bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1835Application of SYNTAX score I, II and residual SYNTAX as predictors of long-term clinical outcomes after coronary artery bypass grafting
Authors: Martins E B , Hueb W , Lima E G , Rezende P C , Garzillo C L , Carvalho G F , Carvalho F P C , Linhares Filho J P P , Batista D V , Silva R R , Boros G A B , Azevedo D F C , Serrano Junior C V , Ramires J A F , Kalil Filho R 
Published: October 2019

Abstract

Background
The evaluation of coronary disease by SYNTAX score I (SSI) is used to grade coronary complexity. Following SSI, two other scores were developed: SYNTAX score II (SSII) and residual SYNTAX score (rSS). Nevertheless, there is still a lack of evidence about the prognostic significance of these scores among patients undergoing CABG.

Purpose
Our aim was to evaluate the relation of the SSI, SSII and rSS score with outcomes in a long-term follow-up after elective CABG.

Methods
This is a single center, registry-based study. Baseline SSI was calculated from patients undergoing CABG by interventional cardiologists. SSI results were considered as usual: <23, 23–32 and >32. SSII and rSRR were then calculated and categorized in tertiles: <21.4, 21.4–29.4 and >29.4 for SSII and 0, 1–5 and >5 for rSS. Primary outcome was a composite of overall death, myocardial infarction, additional revascularization, or stroke (MACCE).

Results
Data were obtained from 559 patients. Median follow-up was 6 years (IQR: 4.9–9.8) and 170 events were documented. The Kaplan-Meier curves (figure 1) showed significant differences of MACCE in higher SSI, SSII and rSS (p=0.039, 0.033, <0.001 respectively). After multivariate adjustment, rSS, ejection fraction (EF) and age were found to be independent predictors of MACCE (p<0.001, 0.034 and 0.006, respectively).
Figure 1

Conclusion
In this sample SSI, II and residual were associated with the occurrence of events. However, just the rSS remained an independent predictor of MACCE together with age and EF.
P1836Constrictive pericarditis after open heart surgery: a 20-year case controlled study
Authors: Moreyra A E , Yang Y , Zinonos S , Cosgrove N M , Cabrera J , Kostis W J , Shindler D M , Kostis J B 
Published: October 2019

Abstract

Background
Constrictive pericarditis (CoPe) after open-heart surgery (OHS) is a rare complication. Information on the incidence, determinants, and prognosis of this condition has been scarcely reported.

Purpose
To investigate the long term prognosis of CoPe after OHS.

Methods
Using the Myocardial Infarction Data Acquisition System database, we analyzed records of 144,902 patients that had OHS in New Jersey hospitals between 1995 and 2015. CoPe was identified in 79 patients after discharge. Differences in proportions were analyzed using chi square. Cases and controls were matched for demographics and comorbidities. Cox proportional hazard models were used to evaluate outcome risks. Log-rank test was used to assess differences in the Kaplan-Meier survival curves.

Results
Patients with CoPe were more likely to have history of valve disease (HVD) (p<0.0001), atrial fibrillation (AF) (p=0.0006) and chronic kidney disease (CKD) (p=0.012). Significant predictors of CoPe were AF (HR 1.62, 95% CI 1.02–2.59), CKD (HR 2.70, 95% CI 1.53–4.76), diabetes (HR 1.73, 95% CI 1.08–2.80) and HVD (HR 3.11, 95% CI 1.88–5.15). Patients with CoPe compared to matched controls had a higher 10-year mortality (p<0.0001). This became a statistically significant difference at 6 years after surgery (Figure).
Survival Curve

Conclusion
Constrictive pericarditis is a rare complication of OHS and occurs more frequently in patients with AF, CKD, diabetes and HVD. It is associated with an unfavorable long-term prognosis. The data highlight the need for strategies to help prevent this complication.

Acknowledgement/Funding
Robert Wood Johnson Foundation
P1840Mid-term results of bioprosthetic aortic valve replacement with the Trifecta valve: A word of caution
Authors: Werner P , Russo M , Seewald M , Coti I , Haberl T , Laufer G , Kocher A , Andreas M 
Published: October 2019

Abstract

Background
Structural valve deterioration (SVD) with associated bioprosthetic valve dysfunction remains an unsolved problem, exposing patients to the risk of aortic valve re-intervention after surgical aortic valve replacement (SAVR). Several strategies have been proposed to improve prosthesis design for optimal performance. The leaflets of the Trifecta valve are mounted on the outside of the prosthetic stent to achieve a larger orifice area. Although favourable early clinical outcomes have been reported, long-term durability still needs to be assessed.

