bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5547First results of TranslatiOnal Registry for CardiomyopatHies (TORCH)
Authors: Sedaghat-Hamedani F , Trebing J , Tan K , Kayvnapour E , Sluka S , Gi W T , Amr A , Weitmann K , Hoffmann W , Katus H A , Meder B 
Published: October 2019

Abstract

Introduction
The cardiomyopathies (CMPs) are a diverse group of cardiac disorders and leading cause of heart failure (HF) and sudden cardiac death (SCD). Clinical courses of CMPs vary considerably even between patients with the same disease entity. The TranslatiOnal Registry for CardiomyopatHies (TORCH) is a comprehensive CMP registry that aims to provide a database and biomaterial bank for basic science and clinical research in this field. The long-term objective of this registry is to increase the understanding of disease pathomechanisms on the way to a better risk stratification as well as identification of new diagnostic and therapeutic approaches in CMP.

Methods
TORCH is a national, prospective, and multicentre registry within the German Centre for Cardiovascular Research (DZHK), which includes 2300 consecutive patients with non-ischemic (primary and secondary) CMP in 20 centres. The minimum follow up time is one year. The DZHK-wide harmonization of datasets and eCRFs (electronic case report form) were performed to ensure a high level of data quality across different study centres.

Results
Seventy percent of the enrolled patients are male. Idiopathic/familial dilated cardiomyopathy (DCM) holds the highest prevalence with 54%, followed by inflammatory DCM/myocarditis with a prevalence of 24%. Hypertrophic cardiomyopathy (HCM) is the third-most prevalent CMP in this registry (16%). Infrequent CMPs such as left ventricular non-compaction (LVNC), arrhythmogenic right ventricular cardiomyopathies (ARVC) are also represented in TORCH with a prevalence of 4% and 2% respectively. Major clinical findings are registered in TORCH. Atrial fibrillation was present with a high prevalence among all CMPs (22%-35%). The highest prevalence of stroke or TIA at baseline was reported in patients with LVNC (15.1%) and the lowest in those with amyloidosis (3.3%). Patients with ARVC had the highest number of ICD implantation and adequate ICD therapy (56.7%, p<0.05; 47.1%, p<0.05). Preliminary data analysis showed higher frequency of therapy refractory heart failure symptoms and worse outcome in patients with familial DCM in comparison to those with inflammatory or idiopathic DCM.

Conclusion and outlook
TORCH represents one of the largest cardiomyopathy registries in Europe. The patients are comprehensively phenotyped through clinical examinations, state-of-the-art imaging modalities, as well as molecular, genetic, and epigenetic investigations. This registry can help researchers design further studies investigating new diagnostic tools or therapeutic strategies in CMPs.
P5554Follow the light - The prognostic value of late gadolinium enhancement in hypertrophic cardiomyopathy
Authors: Fortuni F , Abete R , Raineri C , Ghio S , Angelini F , Scelsi L , Turco A , Crimi G , Leonardi S , Oltrona Visconti L , De Ferrari G M 
Published: October 2019

Abstract

Background and aim
Hypertrophic cardiomyopathy (HCM) is a genetic based cardiomyopathy with heterogeneous phenotypic expression. Since it is one of the most common cause of sudden cardiac death (SCD) in the young different risk score have been proposed to properly identify the patients that would benefit from a primary prevention with an implantable cardioverter-defibrillator (ICD). ESC guidelines on HCM suggest to estimate the risk of SCD considering clinical and echocardiographic parameters and mention the use of cardiac magnetic resonance (CMR) only in the case of poor echo windows. The aim of the present study-level meta-analysis was to explore the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for adverse fatal events.

Methods
We searched PubMed and EMBASE for studies that investigated the prognostic value of LGE in patients with HCM. The outcomes of interest were SCD or aborted SCD, all-cause mortality and cardiovascular (CV) mortality. Random-effects Odds Ratios (ORs) were estimated using a DerSimonian-Laird method with a person-year approach. Moreover, an univariate meta-regression was performed to assess the moderator effect of mean age, LGE % of left ventricle (LV) and gender (expressed as male percentage).

