bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1917Can cryoballoon ablation produce alterations in cardiac and extra-cardiac autonomic nervous system in patients with atrial fibrillation?
Authors: Sakabe S , Unno K , Mori T , Horiguchi M , Takamura T , Tone K , Izumi D , Maeno K , Seko T , Kasai A 
Published: October 2019

Abstract

Background
Cryoballoon ablation (CBA) during pulmonary vein isolation (PVI) for atrial fibrillation (AF) can cause direct thermal injury to structures adjacent to the left atrium, including the periatrial ganglionated plexi (GP). In contrast, it has not been clarified whether cardiac autonomic nervous system (CANS) modification by CBA could indirectly affect extra-CANS.

Purpose
This study was aimed to investigate the impact of CBA on extra-CANS as well as CANS in AF patients.

Methods
Ninety-three Consecutive patients who underwent initial CBA in our institute were enrolled. Among them, 64 subjects (age 67±9 years; male gender 52%; CHADS2 score 1.2±1.0; diabetes mellitus 16%; β-blocker therapy 23%) had paroxysmal AF (G-P) and 29 (age 66±7 years; male gender 90%; CHADS2 score 1.3±1.0; diabetes mellitus 24%; β-blocker therapy 34%) had sustained AF (G-S). In G-P, resting sinus heart rate (R-HR) and coefficient of variation of the R-R intervals (CVR-R) during sinus rhythm were measured in resting 12-lead electrocardiogram before and after CBA as an index of CANS. Decrease in CVR-R after PVI reflects the vagal nerve injury by the procedure. Pupil movement reflects the autonomic nervous function. In both groups, pupillary light reflex, as an indicator of extra-CANS activity, was measured by infrared videopupillography (Iriscorder® Dual C10641, Hamamatsu Photonics, Hamamatsu, Japan) before and after CBA. Velocity of dilatation (VD) is related to sympathetic function, and velocity of contraction (VC) is associated with the balance between sympathetic and vagal tone. All CBA were treated with second generation 28mm cryoballoons (CB). CB temperature was down to a minimum of −60°C and target application time was 180 seconds.

Results
Complete PVI was achieved in all patients, in which touch-up radiofrequency ablation for the PVI was required in 4 cases of G-S. In G-P, R-HR significantly increased (59.2±9.2bpm to 72.5±8.3bpm, p<0.01) and CVR-R significantly decreased (2.32±1.1% to 1.61±0.61%, p<0.01) after CBA, while VC and VD did not significantly change (3.83±1.03mm2/sec to 3.64±0.96mm2/sec and 1.83±0.62mm2/sec to 1.86±0.84mm2/sec, respectively). In G-S, there were not significant changes between before and after CBA in VC and VD (3.77±0.80mm2/sec to 3.71±0.99mm2/sec and 1.81±0.49mm2/sec to 1.80±0.59mm2/sec, respectively). There were no significant differences between two groups in VC and VD before the procedure.

Conclusion
These results suggest that CBA seems to result in local parasympathetic denervation due to damage of adjacent structures including ganglionated plexi while the alteration of CANS by CBA does not seem to efferently affect extra-CANS.
P1918Comparison of the clinical outcome of pulmonary vein isolation with cryoballoon and radiofrequency ablation for atrial fibrillation with pulmonary vein triggers
Authors: Nitta G , Inaba O , Kato S , Kono T , Ikenouchi T , Murata K , Matsuda J , Kanoh M , Inamura Y , Takamiya T , Negi K , Sato A , Yamato T , Matsumura Y , Nitta J 
Published: October 2019

Abstract

Background
Pulmonary vein isolation (PVI) using radiofrequency (RF) or cryoballoon (CB) has been an established treatment for atrial fibrillation. PVI using RF is the most common method with a rather complex technique of a point-by-point tissue heating and navigation of electro-anatomical-guided mapping system, and PVI with CB is also the common method with a relatively simple technique of freezing balloon occlusion. These 2 types of ablation are comparable in terms of the efficacy of the PVI procedure.

