bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2740Quantitative assessment of the entire right ventricle from one acoustic window: an attractive approach in patients with congenital heart disease
Authors: Van Berendoncks A M , Bowen D J , McGhie J , Cuypers J A , Kauling M , Roos-Hesselink J W , Van Den Bosch A E 
Published: October 2019

Abstract

Background
Right ventricular (RV) function is recognized as a prognostic factor in congenital heart disease (CHD). The accuracy of established parameters as tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC) and tissue Doppler imaging (TDI S') are limited as the parameters reflect only a limited region of the RV. We previously introduced a novel four-view approach with different RV walls visualized in their long axis from one apical view using 2D-transthoracic echocardiographic (TTE) iRotate mode.

Aims
To extensive evaluate the entire RV function using iRotate echocardiography in a whole spectrum of CHD patients with abnormally loaded RV; both feasibility and RV echocardiographic parameters as comparison with healthy subjects is evaluated.

Methods and results
One hundred and forty-two CHD patients with abnormally loaded RV and 89 healthy subjects were included. All subjects underwent complete TTE with evaluation of TAPSE, TDI S' and peak systolic global longitudinal RV strain (RV-GLS) from the RV walls using the four-view iRotate model. The feasibility of TAPSE and RV S' ranged between 94% and 100%. The feasibility of RV-GLS in CHD was 98%, 69%, 87% and 72% respectively in the lateral, anterior, inferior and inferior coronal view walls. With the exception of RV S' in the inferior coronal view, all parameters were significantly lower in the CHD vs healthy subjects (p<0.001) (Table).
i-Rotate RV wall GLS (%) RV wall GLS (%) Measurement Feasibility Congenital (n=142) Controls (n=89) P-value Lateral 97.9 −17.6±5.0 −25.4±4.5 <0.001 Anterior 69.0 −15.9±4.9* −24.2±4.5 <0.001 Inferior 88.7 −17.2±4.7 −23.3±4.4 <0.001 Inferior coronal view 72.5 −15.1±4.5* ** −20.8±5.2 <0.001 Data expressed as mean ± SD or %. p<0.05 for *Lateral vs Anterior and vs Inferior CV; **Inferior vs Inferior CV.

Conclusion
The feasibility of all RV parameters in the four-axis iRotate model is excellent in CHD and represents a reproducible, easily applicable and complete RV assessment in daily practice. RV function is significantly decreased in the CHD group using both load dependent and independent parameters. Complete RV strain analysis reveals regional differences in patients with CHD.
P2747Identification of microRNAs in aortic valve calcification patients with bicuspid aortic valve
Authors: Meng Z , Zhang E , Wu Y 
Published: October 2019

Abstract

Background
An individual with bicuspid aortic valve (BAV) has a higher risk of developing aortic valve calcification (AVC) than people with tricuspid aortic valve. AVC in patients with BAV and TAV is known to be distinct in molecular level. But the epigenetic mechanism of AVC in patients with BAV is still undefined.

Purpose
To describe the role of microRNA (miRNA) in the AVC process of patients with BAV

Methods
We collected aortic valve samples of 5 patients with BAV, of which 2 have AVC and 3 of which have not. We performed RNA-seq technology on an Illumina Hiseq 2500/2000 platform to characterized all feathers of miRNAs in BAV. We used miRBase20.0 to look for known miRNA. Gene expression levels between groups of valves were compared with degeR to find out differential miRNAs. Then we predicated the target gene of miRNA by targetscan database. We performed the GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) enrichment analysis for the target gene candidates of differential miRNAs to predict the potential function of AVC specific miRNAs. A value of P<0.05 (2-sided) was considered to be statistically significant.

Results
Compared with noncalcified aortic valves. We found that 33 miRNAs were upregulated and 29 are significantly downregulated in calcified aortic valves. The analysis showed the total of 62 miRNAs to be significantly altered as shown in the heat map in Figure1. the target gene candidates of differential miRNAs were enriched in numerous Go terms including the following: binding, protein binding, ion binding, catalytic activity, localization. The significantly (P<0.05) affected pathways identified by KEGG pathway analysis are presented in table 1.
Table 1 Pathway term Gene number P valvue Lysosome 70 0.001945 Axon guidance 66 0.013212 Glycerophospholipid metabolism 50 0.016075 Calcium signaling pathway 84 0.037645 Synaptic vesicle cycle 34 0.043983 Pyrimidine metabolism 52 0.04501 Homologous recombination 18 0.0453 Other glycan degradation 13 0.048068 Pathway analysis based on the KEGG database.
Figure 1

Conclusion
The present study proved that miRNAs play an important role in AVC of patients with BAV. The result may improve understanding of the special molecular alterations in AVC with BAV and may provide potential targets for future clinical applications.

