bluuebunny/crossref_metadata_2025_split huggingface dataset:
5937Natural history of functional tricuspid regurgitation: implications of quantitative doppler assessment
Authors: Bartko P E , Arfsten H , Frey M , Heitzinger G , Pavo N , Cho A N N A , Neuhold S , Tan T , Strunk G , Hengstenberg C , Huelsmann M , Goliasch G 
Published: October 2019

Abstract

Objectives
To establish the prognostic value of quantitative measures of functional tricuspid regurgitation (TR) severity i.e. effective regurgitant orifice area (EROA) and regurgitant volume.

Methods
382 patients with HFrEF on guideline-directed medical therapy were enrolled and TR EROA as well as regurgitant volume by Doppler/2D-echocardiography were assessed. All-cause mortality was defined as the primary study endpoint.

Results
Quantitative metrics of TR severity were consistently associated with mortality with a HR of 1.27 (95% CI 1.13–1.42, P<0.001) for the EROA and of 1.29 (95% CI 1.14–1.45, P<0.001) for the regurgitant volume (Figure 1, Panels A and B). Results remained unchanged after bootstrap- or clinical confounder-based adjustment. A spline curve pattern illustrates the association with mortality with thresholds for the EROA≥0.2cm2, and the regurgitant volume≥20ml with sustained excess mortality thereafter (Figure 1 Panels C-D).
Figure 1. Panels A–D

Conclusions
This large-scale study demonstrates the prognostic value of quantitative measures of TR severity in HFrEF. Thresholds for EROA and TR regurgitant volume associated with mortality fall within current ranges defining non-severe TR. This may potentially impact therapeutic decision making particularly timing of intervention.
5939Perioperative shift in right ventricular mechanical pattern in patients undergoing mitral valve surgery: a predictor of right ventricular failure?
Authors: Tokodi M , Lakatos B K , Kispal E , Toser Z , Racz K , Soltesz A , Szigeti S Z , Hartyanszky I , Nemeth E , Merkely B , Kovacs A 
Published: October 2019

Abstract

Background
Severe mitral regurgitation (MR) induces significant changes not only in the left, but also in the right ventricular (RV) morphology and function. Early treatment of MR is recommended, however, surgical procedure disrupts the native RV contractile pattern and predisposes the at-risk ventricle to develop postoperative RV failure (RVF) which is associated with poor outcomes.

Purpose
Accordingly, the PREPARE-MVR study (PRediction of Early PostoperAtive Right vEntricular failure in Mitral Valve Replacement/Repair patients) aims to explore the alterations of RV contraction pattern in patients undergoing MVR and to investigate the association of preoperative echocardiographic findings with early postoperative RVF.

Methods
We prospectively enrolled 70 patients (62±12 years, 67% males) undergoing open heart MVR. Thirty age and gender matched healthy volunteers served as control group. Transthoracic 3D echocardiography was performed preoperatively and at intensive care unit discharge. Furthermore, focused 2D echocardiogram was also obtained during the ICU stay. Forty-three patients also completed 6 months follow-up. 3D model of the RV was reconstructed and end-diastolic volume index (EDVi) along with RV ejection fraction (RVEF) were calculated. For in-depth analysis of RV mechanics, we decomposed the motion of the RV to compute longitudinal (LEF) and radial ejection fraction (REF). Right heart catheterization was performed to monitor RV stroke work index (RVSWi).

