bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3371Impact of severe aortic stenosis on layer-specific longitudinal strain and its prognostic value
Authors: Ilardi F , Dulgheru R E , Marchetta S , Cimino S , D'Amico G , Manganaro R , Lancellotti P 
Published: October 2019

Abstract

Background
Global longitudinal strain (GLS) was used to detect early myocardial dysfunction in patients with aortic stenosis (AS), however few data are currently available on the different susceptibility of specific myocardial layer to increased wall stress and its prognostic role. The present study sought to investigate the relationship between changes in LV multilayer strain and the clinical outcome of patients with severe AS and preserved left ventricle ejection fraction (LVEF).

Methods
We included in the analysis 211 patients (56% males, mean age 73±12 years old) with severe AS and LVEF≥50%, divided in symptomatic (n=114) and asymptomatic group (n=97), and 50 controls matched for age and sex. Patients with moderate-to-severe concomitant valvulopathy and inadequate acoustic windows for evaluation by speckle tracking analysis were excluded. Clinical, demographic and resting echocardiographic data were recorded, including quantification of 2D GLS, subendocardial LS and subepicardial LS.

Results
Symptomatic patients had increased LV wall thickness and LV mass index than asymptomatic ones (p<0.001), higher transaortic mean pressure gradients (48±14 vs 44±13 mmHg, p=0.004), and lower aortic valve areas (0.42±0.09 vs 0.45±0.08 cm2/m2, p<0.017). GLS was significantly lower in patients with AS compared to controls, especially in symptomatic group (17.9±3.4 vs 19.1±3.1 vs 20.7±2.1%, p<0.001 in symptomatic, asymptomatic and control groups respectively) suggesting an early, subtle, myocardial dysfunction. In particular, the analysis of layer-specific myocardial deformation revealed a marked difference in both the subendocardial LS (20.1±4.9 vs 21.7±4.2 vs 23.4±2.5%, p<0.001) and subepicardial LS (15.8±3.1 vs 16.8±2.8 vs 18.3±1.8%, p<0.001). At multivariable logistic regression analysis, subendocardial LS was independently associated to symptoms (OR=1.148, p=0.014), together with indexed left atrial volume (OR=1.035, p=0.007) and LV concentric remodelling (OR=2.429, p=0.031). During a mean follow up of 38 months (IQ range 18–60 months), 12 patients with asymptomatic severe AS had a cardiovascular (CV) death. The presence of a subendocardial LS <22% at baseline was associated with a higher rate of CV events at 3 and 5-year follow-up (19% vs 5% at 3-year follow-up, and 22% vs 8% at 5-year follow-up, respectively; log-rank p=0.044).

Conclusion
In patients with severe AS, LS impairment involves all myocardial layers and is more prominent in the advanced phases of the disease. In this setting, the subendocardial LS appears to be independently associated to symptoms than subepicardial LS. In asymptomatic patients, a reduced value of subendocardial LS is associated with higher CV mortality at 3- and 5-year follow-up.
P3374Quantification of mitral valve regurgitation volume by 2D and 3D echocardiography compared with cardiac magnetic resonance: a systematic review and meta-analysis
Authors: Skoldborg V , Abdulla J 
Published: October 2019

Abstract

Background
Accurate determination of mitral valve regurgitation (MVR) volume as a measure of left ventricular overload is of great clinical importance for timing of valve repair. The reliability of different echocardiographic methods for assessment of severity of MVR, particularly in severe cases, is currently unclear.

Purpose
We sought to shed light on this issue by means of a systematic literature review (SLR) and meta-analysis, in which we combined results of all available published studies comparing the different echocardiographic methods with cardiac magnetic resonance (CMR) as standard reference.

Methods
Electronic databases PubMed and Web of Science were searched for studies examining 2-dimensional (D) and 3D transthoracic and transoesophageal echocardiography (TTE and TEE), using proximal isovelocity surface area (PISA) and volumetric methods and comparing these with CMR. Estimated mean bias with limits of agreements (LoA) derived from Bland-Altman tests and correlations coefficients (R) were pooled together using a weighted inverse variance method.

