bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5568Disease stages of structural and functional cardiac changes associate with outcomes in patients with mitral regurgitation receiving mitral valve intervention
Authors: Niikura H , Sorajja P , Goessl M , Bae R , Garcia S , Sun B , Askew J , Harris K , Fukui M , Stanberry L , Cavalcante J L 
Published: October 2019

Abstract

Background/Introduction
Severe mitral regurgitation (MR) produces volume overload resulting in progressive cardiac dysfunction that can extend beyond the left-sided chambers. It is unknown whether a specific MR staging system, that would quantify the extent of structural and functional cardiac changes, would be associated with outcomes in severe MR patients receiving mitral valve (MV) intervention.

Purpose
To examine the clinical utility of a novel MR staging system, based on the extent of cardiac damage, for prediction of clinical outcomes for patients with severe MR who underwent surgical or transcatheter therapy.

Methods
Patients were categorized into five stages using pre-procedural echocardiography; Stage 0: no other cardiac damage detected; Stage 1: Left atrium (LA) abnormality, as defined by the presence of atrial fibrillation or LA chamber enlargement; Stage 2: LV dysfunction, as defined by LV ejection fraction <60%; Stage 3: Pulmonary artery vasculature or tricuspid valve abnormality, as defined by the presence of systolic pulmonary arterial pressure ≥60 mmHg) or ≥grade 2 tricuspid regurgitation; and Stage 4: Right ventricular (RV) disease as defined by the presence of >mild RV dysfunction. The primary outcomes were all-cause mortality, and the combined endpoint of death or heart failure rehospitalization at one-year follow-up.

Results
A total of 696 patients with MR (age 70±14 years; 60% men) who underwent MV surgery (69%) or transcatheter MV repair with MitraClip device (31%) were examined. Prevalences of stage 0, 1, 2, 3, and 4 were 6.6%, 34.6%, 20.0%, 26.6%, and 12.2%, respectively. The median follow-up time was 15 months (IQR, 6.4, 24.4 months). At one-year, there was graded increase in all-cause death and in the combined endpoint of death or heart failure rehospitalization with each MR stage (Figure). In multivariate models, these associations remained independently associated with both one-year endpoints for patients receiving either surgical or transcatheter interventions.
Figure 1

Conclusion
This novel MR staging system is practical and may improve clinical risk stratification of patients with severe MR being considered for MV interventions.
P5576Outcomes and clinical impact of mitral regurgitation in patients with aortic stenosis undergoing with transcatheter aortic valve replacement
Authors: Munoz-Garcia E , Munoz-Garcia M , Munoz Garcia A J , Dominguez-Franco A J , Carrasco-Chinchilla F , Alonso-Briales J H , Hernandez-Garcia J M , Gomez-Doblas J J , Jimenez-Navarro M F 
Published: October 2019

Abstract

Background
Many patients undergoing Trancatheter aortic valve replacement (TAVR) for aortic stenosis also have significant mitral regurgitation (MR). We sought to understand the association of concomitant MR with TAVR clinical outcomes, as well changes in MR after TAVR.

Methods
Patients who underwent TAVR at our center, between April 2008 to December 2017, were studied, with longer-term clinical outcomes.

Results
Of 667patients, 92 (13.8%) had moderate MR, and 47 (2.1%) had severe MR. At 3.2±2.2 years, mortality was 39.4%, 46.1%, 39.1%, 57.6% and 50% and heart failure (HF) rehospitalization was 7%, 7.9%, 17.6%, 21.9% and 46.2% (p<0.001) in the no, mild, moderate, moderate-severe and severe MR patients, respectively. After procedure, 64 patients (9.9%) had moderate MR and 24 patients (3.7%) had severe MR. At follow-up, the mortality was 35.9%, 46.5%, 48.4%, 52.9% and 85.7%, p<0.001 and HF rehospitalization 9.1%, 5.5%, 23.4%, 35.3% and 40% in the no, mild, moderate, moderate-severe and severe MR patients, respectively. MR improved early after TAVI grade in 88 patients (13.2%). Baseline MR is not associated with mortality (HR= 0.883 [95 CI 0.708–1.102], p=0.114), but MR post-TAVR was associated with increase risk of mortality (HR= 1.539 [95 CI 1.187–1.996], p=0.001. In 7 patients with persistent MR received percutaneous mitral repair with MitraClip®.

