bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6488Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation
Authors: Hinojar Baydes R , Garcia Martin A , Gonzalez-Gomez A , Martin-Plaza M , Sanroman-Guerrero M , Pascual-Izco M , Alonso-Salinas G , Lorente A , Jimenez-Nacher J J , Zamorano J , Fernandez Golfin C 
Published: October 2019

Abstract

Background
Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function that can allow detection of subclinical RV dysfunction

Purpose
This study was aimed to evaluate the prognostic value of RV strain in stable patients with significant TR, in comparison with conventional parameters of RV systolic function.

Methods
Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (`S) and with STE derived peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure

Results
A total of 70 patients were included (mean age was 74±8 years, 71% females). 5 patients were excluded due to poor acoustic window. According to ethyology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean values of RV function parameters are shown in the table. During a median follow up of 18 months [IQR: 4–28], 37% of the patients reached the combined end point (n=15 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died). Patients with events showed impaired RV-GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes.
Mean ± SD Mean ± SD Mean ± SD HR (95% confidence interval) P value in Cox regression analysis in all patients in patients with events in patients without events TAPSE 20±5 20±7 21±5 0.97 (0.9–1.06) 0.56 DTI S wave 10.5±2 11±3 10±2 1.08 (0.87–1.35) 0.49 FAC 44±7 43±6 45±8 1.04 (0.97–1.1) 0.22 FW longitudinal strain (FW-LS) 18±5 −16±5* −20±5 0.91 (0.84–0.98) 0.02 Global longitudinal strain (GLS) 19±4 −16±4* −21±4 0.87 (0.81–0.95) 0.001

Conclusion
In patients with asymptomatic TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters may be included in the serial evaluation of these patients.
P6490Paradoxycal restricted motion in diastole is a frequent finding in mitral valve prolapse/dystrophy patients
Authors: Le Tourneau T , Cueff C , Piriou N , Capoulade R , Le Scouarnec S , Merot J , Schott J J 
Published: October 2019

Abstract

Background
Filamin-A mitral valve prolapse/dystrophy (FLNA-MVP) phenotype associates MVP and a paradoxical restricted motion in diastole.

Purpose
We aim to assess the association of mitral valve prolapse to restricted motion in diastole in MVP patients (restricted MVP).

Methods
We prospectively enrolled 475 MVP probands (64±13 years) and controls relatives. Patients underwent a clinical examination and a comprehensive echocardiographic analysis of mitral valve apparatus.

Results
Among 475 consecutive probands, 48 (10.1%, 95% CI 7.7–13.3) had both a MVP and a doming aspect in diastole. Patients with restricted MVP exhibited shorted chordae tendinaes, and a shorter distance between papillary muscle tip and mitral annulus. Compared with controls, mitral valve leaflets were lenghtened, thickened and mitral valve annulus was enlarged. The prevalence of polyvalvular disease and bicuspid aortic valve was not increased in restricted MVP patients compared with conventional MVP. Familial form of restricted MVP was identified even in the absence of Filamin-A mutation.

Conclusion
Restricted MVP is a quite frequent finding in MVP patients and is associated with unique features of the MV apparatus. Restricted MVP can be regarded as a third type of MVP beside myxomatous Barlow disease and fibro-elastic deficiency MVP.

Acknowledgement/Funding
PHRC I Mitral, Fédération Française de Cardiologie, Fondation Coeur et recherche
P6496Endovascular reconstruction from aortic valve to aortic arch by one-piece valved-fenestrated-bifurcated endografting in animal experiments
Authors: Jing Z P , Feng J X , Bao X H , Li T , Zhao Y , Li Y , Li Z J , Liu J , Wu M W , Zhao Z Q , Lu Q S , Bao J M , Feng R , Zhou J 
Published: October 2019

Abstract

Aims
The possibility of endovascular reconstruction of aortic valve, sinus of Valsalva, and ascending aorta by a minimal-invasive single endograft has not been proven in vivo. Combining our own long-term experiences from transcatheter aortic valve replacement (TAVR) and Thoracic Endovascular Repair (TEVAR) for ascending and arch dissection, we designed the special endo-graft: a novel one-piece valved-fenestrated-bifurcated endografting, and tried to endovascularly reconstruct the area from Left ventricular outflow tract to aortic arch in animal experiments.

