bluuebunny/crossref_metadata_2025_split huggingface dataset:
The reveal, reveal 2.0, compera and fphn risk scores in predciting the pah mortality: a single-centre study
Authors: Tanyeri S , Tokgoz H.C , Keskin B , Akbal O.Y , Karagoz A , Hakgor A , Bayram Z , Dogan C , Acar R.D , Kultursay B , Guner Z.E , Tanboga I.H , Ozdemir N , Kaymaz C 
Published: November 2020

Abstract

Aims
Several risk prediction models have been developed for risk assessment at the time of diagnosis and during follow-up in patients (pts) with pulmonary arterial hypertension (PAH). In this single-centre study we aimed to compare baseline REVEAL, REVEAL 2.0, COMPERA and FPHN risk scores in predicting the mortality in pts with PAH.

Methods
Study group comprised of 504 pts (age 54.4±18.9 years, female 64.4%) with PAH out of the overall 852 pts with pulmonary hypertension enrolled fourteen year period. Subgroups of PAH were as follows; IPAH (39%), CHD-PAH (51%), CTD-PAH (7.7%) and other PAH (3.3%). Functional-class (FC), six-minute-walking-distance (6MWD), pericardial effusion (PE), right atrial area (RAA), tricuspid-annular-planary-systolic-excursion (TAPSE) and systolic annular velocity (St), Echo and Catheter pulmonary artery mean presures (PAMP) and N-terminal-pro brain natriuretic-peptide (NT-proBNP) measures were evaluated at baseline and periodical control examinations with 6-months apart. Baseline assessments for REVEAL, REVEAL 2.0, COMPERA and FPHN risk scores were performed in all pts.

Results
In baseline assessment mean FC and 6MWD were 3 (3–4 IQR), and 230±100 m, repectively. Mean PAMP was 51.5±26 mm Hg, and pulmonary vascular resistance was 8.8±6.5 Wood units. Mono, dual and triple combination therapies were noted in 42%, 40%, and 18% of pts. Median follow-up time was (1470 (275–4840 IQR)) and overall all-cause mortality was 32.1%. Using the Cox proportional hazard model, likelihood ratio (LR) of scores and p values were as follows; REVEAL: 95.09 (p&lt;0.001), REVEAL-2: 122.16 (p&lt;0.001), COMPERA: 22.73 (p&lt;0.001) and FPHN: 1.63 (p=0.210). Adding the TAPSE on REVEAL 2.0 score did not increase the LR of REVEAL 2.0.
When comparing the different combinations including REVEAL 2.0, with likelihood ratio test, the LR of REVEAL 2.0 plus TAPSE vs REVEAL 2.0 was 7.32 (p=0.12),

Conclusions
In this single-centre study, REVEAL 2.0 as compared to REVEAL, COMPERA and FPHN models provided the highest prediction for mortality, and adding the TAPSE on the REVEAL 2.0 scoring offered no additional benefit for risk assessment.

Funding Acknowledgement
Type of funding source: None
Patients with blunt traumatic thoracic aortic injury treated with TEVAR present increased flow dynamics alterations and pulse wave velocity: a 4D flow CMR study
Authors: Guala A , Gil Sala D , Ruiz-Munoz A , Garcia Reyes M.E , Dux-Santoy L , Teixido-Tura G , Tello C , Cinque A , Valente F , Lopez Sainz A , Galian Gay L , Ferreira I , Evangelista A , Bellmunt Montoya S , Rodriguez Palomares J.F 
Published: November 2020

Abstract

Background
Thoracic endovascular aortic repair (TEVAR) is widely used for the treatment of blunt traumatic thoracic aortic injuries. Aortic flow dynamics and mechanical implications of this intervention are poorly investigated and may be of particular interest in the long-term follow-up of these mostly young patients.

Purpose
To assess whether the presence of TEVAR in a cohort of otherwise healthy subjects was related to dilation of the proximal aorta or increase in aortic stiffness and flow alterations.