Results
RV morphology as assessed by EDVi was unaffected by surgery (preoperative vs postoperative; 73±17 vs 71±16 mL/m2, p=NS). RVEF was slightly decreased after MVR (52±6 vs 48±7%, p<0.05), whereas RV contraction pattern has changed notably. Before MVR, the longitudinal shortening was the main contributor to global systolic function (LEF/RVEF vs REF/RVEF; 0.53±0.10 vs 0.43±0.12; p<0.001), whereas in controls the longitudinal and radial shortening contributed equally to RVEF (0.47±0.07 vs 0.43±0.09; p=NS). Postoperatively, the radial motion became dominant (0.35±0.08 vs 0.47±0.09; p<0.001). However, this shift was only temporary as 6 months later the contraction pattern became similar to controls showing equal contribution of the two components (0.44±0.10 vs 0.42±0.11; p=NS). Postoperative RVF (defined as RVSWi <300 mmHg*mL/m2 or ICU TAPSE <10 mm) was detected in 14 [20%] patients. Preoperative LEF was associated with postoperative RVSWi (r=−0.61, p<0.001) and it was an independent predictor of postoperative RVF (OR=1.16 [1.03–1.35], p<0.05).

Conclusion
Severe MR induces a significant shift in the RV mechanical pattern which may influence the development of postoperative RV dysfunction and failure after MVR. Advanced indices of RV mechanics are associated with invasively measured parameters of RV contractility and may predict postoperative RVF.
5947Predictive role of C-reactive protein levels in patients with ST-segment elevation acute myocardial infarction for heart failure related events
Authors: Van Tassell B , Trankle C R , Kadariya D , Canada J M , Carbone S , Buckley L F , Wohlford G F , Dixon D L , Christopher S , Vo C , Mankad P , Dell M , Shah K B , Kontos M C , Abbate A 
Published: October 2019

Abstract

Background
ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of death and heart failure (HF). C-reactive protein (CRP) is the inflammatory biomarker most commonly used for risk stratification in patients with cardiovascular diseases. CRP levels are known to rise and fall during STEMI in response to myocardial injury. In this study, we analyzed whether admission CRP or delayed CRP (measured at 72 hours after admission) held a greater predictive value for adverse HF events in patients with STEMI.

Methods
We analyzed data from the VCUART3 clinical trial enrolling 99 patients with STEMI within 12 hours of presentation at 3 sites in the United States of America treated with anakinra or placebo. CRP levels were measured with a high-sensitivity assay at time of admission and again at 72 hours later. A dedicated committee composed of individuals not involved in the conduct of the trial adjudicated HF events including a composite endpoint of death from any reason or incidence of HF defined as new-onset HF requiring hospital admission or a new prescription for a loop diuretic (D+HF) and a composite endpoint of death and HF hospitalization (D+HHF) at 1 year. We used a time-dependent Cox-regression analysis to determine the association of CRP at admission or at 72 hours with the outcomes of interest in univariate and multivariate analysis. Data are presented as median and interquartile range. (ClinicalTrials NCT01950299)

Results
CRP levels from admission and 72 hours were available in 90 and 87 subjects respectively and they increased from 4.6 [2.8–8.5] mg/L to 11.6 [4.6–24.5] mg/L (P<0.001). Both admission CRP (CRP0) and CRP at 72 hours (CRP72) were associated with the risk of D+HF (P=0.011 and <0.001, respectively) and of D+HHF (P=0.010 and P<0.001, respectively); however at multivariate analysis, only CRP72 remained significantly associated with the risk of D+HF (P=0.001) and D+HHF (P=0.004) while CRP0 was not. CRP72 significantly correlated with NTproBNP levels at 72 hours (NTproBNP72, Spearman rho R=+0.37, P=0.001). NTproBNP72 predicted D+HF (P=0.030) but not independently of CRP72 (P=0.096 for NTproBNP72 and P=0.007 for CRP72 at multivariate analysis including the 2 variables). NTproBNP72 did not predict D-HHF.

Conclusions
Among contemporary patients with STEMI, the levels of CRP at 72 hours after admission was superior to admission CRP levels for predicting the incidence of HF events, and independent of NTproBNP levels. Our results indicate the importance of the inflammatory response during STEMI, supporting the concept of inhibiting the inflammatory response as a therapeutic strategy.