Methods and results
For 20 healthy adult female pigs weighed between 62.3±2.2 kilograms, we did aortic compute tomography angiography (CTA) examinations and measured morphologic parameters of aortic root. Then we accordingly customized the valved-fenestrated-bifurcated endograft. The endograft was delivered through transapical access and endovascularly reconstructed the segment from aortic valve to proximal part of aortic arch. The overall technical success rate was 95% because of one case of delivery system failure. Instant transesophageal echography (TEE) and aortic CTA confirmed ideal position of the endograft, satisfactory function of aortic valve, and the patency of coronary arteries in all subjects. During follow-up, 12 subjects were sacrificed according to the plan and seven were followed up for 8.1±3.6 months. There was one unplanned death of cardiac infection (unplanned mortality: 5.3%). Follow-up re-examinations (aortic CTA, cardiac ultrasound, and electrocardiogram) found no adverse events. Among 12 sacrificed subjects, there was no evidence of fenestrations alignment lost and no myocardial ischemia according to the pathological analysis.

Conclusion
The novel one-piece valved-fenestrated-bifurcated endografting might be feasible for minimal-invasive reconstruction of aortic root in animal models, thus provided a prospect to simultaneously treat pathologies involving aortic valve and aortic root in endovascular way.
P6512Prognosis of patients with chronic coronary artery disease undergoing to percutaneous coronary intervention (5 years follow-up)
Authors: Shugushev Z , Maximkin D A , Chepurnoy A , Safonova O , Mambetov A , Faibushevich A , Baranovich V , Veretnik G , Sturov N 
Published: October 2019

Abstract

Aim
To evaluate the prognosis of patients with chronic ischemic heart disease, who underwent percutaneous coronary interventions (PCI) and were only on optimal medical therapy (OMT).

Methods
Measurement of the fractional flow reserve (FFR) was performed for 432 patients. According to the measurement results, all patients were randomized in 2 groups (1:2): Group I (n=168) – included patients, who had a FFR <0.8 and were followed by PCI; Group II (n=264) – included patients with FFR >0.8 - received OMT and were under monitoring for to 5 years. Inclusion criteria: stable angina II-III FK, post-MI, silent myocardial ischemia. Concomitant diseases: diabetes mellitus (19.2%), multifocal atherosclerosis (21%), hypertension (27%), post-MI (24%), PCI in previously (15%). According to angiography, 44% had a one-vessel disease, 35% had two-vessel diseases, and 21% had a three-vessel disease. Primary endpoints: MACE (death, MI, repeated interventions). Observation periods: 6, 12, 24, 36, 48, 60 months. Long-term results were evaluated by repeated coronary angiography and measurement of FFR.

Results
During 6 and 12 months there were not a single case of MACE in both groups. By the 18th month, 7% of cases conversion from the OMT to the PCI group on the basis of FFR measurements was recorded. By the 24th and 36th months in the OMT, PCI group was performed in 12 and 21% of patients, respectively. By the 48th and 60th month, the number of such patients was 24 and 31%, respectively. Among the total number of performed PCI in Group II, 20% of them were due to unstable angina. Thus, over the entire observation period, 149 patients from group II (56%) had PCI performed. The frequency of MACE in group I to 36 months was 2.4%, and in group II - 18%, respectively (p<0.001). By the end of the observation period, the frequency of MACE in groups I and II was 4.2 and 31%, respectively (p<0.001). Multifactor analysis showed that with SYNTAX score>28, multifocal atherosclerosis, diabetes mellitus, MACE was significantly more frequent and there was a need to perform PCI in the long-term period.

Conclusions
The prognosis of patients with chronic coronary artery disease undergoing percutaneous coronary intervention, performed using measurement of FFR, is significantly better than in patients who were only on optimal medical therapy.

Acknowledgement/Funding
Russian Academic Excellence Project 5-100
P6515Balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis
Authors: Denas G , Zoppellaro G , Badawy M R , Squizzato A , Tarantini G , Pengo V 
Published: October 2019

Abstract

Introduction
Balloon pulmonary angioplasty (BPA) is a percutaneous treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH) judged inoperable or with persistent symptoms after surgery.

