bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6551Evaluation of a new ultra low-dose radiation protocol during electrophysiological device implantation
Authors: Eichenlaub M , Astheimer K , Restle C , Maring C , Blum T , Minners J , Schweitzer S , Thiel U , Neumann F.-J , Arentz T , Lehrmann H 
Published: October 2019

Abstract

Objectives
The aim of this study was to evaluate the impact of a new ultra low-dose radiation protocol on radiation doses, feasibility and safety during electrophysiological device implantation.

Background
Radiation is one of the main hazards during electrophysiological procedures. Shielding is especially difficult during device implantation and particularly implantation of cardiac resynchronisation therapy devices (CRT) is associated with high radiation doses.

Methods
From January 2005 to January 2019, 8612 patients underwent de novo device implantation at our University Heart Center.
During 2018, we established a new ultra low-dose radiation protocol and compared 661 patients who were treated during 2017 utilizing the conventional low-dose protocol with 512 patients after the application of the new program (11.5% one-chamber devices, 68.5% two-chamber devices and 19.9% CRT).

Results
After establishment of the radiation reduction protocol, dose area products could be reduced by 62% and the effective doses by 59% (113 (47–292) vs. 43 (14–130) cGycm2, p<0.0001 and 0.25 (0.11–0.63) vs. 0.10 (0.03–0.28) mSv, p<0.0001). These results could be achieved without prolonging procedure time, increasing complication and decreasing success rate.
Male gender, higher BMI, longer procedure and fluoroscopy duration and the use of the conventional radiation protocol were statistically significant factors for the need of higher radiation doses in multivariate regression analysis.
Clinical and procedural characteristics All (n=1173) Group pre (n=661) Group post (n=512) P Age, years 77 (69–82) 77 (69–82) 77 (69–83) 0.6 Male, n (%) 726 (62) 403 (61) 323 (63) 0.5 Body mass index, kg/m2 26.6 (24–29.8) 26.6 (24–29.8) 26.4 (24–29.4) 0.5 Procedure time, minutes 35 (25–50) 37 (26–50) 35 (25–54.5) 0.5 Fluoroscopy time, minutes 3.7 (2–7.8) 4 (2–7.8) 3.4 (1.9–7.7) 0.07 Dose area product, cGy cm2 80 (28–228) 113 (47–292) 43 (14–130) <0.0001 Effective dose, mSv 0.18 (0.06–0.51) 0.25 (0.11–0.63) 0.1 (0.03–0.28) <0.0001 Complications, n (%) 11 (0.9) 7 (1.1) 4 (0.8) 0.8

Conclusions
Radiation exposure during electrophysiological device implantation has been continuously reduced over the last years. By establishing a new ultra low-dose radiation protocol, we could further decrease the radiation dose significantly and reach the lowest radiation values published so far. This protocol can easily be implemented in the workflow of other hospitals and should become standard during implantation procedures.
P6559Long-term follow-up and outcomes of patients with discontinuation of oral anticoagulant therapy after successful ablation procedures for atrial fibrillation
Authors: Fujino T , Yuzawa H , Kinoshita T , Shinohara M , Koike H , Akitsu K , Yano K , Wada R , Suzuki T , Ikeda T 
Published: October 2019

Abstract

Background
Oral anticoagulant therapy (OAT) is effective for preventing strokes in atrial fibrillation (AF) patients. Currently, there is controversy regarding the discontinuation of OATs in patients with ablation procedures to eliminate AF.

Aim
We investigated the incidence of major bleeding and ischemic strokes/systemic embolisms in low-risk patients that discontinued OATs after successful AF ablation procedures.

Methods
Of 330 consecutive patients that underwent AF ablation procedures and were prescribed one of the direct oral anticoagulants or warfarin, 207 AF patients (158 men, mean age 61±11 years) who discontinued OATs three months after the procedure were enrolled. The average CHADS2 and HAS-BLED scores were 1.0±0.9 and 1.2±1.0, respectively, which meant that most patients had a low risk for strokes.

