bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3657Annulus-sparing should be adopted in all suitable patients with Tetralogy of Fallot
Authors: Jiang X , Wang Q 
Published: October 2019

Abstract

Background
Ongoing controversy focuses on whether relieving obstruction of dysplastic pulmonary valve annulus (PVA) requires transannular patch enlargement (TAPE) in TOF patients.

Purpose
Aiming to investigate clinical outcomes of annulus-sparing (AS) repair in nonselective TOF patients.

Methods
87 TOF patients was included, underwent AS repair and traditional TAPE and PV-specific technical performance score (TPS) was selected to evaluate adequacy of PV.

Results
One patient died and one required reintervention. 100% patients achieved AS. After a mean follow-up of 24.8 months, there is no significant difference between AS groups in severe pulmonary stenosis (PS) in Class 3 (7.4% vs 3.0%, p=0.583) and a downtrend of annular peak gradient (APG) in PVA z-score <−2 (-3.2±1.9) with AS repair regardless of a higher rate of PS in Class 2 (74.1% vs 42.5%, p=0.014). Compared with TAPE in PVA z-score <−2 (-3.5±0.9), there is no significant difference in PS in Class 3 (7.4% vs 7.4%, p=1.000) but a lower rate in PR in Class 3 (27.3% vs 70.4%, p=0.006), shorter ventilation duration (20.0h vs 29.0h, p=0.039), quicker recovery from ICU (2.0d vs 4.0d, p=0.022) and fewer postoperative hospitalized days (8.0d vs 11.0d, p=0.008), and APG in TAPE group was demonstrated an upward trend.
Table 1. Clinical outcomes Outcomes AS P value (A vs. B) TAPE P value (B vs. C) Group A Group B Group C Z-score ≥−2 (N=33) Z-score <−2 (N=27) Z-score <−2 (N=27) Repump 2 (6.1) 2 (7.4) 1.000 2 (7.4) 1.000 Hospital mortality 0 (0.0) 0 (0.0) 1.000 1 (3.7) 1.000 Reintervention 1 (3.0) 0 (0.0) 0.413 0 (0.0) 0.601 Adequacy of PV repair TPS for degree of PS   Class 1 (APG <20 mmHg) 18 (54.5) 5 (18.5) 0.004 19 (70.4) <0.001   Class 2 (APG 20–40 mmHg) 14 (42.5) 20 (74.1) 0.014 6 (22.2) <0.001   Class 3 (APG >40 mmHg) 1 (3.0) 2 (7.4) 0.583 2 (7.4) 1.000 TPS for degree of PR   Class 1 (none/trivial PR) 18 (54.5) 9 (33.3) 0.100 3 (11.1) 0.050   Class 2 (mild/mild-moderate PR) 12 (36.4) 9 (33.3) 0.807 5 (18.5) 0.214   Class 3 (moderate or greater PR) 3 (9.1) 9 (33.3) 0.020 19 (70.4) 0.006 Moderate PR 0 (0.0) 8 (29.6) 0.008 11 (40.7) 0.393 Severe PR 2 (6.1) 1 (3.7) 1.000 7 (25.9) 0.048
Figure 1. The trend of RVOT or APG.

Conclusions
AS remained higher APG at discharge but had a downtrend over time and long-term reintervention was rare and minimally invasive, as an alternative to TAPE in dysplastic PVA.
P3665Prevalence of infective endocarditis in patients with positive blood cultures: a Danish nationwide study
Authors: Ostergaard L , Bruun N E , Voldstedlund M , Schonheyder H C , Rosenvinge F , Valeur N , Sogaard P , Skov R , Chen M , Iversen K , Gill S , Lauridsen T K , Dahl A , Povlsen J A , Moser C 
Published: October 2019

Abstract

Background
Increasing attention has been given to the risk of infective endocarditis (IE) in patients with certain blood stream infections (BSI). Previous studies have been conducted on selected patient cohorts, yet unselected data are sparse.

Purpose
To investigate the nationwide prevalence of diagnosed IE in BSIs with bacteria typically associated with IE.

Methods
By crosslinking nationwide registries from 2010–2016, we identified patients with BSIs typically associated with IE: Enterococcus faecalis, Staphylococcus, Streptococcus spp., and coagulase negative staphylococci (CoNS) and examined the concurrent IE prevalence. A trend test was used to examine temporal changes in the prevalence of IE.

