bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modeling survival using decision tree analysis in pulmonary hypertension due to left heart disease. the prognostic significance of PVR &lt;3WU when TAPSE &lt;16mm
Authors: Raitiere O , Berthelot E , Fauvel C , Guignant P , Si-Belkacem N , Sitbon O , Bauer F 
Published: November 2020

Abstract

Aims
In 2019, PVR&lt;3 WU was adopted to stratify patients at low risk of pulmonary hypertension due to left heart disease (PH-LHD) as well those with isolated PH-LHD. We sought to evaluate whether the supervised machine learning with Decision Tree analysis that provides more information than Cox Proportional analysis by forming a hierarchy of multiple covariates, confirms this risk stratification.

Methods
202 consecutive patients (mean age: 69±11 y, females 42%) with mean pulmonary artery pressure (mPAP)≥20mmHg and wedge pressure&gt;15mmHg were recruited. Transpulmonary pressure gradient ≥12mmHg, pulmonary vascular resistance (PVR) ≥3WU, diastolic pressure gradient ≥7mmHg, pulmonary arterial capacitance&lt;1.1 ml/mmHg, TAPSE&lt;16 mm, peak systolic tissue Doppler velocity&lt;10cm/s and right ventricular end-diastolic area ≥25 cm2 were the seven categorical values to enter the model. To predict the mortality from the Decision Tree, we used the CHAID method. Each node and branch were compared using survival analysis at 6-year follow-up.

Results
Mean PAP, wedge pressure, cardiac index, and PVR were 40.3±10.0mmHg, 22.3±7.1mm Hg, 2.9±0.8L/min/m2, and 3.6±2.1WU, respectively. Among the seven dichotomous values linked to the prognosis in PH-LHD, only 2 variables entered the model. To predict the mortality, TAPSE was first selected following by PVR. Compared to patients with PVR&lt;3WU and TAPSE ≥16mm, patients with PVR ≥3WU and TAPSE ≥16mm or patients with PVR ≥3WU and TAPSE &lt;16 mm has significant increased mortality (HR=3,0, 95% CI: [1,4–6,4], p=0.006 and HR=3,3, 95% CI: [1,6–6,9], p=0.002, respectively), while patients with PVR &lt;3WU and TAPSE &lt;16 mm exhibiting the worst prognosis (HR=7,2, 95% CI: [3,3–15,9], p=0.0001).

Conclusion
Used for solving regression and classification problems, decision tree analysis indicates that among 7 prognostic factors, TAPSE and PVR have to be interpreted altogether and simultaneously in PH-LHD for mortality assessment. Therefore, in future research, PVR &lt;3 WU should be understood primarily based on right ventricular systolic function assessed by echocardiography whether TAPSE is or not ≥16 mm.

Funding Acknowledgement
Type of funding source: None
Risk stratification of ulcer-like projections in patients with acute type B aortic intramural hematoma
Authors: Chen L.F , Yang F , Liu L , Luo S.Y , Zhu Y , He C.Y , Hu B.Q , Xie E.M , Ma W.T , Liu J.T , Yang X.Y , Xie N.J , Huang W.H , Xue L , Luo J.F 
Published: November 2020

Abstract

Background
Acute type B aortic intramural hematoma (IMH) with ulcer-like projections (ULP) is associated with various adverse aortic-related events (AAE) and recommended for preventive endovascular repair as alternative. However, we have no therapeutic criterion on which to decide preventive treatment.

Objectives
The purpose of this study was to determine the prognostic value and risk stratification of ULP in patients with acute type B IMH for proper treatment.

Methods
A retrospective study was conducted on 61 consecutive patients with acute type B IMH and with present of ULP from January 2015 to December 2018 in our center. All patients were treated medically initially and CT scans were performed on admission and during follow-up period.