Methods
Nineteen patients who underwent TEVAR implantation after a traumatic injury of the thoracic descending aorta (DAo) (10.0±6.1 years from intervention) and 44 healthy volunteers (HV) underwent 4D flow CMR to compute ascending aorta (AAo) pulse wave velocity (PWV), a marker of aortic stiffness, systolic flow reversal ratio (SFRR), quantifying backward flow during systole and in-plane rotational flow (IRF), measuring in-plane strength of helical flow. IRF and SFRR were assessed at 20 planes between the sinotubular junction and the mid thoracic DAo. Aortic diameters were measured using double-oblique cine CMR.

Results
Patients with TEVAR and HV did not differ in age, sex, body surface area, blood pressure and DAo diameter distal to TEVAR (Table). However, TEVAR patients presented larger diameters at the sinus of Valsalva and AAo, increased AAo PWV and strong flow alterations: IRF was reduced from the distal AAo to the proximal DAo, while SFRR was increased in the whole thoracic aorta (Figure).

Conclusions
In patients with blunt traumatic thoracic aortic injury treated with TEVAR the aorta proximal to TEVAR is dilated, stiffer and present potentially pathogenic flow conditions. Longitudinal studies are needed to assess whether these alterations have prognostic value and may improve clinical prevention and management of these patients.
Figure 1. IRF and SFRR in healthy vs TEVAR

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study has been funded by Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation (PI19/01480). Guala A. received funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I).
Predictors of rapid plaque progression: an optical coherence tomography study
Authors: Araki M , Yonetsu T , Kurihara O , Nakajima A , Lee H , Soeda T , Minami Y , Uemura S , Kakuta T , Jang I.K 
Published: November 2020

Abstract

Background
Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former will cause stable angina when the narrowing reaches a critical threshold, while the latter may lead to acute coronary syndromes or sudden cardiac death.

Purpose
The aim of the study was to identify morphologic predictors for rapid plaque progression.

Methods
Patients who had OCT imaging during the index procedure and follow-up angiography with a minimum of 6-month interval were selected. Non-culprit lesion was defined as a plaque with a diameter stenosis ≥30% on index angiogram. Lesion progression was defined as the decrease of angiographic minimum lumen diameter ≥0.4 mm at follow-up (mean, 7.1 months). Baseline morphological characteristics of the plaques with rapid progression were evaluated by OCT. In a subgroup with follow-up OCT imaging for plaques with progression, morphological changes from baseline to follow-up were assessed.

Results
Among 517 lesions, 50 lesions showed progression. These lesions had a significantly higher prevalence of lipid-rich plaque (76.0% vs. 50.5%), thin-cap fibroatheroma (TCFA) (20.0% vs. 5.8%), layered plaque (60.0% vs. 34.0%), macrophage accumulation (62.0% vs. 42.4%), microvessel (46.0% vs. 29.1%), plaque rupture (12.0% vs. 4.7%), and thrombus (6.0% vs. 1.1%), compared to those without progression. The multivariable analysis identified lipid-rich plaque [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.02–4.62, p=0.045], TCFA (OR 5.85, 95% CI 2.01–17.03, p=0.001), and layered plaque (OR 2.19, 95% CI 1.03–4.17, p=0.040) as predictors of subsequent lesion progression. In a subgroup with follow-up OCT, a new layer was detected in 14/41 (34.1%) plaques.

Conclusions
Lipid-rich plaque, TCFA, and layered plaque were predictors of subsequent rapid plaque progression. A new layer, a signature of rapid progression through plaque disruption and healing, was detected in 1/3 of the cases.

Funding Acknowledgement
Type of funding source: None
Cardiac procedural myocardial injury, infarction and mortality in patients undergoing elective PCI: a pooled analysis of patient-level data
Authors: Silvain J , Zeitouni M , Paradies V , Zheng H , Ndrepepa G , Cavallini C , Feldman D.N , Sharma S.K , Mehilli J , Jaffe A.S , Thygesen K , Montalescot G , Bulluck H , Hausenloy D.J 
Published: November 2020

Abstract

Background
The prognostic implications of cardiac procedural myocardial injury and infarction (MI) in chronic coronary syndrome patients undergoing elective percutaneous coronary intervention (PCI) is still debated.