Results
In total 60,119 BSIs, distributed with 15,407, 16,790, and 27,922 BSIs were identified in the periods of 2010–2011, 2012–2013, and 2014–2016, respectively.
Patients with E. Faecalis had the highest prevalence of diagnosed IE (16.3%) followed by S. aureus (10.2%), Streptococcus spp. (7.3%), and CoNS (1.6%) (Figure). During the study period, the prevalence of IE among patients with E. faecalis increased significantly (p=0.003), Male patients had higher prevalence of IE for all microorganisms investigated compared with females. A significant increase in the prevalence of IE was seen for E. faecalis, Streptococcus spp., and CoNS with increasing age.
Percent with endocarditis

Conclusion
For E. faecalis BSI, 1 in 6 had IE, for S. aureus BSI 1 in 10 had IE, and for Streptococcus spp. 1 in 14 had IE. Our results support screening for IE in patients with E. faecalis, S. aureus, or Streptococcus spp. BSI in order to offer appropriate therapy.
P3666Spondylitis: a frequent and severe complication of infective endocarditis
Authors: Carbone A , Mouhat B , Lieu A , Santelli F , Bohbot Y , Tessonnier L , D'Andrea A , Cammilleri S , Gouriet F , Camoin L , Casalta J P , Riberi A , Philip M , Tribouilloy C , Habib G 
Published: October 2019

Abstract

Background
Spondylodiscitis (SP) is a rare, but severe complication of infective endocarditis (IE). The incidence, clinical features and prognosis of SP in IE are unknown.

Purpose
The primary objective of our study was to assess the incidence, epidemiology, clinical presentation, prognosis, and therapeutic implications of SP in patient with IE. The secondary objectives were to assess factors associated with occurrence of spondylitis and to assess the value of imaging techniques.

Methods
In a French bi-center prospective study of patients who presented in our endocarditis reference centers with a diagnosis of definite IE from 1990 to 2018 (n=1755), 150 (8.5%) presented with SP. Clinical, epidemiological, microbiological, and prognostic variables were prospectively recorded and compared between patients with (n=150) and without (n=1605) SP.

Results
Patients with SP were older (mean age 69.7±18 vs 66.2±14; p=0.004), had more arterial hypertension (48% vs 34,5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without SP. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L3-L4. Neurological symptoms were observed in 59% of patients. Enterococci et Gallolyticus streptococci were more frequent (24% vs 12% and 24% vs 11%; p<0,001, respectively) in the SP group. Observed sensitivities of full spine contrast-enhanced MRI and CT were 95% and 89%, respectively. PET/CT had a great power to differentiate infective to degenerative vertebral processes, and to find embolic foci with a sensitivity of 90%. Clinical outcome did not differ between patients with or without SP, including similar in-hospital mortality (16% vs 13,5%, p=0.38).

Conclusions
We describe the largest ever reported series of patients with spondylodiscitis complicating IE. Spondylodiscitis is a more frequent complication of IE than previously reported (8.5% of IE), is observed in older hypertensive patients with Enterococcal or Streptococcus gallolyticus IE and has a similar prognosis than other forms of IE. Since SP is associated with prolonged antibiotic therapy and may need specific surgical therapy, multimodality imaging including MRI, CT, and PET/CT should be used for early diagnosis of this IE complication.
P3687Abnormal voltage recordings in patients with ventricular arrhythmias: comparison between right and left cardiomyopathy
Authors: Casella M , Gasperetti A , Dello Russo A , Sicuso R , Basso C , Della Rocca D , Catto V , Fassini G , Riva S , Natale A , Tondo C 
Published: October 2019

Abstract

Background
Arrhythmogenic Cardio-Myopathy (ACM) is characterized by epi-endocardial fibro-fatty replacement. Depending on the most affected ventricle, right dominant (RDACM) or left dominant (LDACM) phenotypes can be defined. RDACM voltage mapping characteristics have already been described, with late potentials strongly correlating with arrhythmia recurrence risk; LDACM voltage features have not been described yet.

Purpose
To analyze voltage map characteristics in LDACM patients (pts) and compare them with RDACM; to assess if there is any correlation between late potentials and recurrence rate in LDACM as well.

Methods
We retrospectively enrolled all consecutive ACM patients treated c/o our center and diagnosed according to the 2010 Task Force Criteria. Procedural and follow up data were collected. Patient were sorted by ventricular involvement lateralization. Recurrence rates were evaluated and linearly regressed for the presence of late potentials.