Results
During a median follow-up of 4.5 months (range, 0.3 to 49.8 months) from onset, 36 patients (59.0%) had composites of adverse aortic events, including 1 patient died for aortic rupture, 6 patients converted to endovascular repair, 6 progressed into aortic dissection, and 28 developed to aortic enlargement. A cutoff value to estimate risk is 6.0 mm for maximal ULP width (72.2% sensitivity and 84.0% specificity) and 4.0 mm for maximal ULP depth (94.4% sensitivity and 52.0% specificity). Patients with widest (P=0.005) or deepest ULP (P=0.019) in aortic arch and proximal descending thoracic aorta had significant poorer aorta-related event-free survival rates. On multivariate analysis, maximal ULP width ≥6.0 mm [hazard ratio (HR) = 2.569, 95% confidence interval (CI):1.157 to 5.705, P=0.020], maximal ULP depth ≥4.0 mm (HR=5.198, 95% CI: 1.154 to 23.420, P=0.032) and widest ULP in aortic arch and proximal descending thoracic aorta (HR=2.363, 95% CI: 1.012 to 5.517, P=0.047) were independently associated with AAE. ULP with both risk location (widest ULP in aortic arch and proximal descending thoracic aorta) and size (maximal ULP width ≥6.0 mm) were significantly associated with a poorer aortic-related event-free survival rate than others (both P&lt;0.001).

Conclusions
Maximal ULP width ≥6.0 mm, maximal ULP depth ≥4.0 mm and widest ULP in aortic arch and proximal descending thoracic aorta are predictive for progression of acute type B aortic intramural hematoma. For patients with ULP in both risk location and size, preventive endovascular treatment should be considered.
Figure 1

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): This research was supported by grant DFJH201807 from High-level Hospital Construction Project of Guangdong Provincial People's Hospital.
Sex-dependent association between day-by-day morning blood pressure variability and common carotid artery intima-media thickness: the J-HOP study
Authors: Nagai M , Hoshide S , Kario K 
Published: November 2020

Abstract

Background
Day-by-day home systolic blood pressure variability (BPV) was shown to be associated with increased common carotid artery (CCA) intima-media thickness (IMT) in the hypertensives. Recently, 24 hour ambulatory BPV was revealed to serve as an indicator of higher CCA-IMT only in males. However, there have been no studies that reported the sex-dependent relationship between day-by-day BPV and CCA-IMT.

Purpose
We assessed the hypothesis that day-by-day BPV was associated with higher CCA-IMT in the Japanese males at high-risk of cardiovascular disease.

Methods
Among 4310 patients with one or more cardiovascular risks recruited for the Japan Morning Surge-Home Blood Pressure Study, carotid ultrasound in CCA was performed in the 1365 patients (mean age 65.6 years old, male 52%). The home blood pressure (BP) readings during mean 11.2 days were used to calculate home mean levels and variability in morning systolic BP (SBP). Day-by-day BPV was measured as standard deviation [SD] and delta (maximum-minimum) in SBP.

Results
Average mean CCA-IMT of left and right side was 1.046±0.4mm. Mean (r=0.118, p&lt;0.0001), SD (r=0.120, p&lt;0.0001) and delta (r=0.149, p&lt;0.0001) in morning SBP were significantly correlated with CCA-IMT. In the multiple regression analysis adjustment for confounders including age, gender, body mass index, total cholesterol, high density lipoprotein and mean morning SBP, SD (B: 0.008, 95% CI: 0.001–0.015, p&lt;0.05) or delta (B: 0.004, 95% CI: 0.002–0.006, p&lt;0.001) in morning SBP each had a significant association with CCA-IMT. According to the gender, SD (p&lt;0.01) or delta (p&lt;0.01) in morning SBP each was significantly associated with CCA-IMT only in the male group while neither SD (p=0.4) nor delta (p=0.4) in morning SBP was associated with CCA-IMT in the female group.

