bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5747The effect of additional intracoronary papaverine administration during hyperemia with intravenous adenosine triphosphate infusion, on fractional flow reserve values
Authors: Podmetin P , Burak T Y , Kochanov I N , Kaledin A L 
Published: October 2019

Abstract

Introduction
Fractional flow reserve (FFR) measurement requires the achievement of steady-state maximum hyperemia. One of the main agents used for the induction of hyperemia is adenosine-triphosphate (ATP). But, in some cases, hyperemia may be insufficient, which leads to an underestimation of the true value of the FFR.

Purpose
To determine the effect of additional intracoronary papaverine administration during hyperemia with intravenous ATP infusion, on FFR values in a group of patients with borderline values.

Methods
A total of 165 measurements of FFR were performed in 119 patients. Intravenous infusion of ATP 140 μg/kg/min was used in all patients. In the group of patients with borderline FFR values (28 pts, 0.79–0.86), during achieved ongoing hyperemia, papaverine was additionally administered intracoronary (20 mg for LCA and 12 mg for RCA) with a reassessment of FFR values. The change in the FFR values and hemodynamic parameters were determined.

Results
The average values of FFR during hyperemia with ATP were 0.82±0,02. After additional administration of papaverine, a significant decrease in the mean values of FFR to 0.79±0,03 (p<0.001) occurred. Wherein a decrease in the FFR value by 0.03 or more was noted in 12 patients (43%), a decrease by 0.01–0.02 - in 12 patients (43%), unchanged in 4 patients (14%).
In 15 patients (53%), a change in FFR led to a crossing of the threshold value of 0.80 and a change in treatment strategy.
With intravenous infusion of ATP, was observed a decrease in systolic blood pressure (BP) by 10.6% (132 vs 118 mm Hg, p<0.001), a decrease in mean BP by 12% (101 vs 88 mm Hg, p<0.001) compared to the base pressure. With additional administration of papaverine, systolic BP decreased by more 12% (to 104 mm Hg, p<0.001), mean BP – by more 11% (to 78 mm Hg, p<0.001).
Changes in blood pressure Rest ATP Papaverine Systolic BP, mm Hg 132±22 118±23 104±19 Mean BP, mm Hg 100±13 88±14 79±11
Changes in the values of FFR

Conclusions
Additional intracoronary papaverine administration during hyperemia with intravenous adenosine triphosphate infusion led to a decrease in FFR values of 0.02 or more in 68% of cases. It may indicate a insufficiency of the initial hyperemia induced by only one vasodilator and require a combination of pharmacological agents to achieve lower and more accurate values.
At borderline values of FFR obtained by induction of hyperemia with a single hyperemic agent (ATP), the additional administration of a second hyperemic agent (papaverine) in 53% led to a crossing of the threshold value of 0.80 and a change in treatment strategy.
P5749Haemodynamical effects o fleft ventricular assistance during high-risk percutaneous coronary interventions with a pneumatic left ventricular assist device
Authors: Bastos M B , Schreuder J J , Daemen J , Den Uil C A , Van Mieghem N M 
Published: October 2019

Abstract

Background
Referral for high-risk percutaneous coronary intervention (PCI) is a progressively growing trend. Percutaneous Mechanical Circulatory Support (MCS), may protect the myocardium and reduce the risk of major adverse events. Clinical data on Left Ventricular (LV) unloading by pneumatically driven Percutaneous Left Ventricular Assist Devices (pVAD's) is currently scarce.

Purpose
Describe the unloading pattern produced by a pneumatically driven pulsatile pVAD on LV haemodynamics through real-time Pressure-volume (PV) analysis with a conductance catheter positioned in the left ventricle.

Methods
19 patients undergoing high-risk PCI treated with MCS were monitored with PV loops and pulmonary artery catheterization throughout the intervention.

Results
When activated on 1:1 assist ratio, the mean output produced by the pVAD was 1.36±0.13L/min. Compared to pre-implantation, 1:1 support produced a significant reduction in End-systolic Wall Stress (ΔWSes: −11.95%, p<0.01) and PV area (ΔPVA: −16.67%, p<0.01). Contractility did not significantly change (ΔV100: +29.48%, p=0.073; End-systolic Elastance, ΔEes: 1.24%, p=0.86). Effective Arterial Elastance (Ea), representing afterload, decreased (ΔEa: −12.05%, p<0.05). Total Arterial Compliance (ΔTAC: +31.59, p<0.01) increased and Ventricular-arterial Coupling (ΔEa/Ees: −9.79%, p=0.06) non-significantly improved. Mean arterial pressure non-significantly decreased (ΔMAP: −6.66%, p=0.06) and global Cardiac Output remained stable (ΔCO: −0.06%, p=0.37). When the pVAD was removed after the PCI these changes were reversed (Figure 1).
Image 1