Purpose
The data on the clinical outcome of each AF type with PV triggers has been limited. We compared the outcome of success rate between RF and CB group with respect to each AF type, and further assessed the efficacy of pulmonary vein isolation for AF patients with the origin of only PV.

Methods
A total of 3402 AF patients (age 64±11; 2463 males) underwent initial PVI from May 2009 to July 2018 (PAF: 67%, non-PAF: 37%). Radiofrequency using irrigation-tip catheter was employed to 1796 patients since May 2009 (RF-PAF: 55%, RF-non-PAF: 45%). Second-generation cryoballoon was employed to other 1606 patients since September 2014 (CB-PAF: 81%, CB-non-PAF: 19%). In CB group, PV touch-up ablation with RF was needed for 113 patients (7%) (CB-PAF: 6%, CB-non-PAF: 13%; p<0.001). After PVI, additional ablation for non-PV foci was undergone after the induction by using isoproterenol infusion and rapid atrial pacing (RF-AF: 34%, CB-AF: 32%; p=0.107).

Results
In all PAF patients, AF free survival rate was significantly superior in CB group (2-years Kaplan-Meir event rate, CB 83.2%, RF 75.2%; log-rank p<0.001). The percentage of patients with non-PV foci was almost equivalent in both group (CB 30%, RF 31%, p=0.644). And in PAF patients with only PV-foci, AF free survival rate was significantly superior in CB group (2-years Kaplan-Meir event rate, CB 85.0%, RF 78.8%; log-rank p<0.001). On the other hand, in all non-PAF patients, AF free survival rate was almost equivalent in both non-PAF group (2-years Kaplan-Meir event rate, CB 65.5%, RF-non-PAF 70.0%; log-rank p=0.9). The percentage of patients with non-PV foci was almost equivalent in both group (CB 40%, RF 39%, p=0.731), And in non-PAF patients with only PV-foci, AF free survival rate was almost equivalent in both non-PAF group (2-years Kaplan-Meir event rate, CB 69.7%, RF 73.0%; log-rank p=0.376).

Conclusions
Our study showed better outcome of PVI with CB for PAF patients with PV triggers, and indicated the non-inferiority of PVI with CB for non-PAF patients with PV triggers to PVI with RF.
P1942A trait of inflammation pathogenesis in human atherosclerosis: inflammasome driven interleukin-1 signaling in complex atherosclerotic plaques via hyperlipidemia trained innate immunity
Authors: Jiang X , Wang F , Wang J , Gistera A , Roy J , Berne G P , Hedin U , Lerman A , Hansson G K , Herrmann J , Yan Z 
Published: October 2019

Abstract

A trait of inflammation pathogenesis in human atherosclerosis: inflammasome driven interleukin-1 signalling in complex atherosclerotic plaques via hyperlipidemia trained innate immunity

Objectives
We aimed to investigate interleukin (IL)-1 generation and the regulatory role of inflammasome in human advanced atherosclerosis.

Background
IL-1β is key contributor to the inflammatory process associated with atherosclerosis and its complications. Recent studies suggested that IL-1β blockade reduces the burden of inflammation and recurrence of cardiovascular events. Yet, other cytokines in IL-1 family and the regulation of IL-1 generation in patients with atherosclerosis remains poorly understood.

Methods and results
A focused transcriptomic analysis in human atherosclerotic specimens discovered that human atherosclerotic plaques host a broad reservoir of inflammasome components, characterised by expression of canonical inflammasome gene NLRP6, NLRP12, NLRC4, NLRP3 and non-canonical inflammasome gene caspase 4 significantly elevated in the symptomatic plaques versus the asymptomatic plaques. Upregulation of NLRP3 inflammasome expression in plaque validated by immunohistochemistry staining suggested it as a distinctive characteristic of plaque vulnerability and complexity. Functional studies on atherosclerotic explants obtained from patients undergoing carotid endarterectomy revealed constitutive generation of IL-1β accompanied by secretion of comparable levels of IL-1α from the majority of the plaques, while IL-18 and IL-33 generation from some of the plaques. Stimulation of the plaques with inflammasome activators showed an inducible generation of both IL-1α and IL-1β, not IL-18 or IL-33, mediated by specific canonical and non-canonical inflammasome pathways. Analysis on the medication records of these patients indicated that plaques from patients with suboptimally controlled hyperlipidemia, imaging signs for plaque instability and inadequate statins therapy possessed higher recruitable production of IL-1β, suggesting the conventional atherogenic factor in regulation of inflammasome immunity and disease activity. Mechanistic studies on tissue and cells isolated from atheromatous plaques demonstrate that generation of mature IL-1β is via a mechanism controlled by NLRP3 and the effector caspase-1.

