bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5557Cardiac autoantibodies and ventricular arrhythmias in patients with biopsy-proved myocarditis
Authors: Peretto G , Caforio A L P , Marcolongo R , Rizzo S , Thiene G , Basso C , Della Bella P , Sala S 
Published: October 2019

Abstract

Background
Cardiac autoandibodies have been associated with dilatative cardiomyopathy in subjects with inflammatory heart disease. However, their association with ventricular arrhythmias (VA) in patients with autoimmune myocardits has never been investigated so far.

Purpose
To evaluate the association between cardiac autoantibodies and both baseline and FU VA in patients with a de novo diagnosis of biopsy-proved autoimmune myocarditis.

Methods
We enrolled 44 consecutive patients (59% males, mean age 44±13y, mean LVEF 50±10%) presenting with symptomatic VA (VF, VT, NSVT, >1ehz746.0501 PVC/24h) and a de novo diagnosis of biopsy-proved autoimmune myocarditis according to the ESC criteria. Serum anti-heart (AHA) and anti-intercalated disk (AIDA) autoantibodies were assessed at a referral center at the time of the index hospitalization. Complete baseline data, including ECG, arrhythmia telemonitoring, echocardiogram, cardiac magnetic resonance (CMR) and blood biomarkers (T-troponin, NT-proBNP) were collected. The endpoint of the study was the occurrence of major VA (VT, VF, appropriate ICD shocks) at 5y FU, as assessed by 2/y Holter ECG monitoring and (when applicable) ICD interrogation.

Results
At baseline evaluation, 24 (55%) and 23 patients (52%) were AHA+ and AIDA+, respectively. Clinical onset with major VA was documented in 24 patients (55%): 9 AHA+ vs. 15 AHA- (p=0.017) and 13 AIDA+ vs. 11 AIDA- (p=0.547). At presentation, no significant differences were found between AHA+ vs. AHA- and AIDA+ vs. AIDA- patients in LVEDV, LVEF, T-troponin and NT-proBNP values (all p=n.s.). Positive (2/3) Lake Louise criteria at CMR were found in 33 patients (75%; p=n.s. among different subgroups). Before discharge, 27 subjects (61%) underwent ICD implant. Optimal medical treatment was started in all of the cases, with no significant differences in betablockers, antiarrhythmic drugs and immunsuppressive therapy, among different subgroups (all p=n.s.). Overall, 10 patients (23%) experienced major VA by 5y FU: 3 AHA+ vs. 7 AHA- (p=0.147) and 9 AIDA+ vs. 1 AIDA- (p=0.013). In particular, 18 events were documented (range 1–3 episodes per patient at 2.2±1.7 y mean FU), including 3 VT episodes and 15 appropriate ICD shocks. Taking together baseline and FU data, multiple (>1) major VA episodes occurred in 8 patients: 3 AHA+ vs. 5 AHA- (p=0.436) and 8 AIDA+ vs. 0 AIDA- (p=0.005). Of note, 3/3 AHA+ patients with multiple major VA espisodes were also AIDA+ (double positivity).

Conclusion
In biopsy-proved autoimmune myocarditis presenting with VA, major VA occurrence by 5y FU, as well as arrhythmias recurrences, are more common among AIDA+ patients. By converse, none of the isolated AHA+ cases experienced multiple episodes of major VA. These findings may suggest distinct pathophysiological mechanisms involving the different molecular targets of cardiac autoimmunity.

Acknowledgement/Funding
None
P5567Clinical characteristics, diagnosis and risk stratification of pulmonary hypertension in severe tricuspid regurgitation and implications for transcatheter tricuspid valve repair
Authors: Lurz P , Rommel K P , Orban M , Besler C , Braun D , Schlotter F , Noack T , Desch S , Borger M , Massberg S , Hausleiter J , Thiele H 
Published: October 2019

Abstract

Objective
To assess the role of pulmonary hypertension (PHT) in severe tricuspid regurgitation (TR) and its implications for transcatheter tricuspid valve repair (TTVR).

Background
PHT patients are often excluded from surgical TR therapies. TTVR with the MitraClipTM technique is a novel treatment option for these patients.