Conclusion
High-risk PCI with pneumatic MCS may result in LV unloading and reduced myocardial oxygen consumption. Further insights will be released in the PULSE trial (Clinicaltrials.gov NCT03200990).
P5982Transcatheter aortic valve replacement in elderly patients with severe symptomatic aortic stenosis
Authors: Antunez Muinos P J , Alvarez Rodrigez L , Lopez Pais J , Lopez Otero D , Sanmartin Pena X , Cid Menendez A , Gonzalez Ferreiro R , Trillo Nouche R , Cid Alvarez B , Gonzalez Juanatey J R 
Published: October 2019

Abstract

Introduction
TAVR has proven to be a safe technique for high-risk patients. The objective of our work is to know the results of TAVR in patients older than 90 years; which are the riskiest and had more complications during the admission.

Methods
Observational retrospective analysis based on all a single-center registry of all consecutive TAVR (N=518) during the last 10 years (2008–2018). Patients older than 90 years old represent 5.8 of the procedures (N=30). We performed a descriptive analysis of the baseline characteristics of our patient cohort, and the development of events during follow-up.

Results
Our population, as reflected in TABLE 1, had a median age of 91,32 years old, and the majority were women (57.58%). The procedures were mostly elective, unless in 4 patients (12.12%) that were urgent. None valvuloplasty was done before TAVR in this cohort, neither Valve-in-valve. Stratification scores had a wide range, from 1.45 to 28.8% for EurSCORE II and from 4.19 to 17.19% for STS, with a median of 5.53 and 8.49% respectively.
Mortality in the first 30 days and in the first year was 0.00%. Mortality after the first year was 71.40% due to non-cardiovascular events (median time of follow-up of 34.34 months).
Finally, we would also like to remark that the incidence of heart failure during the first year was 14.29%, taking into account all the follow-up, the incidence was 37.04%. Despite these data, in our registry, the need for pacemaker after the valve implantation was higher than in younger populations (40.62%), probably due to the age-related fibrosis of the cardiac conduction system.

Conclusions
TAVR is a very safe procedure with very successful results in elderly patients, nevertheless, due to the frailty of this population, individualization is mandatory in order to optimize the resources.

Acknowledgement/Funding
None
P6009Poor outcomes in pulmonary arterial hypertension as a member of RNF213-associated vascular diseases
Authors: Hiraide T , Kataoka M , Suzuki H , Aimi Y , Chiba T , Isobe S , Katsumata Y , Goto S , Kanekura K , Satoh T , Sano M , Gamou S , Kosaki K , Fukuda K 
Published: October 2019

Abstract

Background
A variant of c.14429G>A (p.Arg4810Lys, rs112735431) in the ring finger protein 213 gene (RNF213; NM_001256071.2) has been recently identified as a risk allele for pulmonary arterial hypertension (PAH), suggesting that PAH can be added as a new member of RNF213-associated vascular diseases including Moyamoya disease and peripheral pulmonary stenosis.

Purpose
Our aim was to identify the clinical features and outcomes of PAH patients with RNF213 p.Arg4810Lys variant.

Methods
Whole-exome sequencing was performed in 139 idiopathic (or possibly heritable) PAH patients. Hemodynamics and prognosis were evaluated in the patients with RNF213 p.Arg4810Lys variant and the patients with bone morphogenic protein receptor type 2 (BMPR2) mutations.

Results
The RNF213 p.Arg4810Lys variant was identified in a heterozygous state in 11 patients (7.9%). Time-course changes in hemodynamics after combination therapy in the patients with the RNF213 p.Arg4810Lys variant were significantly poorer compared with those in BMPR2 mutation carriers (n=36) (comparison of changes in mean pulmonary arterial pressure, P=0.007). The event-free rate of death or lung transplantation was significantly poorer in RNF213 p.Arg4810Lys variant carriers than in BMPR2 mutation carriers (5-year event-free rate since the introduction of prostaglandin I2 infusion, 0% vs. 93%, P<0.001) (Figure).
Time to death or lung transplantation