Conclusions
The study supports a profound canonical and non-canonical inflammasomes mediated plaque IL-1α/β generation, via a key mechanism by NLRP3 and caspase-1. The results provide biological insights into the clinical merit of high-intensity cholesterol lowering and anti-IL-1 signalling-directed therapies in high-risk patients with atherosclerosis.

Acknowledgement/Funding
KI-Mayo collaboration project, the Swedish Research Council, the Swedish Heart-Lung Foundation, European Union FP7 projects, the NIH
P1952Value of GRACE risk score in risk stratification in acute coronary syndrome patients undergoing PCI in the Global Leaders study
Authors: Komiyama H , Chichareon P , Hamm C , Juni P , Valgimigli M , Vranckx P , Windecker S , Onuma Y , Stegg G , Serruys P 
Published: October 2019

Abstract

Aims
We sought to evaluate the value of GRACE risk score in stratifying acute coronary syndrome patients undergoing percutaneous coronary intervention in the Global Leaders study.

Methods
Global Leaders study was a prospective, multi-center, open-label, all-comers, randomized controlled trial comparing ticagrelor monotherapy after 1 month of dual antiplatelet therapy (DAPT) as experimental therapy with aspirin monotherapy after 12 months of conventional DAPT (reference therapy) in patients who received PCI with biolimus-A9 eluting stent. We assessed the predictive value of GRACE risk score in ACS patients undergoing PCI in the present analysis. Patients were stratified according to GRACE risk score into low (1–108), moderate (109–140), High (141–372) risk group. Clinical outcomes at 2 years after PCI were assessed and compared among risk groups. Interaction between GRACE risk score and antiplatelet regimen were analyzed by the interaction term in Cox model.

Results
GRACE risk score was calculated from 8 clinical parameters at presentation. Among ACS patients, 1664 patients were categorized in low risk group, 2903 patients were in moderate risk group, and 2028 patients were in high risk group. The rate of all-cause mortality, any stroke, patient-oriented composite endpoint (POCE) were highest in the high-risk group at 2 years (All-cause mortality; low risk 1.4%, moderate risk 2.5%, high risk 6.1%, log rank test p value <0.0001, any stroke; low risk 0.7%, moderate risk 1.0%, high risk 2.0%, log rank test p value 0.001, POCE; low risk 12.4%, moderate risk 11.9%, high risk 16.61%, log rank test p value <0.0001). The rate of myocardial infarction, all revascularization and definite or probable stent thrombosis were not different among three groups. There was no interaction between GRACE risk score and treatment regimen on clinical outcomes at 2 years.

Conclusion
GRACE risk score is valuable in identifying ACS patients with highest risk of all-cause mortality, any stroke and POCE at 2 years after PCI. In ACS, ticagrelor monotherapy did not improve the outcomes at 2 years in the three strata of the GRACE risk score.
P1955The CHADS-VASc score is a predictor of No-Reflow in patients with NSTEMI
Authors: Barman H A , Kahyaoglu S K , Durmaz E D , Atici A A , Okuyan E O , Sahin I S 
Published: October 2019

Abstract

Introduction
No-reflow (NR) is one of the major complications associated with primary percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to elucidate the relationship between the CHA2DS2-VASc score and NR phenomena in patients with NSTEMI.

Methods
A total number of 428 consecutive patients with NSTEMI were assessed for this study. Patients were divided into 2 groups, those with NR, NR(+) (n=84), and those without NR, NR(−) (n=307), according to their post-PCI, no-reflow status. The thrombus burden was classified according to the TIMI thrombus grade (TTG). CHA2DS2-VASc scores were calculated for all patients.