Methods
A total of 164 patients at high surgical risk (median age 78 years) and TR underwent TTVR at two centers. Seventy patients were grouped as iPHT+, defined as invasive systolic pulmonary artery pressure (PAPs) >50 mmHg. Patients were similarly stratified according to echocardiographic PAPs (ePHT). The occurrence of the combined clinical endpoint (death, heart failure hospitalization, reintervention) was investigated.

Results
iPHT+ patients were at higher pre-operative risk (p<0.01), had more severe symptoms (p=0.01), higher NT-pro-BNP levels (p<0.01) and more impaired biventricular function (left: p=0.03; right: p=0.02).
Procedural TTVR success was achieved in 86 vs. 82% in iPHT+ and iPHT- patients respectively (p=0.52). Tricuspid valve effective regurgitant orifice area (EROA) was reduced from 0.49 cm2 to 0.20 cm2 (p<0.01) similarly in both groups.
While iPHT+ conveyed risk (HR 1.7 (95% CI 1.1–2.8), p=0.03) for the occurrence of the clinical endpoint, ePHT+ paradoxically conveyed protection (HR 0.61 (95% CI 0.36–0.98), p=0.04). This discrepancy was explained by the highest event rates in patients with iPHT+/ePHT- (n=28). Conversely, iPHT+/ePHT+ patients had comparable outcomes to iPHT- patients.

Conclusions
PHT in TR is associated with worse clinical status and advanced HF, but not procedural failure. Symptomatic benefit can be achieved irrespective of PHT status by TTVR. Although echocardiographic PHT diagnosis is unreliable, the combination of echocardiographic and invasive assessment may identify ideal candidates for TTVR among PHT patients.
P5571MitraClip implantation impairs functional echocardiographic parameters of the left atrium in patients with moderate to severe mitral regurgitation
Authors: Meindl C , Hamerle M , Rogalski D , Paulus M , Schach C , Maier L , Debl K , Birner C , Unsoeld B 
Published: October 2019

Abstract

Background
MitraClip implantation induces hemodynamic unloading and reverse remodeling of the left atrium (LA) and the left ventricle (LV). However little data exist concerning the effects of MitraClip implantation on LA and LV strain reflecting LA and LV function.

Methods and results
From August 2017 to September 2018 62 patients with moderate to severe mitral regurgitation were prospectively enrolled in our single-center RETORT-MR trial (Regensburg Trial on TMVR Techniques in Mitral Regurgitation). All included patients were treated using the MitraClip procedure. Two dimensional speckle tracking echocardiography (2DSTE) of the LA as well as of the LV could be performed in 35 patients with follow-up 2DSTE at four weeks and/or three months after MitraClip implantation. In 25.7% of patients primary mitral regurgitation was present (n=9) and in 74.3% of subjects a secondary entity of mitral regurgitation had been diagnosed (n=26). 57.1% of patients (n=20) suffered from heart failure with preserved ejection fraction (HFpEF) and 42.9% of patients (n=15) had heart failure with reduced ejection fraction (HFrEF). Global longitudinal strain (GLS) was reduced at baseline (−15.3%), at four-week (−14.5%, n=27) and at three-month follow-up (−13.9%, n=28) with no statistically significant differences indicating a sustained mechanical impairment of LV. In contrast significant deterioration was observed in the peak atrial longitudinal strain (PALS) representing LA reservoir function (15.3% at baseline vs. 11.8% at four-week follow-up, n=25, p=0.015 and 16.0% at baseline vs. 13.2% at three-month follow-up, n=25, p=0.03). Similarly to LA reservoir function LA booster function indicating left atrial active contraction was significantly reduced after MitraClip implantation (12.5% at baseline vs. 8.0% at four-week follow-up, n=10, p=0.028). Contrary to LA functional parameters LA size did not change significantly after MitraClip implantation (LA volume index at baseline 74.5 ml/m2 vs. 70.1 ml/m2 at four-week follow-up, n=27, p=0.489).

