bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2694Early and late restenosis after excimer laser coronary angioplasty and paclitaxel-coated balloon combination therapy for drug-eluting stent restenosis
Authors: Higaki T , Nishioka K , Suruga K , Takemoto H , Nakano T , Hashimoto Y , Tomomori S , Oi K , Dai K , Kawase T , Nakama Y , Suenari K , Otsuka M , Masaoka Y , Shiode N 
Published: October 2019

Abstract

Background
Drug-eluting stent restenosis (DES-ISR) is associated with poorer outcomes than those of bare-metal stent restenosis after treatment with paclitaxel-coated balloon (PCB), and late restenosis after PCB angioplasty for DES-ISR is a residual problem. Excimer laser coronary angioplasty (ELCA) is thought to be advantageous for ISR treatment by removing neointima. However, whether the combination of ELCA and PCB angioplasty is more effective than the use of PCB only angioplasty in DES-ISR has not been studied so far.

Purpose
We evaluated the efficacy of ELCA and PCB combination therapy for DES-ISR at mid-and late-term after revascularization.

Methods
From January 2014 to March 2016, 166 DES-ISR lesions were treated with ELCA and no-ELCA prior to PCB. Two serial angiographic follow-ups were planned for the patients (at 6–12 and 18–24 months after procedure). Acute procedural and follow-up angiographic results were assessed by quantitative coronary angiography. ELCA and no-ELCA group included 74 lesions and 92 lesions, respectively.

Results
There was no significant difference between the two groups in the clinical characteristics except the prevalence of hemodialysis, the rate of first-generation DES (37.9% vs 36.8%, p=0.897), previous stent size (2.90±0.39 mm vs 2.77±0.39 mm, p=0.063), and reference vessel diameter (2.65±0.46 mm vs 2.60±0.65 mm, p=0.593). Early follow-up angiography was performed in 66 lesions (89.1%) of ELCA group, and was done in 76 lesions (82.6%) of no-ELCA group. In the ELCA group, percentage diameter stenosis (%DS) just after procedure and at 6–12 months later were significantly smaller than those of no-ELCA group. Besides, target lesion revascularization (TLR) rate at 6–12 months after procedure was tended to be lower in the ELCA group. Late follow-up angiography was performed for 93 lesions (81.6%) of the remaining 114 lesions (excluding TLR lesion), late restenosis was found 9 lesions (18.6%) in the ELCA group and 11 lesions (24.4%) in the no-ELCA group (p=0.504). Late luminal loss was similar in both groups (0.37±0.71 mm vs 0.24±0.82 mm, p=0.438), and %DS at 12–18 months after revascularization was not different between the two groups.
Changes of %DS and TLR rate

Conclusions
%DS in the ELCA group was smaller at just after procedure and the advantage was kept even after 1-year. However, late restenosis and TLR at 2-year after revascularization for DES-ISR could not be reduced by ELCA and PCB combination therapy.
P2700Impact of instantaneous wave-free ratio on graft failure after coronary artery bypass graft surgery
Authors: Wada T , Shiono Y , Higashioka D , Kashiwagi M , Shimamura K , Kuroi A , Honda K , Matsuo Y , Kitabata H , Ino Y , Kubo T , Tanaka A , Hozumi T , Nishimura Y , Akasaka T 
Published: October 2019

Abstract

Background
It has been reported that preoperative fractional flow reserve (FFR) is associated with graft patency after coronary artery bypass graft (CABG) and the patency is excellent when a bypass graft is anastomosed on a vessel with positive FFR. However, the association with graft patency has not yet been investigated in its novel counterpart, instantaneous wave-free ratio (iFR), and iFR sometimes contradicts FFR results.

Purpose
The purpose of this study is to assess an impact of preoperative iFR on a graft failure after CABG in patients with coronary arteries showing positive FFR (≤0.80).