Conclusions
PAH patients with the RNF213 p.Arg4810Lys variant were associated with a poor reactivity to vasodilator drugs and poor clinical outcomes even in the recent era. Earlier consideration of lung transplantation might be required for RNF213 p.Arg4810Lys variant carriers developing PAH. Documentation of the RNF213 p.Arg4810Lys variant, as well as already known pathogenic genes, can provide clinically relevant information for therapeutic strategies, leading to a personalized approach for the treatment of PAH.
P6013Evidence for ANTXR2 as a therapeutic target on systemic-to-pulmonary shunt induced pulmonary arterial hypertension
Authors: Liu X Y , Meng L K , Yuan W , Zheng M L , Chi H J , Yang X C , Li J , Zhong J C 
Published: October 2019

Abstract

Introduction
Pulmonary arterial hypertension secondary to congenital heart disease (CHD-PAH) with systemic-to-pulmonary shunt is characterized by proliferative vascular remodeling. Excessive proliferation and resistance to apoptosis of pulmonary artery smooth muscle cells (PASMCs) are the primary cellular bases of vascular remodeling. Anthrax toxin receptor 2 (ANTXR2) exhibits anti-proliferative properties. The effects of ANTXR2 on vascular remodeling and systemic-to-pulmonary shunt induced PAH remain unexplored.

Purpose
The purpose of this study was to determine the possible roles of ANTXR2 in the pathogenesis of systemic-to-pulmonary shunt induced PAH and explore its possible mechanisms.

Methods
Lung tissue sections from CHD-PAH patients, systemic-to-pulmonary shunt induced PAH rat model, ANTXR2−/− rats, and PASMCs were used. Immunohistochemistry, real time polymerase chain reaction, Western blot, proliferation, apoptosis, and next generation sequencing (NGS) were performed in this study.

Results
ANTXR2 expression was reduced in severe CHD-PAH patient lung tissue and pulmonary arterioles, as well as in lung tissues from rats with systemic-to-pulmonary shunt induced PAH. Over-expression of ANTXR2 in cultured PASMCs inhibited cell proliferation and promoted apoptosis, while knockdown of ANTXR2 promoted cell proliferation and inhibited apoptosis. Male ANTXR2−/− rats showed more severe percent medial thickness and muscularization of pulmonary arterioles than wild type (WT) rats in basal conditions, and exhibited heavier PAH following exposure to systemic-to-pulmonary shunt. To further determine the underling mechanism, NGS was performed in ANTXR2−/− rat lungs and that of WT littermates. A total of 1319 genes were found to be dysregulated, and biological processes influenced by these differentially expressed genes include negative regulation of blood vessel diameter,vasoconstriction, regulation of blood vessel diameter, regulation of blood vessel size, vascular process in circulatory system, etc.

Conclusion
Our work identifies a novel role for ANTXR2 in systemic-to-pulmonary shunt induced PAH based on the findings that ANTXR2 deficiency could exacerbate systemic-to- pulmonary shunt induced vascular remodeling in the development of PAH. ANTXR2 may be a potential target for CHD-PAH treatment.

Acknowledgement/Funding
Beijing Natural Science Foundation (7172078 and 7172182), the National Major Research Plan Training Program of China (91849111)
P6146Atmospheric front patterns and acute cardiovascular diseases, a new perspective in the cardiovascular threat of global climate change
Authors: Boussoussou N , Boussoussou M , Rakovics M , Entz L , Nemes A 
Published: October 2019

Abstract

Background
There is substantial evidence that the health threat of global climate change is real and it could be a medical emergency. The impact of climate change on health is mediated through atmospheric parameters which are direct environmental stressors on the human body and have a potential cardiovascular (CV) morbidity and mortality effect. Acute cardiovascular diseases (ACVDs) are already major public health issues and in the future unfavourable atmospheric situations, such as increasingly volatile fronts and their negative effects can further increase this problem. Despite evidence about the importance of different atmospheric parameters on health outcomes, there have been few results for atmospheric front patterns' CV effects. Weather fronts are the most complex atmospheric phenomena therefore these atmospheric parameters might have the greatest influence on ACVDs.

Purpose
We aimed to explore the effects of atmospheric front patterns on ACVDs.

Methods
A time series Poisson-regression analysis was used to analyse 6499 ACVD hospital admissions, during a five-year period (2009–2013), in light of front patterns. Covariates were three-day (target day and the two previous days) front sequence patterns comprised of the five major front types (no front, warm front, occluded front, cold front, stationary front). Relative risk (RR) estimates for front effects were adjusted for seasonality. The relationship on all ACVDs combined and separately on patient groups by major CV risk factors (hypertension, hyperlipidaemia, diabetes, previous CV diseases) was examined.