Conclusion
The present study revealed a deterioration of LA functional parameters (LA reservoir and LA booster function) after MitraClip insertion. It is known that severe mitral regurgitation can cause structural changes of the LA such as fibrosis. MitraClip insertion leads to a significant reduction of regurgitant volumes but structural changes of the LA may not be reversible. In addition MitraClip implantation increases afterload in the LA potentially explaining the observed deterioration of LA functional parameters.

Acknowledgement/Funding
None
P5573Disproportionate functional mitral regurgitation: advancing a conceptual framework from bench to bedside
Authors: Bartko P E , Heitzinger G , Arfsten H , Pavo N , Spinka G , Andreas M , Mascherbauer J , Hengstenberg C , Huelsmann M , Goliasch G 
Published: October 2019

Abstract

Introduction
A recently proposed conceptual framework seeks to rearrange the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) cut-offs according to left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) in functional mitral regurgitation introducing “disproportionate FMR” to describe clinically meaningful FMR. The conceptual framework, however, remains hypothetical.

Purpose
To test the significance of disproportionate FMR.

Methods
Data of 291 heart failure patients with reduced ejection fraction (HFrEF) under guideline directed therapy were embedded into this conceptual framework (Figure 1A). The black line represents the relationship when the degree of FMR is proportionate to LVEDV with a regurgitant fraction of (RegFrac) of 50%. The dashed lines represent the degree of uncertainty determined by the imprecision inherent to the measurement of RegFrac defined as 2SD for inter- and intraobserver variability by Bland-Altmann analysis (equals ±6.6%). Cox-regression and Kaplan-Meier analysis were applied to assess the association between FMR proportionality and mortality.

Results
Median age was 68 years (IQR 61–75), 77% were male. Median LVEF was 25% (IQR 18–33) and LVEDV was 214ml (IQR 165–267). Disproportionate FMR was present in 71 patients (24%) (red dots Figure 1A) with a median EROA of 0.26cm2 (IQR 0.18–0.34) and a median RegVol of 42ml (IQR 28–52), proportionate FMR (yellow dots Figure 1 A) in 81 patients (28%) with a median EROA of 0.12cm2 (IQR 0.09–0.17) and a median RegVol of 18ml (IQR 14–27). During 7-years follow-up, 166 patients died. Disproportionate FMR was associated with excess mortality compared to patients with non-severe FMR (HR 1.97, 95% CI 1.04–0.71, P<0.001), whereas proportionate FMR was not associated with increased long-term mortality (HR 1.04, 95% CI −1.53–0.71, P=0.83, Figure 1B).
Figure 1. Panel A and B

Conclusion
Every fifth patient suffers from disproportionate FMR which conveys a two-fold increased risk of mortality. Disproprtionate FMR corresponds to an EROA of roughly 0.3cm2 and a RegVol of 45ml – the unifying intersection between ESC and ACC/AHA guidelines to define severe FMR. The RegFrac provides a measure proportionated to left ventricular size and function supporting its use to define clinically relevant FMR. However, RegFrac is subject to compound error due to imputation of multiple measurements limiting its use as the leading contender for FMR grading. Regardless of the term used to describe clinically significant FMR, the conceptual framework emphasizes the unmet clinical need for recalibrated cut-offs for FMR severity condensed to an algorithm that combines the strengths of several measurements of FMR severity in an integrated manner.
P5574Prognostic impact of left atrial function following transcatheter mitral valve repair
Authors: Ledwoch J , Fellner C , Poch F , Olbrich I , Thalmann R , Kossmann H , Dommasch M , Dirschinger R , Stundl A , Laugwitz K L , Kupatt C , Hoppmann P 
Published: October 2019

Abstract

Background
Left atrial (LA) function predicts clinical outcome in a variety of cardiovascular diseases. However, limited data is available in the setting of mitral regurgitation (MR).

Purpose
The aim of the present study was to assess potential changes in LA ejection fraction (LA-EF) and its prognostic value in patients following transcatheter mitral valve repair using the mitraclip.

Methods
A total of 88 consecutive patients undergoing mitraclip implantation with complete echocardiography at baseline and follow-up between 3 and 6 months post-procedure were enrolled.