Results
During follow-up, 31 patients (15%) had recurrences of AF. Those patients underwent a re-ablation procedure and then re-discontinued their OATs three months after the session. During a 60±13 months follow-up, major bleeding was observed in five patients (2.4%) and was associated with a higher HAS-BLED score (2.2±0.4 vs. 1.1±1.0, P=0.027). In contrast, none of the patients experienced ischemic strokes/systemic embolisms.

Conclusions
This prospective study demonstrated that in patients with successful ablation procedures and low risk scores for AF management, OATs could be discontinued three months after the procedure. Unnecessary continuation of OATs may increase the incidence of major bleeding during the follow-up.
P6585Number of ECG leads and prognosis of spontaneous type 1 Brugada syndrome
Authors: Probst V , Arnaud M , Behar N , Mabo P , Guyomarch B , Tixier R , Briand J , Berthome P , Mansourati J , Babuty D , Maury P , Clerici G , Thollet A , Sacher F , Gourraud J B 
Published: October 2019

Abstract

Introduction
Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of sudden cardiac death (SCD). The recent single lead-based diagnosis of Brugada syndrome recommended criterion may lead to overdiagnosis of Brugada syndrome and overestimation of the risk of SCD.

Objective
We aim to investigate the value of a single lead diagnosis in spontaneous type 1 ECG Brugada patient and to investigate the association between the number of ECG leads with a spontaneous type 1 ST elevation and the arrhythmic risk.

Methods
Consecutive patients affected with BrS were recruited in a multicentric prospective registry in France (15 centers) between 1994 and 2016. A total of 1613 patients affected by the Brugada syndrome were enrolled. For this specific study, only patient with a spontaneous type 1 BrS were enrolled (n=505). Data were prospectively collected with an average follow-up of 6.5±4.7 years. ECGs were reviewed by 2 physicians blinded to clinical status. Type 1 ST elevation was defined by ≥2 mm J-point elevation with coved ST segment and negative T wave.

Results
A total of 505 patients with a spontaneous type 1 BrS (mean age 46±15 years, 398 males, 79%) were enrolled. 117 patients (23%) were symptomatic at baseline (32 (6%) aborted SCD, 85 (17%) syncope). Implantable cardiac defibrillator (ICD) was implanted in 191 patients (38%).
Brugada ECG pattern was found in 1 lead in 250 patients (50%, group 1), in 2 leads in 227 patients (45%, group 2) and in 3 leads in 28 patients (5%, group 3). Groups were comparable in term of clinical presentation except for group 3 who presented more frequently an early repolarization pattern (n=19 (8%) in group 1, n=15 in group 2 (6%) and n=7 (25%) in group 3, p=0.02) and more frequently QRS fragmentation (n=6 (2%) in group 1, n=3 in group 2 (1%) and n=3 (11%) in group 3, p=0.03).
During follow-up, 46 (9%) patients presented an arrhythmic event: 22 (9%) in group 1 (4 SCD, 14 appropriate ICD therapy, 4 ventricular arrhythmias), 22 (10%) in group 2 (6 SCD, 11 appropriate ICD therapy, 5 ventricular arrhythmias) and 2 (7%) in group 3 (1 SCD, 1 appropriate ICD therapy). Patients with type 1 BrS pattern in 2 or 3 ECG leads had not a significantly higher rate of arrhythmic events than patients with type 1 BrS pattern in only 1 ECG lead (HR: 1.1; 95% CI: 0.6–1.9 for group 2 and HR: 0.7; 95% CI: 0.2–3 for group 2; p=0,087).