Conclusions
In addition to the conventional risk factors, day-by-day morning SBP variability was a significant indicator of increased CCA-IMT in the high-risk Japanese population. The significant relationship between day-by-day morning SBP variability and CCA-IMT was observed only in the males. Gender specific impact of day-by-day morning home systolic BPV on carotid artery atherosclerosis should be taken into account in the high-risk elderly at cardiovascular disease.

Funding Acknowledgement
Type of funding source: None
PRediction and detection of Occult Atrial fibrillation in patients after acute Cryptogenic stroke and Transient Ischemic Attack (PROACTIA)
Authors: Skrebelyte-Strom L , Steine K , Ronning O.M , Dahl F , Kjekshus H 
Published: November 2020

Abstract

Background
Studies with implantable cardiac rhythm monitors (ICRM) have shown that a 1/3 of patients with cryptogenic stroke/transitory ischemic attack (TIA) have episodes of subclinical atrial fibrillation (SCAF) as one of the potential risk factor for cerebral embolism. However, ICRM are costly and resource demanding.

Purpose
The PROACTIA study seeks to test a pre-specified scoring system to assess individual risk of SCAF in order to offer tailored therapy to patients after cryptogenic stroke/TIA.

Methods
Patients admitted with first time cryptogenic stroke or TIA were eligible for the study and underwent blood sampling, cerebral CT/MRI, carotid Doppler ultrasound, ECG, 24h-HolterECG, transthoracic transesophageal echocardiography, registration of medical history and implantation of ICRM during the index hospitalization
The scoring system was composed of variables that have previously been found associated with AF occurrence: CHA2DS2-VASc, P-wave duration (P-dur), premature atrial contractions (PAC)/24h, supraventricular runs (SVR)/24h, left atrial end-systolic volume index (LAVI), and the biomarkers TnT, NT-proBNP and D-dimer.
Data are presented as median (inter quartile range).

Results
Within 25 months, 434 patients screened and 251 patients were included in the present study and had an ICRM implanted. Eleven patients were later excluded yielding a study cohort of 176 patients with cerebral infarction and 61 with TIA that were followed for 833 (633–1028) days. AF was detected in 36%. It took 113 (25–336) days to detect AF, and 5 (2–14) days from AF-detection to initiation of NOAC. All variables were significantly increased in AF patients: no-AF vs AF: CHADS-VASC: 4 (3–5) vs 5 (4–6)*, LAVI mL/m2: 35 (28–40) vs 40 (35–50)**, PAC/24h: 69 (29–211) vs 347 (59–1917)**, SVR / 24-h: 1 (0–3) vs 3 (1–17)**, P-dur ms: 100 (100–120) vs 120 (100–120)**, D-dimer mg/L: 0,3 (0,2–0,6) vs 0,5 (0,3–0,9)**, TnT ng/L: 10 (7–16) vs 15 (9–27)**, NT-proBNP ng/L: 103 (49–283) vs 245 (102–774)**. *p&lt;0.01, **p&lt;0.001.
Multivariate analysis yielded the following model: −8.524 + 0.057*LAVI (p&lt;0.001) + 0.035*P-dur (p&lt;0.001) + 0.873*LogPAC/24h (p&lt;0.001). ROC analysis using leave-one-out cross validation: AUC=0.77. Applying the model to our population, it would identify a high-risk group (&gt;80% true positive) consisting of 17 true positive and 4 false positive, and a low-risk group (&lt;5% false negative) consisting of 17 true negative and 1 false negative.

Conclusions
ICRM detected SCAF in 36% of cryptogenic stroke/TIA patients within 27 months. LAVI, PAC/24h and P-duration were strong independent predictors of SCAF enabling a meaningful risk stratification that can be used for tailoring therapy in cryptogenic stroke/TIA patients.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Stiftelsen Dam
Comparison of neointimal coverage between biodegradable-polymer everolimus-eluting stent and durable-polymer everolimus-eluting stent using angioscopy for the patients with acute coronary syndrome
Authors: Umemoto T , Matsuda J , Hatano Y , Lee T , Yonetsu T , Sasano T 
Published: November 2020

Abstract

Background
New-generation biodegradable-polymer platinum chromium everolimus-eluting stent (BP-PtCr-EES) is available, which has different polymer and alloy compare to more established stent design, a durable-polymer cobalt-chromium everolimus-eluting stent (DP-CoCr-EES).