Results
LA-EF improved in 58% of the population. Change in LA-EF was associated with residual MR, residual transmitral gradient and left ventricular ejection fraction (LV-EF) changes. Compared to their counterparts, patients with residual MR ≥ grade 2 (−6% [−9 to 1%] vs. 4% [−5 to 15%]; p=0.05) and with residual transmitral gradient ≥5 mmHg (−2% [−9 to 9%] vs. 5% [−4 to 16%]; p=0.03) showed a decline in LA-EF, respectively. Furthermore, LA-EF significantly correlated with changes in LV-EF (r=0.40; p=0.001). With regards to clinical outcome, heart failure symptoms as assessed by NYHA class were more severe in patients with worsened LA-EF at follow-up. Finally, LA-EF change was identified as independent predictor of all-cause mortality (HR 0.94 [0.90–0.98]; p=0.008).
Kaplan-Meier estimates for survival

Conclusion
The present analysis showed changes in LA function in patients undergoing mitraclip implantation to be associated with important measures including residual MR, elevated transmitral gradient and LV function. Importantly, LA function alterations represent a strong predictor for all-cause mortality.
P5581In patients with aortic valve regurgitation, left ventricular geometry and strain, more than pulmonary artery systolic pressure, affect right ventricular function
Authors: Abdelgawad H , Abdelhay M A , Ashour S , Shehata M , Previato M , Cucchini U , Muraru D , Badano L 
Published: October 2019

Abstract

Background
Left ventricular (LV) overload due to aortic valve (AR) regurgitation may affect right ventricular (RV) function. Elevation of pulmonary artery pressures secondary to isolated AR is not common. Thus, the effects of chronic LV overload due to AR on RV function remains to be clarified.

Purpose
To assess the determinants of RV dysfunction in chronic AR.

Methods
We studied 36 patients with moderate or severe AR (53±18 years, 81% were men). We used 3D echocardiography to acquire multi-beat, full-volume data sets of LV and RV and to measure volumes and EF. RV fractional area change (FAC) was calculated. LV global longitudinal strain (GLS) and RV peak longitudinal strain (RVLS) were assessed by 2D speckle tracking echocardiography.

Results
RV EF and RV FAC were 40±6% and 34±9%. LV GLS and peak RVLS were reduced (Table). LV EDVi showed negative correlations with RV function (RV EF: r=−0.545, p<0.001; RV FAC: r=−0.816, p<0.001). LV sphericity index showed negative correlations with RV function (RVFAC: r=−0.608, P=0.001; RV EF: r=−0.469, P=0.004). Moreover, LV GLS and RVLS correlated positively with RV function (FAC: for GLS: r=0.475, p=0.003 and for RVLS: r=0.389, p=0.019) (RV EF: for GLS: r=0.526, p=0.001 and for RVLS: r=0.475, p=0.003). On multivariable linear regression analysis, LV EDVi, LV sphericity index, LV GLS and peak RVLS were found to be the only independent predictors of RV EF and FAC.
Left and right ventricular volumes and function in patients with chronic aortic regurgitation AR (n=36) Control (n=25) p value LV end-diastolic volume (ml/m2) 106±36 56±8 <0.001 LV end-systolic volume (ml/m2) 50±28 22±4 <0.001 LV ejection fraction (%) 54±10 60±4 <0.001 LV sphericity index 0.53±0.11 0.38±0.08 <0.001 Pulmonary artery systolic pressure (mm Hg) 27±8 RV end-diastolic volume (ml/m2) 59±12 35±7 <0.001 RV end-systolic volume (ml/m2) 31±9 17±3 <0.001 RV ejection fraction (%) 40±6 50±4 <0.001 RV fractional area change (%) 34±9 44±6 <0.001 LV GLS (%) −18±3 21±1 <0.001 Peak RVLS (%) −26±5 −31±3 <0.001

Conclusions
RV remodeling in chronic LV overload due to AR occurs independent on PASP values. LV size, shape and strain are the only independent predictors of RV function.
P5589Patterns of extended apixaban treatment for unprovoked venous thromboembolism in routine clinical practice
Authors: Keshishian A , Lee T , Wygant G , Rosenblatt L , Hlavacek P , Mardekian J , Wiederkehr D , Sah J , Sun X , Luo X 
Published: October 2019

Abstract

Background
Current CHEST guidelines recommend extended anticoagulation therapy without a scheduled stop in patients with unprovoked VTE and low bleeding risk following initial anticoagulation treatment of 3 months. AMPLIFY-EXT suggests that extended treatment with apixaban beyond 6 months reduces the risk of recurrent VTE without increasing major bleeding rates. This study evaluated patterns of extended apixaban treatment among unprovoked VTE patients.

