bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of tube angulation on radiation dose using image noise reduction technology
Authors: Haj Abdo M , Langenbrink L , Michaelsen J , Wirtz M , Altiok E , Reimann D , Hoffmann R 
Published: November 2020

Abstract

Objectives
This study sought to evaluate the impact of tube angulation on radiation dose using image noise reduction technology in a clinical setting. Image noise reduction technology has been shown to significantly reduce radiation dose in coronary angiography in particular by reduction of radiation in cine mode.

Methods
In 500 coronary angiograms performed by the same operator the dose-area product (DAP) was determined. The DAP was determined for the cine mode as well as for the fluoroscopy mode. Furthermore, in the cine mode, the DAP on a per image (DAP/frame) basis was determined for the posterior-anterior projection (PA) as well as a left anterior oblique (LAO) cranial (LAO 20°/20°) and caudal (LAO 45°/−20°), right anterior oblique (RAO) cranial (RAO 20°/20°) and caudal (RAO 30°/−20°) angulations. The image intensifier area was kept constant for all angulations.

Results
Mean body mass index was 28.6±5.5 kg/m2. Mean total DAP was 1227±1417 cGy cm2. The mean ratio of DAP in cine mode/DAP in fluoro mode was 0.54±0.32. Mean DAP/frame in PA angulation was 5.5±3.3 (cGy cm2). Considering the cine mode, for the LAO cranial and LAO caudal angulations, the relative DAP/ frame compared to the PA angulation was 2.8±1.8 and 4.2±1.6, respectively. For the RAO cranial and RAO caudal angulations, the relative DAP/frame compared to the PA angulation was 1.7±2.2 and 1.8±1.4.

Conclusions
Using image noise reduction technology, radiation during fluoroscopy mode contributes more to total radiation dose than radiation during cine mode. In cine mode, the PA angulation has least radiation/ frame. The LAO caudal angulation is associated with greatest increase in radiation dose compared to the PA angulation, while LAO cranial angulation and RAO cranial and caudal angulations increase radiation dose to a lesser extent.

Funding Acknowledgement
Type of funding source: None
Optical coherence tomography findings in healed vulnerable plaques in patients with coronary artery disease
Authors: Kimura S , Hara K , Ohmori M , Tateishi R , Kaneda T , Yamakami Y , Shimada H , Manno T , Iishiki A , Shimizu M , Fujii H , Suzuki M , Sasano T 
Published: November 2020

Abstract

Background
Histopathological analysis or intracoronary image assessment of healed plaques (HPs) has been reported both in acute coronary syndrome (ACS) and stable angina pectoris (SAP) patients. However, background characteristics or lesion morphologies of HPs could not be fully clarified and their differences according to the clinical status remain undetermined.

Purpose
We sought to investigate the clinical and morphological characteristics and compare their differences among ACS and SAP patients in order to clarify the clinical significance in HPs lesions.

Methods
We enrolled consecutive 201 patients with 213 native coronary artery lesions (139 lesions with SAP, 42 ST elevation-ACS (STE-ACS) and 32 non-ST elevation ACS (NSTE-ACS) undergoing pre-intervention optical coherence tomography (OCT). HPs was defined as layered phenotype on OCT. Clinical and angiography characteristics and lesion morphologies on OCT were assessed.

Results
HPs were observed in 110 lesions (51.6%) and their prevalence were not different according to the clinical status (SAP:55.1%, STE-ACS:38.1%, NSTE-ACS:56.3%, p=0.14). Lesions with HPs had higher frequencies of angiography-eccentric lesions (62.7% vs. 35.9%, p&lt;0.001) and OCT-macrophages (65.5% vs. 43.1%, p&lt;0.001), and greater OCT-lumen area stenosis (%-AS) (77.1±10.2% vs. 73.6±10.6%, p=0.01) than those without HPs. Of lesions with HPs, OCT-thin-cap fibroatheroma (SAP 14.4%, STE-AC43.8%, NSTE-ACS 16.7%, p=0.03), plaque rupture (5.3%; 37.5%; 11.1%, p&lt;0.001) and thrombus (6.6%, 75.0%, 22.2%, p=0.007) were more frequently observed in STE-ACS than in SAP patients, whereas OCT-microvessels were more frequent in SAP than in ACS patients (19.7%, 0.0%, 0.0%, p=0.02). Other OCT findings such as macrophages, cholesterol crystal, multiple layered phenotype, and %-AS were not significantly different according to the clinical status. Multivariate logistic regression analysis identified the angiography-eccentric lesions (odds ratio (OR): 2.97, 95% confidence intervals (CI): 1.68–5.25, p&lt;0.001) and OCT macrophages (OR 2.41, 95% CI 1.36–4.27, p=0.003) as independent related factors for the existence of HPs.