Conclusions
In our series, Moderate or severe MR after TAVR is associated with increased mortality or HF rehospitalization, this increased risk may be attributable to the minority of patients whose MR does not improve and could benefit from percutaneous mitral procedures (Mitraclip®).
P5587Elevated D-dimer level after 1 month anticoagulant therapy as a predictor for adverse outcomes in patients with venous thromboembolism: 10-year follow-up results
Authors: Vorobyeva N M , Dobrovolsky A B , Panchenko E P , Titaeva E V , Karabasheva M B , Yarovoy S Y , Danilov N M , Kirienko A I 
Published: October 2019

Abstract

Background
Our previous study showed that elevated D-dimer (D-D) level after 1 month of the anticoagulant therapy was an independent predictor of deep vein thrombosis (DVT) recurrences and combined endpoint (DVT recurrence and/or death from any causes) during 18 months. Prognostic value of elevated D-D level after 1 month of the anticoagulant therapy for the long-term venous thromboembolism (VTE) outcomes is unknown.

Purpose
To estimate the elevated D-D level influence after 1 month of the anticoagulant therapy on the 10-year prognosis in VTE pts.

Methods
One hundred and twelve pts (77 men) aged 18–76 (mean 54±14) years with DVT and/or pulmonary embolism were included in the study. Pts received unfractionated or low molecular weight heparin for at least 5 days followed by the long-term warfarin therapy (target international normalized ratio 2,0–3,0). D-D level was measured after 1 month from the start of the anticoagulant therapy by a quantitative assay with an estimated cut-off level of 0,5 ug/ml. The follow-up period was 10 years. Endpoints were VTE recurrence and combined endpoint (VTE recurrence and/or death from any causes).

Results
In all pts, median of follow-up was 2,77 years (min 2 weeks, max 11,61 years, IQR 1,44 to 10,31 years). Seventy seven (69%) pts had ended the 10-year follow-up period completely or achieved the endpoint. In these pts, median of follow-up was 9,23 years (IQR 1,70 to 10,53 years). Thirty-five cases were censored. During 10 years, the VTE recurrences rate was 27,7%, 14 pts died, the combined endpoint rate was 36,6%. Kaplan-Meier analysis showed that pts with elevated D-D level after 1 month of the anticoagulant therapy had higher 10-year cumulative risk for adverse outcomes (chi-square=6,0, p=0,014 for VTE recurrence; chi-square=13,7, p<0,001 for combined endpoint). Cox regression confirmed that elevated D-D level after 1 month of the anticoagulant therapy was associated with a 2,5-fold increase in the 10-year VTE recurrences risk (HR 2,52; 95% CI 1,18–5,42; p=0,018) and a 3,2-fold increase in the 10-year combined endpoint risk (HR 3,21; 95% CI 1,68–6,15; p<0,001) compared pts with normal D-D level after 1 month of the anticoagulant therapy.

Conclusions
During 10 years, the VTE recurrences rate was 27,7%, combined endpoint rate (VTE recurrence and/or death from any causes) was 36,6%. Elevated (>0,5 ug/ml) D-D level after 1 month of the anticoagulant therapy had a prognostic value and was associated with the 2,5-fold increase in the 10-year VTE recurrences risk and the 3,2-fold increase in the 10-year adverse outcomes risk.
P5602Comparison of innominate vs axillary artery cannulation for cerebral protection on neurocognitive outcomes in aortic surgery: a pre-specified analysis of the ACE CardioLink-3 randomised trial
Authors: Garg V , Verma S , Peterson M D , Chu M W A , Quan A , Zuo F , Teoh H , Mazer C D , Smith E E 
Published: October 2019

Abstract

Background
Success after aortic surgery depends on avoidance of neurocognitive dysfunction, thus novel adjuncts to proximal aortic surgery must be evaluated for efficacy of cerebral protection during circulatory arrest. We report the primary neurocognitive results from the ACE CardioLink-3 randomised controlled trial comparing innominate to axillary artery cannulation for cerebral protection (NCT02554032).

Methods
The primary safety endpoint was the proportion of patients with new radiologically severe ischaemic cerebral lesions found on post-operative versus pre-operative diffusion weighted magnetic resonance imaging (DW-MRI). Neurocognitive outcomes were assessed using the Mini-Mental State Exam (MMSE), and the Montreal Cognitive Assessment (MoCA). Continuous and binary outcomes were analysed using ANCOVA (controlling for baseline score) and chi-square/Fisher's exact tests.