Acknowledgement/Funding
Funded by NHLBI 1R34HL121402; Drug supply from Swedish Orphan Biovitrum
5964Hybrid PET/MR imaging for the prediction of left ventricular (LV) recovery after revascularisation of chronic total occluded coronaries
Authors: Vitadello T , Rischpler C , Langwieser N , Kunze K , Nekolla S , Laugwitz K L , Schwaiger M , Ibrahim T 
Published: October 2019

Abstract

Background
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents one of the major challenges in interventional cardiology. Physicians are still reluctant in referring for PCI, assuming non viability of the myocardium subtended by the CTO. Data are controversial in assessing the improvement of left ventricular (LV) wall motion after revascularisation and the prognostic value of viability testing to guide patient selection.

Purpose
The aim of this study was to determine, whether hybrid fluorodeoxyglucose positron emission tomography/magnetic resonance (FDG PET/MR) imaging allows a more accurate prediction of LV regional wall motion recovery after successful PCI of CTOs in comparison to PET or MR alone.

Methods
We enrolled 49 consecutive symptomatic patients with CTO and evidence of wall motion abnormality in the corresponding CTO-territory. All patients underwent hybrid FDG PET/MR imaging as semi-quantitative assessment of myocardial viability - glucose metabolism in PET and late gadolinium enhancement (LGE) transmurality in MR – prior of PCI of the CTO. Follow-up MRI was performed in 23 patients 3–6 months after successful revascularisation to evaluate wall motion changes.

Results
We assessed viability in 124 myocardial segments subtended by a CTO in 23 patients with successful PCI who underwent serial imaging. Segments with wall motion abnormality at baseline (n=80) were analysed. Most of these segments (n=54, 68%) were concordantly assessed viable by PET and MR, conversely only 2 (2%) segments were assessed non-viable by both imaging techniques. However, almost one third of the segments showed discordant patterns of viability either PET not viable/ MR viable (3 (4%) segments) or PET viable/ MR not viable (21 (26%) segments): particularly the latter revealed a significant wall motion improvement (p=0.033).
The combination of PET and MR showed a fair accuracy in predicting myocardial segments with wall motion improvement after CTO revascularisation (PET/MR area under ROC curve (AUC) 0.72, SE 0.07, p=0.002), which was superior to MR-LGE (AUC=0.66, SE 0.09) and FDG-PET (AUC=0.58, SE 0.10) alone (Figure).
Comparisons of ROC curves

Conclusion
Hybrid PET/MR imaging prior to successful CTO showed a better performance than PET or MR alone in predicting regional improvement of disturbed wall motion.
The complimentary information derived from both modalities may particularly help to identify small amounts of viable epicardial myocardium within large scars which can improve contractility after CTO-revascularisation.
5965Perimatrial inflammation measured by fluoine-18-fluorodeoxyglucose-positron emission tomography/computed tomography to predict new-onset atrial fibrillation
Authors: Hada Y , Iwamiya S , Hijikata S , Yoshitake T , Sato H , Konishi Y , Sakurai K , Azegami K , Hirao K 
Published: October 2019

Abstract

Background
Fluoine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is a useful modality of inflammatory disease. Epicardial adipose tissue (EAT) contains abundant ganglionated plexi, therefore EAT inflammation may cause atrial arrhythmia, such as atrial premature contraction (APC) and atrial fibrillation (AF). Previous studies have shown that inflammatory activity of EAT has relation to the presence of AF. However, it is unknown whether EAT inflammation contributes to the occurrence of AF.

Methods
Out of 20720 examinees who underwent FDG-PET/CT for screening of cancer in the years 2012–2018, 151 (aged 65.6±12.0 years old, 62 females) had ambulatory electrocardiographic monitoring (Holter ECG) within a year and non-detection of AF. Standardized uptake value (SUV) was measured in fat adjacent to roof of left atrium (ROOF), atrioventricular groove (AV), left main coronary artery (LMT), and right ventricular blood pool (RV). In order to correct for blood pool activity, SUV of ROOF, AV, and LMT were divided by SUV of RV respectively, yielding target-to-background ratio (TBR). As regards to arterial inflammation, measurements were performed with SUV in ascending aorta (A-Ao) and in superior vena cava (SVC) as blood pool. In the same way, SUV of A-Ao was divided by SUV of SVC, yielding TBR.