Purpose
The aim of the current study was to assess the mid-term overall mortality and re-intervention rate in patients who received a Trifecta valve with a follow-up >5 years.

Methods
Patients who underwent SAVR at our centre between 2011 and 2012 were identified in the internal, prospective database. All patients with implantation of a Trifecta valve in aortic position were included. Primary endpoints were freedom from overall mortality and from re-operation at latest follow-up (FU). Additionally, assessment of echocardiographic parameters at baseline and follow-up was performed.

Results
Seventy-six patients (age 77.3±9.5 years, BMI 28.6±5.8, 68% male) were included in the study. EuroScore II was 7.2% (± 7.7) while mean STS-Mortality score was 2.4±1.1%. Of all procedures, 53% were isolated aortic valve replacements, whereas concomitant procedures were performed in 47% of cases (37% CABG, 12% mitral surgery, 8% tricuspid surgery). Baseline echocardiographic assessment showed a mean pressure gradient (MPG) of 51±21 mmHG, a peak pressure gradient (PPG) of 78±36 mmHG and a peak velocity (Vmax) of 4.2±1.1 m/s.
Thirty-day mortality was 7%. Freedom from overall mortality at 1 year and 5 years was 84% and 73%, respectively. Freedom from death and freedom from re-operation at latest FU (6.7±0.5 years) was 68% and 90%, respectively. In a composite endpoint analysis, freedom from death or re-intervention at latest follow up was 60%. A total of 7 patients underwent aortic valve re-interventions (re-replacements n=5, valve-in-valve n=2). Indications for re-interventions were SVD (n=5), NSVD (n=1, pannus ingrowth) and endocarditis (n=1). One case of re-stenosis occurred in a patient who was deemed not feasible for aortic valve re-intervention and died.
Kaplan Meier analysis

Conclusion(s)
To our knowledge, this patient cohort presents with the lowest rate of freedom from re-operation (90%, 6.7±0.5 years) after SAVR with the Trifecta valve. A relatively high number of SVD and NSVD has been observed, which might be attributable to the specific leaflet mounting or the deformable valve frame of the first generation. Current results call for further investigation with prospective echocardiographic follow-up in this patient group.

Acknowledgement/Funding
None
P184511 years of transcatheter aortic valve implantation in a single centre and outcomes for all 1004 patient cases completed
Authors: Brennan P F , Wilson S J , Alkhalil M , Santos A , McNiece A , Johnston N G , Jeganathan R , Owens C G , Manoharan G , Spence M S 
Published: October 2019

Abstract

Background
Long-term outcome data after TAVI is of key importance as indications have extended from high risk patients to intermediate risk alongside contemporary study of low risk patients.

Purpose
We report our complete 11 y experience of TAVI.

Methods
All patients (n=1004) treated with TAVI in our institution between Feb 2008 & Nov 2018 were included. Data was collected prospectively and all death certificates were reviewed. Independent predictors of mortality were determined by multivariable cox proportional hazard modelling. Annular sizing was performed via echocardiography +/or angiography until Aug 2012 after which time cardiac CT was used.

Results
Patients were 53% female & had mean age 81.9±6.6 y, logistic EuroScore 18.5%. 89% were NYHA >2, and 26.7% had a left ventricular ejection fraction (LVEF) of <50%. TAVI was performed for severe degenerative aortic valve disease (93.5%), while valve-in-valve (2.4%) bicuspid (2.1%) & rheumatic (2%) made up the remainder. Self-expanding valves were implanted in 73% cases. 98% cases were performed under local anaesthesia. A percutaneous transfemoral approach was used in 92% cases. For the first 6 y 19% procedures were performed for urgent inpatients, rising to 42% over the last 5 y. The mean time to discharge was 5.5 d, overall, & 60% cases were discharged within 72 h in the last 5 y. Mortality, for those at risk, was 3.2%, 12.8%, 53% & 88% at 30 d, 1 y, 5 y & 10 y. The median time to death was 2.6 y. Non-cardiac death accounted for 62% deaths, with sepsis being the main cause (55%). The main cause of cardiac death was heart failure (HF (53%)). Independent clinical predictors of death were increased age, atrial fibrillation, pulmonary disease & LVEF <50%. Use of a 2nd generation valve was associated with better survival at 5 y (p<0.001).
30 d new permanent pacemaker and stroke incidence were 13.7% and 2% respectively. 30 d readmission occurred in 13% patients. Independent clinical predictors of 1 y HF (7%) readmission were NYHA Class >2 and LVEF <50%. Endocarditis was seen in 1.6% during a mean follow-up 2,593 patient y. Mean aortic gradients at 1 y, 5 y & 10 y were 9.7mmHg, 8.4mmHg & 10.53mmHg. One patient had severe trans-aortic regurgitation during the follow-up. A 2nd TAVI procedure was performed in 5 patients with clinically significant paravalvular regurgitation, all within 30 d.
Figure 1. A. Survival. B. Predictors death