Methods
Utilizing 4 US commercial claims databases, this retrospective study assessed unprovoked VTE patients (VTE events that were not preceded by a provoked factor or event) who initiated apixaban within 30 days from the VTE event (01SEPT2014–31MAR2018). Patients were required to have ≥6 months continuous apixaban treatment (without a gap of >30 days). Characteristics of patients treated beyond 6 months and those who discontinued at 6 months were evaluated respectively. An additional analysis was conducted to assess proportion with apixaban treatment for ≥3 months.

Results
Among unprovoked VTE patients, 60.8% and 34.6% had apixaban treatment for ≥3 and ≥6 months, respectively. Of those treated for ≥6 months (3,015 after applying additional selection criteria), 75.6% continued treatment beyond 6 months and 24.4% discontinued at 6 months. Younger age and having thrombophilia were associated with a higher likelihood of treatment beyond 6 months (Table). Among patients with treatment beyond 6 months, 7.5% of patients switched from apixaban 5mg to 2.5mg, 36.5% discontinued therapy, and 1.1% switched to another oral anticoagulant (Figure).
Baseline characteristics Variables Discontinued at 6 months Continued treatment beyond 6 months P-value N=735 N=2,280 Age, Mean (SD) 63.0 (15.2) 61.7 (14.3) 0.037 Gender – Female, n (%) 307 (41.8%) 892 (39.1%) 0.203 Setting of Unprovoked VTE Event – Ambulatory, n (%) 592 (80.5%) 1,834 (80.4%) 0.950 VTE Diagnosis – DVT Only, n (%) 494 (67.2%) 1,498 (65.7%) 0.452 Deyo-Charlson Comorbidity Index, Mean (SD) 1.3 (1.9) 1.3 (1.8) 0.305 Thrombophilia, n (%) 54 (7.3%) 296 (13.0%) <0.001 Coagulation Defects, n (%) 38 (5.2%) 153 (6.7%) 0.136 Baseline Bleed, n (%) 77 (10.5%) 210 (9.2%) 0.309
KM curve after 6 months of apixaban use

Conclusion
Among unprovoked VTE patients treated with apixaban, a large proportion did not receive ≥3 months of treatment. Although AMPLIFY-EXT showed beneficial effects of extended treatment, the percentage of patients with ≥6 months of treatment was low. Thrombophilia was the only meaningful predictor of treatment beyond 6 months.

Acknowledgement/Funding
This study was funded by Bristol-Myers Squibb and Pfizer Inc
P5626The clinical impact of the angle of OCT detected irregular protrusion after primary PCI at the STEMI culprit lesions
Authors: Kyodo A , Soeda T , Kamon D , Hashimoto Y , Ueda T , Watanabe M , Saito Y 
Published: October 2019

Abstract

Background and introduction
The percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) shows worse clinical outcomes than that for stable angina. As the one of the reasons, a recent optical coherence tomography (OCT) registry showed that the presence of irregular protrusion (IP)after coronary stenting was the worse predictor of 1-year device-oriented clinical end points. However, the impact of the quantitative findings on IP has not been well investigated in ACS patients.

Aim
To investigate the clinical impact of the post stent OCT findings, especially IP, detected by OCT after coronary stenting in ACS patients.

Methods
Consecutive 256 ACS lesions treated with OCT-guided PCI in our Medical University Hospital from January 2013 to November 2016 was retrospectively analyzed. In 256 lesions, 173 lesions were enrolled which had ST-elevation acute myocardial infarction (STEMI) with the onset to recanalization time within 720 minutes. In 170 lesions, the OCT images were available. In OCT image, IP was detected in 140 lesions (82.3%). Quantitative analysis of IP in post-procedure OCT imaging was observed to identify the OCT predictors for clinical endpoint including cardiac death, target vessel revascularization ant stent thrombosis in 1 year after index PCI.