Results
A total of 7 studies (n=3351) were included in the analysis. Mean follow-up was 3±0.63 years. Mean age was 47.7±14.6 years and 56.9% were male. LGE was detected in 1845 (55%) patients with a mean LGE percentage of LV of 7%. The presence of LGE was associated with an increased incidence of SCD or aborted SCD (OR 3.44; 95% CI 2.02–5.86; p<0.001- Figure), all-cause mortality (OR 1.92; 95% CI 1.31–2.81; p<0.001) and CV mortality (OR 3.16; 95% CI 1.77–5.64; p<0.001) compared with the absence of LGE at CMR. The LGE percentage of LV, mean age and gender did not have any moderator effect on the outcomes of interest. However, LGE % of LV was reported only in 4 studies and the absence of any moderator effect of this parameter could be due to a type II error.
Prognostic value of LGE for SCD

Conclusions
The presence of LGE at CMR in patients with HCM exhibited a substantial prognostic value in fatal events and, in particular, in the prediction of SCD. LGE assessment is an effective tool to stratify the arrhythmic risk in HCM. Therefore, it should be considered, especially in borderline cases, to improve the identification of HCM patients who could benefit from ICD implantation.
P5562Increased microRNA-21 gene expression levels as a biomarker of myocardial damage in acute myocarditis
Authors: Marketou M , Kontaraki J , Konstantinou J , Maragkoudakis S , Plevritaki A , Lempidakis D , Vougia D , Fragiadakis K , Kassotakis S , Theodosaki O , Vardas P , Parthenakis F 
Published: October 2019

Abstract

Purpose
MicroRNAs (miRs) are implicated in various cardiovascular pathologies and are promising diagnostic and therapeutic targets. miR-21 plays a critical role in the regulation of inflammation and cardiac fibrosis. In this study, we evaluated miR-21 expression levels in peripheral blood mononuclear cells from patients with acute myocarditis compared to healthy individuals and explored their diagnostic potential as predictor of myocardial damage.

Methods
We assessed the expression levels of miR-21 in 55 patients with acute myocarditis (40 men, mean age 30±12 years) and 20 healthy individuals (15 men, mean age 30±9 years). Blood samples were taken on admission and miR-21 expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Plasma high sensitive troponine (TnI) was measured by immunoassay and a value above the laboratory reference range (11.6 pg/ml) was considered elevated.

Results
Myocarditis patients showed significantly higher troponine levels compared to healthy individuals (256.59±94.9 versus 11.9±9.01, p<0.001). miR-21 expression levels in peripheral blood mononuclear cells were significantly elevated in the myocarditis group compared to the control group (47.01±18.3 versus 3.8±2.2, p=0.02). In addition, miR-21 expression levels in peripheral blood mononuclear cells revealed a significant correlation with troponine levels in those patients (r=0.55, p<0.001)

Conclusions
Our data reveal that miR-21 is upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals and is significantly correlated with myocardial damage in those patients. Our findings indicate that miR-21 may be involved in the pathophysiology of myocarditis and represent promising biomarker in the disease.
P5580Stroke volume an echocardiographic prognostic marker in patients with high gradient aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)
Authors: Alkhalil M , Brennan P B , McQuillan C M , Jeganathan R J , Manoharan G M , Owens C O , Spence M S 
Published: October 2019

Abstract

Background
TAVI is currently being evaluated in patients with low surgical risk. Better characterisation of aortic stenosis to reflect the disease process is needed to more precisely identify those who are at increased risk. Indexed stroke volume (SVi) is an echocardiographic measurement that is used for low gradient aortic stenosis.

Purpose
We studied whether (SVi) is a high-risk marker in high gradient aortic stenosis patients and whether SVi is related to other clinical factors contributing to this risk.