Results
Twenty prospective studies were eligible for meta-analysis. Overall 1187 patients with primary or secondary, mild to severe MVR were included. The mean age was 59±13 years and male gender constituted 678 (57%) of patients. Meta-analysis of bias and LoA comparing all echocardiographic methods with CMR showed moderate overestimation and poor agreement with a bias and LoA of 8.24 (−3.55, 20.03) ml, and moderate correlation with R=0.74 (0.70–0.78) p<0.001, Fig 1. 3D-PISA followed by 3D-volumetric methods showed better agreement with an underestimation of −3.20 (−12.33, 5.92) ml, R=0.84 (0.78–0.89) p<0.001 and overestimation of 4.61 (−10.17, 19.39) ml, R=0.90 (0.86, 0.94) p<0.001, respectively. 2D volumetric method showed the poorest agreement with a bias and LoA of 23.56 (−4.19, 51.31) ml, and a moderate correlation with R=0.64 (0.54–0.73), p<0.001. In 172 patients with severe degree of MVR, echocardiographic techniques (2D and 3D) were able to correctly quantify regurgitation severity only in 114 (66%) of cases.

Conclusions
Echocardiographic methods either under- or overestimate the severity of MVR volume, however, 3D-PISA seems to be more reliable. CMR should be considered particularly in cases of severe MVR where a decision-making prior to valve surgery deems necessary. Powerful randomized studies are needed to further assess the accuracy of different echocardiographic methods in relation to CMR.
P3382Vascular calcium Index: an imaging tool to predict vascular complications and major bleeding in TF-TAVI
Authors: Felix-Oliveira A , Campante Teles R , Ferreira A , Brito J , Goncalves P A , Raposo L , Gabriel H M , Nolasco T , Cunha G , Abecasis J , Saraiva C , Almeida M S , Mendes M 
Published: October 2019

Abstract

Introduction
Vascular calcification has been associated with worse outcomes in transfemoral TAVI (TF-TAVI). However, there is currently no simple method to assess it and identify different patterns of calcification in an objective and quantitative manner. The purpose of this study was to develop a quantitative score of aortic (Ao) and ileofemural (IF) calcification and to assess its ability to predict life-threatening bleeding (LTB) and major vascular complications during TF-TAVI.

Methods
Case-control single center retrospective study of patients undergoing TF-TAVI between Nov2015 and Aug2018 including 183 consecutive patients (99 women, mean age 83±3 years, mean Euroscore II - ESII - 6.0±4.1). The Vascular Calcium Score was calculated for the entire Ao and IF vessels using a modified Agatston score derived from contrast-enhanced CT images, with calcium threshold locally adjusted for luminal attenuation (mean attenuation + 5x SD). A luminal attenuation threshold >600UH impaired vascular calcium evaluation and patients were excluded. LTB and major vascular complications were adjudicated according to the VARC-2 classification and identified by chart review by and independent team.

Results
Thirty patients (16%) suffered major bleeding and 13 (7%) experienced LTB. Major vascular injury occurred in 11 patients (6%). The median total vascular calcium score (TCS) was 11752 AU (IQR: 6388–19844) and median IF score (IFS) was 2210AU (IQR: 865–4170). TCS indexed for body surface area (TCSi) was predictor of LTB (AUC: 0.78±0.07, p<0.05) and of major vascular complications (AUC: 0.85±0.05, p<0.05). After multivariate analysis, iTCS and glomerular filtration rate (GFR) remained as predictors of LTB with an HR of 1.11 for each increase in 1000UA/m2 of TCSi (95% CI: 1.03–1.18) and 0.94 (95% CI: 0.88–0.985) respectively, independently of the ESII. iTCS and GFR were also independently associated with major vascular complications (p<0.05). Patients with an iTCS above 9750AU/m2 have an odds ratio of 7.7 (95% CI: 2.0 - 29.2) for LTB. This cut-off has a sensitivity of 77% and a specificity of 70% for LTB. Similarly, patients with an iTCS above 9750AU/m2 have an odds ratio of 10.3 (95% CI: 22 - 49.3) for major vascular injury.