Conclusions
The present study showed that HPs lesions had eccentric and large plaque burden, and persistent plaque inflammations regardless of clinical status, which might lead to future coronary events.

Funding Acknowledgement
Type of funding source: None
Diagnostic feasibility of resting full-cycle ratio between systole and diastole to assess functional lesion severity of intermediate coronary artery stenosis
Authors: Takashima H , Ohashi H , Ando H , Sakurai S , Nakano Y , Suzuki A , Sawada H , Fujimoto M , Waseda K , Amano T 
Published: November 2020

Abstract

Background
Recently, non-hyperemic physiologic indices have become widespread for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique non-hyperemic index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether RFR may detect functionally significant coronary stenosis that cannot be detected with other resting indices due to differences in the cardiac cycle. The aim of this study is to compare the diagnostic performance of RFR based on cardiac cycle.

Method
This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis.

Results
In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR systole was observed in 24 lesions (10.9%). Regarding to the coronary lesions, RFR systole was more frequent in non-LAD (LAD; 4.2%, left circumflex artery (LCX); 9.8%, and right coronary artery (RCA); 30.4%, respectively, p&lt;0.018). RFR showed a significant correlation with FFR in both systole and diastole (R = 0.918, p&lt;0.001, R = 0.733, p&lt;0.001, respectively). The ROC curve analysis showed similar agreement in both systole and diastole (AUC: 0.881, p&lt;0.001, AUC: 0.864, p&lt;0.001, respectively). RFR provided a good diagnostic accuracy and no difference in both systole and diastole (79.6% and 87.5%, respectively, p=0.58).

Conclusion
RFR is feasible and reliable non-hyperemic index regardless of the difference of cardiac cycle to evaluate physiological lesion severity in daily practice.

Funding Acknowledgement
Type of funding source: None
The impact of hydrostatic pressure on the result of physiological measurements in various coronary segments
Authors: Uveges A , Tar B , Jenei C.S , Agoston A , Czuriga D , Papp Z , Csanadi Z , Koszegi Z.S 
Published: November 2020

Abstract

Background
The effect of hydrostatic pressure on physiological intracoronary measurements is usually ignored in the daily clinical practice.

Purpose
To investigate the effect of resting Pd/Pa (distal/aortic pressure) and FFR (fractional flow reserve) adjustment based on the calculation of hydrostatic pressure gradient between the coronary orifice and the pressure wire sensor.

Methods
41 FFR measurements (between 0.7 and 0.9) were selected. The difference in height of the orifice and the sensor was defined in cm on the basis of 3D coronary reconstruction. The resting Pd/Pa and FFR were adjusted by subtracting the pressure gradient from the distal pressure. Measurements were also performed from 2D lateral projections for each coronary segment visible (n=305).

Results
In case of the left anterior descending artery (LAD), each segment was located higher (proximal: –13.69±5.4; middle: –46.13±6.1; distal: –56.80±7.7 mm), whereas for the circumflex (CX), lower (proximal: 14.98±8.3; distal: 28.04±6.3 mm) compared to the orifice. In case of the right coronary artery (RCA), the distance from the orifice was much less (proximal: –6.39±2.9; middle: –6.86±7.0; distal: 17.95±6.6 mm). The posterolateral (PL) and posterior descending (PD) branches of the distal RCA were located lower than the orifice (PL: 29.65±6.1; PD: 17.53±6.6 mm). The effect of these distances on pressure ratios at 100 Hgmm aortic pressure was between −0.044 and 0.023. After correction, values of 11 and 5 patients (27% and 12%) stepped the 0.92 Pd/Pa and 0.80 FFR cut-off values, respectively. There was a strong correlation between the 3D and 2D methods (r=0.98; p&lt;0.001).