Methods
699 consecutive patients who underwent TAVI were screened, and only patients with high gradient aortic stenosis were included. A 35 ml/m2 cut-off for SVi was used to define patients with high versus low flow. The primary endpoint was defined as a combination of cardiovascular death and re-admission to hospital with heart failure at 30 days.

Results
Of the 390 patients with high gradient severe aortic stenosis, 168 (43%) had low flow. They had higher NTproBNP [2578 (1043–5480) vs. 1714 (821–3599) ng/L, P=0.005], and smaller indexed valve area [0.28 (0.23–0.36) vs. 0.35 (0.29–0.42) cm2/m2, P<0.001]. The primary endpoint was significantly more frequent in low flow compared to high flow patients [8.92% vs. 3.60%, HR 2.54 (95% CI 1.08 to 5.98), P=0.034] (Figure). This was driven mainly by a higher incidence of cardiovascular death [7 (4.2% vs. 0 (0%), P=0.003].
Previous myocardial infarction, CAD, AF, LV impairment, logistic Euroscore, in addition, to low flow were all predictors of 30 days clinical outcomes in an unadjusted model. When all these factors were included in the same adjusted model, only low flow appear to be a predictor of clinical outcomes (HR 2.43, 95% CI 0.86 to 6.64, P=0.08), although this did not reach statistical significance (Table).
Unadjusted and adjusted predictors of 30 HR (unadjusted) 95% CI P value HR (adjusted) 95% CI P value Low flow 2.54 1.08, 5.98 0.03 2.43 0.86, 6.64 0.08 Previous MI 2.55 1.08, 6.01 0.03 1.88 0.65, 5.45 0.24 AF 2.47 1.09, 5.60 0.03 2.11 0.81, 5.47 0.13 Severe LV impairment 4.68 1.10, 19.96 0.04 1.55 0.20, 12.23 0.68 CAD 2.69 1.16, 6.21 0.02 1.61 0.57, 4.51 0.37 Logistic Euro score 1.04 1.01, 1.07 0.02 1.01 0.98, 1.05 0.47

Conclusions
SVi can further characterise patients with high gradient aortic stenosis and may help to identify those who are at increased risk following TAVI.
P5591Efficacy and safety of lower dose slow infusion of t-PA for intermediate-risk pulmonary embolism patients with risk for bleeding
Authors: Obradovic S , Dzudovic B , Sekulic I , Subotic B , Matijasevic J , Batranovic U , Salinger S , Nikolic M , Miloradovic V , Markovic-Nikolic N , Kos L J , Preradovic-Kovacevic T 
Published: October 2019

Abstract

Background
Current guidelines do not recommend thrombolytic therapy for the treatment of intermediate-risk pulmonary embolism (PE) because of the tight balance between the benefit and safety with classic protocols.

Aim
The aim of this study was to compare the new thrombolytic protocol with lower-dose slow-infusion (LDSI) of tissue plasminogen activator (tPA) to classic 2-hours tPA infusion protocol or no-reperfusion in patients with intermediate-high risk PE with higher bleeding risk regarding 30-day efficacy and safety.

Methods
Among 849 patients with PE from the Serbian multicenter registry, 469 patients who fulfilled criteria for intermediate-risk PE were involved in the study. After propensity score matching 425 patients [263 (61.9%), 99 (23.3%) and 63 (14.8%) were treated with no-reperfusion, classic tPA protocol (100 mg for 2 hours) and LDSI of tPA (2–5 mg/hour either vie local catheter or systemic venous infusion with dose range of 25–50 mg)]. The basic characteristics of patients were well balanced between groups except that patients treated with LDSI of tPA had significantly higher usage of drugs which can be associated to bleeding and more previous bleeding events. Thirty day all-cause and PE-caused mortality and 7-day major bleeding were the main efficacy and safety end-points, respectively.