Results
We found that in general, front patterns containing warm front days had a detrimental effect. A warm front, when followed by two days with no fronts present, increased RR by 46% (CI: 4–89%, p=0,015). Cold fronts however were protective. A no front – cold front – occluded front pattern corresponded to a 28% (CI: 8–49%, p=0,037) decrease in RR, with this pattern being present in 1.1% of all days of the study period. Out of the group specific results an occluded front, following days with no fronts present, showed to have the largest effect on hyperlipidaemic patients, increasing RR by 144% (CI: 51–295%, p<0.001).

Conclusions
This work provides both independent evidence of front patterns' CV effects and a novel tool to investigate and help the understanding of complex associations between atmospheric fronts and ACVDs. The importance of our findings is growing in the context that extreme atmospheric conditions and changes are likely to become more common in the future as a result of climate change. Medical meteorology may open up a new horizon and become an important field of preventive cardiology in the future. In conclusion, a better understanding of atmospheric front effects is of particular importance in order to help identify possible targets for future prevention strategies.
P6154Association between n-3 and n-6 polyunsaturated fatty acids and plaque vulnerability by optical coherence tomography in acute myocardial infarction patients
Authors: Kanehama N , Kimura S , Kawakami T , Tateishi R , Tachibana S , Hayasaka K , Arai H , Hiroki J , Yoshioka K , Kuroda S , Ueshima D , Iwatsuka R , Hayashi T , Mizukami A , Matsumura A 
Published: October 2019

Abstract

Background
The values of n-3 and n-6 polyunsaturated fatty acids (PUFAs) like low eicosapentaenoic acid (EPA) /arachidonic acid (AA) ratio are known to be associated with cardiovascular events, however their relationship with coronary plaque vulnerability in acute myocardial infarction (AMI) is not revealed.

Purpose
We evaluated the relationship between n-3 and n-6 PUFAs and coronary plaque vulnerability assessed by optical coherence tomography (OCT) in AMI patients.

Methods
We investigated 79 AMI lesions (51 ST elevated myocardial infarction (STEMI) lesions and 28 non-STEMI lesions) that had undergone emergency percutaneous coronary intervention using OCT. Coronary plaque characteristics by OCT were compared with n-3 and n-6 PUFAs values which were measured on admission.

Results
Of all AMI lesions (n=79), 43 thin-cap fibroatheroma (TCFA) and 35 plaque rapture (PR) were detected by OCT. Lesions with TCFA had no significant relationship with n-3 and n-6 PUFAs values, whereas lesion with PR had significantly lower EPA values than those without (55.8±29.5 vs 74.3±37.1 μg/ml, p=0.018). Median low-density lipoprotein (LDL) cholesterol value was 117 (98–137) mg/dl and sub-analysis in patients who had lower LDL cholesterol values than median (n=39) revealed that EPA values were significantly lower in lesions with TCFA (56.3±30.9 vs 85.3±47.7 μg/ml, p=0.03). In STEMI patients, the values of EPA and EPA/AA ratio were significantly lower in lesions with TCFA (EPA: 55.5±22.8 vs 80.8±46.1 μg/ml, p=0.01; EPA/AA ratio: 0.34±0.16 vs 0.50±0.36, p=0.03). STEMI patients who had lower LDL cholesterol values <114 mg/dl of median (n=26), the values of EPA, EPA/AA ratio, and EPA+ docosahexaenoic acid (DHA) /AA ratio were significantly lower in lesions with TCFA (EPA: 51.4±20.7 vs 93.1±53.0 μg/ml, p=0.01; EPA/AA ratio: 0.37±0.16 vs 0.67±0.41, p=0.01; EPA+DHA/AA ratio: 1.13±0.41 vs 1.63±0.76, p=0.04). In STEMI patients with lower LDL cholesterol values, EPA/AA ratio positively correlated with fibrous cap thickness (Spearman, ρ=0.35, p=0.08). The cutoff value of EPA/AA ratio predicting the existence of TCFA was 0.52 (area under the curve 0.78, sensitivity 93.8%, specificity 70.0%, p=0.02).

Conclusion
This study demonstrated that n-3 and n-6 PUFAs values were associated with coronary plaque vulnerability by OCT in AMI patients, especially in STEMI. These results suggest that n-3 and n-6 PUFAs may be residual risk markers of severe acute cardiovascular events in patients with low LDL cholesterol values.
P6159The efficacy of heart rate reduction with bisoprolol transdermal patch prior to coronary computed tomography angiography
Authors: Misawa T , Utsugi Y , Matoba T , Koura K , Nakashima E , Onishi K , Ishimaru G , Okada H , Toshida N , Inagaki H 
Published: October 2019

Abstract

Background
Oral or intravenous beta-blockers have commonly been used to control the heart rate (HR) prior to coronary computed tomography angiography (CCTA). However, the administration after arrival at the hospital was time-consuming, and could not achieve the target heart rate in several cases. Moreover, the efficacy of transdermal beta blockers in HR control for patients who underwent CCTA have not been fully reported.