Result
In post-procedure OCT findings, stent edge dissection was detected in 32.4% of lesions. Incomplete stent apposition was detected in 74.1%. Maximum angle of irregular protrusion was 194±86 degree and the incidence of maximum IP angle >180 degree was 52.9%. Maximum height of IP was 0.26±0.11mm. Small minimal stent area, defined as a lesion with minimal stent area <5.0 mm2 in a drug-eluting stent or <5.6 mm2 in a bare metal stent, was observed in 32.4% of lesions. Maximum IP angle and that of >180degree was significantly associated with the clinical endpoint (p=0.0259 and 0.0429, respectively).

Conclusion
In STEMI patients, IP was frequently observed in post-procedure OCT imaging during primary PCI. The maximum angle of IP was significantly associated with the clinical end points. The prognostic impact of maximum IP angle in STEMI patient needs further investigations.
P5635Predictive ability of lipdic burden for FFR-derived physiological measures: insights from near-infrared spectroscopy imaging analysis
Authors: Murai K , Kataoka Y , Hirayama A , Hosoda H , Nakashima T , Honda S , Fujino M , Nakao K , Yoneda S , Otsuka F , Nishihira K , Kanaya T , Asaumi Y , Noguchi T , Yasuda S 
Published: October 2019

Abstract

Background
Fractional flow reserve (FFR) has enabled to physiologically assess the myocardial ischemia of coronary artery with intermediate stenosis. Mechanistically, not only the severity of coronary stenosis but also the extent of maximal vasodilatation within the entire coronary artery potentially affects this physiological measure. Since the accumulation of lipidic materials within vessel wall increases vascular stiffness via inducing endothelial dysfunction, the presence of lipidic atheroma burden may affect physiological measures.

Purpose
To investigate the association of FFR with lipidic coronary atheroma by near-infrared spectroscopy/intravascular ultrasound (NIRS/IVUS) imaging, which quantitatively visualize lipidic burden in vivo.

Methods
We analyzed 61 coronary arteries (LAD/RCA/LCX=52/5/4) with FFR≤0.80 in 59 stable coronary artery disease subjects receiving PCI. Following FFR measurement, NIRS/IVUS imaging was conducted to evaluate the extent of atheroma burden (maximum percent plaque area=max%PA) and lipidic materials (lipid core burden index within the entire vessel=LCBIvessel). The analyzed vessels were stratified according to FFR: definite FFR group (FFR≤0.74, n=34) and gray-zone FFR group (0.75≤FFR≤0.80, n=27).

Results
NIRS/IVUS imaging analysis (analyzed longitudinal length=77±7mm) was more likely to exhibit a significantly higher LCBIvessel and a larger max%PA in the definite FFR group (Table). Of note, FFR was significantly correlated to LCBIvessel (ρ=-0.299, p=0.02), but not max%PA (ρ=-0.255, p=0.07). Multivariate analysis demonstrated that an independent determinant of FFR≤0.74 was LCBIvessel [odds ratio (OR)=1.016, 95% confidential interval (CI)=1.002–1.031, p=0.02], but not max%PA [OR=1.084, 95% CI=0.994–1.182, p=0.07]. Area under the receiver-operating characteristic curve analysis elucidated that the addition of LCBIvessel to angiography- and IVUS-derived measures resulted in a significant improvement for detecting FFR≤0.74 (picture).
Definite FFR Group (FFR≤0.74, n=34) Gray-zone FFR Group (0.75≤FFR≤0.80, n=27) p value Fractional flow reserve (FFR) 0.68±0.05 0.78±0.02 <0.01 Percent diameter stenosis (%) 56.2±13.1 51.9±7.8 0.16 Maximum percent plaque area (max%PA, %) 84.3±6.9 79.9±7.2 0.01 Lipid core burden index within the entire vessel (LCBIvessel) 102.0±60.2 65.6±51.6 0.01
ROC analysis for detecting FFR≦0.74

Conclusion
The propagation of lipidic burden associates with the physiological measures. The present findings indicate the possibility that vessel characteristics or instability may have influence for causing ischemia on the coronary artery.