Purpose
To compare neointimal coverage (NIC) between BP-PtCr-EES and DP-CoCr-EES by using coronary angioscopy (CAS).

Methods
A total of 36 patients (44 stents) with BP-PtCr-EES or DP-CoCr-EES who underwent CAS at 1 year after stenting were investigated. We compared angioscopic findings assessed by angioscopy between BP-PtCr-EES (n=18) and DP-CoCr-EES (n=26). NIC grade and yellow plaque grade (YPG) was adopted from earlier reports from grade 0 to 3. We determined maximum (max-) and minimum (min-) NIC grade and heterogeneity score (HGS = max NIC grade minus min NIC grade). We also assessed YPG and the presence of thrombus (TH).

Results
Six lesions (33.3%) in BP-PtCr-EES group and 7 (26.9%) lesions in DP-CoCr-EES group were culprit lesions of acute coronary syndrome, which did not statistically differ between the two groups (p=0.74). And there were no significant differences in stent diameter (BP-PtCr-EES: 2.97±0.39 mm vs DP-CoCr-EES: 3.14±0.45 mm, p=0.22) and length (BP-PtCr-EES: 26.9±7.9 mm vs DP-CoCr-EES: 28.4±8.0 mm, p=0.54). In terms of CAS findings, BP-PtCr-EES group has better neointimal coverage than DP-CoCr-EES group (max NIC grade: 2.6±0.7 vs 2.0±0.9, p=0.01. min NIC grade: 1.1±0.8 vs 0.5±0.5, p&lt;0.01), but HGS was almost same (1.6±0.7 vs 1.5±0.9, p=0.70). YPG of BP-PtCr-EES group showed significantly lower than DP-CoCr-EES group (1.0±1.0 vs 1.7±1.0, p=0.02). The rate of TH was significantly lower in BP-PtCr-EES group than DP-CoCr-EES group (25%, n=6, vs 75%, n=18, p=0.03). There were no clinical events such as stent thrombosis or restenosis during the observation period in both stent groups.

Conclusion
Superior neointimal coverage and less YPG or TH were observed by CAS in the BP-PtCr-EES group at 1 year after stenting. Clinical significance was still unknown because of no clinical events in both groups. Prospective and large populations studies may be required.

Funding Acknowledgement
Type of funding source: None
Coronary circulatory indices in non-infarct related vascular territories in a porcine acute myocardial infarction model
Authors: Lee S.H , Kim H.K , Lee J.M , Hong Y.J , Choi K.H , Shin E.S , Nam C.W , Doh J.H , Yang J.H , Song Y.B , Hahn J.Y , Choi S.H , Jeong M.H , Samady H , Escaned J 
Published: November 2020

Abstract

Background
There has been debate on the reliability of fractional flow reserve (FFR) or resting pressure-derived indices in non-IRA of patients with acute ST-segment elevation myocardial infarction.

Purpose
This study aimed to evaluate temporal changes of coronary hemodynamic and physiologic indices in non-infarct related artery (non-IRA), which might be affected by adjacent infarcted myocardium, using an experimental animal model of acute myocardial infarction (AMI).

Methods
In Yorkshire swine, acute myocardial infarction was simulated with selective balloon occlusion at left circumflex artery (LCX) as IRA for 30 minutes. Non-IRA stenosis was created using bare metal stent implantation in left anterior descending artery (LAD) 4 weeks before the experiments. Serial changes of systemic hemodynamics, coronary pressure, and Doppler-derived coronary flow velocity were measured in a non-occluded LAD as non-IRA from baseline, balloon occlusion of LCX, and 15 minutes after reperfusion of LCX.