Results
Of the 111 patients randomised, 102 patients were included in the primary safety per-protocol analysis. The primary safety outcome (significant new ischaemic lesions on DW-MRI) occurred in 34% in the innominate group and 38.8% in the axillary group (OR 0.81; 0.41 to 1.60; P=0.0009 for non-inferiority). Rates of post-operative stroke/transient ischaemic attack, seizure, delirium, and encephalopathy were similar between groups. The rate of patients with a post-operative MoCA score less than 26 was 44.9% and 39.1% in the innominate and axillary groups respectively (P=0.807). A post-operative MMSE score of less than 24 was observed in 2% vs. 6.5% of the patients in the innominate and axillary groups respectively (P=0.866). A >1-point decrease in the MoCA score from pre-operatively to post-operatively was seen in 32.7% and 34.8% in the innominate and axillary groups respectively (P=0.962). A >1-point decrease in the MMSE score from pre-to post-operative was observed in 20.4% in the innominate artery group compared with 30.4% in the axillary group (P=0.346).

Conclusion
Post-operative neurocognitive dysfunction and DW-MRI incidence of severe ischaemic lesions did not differ in patients randomised to innominate artery cannulation vs, conventional axillary artery cannulation, though the burden of new severe ischaemic lesions is high in both groups.
P5604Combining aortic size with measures of aortic stiffness and pulsatile hemodynamics enhances prediction of future thoracic aortic aneurysm expansion
Authors: Zhu T , Boodhwani M , Beauchesne L , Chan K , Dennie C , Wells G , Coutinho T 
Published: October 2019

Abstract

Introduction
Thoracic aortic aneurysm (TAA) is a clinically silent disease which can lead to significant morbidity when complicated by an acute aortic syndrome. Although TAA size is the only variable used in decision-making, it is an imperfect predictor of risk. Conversely, hemodynamic measures that reflect the aorta's function, such as aortic stiffness and pulsatile hemodynamics, may provide additional insights into risk of TAA expansion.

Purpose
We hypothesized that combining aortic size with measures of arterial function (stiffness and pulsatile hemodynamics) would improve prediction of TAA expansion, as compared to aortic size alone.

Methods
105 unoperated participants with TAA were recruited between 2014 and 2017 and followed prospectively for ≥1 yr. TAA size was measured at enrolment and at the latest imaging study according to published consensus; TAA expansion was calculated as mm/year. Arterial function was non-invasively assessed at baseline with validated methods that integrate arterial tonometry with echocardiography. Multivariable linear regression assessed independent associations of baseline TAA size and each arterial function measure, initially separately and then in combination (by multiplying them when direction of association was the same, and dividing them when direction of association was opposite), with future TAA expansion. Standardized beta coefficients were calculated to allow direct comparisons. Models were adjusted for age, sex, body size, aneurysm location and etiology, type of imaging modality, follow-up time, mean arterial pressure, and history of hypertension, diabetes and smoking.

Results
Seventy-seven percent of participants were men, and the ratio of degenerative to heritable TAAs was 62/43. Mean ± SD age, baseline TAA size, and follow-up time were 62.8±11.3yrs, 46.3±3.9cm, and 2.2±0.7 years, respectively. Results of the multivariable linear regression models are summarized in the Table. While baseline TAA size and each arterial function measure were independently associated with TAA expansion, some of the arterial function measures were superior in predicting TAA growth (Table, left). In addition, combining aortic size and function further improved the prediction of TAA growth beyond each variable alone (Table, right).

Conclusion(s)
Combining aortic size with arterial function improved prediction of TAA expansion over any individual variable alone, independently of confounders. Assessing arterial function may confer a clinical advantage, when compared to current practice, in determining TAA disease activity and estimating one's TAA-related risk.

Acknowledgement/Funding
Canadian Institute of Health Research, Canadian Vascular Network, and Heart and Stroke Foundation of Canada
P5624Late acquired tissue protrusion after drug-eluting stent implantation: a serial follow-up of 1-month optical coherence tomography imaging
Authors: Otagaki M , Fujii K F , Matsumura K M , Noda T N , Shibutani H S , Park H P , Yamamoto Y Y , Shiojima I S 
Published: October 2019

Abstract

Background
Tissue protrusion (TP) between the stent struts after stent implantation has been implicated as a potential factor in the subsequent development of stent thrombosis. However, the incidence, natural history, and predictive factor of TP after stent implantation remains unclear.