Conclusions
A quantitative score for vascular calcification in contrast-enhanced CT images was developed. iTCS was independently associated with life-threatening bleeding and major vascular complications.
P3383Left atrial appendage and left atrial morphology is associated with cryptogenic stroke
Authors: Adukauskaite A , Barbieri F , Senoner T , Plank F , Knoflach M , Boehme C , Hintringer F , Mueller S , Dichtl W , Feuchtner G 
Published: October 2019

Abstract

Background
Stroke causes a high burden of morbidity and mortality worldwide. Approximately 30% of stroke cases remain cryptogenic (CS), of which one third is due to occult atrial fibrillation (AF) with left atrial appendage (LAA) being the most frequent thrombus source.
Hence, aim of our study was to assess if LAA morphological parameters analysed by computed tomography angiography (CTA) are associated with CS.

Methods and materials
In 184 patients (Table 1), 82 CS patients and 102 controls (age median 62 (52,2–72), 40.2% females), matched for BMI, a CTA was performed, and LAA morphology evaluated retrospectively.
LAA morphology was classified into 5 types (Figure 1): Cactus, Cauliflower, Chicken-wing, Windsock and the new “Seahorse” with a distinctive tip angulation of ≤90° and 2 bends (Z-shape). Further measurements included: LAA tip angulation (≤90°, 91–110°, >110°), LAA lobe number, LAA ostium size (length) and angulation, left atrium wall thickness (LAWT).

Results
LAA and left atrium (LA) parameters associated with CS on multivariable analysis after adjusting for CHA2DS2-VASc score were: Chicken-wing type (OR 2.15; 95% CI: 1.01–4.56, p=0.046), a greater lobe number (OR 2.01; 95% CI: 1.52–2.64, p<0.001), a greater middle and mean LAWT (respectively, OR 2.13; 95% CI: 1.49–3.05, p<0.001, OR 2.64; 95% CI: 1.63–4.29, p<0.001), a larger (length, OR 1.08; 95% CI: 1.0–1.16, p=0.039) and a less bent LAA ostium (OR 1.02; 95% CI: 1.01–1.03, p=0.006). In contrast, a sharp-angled LAA tip (≤90°) was protective from CS (OR 0.43; 95% CI: 0.23–0.83, p=0.012) on multivariable analysis.
Table1. Clinical patient characteristics CS (n=82) Non-stroke (n=102) p value Females 21 (25.6%) 53 (52%) p<0.001 Age, y 66.5 (57–73) 57.5 (50–70) 0.001 BMI, kg/m2 25.6 (23.9–28.2) 26 (23.3–30.1) 0.320 CHA2DS2-VASc score 2 (1–3) 2 (1–3) 0.387 AF (paroxysmal/permanent) 0 4 0.071 Hypertension 68 (82.9%) 54 (56.3%) p<0.001 Diabetes mellitus, type 2 16 (19.8%) 11 (11.5%) 0.145 Values are given in median ± IQR. AF, atrial fibrillation; BMI, body mass index.
LAA and LA morphology in CTA.

Conclusion
In CS, a Chicken-wing LAA, a greater number of lobes and a thicker LA wall are independently associated with CS while a sharp LAA tip (≤90°) mostly seen in Seahorse type LAA is protective. Such “high-risk” LAA and LA morphology could help to select CS patients benefiting from extended rhythm-monitoring to detect an occult AF, however, further prospective studies are needed to confirm this hypothesis.
P3387Cholesterol crystals in superficial plaque layer detected by optical coherence tomography as a new morphological feature for plaque rupture
Authors: Katayama Y , Tanaka A , Kitabata H , Kashiwagi M , Terada K , Emori H , Shiono Y , Kuroi A , Matsuo Y , Ino Y , Kubo T , Hozumi T , Akasaka T 
Published: October 2019

Abstract

Background
While plaque rupture (PR) is the leading cause of acute myocardial infarction (AMI), other etiologies are also involved in the onset of AMI. Cholesterol crystals (CCs) are usually present abundantly in atherosclerotic plaques, especially in the culprit site of AMI. However, the relationship between in vivo CCs and PR is unclear. Optical coherence tomography (OCT) is a high-resolution imaging technique that allows for the in vivo identification of various plaque characteristics including PR and CCs.