Conclusion
In the largest cohort of BrS patients ever described, the prognosis of Brugada syndrome with a spontaneous ECG pattern does not appear to be affected by the number of leads required for diagnostic.
P6602Plasma signature of apoptotic microparticles in acute coronary syndromes is associated with endothelial dysfunction and plaque rupture
Authors: Zacharia E , Papageorgiou A , Antonopoulos A S , Pallantza Z , Oikonomou E , Miliou A , Mistakidi C V , Kriebardis A , Orologas N , Valasiadi E , Papaioannou S , Tousoulis D 
Published: October 2019

Abstract

Background
Circulating microparticles (MP) are surrogate biomarkers of atherosclerosis and are elevated in acute coronary syndromes (ACS) but its exact biological role remains unknown.

Purpose
To explore the diagnostic and biological significance of circulating apoptotic MP signature in patients with ACS.

Methods
We enrolled 122 ACS patients: n=38 with unstable angina (UA), n=49 with STEMI, 35 with NSTEMI. Flow cytometry analysis was used to quantify circulating apoptotic (annexin+) endothelial cell (EMP), red blood cell (RMP) and platelet (PMP) derived microparticles. Endothelial function was estimated with flow mediated dilation (FMD), and inflammatory status with C-reactive protein (hsCRP).

Results
The association between EMP, RMP and PMP is shown on a cloud plot (A). Using an unbiased approach, we performed hierarchical clustering (A) of the total population of patients with ACS by using the circulating levels of EMP, RMP and PMP (B). Hierachical clustering identified two discreet clusters of patients (Cluster A and B) without any differences in the presence of traditional risk factors (not shown), but significant differences in the distribution of ACS type (C). STEMI subtype (a surrogate for definite plaque rupture) was significantly increased in Cluster B, which also had significantly decreased FMD (D), but not hsCRP (p=NS).

Conclusions
Apoptotic MP are involved in the pathogenesis of acute coronary syndromes via promotion of endothelial dysfunction and plaque rupture. The diagnostic and/or predictive value of microparticles' profiling for plaque vulnerability should be explored in future studies.
88Oxygen therapy in myocardial infarction patients with or without diabetes mellitus - A predefined subgroup analysis from the DETO2X-AMI trial
Authors: Hofmann R , Jernberg T , Lindahl B , Ostlund O , Erlinge D , Herlitz J , Svensson L , Witt N , James S K , Nystrom T 
Published: October 2019

Abstract

Background
In diabetes, there is an interaction between hyperglycaemia and cellular hypoxia, which may induce oxidative stress. Oxygen therapy in patients with diabetes and myocardial infarction (MI) has not been studied.

Purpose
Our aim was to determine the effects of supplemental oxygen in MI patients with or without diabetes.

Methods
The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomised 6629 patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6–12 hours or ambient air. In this prespecified analysis involving 5010 patients with confirmed MI, 934 had known diabetes (19%). The main composite endpoint was the effect of supplemental oxygen on all-cause death, rehospitalisation with MI, or heart failure at one year in patients with diabetes. Key secondary endpoint was the comparison between patients with or without diabetes.

Results
In patients with diabetes, the main composite endpoint occurred in 16.2% (72 of 445) of patients allocated to oxygen compared to 16.6% (81 of 489) allocated to ambient air (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.67–1.27, P=0.81) at one year (figure). There was no statistically significant difference for the individual components of the main composite endpoint, or the rate of cardiovascular death up to one year. In comparison, corresponding endpoints in patients without diabetes were similar between the treatment groups.
However, when comparing patients according to diabetes status, event rates were significantly higher in the diabetic population (main composite endpoint: HR 1.60; 95% CI, 1.32–1.93, P<0.01).
Kaplan-Meier curves for main endpoint

Conclusions
Oxygen therapy in normoxemic MI patients did not significantly affect 1-year all-cause death, cardiovascular death, rehospitalisation with MI or heart failure, irrespective of underlying diabetes. Noteworthy, despite that the incidence of cardiovascular outcomes has declined substantially in patients with diabetes over the last decades, we still observed markedly increased event rates in patients with diabetes.