Acknowledgement/Funding
the National Natural Science Foundation of China (No.81370435; 91339103; 81700405)
P2764Medical management of Staphylococcus aureus infective endocarditis: unexpectedly favourable outcomes in an aggressive disease
Authors: Primus C P , McCue M , Bvekerwa I , McGuire E , Wong K , Uppal R , Ambekar S , Menezes L , Khanji M , Davies L C , Bhattacharyya S , Serafino-Wani R , Das S , Woldman S 
Published: October 2019

Abstract

Introduction
Early surgical intervention (ESI) for infective endocarditis (IE) is associated with improved outcomes. Staphylococcus aureus endocarditis (SAE) is associated with particularly high rates of tissue destruction, morbidity and mortality. However, the question as to whether ESI is mandated in all SAE continues to be debated, in both native (NVE) and prosthetic (PVE) endocarditis.

Methods
Retrospective review of all IE cases presenting to our institution from October 2015 to January 2019. IE was diagnosed following imaging and microbiological protocols as per ESC guidance, and data were extracted for those with SAE. Patients with isolated cardiac implantable electronic device IE or bacteraemia secondary to indwelling long-term venous catheter infection were excluded (non-valvular IE).

Results
Valvular IE was diagnosed in 411 patients overall; NVE in 286 (69.6%) and PVE in 125 (30.4%). S aureus was isolated in 111 patients (28.1%), of whom 5 had a Methicillin-resistant strain. SAE was confirmed in a similar proportion of NVE and PVE cases [83/111 (74.8%) and 28/111 (25.2%), respectively]. Surgical intervention was mandated in 35/83 with NVE (42.2%) and 11/28 (39.3%) with PVE, lower than in our overall cohort (55.9% and 48.8%, respectively).
In-hospital SAE mortality was 16.2% overall (18.4% medical vs 13.0% surgical), and contributes a significant proportion to overall mortality (29% to medical & 26% to surgical mortality). Figure 1 identifies the cause of death per mode of treatment, highlighting the aggressive nature of S aureus infection (abscess, disseminated infection and septic shock; n=8), the importance of advanced non-cardiac comorbidity precluding intervention (n=3) and ongoing intravenous drug use in those with PVE (n=4). However, medical management was successful in 57.8% (38/83) of NVE and 60.7% (17/28) of PVE cases, both in hospital and to a minimum follow-up of 3-months.

Conclusion
Staphylococcus aureus is virulent and highly pathogenic, driving severe sepsis and advanced tissue destruction in SAE. Despite this, medical management can be successful when following international guidance, but requires co-ordinated care driven by a multidisciplinary IE team at a cardiothoracic centre.
P2768Post-PE impairment is mostly related to newly diagnosed heart failure with preserved ejection fraction
Authors: Dzikowska-Diduch O , Kostrubiec M , Brodka K , Wyzgal-Chojecka A , Pacho S , Kurnicka K , Lichodziejewska B , Roik M , Labyk A , Pruszczyk P 
Published: October 2019

Abstract

Introduction
Recently, the concept of post-PE impairment (PPEI) was proposed which includes various combinations of functional, haemodynamic or imaging abnormalities in patients after acute pulmonary embolism (PE). Chronic residual obstruction of pulmonary vascular bed, despite adequate anticoagulation, is suggested to be a major cause of PPEI.

Material and methods
We report data of consecutive 700 PE survivors (390 F, aged 62±18 yrs). In all patients PE was diagnosed and treated according to ESC recommendations. Patients were anticoagulated and followed for at least 6 months in outpatient clinic (median 6, 6–18 months). All symptomatic subjects underwent detailed diagnostic workup which included standardized echocardiography, lung scintigraphy, pulmonary functional tests, and chest CT, RHC and coronary angiography when appropriate.