Methods
We retrospectively identified patients who had undergone preoperative coronary angiography in conjunction with resting and hyperemic intra-coronary pressure measurements, CABG, and graft evaluation by coronary computed tomography angiography. After excluding vessels with negative FFR (>0.80), vessels were divided into two groups: negative iFR group (iFR >0.89) and positive iFR group (iFR ≤0.89). The rate of graft failure within 1 year after CABG was compared between the two groups.

Results
We analyzed 131 vessels in 89 patients (35 vessels in the negative iFR group and 96 vessels in the positive iFR group). The negative iFR group showed significantly higher iFR (0.92±0.02 vs. 0.74±0.13, P<0.0001) and FFR (0.72±0.06 vs. 0.63±0.09, P<0.0001) than the positive iFR group, although percent diameter stenosis (%DS) was comparable (57±10 vs. 56±9, P=0.47). The graft failure significantly often occurred in the negative iFR group than in the positive iFR group (28.6% vs. 8.3%, P=0.0029). In order to reduce the imbalance in the baseline characteristics except for iFR, 70 vessels were selected by using propensity score matching (n=35 in each group). The propensity score matched vessels also demonstrated significantly higher rate of graft failure in the negative iFR group than in the positive iFR group (28.6% vs. 5.7%, p=0.026) despite much more balanced FFR (0.72±0.06 vs. 0.69±0.07, p=0.02) and %DS (57±10 vs. 57±9, p=1.000).

Conclusions
Even when FFR is positive, the graft failure is likely to occur when a bypass graft is anastomosed on a vessel with negative iFR compared to a vessel with positive iFR.

Acknowledgement/Funding
None
P2703Impact of subtended myocardial mass on the assessment of functional ischemia as evaluated by FFR and QFR
Authors: Kanno Y , Hoshino M , Sugiyama T , Kanaji Y , Yamaguchi M , Hada M , Ohya H , Sumino Y , Hirano H , Horie T , Yonetsu T , Kakuta T 
Published: October 2019

Abstract

Background
The fractional flow reserve (FFR) becomes a standard practice for revascularization decision-making in evaluating the functional significance of angiographically intermediate epicardial coronary stenosis. The quantitative flow ratio (QFR) is a novel method for rapid computational estimation of FFR without pressure wire and hyperemic induction. FFR has been reported to be associated with not only epicardial stenosis but also subtended myocardial mass (Vsub). In contrast, the relationship between QFR and Vsub has not been clarified.

Purpose
We sought to examine if subtended myocardial mass (Vsub) assessed by coronary computed tomography showed a significant relationship with QFR in comparison with FFR.

Methods and results
We performed a post-hoc analysis of 152 territories (LAD 116, RCA 25 and LCX 11 lesions) with angiographically intermediate-to-severe stenosis in 152 patients who underwent FFR assessment. The median FFR and QFR values were 0.76 (0.64–0.84) and 0.76 (0.72–0.83), respectively. The median diameter stenosis (%DS) and minimum lumen diameter (MLD) were 54.5 (43.9–64.2) and 1.2 (0.9–1.6), respectively. In total, 123 (80.9%) and 29 (19.1%) lesions showed concordant and discordant FFR and QFR functional classifications, respectively. The ability of Vsub/MLD2 to discriminate lesions with FFR≤0.80 and QFR≤0.80 was assessed compared with QCA data. FFR values were associated with Vsub (R=0.37, P<0.001). In contrast, a trend albeit no significant linear relationshipwas detected between QFR and Vsub (R=0.15, P=0.060). The area under the curve (AUC) of Vsub/MLD2 predicting FFR≤0.80 (0.88: 95% confidence interval [CI], 0.83–0.94)was significantly better than that of MLD (0.80: 95% [CI], 0.72–0.88) (P<0.001). On the other hand, the AUC of Vsub/MLD2 predicting QFR≤0.80 (0.82: 95% [CI], 0.75–0.90) was similar to that of MLD (0.80: 95% [CI], 0.72–0.87) (P=0.276). Multivariate analysis showed that the value of Vsub/MLD2 was an independent predictor of FFR≤0.80 (odds ratio [OR]: 1.09, 95% [CI]: 1.03–1.15, P=0.002), whereas it was not an independent predictor of QFR≤0.80.