Conclusion
This comprehensive evaluation of all patients treated with this innovative technology provides reassurance regarding the long-term clinical efficacy of TAVI & gives insight into the evolution of our programme with time.
P1864Primary predictor of esophageal injury after catheter ablation of atrial fibrillation
Authors: Ito M , Kanazawa H K , Kaneko S K , Kanemaru Y K , Kiyama T K , Arima Y A , Takashio S T , Yamamoto E Y , Kaikita K K , Fujisue K F , Sueta D S , Usuku H U , Suzuki T S , Sakamoto K S , Tsujita K T 
Published: October 2019

Abstract

Background
It has been demonstrated that the short distance between the esophagus and the posterior left atrium (LA) is closely associated with the occurrence of esophageal injury (EI) after catheter ablation of atrial fibrillation (AF). Meanwhile, it has not been fully elucidated whether esophageal temperature monitoring sufficiently prevent EI.

Objectives
The purpose of this study was to examine the usefulness of esophageal temperature monitoring for avoiding EI. Further we analyzed the relation between the incidence of EI and the distance between the esophagus and the posterior LA measured on the contrast computed tomography (CT).

Methods
Among 403 patients who underwent catheter ablation of AF, upper gastrointestinal tract endoscopy was performed the next day after ablation to examine for EI. The incidence of EI was compared between 95 patients who used esophageal temperature probe (ETP) (ETP Group) and 308 patients who did not used ETP (Non-ETP Group) during ablation. The shortest distance between esophagus and posterior LA measured on contrast CT (SD-CT) was also compared between the ETP and Non-ETP Groups.

Results
In all patients, EI was found in 35 patients (8.6%). The SD-CT in patients with EI was significantly lower than that in patients without EI (2.3±0.6 vs 4.1±0.8 mm, p<0.001).
No differences were observed between the two groups in terms of age, body mass index, LA diameter, esophageal course, total number of radiofrequency (RF) energy applications, total amount of RF energy applications, or the location of SD-CT. Also, EI occurred at nealy the same frequency between the ETP Group and Non-ETP Group (8/95 patients; 8.4% vs 27/308 patients; 8.8%, p=0.553). The severity diagnosed as moderate (erosion) in 3 patients and mild (erythema) in 5 patients of ETP Group, and as severe (ulcer) in 23 patients and mild (erythema) in 4 patients of Non-ETP Group. There was no significant difference in the SD-CT between the ETP Group and Non-ETP Group (3.96±0.98 vs 4.19±1.01 mm, p=0.54). However, the SD-CT in patients with EI was significantly shorter than the SD-CT in patients without EI, both in the ETP Group (2.3±0.6 vs 4.1±0.9 mm, p<0.001) and in the Non-ETP Group (2.5±0.2 vs 4.2±0.9 mm, p=0.017), respectively. Multiple regression analysis revealed that only SD-CT significantly correlated with EI. The area under a receiver operating characteristic curve using ST-CT as a predictive marker in EI patients was 0.971 (p<0.001). When the cut-off value of EI was set at 2.9mm, the sensitivity and specificity for EI diagnosis were 96.6% and 87.5%.

Conclusions
The incidence of EI was significantly correlated with SD-CT. Esophageal temperature monitoring did not reduce EI, however, the use of monitoring alleviated the severity of EI, especially in patients with short SD-CT.

Acknowledgement/Funding
None
P1867Diagnostic value of fragmented QRS complex and early repolarization pattern in detecting myocardial fibrosis and inflammatory
Authors: Gordeeva M , Karlina V , Parmon E , Shlyakhto E 
Published: October 2019

Abstract

Myocardial fibrosis (MF) and inflammatory (MI) play a significant role in pathogenesis of arrhythmias, heart failure and sudden cardiac death. Endomyocardial biopsy (EMB) and cardiac magnetic resonance with late gadolinium enhancement (CMRI-LGE) are used to detect this structural abnormalities. These methods are very informative but not a screening. ECG patterns: fragmented QRS complex (fQRS) and early repolarization (ERP) can be used as markers of MF and MI.