Results
All-cause and PE-cause 30-day mortality were 8.7% vs 16.2% vs 1.6% (Log rank p=0.007) and 4.5% vs 11.0% vs 0.0% (Log rank p=0.008) in patients with no-reperfusion, classic tPA protocol and LDSI of tPA protocol, respectively. Major bleeding at 7 days were 2.7% vs 8.1% vs 14.3% (Log rank p=0.001) in patients with no-reperfusion, classic tPA protocol and LDSI of tPA protocol, respectively. There was one fatal intracranial bleeding during catheter infusion of tPA.

Conclusion
Lower-dose slow-infusion of tPA protocol decreased significantly all-cause and PE-cause mortality at 30-day at the cost of excess of non-fatal major bleeding at 7-day in patients with intermediate-risk PE and higher risk for bleeding.

Acknowledgement/Funding
None
P5600Surgical reconstruction of type A aortic dissection in octogenarians
Authors: Masuyama S , Inoue T , Ichihara T 
Published: October 2019

Abstract

Introduction
Because the population is aging, the indication for surgical reconstruction in older patients will increase. Japan is especially facing the most aging society worldwide. However, surgical reconstruction of type A aortic dissection (AADA) in patients who are octogenarians is not often performed because of the decision of the patient or surgeon. We examined the outcome of surgical reconstruction of AADA in octogenarians.

Method
Over 4 years, 132 cases of surgical reconstruction of AADA were analyzed. Twenty-five consecutive octogenarians with AADA were retrospectively reviewed. In our institution, we recommend an emergent operation to the patient or family in all generations unless they reject it for some reason.

Results
Operative factors in octogenarians with AADA were not significantly different compared with those in patients aged younger than 79 years (n=107) (operation: 238±11 vs. 246±5 min, p=0.54; cardiopulmonary bypass: 147±7.4 vs. 154±3.5 min, p=0.42; aortic-clamp: 114±6.0 vs. 120±2.8 min, p=0.36; hypothermic-arrest: 43±2.7 vs. 42±1.3 min, p=0.81). The overall mortality rate was 24.0% (n=6). The mortality rate was no difference between younger patients and octogenarians (OR: 2.7, 95% CI: 0.86–8.21, p=0.08). Furthermore, MACE (Major Adverse Cardiac Event) and the postoperative stroke rate were not significantly different between the two groups (OR: 1.5, 95% CI: 0.52–3.93, p=0.42; OR: 0.77, 95% CI: 0.16–2.59, p=0.69, respectively).

Conclusion
In AADA, the outcome of emergent surgical reconstruction in octogenarians is acceptable. Even with the risk of aging, surgeons should consider aggressive surgical reconstruction in octogenarians.
P5603Distal stent graft induced new entry: risk factors in acute and chronic type B aortic dissections
Authors: Lortz J , Leinburger F , Tsagakis K , Rammos C , Lind A , Schlosser T , Jakob H , Rassaf T , Janosi R A 
Published: October 2019

Abstract

Background
Distal stent graft induced new entry (dSINE) is a rare complication occurring in acute and chronic dissections after thoracic endovascular aortic repair (TEVAR) and is linked to a high reintervention rate. We analyzed potential predicting risk factors for dSINE and analyzed the long-term outcome in patients after reintervention.

Methods
In this single-center, retrospective study we evaluated patients after TEVAR and investigated possible predictors for dSINE development. Therefore, we used a multivariate analysis to test important interventional parameters such as distal oversizing (dOS), taper ratio (TR), angle between distal stent graft and aorta, acute dissection and stent graft length. Reinterventional characteristics were analyzed and further long-term follow-ups after reintervention evaluated.