Acknowledgement/Funding
Swedish Heart-Lung Foundation; Swedish Research Council; Stockholm County Council
99Non-ruptured plaque and platelet-rich thrombi in ST-segment elevation myocardial infarction: new insight into early spontaneous reperfusion
Authors: Chen J , Wang G Z , Liu Z , Zhang Y H , Guo J C , Li J 
Published: October 2019

Abstract

Objectives
To detect the potential mechanism of early spontaneous reperfusion (ESR) in STEMI.

Background
Early spontaneous reperfusion occurs in around 20% of STEMI and is associated with favorable outcomes. Optical coherence tomography (OCT) is more accurate in detecting subtle morphological details of the culprit lesion.

Methods
In this prospective study, a total of 107 consecutive patients with STEMI were enrolled from July 2016 to May 2017. Of that total, 21 (19.6%) met the criteria of angiographic ESR (TIMI-3 flow in the initial angiogram). Among those without ESR (TIMI-0 flow in the initial angiogram), 21 patients were assigned into the control group according to propensity score matching with the ESR group. The OCT findings and one-year clinical outcomes were compared between the two groups.

Results
Although baseline characteristics were comparable, plaque features significantly differed between the ESR and control group (P<0.001), including plaque rupture (23.8% vs. 66.7%), plaque erosion (47.6% vs. 33.3%), calcified nodule (9.5% vs. 0%) and vasospasm (19.1% vs. 0%). Red thrombus (19.1% vs. 85.7%) was far less found whereas white thrombus (61.9% vs. 14.3%) was more common in the ESR group. In addition, despite of less stent placement (0.6±0.5 vs. 1.3±0.9, P<0.001), patients in the ESR group had a non-statistically lower rate of cardiac adverse events (4.8% vs. 14.3%, P=0.269) during one-year follow up.
The OCT finding Variables ESR group (n=21) Control group (n=21) P value The OCT imaging <0.001   Plaque erosion 10 (47.6) 7 (33.3)   Plaque rupture 5 (23.8) 14 (66.7)   Calcified nodule 2 (9.5) 0 (0)   Vasospasm 4 (19.1) 0 (0) The Type of Thrombus <0.001   Red thrombus 4 (19.1) 18 (85.7)   White thrombus 13 (61.9) 3 (14.3)   No thrombus (vasospasm) 4 (19.1) 0 (0)   MLA (mm2) 2.7±2.2 2.3±2.4 0.534 Values are n (%), mean ± SD. ESR = early spontaneous reperfusion; MLA = Minimum lumen area; OCT = optical coherence tomography.
ESR and control group

Conclusions
Relief of coronary occlusion induced by non-ruptured plaque and platelet-rich thrombi may be one of the main mechanism underlying early spontaneous reperfusion in STEMI.

Acknowledgement/Funding
No.81470491 from the National Natural Science Foundation of China and No.7192078 from Beijing Municipal Natural Science Foundation to Dr. Li.
106Plasma trimethylamine N-oxide is associated with culprit plaque characterization as assessed by optical coherence tomography in patients with acute myocardial infarction
Authors: Sheng Z , Tan Y , Yan H 
Published: October 2019

Abstract

Background
Previous study have demonstrated that plasma trimethylamine N-oxide (TMAO) is associated with vulnerable plaque characteristics as assessed by optical coherence tomography (OCT) in patients with coronary artery disease. However, the relation between TMAO and the culprit plaque characteristics as assessed by OCT in patients with acute myocardial infarction (AMI) exhibiting plaque rupture at the site of the culprit stenosis is unknown.

Objective
To explore the relation between plasma TMAO and coronary culprit plaque characterization assessed by OCT in AMI patients exhibiting plaque rupture.

Method
We prospectively enrolled 90 AMI patients with plaque rupture identified by OCT and collected demographic data, risk factors, coronary angiography and OCT data, medical history and laboratory findings of all patients. Plasma TMAO levels were detected by stable isotope dilution liquid chromatography tandem mass spectrometry. Macrophage presence in coronary culprit plaque was quantified by normalized standard deviation (NSD).