Purpose
To elucidate the fate of TP, we undertook the study assessing TP using short term serial optical coherence tomography (OCT), immediately after deployment of stents and at 1-month follow-up.

Methods
This was a prospective, single-center study evaluating vascular healing responses with OCT both immediately after and at 1-month after biodegradable-polymer sirolimus-eluting stent (SES) implantation. A total of 18 stable angina patients having OCT-guided PCI with SESs underwent assessment of TP with OCT pre-procedure, post-procedure, and at 1-month follow-up. TP was defined as a tissue prolapse for more than 200 μm between stent struts that directly correlates with the underlying plaque, without abrupt transition and different optical properties. TP was classified into the following 3 groups on the basis of serial assessment: (1) healed, TP present after the procedure but covered by tissue with smooth surface at 1-month follow-up; (2) persistent, TP present both after the procedure and 1-month follow-up; and (3) late-acquired, TP not present at baseline but present at 1-month follow-up.

Results
Immediately after the procedure, 29 TPs in 13 patients (72%) were identified. Of those, 16 (55%) were healed and 13 (45%) were persistent at 1-month follow-up. Although the size of TP on post-procedural OCT was similar, neointimal area in lesions with healed TP was significantly larger than in lesions with persistent TP due to neointimal proliferation at 1-month follow-up. A synchronous comparison between the post-procedural OCT and the follow-up OCT image showed that 5 TPs were observed only at 1-month follow-up (late-acquired). In lesions with late-acquired TP, calcified nodule or thin-cap fibroatheroma was identified as an underlying plaque morphology on pre-procedural OCT. A representative example is presented in Figure.
Incidence of TP and representative case

Conclusion
Short term serial OCT analysis found that TP can occur not only immediately after SES implantation, but also 1 month after SES implantation. This new concept may provide a new insight into the mechanism of in-stent restenosis and stent thrombosis development after stent implantation.

Acknowledgement/Funding
None
P5660Clinical impact of polycythemia on cardiovascular outcome from the general population: a nationwide cohort study
Authors: Kim I.-S , Lee B K , Yang P S , Yu H T , Kim T H , Uhm J S , Pak H N , Lee M H , Kim J Y , Joung B 
Published: October 2019

Abstract

Background
Although adverse effect of anemia had been reported, effect of polycythemia on cardiovascular outcome from the general population had not been revealed yet.

Methods
We included 451,107 subjects who received national health examinations from the Korean National Health Insurance Service-based National Sample Cohort from 2009–2013. Medical records were screened from January 2002 to investigate the subjects' disease-free baseline period. They were followed until December 2013. We divided male and female subjects into four categories each based on hemoglobin level (normal, moderate to severe and mild anemia, polycythemia) to assess each outcome.

Results
During 1,735,964 person·years, 12,107 major adverse cardiovascular and cerebrovascular events (MACCE), 862 incident acute myocardial infarction (MI), 5,850 incident ischemic stroke, and 2,430 incident atrial fibrillation (AF) were observed. Compared to normal hemoglobin range group, polycythemia group showed higher MACCE (HR=1.23 [1.12–1.35] in male, HR=1.79 [1.20–2.67] in female, each p<0.001), incident MI (HR=1.37 [1.05–1.79] in male, HR=3.46 [1.06–14.00] in female, each p<0.001), incident ischemic stroke (HR=1.27 [1.10–1.46] in male, HR=1.72 [1.02–2.91] in female, each p<0.001), and incident AF (HR=1.46 [1.21–1.74] in male, HR=2.13 [1.03–4.77] in female, each p<0.001). Each outcome was linearly increased with the increase of hemoglobin among subjects with polycythemia (p<0.001), and with the decrease of hemoglobin among subjects with anemia (each p<0.001, U-shaped relationship). These relationship was more profound in obese female younger than 60-year-old.

Conclusion
Not only anemia but also polycythemia were significantly associated with higher rate of MACCE including death, incident MI, ischemic stroke, and AF among the general population.
P5663Impact of proteinuria on cardiovascular outcomes in Japanese diabetic patients with atrial fibrillation: the Fushimi AF Registry
Authors: Ikeda S , Iguchi M , Ogawa H , Ishigami K , Aono Y , Doi K , An Y , Ishii M , Masunaga N , Esato M , Wada H , Hasegawa K , Abe M , Akao M 
Published: October 2019

Abstract

Background
Previous studies have suggested that proteinuria is independently associated with clinical outcomes in diabetic patients, irrespective of the presence of renal dysfunction. However, data regarding the impact of proteinuria on clinical outcomes in diabetic patients with atrial fibrillation (AF) are limited.