Results
The CHA2DS2-VASc score was significantly higher in the NR(+) group compared to the NR(−) (3.48±1.19 vs 1.81±0.82, p<0.001). After a multivariate regression analysis, a higher CHA2DS2-VASc score (OR: 6.52, 95% CI: 3.51–12.14, p<0.001), hs-Troponin (OR: 1.077, 95% CI: 1.056–1.099, p<0.001) and TTG (OR: 1.563, 95% CI: 1.134–2.154, p=0.006) were independent predictors of NR. In-hospital mortality rates were significantly higher in the NR(+) group compared to the NR(−) (15% vs. 5%, p<0.001).
Table 1. Demographic, clinical, and angiographic characteristic of the patients Variables NR(−) (n=307) NR(+) (n=84) p Age, years, mean ± SD 55.50±8.95 56.67±8.80 0.248 Female gender, n (%) 83 (%27) 25 (%30) 0.536 CHF, n (%) 30 (%10) 17 (%20) 0.019 HT, n (%) 116 (%38) 45 (%54) 0.004 DM, n (%) 67 (%22) 30 (%36) 0.009 Previous stroke/TIA, n (%) 9 (%3) 9 (%11) <0.001 CHA2DS2-VASc score, mean ± SD 1.81±0.82 3.48±1.19 <0.001 LVEF (%), mean ± SD 56.11±9.31 51.15±11.32 <0.001 hs-troponin (pg/ml) (NRI <14pg/ml) 56.59±11.83 114.23±26.42 <0.001 Serum creatinine, mean ± SD, mg/dl 0.89±0.13 0.91±0.22 0.852 Hemoglobin (g/dl) 14.16±1.76 14.10±1.74 0.782 TTG, median 1 (0–3) 3 (1–5) <0.001 TTG(4,5), n (%) 70 (%23) 36 (%42) <0.001 In-hospital mortality, n (%) 16 (%5) 13 (%15) <0.001

Conclusions
In conclusion, CHA2DS2-VASc score is associated with higher risk of no-reflow in patients with NSTEMI undergoing PCI.

Acknowledgement/Funding
None
P1959Impact of hemodialysis in patients undergoing bypass surgery for peripheral arterial disease - 10-year follow-up study
Authors: Kumada Y , Ishii H , Oshima T , Sakakibara T , Ito R , Takahashi H , Murohara T 
Published: October 2019

Abstract

Background
Although lower extremities bypass surgery has been commonly performed as the standard option to treat peripheral artery disease (PAD) even in patients on hemodialysis (HD) as well as general population, poorer prognosis still remains major problems in this specific population. In this 10-year follow-up study, we investigated the impact of HD after surgical revascularization in patients with PAD.

Methods
A total of 660 patients undergoing successfully bypass surgery were enrolled. Patients with acute limb ischemia were excluded. We compared 392 HD patients with 428 limbs and 268 non-HD (NHD) patients with 296 limbs during 10 years follow-up period. Primary endpoint was defined as major adverse cardiovascular events (MACE) including all-cause death, non-fatal myocardial infarction and stroke. Second endpoint was major adverse limb events (MALE) including any revascularization and major amputation. To minimize the differences of clinical characteristics between the two groups, propensity score adjusting with all baseline variables was performed.

Results
Prevalence of diabetes (53.3% vs. 35.2%), critical limb ischemia (77.5% vs. 52.1%) and infra-popliteal artery (48.2% vs. 19.6%) were higher in HD group compared to NHD group (p<0.0001 in all), inversely, age was younger in HD group than in NHD group (67±9 years vs. 71±9 years, p<0.0001). The 30-day mortality rate was comparable (3.1% in HD group vs. 1.5% in NHD group, p=0.19). The 10-year event-free survival rate for MACE was significantly lower in HD group compared to NHD group (45.3% vs. 67.4%, p<0.0001) and for MALE (60.0% vs. 80.0%, p=0.0007), respectively. After propensity score adjustment, the freedom rate from MACE was still lower in HD group compared to NHD group [45.6% vs. 67.6%, hazard ratio (HR) 1.89, 95% confidence interval (CI) 1.33–2.72, p=0.0003], however, the rate from MALE was statistically comparable between the two group (65.7% vs. 76.9%, 1.27, 95% CI 0.87–1.90, p=0.21). Furthermore, although the 10-year limb salvage rate was crudely lower in HD group compared to NHD group (80.6% vs. 91.6%, HR 1.57, 95% CI 1.05–2.40, p=0.0027), it was comparable after propensity score adjustment (89.4% vs. 90.1%, HR 1.09, 95% CI 0.59–1.88, p=0.79). Also, the mortality rate was consistently lower in HD patients (adjusted HR 2.37, 95% CI 1.62–3.50, p<0.0001).