Result
All patients were divided into two groups (high TMAO group and low TMAO group) according to the median plasma TMAO level (3.22uM). The culprit plaques in the high TMAO group exhibited a thinner fibrous cap thickness (60um [60–100um] versus 90um [70–110um], P=0.013]), higher frequency of thin-cap fibroatheroma (TCFA) (15.6% versus 55.6%, P<0.001), microvessel (24.4% versus 4.4%, P=0.014) and macrophage infiltration (66.7% versus 26.7%, P<0.001) compared with the low TMAO group. Moreover, the level of TMAO was significantly positively associated with NSD (Pearson's correlation coefficient: r=0.766, P<0.001).

Conclusion
Plasma TMAO levels are associated with coronary plaque vulnerability and inflammation in patients with AMI exhibiting plaque rupture.

Acknowledgement/Funding
Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2016-I2M-1-009)
125Incidence and outcomes of bailout stenting following use of drug coated balloon
Authors: Basavarajaiah S , Handi S , Foley L , Watkin R , Freestone B , Pitt M , Lee K , Bhatia G , Ment G , Pulikal G 
Published: October 2019

Abstract

Background
The incidence of bailout stenting post-drug coated balloon use (DCB) in the literature has been more than 10%; ranging up-to 21% in Bello trial and this variation could be due to the different criteria used to consider bailout stenting and may also reflect aggressive pre-dilatation. Our eyes are trained to expect stent like result and anything less is considered sub-optimal and this could be one of the reasons for high incidence of bailout stenting. The current recommendation is to use drug eluting stent (DES) for bailout stenting and hence raising in the possibility of drug toxicity or maybe even synergistic effect from combination of Paclitaxel (DCB) and limus (DES).

Aim
We have evaluated the incidence and outcomes of patients needing bailout stenting in our centre.

Methods and results
We evaluated all patients who were treated with DCB between January 2016-August 2017. Bailout stenting per lesion were identified and studied for endpoints which included cardiac death, target vessel MI, stent thrombosis, target lesion revascularization and target vessel revascularisation.
Between the study period; 468 lesions (in 364 patients) were treated with paclitaxel DCB (Sequent Please, B Braun, Germany). Bailout stenting was required in 23 lesions (4.9%) and of which 12 (52%) was for flow limiting dissections (type C or more) and the remaining 11 was for recoil of more than 50%. Majority of the lesions were de novo (18; 78%). All bailout stenting was performed with third generation limus eluting stents. During a median follow-up of 18.14 months; range; 7–33 months, there was no cardiac death and target vessel MI occurred in 1 patient (4.3%), TLR and TVR were in 3 lesions (13%). MACE rate (combination of cardiac death, target vessel MI and TVR) was 13%. There were no cases of stent thrombosis as per the ARC definition.

Conclusion
One of the highlighting features of our study is very low-rates of bailout stenting. This may be due to our criteria of not stenting mild dissections (unless they are flow limiting) and also to accepting recoil of up-to 50% post-DCB use. The outcome in bailout stenting group is acceptable especially with hard endpoints (cardiac death, target vessel MI and stent thrombosis) although TLR and TVR rates were higher indicating synergistic effect of paclitaxel and limus may not offer additional benefits.
127Prevalence of coronary artery disease and coronary microvascular dysfunction in heart failure with preserved ejection fraction
Authors: Rush C , Berry C , Oldroyd K , Rocchiccioli P , Lindsay M , Campbell R , Ford T , Sidik N , Murphy C , Touyz R , Petrie M , McMurray J 
Published: October 2019

Abstract

Background/Introduction
The prevalence of epicardial coronary artery disease (CAD) and coronary microvascular dysfunction (CMD) have not been studied systematically in an unselected cohort of patients with heart failure and preserved ejection fraction (HFpEF). Both types of coronary disease may play an important role in the pathophysiology and prognosis of HFpEF.

Methods
This prospective multi-centre observational study enrolled near-consecutive patients hospitalized with HFpEF. Patients underwent invasive coronary angiography. Where possible, patients also had guidewire-based assessment of fractional flow reserve, coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) performed, followed by vasoreactivity testing with intracoronary acetylcholine.