Objective
To determine the optimal cardiac troponin threshold for identifying prognostically important events.

Methods
Using a pooled dataset of nine registries and one randomized trial, we analysed individual data of 14,433 patients undergoing elective PCI with a normal or moderately elevated baseline pre-PCI cardiac troponin (cTn). A multivariate model was performed to evaluate the associations between post-PCI cTn elevation and 1-year mortality after PCI, including thresholds used by existing procedural myocardial injury definitions (Fourth Universal Definition of MI [UDMI] and Academic Research Consortium 2 [ARC-2] / Society for Cardiovascular Angiography and Interventions (SCAI)). The association between type 4a MI and 1-year mortality was also evaluated.

Results
Procedural myocardial injury defined by the Fourth UDMI occurred in 52.5% of patients and was not associated with 1-year mortality (adjOR 1.27, 95% CI [0.90–1.81] p=0.18). The association between post-PCI cTn elevation and 1-year mortality was significant above a 3-fold increase above the upper reference limit, and was optimal for a 5.2-fold increase which corresponded to an 18.3% rate of event, and an adjOR of 2.03 (95% CI [1.31–3.14], p=0.002) (figure). Procedural myocardial injury defined by the ARC-2/SCAI definition occurred in 1.3% of the patients, had a strong association with 1-year mortality (adjOR 4.15, 95% CI [1.62–10.64], p&lt;0.01) but lacked sensitivity (5.2% sensitivity). Type 4a MI occurred in 12.7% of patients, was strongly associated with 1-year mortality (adjOR 3.18, 95% CI [1.47–6.90], p=0.002), but could only be evaluated in a subset of patients (n=3 084) with available data on new myocardial ischaemia post-PCI.

Conclusions
We have demonstrated that a post-PCI cTn elevation ≥5x the 99th percentile URL in CCS patients with normal baseline cTn, represents the optimal threshold for defining prognostically important or “Major” procedural myocardial injury in the absence of evidence for new myocardial ischaemia. Major procedure related myocardial injury and type 4a MI should be considered as a quality metric and endpoints in clinical trials.
Adjusted OR of mortality at 1 year

Funding Acknowledgement
Type of funding source: None
Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip
Authors: Benito Gonzalez T , Freixa X , Godino C , Taramasso M , Estevez-Loureiro R , Pascual I , Serrador A , Nombela L , Grande D , Cruz I , San Antonio R , Galasso M , Gavazzoni M , Portoles A , Fernandez-Vazquez F 
Published: November 2020

Abstract

Background
Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR.

Methods
We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up.

Results
93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed.

Conclusion
PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort.
Proportion of patients who presented ven

Funding Acknowledgement
Type of funding source: None
Patent foramen ovale screening and prevention of decompression sickness in divers
Authors: Honek J , Tomek A , Sefc L , Horvath M , Fiedler J , Sramek M , Honek T , Januska J , Veselka J 
Published: November 2020

Abstract

Background/Introduction
Patent foramen ovale (PFO) is associated with increased risk of decompression sickness (DCS) due to paradoxical embolization of nitrogen bubbles that form during and after ascent. Screening for PFO using transcranial Doppler ultrasonography (TCD) is currently not recommended for all divers. If a diver is diagnosed with a high-grade PFO and wishes to continue diving there are currently two options to reduce the risk of DCS: catheter-based PFO closure or recommendation of conservative approach to diving. However, to date the evidence for the long-term effectiveness of these measures is limited.

Purpose
This study sought to compare the effectiveness of catheter-based PFO closure and conservative diving in the reduction of DCS incidence in divers with a high-grade PFO.

Methods
A total of 829 consecutive divers (35.4±10.0 yrs, 81.5% males) were screened for PFO between January 2006 and December 2018 by means of TCD. All patients were prospectively included in the study registry. Patients with a high-grade PFO were offered either catheter-based PFO closure (closure group) or advised to dive within the limits of recreational diving (conservative group). A trans-telephonic follow-up was performed at the end of the study. In this study we compared the incidence rate of DCS prior to enrollment and during the follow-up period in the closure and conservative group.