Conclusions
Subtended cardiac mass volume derived from CT segmentation improved the diagnostic performance of angiography-derived parameters to identify ischemia-producing lesions when FFR used as a reference standard, whereas QFR showed non-significant relationship with subtended cardiac mass.
P2705Hybrid QFR-FFR decision making strategy for revascularization
Authors: Kanno Y , Hoshio M , Sugiyama T , Kanaji Y , Yamaguchi M , Hada M , Ohya H , Sumino Y , Hirano H , Horie T , Yuki H , Yonetsu T , Kakuta T 
Published: October 2019

Abstract

Background
Measurement of the fractional flow reserve (FFR) has become a standard practice for revascularization decision-making in evaluating the functional significance of angiographically intermediate epicardial coronary stenosis. The quantitative flow ratio (QFR) is a novel method for rapid computational estimation of FFR without pressure wire and vasodilator drugs.

Purpose
Nevertheless, the evidence was shown the clinical better outcome of coronary revascularization stratified by FFR, the adoption of FFR remains low. We hypothesized that combined QFR and FFR hybrid strategy could improve the physiological assessment without pressure wire and drugs.

Methods and results
We performed a post-hocanalysis of 549 vessels with angiographically intermediate stenosis in 549 patients who underwent measurement of FFR. The median FFR and QFR values were 0.81 (0.73–0.87) and 0.79 (0.74–0.87), respectively.The ischemic threshold was defined as 0.80 for both QFR and FFR measures. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the QFR for predicting an FFR of ≤0.80 were 86.2%, 71.9%, 78.9%, 74.5%, and 84.5%, respectively. The area under the receiver operating characteristic curve using the cut-off threshold of ≤0.80 for the FFR was 0.85 (95% confidence interval [CI], 0.81–0.88) for the QFR.In total, 433 (78.9%) and 116 (21.1%) lesions showed concordant and discordant FFR and QFR functional classifications, respectively. A hybrid QFR-FFR strategy was developed, by allowing deferral when QFR values providing negative predictive value greater than 90% and treat others when QFR values greater than that showing 90% positive predictive value, with adenosine being given only to patients with QFR in between those values. For the FFR cut-off (0.8), an QFR of <0.73 could be used to confirm treatment (PPV of 90.7%), while an QFR value of >0.83 could be used to defer revascularization (NPV of 90.0%). When QFR values fall between 0.73 and 0.84, adenosine is given for hyperemic induction and the FFR cut-off of 0.8 is used to guide revascularization. This hybrid QFR-FFR approach has a 95% agreement with an FFR-only decision making, and 285 lesions (51.9%) would have obviated the need of a pressure wire and adenosine.
Hybrid QFR-FFR strategy

Conclusions
A hybrid QFR-FFR strategy for coronary revascularization could reduce the need of a pressure wire and vasodilator drugs, which may increase the penetration of functional assessment of coronary lesions.
P2728Prognostic impact of left atrial function in patients with cardiac amyloidosis: a cardiac magnetic resonance study
Authors: Morini S , Aquaro G D , Taborchi G , Martone R , Gabriele M , Bartolini S , Vignini E , Vergaro G , Barison A , Emdin M , Olivotto I , Perfetto F , Di Mario C , Cappelli F 
Published: October 2019

Abstract

Background
Left atrial function (AEF) is a parameter of paramount importance that has a prognostic value in a number of heart conditions. Cardiac involvement in both light-chain and transthyretin amyloidosis is the main driver of prognosis and influences treatment strategies. Cardiac magnetic resonance (CMR) provides high quality images of the left and right atria using high temporal resolution steady state free precession (SSFP) cine sequences.