Results
According to Holter ECG, APC≥100 beats per day was seen in 60 patients (Group A), but not in the other 91 (Group B). In Group A, TBR of ROOF, AV, and LMT were all significantly higher than Group B (p<0.001, p=0.004, and p=0.008, respectively). During a median follow-up of 179 days, new-onset AF was diagnosed in 7 patients (4 in Group A (6.7%), 3 in Group B (3.3%), p=0.046). There was significant difference in TBR of ROOF between patients with and without new-onset AF (p<0.001), but not in TBR of AV and LMT. In addition, no significant difference was observed in TBR of A-Ao between these two groups. In the Cox proportional hazard analysis, TBR of ROOF was found to be an independent predictor of new-onset AF (odds ratio 40.1, 95% confidence interval 6.05 to 265.9, p<0.001).

Conclusions
Although EAT inflammation evaluated by SUV is related to frequent APCs, only in fat adjacent to roof of left atrium is associated with and predicts future occurrence of AF. Arterial inflammation measured by SUV has no relation to atrial arrhythmia.
6067Right ventricular global longitudinal strain predicts cardiovascular mortality and heart failure hospitalization in patients with functional tricuspid regurgitation
Authors: Ochoa-Jimenez R , Guta A C , Previtero M , Palermo C , Aruta P , Badano L P , Muraru D 
Published: October 2019

Abstract

Background
Functional tricuspid regurgitation (FTR) and its increasing severity are well-known factors associated with increased morbidity and mortality in patients with pulmonary artery hypertension or left heart diseases.

Purpose
To assess the main clinical and echocardiographic determinants of outcome in patients with various causes of FTR.

Methods
A total of 140 patients (pts) (72±14 years, 40% men) with FTR of diverse etiologies underwent complete 2D and additional 3D echocardiography acquisitions and were followed for a median of 5.2 years (interquartile range 2.1 - 6.7 years). Severe FTR was defined by ≥2 parameters: (1) coaptation defect; (2) vena contract ≥7; (3) PISA radius >9 mm; (4) hepatic vein systolic flow reversal. The primary composite outcome was defined as death from cardiovascular causes and hospitalization due to right-sided heart failure (HF).

Results
74 pts (53%) developed the primary composite outcome. Death occurred in 31 pts (22%), while hospitalization due to right-sided HF occurred in 66 pts (47%). At baseline, patients who developed the primary composite outcome, compared to those who did not, had more symptoms, more severe FTR, higher pulmonary systolic pressure (60±27 vs 43±16 mmHg), larger right atrium (69±34 vs 51±22 mL/mm2), right ventricular (RV) basal diameter (29±6 vs 24±4 mm/m2), larger RV end-diastolic (102±45 vs 76±25 mL/m2) and end-systolic (62±37 vs 43±17 mL/m2) volumes, larger tricuspid annulus area (7.7±1.8 vs 6.8±1.8 cm2/m2), lower RV systolic function (RVEF [42±11 vs 46±8%], TAPSE [18±4 vs 21±4], S' [11±3 vs 12±2], RV global longitudinal strain (RVGLS) [16±5 vs 19±4], RV free wall longitudinal strain [19±7 vs 23.5]); all p-values <0.03. There were no significant differences in age, body size or comorbidities. After multivariable Cox regression analysis, FTR grade severity (hazard ratio [HR]=2.95, 95% confidence interval [CI] 2.14–4.06, p<0.001) and RVGLS (HR= 0.91, 95% CI 0.86–0.95) were the only independent predictors of mortality. A cutoff of −17.5 for RVGLS had 57% sensitivity, 73% specificity and a HR of 2.34 (95% CI of 1.42–3.88, p-value=0.001). The Kaplan Meier survival curve showed that patients with an RVGLS ≥ −17.5 had a higher probability of developing the primary composite outcome, especially at an earlier phase of the follow up when compared to those with higher LS (log rank test chi-square = 13.0, p<0.001) (Figure). At the end of follow up, 60% of patients with a RVGLS ≥-17.5 did not developed the primary composite outcome vs 29% in the group with a LS lower than −17.5.
Kaplan-Meier curve of outcome by RVGLS