Results
207/700 (29,6%) of PE survivors completely recovered functionally. However, when compared to prePEperiod 493/700 (70,4%) patients reported functional limitation compatible with PPEI. Exertional dyspnoea was present in 36,5% of symptomatic patients, then 25,5% others presented effort angina with or without dyspnoea, 11% of symptomatic patients reported palpitations and 27% complained of reduced exercise tolerance.
After diagnostic workup, CTEPH was diagnosed in 38 of 493 (7,7%) symptomatic subjects (5,4% of all survivors) and chronic thromboembolic pulmonary disease (CTED) in 12/493 (2,4%) of them. 52,9% pts have chronic heart failure with reduced ejection fraction (EF) 4,2% and 37,2% with preserved EF; valve heart disease was detected in 8,9% and significant arrhythmia, mostly atrial fibrillation, in 2,6%. Breathlessness and reduce exercise tolerance in the others were caused by coronary artery diseases or non-cardiovascular pathologies (e.g. anaemia, pulmonary disease).

Conclusions
Follow-up demonstrated that after an episode of PE, approximately 70% of patients report functional impairment. Although persistent pulmonary artery thromboemobli resulting in CTEPH or CTED were detected in 7,1% of PE survivors and 10% of symptomatic patients. Left ventricular diastolic dysfunction is the most common cause of PPEI.
P2785Persons with dilated aorta ascendens - who are they?
Authors: Lekedal H , Engvall J , Swahn E , Jonasson L 
Published: October 2019

Abstract

Background
Dilation of the ascending aorta (AscA) may result in life-threatening events. However, it often remains asymptomatic and undiagnosed until the catastrophic complication occurs. The prevalence of dilated AscA in the general population is largely unknown. It is also unclear whether traditional cardiovascular risk factors are associated with dilated AscA.

Purpose
The aim was to study the prevalence of dilated AscA and its determinants with focus on cardiovascular risk factors in a middle-aged population.

Methods
Five thousand subjects from the Swedish CardioPulmonary BioImage Study (SCAPIS), aged 50–65 years, underwent transthoracic echocardiography (echo) and coronary CT angiography. Subjects with dilated AscA (diameter ≥40 mm) were identified. Two age- and gender-matched controls with normal AscA diameter were selected per case. Presence of carotid artery plaques was determined by duplex ultrasound.

Results
Seventy one cases (16 women, 55 men) and 142 controls were included. In cases, echo and CT measurements were 42 (41–43) and 42 (41–45) mm, respectively. Body surface area-adjusted AscA diameters were higher in female than in male cases, 22,7 (21,9–23,6) vs 20,2 (19,0–20,8) mm/m2 (p<0,001), see Figure. Bicuspid aortic valves and mild aortic regurditation were more common in cases than in controls (12% vs 0% and 30% vs 11%). The use of antihypertensive drugs was higher among cases, 47% vs 32%, p=0.035. There were no differences in body size, smoking status, diabetes, history of cardiovascular disease or presence of carotid plaques between cases and controls.

Conclusions
The prevalence of dilated AscA was 1.4% in a Swedish middle-aged population. Dilated AscA was associated with male sex, aortic valve pathology and antihypertensive medication. Whether dilated AscA is associated with impaired regulation of blood pressure and vascular function deserves further investigation. Also, data raise the intriguing question that a 40 mm cut-off value may not be appropriate for the diagnosis in women.
P2809Comparison between treatment of “established” versus complex “off-label” coronary lesions with Absorb bioresorbable scaffold implantation: results from the GABI-R registry
Authors: Huseynov A , Baumann S , Nef H , Riemer T , Schneider S , Pfannebecker T , Achenbach S , Mehilli J , Gori T , Woehrle J , Zahn R , Schmermund A , Richard G , Hamm C , Akin I 
Published: October 2019

Abstract

Objectives
The purpose of this study was to compare the clinical outcomes of patients treated with bioresorbable scaffold (BRS) for off-label versus approved indications.

Background
The BRS promised some advantages in terms of complete biodegradation, however, the implication of BRS for off-label indications is not well described.

Methods
The short- and long-term outcome after implantation of a bioresorbable scaffold system (ABSORB, Abbott Vascular, USA) was evaluated in the prospective, non-interventional, multicenter real-world German-Austrian ABSORB RegIstRy (GABI-R).