Results
Follow-up was available in 748 (90%) divers. Mean follow-up was 6.5±3.5 years. There were a total of 154 divers with a high-grade PFO that continued diving after the initial screening examination. Fifty-five (36%) of them underwent a catheter-based PFO closure (closure group), the remaining 98 divers were advised to dive within the limits of recreational diving (conservative group). The 55 divers in the closure group performed a total of 63,436 dives (30,684 prior to enrollment and 32,752 during the follow-up). Prior to enrollment there were 108 DCS episodes in 33 divers (incidence rate 3.3/1000 dives) and none during follow-up (p&lt;0.001). The 98 divers in the conservative group performed a total of 48,069 dives (25,328 prior to enrollment and 22,741 during follow-up). There were 91 DCS episodes in 33 divers (incidence rate 3.6/1000 dives) prior to enrollment and 19 episodes in 11 divers (incidence rate 0.75/1000 dives) during follow-up (p&lt;0.001). The incidence rate of DCS was similar for both groups prior to enrollment (p=0.196) but lower in the closure group during the post-interventional follow-up (p&lt;0.001).

Conclusion(s)
In divers with a high-grade PFO both strategies decreased the incidence rate of DCS. Catheter-based PFO closure was more effective than conservative approach. The results also suggest that divers might benefit from screening for PFO.

Funding Acknowledgement
Type of funding source: None
Association between office blood pressure, antihypertensive medication use and male sexual dysfunction: a penile Doppler study
Authors: Ioakeimidis N , Rokkas K , Terentes-Printzios D , Angelis A , Dima I , Gardikioti V , Sigala E , Aznaouridis K , Tousoulis D , Vlachopoulos C 
Published: November 2020

Abstract

Background
Arterial hypertension is associated with an almost two-fold increase in the likelihood of having an abnormal penile blood flow. Recent evidence supports the independent of age and blood pressure (BP) level predictive value of severe penile arterial insufficiency for adverse cardiovascular events.

Purpose
Aim of this study is to quantify the association between BP level and severity of penile vascular disease and to examine the potential for differences in effect of BP lowering medication use on the associations between BP level and penile vascular damage.

Methods
We measured penile peak systolic velocity (PSV) in 356 consecutive men with erectile dysfunction (ED) and without a history of diabetes and cardiovascular disease; The cohort was divided according to office systolic BP (SBP) and diastolic BP in three BP categories: normal (SBP &lt;130 and DBP &lt;85 mmHg, n=117), high normal (130≤SBP&lt;140 or DBP 85≤DBP&lt;90mmHg, n=91), and hypertension (SBP≥140 or DBP≥90mmHg, n=148). 164 (46%) patients of the whole study population were treated with antihypertensive medications. Low PSV values after intracavernous injection of prostanglandin E1 indicate impaired penile blood inflow and severe vasculogenic ED.

Results
Figure shows PSV measurements of the three office BP categories subdivided according to use of antihypertensive therapy. Treated and untreated hypertensive patients had similar mean PSV. Interestingly, the mean PSV of men with high normal BP not receiving antihypertensive drugs was significantly higher compared to PSV of men with high normal BP under therapy and significantly lower compared to PSV of normotensive males without therapy (all P&lt;0.05). Among males not receiving antihypertensive medications there was a progressive decrease in PSV values from normal BP, to high normal BP and to hypertension (P=0.01, after adjustment for age), while among males under antihypertension therapy, the three BP categories had similar PSV level (P=0.54 after adjustment for age) (figure).

Conclusion
The inverse associations observed between hypertension status and penile arterial insufficiency in men not taking antihypertensive medication were attenuated or disappeared among men reporting antihypertensive medication use reflecting a medication effect or structural effects of longstanding hypertension on the penile vasculature.
BP level, hypertension therapy and PSV

Funding Acknowledgement
Type of funding source: None
Assessing the relationship between serum potassium variability and the risk of hyperkalaemia and adverse clinical outcomes
Authors: McEwan P , Badora K , Sugrue D , James G , Hurst M , Hoskin L , Tafesse E 
Published: November 2020

Abstract

Background
Serum potassium (SK+) is a vital electrolyte, which level is maintained by adjusting renal K+ excretion. Variability in SK+ has been linked to increased risk of mortality and other adverse clinical events in patients in intensive care and/or receiving haemodialysis, prompting a similar investigation in cardiovascular patients.

