bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3378Differences in valve morphology and aortopathy between patients with bicuspid and tricuspid aortic valves: a Computed Tomography Study
Authors: Nassar M , Perlman G , Arow Z , Lessick J , Segev A , Assali A , Danenberg H , Goitein O , Vaknin-Assa H , Orvin K , Sabtan O , Finkelstein A , Banai S , Kornowski R , Hamdan A 
Published: October 2019

Abstract

Background
Transcatheter aortic valve implantation (TAVI) has been shown safe and feasible in patients with bicuspid aortic valve (BAV) morphology. Evaluation of differences in valve morphology and aortic root dimensions in patients with BAV in comparison to patients with tricuspid aortic valve (TAV) is important for the spread of TAVI in patients with BAV.

Purpose
The present study evaluated the prevalence of BAV subtypes and the differences in valve morphology and aortic root dimensions between BAV and TAV in patients undergoing computed tomography (CT) before TAVI.

Methods
In five medical centers in Israel, 104 patients (69±13.5 years) with BAV and 105 patients (81±8.22 years) with TAV underwent CT angiography. BAV morphology was defined according to the number of commissures and raphe following Siever's classification. Functional BAV was defined as 3 cusps with focal fusion of 1, 2, or 3 commissures. Aortic root dimensions were measured at the level of the aortic annulus, sinus of Valsalva (SOV), sino-tubular junction (STJ), and ascending aorta (AA). Membranous septum (MS) length was measured in coronal view. The volume and agatston score of aortic valve calcification were evaluated.

Results
Type 0 account for 22% (23/104), type IA for 58% (60/104), Type IC for 9% (9/104), functional BAV for 11% (12/104). Type IB and II were not found in the studied population. As compared with TAV, patients with BAV have significantly larger aortic annulus area, SOV area, STJ area and AA Area; however, the ellipticity index of aortic annulus, SOV, STJ, and AA were similar. MS length was significantly smaller in patients with BAV compared to patients with TAV (6.4±2.3 mm vs. 8.1±2.7mm; retrospectively; P<0.001) and the volume of aortic valve calcifications was significantly higher in BAV compared to TAV patients: 2.3±1.6 ml3 vs. 1.4±1.2 ml3 retrospectively; P=0.003).

Conclusions
In Israel, patients with BAV showed more frequently type 1A BAV. BAV patients have larger aortic root dimensions than patients with TAV without difference in regard to the ellipticity index. MS length was smaller and the amount of aortic leaflet calcifications was higher in patients with BAV. These findings may have important impact on procedural outcome.
P3380Longitudinal assessment of coronary atherosclerosis according to baseline and changes of serum hemoglobin level
Authors: Won K.-B , Lee B K , Rizvi A , Hadamitzky M , Budoff M J , Leipsic J A , Berman D S , Min J K , Chang H.-J 
Published: October 2019

Abstract

Introduction
Little is known regarding the impact of serum hemoglobin level changes (Δ hemoglobin) on coronary plaque volume. This study evaluated the association between Δ hemoglobin and coronary plaque volume change (PVC) using serial coronary computed tomographic angiography (CCTA).

Methods
A total of 830 subjects (61±10 years, 51.9% male) who underwent serial CCTA with available hemoglobin levels were analyzed from the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry. The median inter-scan period was 3.2 (2.5 to 4.4) years. Quantitative assessment of coronary plaques was performed at both scans. All participants were stratified into four groups based on the quartile of baseline hemoglobin levels. Annualized PVC was defined as total PVC divided by inter-scan period. Plaque progression (PP) was defined as plaque volume at follow-up minus plaque volume at index >0.

Results
Baseline total plaque volume (mm3) was not different among all groups (group I [lowest]: 34.1 (0.0–127.4) vs. group II: 28.8 (0.0–123.0) vs. group III: 49.9 (5.6–135.0) vs. group IV [highest]: 34.3 (0.0–130.7); p=0.235). During follow-up, Δ hemoglobin was related to annualized PVC (β:−0.114; p=0.001) and PP (odds ratio: 0.868; 95% confidence interval: 0.770–0.978; p=0.020). Multiple linear regression models showed that Δ hemoglobin significantly impacted on annualized PVC in only the composite of I and II groups.