Conclusions
In patients with FTR, a decreased RVGLS, with a cutoff of −17.5, proved to be an independent prognostic factor for the development of HF hospitalizations and death from cardiovascular causes.
6110OCT guidance during primary PCI may increase long-term risk of device oriented events: subanalysis of ROBUST study
Authors: Jakl M , Cervinka P , Kala P , Kanovsky J , Kupec A , Vanek J , Bezerra H G , Schnell A , Costa M A 
Published: October 2019

Abstract

Background
Optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI) is expected to be safe in short and mid-term follow-up. Long term merits or risks of OCT guidance are unknown.

Purpose
To assess the possible merits of OCT guidance in pPCI in long-term follow-up.

Methods
201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. The OCT study was performed after PCI with C7-XRTM intravascular imaging system employing a non-occlusive technique.
Incidence of Device-oriented Composite Endpoints (DoCE) was compared in both study groups. DoCE were defined as composite of definite or possible cardiovascular death, myocardial infarction and target vessel revascularization. The search for DoCE was performed by means of medical check-ups, repeated telephone contacts, analysis of medical records and search in national population registry.

Results
Mean follow-up was 6.5 (6.5–7.1 years). Of these patients, 2 (1.0%) patients died of cardiovascular reason, 4 patients (2%) suffered myocardial infarction and 7 (3.5%) patients underwent target lesion revascularization. In OCT guided group, number of stents per patient was higher (1.4 vs. 1.2, p=0.03). Risk of DoCE was significantly higher in OCT-guided group (7.6% vs. 2.1%, p=0.023).
Event-free survival in study groups

Conclusion
Our data suggest increased risk of adverse events related to OCT guided tailoring of stent implantation performed after pPCI. These findings should be confirmed by further randomised trials with higher statistical power.

Acknowledgement/Funding
The work was supported by a long-term organization development plan 1011 (FMHS)
6115Influence of microvascular function and coronary flow in the diagnostic precision of resting full-cycle ratio
Authors: Tamargo Delpon M A , Gutierrez Ibanes E , Diez-Delhoyo F , Gonzalez-Saldivar H , Rivera A R , Casado A , Vazquez M E , Sanz R , Soriano J , Elizaga J , Fernandez-Aviles F J 
Published: October 2019

Abstract

Introduction
Resting full-cycle ratio (RFR) has been recently described as a non-hyperemic index of coronary stenosis with good concordance with Fractional Flow Reserve (FFR). However, there is no information concerning the influence of microvascular function and coronary flow on RFR results.

Purpose
To determine if the accuracy of this novel parameter might be influenced by changes in microvascular function.

Methods
133 patients admitted in our center between July 2016 and December 2017 underwent coronary physiology study of an angiographically intermediate lesion. 67 subjects presented with AMI and an intermediate lesion in a non-culprit artery, and 66 subjects stable coronary disease. We performed FFR, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR) and Resistance Reserve Ratio (RRR) in all of them. We calculated RFR retrospectively from the pressure tracings.