Purpose
We performed a systematic review of the literature to better understand the effectiveness and safety of balloon pulmonary angioplasty.

Methods
PubMed and EMBASE were searched for studies reporting BPA results in patients with CTEPH. Differences in clinical and hemodynamic parameters including 6-minute walking distance, NYHA class, mean PAP, pulmonary vascular resistance, and cardiac output, before and after the procedure were analyzed. Weighted mean proportion and 95% confidence intervals (CIs) of adverse events were calculated.

Results
Of the 1084 potentially eligible studies, 13 were included in the final analysis, yielding on overall cohort of 676 patients. BPA was associated with a reduction in mean pulmonary artery pressure (median: from 43 to 30 mmHg), reduction in pulmonary vascular resistance (median: from 10.22 to 5.00 Woods Units), increase in cardiac index (median: from 2.45 to 2.72 l/min/m2), and improvement of 6-minute walking distance (median: from 328 to 442 meters). Estimated peri-procedural mortality was 2.2% of patients (95% CI 0.7–4.4) with a low risk of publication bias. Mortality rate tends to be higher in older studies and this is consistent with the progressive experience gathered by operators. Reperfusion and pulmonary vessel injuries occurred in 9.5% (95% CI 2.7–19.6) and 2.5% (95% CI 0.8–5.0) of the total BPA sessions, respectively, with on overall high risk of publication bias.
Haemodynamic parameters and 6-minute wal

Conclusions
Our findings suggest that BPA in CTEPH patients is an effective and safe treatment option in inoperable patients or patients with persistent-recurrent symptoms after surgery. Balloon pulmonary angioplasty might be considered as a second line-treatment in patients with chronic thromboembolic pulmonary hypertension not amenable for surgery.
P6516The association between prior coronary artery bypass graft surgery and outcome after percutaneous coronary intervention (PCI): an observational study of 123,780 patients
Authors: Beirne A , Rathod K , Jain A , Mathur A , Wragg A , Smith E J , Jones D A , Kalra S , Malik I , Redwood S , MacCarthy P , Bogle R , Firoozi S , Dalby M 
Published: October 2019

Abstract

Background
Limited information exists regarding procedural success and clinical outcomes in patients with previous CABG undergoing percutaneous coronary intervention (PCI). We sought to compare outcomes in patients undergoing PCI with or without previous coronary artery bypass grafts (CABG).

Methods
This was an observational cohort study of 123,780 consecutive PCI procedures from the Pan-London (United Kingdom) PCI registry, from January 2005 to December 2015. The primary end-point was all-cause mortality at a median follow-up of 3.0 years (interquartile range 1.2–4.6 years).

Results
12,641 (10.2%) patients had a history of previous CABG, of whom 29.3% (n=3,703) underwent PCI to native vessels and 70.7% (n=8,938) to bypass grafts. There were significant differences in the demographic, clinical, and procedural characteristics of these groups. The risk of mortality during follow-up was significantly higher in patients with prior CABG (23.2%) (p=0.0005) compared to patients with no history of prior CABG (12.1%) and was seen for patients who underwent either native vessel (20.1%) or bypass graft PCI (24.2%, p<0.0001). However, after adjustment for baseline characteristics, there was no significant difference in outcomes seen between the groups when PCI was performed in native vessels in patients with previous CABG (HR 1.02, 95% CI 0.77–1.34; P=0.89) but a significant increase in mortality among patients with PCI to bypass grafts (HR 1.33 95% CI 1.03–1.71, P=0.026). This was seen after multivariate adjustment and propensity matching.
Figure 1. Kaplan-Meier Curves

Conclusion
Patients with prior CABG are older, with a greater comorbid burden and more complex procedural characteristics, but after adjustment for these differences clinical outcomes are similar to patients undergoing PCI without prior CABG. In these patients, native vessel PCI was associated with better outcomes compared to the treatment of vein grafts.
P6528Impact of chronic kidney disease on clinical outcomes in patients with unprotected left main coronary artery disease: insights from a large-sized all-comers registry
Authors: Kim D W , Her S H 
Published: October 2019

Abstract

Aims
Clinical outcomes according to the status of renal insufficiency were not fully evaluated in patients with significant left main coronary artery disease (LMCAD).