Conclusion
The clinical implementation of hydrostatic pressure calculation should be considered during intracoronary pressure measurements. A correction for this parameter may become crucial in case of borderline significant coronary artery stenosis, especially in distal coronary artery segments.
Effect of hydrostatic pressure on FFR

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Άron Üveges was supported by the EFOP-3.6.2-16-2017-00006 project. The project is co-financed by the European Union and the European Social Fund.
Coronary flow reserve can explain some of FFR and iFR discrepancies. Results from international, multicenter and prospective trial
Authors: Kovarnik T , Matsuo H , Jerabek S , Kawase Y , Omori H , Tanigaki T , Zemanek D , Kral A , Pudil J , Vodzinska A , Branny M , Kala P , Mendiz O , Mates M , Mrozek J 
Published: November 2020

Abstract

Background
The trial collected prospective data from physiology measurements of borderline lesions in five Czech, one Japan and one Argentinian cathlabs. The main purposes were to analyze diagnostic agreement between FFR (fractional flow reserve) and iFR (instantaneous wave free ratio) examinations and to find possible explanations for discrepant results.

Methods
FFR and iFR examinations were analyzed using Philips-Volcano console and coronary flow reserve (CFR) was analyzed by using Combomap machine Philips-Volcano. Hyperemia for FFR and CFR measurements was induced by intracoronary administration of adenosine. We used CFR as a truth for comparison between FFR and iFR, because CFR has higher impact on patients prognosis than pressures indices.

Results
Data were collected from February 2016 to June 2019 and the database includes 1.789 examinations from 1.492 patients (282 of them, 15.8%, with ACS). CFR were measured in 343 lesions in 293 patients. (ACS 31.2%). Overall correlation between FFR and iFR is high (R=0.86 p&lt;0.0001). The FFR/iFR discrepancy occurred in 84 measurements (24.5%), more frequently it was FFRp (positive) / iFRn (negative) type of discrepancy (65, 18.9%) compare to FFRn/iFRp (19, 5.5%) one. There was no difference in occurrence of FFR/iFR discrepancy in stable patients and ACS ones (25.1%vs. 22.4%, p=0.59). The CFR correlated better with iFR than with FFR (R=0.56, p&lt;0.0001 vs. R= 0.36, p&lt;0.0001) (see table). In lesions with FFRp/iFRn type of discrepancy we found substantially higher CFR value compared to FFR/iFR agreement group (2.4±0.7 vs. 1.5±0.5, p&lt;0.0001). Unlike to FFRn/iFRp discrepancy, where CFR value was similar with agreement group (1.4±0.1 vs. 1.5±0.1, p=0.25)

Conclusion
The FFR/iFR discrepancy occurred in almost one quarter of examinations. Correlation between CFR and iFR is better than between CFR and FFR. High flow is probably one of the main reason for FFRp/iFRn type of discrepancy.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Czech Health Research Council
Intersection of the Academic Research Consortium – high bleeding risk criteria in patients undergoing PCI for acute coronary syndromes: insights from a high-volume single centre registry
Authors: Nicolas J , Cao D , Claessen B , Sartori S , Roumeliotis A , Goel R , Chandiramani R , Stefanini G , Turfah A , Chen S , Dangas G , Baber U , Sharma S , Kini A , Mehran R 
Published: November 2020

Abstract

Introduction
Patients presenting for percutaneous coronary intervention (PCI) with acute coronary syndromes (ACS) often have overlapping bleeding and ischaemic risk factors that offset the long-term success of PCI and limit the post stenting therapeutic options. Aiming at improving outcomes following PCI, the Academic Research Consortium (ARC) recently published a set of major and minor criteria that identify, a priori, patients at high bleeding risk (HBR). Indeed, knowledge of these risk factors will help in optimization of pre-procedural therapy and minimization of post intervention complications. Nonetheless, the actual prevalence of these criteria among patients undergoing PCI for ACS is not well known.

Purpose
To determine the intersection and distribution of ARC-HBR major and minor criteria in a real-world ACS population presenting for PCI.

Methods
In this analysis, we included all patients who presented with ACS to a high-volume PCI centre from 2012 to 2017 and underwent PCI with 2nd generation drug-eluting stent (DES) implantation. Patients were then classified as HBR if they met ≥1 major or ≥2 minor criteria according to the ARC-HBR definition. Baseline clinical and procedural characteristics were extracted from each patient electronic health records. The most common exclusive intersections of ARC-HBR major and minor criteria were quantitatively visualized using an Upset Plot.