Results
89 ACM patients were enrolled (67 RDACM, 22 LDACM; 76% males, 69±4 y.o.) in our study. All patients underwent endocardial voltage mapping; procedurally, 43 (48%) pts underwent catheter ablation, while 46 (52%) were managed conservatively with anti-arrhythmic drugs.
Bipolar pathological potentials were found in 43 (64%) and 13 (59%), unipolar pathological potentials in 45 (67%) and 14 (63%), while late potentials in 19 (31%) and 8 (36%) in the RDACM and LDACM group respectively [p = 0.66, p=0.63, and p=0.33].
The average follow-up was 18 months [14–48]; 15 (22%) in the RDACM and 9 (40%) in LDACM arrhythmic recurrences were respectively encountered; recurrences in both groups were regressed for the presence of late potentials. Results were as follows: the presence of late potentials correlated with recurrences with an 4,3 [1.15–16.1; p=0.03] OR and with an 11 [0.4–85; p=0.022] OR in the RDACM and LDACM group respectively.

Conclusion
Pathologically low unipolar, bipolar and late potentials can be found in comparable % both in RDACM and LDACM; like in RDACM, late potentials represent an important risk factor for arrhythmic recurrence in LDACM as well.
P3709Risk of recurrent cerebral ischemia in young patients with cryptogenic ischemic stroke and patent foramen ovale
Authors: Hutyra M , Sanak D , Kral M , Veverka T , Dornak T , Divisova P , Precek J , Spacek M , Latal J , Kanovsky P , Taborsky M 
Published: October 2019

Abstract

Background
The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. A persistent foramen ovale (PFO) is a known risk factor for paradoxical embolism, including ischemic stroke (IS).

Aims
The aims of our prospective study were to assess the rates of recurrent ischemic stroke events in young IS patients with PFO during a 35-month follow-up period (FUP) on effective antiplatelet therapy (OAT) and to evaluate a potential relationship with the presence of PFO on transesophageal echocardiography (TEE).

Methods
The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, transesophageal echocardiography, 24-hour and 3-week ECG-Holter were performed in all patients.

Results
Out of 980 patients enrolled in the HISTORY study, 260 patients were younger than 50 years and 185 (56% males, mean age 41±8 years) patients were classified as cryptogenic IS in ASCOD classification. PFO was diagnosed in 60 patients (32%). Six new clinically apparent recurrent ischemic brain events were recorded during a 35-month FUP. No significant difference was found in the presence of IS recurrence between patient group with PFO and without PFO (2 [3.2% patients with PFO] versus 4 [3.2% without PFO] of young IS patients, P=0.99).

Conclusion
The presence of PFO was not associated with a higher risk of new brain ischemic lesions in young patients with with cryptogenic ischemic stroke during a 35-month follow-up period. Number of recurrent clinical IS is relatively small, thus achieved results may be not so robust.

Acknowledgement/Funding
Grant support IGA MZ CR NT/14288-3, AZV MZ CR 17-30101A, IGA LF UP Olomouc (2016-2018), FNOL SUG No. 87-85
P3730Left atrial appendage perimeter measurement by cardiac CT is superior to transesophageal echocardiography for Watchman device sizing
Authors: Seibolt L , Verma D , Mulroy W , Loli A 
Published: October 2019

Abstract

Background
Left atrial appendage occlusion with Watchman device traditionally relies on accurate left atrial appendage (LAA) ostium diameter measurement by 2D or 3D transesophageal echocardiogram (TEE). Alternate methods of ostium measurement including area-derived diameter and perimeter-derived diameter using cardiac computed tomography (CT) have been proposed.

Purpose
We aim to use CT technology with an advanced medical imaging application to measure LAA ostium perimeter for improved pre-procedural device sizing.

Methods
We performed a retrospective analysis of 92 patients with atrial fibrillation (Afib) who underwent Watchman implantation with pre-procedural TEE and cardiac CT between May 2015 and December 2018. LAA characteristics including ostial or landing zone perimeter, minimum and maximum diameters were acquired utilizing 3mensio Structural Heart Imaging Program. Proposed Watchman device size was estimated utilizing ostium perimeter by CT and compared to the current standard utilizing ostium diameter by 2D-TEE. Both measurements were then compared to actual implanted Watchman device size which met the P.A.S.S. criteria of position, anchor, size and seal.