Results
Coronary physiology parameters showed a non-normal distribution and are presented as median [IQR]: FFR 0.86 [0.79–0.92]; CFR 2.05 [1.4–2.95]; IMR 20.5 [14–32.55]; RRR 2.5 [1.85–3.63]; RFR 0.897 [0.83–0.94]. Patients with abnormal CFR displayed lower RFR values although FFR was not markedly affected (Table 1). These findings remained irrespective of the clinical scenario at presentation.
61 patients had a CFR lower than 2. Correlation between RFR and FFR was not significantly different in patients with abnormal CFR than in those with normal CFR (0,73 vs 0,88; p=0,067) (Figure 1); however, overall binary agreement between RFR and FFR was worse in patients with a low CFR (69% vs 83%; p=0,047).
48 patients had a high IMR (>25). Linear correlation between RFR and FFR was similar in patients with high and normal IMR (0,81 vs 0,83; p=0,784); likewise, binary concordance showed no significant difference between both groups (77% vs 75%, p=0,78).
The mean difference between RFR and FFR was 0,025. This was only influenced by CFR: patients with a low CFR had a smaller difference than those with a normal CFR (0,012 vs 0,035; p=0,019).
Physiology parameters by CFR group Normal CFR (≥2) Low CFR (<2) P-value FFR 0.88 [0.82–0.93] 0.84 [0.79–0.92] 0.14 RFR 0.91 [0.88–0.95] 0.86 [0.80–0.92] 0.0009 IMR 16.5 [13–27] 25 [16–45.5] 0.002 RRR 3.6 [2.7–4.9] 1.7 [1.3–2.1] <0.0001 Physiological coronary parameters (Median [IQR]) according to CFR.
Correlation between RFR and FFR by CFR

Conclusion
RFR has good overall correlation and concordance with FFR. However, RFR has a lower diagnostic accuracy in patients with a low CFR.

Acknowledgement/Funding
None
6125High wall shear stress predicts plaque rupture of the aortic arch: computational fluid dynamics model and non-obstructive general angioscopy study
Authors: Kojima K , Hiro T , Ebuchi Y , Morikawa T , Migita S , Tamaki T , Mineki T , Akutsu N , Murata N , Kitano D , Sudo M , Fukamachi D , Takayama T , Hirayama A , Okumura Y 
Published: October 2019

Abstract

Background
Wall shear stress (WSS) has been considered as a major determinant of aortic atherosclerosis. Recently, non-obstructive general angioscopy (NOGA) was developed to be able to visualize a variety of its atherosclerotic pathology, including in vivo ruptured plaque (RP) in the aorta. We, therefore, investigated the relationship between NOGA derived RP in the aortic arch and the stereographic distribution of WSS by using computational fluid dynamics modeling (CFD) on three-dimensional CT angiography (3D-CT).

Methods
We investigated 30 consecutive patients who underwent 3D-CT before and NOGA during coronary angiography. WSS in the aortic arch was measured with an application of CFD based on finite element method by using uniform inlet and outlet flow conditions. Aortic RP was detected by NOGA.

Results
The maximum and mean values of WSS were 67.2±29.2 Pa and 2.4±0.6 Pa. A total of 18 RPs was detected by NOGA. The patients with a distinct RP showed a significantly higher maximum WSS in the whole aortic arch, and the greater and lesser curvature of the aortic arch than those without it (73.3±29.0 Pa vs 50.4±15.2 Pa, p=0.035, 95.0±27.5 Pa vs 42.8±25.2 Pa, p=0.003, 70.8±29.3 Pa vs 46.1±11.9 Pa, p=0.013, respectively), whereas there was no significant difference in the mean WSS between those with and without it. In a multivariate analysis, the maximum value of WSS was an independent predictor of RP in the aortic arch (odds ratio 1.05, 95% confidence interval 1.01–1.13, p=0.019).
Representative picture of WSS and NOGA

Conclusions
Aortic RP detected by NOGA was strongly associated with the higher maximum WSS in the aortic arch derived by CFD using 3D-CT. Maximum WSS may explain the underlying mechanism of not only aortic atherosclerosis, but also aortic RP.