Methods and results
The current study analyzed 4894 patients with unprotected LMCAD enrolled in the multicenter IRIS-MAIN registry. Renal insufficiency was graded according to the baseline renal function (eGFR). The primary clinical outcome was major adverse cardiocerebrovascular event (MACCE), defined as a composite of death, myocardial infarction, stroke, and any revascularization. At baseline, 3824 (78%) had preserved renal function (eGFR ≥60 ml min–1 1.73m–2), 838 (17%) had moderate renal dysfunction (eGFR of ≥30 and <60), and 232 (5%) had severe renal dysfunction (eGFR <30). At 2 years, the rates of MACCE were significantly higher in patients with lower levels of eGRF (9.1% in eGRF ≥60, 16.0% in eGFR of ≥30 and <60, and 36.2% in eGRF <30, respectively, P<0.001). After multivariable adjustment, as compared with patients with eGFR ≥60, the hazard ratios (HR) for MACCE proportionally increased for patients with eGFR of ≥30 and <60 (HR 1.46, 95% CI 1.18–1.79) and for those with eGFR <30 (HR 3.39, 95% CI 2.61–4.40). The adjusted risks for MACCE was similar between percutaneous coronary intervention (PCI) and coronary-artery bypass grafting (CABG) in patients with preserved and moderate renal dysfunction. However, in patients with severe renal dysfunction, PCI was associated with a significantly higher risk of MACCE compared to CABG (38.5% vs. 24.7%, HR 1.80, 95% CI 1.03–3.13, P=0.04).
Crude and Adjusted Risk of Primary Composite Outcome After PCI and CABG, According to the Status of Baseline Renal Function Patient Groups 2-Year Event Rate, n (%) Crude Risk Adjusted Risk* Revascularization type HR 95% CI P value HR 95% CI P value PCI CABG (reference) All patients 306/2825 (10.8) 144/1453 (9.9) 1.160 0.952–1.414 0.141 1.265 1.036–1.546 0.021 Subgroups by baseline eGFR   Preserved renal function (eGFR >60) 190/2289 (8.3) 89/1098 (8.1) 1.080 0.840–1.389 0.549 1.125 0.874–1.449 0.360   Moderate renal dysfunction (eGFR ≥30 and <60) 71/419 (169%) 37/282 (13.1%) 1.394 0.936–2.074 0.102 1.276 0.854–1.909 0.234   Severe renal dysfunction (eGFR <30) 45/117 (38.5%) 18/73 (24.7%) 1.997 1.154–3.458 0.014 1.798 1.032–3.130 0.038

Conclusions
The degree of renal insufficiency was proportionately associated with worse clinical outcomes in patients with LMCAD. In patients with severe renal dysfunction of eGFR of <30, PCI was associated with a higher risk of MACCE as compared with CABG.

Acknowledgement/Funding
This work was supported by a grant from the CardioVascular Research Foundation, Seoul, Korea (2015-09).
P6529Safety of emergency pretreatment regimen for contrast allergy before percutaneous coronary intervention for ST-elevation myocardial infarction
Authors: Jha K , Berger A , Blankenship J 
Published: October 2019

Abstract

Background
Primary percutaneous coronary intervention (PPCI) is the best treatment for ST-elevation myocardial infarction (STEMI). However, patients with prior contrast reactions may not receive PCI due to concern over a recurrent contrast reaction.

Purpose
To determine the clinical efficacy of emergency pretreatment regimens for contrast allergy in STEMI patients undergoing PPCI.

Methods
We retrospectively identified all individuals with a history of contrast allergy who presented with STEMI, were pretreated for contrast allergy, and underwent PPCI at our medical center between January 2005 to May 2018. Emergency pretreatment regimen included a combination of intravenous (IV) steroid, IV famotidine and IV diphenhydramine administered immediately before PCI. Laboratory records, inpatient notes, and discharge summaries were reviewed to confirm the severity of the original contrast allergy and identify any allergic breakthrough reaction after pretreatment with an emergency regimen. Reactions were characterized as mild, moderate, severe, or of unknown severity.