Results
A total of 3,188 patients were enrolled. Patients were divided into two groups: on-label BRS use (33.0%) and off-label use (66.9%) if at least one off-label use criteria was met. The incidence of scaffold thrombosis in confirmed cases was significantly higher in off-label group (1.36% vs. 0.57%, p=0.04; OR 2.41 (95% CI: 1.00–5.82) with also a trend towards higher myocardial infarction rate (2.39% vs. 1.42%, p=0.077; OR 1.70 (95% CI: 0.95–3.03) and cardiovascular death (1.27% vs. 1.14%, p=0.76, OR 1.11 (95% CI: 0.56–2.21) at 6 months follow up.
Clinical outcome at 6 months Total Off-label On-label p-value* OR (95%-CI) Patients with 6m FU record 99.0% 99.0% 99.1% 0.82 0.92 (0.43–1.95) Confirmed cardiovascular death 1.22% 1.27% 1.14% 0.76 1.11 (0.56–2.21) Confirmed non-cardiovascular death 0.22% 0.14% 0.38% 0.18 0.37 (0.08–1.66) Cause unknown 0.22% 0.28% 0.09% 0.29 2.97 (0.36–24.73) Hospitalisation 27.5% 27.9% 26.7% 0.51 1.06 (0.89–1.27) MI 2.07% 2.39% 1.42% 0.07 1.70 (0.95–3.03) ARC definite scaffold thrombosis 1.10% 1.36% 0.57% 0.04 2.41 (1.00–5.82) TLF 2.70% 3.00% 2.09% 0.13 1.45 (0.89–2.37) TVF 3.98% 4.31% 3.32% 0.18 1.31 (0.88–1.95) MACE 4.33% 4.64% 3.70% 0.22 1.27 (0.87–1.85) Values are mean ± standard deviation (SD) or number and percentage (n, %). *Comparison between off-label and on-label use. The p-values are from Chi-squared test or Mann-Whitney-Wilcoxon test. ARC, academic research consortium; FU, follow up; MACE, major adverse cardiac events; PCI, percutaneous coronary intervention; TLF, target lesion failure; TVF, target vessel failure.
Kaplan-Meyer curve stent thrombosis

Conclusions
The off-label use of BRS compared to confirmed indications appears to be associated with a higher rate of clinical endpoints considering more complex lesions and higher morbidity in this patients' group.

Acknowledgement/Funding
This research was supported by a grant from Abbott Vascular.
P2813The improvement of chronic local coagulative response according to the progress of drug eluting stent
Authors: Yamaguchi K , Wakatsuki T , Ueno R , Kawabata Y , Matsuura T , Ise T , Kusunose K , Tobiume T , Yagi S , Yamada H , Soeki T , Sata M 
Published: October 2019

Abstract

Background
We have previously reported local persistent hypercoagulation after sirolimus-eluting stent (SES) implantation by measuring local plasma prothrombin fragment 1+2 (F1+2) levels. The aim of this study is to examine chronic local coagulative response after each generation- drug eluting stent (DES) implantation.

Methods
Ninety-five patients who were treated about eight months earlier with coronary angioplasty, with no evidence of restenosis, were studied [1stgeneration durable polymer (DP)-DES {SES; Cypher®: 26pts, paclitaxel-eluting stent (PES); Taxus®:16pts}, 2ndgeneration DP-DES {everolimus-eluting stent (EES); Xience®:15pts, zotarolimus-eluting stent (ZES); Endeavor®:15pts}, and 3rdgeneration biodegradable polymer (BP)-DES {BP-biolimus-eluting stent (BES); Nobori®: 11pts and BP-SES; Ultimaster®: 12pts}]. We measured plasma levels of F1+2 sampled in coronary sinus (CS) and sinus of Valsalva (V). The transcardiac gradient (Δ) was defined as CS level minus V level.

Results
No significant differences were observed in the percent diameter stenosis among 1st, 2nd, and 3rd DES groups (12.5±15.5 vs 16.1±12.9 vs 13.1±11.9%). The ΔF1+2 was significantly lower in the 2nd and 3rd DES groups than in the 1st DES group (9.0±15.4 and 10.0±17.4 vs 27.3±23.8pmol/l, p<0.05, respectively). The ΔF1+2 was significantly lower in the BP-DES groups (BP-BES and BP-SES) than in the DP-DES groups (DP-SES, DP-PES, DP-ZES, and DP-EES) (10.0±17.4 vs 18.1±19.5pmol/l, p<0.05). The ΔF1+2 was significantly lower in the thin strut-DES groups (BP-SES, DP-ZES, and DP-EES) than in the thick strut-DES groups (DP-SES, DP-PES, and BP-BES) (8.4±15.4 vs 21.7±18.5pmol/l, p<0.05). In the BP-DES groups, the ΔF1+2 was lower in the BP-SES group than in the BP-BES group (8.0±16.1 vs 12.7±18.1pmol/l, p=0.08).