Results
Among the 6 experimental subjects, the median diameter stenosis of non-IRA was 33.9% (Q1-Q3: 21.7%-46.1%). During balloon occlusion of IRA, there were transient significant changes in both resting and hyperemic aortic pressure (Pa), distal coronary pressure (Pd), averaged peak velocity (APV), trans-stenotic pressure gradient (PG), and microvascular resistance of non-IRA (all P values&lt;0.020). After reperfusion of IRA, the resting APV (P=0.002) and resting trans-stenotic PG (P=0.004) were significantly increased and resting microvascular resistance (P=0.004) was significantly decreased than those in baseline phase. However, the hyperemic APV (P=0.479), hyperemic trans-stenotic PG (P=0.778), and hyperemic microvascular resistance (P=0.816) were not significantly different compared with those in the baseline phase. After reperfusion, the FFR in non-IRA was not significantly different (0.94±0.01 vs. 0.93±0.01, P=0.353), while the CFR (1.93±0.07 vs. 1.36±0.07, P=0.025) and resting Pd/Pa (0.98±0.01 vs. 0.94±0.01, P=0.017) were significantly lower than baseline values.

Conclusions
In a porcine AMI model, occlusion of IRA induced significant changes of systemic hemodynamics and coronary circulatory indices of non-IRA. However, after reperfusion of IRA, FFR did not change significantly, while resting
Summarizing Figure

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): 1. Philips/Volcano, 2. Bio & Medical Technology Development Program of the National Research Foundation of the Korean government
Association between bleeding avoidance and outcomes: Japanese coronary intervention registry report in collaboration with ACC-NCDR
Authors: Sawano M , Numasawa Y , Spertus J.A , Kennedy K , Inohara T , Miyata H , Fukuda K , Rumsfeld J.S , Masoudi F.A , Kohsaka S 
Published: November 2020

Abstract

Background
Bleeding avoidance strategies (BASs) such as radial access and closure device use for femoral access have been increasingly being implemented but its association with bleeding events among East Asians with reported higher bleeding risk remains unclear.

Purpose
To demonstrate the performance of the National Cardiovascular Data Registry (NCDR) CathPCI bleeding risk score, 10-year trend of BAS utilization rate and its relationship with observed bleeding within a Japanese PCI quality improvement initiative established in collaboration with the American College of Cardiology-NCDR.

Methods
A cohort of 19,656 consecutive Japanese patients undergoing PCI was included. First, we assessed the discrimination of the validated NCDR CathPCI bleeding score in the study population. We then assessed temporal trends in the implementation of BAS for PCI and calculated the observed versus expected bleeding rate [O/E ratio] in four time periods (T1: 2008–2011, T2: 2012–2013, T3: 2014–2015, T4: 2016–2018). In multivariable logistic models, we calculated the correlation between BAS use and bleeding rates in individual time frames.

Results
During the study period, the application of BAS increased from 42.2% (T1) to 90.3% (T4) and observed bleeding rate declined from 10.2% (T1) to 7.3% (T4). The discrimination of the NCDR CathPCI bleeding risk score was acceptable in the Japanese population (c-statistics 0.760–0.845). The calculated O/E ratio declined from 1.34 (T1) to 1.14 (T4). The use of radial access and vascular closure devices after transfemoral access use was associated with 46.7–56.6% and 25.6–47.5% bleeding reduction rates, respectively. The correlation between greater BAS adoption and the decline in bleeding rates was greater among elective cases than urgent/emergent cases.

Conclusion
Our findings support the positive impact of the adoption of BAS in Japanese patients undergoing PCI. This study demonstrates the value of common data standards and risk adjustment developed in registries to support high quality care.
Trends in BAS use & Bleeding Rate

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science
The long-term impact of transcatheter aortic valve implantation on arterial stiffness and central hemodynamics
Authors: Gardikioti V , Terentes-Printzios D , Aznaouridis K , Latsios G , Siasos G , Drakopoulou M , Oikonomou E , Christoforatou E , Tsigou V , Xanthopoulou M , Toutouzas K , Vavuranakis M , Tousoulis D , Vlachopoulos C 
Published: November 2020

Abstract

Background/Introduction
The study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal.