Conclusion
Based on serial CCTA findings, Δ hemoglobin independently impacted on coronary PVC in individuals with low to normal baseline hemoglobin level.
P3386Angioscopic comparison between polymer-free biolimus A9-coated stent and durable polymer drug-eluting stent 10 months after the implantation
Authors: Tsujimura T , Ishihara T , Iida O , Asai M , Masuda M , Okamoto S , Nanto K , Kanda T , Okuno S , Matsuda Y , Mano T 
Published: October 2019

Abstract

Background
Polymer-free biolimus A9-coated stent (DCS) has currently emerged as expected better arterial healing compared to durable polymer drug-eluting stent (DP-DES). However, superiority of DCS on arterial healing over DP-DES has not been well elucidated using intracoronary images.

Methods
This study examined 288 stents in 224 patients with de novo coronary artery lesions. We angioscopically compared 55 DCS from 35 patients with 233 DP-DES from 189 patients 10±2 months after the implantation. We assessed thrombus adhesion, which is a marker of incomplete re-endothelialization. Dominant neointimal coverage (NIC) grade, heterogeneity of NIC and maximum yellow color of plaque underneath the stent were also evaluated. Neointimal coverage was graded as follows: grade 0, stent struts exposed; grade 1, struts bulged into the lumen, although covered; grade 2, struts embedded by the neointima, but translucent; grade 3, struts fully embedded and invisible. NIC was judged as heterogeneous when differences in the NIC grade became apparent. Yellow plaque was graded as follows: grade 0, white; grade 1, light yellow; grade 2, yellow; grade 3, intensive yellow.

Results
Thrombus adhesion was similar between DCS and DP-DES (29% versus 23%, P=0.32). Dominant NIC was greater in DCS than in BP-DES (P<0.001), while NIC was more heterogeneous in DCS than in BP-DES (P=0.001, Figure). Maximum yellow color of stented segment was similar between DCS and DP-DES (P=0.09).

Conclusion
DCS provided similar thrombus adhesion to DP-DES, which suggested similar re-endothelialization 10 months after implantation. However, DCS showed thick and heterogeneous NIC compared to DP-DES. The specific feature of polymer-free and Biolimus A9 would cause the difference, and further investigation is necessary to evaluate the longer-term safety and efficacy.

Acknowledgement/Funding
None
P3398Cystatin C based eGFR estimation compared to crea-based estimation equation for assessing risk of cardiovascular and total mortality in population-based studies and patients with manifest CVD
Authors: Rothenbacher D , Rehm M , Iacoviello L , Tunstall-Pedoe H , Soederberg S , Salomaa V , Linneberg A , Sans S , Thorand B , Kee F , Kuulasmaa K , Waldeyer C , Zeller T , Blankenberg S , Koenig W 
Published: October 2019

Abstract

Introduction
Chronic kidney disease (CKD) represents a global public health problem and affects a large proportion of the adult population worldwide. Early detection, adequate risk stratification and specific treatment can prevent or delay the adverse effects of CKD.

Purpose
To assess cardiovascular risk and total mortality of subjects with CKD using cystatin C based and Crea-based estimated glomerular filtration rate (eGFR) equations (CKDEpi) in the general population, in diseased cohorts, and in specific subgroups.

Methods
The present study has been conducted within the BiomarCaRE project, with harmonized data from 21 population-based cohorts from 6 European countries and 3 cardiovascular disease (CVD) cohorts from Germany. Cox proportional hazards models were used to assess hazard ratios (HRs) for the various CKD definitions with adverse outcomes and mortality after adjustment for age, sex, cohort, smoking status, body mass index, history of diabetes, history of hypertension, and total cholesterol.

Results
21 population-based cohorts (n=76,954, median age 51 years, 52.2% men, 4.4% diabetic) and 3 diseased cohorts (n=4,982, median age 63 years, 75.6% men, 18.7% diabetic) with an average follow-up between 2.8 and 23.5 years and between 0.5 and 9.4 years, respectively, were included in the analysis. Prevalence of CKD-stage 3–5 by CKD-EPIcrea and CKD-EPIcys eGFR respectively, was 3.4% and 7.3% in the population-based cohorts and 13.9% and 14.4% in the diseased cohorts. In the population-based cohorts the incidence (per 1000 person years) of a non-fatal or fatal CVD event and total mortality respectively, was 10.0 and 11.8, whereas it was 21.2 and 17.8 in the diseased cohorts. In the population-based cohorts the HR for a CVD-event was 1.32 (95% CI 1.21–1.44) for the population with CKD-EPIcrea stage 3–5 and it was 1.47 (95% CI 1.35–1.60) based on CKD-EPIcys after adjustment for covariates. The HR for total mortality for those with CKD-EPIcrea stage 3–5 was 1.31 (1.21–1.41) and for CKD-EPIcys it was 1.86 (95% CI 1.73–2.00). Discrepancies between CKD-EPIcrea and CKD-EPIcys were even more striking across subgroups with and without diabetes or across specific age groups.