Conclusion
The long-term freedom rate from MACE and mortality was markedly lower in HD patients compared to non-HD patients. However, the rate from MALE, especially limb salvage rate was similar between HD and NHD after adjustment for clinical characteristics. These results suggest that detection at the early stage of PAD may potentially improve the poor outcomes in this high risk population.
P2242Prognostic impact of CT derived quantified coronary artery plaque volume: A 10 year follow-up study
Authors: Deseive S D C , Straub R , Kupke M , Broersen A , Kitslaar P , Hadamitzky M , Massberg S , Hausleiter J 
Published: October 2019

Abstract

Background
Automated plaque quantification derived from coronary CT angiogragphy (CCTA) datasets provides exact and reliable assessment of coronary atherosclerosis burden.

Purpose
To investigate the long-term predictive value of quantified coronary plaque volume (PV) in comparison to Calcium Score (CACS).

Methods
Dedicated software was used to quantify PV in 1577 patients. A combination of cardiac death and acute coronary syndrome was used as endpoint. Incremental prognostic value was tested with c-statistics and continuous net reclassification improvement (NRI). The Morise Score was used to summarize patients clinical risk profile.

Results
Patients were followed for 10.4 years. The combined endpoint occurred in 59 patients, of whom 36 suffered from cardiac death, 18 had non-fatal myocardial infarction and 5 presented with unstable angina requiring revascularisation. The additive predictive value of PV and CACS was tested against a baseline model (c-index 0.741) including clinical risk and the number of diseased coronary segments (segment-Involvement score). While PV provided additive prognostic value (rise in c-index to 0.763, p=0.01 and NRI 0.247, p=0.03), CACS did not (c-index 0.749, p=0.2 and NRI 0.162, p=0.12).
A threshold of 110.5 mm3, which was established by a previous analysis of our group, provided excellent separation of patients into low (no PV), intermediate (PV <110.5 mm3) and high (PV >110.5 mm3) risk categories based upon quantified PV (see attached Figure).

Conclusion
Quantification of PV from CCTA datasets provides excellent prognostic information on long-term follow-up.
P2248Impact of Lipoprotein (a) levels on the presence and severity of coronary artery disease in female patients: a large cross-sectional Chinese cohort study
Authors: Wu N Q , Liu S L , Guo Y L , Zhu C G , Gao Y , Sun J , Xu R X , Liu G , Dong Q , Li J J 
Published: October 2019

Abstract

Background
Lipoprotein (a) [Lp(a)] is recently recognized as a risk factor of atherosclerosis, and the development of coronary artery disease (CAD) in women is not fully understood.

Purpose
The present study aimed to examine the association of Lp(a) levels with the presence and severity of (CAD) in female patients pre- and post-menopause.

Methods
A total of 3712 female patients who received coronary angiography were consecutively enrolled. The level of Lp(a) was measured and compared among patients with and without CAD or myocardial infarction (MI), pre- or post- menopause. The association of Lp(a) with the presence of CAD and the severity of coronary atherosclerosis assessed by Gensini Score were examined.