Purpose
We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections opting for a global approach.

Methods
We enrolled 90 patients (mean age 80.2±8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by both carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate (AIx@75), an index of wave reflections, and central pressures were assessed with arterial tonometry. Measurements were conducted at baseline, after the procedure and at 1 year.

Results
Immediately post-TAVI there was a statistically significant increase in arterial stiffness (7.5±1.5 m/s vs 8.4±1.9 m/s, p=0.001 for cfPWV and 1,773±459 cm/s vs 2,383±645 cm/s, p&lt;0.001 for baPWV) despite no change in systolic blood pressure. At 1-year follow-up, TAVI was still associated with an increase in arterial stiffness compared to pre-TAVI (7.5±1.5 m/s vs 8.7±1.7 m/s, p&lt;0.001 for cfPWV and 1,773±459 cm/s vs 2,286±575 cm/s, p&lt;0.001 for baPWV) but not to post-TAVI values. We also observed a decrease in AIx@75 (32.2±12.9% vs 27.9±8.4%, p=0.016) post-TAVI that was attenuated at 1 year (32.2±12.9% vs 29.8±9.1%, p=0.38).

Conclusions
Our study shows that after TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term. Our findings further elucidate the immediate and long-term hemodynamic changes of TAVI to the aorta that may entail prognostic role in this growing population.
Change of vascular biomarkers post-TAVI

Funding Acknowledgement
Type of funding source: None
Is high-normal blood pressure a more important risk factor for cardiovascular disease in women than in men? The Hordaland Health study
Authors: Kringeland E.A , Tell G.S , Midtbo H.B , Haugsgjerd T.R , Igland J , Gerdts E 
Published: November 2020

Abstract

Background
Hypertension is a major risk factor for cardiovascular disease (CVD), but the definition of hypertension is currently debated. Little is known about whether high-normal blood pressure (BP) carries a different risk for CVD in women and men.

Purpose
The aim of the current study was to test associations of high-normal BP with CVD in women and men participating in the community-based Hordaland Health Study (HUSK).

Methods
Data from 8252 participants aged 40–43 years (52% women) participating in the HUSK survey in 1992–93 were coupled with hospitalization or death from CVD documented by ICD codes in national registries in the period 1994–2009. Attended BP was measured in accordance with current guidelines. The average of the two last measurements was taken as the clinic BP measure. The cohort was grouped into normal BP (BP&lt;130/85 mmHg), high-normal BP (BP 130–139/85–89 mmHg) and hypertension (BP≥140/90 mmHg or use of antihypertensive drugs). CVD was defined as hospitalization or death from any CVD diagnosis. The association between BP category and CVD was tested in sex-specific Cox regression analyses, using normal BP as the reference group and adjusting for diabetes, smoking, body mass index and total cholesterol.

Results
At baseline, 17% women and 27% men had high-normal BP and 16% women and 32% men had hypertension (both p&lt;0.001 between sexes). During 16 years follow-up, 15% of women and 22% of men experienced hospitalization or death from CVD (p&lt;0.001). A significant sex-interaction of BP group and outcome was found (p&lt;0.05). In multivariable analyses in women, both hypertension and high-normal BP were associated with incident CVD (both p&lt;0.01) independent of confounders (Table). In men, only hypertension was associated with incident CVD in the same model, while high-normal BP was not (p&lt;0.001 and p=0.53, respectively) (Table).

Conclusion
High-normal BP was a more important risk factor for CVD in middle-aged women than men. Our findings challenges whether hypertension-associated CVD risk is optimally detected in women by the current hypertension definition in European guidelines.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): University of Bergen