Methods
The Fushimi AF Registry is a community-based prospective survey of AF patients in our city in Japan. Follow-up data were available in 4,454 patients, and 634 diabetic patients with available data of proteinuria and estimated glomerular filtration rate (eGFR) were examined. We compared the clinical background and outcomes between patients with proteinuria (n=251) and those without (n=383). Then, we divided the patients into 4 subgroups according to the presence of proteinuria and renal dysfunction, and compared the clinical outcomes between groups; group 1 (without proteinuria, eGFR ≥60 ml/min/1.73 m2; n=203), group 2 (with proteinuria, eGFR ≥60; n=96), group 3 (without proteinuria, eGFR <60; n=180), group 4 (with proteinuria, eGFR <60; n=155).

Results
Age was comparable between patients with or without proteinuria. Patients with proteinuria had higher prevalences of previous heart failure (HF), stroke/systemic embolism, hypertension and renal dysfunction. The prevalences of previous myocardial infarction, and major bleeding were similar between two groups. During the median follow-up of 1,505 days, the incidence rates of HF hospitalization (4.1/100 person-years vs. 2.5/100 person-years; p<0.01) and cardiovascular death (1.8/100 person-years vs. 0.4/100 person-years; p<0.01) were higher in patients with proteinuria. When we divided patients into 4 subgroups, the incidences of HF hospitalization (group 1: 1.8/100 person-years vs. group 2: 3.4/100 person-years vs. group 3: 3.8/100 person-years vs. group 4: 4.9/100 person-years; p<0.01) and cardiovascular death (group 1: 0.3/100 person-years vs. group 2: 1.8/100 person-years vs. group 3: 0.5/100 person-years vs. group 4: 2.2/100 person-years; p<0.01) tended to be higher in not only group 3 and group 4 but also group 2 than group 1 (Figure). Multivariate Cox proportional hazards regression analysis including female gender, age (≥75 years), hypertension, pre-existing HF, renal dysfunction (eGFR <60),low left ventricular ejection fraction (<40%) and proteinuria revealed that proteinuria was an independent determinant of both of HF hospitalization (adjusted hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.05–2.34) and cardiovascular death (HR: 3.76, 95% CI: 1.59–8.88).
Figure 1

Conclusion
In Japanese diabetic patients with AF, proteinuria was associated with higher incidences of HF hospitalization and cardiovascular death, irrespective of the presence of renal dysfunction.
P5665The independent effect of insulin resistance on incidence of atrial fibrillation in non-diabetics
Authors: Park J K , Park J H , Lee Y G , Shin J H , Lim Y H , Heo R , Shin J 
Published: October 2019

Abstract

Purpose
Patients with diabetes mellitus have an elevated risk of atrial fibrillation (AF). However, whether insulin resistance may elevate risk of AF incidence in non-diabetic is inconsistent. The aim of our study was to verify the association between insulin resistance and incidence of AF in non-diabetics.

Methods
We evaluated population-based cohorts embedded in the Korean Genome Epidemiology Study. Insulin resistance was expressed as Homeostasis Model Assessment for Insulin resistance (HOMA-IR). Baseline data including HOMA-IR and electrocardiography (ECG) were obtained at 2001. Subsequent biennial ECG was performed for identification of AF until 2016.

Results
Among the 8220 participants (46.8% male; median age 49 years), 25 participants had AF (0.3%) at baseline and 101 participants developed AF (1.2%) during follow up of 12 years. In multivariate Cox regression analysis, high HOMA-IR (≥1.4) was significantly associated with incident AF compared with low HOMA-IR (<1.40) (adjusted hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.3–3.0). In subgroup analysis, these association was consistent regardless of obesity (BMI<25; adjust HR 1.8, 95% CI 1.1–3.0, BMI≥25; adjust HR 2.3, 95% CI 1.3–4.0)
Subgroup analysis

Conclusion
Based on prospective cohort study, insulin resistance (HOMA-IR) was associated with AF independently of obesity in non-diabetics.