Purpose
To analyze the relationship between structural changes of myocardium, determined using by CMRI-LGE and EMB and fQRS and ERP.

Materials and methods
We analyzed results of CMRI-LG, EMB and 12-lead ECG in 46 patients (28 male, median age – 47.3±12.7). We used the criteria by Das M., 2006 to identify FQRS and the criteria by Macfarlane P.W., 2015 to identify ERP.

Results
Based on the results of CMRI-LGE and EMB all patients were divided into 3 groups: 1st – 20 patients (70% male, median age 56 (48.5; 58.5)) with acute inflammatory (more then 14 leucocytes per mm2) and myocardial fibrosis (detecting by EMB and/or CMRI-LGE); 2nd group – 20 patients (65% male, median age 37 (28.0; 49.5)) with myocardial fibrosis without inflammatory changes; 3rd group – 6 patients without fibrosis or inflammatory. In the 1st group fQRS were detected in 7 (35%) patients, ERP – 6 (30%). In the 2nd group fQRS were detected in 5 (25%) patients, ERP – 6 (0%). In the 3rd group fQRS were not detected in 7 (35%) patients, ERP – 6 (30%).
We assessed sensitivity and specificity of fQRS and ERP in detected MF and MI by comparing with CMRI-LGE and EMB (table 1).
Sensitivity and specificity ECG patterns Myocardial fibrosis Myocardial inflammatory ECG pattern Method Sensitivity Specificity ECG pattern Method Sensitivity Specificity FQRS EMB 76.9% 39.4% FQRS EMB 53.8% 63.6% MRI 83.3% 56.0% MRI 30.8% 84.0% ERP EMB 42.9% 30.8% ERP EMB 85.7% 66.7% MRI 50.0% 41.9% MRI 33.3% 81.3% FQRS, fragmented QRS; ERP, early repolarization pattern; EMB, endomyocardial biopsy; MRI, cardiac magnetic resonance with late gadolinium enhancement.

Conclusions
FQRS have significant sensitivity (83.3%) and specificity (56%) for detecting MF. And ERP has significant sensitivity (85.7%) and specificity (66.7%) for detecting MI. This ECG patterns could be discussed as screening markers of structural myocardial abnormalities.
P1872Canadian electrophysiology labs registry report update 2011–2018
Authors: Kaoutskaia A , Shurrab M , Amit G , Parkash R , Exner D , Toal S , Sterns L , Sarrazin J F , Glover B , Chauhan V , Sultan O , Nair G , Deyell M W , Macle L , Crystal E 
Published: October 2019

Abstract

Background
Interventional cardiac electrophysiology (EP) is rapidly evolving; a nationwide registry was established and re-administered since 2011 to conduct a periodic review of resource allocation across Canada.

Methods
The registry collects annual data on EP lab infrastructure, imaging, tools, human resources, procedural volumes, and wait times. Leading physicians from each EP lab were contacted electronically.

Results
All Canadian EP centres were identified (n=30); 50% and 45% of active centres participated in the last 2 instalments of the registry. Since 2011, data has been consistently obtained from 11 university-affiliated centres. Table 1 reports trends in procedural volumes and operators. Figure 1 depicts the ablations done per operator. The mean wait time to see an electrophysiologist for an initial non-urgent consult is 23 weeks. The wait time between an EP consult and ablation date is 17.8 weeks for simple ablation, 15.9 weeks for VT ablation, and 30.1 weeks for AF ablation. On average centres have 2 (range: 1–4) rooms equipped for ablations; each centre uses the EP lab an average of 7 shifts per week. While diagnostic studies and radiofrequency ablations are performed in all centres, point-by-point cryoablation is available in 85% and cryoballoon in 77% of the centres; 38% of the respondents use circular ablation techniques.
Trends in procedural volumes + operators 2015–2016 2013–2014 2011–2012 Procedures per operator 117±70 120±68 113±42 Procedures per centre 498±299 477±245 446±237 Ratio of staff to trainees 2.0:1 1.6:1 1.5:1 Full time physicians per centre 4.1 (0–7) 4.1 (1–7) 3.5 (0–7) Nurses trained specifically for EP 4.6 (0–10) 4.4 (0–10) n/a Ablation procedures volume:   AV Reciprocal Tachycardia 12% 10% 11%   AV Nodal Re-entry Tachycardia 18% 19% 23%   Atrial Fibrillation/Atypical Flutter 33% 35% 30%   Typical Flutter 20% 14% 19%   Ventricular Tachycardia 8% 8% 10%   Total annual ablations in all respondent centres 5478 5243 4908 Mean ± standard deviation. Staff (full-time + part-time prorated to 0.5).
Annual ablation volumes per operator