Purpose
To examine the effect of SK+ variability on all-cause mortality (ACM) and the incidence of major adverse cardiovascular events (MACE), comprising arrhythmia, [subsequent records of] HF, myocardial infarction, or stroke, in patients with heart failure (HF) or resistant hypertension (RHTN).

Methods
Patients aged ≥18 years with HF or RHTN were identified from the UK Clinical Practice Research Datalink (CPRD, primary care data) and linked Hospital Episode Statistics (HES, secondary care data). HF and RHTN were defined through READ codes recorded during the study period (2008-June 2018) or the five-year look-back period (2003–2007). Index date was set to 1st January 2008 or initial diagnosis; whichever occurred later. Mean SK+ and variability of measurements (quantified as standard deviation [SD] and each patient categorised as low or highly variable based on the median SD of the cohort), and crude incidence rates of ACM and MACE were estimated over a follow-up period from index date to event or end of follow-up (death, loss to follow-up or end of study, whichever was earlier).

Results
The eligible population included 317,135 RHTN patients and 84,210 HF patients with a mean follow-up of 6.37 (SD 3.06) and 5.01 (SD 3.20) years, respectively. In both cohorts, higher mean SK+ ≥5.0 mmol/L was associated with increased rates of ACM and MACE relative to a mean SK+ of 3.5–5 mmol/L (Table 1). High SK+ variability was associated with increased incidence of adverse outcomes, with rates consistently higher in the high SK+ variability group compared to low-variability patients with the same diagnosis and mean SK+ category (Table 1); all comparisons were statistically significant except for ACM in HF patients with mean SK+ ≥5 mmol/L.

Conclusion
Independently of mean SK+, increased variability in SK+ levels was associated with an increased rate of mortality and MACE in patients with RHTN or HF. Careful SK+ monitoring and management to maintain SK+ concentrations may improve the outcomes of patients with RHTN and HF.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): AstraZeneca
The effects of different preventive counseling programs on anxiety and depression symptoms in patients with paroxysmal atrial fibrillation after catheter ablation
Authors: Pogosova N , Ovchinnikova A.I , Yufereva Y.M , Sokolova O.Y , Davtyan K.V 
Published: November 2020

Abstract

Background
Depression and anxiety are common in patients (pts) with atrial fibrillation (AF). These psychosocial risk factors add to the symptoms burden and further deteriorate the quality of life.

Purpose
To assess the effects of different preventive counseling programs on anxiety and depression symptoms in pts after catheter ablation (CA) performed for paroxysmal AF.

Methods
This is a prospective randomized controlled study with 3 parallel groups of pts with paroxysmal AF after CA (radiofrequency or cryoablation). Pts were randomized into 3 groups in 1:1:1 ratio. During hospitalization for CA pts from all groups received single-session preventive counseling with focus on their individual cardiovascular risk factors profile. After discharge pts from Group 1 received remote preventive counseling by phone and pts from Group 2 – by email every two weeks for the first 3 months after enrollment (a total of 6 sessions). Group 3 received usual care. All pts underwent anxiety and depression assessment using Hospital Anxiety and Depression Scale (HADS) at baseline and at 12 months.

Results
A total of 135 pts aged 35 to 80 years were enrolled (mean age 57.3±9.1 years, 51.8% men). The groups were well balanced according to demographic and clinical features. At 1 year of follow-up there was a significant decrease in anxiety and depression scores as measured by HADS in both intervention groups vs. control (Table).

Conclusions
Preventive counseling followed by 3 months of remote support via phone and email reduced anxiety and depression level in AF pts after CA.

Funding Acknowledgement
Type of funding source: None