bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6020His bundle pacing in patients with abnormal versus intact atrioventricular conduction: from the IMAGE-HBP Study
Authors: Koneru J A Y , Dandamudi G O P I , Subzposh F A I Z , Shepard R K S , Kalahasty G K , Strobel J S , Ellenbogen K A E , Bergemann T B , Zhou X Z , Hughes L H , Vijayraman P V 
Published: October 2019

Abstract

Background
Frequent right ventricular pacing causes ventricular dyssynchrony and adverse outcomes. His bundle pacing (HBP) offers a physiological alternative. HBP electrical performance characteristics with cardiac conduction system abnormalities are not well established.

Purpose
To compare HBP implant procedure related parameters in patients with abnormal atrioventricular (AV) conduction versus those with intact AV conduction.

Methods
Patients prospectively enrolled in the IMAGE-HBP study undergoing implant attempt with a SelectSecure 3830 lead placed at the putative His-bundle location were included in the analysis. Patients were divided into groups based on AV conduction status. Implant characteristics and electrical performance of the pacemaker were tabulated and compared between the two groups with formal statistical tests.

Results
Among 60 patients (age 74.7 years old and 60% male), 29 patients (48%) had abnormal AV conduction at or below the AV node (18 with AV block of which 5 also had bundle branch block (BBB), 6 with SND and BBB, and 5 with AV node ablation). The remaining 31 patients (52%) had intact AV conduction. Procedure times were not significantly different between the groups (P=0.26). Selective HBP was achieved in 20.7% of abnormal AV conduction patients and 45.2% of intact AV conduction patients (P=0.06); the remaining patients had non-selective HBP. There were no differences detected in pacing characteristics at implant and paced QRS durations by AV conduction status.
Patient with intact AV conduction (N=31) Patients with abnormal AV conduction at or below AV node (N=29) Procedure time in minutes (mean ± SD, Median, IQR) 99±38; 87 [43, 180] 108±32; 108 [65, 182] Fluoroscopy time in minutes (mean ± SD, Median, IQR) 15±12; 11 [3, 50] 16±9; 13 [4, 36] Number of fixation attempts 3.0±2.2 2.2±2.0 sHBP PCT N=14 N=6 V at 0.5ms 1.8±0.9 1.7±1.2 V at 1.0ms 1.6±1.2 1.2±0.8 nsHBP PCT N=17 N=22 V at 0.5ms 2.2±1.9 1.7±1.3 V at 1.0ms 1.5±1.1 1.3±1.1 His signal recorded, number 30 (96.8%) 28 (96.6%) H-QRS interval, ms 46±7 48±13 His Injury of Current, N (%) 23 (74.2%) 18 (62.1%) Baseline Intrinsic QRS, ms 96±16 107±22 Paced QRS duration, ms (from HBP at 1.0ms) 119±23 121±19

Conclusions
Selective and non-selective HBP are achievable in bradycardic patients with abnormal and intact AV conduction, including those with BBB. There were no major differences in HBP implant parameters between patients with abnormal AV conduction and those with intact AV conduction.
P6143Body-mass index, blood pressure, diabetes and cardiovascular mortality in Cuba: prospective cohort study of 146,665 participants
Authors: Lacey B W H , Armas N , Burrett J A , Peto R , Duenas A , Lewington S 
Published: October 2019

Abstract

Background
Cardiovascular disease (CVD) is a leading cause of premature death in Cuba, accounting for about one third of all deaths under age 70 years. Substantial uncertainty remains, however, about the relevance of major metabolic risk factors to CVD mortality in this population.

Purpose
To relate body-mass index (BMI), systolic blood pressure (SBP), and diabetes to risk of CVD death in Cuba.

Methods
In a prospective cohort study, 146,665 adults were recruited from the general population in five areas of Cuba between 1996 and 2002. Participants were interviewed, measured (height, weight and blood pressure) and followed up by electronic linkage to Cuban national death registries to Jan 1 2017; 24,345 participants were resurveyed between 2006 and 2008. After excluding all with missing data or chronic disease at recruitment or, to further limit reverse causality, those who died in the first 5 years, Cox regression (adjusted for age, sex, education, smoking, alcohol and, where appropriate, BMI) was used to relate mortality rate ratios (RRs) at ages 35–79 years to BMI, SBP and diabetes. Correlations of baseline and resurvey values were used to corrected RRs for regression dilution, and thereby estimate associations with long-term average (“usual”) levels of SBP and BMI.