Results
Watchman device sizing based on novel LAA landing zone perimeter size by CT had a very high correlation with the actual implanted Watchman size (Pearson coefficient r=0.94, p<0.001). Traditional TEE based Watchman sizing only had a modest correlation with the implanted Watchman size (Pearson coefficient r=0.66, p<0.001). CT predicted Watchman size had a significantly higher agreement compared to current standard TEE based sizing (93.4% vs 47.8%), inter-rater agreement was very high for CT based Watchman sizing compared to current standard TEE based sizing (Cohen's kappa = 0.91 vs Cohen's kappa = 0.32, p<0.001, p<0.001 respectively). Bland-Altman analysis also showed better correlation with CT based sizing compared to TEE (see Figure 1).
Figure 1

Conclusion
CT LAA perimeter sizing is superior to the current standard TEE based Watchman sizing. Larger, multi-center studies may be necessary to further validate our results.
P3733Long term follow-up after percutaneous closure of patent foramen ovale for secondary prevention of stroke
Authors: Guedeney P , Hauguel-Moreau M , Hage G , Sabben C , Deltour S , Hammoudi N , Molho A , Mesnier J , Alamowitch S , Silvain J , Montalescot G 
Published: October 2019

Abstract

Background
Recent randomized trials have demonstrated the superiority of percutaneous patent foramen ovale (PFO) closure for the secondary prevention of stroke compared to antithrombotic therapy. However, real-world data on long-term outcomes after percutaneous PFO closure are scarce.

Purpose
To describe real-world long-term outcomes following PFO percutaneous closure and the impact of the use of intracardiac echocardiography under local anesthesia for the procedure

Methods
All consecutive patients undergoing PFO closure in a single high-volume tertiary center from January 2006 to December 2018, for secondary prevention of stroke, transient ischemic attack (TIA) or any other paradoxical arterial embolism were prospectively studied. A systematic contrast transthoracic echocardiography (TTE) was performed 3 months after closure. Clinical endpoints of interest were the occurrence of death, stroke or transient ischemic attack, as defined in previous randomized trials.

Results
Of the 242 closure procedures performed, a total of 208 (86.3%) were performed in secondary prevention of stroke, TIA or paradoxical arterial embolism (mean age 49.8±12.7 years; 62.0% male). An atrial septal aneurysm and a large shunt were present in 137 (66.8%) and 172 (84.7%) patients, respectively. General anesthesia associated with transesophageal echocardiography was initially used in all patients with a temporal trend towards the use of local anesthesia associated with either intracardiac echocardiography (Viewflex catheter, Abbott) in 23 more cases or micro transesophageal probe in 7 cases, without periprocedural complications. Discharge medication comprised of dual antiplatelet therapy, oral anticoagulation and single antiplatelet therapy in 80.7%, 16.8% and 2.5% of the patients, respectively. Contrast TTE with Valsalva maneuver was performed at a mean delay of 3.2±0.7 months after intervention and found no or minimal residual shunt in 87.0% of patients. Clinical follow-up was available up to 12.8 years (mean 2.1±3.0 years). A total of 3 patients died from cancer or unknown cause while stroke and TIA occurred in 2 and 1 patients, respectively. Event rate for death was 0.69 events per 100 patients-years. The event rates for stroke, TIA and stroke or TIA were 0.46, 0.23 and 0.70 events per 100 patients-year of observation, respectively, which compare favorably with reported outcomes following percutaneous closure in randomized clinical trials (Figure).

Conclusion
In an experienced center, percutaneous PFO closure appears to be a safe procedure providing adequate protection against recurrent strokes over a long follow-up.

Acknowledgement/Funding
ACTION study group
P3741Incidence and outcomes of delirium in patients undergoing transcatheter aortic valve replacement
Authors: Luque Diaz T S , Travieso A , Corrochano D , Noriega F , Nombela-Franco L , Jimenez-Quevedo P , Ferrera C , Viana-Tejedor A 
Published: October 2019

Abstract

Introduction and objective
Delirium is a frequent problem in the intensive care unit (ICU), often underdiagnosed, and is associated with increased mortality. We sought to evaluate the incidence and implact on prognosis of delirium in patients admitted to ICU after transcatheter aortic valve replacemente (TAVR).

Methods
We included 294 patients admitted to ICU from February 2013 to December 2017 after transfemoral aortic valve implantation. Incidence of delirium was assessed using DSM-IV diagnostic criteria. Risk factors were evaluated, as well as overall mortality and incidence of hospital readmissions.