Purpose
The aim of this study was to investigate prevalence and distribution of CCs between patients with AMI with PR, AMI without PR, and SAP.

Method
This study consisted of 146 patients with coronary artery disease (AMI with PR; n=64, AMI without PR; n=41, and SAP; n=41) who underwent OCT prior to percutaneous coronary intervention. Plaque characteristics in OCT images were assessed according to the consensus document. We classified the distribution of CCs as follows; superficial type CCs were defined by any of the CCs invading the fibrous cap and remaining CCs as deep type CCs.

Result
There was no statistical difference in clinical characteristics among the three groups. The % diameter stenosis was significantly smaller in the SAP group than others (AMI with PR 91±12% vs. AMI without PR 86±13% vs. SAP 65±9%, p<0.001). The prevalence of CCs was significantly higher in the AMI with PR group than others (AMI with PR 78% vs. AMI without PR 41% vs. SAP 39%, p<0.001). The prevalence of superficial type CCs was significantly different among the groups (AMI with PR 72% vs. AMI without PR 24% vs. SAP 7%, p<0.001). Multivariable logistic analysis demonstrated that lipid plaque (OR 84.5, 95% CI [6.30–11332.33], p<0.001) and superficial type CC (OR 9.5, 95% CI [2.61–34.89], p<0.001) were independent predictors of PR.

Conclusion
Plaque with CCs invading the fibrous cap is frequently associated with PR in patients with AMI, suggesting. In vivo CC detection is a new morphological feature for plaque rupture.

Acknowledgement/Funding
This study was supported by a grant from JSPS KAKENHI (17K09557).
P3389Angioscopic differences in quality and quantity of neointima in patients experiencing an acute coronary syndrome treated with bare metal, first-, second-, and third generation drug-eluting stents
Authors: Matsuura T , Ueno M , Watanabe H , Yasuda M , Nakamura T , Takase T , Yamaji K , Iwanaga Y , Miyazaki S 
Published: October 2019

Abstract

Background
Although drug-eluting stents (DES) have substantially reduced the need for early target lesion revascularization (TLR) compared with bare-metal stents (BMS) by inhibiting neointima hyperplasia, early generation DES have been associated with an increased risk of very late stent failure (VLSF) due to stent thrombosis and TLR after 1 year. Although the incidence of VLSF is reduced with newer generation DES, VLSF remains an unresolved problem and its mechanisms are not fully explored.

Purpose
The purpose of this study was to evaluate quality and quantity of neointima and presence of thrombus by using coronary angioscopy at long-term follow-up in patients who experienced an acute coronary syndrome (ACS) treated with BMS and DES on dual antiplatelet therapy.

Methods
Coronary angioscopy was performed at 6 and 10 months after BMS and DES implantation, respectively, in ACS patients. We assessed neointimal coverage (NC) of the stent struts, yellow color grade (YG) of stented segment and the existence of thrombus. Angioscopic NC was defined as follows: grade 0= fully visible struts; grade 1= visible struts through thin neointima; grade 2= no visible struts. We determined maximum (Max-NC) and minimum coverage (Min-NC) grades and the dominant NC grades. YG was classified into 4 grades (0= white; 1= slight yellow; 2= yellow; 3= intensive yellow). The obtained findings were compared with BMS, first-generation (1st-) DES, second-generation (2nd-) DES and third-generation (3rd-) DES.