Results
The average of Lp(a) levels were elevated as age increased in female subjects. Notably, women after menopause had higher Lp(a) levels compared with that before menopause [16.8 mg/dL (IQR 7.54–41.12 mg/dL) vs. 14.7 mg/dL (IQR 6.72–30.82 mg/dL), p=0.002]. Furthermore, multiple logistic regression analysis identified that Lp(a) >30mg/dL was an independent risk factor of CAD in the postmenopausal female (OR1.38, 95% CI 1.13–1.69, p=0.002). Finally, Lp(a) had a positive correlation with Gensini score (r=0.11, p<0.001), and Lp(a) >30mg/dL was an independent risk factor for high Gensini score (OR 1.43, 95% CI 1.14–1.79, p<0.001). While such results were not observed in the premenopausal females.
Baseline characteristics of all patients Before menopause (n=525) Post menopause (n=3187) P value Age, (years) 46 (42–49) 62 (58–68) <0.001* Hypertension, n (%) 231 (44.00) 2097 (65.80) <0.001* Diabetes mellitus, n (%) 68 (12.95) 849 (26.64) <0.001* LDL-C (mmol/L) 2.73±1.05 2.77±0.99 0.366 Lp(a) (mg/dL) 14.7 (6.72–30.82) 16.8 (7.54–41.12) 0.002* Data are expressed as mean ± SD or median (interquartile range) and numbers (percentages). BMI, body mass index; TC, total cholesterol; TG, triglyceride; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; Lp(a), lipoprotein(a); HsCRP, high-sensitivity C-reactive protein. *Statistically significant differences exist between two groups. CAD, coronary artery disease.
Lp(a) in pre- and post-menopausal women

Conclusion
The present study indicated that circulating Lp(a) levels were independently associated with the presence and severity of CAD in the postmenopausal female, suggesting that further study may be needed to examine the role of Lp(a) in the development of CAD in female individuals with different menopausal status.
P2258Pulse wave velocity, total arterial compliance, and cardiac structure and function in late life
Authors: Teramoto K , Cheng S , Claggett B , Solomon S , Heiss G , Tanaka H , Matsushita K , Shah A 
Published: October 2019

Abstract

Background
Coupled abnormalities in arterial and left ventricular (LV) stiffness characterize aging and heart failure with preserved ejection fraction. We hypothesized that two measures of aortic stiffness, pulse wave velocity (PWV; reflecting segmental arterial wall stress in late systole) and total arterial compliance (TAC; reflecting distensibility of entire arterial system) differentially relate to cardiac structure and function in the elderly.

Methods
Among participants in the Atherosclerosis Risk In Community (ARIC) study, we assessed the cross-sectional relationship of carotid-femoral PWV (cfPWV) and TAC with echocardiographic measures of cardiac structure and function using multivariable linear regression adjusting for demographics and co-morbidities. TAC defined as stroke volume over pulse pressure [mL/mmHg]. Exclusions were LVEF <50%, prevalent HF, ≥moderate valvular disease.

Results
Of the 4,141 participants included in this study, mean age was 75±5 years, 41% were male, and 80% were white. Mean values were: cfPWV: 11.7±3.4 m/sec; TAC: 1.1±0.3 mL/mmHg. Greater cfPWV was associated with greater LV mass, worse systolic function, and worse diastolic function (Table). In contrast, worse TAC was not related to LV structure and did not demonstrate consistent relationships with measures of LV diastolic function, but was associated with worse LV longitudinal strain.
Echo measures cfPWV (1SD increase) TAC (1SD decrease) β Coefficient p-value β Coefficient p-value Cardiac structure Mean wall thickness, cm 0.10 <0.001 -0.01 0.499 LVMI, g/m2 0.04 0.016 0.02 0.299 LVEDVI, ml/m2 -0.07 <0.001 -0.02 0.332 LV systolic function LVEF (Simpson's), % -0.04 0.01 -0.16 <0.001 Longitudinal strain, % 0.14 <0.001 0.19 <0.001 LV diastolic function Septal e', cm/sec -0.08 <0.001 -0.02 0.169 E/e' septal 0.04 0.005 -0.02 0.138 LAVI, ml/m2 -0.05 0.003 -0.04 0.026

Conclusion
Two non-invasive measures of aortic stiffness, cfPWV and TAC, demonstrate differential associations with LV structure and function in late life. Greater cfPWV is more robustly associated with LV structure and function than TAC.