Conclusion
CKD is an important risk factor for subsequent CVD events and total mortality. However, point estimates of CKD-EPIcrea and CKD-EPIcys eGFR differ considerably between specific risk groups. Therefore, the clinical utility of both equations in different risk groups has to be considered and should be evaluated further.

Acknowledgement/Funding
7th framework programme collaborative project, grant agreement no. HEALTH-F2-2011-278913
P3402Validation of the SCORE O.P. for prediction of cardiovascular disease mortality in a large population of elderly individuals
Authors: Andexlinger S , Fritz J , Edlinger M , Concin H , Nagel G , Brozek W , Ruttmann E , Foeger B , Ulmer H 
Published: October 2019

Abstract

Background
Estimation of absolute cardiovascular risk in apparently healthy individuals, using SCORE (Systematic COronary Risk Evaluation) is recommended by the ESC guidelines on cardiovascular disease (CVD) prevention in clinical practice. Recently, the SCORE system has been extended by the SCORE O.P. aiming to improve estimates of cardiovascular risk specifically in older persons (65 years and older).

Purpose
The aim of this study was to validate the SCORE O.P. in an Austrian population of 34,909 healthy individuals aged between 65 and 80 years which were prospectively followed for a minimum of 10 years.

Methods
Predicted fatal CVD and coronary heart disease (CHD) event rates within 10 years were calculated using the “SCORE O.P. risk function for low risk regions” and compared to the actually observed rates, thereby assessing calibration. In addition, predicted probabilities were plotted against observed mortality by deciles of predicted risk. Regarding discrimination, receiver operating characteristics (ROC) analysis and corresponding c-statistics were used.

Results
In 14,586 males, 1,509 deaths from CVD (10.4%) and 847 deaths from CHD (5.8%) occurred within 10 years of follow-up. SCORE O.P. predicted 1,699 fatal CVD (11.7%) and 872 CHD (6.0%) events. In male high risk individuals (10th decile), SCORE O.P. overestimated mortality from CVD and CHD. C-statistics were 0.68 (95% CI 0.67–0.70) for CVD and 0.67 (0.65–0.69) for CHD.
In 20,323 females, 1,340 deaths from CVD (6.6%) and 672 deaths from CHD (3.3%) were observed. SCORE O.P. predicted 1,232 fatal CVD (6.1%) and 539 CHD events (2.7%). In female high risk individuals (8–10th deciles), SCORE O.P. underestimated mortality from CVD and CHD. C-statistics were 0.77 (0.75–0.78) for CVD and 0.77 (0.75–0.79) for CHD.

Conclusion
With regard to overall accuracy, the SCORE O.P. performed considerably well in this elderly Austrian population. However, in high-risk individuals, cardiovascular risk was overestimated for males and underestimated for females. SCORE O.P. was able to discriminate high-risk from low-risk individuals, better in women than in men.
P3409Comparison of the European Society of Hypertension stratification and European Society of Cardiology HeartScore for prediction of coronary artery disease and stroke in essential hypertension
Authors: Vogiatzakis N , Tsioufis C , Dimitriadis K , Iliakis P , Kasiakogias A , Liatakis I , Koutra E , Leontsinis I , Konstantinidis D , Laina A , Kouremeti M , Thomopoulos K , Tousoulis D 
Published: October 2019

Abstract

Background/Introduction
For estimation of overall cardiovascular risk the European Society of Hypertension (ESH) proposes stratification according to blood pressure (BP), prevalence of risk factors, asymptomatic target organ damage, diabetes, kidney and symptomatic cardiovascular disease, while the European Society of Cardiology (ESC) HeartScore constitutes another potent predictive tool of adverse outcome.

Purpose
The aim of the present study was to compare the predictive role of ESH stratification and ESC HeartScore for the incidence of the composite end-point of coronary artery disease (CAD) and stroke in a cohort of essential hypertensive patients.

Methods
We followed up 2150 essential hypertensives (mean age 55.7 years, 1085 males, office BP=145/91 mmHg) for a mean period of 8 years. All subjects had at least one annual visit. Patients were divided based on the ESH risk categories as well as according to the ESC HeartScore. CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure. Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging findings.