Results
After exclusions, there were 117,008 participants age 35–79 (mean age 52 [SD 12]; 55% women). At recruitment, mean SBP was 124 mm Hg (SD 15), mean BMI was 24.2 kg/m2 (SD 3.6) and 5% had diabetes; mean SBP and diabetes prevalence were both strongly related to BMI. Correlations of resurvey and baseline measurements were 0.48 for SBP and 0.60 for BMI. At ages 35–79 years, there were 3780 CVD deaths (1871 ischaemic heart disease [IHD], 766 stroke, and 1143 other). CVD mortality was positively associated with BMI (down to about 22–23 kg/m2; figure), SBP and diabetes: 10 kg/m2 higher usual BMI approximately doubled CVD mortality (RR 1.90, 95% CI 1.61–2.24), as did 20 mmHg higher usual SBP (2.03, 1.88–2.20), and a prior diagnosis of diabetes (2.18, 1.97–2.42). The associations were similar in men and women. Given these associations, about one quarter (27%) of CVD deaths in this study were attributable to these metabolic risk factors combined.

Conclusion
These associations differ to those reported from other parts of Latin America, and are more consistent with studies in Europe and North America, highlighting the need for many more large-scale prospective studies in low and middle income countries. This study provides direct evidence for the expected benefit on CVD mortality of addressing major metabolic risk factors in Cuba. As the levels of these metabolic risk factors are increasing in Cuba, so too is their importance as determinants of premature CVD death.

Acknowledgement/Funding
Medical Research Council, British Heart Foundation, Cancer Research UK
P6149Coronary computed tomographic angiography (CTA) for risk stratification in the diagnostic triage of patients undergoing liver transplantation (LT): A long-term outcome study
Authors: Strobl S , Senoner T , Finkenstedt A , Widmann G , Plank F , Zoller H , Steinkohl F , Friedrich G , Feuchtner G M 
Published: October 2019

Abstract

Background
Cardiovascular (CV) risk stratification in patients with end-stage liver disease (ESLD) prior to liver transplantation (LT) is crucial: CV-disease poses a major threat for posttransplant survival.
Therefore, our purpose was to assess safety of coronary computed tomographic angiography (CTA) in patients prior to orthotopic LT over a long-term follow up period, and its value for CV risk stratification.

Methods
In this single center, retrospective observational study 458 patients underwent coronary calcium score (CCS) and coronary CTA for pre-LT risk stratification between 2005 and 2016. CTA was evaluated for 1) stenosis severity (CADRADS: 4-severe>70%/3-intermediate50–70%/2-mild<50%/1-minimal<25%/0=no CAD) 2) plaque burden (SIS, G-score), 3) high–risk plaque features (Napkin Ring Sign, low attenuation plaque, positive remodelling) and 4) Coronary Calcium Score. Primary endpoint was mortality (all-cause and cardiovascular), secondary endpoint major cardiovascular events (MACE).

Results
Finally 270 patients (79.3% males, age 61±8.5 years) who underwent orthotopic LT were included (mean follow-up 7.5 years±3.1, range 2–13). 87 (32.2%) had CCS zero and 60 (22.2%) CCS >300 Agatston Units (CCS 335.6 AU± 868.9). 248 patients underwent CTA after CCS. The majority had CAD (n=173, 72.3%) by CTA while only 75 (27.7%) had no CAD. 102 patients (38.8%) had minimal-or-mild stenosis<50% (CADRADS 1–2), 34 (12.9%) intermediate and 17 (6.5%) severe stenosis.Out of CCS 0 patients, 13 had non-calcified plaque.
All-cause mortality rate was 46 (17.0%), with the majority of patients (43 (93.5%) experiencing non-cardiac death and 3 (6.5%) cardiovascular death due to 1 myocardial infarction and 2 cardiopulmonary failure. CADRADS predicted mortality (Kaplan Meir, p<0.001). On multivariate Cox Regression modell, SIS and G-score predicted all-cause mortality (HR 1.1:p=0.034; 95% CI: 0.649–0.983 and HR 1.1, p=0.029; 95% CI: 1.0–1.6), while Calcium Score did not. There were 6 MACE (3 STEMI, 3 NSTEMI). MACE rate was 0% in CADRADS 0 or 1, 1 in CADRADS-2 and increasing to 5 in CADRADS 3 and 4 groups.
Coronary CTA for LT risk stratification