Conclusion
This initiative provides contemporary data on invasive EP practices. The results show feasibility in data collection which will serve as a reference for decisions regarding resource planning.
P1876Atrial fibrillation related symptoms and cardiovascular outcomes
Authors: Krisai P , Blum S , Aeschbacher S , Beer J H , Moschovitis G , Witassek F , Kobza R , Rodondi N , Mahmood A , Meyer-Zuern C , Kuehne M , Osswald S , Conen D 
Published: October 2019

Abstract

Background
Comprehensive information on the impact of atrial fibrillation (AF)-related symptoms and quality of life (QoL) on adverse outcomes is sparse.

Purpose
We aimed to investigate whether AF-related symptoms and/or QoL are associated with cardiovascular outcomes in a large cohort of AF patients.

Methods
A total of 3902 participants with documented AF from two nationwide prospective cohort studies in Switzerland were included. Information on AF-related symptoms was assessed yearly by standardized questionnaires, QoL was quantified using a visual analog scale (0–100, with higher scores indicating better QoL). The primary endpoint was a composite of stroke and systemic embolism. The secondary endpoint was a composite of cardiovascular death, hospitalization for heart failure and myocardial infarction. We assessed associations using multivariable, time-updated Cox proportional-hazards models including age, sex, study cohort, history of heart failure, hypertension, diabetes, prior stroke, prior myocardial infarction, vascular disease and prior catheter ablation for AF as covariates.

Results
Mean age was 72 years, and 72% were male. The median QoL score was 75 points, and 2572 (66%) participants had AF-related symptoms. Symptomatic individuals were younger (71 vs 75 years) and had more often paroxysmal AF (29 vs 23%) (p for both <0.001). The most frequent symptoms were palpitations (42%), dyspnea (25%) and fatigue (18%). In multivariable, time-updated models, the hazard ratio (HR) was 1.24 (95% confidence intervals (CI) 0.72; 2.11, p=0.43) for the primary endpoint and HR 0.83 (95% CI 0.65; 1.06, p=0.14) for the secondary endpoint in symptomatic vs non-symptomatic individuals. There was a significant, inverse association for a 5-point increase in the QoL score with both the primary (HR 0.94 (95% CI 0.88; 0.99), p=0.04) and secondary (HR 0.91 (95% CI 0.88; 0.93), p<0.0001) endpoints.

Conclusions
AF-related symptoms are not associated with adverse cardiovascular events in AF patients. In contrast, QoL is inversely associated with to adverse cardiovascular outcomes.
P1882Association between acute hepatitis B flare and long-term clinical outcomes in patients with atrial fibrillation
Authors: Im S I , Park H S 
Published: October 2019

Abstract

Background
Relationship between AF and inflammation was shown in previous studies. However, there was limited data about the association between the acute hepatitis B flare (AVHF-B) and AF in the long-term follow-up.

Purpose
The aim of this study was to evaluate the association of AVHF-B and long-term clinical outcomes in patients with AF.

Methods
Our University echocardiography, electrocardiogram (ECG) and hepatitis B database were reviewed from 2008 to 2017 to identify patients with AF and AVHF-B. Patients were followed for a mean 26.4±0.9 months and were divided into two groups according to the absence or presence of AVHF-B with AF.

Results
Among 280 patients with AF, 100 (35.7%) patients had AVHF-B. Total any event rates were significantly higher in patients with AVHF-B compared to those without AVHF-B (P<0.001). Arrhythmias including AF, atrial tachycardia,APC, VT, and VPC also occurred in 54 (19.3%) patients, with a significantly higher incidence in patients with AVHF-B than in those without AVHF-B (P<0.001). In univariate analysis, CHA2DS2 VASc, Left atrial diameter (LAD), E/E' (the peak mitral flow velocity of the early rapid filling wave/early diastolic mitral annulus velocity) and AVHF-B were significantly associated with arrhythmic events and total any events including thromboembolic events, arrhythmic events, re-hospitalizations and mortality. In multivariate analysis, AVHF-B was independent risk factors for arrhythmic events (P=0.031) at the long-term follow-up.

Conclusion
The patients with AVHF-B were associated with higher arrhythmic events and total any events, suggesting more intensive medical therapy with close clinical follow-up will be required.

Acknowledgement/Funding
None