Results
The incidence of CAD, stroke and their composite over the follow-up period were 2.8% (n=60), 1.11% (n=24) and 3.9% (n=84), respectively. By using the ESH stratification, regarding the total population 15.3% (n=329) was of low and moderate risk, 54.4% (n=1170) was of moderate to high and high risk and 30.3% (n=651) was high to very high and very high risk. According to the ESC HeartScore 89.2% (n=1918) was of low to moderate risk, 10% (n=215) of high risk and 0.8% (n=17) of very high risk. Cox-regression analyses revealed that high to very high and very high ESH risk category was related to increased risk for the composite end-point of CAD and stroke (hazard ratio=4.5, p<0.0001), while focusing on the ESC Heart Score the composite end-point was predicted by the high risk category (hazard ratio=3.43, p<0.0001). Using the Akaike's information criterion the ESH risk model had better fit than the ESC HeartScore due to the lowest Akaike's values (1442.66 vs 1498.31, respectively).

Conclusions
In essential hypertensive patients categorization of patients by means of the ESH stratification and the ESC HeartScore are both predictive of future cardiovascular events. Based on our results, the ESH risk stratification constitutes a better prediction model for CAD and stroke than the ESC HeartScore in essential hypertension and its estimation is essential in order to improve overall risk assessment in this setting.
P3412Risk factors, biomarkers and framingham risk estimate fail to identify presence of subclinical atherosclerosis in young individual with family history of premature coronary artery disease
Authors: Ghadiri S , Leipsic J , Elahi N , Anastasius M , Huang A , Mugharbil A , Brunham L , Pimstone S , Golmohammadzadeh M , Thompson C , Argulian E , Narula J , Ahmadi A 
Published: October 2019

Abstract

Introduction
Patients with family history of premature coronary artery disease (CAD) are at increased risk of CAD events at a younger age. Risk factor based approaches and clinical evaluation are most commonly used to assess these individuals. However, it has been recently shown that up to 50% of individual presenting with their first myocardial infarction (MI) were considered to be “low risk” prior to that event. MI is often a result of plaque rupture preceded by progression of subclinical atherosclerosis. Detection of subclinical atherosclerosis may therefore help target prevention of plaque progression. We assessed the value of clinical risk factor, biomarkers and Framingham Risk Score (FRS) in predicting subclinical atherosclerosis in individuals with a family history of premature CAD.

Methods
From 310 referrals, 222 individuals between the ages of 35 and 55 with a family history of premature CAD (CAD events in first-degree family members (male <55, female <65)) were enrolled for evaluation of risk of CAD. Those with familial hypercholesteremia (possible, probable or definite) were excluded. Patients underwent clinical and risk factor evaluations as well as Cardiac CT or Calcium Score (CS) to assess presence of subclinical / clinical atherosclerosis at the discretion of the treating physician.

Results
In this pilot, 141 individuals (59% male, mean age 45.9±6.0 years) completed evaluation, and 65 (46%) had evidence of subclinical atherosclerosis on CT coronary angiography or CT calcium score with a mean segment involvement score (SIS) of 2.8 and mean CS of 152, putting them above the 80th percentile for their age and sex. Aside from male sex, age, and smoking history, other traditional risk factors and biomarkers including diabetes mellitus, hypertension, total cholesterol, LDL-C, HDL-C and Cholesterol/HDL-C were not significantly different between those with or without subclinical atherosclerosis (Table 1).
Table 1

Conclusion
In young individuals with a family history of premature CAD, risk factors, biomarkers, and FRS failed to identify individuals with premature, subclinical atherosclerosis in this pilot study. Detection of subclinical atherosclerosis and early implementation of treatment with the aim of stabilizing plaques and stopping progression might prove vital in reducing events in these individuals. Further studies are warranted.
P3424Gender differences in the implementation of CVD prevention In patients with coronary disease: Results from the EUROASPIRE V Survey
Authors: Kotseva K , De Backer G , De Bacquer D , Grobbee D , Hoes A , Jennings C , Maggioni A , Marques-Vidal P , Ryden L , Wood D 
Published: October 2019

Abstract

Introduction
EUROASPIRE V was a cross-sectional survey carried out by the European Society of Cardiology, EURObservational Research Programme in 2016–2017 in 27 European countries

Purpose
To describe gender differences in lifestyle and risk factor management, and the use of cardioprotective drug therapies in patients with coronary heart disease in Europe.