Results
A total of 212 patients were enrolled: BMS (n=127), 1st DES (n=26, sirolimus-eluting stent), 2nd-DES (n=38, permanent polymer everolimus-eluting stent), and 3rd-DES (n=21, bioresorbable polymer everolimus-eluting stent). Max-NC and Min-NC grade were significantly lower with 1st- and 2nd-DES than with BMS and 3rd-DES (Figure). The same trend was also observed in the dominant NC grades. There was a lower trend of YG in BMS and 3rd-DES than in 1st or 2nd-DES (Figure). The presence of thrombus was significantly lower in 3rd-DES in comparison with BMS, 1st-, and 2nd-DES (3rd-DES 0%, BMS 20.5%, 1st-DES 24%, 2nd-DES 13.5%, P=0.01).
Figure 1

Conclusion
Patients treated with 3rd-DES have higher NC grade, lower incidence of intrastent thrombus, and lower YG than in 1st and 2nd-DES. These findings may explain the lower incidence of VLSF associated with these newer generation stent platforms.
P3397Risk Or Benefit IN Screening for CArdiovascular disease (ROBINSCA): results from screening for a high cardiovascular disease risk by using a risk prediction model or coronary artery calcium scoring
Authors: Denissen S , Van Der Aalst C M , Vonder M , Gratama J W , Adriaansen H J , Dijkstra J , Kuijpers D , Van Der Harst P , Braam R L , Van Dijkman P R M , Van Bruggen R , Beltman F W , Oudkerk M , De Koning H J 
Published: October 2019

Abstract

Introduction
The ROBINSCA (Risk Or Benefit IN Screening for CArdiovascular disease) trial is a large-scale population-based randomized controlled screening trial with the aim to investigate whether screening for a high risk of cardiovascular disease (CVD) by means of either the Systematic COronary Risk Evaluation (SCORE) model or coronary artery calcium (CAC) scoring followed by preventive treatment is effective in reducing morbidity and mortality from coronary heart disease (CHD). This study shows the results of the CVD risks as assessed by the two screening tools.

Methods
Based on the Dutch population registry, 394,058 men aged 45–74 years and women aged 55–74 years received an information brochure, an invitation to participate in the trial, a baseline questionnaire with waist circumference tape and an informed consent form. Eligible individuals with an expected high CVD risk were randomized (1:1:1) into a control arm (n=14,519), intervention arm A (n=14,478) or intervention arm B (n=14,450). In the control arm, usual care was continued. In intervention arm A, participants were screened for a high risk of CVD using the SCORE model based on traditional risk factors. In intervention arm B, CAC scoring after computed tomography scanning was used for screening. After screening en risk communication, preventive treatment according to the Dutch guidelines is advised for high risk persons.

Results
Screening uptake was 84.2% in intervention arm A and 89.6% in intervention arm B. Of the screened participants, 48.7% was female, median age at screening was 62 (Interquartile Range 10), 35.2% was high educated, 19.6% was baseline smoker and 41.4% had a positive family history of myocardial infarction. The assessed CVD risk status according to SCORE screening was stratified into three risk categories; 45.1% was at low risk (SCORE<10%), 26.5% was at intermediate risk (SCORE 10–20%), and 28.4% was at high risk (SCORE ≥20%). According to CAC screening, 76.0% was at low risk (Agatston <100), 15.1% was at high risk (Agatston 100–399), and 8.9% was at very high risk (Agatston ≥400). Associations between baseline variables and increased CVD risk will be analyzed soon and will be available in summer 2019.

Conclusions
Using different screening tools resulted in reclassification of the CVD risk. CAC screening caused a substantial shift to more low risk individuals. This might, when screening is found to be effective, lead to less overtreatment in prevention of CVD events. Future 5-year follow-up data should provide evidence about whether population-based screening with subsequent preventive treatment is (cost-)effective in reducing CHD-related morbidity and mortality.
P3399Influence of TCF21 rs12190287 in the coronary artery disease risk prediction. An association study in a Portuguese population
Authors: Sousa J , Mendonca M , Pereira A , Mendonca F , Monteiro J , Neto M , Sousa A C , Henriques E , Freitas S , Guerra G , Borges S , Ornelas I , Drumond A , Palma Dos Reis R 
Published: October 2019

Abstract

TCF21 is a member of the basic-helix-loop-helix (bHLH) transcriptor factor family, being critical for embryogenesis of the heart, kidney and spleen. TCF21 also regulates epicardium-derived cells differentiation into smooth muscle and fibroblast lineages.