Results
During the study period 15,712 individuals underwent PCI, of which 176 patients presented with STEMI, had confirmed contrast allergy, and were pretreated before undergoing PCI. No patient with a history of contrast allergy underwent PPCI without pre-treatment. Mean age was 64 years, with 52% males, and all individuals were white. The majority had hypertension (77%), 67% had dyslipidemia, 29% had diabetes mellitus, and 20% patients had a prior history of MI. Intravenous steroids used in the emergency regimen included methylprednisone (n=100), hydrocortisone (n=70), and dexamethasone (n=6). The original allergic response to ICM was mild in 59% patients, moderate in 15%, severe in 20% and of unknown severity in 13% patients. Of the 176 patients only 10 (5.6%) developed a breakthrough reaction. Most of which were mild; none was fatal. Median length of hospital stays was three days and nine patients (10.8%) passed away within 30 days of hospital admission.

Conclusions
Patients with prior contrast allergy presenting with STEMI can safely undergo PPCI after emergency pretreatment. Breakthrough reactions are infrequent and mild.
P6531Evidence-practice gap in the preprocedural risk assessment for contrast-induced acute kidney injury
Authors: Shoji S , Sawano M , Shiraishi Y , Ikemura N , Noma S , Suzuki M , Numasawa Y , Fukuda K , Kohsaka S 
Published: October 2019

Abstract

Background
Contrast-induced acute kidney injury (CI-AKI) is one of the frequently encountered and costly complications after percutaneous coronary intervention (PCI). Clinical practice guidelines strongly recommend that PCI patients should universally undergo preprocedural assessment for the risk of CI-AKI, and the contrast volume (CV) should be minimized to an achievable level, particularly among the high AKI risk patients. However, data on the CV use based on the comprehensive preprocedural risk assessment is still lacking.

Purpose
Our study aimed to 1) assess the impact of CV increase with the incidence of AKI among high AKI risk patients, and 2) retrospectively evaluate the used CV based on the preprocedural comprehensive risk assessment for patients undergoing PCI within multicenter longitudinal registry.

Methods
Between 2009 and 2018, 22,373 patients underwent PCI in 14 participating facilities, and consecutive patient data was registered. AKI was defined as a >0.3mg/dl absolute or >1.5-fold relative increase in post-PCI creatinine or new initiation of dialysis, based on the Acute Kidney Injury Network criteria. The post-procedural creatinine was defined as the highest value within 30 days after the indexed procedure. Congruent with the National Cardiovascular Data Registry (NCDR) definition, if more than 1 post-procedural creatinine level was measured, the highest value was used for determining AKI. We divided the patients into four groups according to quartile of NCDR AKI risk scores.

Results
Mean age of the patients were 68.7±11.1 years, and 79.1% were male. Mean CV use was 161.4±74.8ml. The incidence of CI-AKI was 8.9%, and was particularly high among high AKI risk patients (21.1%); CV (per 1ml linear increase) was directly associated with the occurrence of AKI (OR: 1.002 per unit in CV; 95% CI: 1.001–1.003; P<0.001) in these patients. CV during PCI decreased with the progression of chronic kidney disease (CKD), but it did not alter by the overall NCDR AKI risk score (Figure). After multivariable adjustment, CV was predicted by stage of CKD (−13.68ml; 95% CI: −12.05 to −15.30ml; P<0.001), but not by the value of pre-procedure prediction score (NCDR AKI risk score, P=0.575).
CV according to CKD/NCDR AKI risk score

Conclusions
Higher CV was directly associated with the occurrence of AKI among higher AKI risk patients. However, CV use was largely influenced by the stage of renal disease, and not with overall patient risk presented by contemporary risk scores. Our results have identified an important evidence-practice gap and emphasizes the importance of total preprocedural assessment to minimize CV and prevent subsequent AKI.

Acknowledgement/Funding
KAKENHI (16KK0186, 16H05215, 25460630, 25460777), Bayer, Daiichi Sankyo, Bristol-Myers Squibb, Teikoku Seiyaku, Sumitomo Dainippon, AstraZeneka, Pfizer