Conclusions
The improvement of chronic local coagulative response was observed according to the progress of DES. These findings might be associated with lower strut thickness and faster polymer resorption in the newer-generation DES.
P2821Diagnostic yield and outcomes of systematic work-up of aborted sudden cardiac death victims and their relatives
Authors: Muetze Jacobsen E , Kjerrumgaard A J , Hansen B L , Winkel B G , Christensen A H , Bundgaard H 
Published: October 2019

Abstract

Introduction
Cardiac arrest can be the first manifestation of most inherited cardiac diseases. This motivates the international guidelines recommending screening of relatives of cardiac arrest survivors (aSCD) if an inherited cardiac disorder might have caused the cardiac arrest.

Purpose
To assess the presence of inheritable cardiac diseases in cardiac arrest survivors and their relatives.

Methods
In this retrospective study we consecutively included cardiac arrest survivors (probands) and their relatives referred to our tertiary referral center from 2005 to 2018. All probands and relatives underwent a systematic screening protocol. Data were retrieved from medical files. Only probands with non-ischemic heart disease were included.

Results
We included 155 probands (41±16 years old, 94 (61%) male) and 284 relatives (36±19 years old, 144 (51%) male). We identified an inheritable cardiac disease in 70 (45%) probands, most frequently cardiomyopathies (41, 26%) followed by channelopathies (27, 17%) (figure). A borderline diagnosis was found in 32 (21%) probands. In the relatives, an inheritable diagnosis was identified in 38 (13%) individuals, most frequently channelopathies (23, 8%), and a borderline diagnosis was identified in 33 (12%) individuals.

Conclusion
Clinical assessment of aSCD cases on a non-ischemic basis identified an inheritable cardiac disease as the most likely etiology in almost half of the probands and in 13% of the relatives.
P2823Lack of early systematic investigations among young victims of sudden cardiac arrest
Authors: Sharifzadehgan A , Bougouin W , Dumas F , Waldmann V , Karam N , Aissaoui N , Geri G , Lamhaut L , Bruneval P , Billon C , Plu I , Wahbi K , Cariou A , Jouven X , Marijon E 
Published: October 2019

Abstract

Introduction
Since a large proportion of patients resuscitated from out-of-hospital sudden cardiac arrest (SCA) die in the intensive care unit (ICU), early systematic investigation towards identifying etiology may be crucial to ensure targeted therapy and appropriate future prevention among relatives, especially when the index case is young.

Purpose
We hypothesized that etiologic investigations were not initiated in a timely manner in a significant proportion of young SCA patients, alive at ICU admission, prior to death.

Methods
In this prospective, ongoing, multicenter, population-based registry (6.7 million inhabitants), data from all SCA over a 5-year period were analyzed, in collaboration with all the 48 hospitals of the area, with a specific focus on young patients (<45 year-old) alive at hospital admission and who eventually died prior to ICU discharge. Investigations performed and diagnoses arrived at were analyzed from the medical records by two cardiologists for each case.

Results
Of the 18,622 out-of-hospital cardiac arrests from May 2011 to May 2016, 3,028 were admitted alive to ICU. Among them, 2,190 (72.3%) died in ICU, including 367 (16.8%) young cases (<45 yo). Among the young patients, while 163 cases (44.4%) had a specific diagnosis established, 204 (55.6%) remained unexplained. Coronary angiograms (18.3%), CT scan (brain and chest) (24.5%), and transthoracic echocardiography (29.1%) were all underutilized. Main established SCA causes were acute coronary syndrome (44.5%), followed by structural non-ischemic heart disease (25.5%), pulmonary embolism (13.6%), chronic CAD (10%), non-structural heart disease (1.8%) and miscellaneous (4.6%). The proportion of systematic autopsy (10.9%), as well as blood sample collection for further genetic testing (1.4%) was low. Information on family screening was rarely provided in the ICU.

Conclusion
More than half of young SCA cases who died in ICU remained unexplained. There was significant underuse of core cardiac investigations. Efforts to promote prompt and systematic investigation through better collaboration between intensivist and cardiologist may improve both acute management and future targeted preventive strategies for family members.