Results
Only 44.6% (n=2,717) of ACS patients (n=6,097) fulfilled the ARC-HBR definition. There were significant differences in baseline clinical characteristics between HBR and non-HBR groups: age (71.4±11.5 vs. 60.9±10.3 years, p&lt;0.001), females (40.7% vs. 25.5%, p&lt;0.001), cerebrovascular disease (19.5% vs. 3.9%, p&lt;0.001), and diabetes (55.4% vs. 42.1%, p&lt;0.001). The prevalence of active smoking, a major risk factor for bleeding, was higher in the non-HBR group (20.6% vs. 9.9%, p&lt;0.001). The most frequent major and minor criteria were severe anemia (n=1,072) and age ≥75 (n=1,264), respectively. The top five criteria intersections were: severe anemia (n=215), age ≥75 and moderate chronic kidney disease (CKD) (n=145); moderate CKD and mild anemia (n=142); age ≥75 and mild anemia (n=140); age ≥75, moderate CKD, and mild anemia (n=130) (Figure 1).

Conclusion
Among patients who have undergone PCI for ACS, a significant proportion of individuals fulfilled the ARC-HBR definition. Severe anemia was the most prevalent major criteria. Different combinations of minor criteria, mainly age ≥75, moderate CKD and mild anemia, represented the most common intersections.
Figure 1

Funding Acknowledgement
Type of funding source: None
Ten-year all-cause death after percutaneous or surgical revascularization for men and women with multivessel or left main coronary artery disease: insights from the SYNTAX extended survival study
Authors: Hara H , Takahashi K , Klaveren D , Ono M , Kawashima H , Kappetein P , Mohr F , Mack M , Holmes D , Morice M , Davierwala P , Head S , Thuijs D , Onuma Y , Serruys P 
Published: November 2020

Abstract

Background
In patients with complex coronary artery disease (CAD), women favored coronary artery bypass grafting surgery (CABG) compared to percutaneous coronary intervention (PCI) at 5 years in the SYNTAX trial, whereas mortality rates after PCI and CABG were not different in men. On the other hand, poor outcomes of women undergoing PCI were not observed in the PRECOMBAT and BEST trials.
The long-term optimal revascularization strategy according to gender has not been fully evaluated.

Purpose
In the SYNTAX Extended Survival (SYNTAXES) study, no significant difference existed in all-cause death between PCI and CABG at 10 years. This study aimed to assess treatment effect of PCI and CABG for 10-year all-cause death according to gender.

Methods
The SYNTAXES study evaluated vital status up to 10 years in 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to treatment with CABG or PCI in the SYNTAX trial, and the pre-specified primary endpoint was all-cause death at 10 years. In this prespecified analysis, all-cause death at 10 years according to gender in patients undergoing PCI or CABG was evaluated.

Results
Of 1800 patients, 402 (22.3%) were women and 1398 (77.7%) were men. In women, the rate of mortality was significantly higher in the PCI arm at 5 years than in the CABG arm (19.3% vs. 10.3%; Log-rank p=0.010, Figure A), but the rates of mortality were not different at 10 years between the PCI and CABG arms (33.0% vs. 32.5%; Log-rank p=0.600, Figure A). In men, the mortality rate tended to be higher in the PCI arm at 10 years than in the CABG arm (27.0% vs. 22.5%; Log-rank p=0.082, Figure B), although the mortality rates were not different at 5 years between the PCI and CABG arms (12.4% vs. 12.3%; Log-rank p=0.957, Figure B).

Conclusion
The efficacy of CABG observed at 5 years disappeared at 10 years in women, whereas the efficacy of CABG became apparent after 5 years in men.
Figure 1

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Erasmus University Medical Centre, Rotterdam, Netherlands, reference: MEC-2016-716
Comparison of standard versus ultrasound guidance in radial and femoral access: a subanalysis of the randomised SURF trial
Authors: Nguyen P , Makris A , Hennessy A , Jayanti S , Xuan W , Juergens C 
Published: November 2020

Abstract

Background
Ultrasound (US) guidance in facilitating arterial access may reduce vascular complications and possible bleeding. There are still limited trials assessing real-time US guidance for coronary angiography. The SURF (Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention) trial showed no difference in primary outcome when the combined radial and femoral ultrasound analysis compared with standard (SD) technique, but significantly improved access efficiency and success rate.