Conclusion
Cardiac CT is a reliable non-invasive modality for pre-LT assessment of CV-risk over a long-term period, with 0% MACE in patients with no CAD or minimal CAD. CTA allows for an improved CV-risk stratification by stenosis severity (CADRADS) and plaque burden as compared to calcium scoring.
P6156Coronary atherosclerosis characteristics in long-term antiretroviral therapy and HIV infection: insights from coronary CTA
Authors: Senoner T , Barbieri F , Adukauskaite A , Sarcletti M , Plank F , Beyer C , Dichtl W , Feuchtner G M 
Published: October 2019

Abstract

Purpose
To assess coronary artery disease (CAD) characteristics by coronary CT-angiography (CTA) in individuals with HIV-infection on long-term ART in a retrospective matched case-controlled cohort study.

Methods
69 HIV positive patients who underwent 128-slice dual source coronary CTA (mean age 54.9 years, 26.1% females) with mean 17.8±9.4 years of HIV-infection and a mean duration on ART of 13±7.3 years were propensity score matched with 69 HIV negative controls.
CTA was evaluated for: Stenosis severity (CAD-RADS), total plaque burden, mixed-non-calcified plaque burden (G-score), high-risk-plaque (HRP) features (Napkin-Ring-Sign, low-attenuation-plaque, spotty calcification, positive remodeling), perivascular fat attenuation index (FAI) and ectatic coronary segments.

Results
CAD-RADS was higher in HIV-positive participants as compared to controls (2.21±1.4 vs 1.69±1.5, p=0.031). A higher prevalence of CAD and G-score (p=0.043 and p=0.003) were found.
HRP prevalence (23 (34.3%) vs 8 (12.1%); p=0.002) and the number of HRP (36 vs 10, p<0.001) were higher in HIV-positive individuals. A positive perivascular FAI >-70 HU was present in 27.8% of HRP. Ectatic coronary arteries were found in 10 (14.5%) individuals with HIV-infection vs 0% in controls (p=0.003).

Conclusion(s)
HIV positive individuals on long-term ART display higher CAD burden and more HRP indicating vulnerable, potentially inflamed plaques.
CT- Angiography results HIV+ (N=67) HIV− (N=67) P-value CAD prevalence (any plaque), n (%) 56 (83.6) 46 (68.7) 0.043 SSS, mean ±SD 1.16±1.6 0.95±2.1 0.038 CAD RADS   0 11 22   1 11 7   2 10 21 <0.001   3 23 4   4 12 13   Total >50%, n (%) 35 (52.2) 17 (25.4) 0.001 CAD RADS, mean ±SD 2.21±1.4 1.69±1.5 0.031 SIS, mean ±SD 3.93±3.0 3.06±3.1 0.067 G-score, mean ±SD 10.04±8.5 5.76±5.9 0.003 Calcium score, mean ±SD 149.4±287.1 133.2±329.3 0.015 HRP, n (%) 23 (34.3) 8 (12.1) 0.002 HRP, n 36 10 <0.001 Non-calcifying plaque component, n (%) 44 (65.7) 34 (51.5) 0.097 Ectatic coronary segments, n (%) 10 (14.5) 0 (0) 0.003 CAD RADS: coronary artery disease reporting and data system; CCS: coronary calcium score; HRP: high-risk plaque; SIS: segment involvement score; SSS: stenosis severity score.
60 yo HIV-infected (31 yrs) male patient
These features strongly support the predominant inflammatory theory of cardiovascular events in HIV-infected individuals.

Acknowledgement/Funding
None
P6163Promotion of coronary plaque progression associated with different anticoagulation agents - a longitudinal CTA analysis
Authors: Beyer C , Wildauer M , Feuchtner G , Friedrich G , Hintringer F , Stuehlinger M , Plank F 
Published: October 2019

Abstract

Objective
Possible antithrombotic effect of anticoagulants in coronary artery disease have been proposed but mechanism are poorly understood. Experimental and clinical data indicate a key role of coagulation factors in the progression of atherosclerosis. We sought to evaluate the effect of different oral anticoagulation agents on the progression of atherosclerosis.