Purpose
The aim of our study was to assess by CMR left atrial function and his correlation with prognosis in patients with cardiac amyloidosis.

Method
We enrolled 80 consecutive patients with diagnosis of cardiac amyloidosis: 38 patients (47%) with light-chain and 42 patients (53%) with transthyretin one. CMR was performed using a 1.5-T scanner. In all subjects, the study of atria was obtained by acquiring cine steady-state free precession (SSFP). Left Atrial function was evaluated by the ratio between the maximum and the minimum LA volume. A median follow up of 937 days was performed and 36 patients (44%) died of cardiac causes. We evaluated cardiac death as endpoint. We split out all the patient in 4 different quartiles depending on left atrial function: in the first quartile patients with AEF≤14% that reflects severe atrial dysfunction, in the second quartile patients with AEF between 14 and 19%, in the third quartile patients with AEF between 19 and 36% and in the last one patients with AEF≥36% that represent patients with normal value of left atrial function.

Results
We found that CMR assessed left atrial function allowed to individuate and stratify the prognosis in patients with cardiac amyloidosis. The most effective parameter to evaluate cardiac death was left atrial function with a cut off ≤14% that could predict cardiac related mortality with the same accuracy in both light-chain and transthyretin amyloidosis patients. Kaplan Meier analysis showed that patients with AEF≤14% had a worse prognosis as compared to patient with AEF≥14% (log rank p. 0001). Furthermore patients with AEF≤14% have a cardiac death risk of 32% at 1 year and 61% at 3 years.
Kaplan Meier analysis

Conclusion
Cardiac magnetic resonance is an imaging modality that allows to individuate with great accuracy left atrial function in patients with various heart conditions and especially cardiac amyloidosis. CMR left atrial function assessment clearly identifies a subgroup of cardiac amyloid patients with an increased risk of death.
P2739Can cardiac mechanics predict outcome in hypoplastic left heart syndrome patients? A speckle tracking echocardiography study
Authors: Borrelli N S , Di Salvo G , Sabatino J , Spada M , Delle Donne G , Josen M , Ibrahim A , Penco M , Ghez O , Fraisse A , Michielon G 
Published: October 2019

Abstract

Introduction
Hypoplastic Left Heart Syndrome (HLHS) still carries a high morbidity and mortality. Right ventricle (RV) dysfunction is one of the most important responsible of a worse outcome. Unfortunately, RV assessment is a challenge. Speckle tracking echocardiography (STE) demonstrated an excellent ability in the estimation of RV function.

Purpose
The aim of our study is to evaluate the ability of STE and standard 2D echo parameters in predicting death and need for heart transplantation (HT) in HLHS patients.

Methods
31 patients with diagnosis of HLHS successfully completed Norwood (n=29) or comprehensive Norwood stage II at our Institution between 2016 and 2018. Survival at 6 months was 93.3%, survival at 18 months was 81.1%. We present our preliminary data on 23 HLHS patients (13 male).
All the studied patients underwent in-hospital interstage stay. Serial echocardiographic assessments were performed in all the included patients (baseline, one month after Norwood, three months after Norwood, one week before bidirectional cavopulmonary anastomosis [BCPA] and two months after BCPA).
From apical view we measured: tricuspid annulus peak systolic excursion (TAPSE), fractional area change (FAC), longitudinal strain (LS) and strain rate (LSR).

Results
After a median follow-up of 2.2 years (1.7–2.6 years), 6 out of 23 patients met the composite endpoint of death/HT.
At pre-Norwood assessment, there was no statistical difference between survivor and death/HT patients.
In death/HT group TAPSE declined at one-month after Norwood procedure. LS decreased significantly at three-months after Norwood. After BCPA, death/HT patients had much lower FAC, TAPSE, LS and LSR than survived patients.
At one-month evaluation, TAPSE ≤5 mm had a good specificity for death/HT (80%) and a moderate sensitivity (70.6%) with an area under the curve (AUC) of 0.80. Still at one-month evaluation, Δ LS ([{baseline LS – one-month post Norwood LS}/ baseline LS] *100) >7.7% showed a 100% sensibility and moderate specificity (76.5%) for death/HT (AUC 0.841).
LS in HLHS patient and LS ROC curve.