Purpose
This subanalysis compared clinical and procedural outcomes of the individual radial and femoral access with US guidance versus standard technique.

Methods
Patients (n=1388) undergoing coronary angiography and percutaneous coronary intervention were randomised (1:1) into radial or femoral access, and (1:1) to SD or US guidance. The primary outcome was a composite of ACUITY (Acute Catheterisation and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularisation) and vascular complications at 30 days. Secondary outcomes were access time, number of attempts, venepuncture, difficult accesses and first-pass success.

Results
Compared to standard, US guidance produced no difference in composite endpoint for both radial (1.4% vs 1.2%, p=0.78) and femoral (3.1% vs 3.8%, p=0.65) accesses. ACUITY major bleeding (radial: 0.9% US vs 0.6% SD, p=0.69; femoral: 1.9% US vs 2.3% SD, p=0.69), vascular complications (radial: 0.3% US vs 0.3% SD, p=0.98; femoral: 1.3% US vs 0.9% SD, p=0.63) and MACE (radial: 0.6% US vs 0.3% SD, p=0.59; femoral: 0.9% US vs 1.2% SD, p=0.78) were similar in the US and SD approaches, respectively. However, US guidance resulted in improved procedural outcomes for both accesses. Femoral access derived the most benefit from US, with reduced mean access time (73 sec vs 97 sec, p=0.006), attempts (1.35 vs 1.84, p≤0.0001), difficult accesses (1.8% vs 6.2%, p=0.004), venepuncture (5.8% vs 12.6%, p=0.002) and improved first-pass success (77.2% vs 58.8%, p≤0.0001). For radial, US reduced attempts (1.59 vs 1.97, p=0.0007), difficult accesses (6.9% vs 12.3%, p=0.02), venepuncture (2.5% vs 5.6%, p=0.04) and improved first-pass success (69.2% vs 60.7%, p=0.02). There was no difference in radial mean access time (111 sec vs 126 sec, p=0.18).

Conclusions
US guidance in radial and femoral access did not reduce primary outcome compared to standard technique. The use of US significantly improved the efficiency and success rate of arterial cannulation, with femoral access derived the most benefit.

Funding Acknowledgement
Type of funding source: None
Transradial access by cardiology catheter lab nurses
Authors: Wojcik D , Correia Tinoco R.T , Alves Gaspar D.G , Ahmad M.A , Little C.L , Candilio L.C , Lockie T.L , Rakhit R.R , Coghlan J.C 
Published: November 2020

Abstract

Introduction
Nurse led radial arterial access (RAA) is emerging as an attractive alternative to traditional physician-led access.[1]

Methods
A multidisciplinary program was developed by the nursing and medical teams in a busy tertiary cardiac centre performing over 3000 interventional cardiology procedures of which 90% of cases are done radially.
Phase 1 of the training programme consisted of 50 procedures per nurse performed under direct consultant operator supervision. Phase 2 consisted of routine nurse led radial artery cannulation on unselected patients. In addition 2 sub-studies were performed an audit of patient experience comparing the two nurse practitioners with cardiology trainees. An audit of the time to sheath insertion was carried out.

Results
Technical success was defined as access within two puncture attempts. In phase 1 of the training two nurses were successful in 84% of cases. In this case cohort there were no identified vascular complications. One patient needed an alternate access route.
In Phase 2 311 cases were performed independently on unselected patients.
The technical success rate was 86.5% for both nurses in total in this cohort. This included a mixture of both right radial (249 cases) and left radial (25 cases) access. 8 of these were also PPCI cases. No major vascular complications were identified. In cases where no access after two attempts was secured access was gained by a consultant. In 6 cases ultrasound guidance was used by the consultant.
A patient discomfort score was recorded immediately via a questionnaire post access procedure. Results were compared with cardiology trainees performing RAA in parallel, demonstrating excellent outcomes.
Similarly when comparing difference between patient on table to sheath insertion times between trainees and nurses performing the radial access, nurse radial access had competitive outcomes.

Discussion
Nurse led RAA procedure is an advanced practice skill which can be adopted by appropriately trained and experienced senior members of the nursing team.
The advantages include facilitating flow through the catheter lab, greater advocacy of patients through their clinical pathway and high levels of patient satisfaction.
Median Time

Funding Acknowledgement
Type of funding source: None