Methods
This retrospective matched case controlled study included patients with atrial fibrillation (AF) who underwent repeated CT angiography for ablation planning. Patients with known structural cardiac pathologies or significant comorbidities were excluded.
Patients were stratified according to their anticoagulation into 3 groups: vitamin K antagonist (VKA), direct oral anticoagulation (DOAC) and control (CR; aspirin or no therapy) with equal distribution of age and cardiovascular risk factors. Baseline and follow-up CT exams for repeated AF ablations were evaluated for the CAD profile and (semi)automated quantitative plaque analysis.

Results
One-hundred sixty-one patients were included (mean CT time interval: 31 months). The three cohorts did not differ in patient characteristics or CT findings at baseline. Absolute plaque volume progression was significantly higher in patients using VKA (66.5±136.7 mm3) compared to both CR (27.2±73.6 mm3) and DOAC (−7.1±42.1 mm3, p<0.001), translating into an annual change of 23.2±47.0 mm3 for VKA, 12.3±4.3 mm3 for CR and −4.6±22.9 mm3 for DOAC (p=0.003). The number of affected segments (SIS) increased by 1.2±1.3 compared to 0.6±1.3 in the control group and 0.2±0.7 in the DOAC group (p<0.0001).
Baseline CTA findings Control (n=61) DOAC (n=50) VKA (n=50) p Vessel Volume (mm3) 26.9±42.9 23.1±43.3 27.9±40.7 0.85 Lumen Volume (mm3) 15.7±24.8 13.3±25.1 16.6±27.0 0.82 Coronary Calcium Score (AU) 63.4±187.2 42.0±114.6 53.8±118.6 0.75 Segment Involvement Score 1.8±2.1 1.8±2.3 1.9±2.2 0.96 Stenosis Average Area (%) 19.0±21.7 0.5±0.7 0.5±0.7 0.71 Maximal Plaque Thickness (mm3) 0.5±0.7 0.5±0.7 0.5±0.7 0.69 Total Plaque Volume (mm3) 33.6±60.0 30.0±55.6 34.2±48.0 0.92 AU, Agatston units; DOAC, direct oral anticoagulation; SIS, segment involvement score; VKA, vitamin K antagonist.
Changes between baseline and follow-up

Conclusion
In serial coronary CTs, patients using vitamin K antagonists showed the highest plaque volume progression while patients using a direct oral anticoagulant showed a regression of total plaque volume. Therefore, direct anticoagulation may have a beneficial effect on atherosclerosis.
P6164High level of EPA is associated with lower perivascular coronary attenuation as measured by coronary CTA
Authors: Bittner D O , Goeller M , Zopf Y , Achenbach S , Marwan M 
Published: October 2019

Abstract

Introduction
Pericoronary adipose tissue (PCAT) composition has been recently shown to be a potential novel marker of coronary inflammation with higher PCAT attenuation shown to indicate increased cardiac mortality. Polyunsaturated fatty acids (PUFAs), especially Omega-3 fatty acids (n3), are thought to alter inflammatory response and intake of high dose Eicosapentaenoic acid (EPA, C20_5 n3) was shown to decrease mortality, however exact pathophysiological mechanisms are unclear. Therefore, we sought to determine whether blood levels of PUFAs are associated with differences in pericoronary fat attenuation.

Methods
In 64 symptomatic patients with intermediate pretest-likelihood for coronary artery disease presenting with atypical angina, coronary CTA was performed. PCAT attenuation was measured in Hounsfield Units (HU) around the proximal 40mm of the right coronary artery (RCA) using semi-automated software. Erythrocyte membrane fatty acid composition (in percentage) was analyzed with a standardized analytical methodology, displaying a variety of fatty acids including n-3 fatty acids using gas chromatography.