Results
A total of 75 patients underwent invasive coronary angiography. Guidewire-based assessment of FFR/CFR/IMR was performed in 62 patients, and vasoreactivity testing was possible in 41 patients. Obstructive epicardial CAD was identified in 38 patients (51%). CMD (defined as a CFR <2.0 and/or IMR ≥25) was present in 66% of patients assessed and was similarly prevalent in those with and without obstructive epicardial disease (62% vs. 69%, p 0.52). During vasoreactivity testing, 24% of those assessed had evidence of coronary microvascular endothelial dysfunction. Patients with obstructive CAD were more often male (63% vs. 38%, p 0.028), and had a history of CAD (50% vs. 19%, p 0.005), diabetes mellitus (63% vs. 41%, p 0.05), and a higher E/e' on echocardiography (median 14.4 vs. 12.3, p 0.044) than those without obstructive coronary disease. Patients with CMD had higher B-type natriuretic peptide levels (median 569 vs. 197 pg/ml, p 0.036) than those without microvascular dysfunction.
Selected baseline characteristics No obstructive CAD (n=37) Obstructive CAD (n=38) p-value No CMD (n=21) CMD (n=41) p-value Age (mean, years) 72 73 0.4 74 72 0.41 Female, n (%) 23 (62%) 14 (37%) 0.028 11 (52%) 22 (54%) 0.92 CAD history, n (%) 7 (19%) 19 (50%) 0.005 7 (33%) 12 (29%) 0.74 Diabetes mellitus, n (%) 15 (41%) 24 (63%) 0.05 11 (52%) 22 (54%) 0.92 BNP (median, pg/ml) 323 315 0.9 197 569 0.036 Ejection fraction (median, %) 59 58 0.35 60 56 0.064 E/e' (median) 12.3 14.4 0.044 14.2 12.4 0.74
Study flow diagram

Conclusion
Both epicardial CAD and CMD are common in HFpEF and each may be a therapeutic target in this condition. Although it has been hypothesized that CMD may be due to endothelial dysfunction, our findings suggest that CMD is predominantly due to structural abnormalities in HFpEF.

Acknowledgement/Funding
Chief Scientist Office
227A novel risk prediction model for sudden cardiac death in childhood hypertrophic cardiomyopathy (HCM Risk-Kids)
Authors: Norrish G , Ding T , Field E , O'mahony C , Elliott P M , Omar R Z , Kaski J P 
Published: October 2019

Abstract

Background
Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM) but there is no validated algorithm to identify those at highest risk. This study sought to develop and validate a SCD risk prediction model that provides individualized risk estimates.

Methods
A prognostic model was derived from an international, retrospective, multi-center longitudinal cohort study of 1024 consecutively evaluated patients aged ≤16 years. The model was developed using pre-selected predictor variables [unexplained syncope, maximal left ventricular (LV) wall thickness (MWT), left atrial diameter (LAD), LV outflow tract (LVOT) gradient and non-sustained ventricular tachycardia (NSVT)] identified from the literature and internally validated using bootstrapping.

Results
Over a median follow up of 5.3 years (IQR 2.6, 8.2, total patient years 5984), 89 (8.7%) patients died suddenly or had an equivalent event [annual event rate 1.49 (95% CI 1.15–1.92)]. The pediatric model was developed using pre-selected variables to predict the risk of SCD. The model's ability to predict risk at 5 years was validated; C-statistic was 0.69 (95% CI 0.66–0.72) and the calibration slope was 0.98 (95% CI 0.58–1.38). For every 10 ICDs implanted in patients with ≥6% 5-year SCD risk, potentially 1 patient will be saved from SCD at 5 years.

Conclusions
This new validated risk stratification model for SCD in childhood HCM provides accurate individualized estimates of risk at 5 years using readily obtained clinical risk factors.

Acknowledgement/Funding
British Heart Foundation