Purpose
The purpose of this study was to clarify the usefulness of the bisoprolol patch prior to the arrival at the hospital in HR control for patients who underwent CCTA.

Methods
A total of 282 consecutive patients (160 male, age 64±12 years) who underwent CCTA were included in this study. The bisoprolol transdermal patch (8mg) was administered before arrival at the hospital in 191 patients (beta group), and no additional medication was administered in 91 patients (control group). Intravenous landiolol hydrochloride was administered when HR remained over 65 bpm on arrival at the hospital. The HR on arrival, during and after CCTA was evaluated.

Results
The baseline HR was significantly higher in the beta group (80±15 vs. 72±15, P<0.0001). However, the achievement rate of HR ≤65 bpm on arrival was significantly higher in the beta group (56.5% vs. 44.0%, P=0.047). Thus, additional treatment with intravenous landiolol hydrochloride was administered to 43.5% of the patients in the beta group and 56.0% of those in the control group. There were no significant differences in the HR during and after CCTA between the 2 groups. Multivariate analysis revealed that the use of bisoprolol transdermal patch (OR, 3.54; 95% CI 1.67–7.51, P=0.001) and the baseline HR (OR, 0.91; 95% CI 0.89–0.94, P<0.0001) were significant predictors of the achievement rate of HR ≤65 bpm on arrival. There were no serious adverse effects throughout CCTA in all patients.

Conclusions
The administration of bisoprolol transdermal patch before arrival at the hospital was useful for HR control and reduced the rate of additional intravenous treatment in patients who underwent CCTA.
P6166Radiomics-based machine learning versus histogram analysis and visual assessment to identify advanced atherosclerotic lesions on coronary computed tomography angiography
Authors: Kolossvary M , Karady J , Kikuchi Y , Ivanov A , Schlett C L , Lu M T , Foldyna B , Merkely B , Aerts H J , Maurovich-Horvat P , Hoffmann U 
Published: October 2019

Abstract

Background
Currently used coronary CT angiography (CTA) plaque classification and histogram-based methods have limited accuracy to identify advanced atherosclerotic lesions. Radiomics-based machine learning (ML) could provide a more robust tool to identify high-risk plaques.

Purpose
Our objective was to compare the diagnostic performance of radiomics-based ML against histogram-based methods and visual assessment of ex-vivo coronary CTA cross-sections to identify advanced atherosclerotic lesions as defined by histology.

Methods
Overall, 21 coronaries of seven hearts were imaged ex vivo with coronary CTA. From 95 coronary plaques 611 histological cross-sections were obtained and classified based-on the modified American Heart Association scheme. Histology cross-sections were considered advanced atherosclerotic lesions if early, late fibroatheroma or thin-cap atheroma was present. Corresponding coronary CTA cross-section were co-registered and classified into homogenous, heterogeneous, napkin-ring sign plaques based on plaque attenuation pattern. Area of low attenuation (<30HU) and average CT number was quantified. In total, 1919 radiomic parameters describing the spatial complexity and heterogeneity of the lesions were calculated in each coronary CTA cross-section. Eight different radiomics-based ML models were trained on randomly selected cross-sections (training set: 75% of the cross-sections) to identify advanced atherosclerotic lesions. Plaque attenuation pattern, histogram-based methods and the best ML model were compared on the remaining 25% of the data (test-set) using area under the receiver operating characteristic curves (AUC) to identify advanced atherosclerotic lesions using histology as a reference.

Results
After excluding sections with heavy calcium (n=32) and no visible atherosclerotic plaque on CTA (n=134), we analyzed 445 cross-sections. Based on visual assessment, 46.5% of the cross-sections were homogeneous (207/445), 44.9% heterogeneous (200/445) and 8.6% were with napkin-ring sign (38/445). Radiomics-based ML model incorporating 13 parameters significantly outperformed visual assessment, area of low attenuation and average CT number to identify advanced lesions (AUC: 0.73 vs. 0.65 vs. 0.55 vs. 0.53; respectively; p<0.05 for all).

Conclusions
Radiomics-based ML analysis may be able to improve the discriminatory power of CTA to identify high-risk atherosclerotic lesions.