Results
Patients were divided into two groups (each n=32) using the median PCAT attenuation of −78.1 Hounsfield units (HU), resulting in one group with low (−95.58 to −78.17 HU) and one with high (−78.06 to −62.92 HU) PCAT attenuation. Among both groups, no differences were seen in age, sex, BMI, traditional cardiovascular risk factors or the number of cardiovascular risk factors (all p>0.05). In univariate analysis, significantly higher values of EPA (1.00% [0.78; 1.26] vs. 0.78% [0.63; 0.99]; p=0.02) were seen in patients with lower PCAT attenuation. All other fatty acids showed no significant differences (all p>0.05). Moreover, a significant negative correlation was seen between PCAT attenuation and EPA (Pearson correlation coefficient −0.38; p=0.002), but not for age, sex, BMI or number of cardiovascular risk factors (all p>0.1). Multivariable linear regression analysis confirmed this association and showed a significant inverse association of EPA to PCAT attenuation (β=−0.31, p=0.017), independent of age, gender, BMI and number of CV risk factors (all p>0.1).

Conclusion
High levels of EPA are associated with lower PCAT attenuation on coronary CTA indicating different composition of pericoronary adipose tissue potentially caused by a lesser degree of coronary inflammation.
P6168Low PCSK9 plasma level is an independent predictor of coronary atherosclerotic burden in patients with stable coronary artery disease
Authors: Caselli C , Ragusa R , Del Turco S , De Graaf M , Basta G , Scholte A , De Caterina R , Neglia D 
Published: October 2019

Abstract

Background
Circulating proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator of LDL cholesterol levels and has emerged as a new therapeutic target in coronary artery disease (CAD). Plasma PCSK9 levels have also been related to other components of the lipid profile associated with atherosclerotic risk.

Purpose
Aim of the present study was to evaluate the relationship of plasma PCSK9 levels with lipid profile and measures of coronary atherosclerotic burden and risk in patients with stable CAD enrolled in the European EValuation of INtegrated Cardiac Imaging (EVINCI) study.

Methods
PCSK9 was measured in 412 patients (60.3±8.6 years, 256 males) with symptoms of stable CAD fully characterized by clinical risk factors, bio-humoral profiles, and treatment. All patients underwent coronary computed tomography (CT) angiography to assess the presence and characteristics of coronary atherosclerosis. We calculated an individual CT risk score, expressing the coronary atherosclerotic burden, combining extent, severity, composition, and location of plaques.

Results
Patients were divided in groups according to PCSK9 quartiles: I (<136 ng/mL), II-III (136–266 ng/mL), and IV quartile (>266 ng/mL). LDL and HDL-cholesterol levels were significantly lower while total/HDL-cholesterol ratio was significantly higher in patients in the quartile I than in those in quartile IV (Figure A). CT angiography documented normal vessels in 30 and obstructive CAD in 35% of cases. Compared with patients with the highest levels (quartile IV), patients with the lowest PCSK9 levels (quartile I) had a higher CT risk score, a higher number of mixed plaque and higher hs-cTnI plasma levels (Figure B). PCSK9 itself was not associated with obstructive CAD. At multivariable analysis including clinical variables, medications and lipid variables PCSK9 was an independent predictor of the CT risk score (Coefficient - 0.129 (SE 0.03), p<0.0001), together with age, male gender and statin treatment.
Figure 1

Conclusion
PCSK9 levels are independently and inversely associated with the coronary atherosclerotic burden in patients with stable CAD.

Acknowledgement/Funding
AMGEN grant, EU FP7-CP-FP506 2007 project (grant agreement no. 222915)
P6171Role of myocardial mass for identifying FFR-verified ischemia and determining therapeutic strategy
Authors: Kawai H , Motoyama S , Miyajima K , Hoshino M , Ohta M , Takahashi H , Ishii J , Muramatsu T , Sarai M , Ozaki Y 
Published: October 2019

Abstract

Background
Conventional noninvasive approach using coronary CT angiography (CTA) focusing on only coronary artery lesions remains mismatch in identifying functional ischemia and determining indication for coronary revascularization.

Purpose
We aimed to assess the usefulness of CT-verified myocardial mass for identifying FFR-verified myocardial ischemia and determining the indication of coronary revascularization after FFR examination.