Methods
Patients <80 years with coronary disease (CABG, PCI or an acute coronary syndrome) were identified from the hospital medical records and interviewed and examined by trained staff ≥6 months and ≤2 years later using standardized methods including central laboratory measurements.

Results
A total of 8,261 (25.8% females), mean age 63.6 (SD 9.6) were interviewed, with a median time between the index event and interview 1.12 years (IR 0.82–1.56). Women were older (mean age 65.4 years [SD 9.2] vs 63.0 [9.7] and had a lower level of education than men.Comparing women with men, the prevalence of the risk factors were as follows: current smoking 12.8% vs 20.7%,obesity (BMI ≥30 kg/m2) 45.7% vs 34.9%, central obesity (waist circumference ≥102 cm in men or ≥88 cm in women) 78.0% vs 51.8%, raised blood pressure (BP ≥140/90 mmHg, ≥140/80 mmHg in patients with diabetes) 47.1% vs 46.0%, elevated LDL-cholesterol (≥1.8 mmol/l) 77.9% vs 68.5% and self reported diabetes 33.1% vs 28.0%. Reported use of prophylactic drug therapies for the same comparison was: antiplatelets 91.8% vs. 92.8%; beta-blockers 81.8% vs. 80.8%; ACE inhibitors/ARBs 75.0% vs. 75.3%; and statins 76.8% vs. 82.2%. The therapeutic control of blood pressure, LDL-cholesterol and diabetes (HbA1c <7 mmol/L) was: 48.2% vs 49.9%; 25.7% vs 34.1% and 48.5% vs 56.7%, respectively.

Conclusions
The results show that women with coronary disease have higher prevalence of obesity, central obesity, elevated LDL-cholesterol and self-reported diabetes than men. There were no differences in terms of blood pressure management. All coronary patients require professional support to make lifestyle changes and manage risk factors more effectivelyin order to reduce their risk of recurrent cardiovascular events.

Acknowledgement/Funding
ESC-EORP supported by Amgen, Eli Lilly, Pfizer, Sanofi, Ferrer and Novo Nordisk
P3432Coronary artery calcium score is of limited sensitivity in detecting subclinical atherosclerosis in young individuals with family history of coronary artery disease
Authors: Huang A , Mugharbil A , Anastasius M , Ghadiri S , Leipsic J , Elahi N , Brunham L , Pimstone S , Golmohammadzadeh M , Thompson C R , Argulian E , Narula J , Ahmadi A 
Published: October 2019

Abstract

Introduction
Family history of premature coronary artery disease (CAD) is known to predispose individuals to adverse CAD events, often at a younger age. Current risk stratification strategy is suboptimal, as up to 50% of individuals were considered “low-risk” prior to their first presentation of myocardial infarction. Coronary artery calcium score (CACS) is a marker of atherosclerosis and provides incremental value in risk stratification. However, the utility of CACS may be limited in younger patients as they often have non-calcified atherosclerotic plaques. In this study, we evaluate the sensitivity of CACS in detecting subclinical atherosclerosis in different age groups.

Method
From 310 referrals to a specialized unit in the management of early atherosclerosis, 222 individuals with a family history of premature CAD (defined as CAD events in first-degree family members, male<55 and female<65) and aged between 35 and 55 were enrolled for assessment of their CAD risks. Individuals with possible, probably or definite familial hypercholesterolemia were excluded. In addition to clinical and risk factor evaluation, cardiac CT and CACS were performed in select individuals, at the discretion of the treating physician.

Results
Of the 141 (59% male, mean age 45.9±6.0 year) individuals that completed clinical evaluation, 65 (73% male, mean age 47.4±6.9 years) have subclinical atherosclerosis (defined by the presence of atherosclerotic plaques in any of the coronary artery segments in cardiac CT). Of them, 52 have CACS>0, giving an overall sensitivity of 80%. The breakdown by age group is shown in table 1. The sensitivity of CACS in detecting subclinical atherosclerosis is quite modest in younger individuals (60% in individuals <45 year-old) but improves with patient age (>85% in >45 years).
Table 1. Sensitivity of CACS in different age groups Age group True Positive Fast Negative Sensitivity N (CAC+ CTCA+) (CAC+ CTCA−) (%) <40 6 4 60 10 41–45 7 4 55 11 46–50 19 3 86 22 51–55 20 1 95 21

Conclusion
In younger individuals (<45 years) with family history of premature CAD, CACS is of limited sensitivity in detecting subclinical atherosclerosis, and should not be used to rule out CAD. Further studies are warranted.