Aim
Investigate the impact of TCF21 rs12190287 in the prediction and discrimination of CAD risk, individually or into a genetic risk score (GRS) formed by a set of 13 genetic variants.

Methods
We performed a case-control study with 3050 subjects (1619 coronary patients with 53.3±8 years; 78.9% male and 1431 controls with 52.8±8 years; 76.6% male) from GENEMACOR study. We investigated all traditional risk factors (TRF), as well as 13 genetic variants from GWAS with unknown pathophysiological pathway so far, including TCF21 (rs12190287), ZC3HC1 (rs11556924), PSRC1/SORTI (rs599839), PHACTR1 (rs1332844), MIA3 (rs17465637), SMAD3 (rs17228212), ZNF259 (rs964184), ADAMTS7 (rs3825807), CDKN2B (rs4977574), 9p21.3 (rs1333049), KIF6 (rs20455), PCSK9 (rs2114580) and GJA4 (rs618675). A multiplicative genetic risk score with these 13 genetic variants (m13GRS), was calculated. Subsequently, two logistic regressions were performed; primarily with all the TRF and all the genes individually and the second with TRF and m13GRS.

Results
The first multivariate analysis shows that, besides the strong association of the TRF with CAD risk (with smoking status on the top of the list, with an OR of 3.2; p<0.0001), TCF21 rs12190287 was the most significant variant from all the studied genetic set with a CAD risk of 1.5 (95% CI: 1.1–1.9; p=0.004), followed by the well-known genetic determinant CDKN2B rs4977574 (OR=1.4; 95% CI: 1.1–1.7; p<0.002) and ZC3HC1 rs11556924 (OR=1.3; 95% CI: 1.0–1.7; p=0.034). When GRS is included to the model, all the TRF remain in the equation by the same order, and the m13GRS persisted as an independent predictor for CAD risk (OR=1.7; 95% CI: 1.4–2.0; p<0.0001).

Conclusion
TCF21 rs12190287 is a risk factor for CAD in the Portuguese population, either individually or incorporated in a m13GRS. TCF21 risk is independent from TRF. In the future, TCF21 can provide a new clues to identify patients at high cardiovascular risk and become a potential target for gene therapy.
P3413Preventable premature CVD mortality and mortality trends in eight Northern Dimension partnership countries
Authors: Jousilahti P , Vohlonen I , Vienonen M 
Published: October 2019

Abstract

Background
In 2016 an EU-funded international study of premature deaths and their causes in eight Northern Dimension (ND) partnership and associated countries (Belarus, Estonia, Germany, Finland, Latvia, Lithuania, Poland and Sweden) was conducted.

Purpose
The aim of the study was to examine the present situation and 10-year trends of preventable premature loss of life in countries sharing the same geographical area, but having considerable differences in history and social and economic development.

Methods
Potential Years of Life Lost (PYLL) is a method to examine premature avoidable mortality which combines the number of deaths with the age of dying. Based on the WHO definition on premature mortality, CVD deaths (ICD codes I00-I425, I427-I99) before the age of 70 years were considered premature. Age-standardized PYLL-rates per 100,000 person years were calculated in 2003, 2009 and 2013 based on the official mortality statistics of each country.

Results
Premature CVD mortality and mortality trends varied largely between the participating countries. In 2013, premature CVD mortality was highest in Belarus and lowest in Sweden. Largest relative decrease from 2003 to 2013 was observed in Estonia and smallest in Lithuania.
Years of life lost due to premature CVD mortality per 100,000. Country Men 2013 Women 2013 Men and women 2003 Men and women 2013 Relative reduction 2003–2013 Belarus 3235 922 2884 1978 −31% Estonia 1509 444 1607 939 −42% Finland 716 220 681 467 −31% Germany 618 254 638 435 −32% Latvia 2532 633 2158 1512 −30% Lithuania 2442 649 1616 1477 −9% Poland 1482 436 1182 945 −20% Sweden 485 202 462 345 −25%

Conclusions
Enormous health gain can be achieved by effectively applying evidence-based CVD prevention in Europe.

Acknowledgement/Funding
European union