, rapid hemodynamic progression and impaired left ventricular (LV) systolic function. LV global longitudinal strain (GLS) quantifies myocardial deformation and LV function and is associated with prognosis in patients with severe aortic stenosis (AS). Multi-detector row computed tomography (MDCT) data are key in the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI) and when acquired throughout the entire cardiac cycle, LV systolic function can be assessed. Novel software can assess LV GLS from MDCT-data.

Purpose
The present study aimed at assessing the feasibility of determining novel MDCT-derived LV GLS as well as MDCT-derived LV ejection fraction (EF) and their agreement with echocardiographic LV GLS and LVEF in patients treated with TAVI.

Methods
LVEF and LV GLS were measured on echocardiography and dynamic MDCT using novel CT-software. Agreement between the measurements of two different modalities was assessed using Bland-Altman analysis.

Results
A total 214 patients (51% male, mean age: 80±7 years) were analysed retrospectively. Mean value of LV GLS on echocardiography was −14±4% whereas mean MDCT-derived GLS was −12.5±4%. Mean value of LVEF on echocardiography was 47±10% and mean MDCT-derived LVEF was 39±11%. On Bland-Altman analysis, MDCT-derived strain analysis underestimated LV GLS compared to echocardiography with a mean difference of 1.44% (95% limits of agreement −3.8 to 6.7%). LVEF was also underestimated on CT with a mean difference of 7.68% (95% limits of agreement −11.5% to −26%). Correlation of measurements between MDCT-derived LV GLS and echocardiographic LV GLS was significant (r=0.791, p<0.001), as well as the correlation between MDCT-derived LVEF and echocardiographic LVEF (r=0.590, p<0.001) (Figure).

Conclusions
Assessment of LV GLS and LVEF on dynamic MDCT data provides similar values to those obtained with echocardiography and could be used in the risk-stratification of severe AS patients undergoing TAVI.
P3384Left atrial appendage pseudo-thrombus as an independent risk factor for ischaemic stroke in patients with non-valvular atrial fibrillation
Authors: Nicol E , Semple T , Baleswaran S , Wong T O M 
Published: October 2019

Abstract

Background
Left atrial appendage (LAA) pseudo-thrombus is a well recognised phenomenon in patients with atrial fibrillation (AF) undergoing cardiovascular CT (CCT). The clinical significance of LAA pseudothrombus on CCT, in those with non-valvular AF (NVAF) is unknown.

Objectives
To determine the association of LAA pseudo-thrombus in those with NVAF and ischaemic stroke.

Methods
216 consecutive patients with NVAF, referred for CCT (with both standard and 60-second delayed acquisitions) were assessed for the LAA pseudo-thrombus, LA and LAA dimensions and morphology, cardiovascular risk factors, treatment, and ischaemic stroke risk

Results
Mean age (±SD) was 65.0±10.6 years (range 32–89) and 70.8% were male. LAA pseudo-thrombus was present in 59/216 (27%) patients. Ischaemic stroke is more frequent with increasing age (OR 1.10 (95% confidence intervals (CI) 1.06, 1.16), p<0.0001), vascular disease (3.21 (1.18, 8.75) p=0.023), pseudo-thrombus on CCT (4.18 (1.97, 8.88) p<0.0001), cauliflour LAA morphology (4.93 (1.06, 22.09) p=0.042), and increased LAA ostial area: LAA tortuosity (4.64 (1.57, 13.71) p=0.006).
Age (1.09 (1.03, 1.15) p<0.0001), vascular disease (4.07 (1.19, 13.98) p=0.026), cauliflour LAA morphology (15.01 (2,93, 76.81) p=0.001) and pseudothrombus on CCT (3.62 (1.38, 9.50), p=0.009) were independently associated with ischaemic stroke. Pseudothrombus remained an independent risk factor even after CHA2DS2-VASc was included (3.21 (1.22, 8.41), p=0.018).

Conclusion
Pseudothrombus on CCT is a common finding in patients with NVAF and has a strong positive association with ischaemic stroke. Inclusion of pseudothrombus on CCT in risk assessment is additive to CHA2DS2-VASc in prediction of ischaemic stroke risk in patients with NVAF.
P3390Relationship of thrombus healing to underlying plaque characteristics in ST-segment elevation myocardial infarction: an optical coherence tomography study
Authors: Cao M , Yang G , Fang S , Jia H , Hou J , Yu B 
Published: October 2019

Abstract

Background
Acute ST-segment elevation myocardial infarction (STEMI) is typically characterized by an occlusive coronary thrombus propagation on a disrupted or eroded atherosclerotic plaque. A variable period of plaque instability and thrombus formation occur days or weeks old in approximately 50% of patients with STEMI. Presence of late stage (older) thrombi in aspirated coronary material is an independent predictor of 1-year and long-term mortality in STEMI patients. However, the relationship between coronary thrombus healing to underlying plaque morphology and characteristics in vivo still remains largely unknown.

Purpose
Our objective was to assess differences in thrombus healing between ruptured and eroded plaques in vivo and evaluate the impact of underlying plaque characteristics on thrombus healing using optical coherence tomography (OCT).

Methods
Analyzable coronary material was obtained during primary percutaneous coronary intervention (PCI) from 135 patients with STEMI within 12h of symptom onset. Thrombi were morphologically classified as either early or late stage (lytic changes or organization). Of the 135 patients, 110 were eligible for culprit lesion evaluation using OCT. Quantitative and qualitative underlying plaque characteristics were assessed by OCT.

Results
Late-stage thrombi were found in 49 of 110 (44.5%) culprit plaques. Patients with eroded plaques more frequently had late-stage thrombi compared with ruptured plaques (59.0% vs. 36.6%, p<0.001). Subgroup analysis was performed between plaque rupture, identified in 71 patients (64.5%) and plaque erosion in 39 patients (35.5%). In plaque ruptures, patients with late-stage thrombi had larger lipid core length (12.4±3.3 vs. 14.5±3.8, p=0.020), larger rupture cavity length [1.5 (1.0, 2.0) vs. 1.9 (1.5, 2.8), p=0.034] and increased residual thrombus length [7.8 (6.3, 11.2) vs. 10.3 (7.8, 13.8), p=0.021] assessed by OCT compared with early thrombus group. However, in plaque erosions, late stage thrombi were associated with decreased residual thrombus burden compared with patients with early thrombus group [16.8 (12.8, 20.4) vs. 13.4 (10.7, 14.8), p=0.012]. No significant difference was found between thrombus healing with peak creatine kinase concentration or maximum NT-pro BNP in subgroup analysis.

Conclusions
Coronary thrombi in STEMI patients exhibited diverse phases of healing, depending on the etiology of the underlying culprit plaque in vivo. These observations indicate entirely distinct mechanisms of thrombus propagation, maturation and healing between plaque rupture and erosion, illustrating an opportunity for more tailored treatment in patients with different plaque type.