Results
The mean clinical follow-up was 526 days. Delirium was diagnosed in 60 patients (20.4%). In most cases (78.3%), it occurred in the first 24 hours after the procedure. Age, cognitive impairment and peripheral artery disease were risk factors for the development of Delirum, without finding differences by sex, cardiovascular risk factors (except dyslipidemia) or the usual treatment with benzodiazepines or neuroleptics. Severe bleeding during the procedure was also associated with a higher incidence, but no risk augmentation was seen with the use of general anaesthesia, the urgency of the procedure, use of a transient pacemaker for more than 24 hours after the intervention or the development of a peripheral vascular complication during admission (both related to patient immobility).
The development of Delirium was associated with longer hospital stay (10.8 vs 7.9 days, p=0.004) and with higher mortality (38.8% vs 20.4%, p=0.007). No differences were found in hospital readmissions during follow-up (54.3% vs 48.2%, p=0.453).

Conclusion
Delirium is a frequent complication after TAVR. Age, cognitive impairment and peripheral arteriy disease were risk factors for its development, but no factors that determine patient immobility, use of general anesthesia or the urgency of the procedure. Delirum after TAVR is associated with longer in-hospital stay and with higher mortality.
P3752Ablation of the superior left ganglionic plexus is not necessary for effective denervation of the sinoatrial and atrioventricular nodes
Authors: Jansova H , Stiavnicky P , Stojadinovic P , Konecny P , Cihak R , Peichl P , Kautzner J , Wichterle D 
Published: October 2019

Abstract

Background
Cardioneuroablation by targeting of atrial ganglionic plexi (GP) has been proposed as a new therapeutic option in selected patients with reflex syncope. Contribution of individual GPs to cardiac autonomic regulations is not fully established.

Purpose
Because consistent vagal responses have been observed during left superior pulmonary vein isolation in patients undergoing ablation for atrial fibrillation, we investigated whether standalone ablation of the superior left GP modifies the vagal input into the sinoatrial (SAN) and atrioventricular node (AVN).

Methods
Study hypothesis was investigated in otherwise healthy patients undergoing cardioneuroablation for symptomatic bradyarrhythmias. All had preprocedural atropine test suggesting functional disorder. Anatomically-navigated (CARTO-3) radiofrequency (RF) ablation (25–30 W/30 s/20 ml/min) at empirical GP sites was performed in general anaesthesia. Extracardiac high-frequency vagal nerve stimulation (25–60 V/30–50 Hz/0.05–0.1 ms) via right jugular vein was performed at baseline, after initial superior left GP ablation, and after the ablation of remaining septal and inferior GPs. High-frequency vagal nerve stimulation was always done in both sinus rhythm and atrial pacing. The elimination of all stimulation-induced vagal responses was the endpoint of the procedure.

Results
A study included 8 patients (34±8 years; 5 males). Six of them had recurrent syncope with cardioinhibitory response at the SAN (n=4), AVN (n=1) or both nodes (n=1); and 2 patients had symptomatic sinus bradycardia. At baseline, high-frequency vagal nerve stimulation induced long episodes of sinus arrest and advanced AV block in all patients. Cluster ablation at the superior left GP (RF time: 192±28 s) did not change the sinus rate (59±14 vs 60±15, NS), PQ interval (174±37 vs 173±37, NS), and did not induce any tangible change in SAN/AVN response to high-frequency vagal nerve stimulation. Subsequently, anterior right GP was targeted from the aspect of right atrium (n=7), from the anterior antrum of right pulmonary veins (n=6), and inferior GPs were targeted from the aspect of left atrium (n=7). This lesion set finally resulted in complete non-responsiveness of SAN and AVN to high-frequency vagal nerve stimulation in all patients. Ablation procedure overall (duration: 172±15 min; RF time: 988±306 s; radiation dose: 70±34 μGy·m2) led to sinus rate acceleration by a median of 29 (IQR: 18–38) bpm, increase of Wenckebach point by 21 (IQR: 9–28) bpm, and shortening of AVN effective refractory period by 40 (IQR: 15–73) ms.

Conclusions
Cardioneuroablation guided by extracardiac high-frequency vagal nerve stimulation can achieve complete denervation of SAN and AVN by ablation of postero(para)septal and inferior GPs only. Ablation of the superior left GP appears unnecessary and can be eliminated from the lesion set design.