Conclusions
HLHS patients with TAPSE ≤5 mm and Δ LS of >7.7% one-month after Norwood had a high likelihood of death or HT. These preliminary data encourage the routine use of TAPSE and LS to monitor cardiac function in HLHS patients and to identify subgroup patients at high risk.
P2759Value of biomarkers (urinary KIM-1, NGAL, albumin, serum Cys C) for predicting renal lesions and prognosis in patients with infective endocarditis
Authors: Pisaryuk A , Povalyaev N , Sorokina M , Teterina M , Balatskiy A , Kotova E , Mal'kov P , Karaulova Y , Efremovtseva M , Ratchina S , Milto A , Safarova A , Kobalava Z 
Published: October 2019

Abstract

Background
Infective endocarditis (IE) is frequently complicated by kidney damage of various pathogenesis. The essential differences in pathophysiological mechanisms of kidney lesions (glomerular and tubular damage, mixed mechanisms) create different therapeutical targets. Nowadays these mechanisms are only possible to differentiate with the use of nephrobiopsy or autopsy. Non-invasive methods to assess the genesis of kidney damage are eagerly wanted. It is possible that kidney biomarkers may be such method.

Materials and methods
209 patients with verified IE (DUKE 2009, 2015), hospitalized and treated in city clinical hospital named after V.V. Vinogradov in Moscow from January 2010 to June 2018, were included in the study. Kidney function was assessed using CKD-EPI formula. Acute kidney injury (AKI) and acute kidney disease (AKD) were diagnosed according to current guidelines (KDIGO 2012) and the work group consensus (ADQI 16 Workgroup 2017). Serum creatinine decrease on ≥26,5 mcmol/L in 48 hours after the hospitalization was counted as early-onset AKI. Patients with serum creatinine elevation on ≥26,5 mcmol/L in 48 hours during the hospitalization were diagnosed with late-onset AKI. Biomarkers were assessed at the admission. Cystatin C level was assessed in serum; neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), albumin levels were assessed in urine.

Results
Kidney damage biomarkers' levels were analyzed in 65 patients with IE. Patients with kidney dysfunction (n=45) comparing to ones without AKI (n=20) had higher mean value of all kidney biomarkers, however, the significant difference was established only for cystatin C. (1.9 vs 1.3 mg/l respectively; p<0.001). Patients with early-onset AKI (n=11) next to patients without AKI had significantly higher cystatin C value at admission (1.9 vs 1.3 mg/l respectively; p=0,0186). In similar manner patients with late-onset had had significantly higher cystatin C value at admission (1.9 vs 1.3 mg/l respectively; p=0,002). Cystatin C appeared to be an independent AKI predictor with threshold value 1.35 mg/l (OR 14.0; 95% CI 1.74–112.2; p=0.013), and also cystatin C was an independent predictor of the in-hospital mortality with threshold 1.87 mg/l (OR 3.16; 95% CI 1.25–7.99; p=0.006). After analysis of patients with AKD it was established that they had significantly higher levels of cystatin C (1.7 vs 1.3 mg/l respectively; p=0.035) and NGAL (19 vs 1.9 ng/ml; p=0.05) in comparison with patients without AKD. Albumin and KIM-1 didn't show significant associations.