Methods
We examined 244 vessels with intermediate stenoses (50 to 90% stenosis visually on CTA) in 216 patients (mean age 69.2±9.2, 166 men) who underwent both coronary CTA and invasive FFR. In addition to coronary stenosis severity and plaque characteristics on visual, minimal lumen diameter (MLD), minimal lumen area (MLA), plaque volume, the entire myocardial volume of the target vessel (MTV) and that exposed to ischemia (FFR ≤0.80) (myocardial volume of ischemia: MVI) were evaluated. Additionally, therapeutic strategy after FFR was recorded.

Results
Of 244 vessels, myocardial ischemia (FFR ≤0.80) was shown in 99 (40.6%). MTV was larger in the patients with FFR-verified ischemia than those without (53.3±19.2 vs. 41.5±21.6, P<0.001); MLA, plaque burden (PB) and percentage of aggregated plaque volume (%APV) were also associated with ischemia. The area under the curves (AUCs) of MLA, PB, %APV, and MTV were 0.69, 0.67, 0.64, and 0.71, respectively. Addition of MTV to a model with coronary stenosis on visual, MLA, PB, and %APV improved C-index (from 0.72 to 0.79, P<0.01), net reclassification improvement (NRI) (0.71, P<0.01), and integrated discrimination improvement (IDI) (0.10, P<0.01). Of 99 vessels with FFR ≤0.80, MVI was larger in the vessels with early revascularization after FFR than those without (38.8 vs. 29.1, P=0.01).

Conclusions
The measurement of myocardial mass improves the diagnostic performance of coronary CTA for the identification of coronary arteries with FFR-verified ischemia. Furthermore, it is associated with therapeutic strategy for the diseased vessels after FFR examination.
P6174On-site CT-derived FFR predicts the need for revascularization
Authors: Bos Real L , Vilades D , Jimenez M , Altisent O , Rodriguez O , Alomar X , Ferrero A , Schuijf J , Carreras F , Leta R 
Published: October 2019

Abstract

Background and purpose
Coronary computed tomography angiography (CTA) in combination with CT-derived fractional flow reserve (CT-FFR) is a solid tool for assessing both the anatomical and functional impact of coronary atherosclerotic disease (CAD) in a single study. The development of new software for on-site CT-FFR quantification may reduce costs and increase availability. The aim of this study was to analyze the incremental value of CT-FFR over CTA alone and its ability to predict the need for revascularization.

Methods
Patients referred for invasive coronary angiography (ICA) who accepted to undergo a CTA/CT-FFR study were prospectively included. Patients with any contraindication for CT, atrial fibrillation, chronic total occlusions, severe ventricular hypertrophy or previous coronary revascularization were excluded. On-site CT-FFR was calculated for each coronary vessel. Invasive FFR was quantified during ICA, considering ≤0.8 as a surrogate for the need for revascularization.

Results
33 patients (90 vessels) were included. Mean age was 65±10 years, 88% were males, 60% had hypertension, 77% dyslipidaemia and 40% diabetes. The average analysis time of CT-FFR was 16±4 minutes. There was a good correlation between CT-FFR and FFR in all three main epicardial vessels as well as in proximal segments or in moderate to severe stenosis (see Table). 83% of vessels with FFR≤0.8 were predicted by CT-FFR study (89% of LAD lesions, 86% of LCX and 66% of RCA). CT-FFR added incremental diagnostic value over CTA alone to predict FFR≤0.8 (ΔAUC 0.0336 with a net reclassification index 1.4±0.23; p<0.001) (see Image).
n Mean difference from Bland-Altman Pearson's r coefficient p value All-vessels 90 0.037±0.1 0.8 <0.001 Lesions in LAD 40 0.005±0.11 0.81 <0.001 Lesions in LCX 32 0.061±0.094 0.85 <0.001 Lesions in RCA 18 0.06±0.11 0.83 <0.001 Moderate lesions (50–69% QCA stenosis) 24 0.02±0.06 0.88 <0.001 Severe lesions (70–99% QCA stenosis) 25 0.034±0.18 0.4 <0.001 Proximal lesions 42 0.012±0.11 0.84 <0.001 Non-proximal lesions 48 0.061±0.1 0.78 <0.001

Conclusions
On-site CT-FFR is a good predictor of the need for revascularization in all three main coronary vessels and adds incremental diagnostic value over CTA alone. There is higher dispersion of the values in severe stenosis, lesions in LCX or RCA although this do not result in misclassification.