Conclusions
The results of a study allow to consider serum cystatin C as AKI marker, AKI predictor and in-hospital mortality predictor in patients with IE, and urinal NGAL and serum cystatin C may be considered as AKD markers.
P2760Prognostic value of 18-fluorodeoxyglucose positron emission tomography/computed tomography in infective endocarditis
Authors: Sovannarith S , Ravis E , Tessonnier L , Philip M , Cammilleri S , Oliver L , Arregle F , Martel H , Renard S , Gouriet F , Casalta J P , Collart F , Drancourt M , Raoult D , Habib G 
Published: October 2019

Abstract

Background
18-Fluorodeoxyglucose Positron emission tomography (18F-FDG PET/CT) has been shown to be useful for the diagnosis of IE, but its prognostic value is unknown.

Objectives
This study sought to assess the prognostic value of 18F-FDG PET/CT in prosthetic (PVE) and native valve endocarditis (NVE).

Methods
We prospectively studied 173 consecutive patients (109 PVE and 64 NVE) with definite IE who underwent a 18F-FDG PET/CT study and were follow-up for one year. Primary end-point was a composite of major cardiac events i.e. death, recurrence of IE, acute cardiac failure, non-scheduled hospitalization for cardiovascular reason, and new embolic event

Results
18F-FDG PET/CT was positive in 98 (57%) patients, 82% (n=88/109) in the PVE and 16% (n=10/64) in the NVE group. At a mean follow of 225±18 days, the primary end-point occurred in 94 (55%) patients, 63 (58%) in the PVE group and 31 (48%) in the NVE group. In the PVE group, positive 18F-FDG PET/CT was significantly associated with higher rate of primary end-point (OR=2.6, IC95%=1.04 to 6.6; p=0.04). Moderate to intense 18F-FDG valvular uptake was also associated with worse outcome (OR=2.1; IC95%=1.1 to 4.0; p=0.03) and to new embolic events, (OR: 8.8; IC95%= 1.1 to 69.5; p=0.02). In the NVE group, 18F-FDG PET/CT was not associated with occurrence of the primary end-point.

Conclusion
In addition to be an accurate diagnostic tool, 18F-FDG PET/CT is predictive of major cardiac events in PVE and to embolic events during the first year following IE episode
P2773Evaluation of the bleeding prediction score VTE-BLEED for predicting recurrent VTE
Authors: Klok F A , Presles E , Tromeur C , Barco S , Konstantinides S V , Couturaud F 
Published: October 2019

Abstract

Introduction
VTE-BLEED is a validated score for identification of patients at a 3 to 5-fold increased risk of major bleeding during extended anticoagulation for venous thromboembolism (VTE; table 1). It is unknown whether VTE-BLEED high-risk patients also have an increased risk for recurrent VTE, which would limit the potential usefulness of the score.

Methods
This was a post-hoc analysis of the randomised double-blind placebo-controlled PADIS-PE trial, in which patients with a first unprovoked pulmonary embolism (PE) initially treated for 6 months were randomised to receive an additional 18-month of warfarin versus placebo. Primary outcome of the current analysis was recurrent VTE during 2-year follow-up after anticoagulant discontinuation, i.e. after the initial 6-month treatment in the placebo arm and after 24 months of anticoagulation in the active treatment arm. This rate, adjusted on study treatment allocation, was compared between patients in the high- versus low-risk VTE-BLEED group.

Results
In complete case analysis (n=308; 82.4% of total population), 89 (28.9%) patients were classified as VTE-BLEED high risk. A total of 44 VTE events occurred after anticoagulant discontinuation during 668 patient-years. The cumulative incidence of recurrent VTE was 16.4% (95% CI 10.0–26.1%; 14 events) and 14.6% (95% CI 10.4–20.3%; 30 events) in the high-risk and low-risk VTE-BLEED groups, respectively, for an adjusted Hazard Ratio of 1.16 (95% CI 0.62–2.19; Figure 1).
Figure 1

Conclusion
In this study, patients with unprovoked PE classified at high risk of major bleeding by VTE-BLEED did not have a higher incidence of recurrent VTE after cessation of anticoagulant therapy, supporting the potential yield of the score for making management decisions on the optimal duration of anticoagulant therapy.