Results
We analyzed 185 patients with acute (n=77) and chronic (n=108) dissections after TEVAR with a follow-up of 68.9±32.5 months. Within the follow-up period, 12 (6.5%) patients developed dSINE after a median time of 22.2±20.7 months. We identified acute dissection as a major predicting factor for dSINE development with a 15.8 times higher odds, followed by an increased dOS and TR. The reintervention rate was higher in the dSINE group (83% vs. 20%, p=0.001), but reinterventional results were mostly satisfying, including further freedom from reintervention and/or new endoleak development up to a mean follow-up of 60.7±54.8 months. No dSINE was seen in association to tapered stent grafts.

Conclusion
We found acute aortic dissection as a major predicting factor for dSINE development, followed by increased dOS and TR. The use of tapered stent grafts might be beneficial in cases with expected high dOS and TR. In rare cases with dSINE occurrence, reintervention is often required, but has a good prognosis even after years.
P5616Risk stratification of cardiovascular events among patients with functionally non-significant coronary stenosis
Authors: Jujo K , Shimazaki K , Furuki Y , Moriyama T , Shiozaki N , Iwanami Y , Arashi H , Hagiwara N , Saito K 
Published: October 2019

Abstract

Introduction
Deferral of percutaneous coronary intervention (PCI) of a functionally non-significant stenosis is associated with a favorable long-term clinical prognosis. However, to date, there has been limited evidence to stratify the risk for the development of cardiovascular (CV) adverse events in patients who were deferred of PCI due to a greater fractional flow reserve (FFR) than 0.80 at the target lesion.

Purpose
We aimed to stratify the risk of CV events in patients with functionally significant and non-significant coronary stenosis.

Methods
This observational study included 458 patients who were proven angiographically intermediate coronary stenoses and were measured FFR, of whom 298 deferred patients with FFR>0.80 and 160 intervened patients with FFR<0.80. The primary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE) including any death, non-fatal myocardial infarction, hospitalization due to heart failure, ischemic stroke and any unplanned revascularization. ROC curve for MACCE indicated the cut-off point of FFR as 0.85 and 0.76 in deferred patients and intervened patients, respectively.

Results
During the observation period, 27 MACCE (9.1%) in the Deferred group, and 33 MACCE (20.6%) in Intervened group were occurred. Kaplan-Meier curves showed a higher MACCE rate in the Intervened group than Deferred group (hazard ratio (HR): 2.19, 95% confidence interval (CI): 1.29–3.71, Figure A). However, even among patients in the Deferred group, the population with “intermediate” FFR (0.81–0.85) had a significantly higher MACCE rate than those with higher FFR (>0.85) (HR 2.55, 95% CI 1.14–5.69, Figure B). This rate was comparable to that of the Intervened group at the remote phase (at 4-year: 32.0% vs. 35.8%). Conversely, in the Intervened group, there was no statistically significant difference in MACCE rate between patients with higher FFR (0.76–0.80) and those with lower FFR (<0.76) (Log-rank: p=0.21, Figure C).

Conclusion
The population with relatively low FFR in patients who were deferred PCI by FFR>0.80 had comparable MACCE rate to patients with FFR<0.80. Close observation after the FFR evaluation should be considered in those population.
P5623Plaque characteristics, slow flow during percutaneous coronary intervention, and clinical outcomes of irregular protrusion by optical coherence tomography
Authors: Amano H , Noike R , Saito D , Yabe T , Watanabe I , Koizumi M , Okubo R , Toda M , Ikeda T 
Published: October 2019

Abstract

Introduction
In pathological studies, penetration of the lipid core into the stent strut is associated with neointimal growth and stent thrombosis. Irregular protrusion on optical coherence tomography (OCT) is associated with clinical events and target lesion revascularization. However, there are few reports about the relationship among irregular protrusion, plaque characteristics, and slow flow during percutaneous coronary intervention. We investigated clinical and procedure characteristics, plaque characteristics, slow flow after stent implantation, and clinical outcomes with irregular protrusion by using OCT.

Methods
Eighty-four lesions in 76 patients undergoing OCT before percutaneous coronary intervention were evaluated. Irregular protrusion was defined as protrusion of material with an irregular surface into the lumen between stent struts with a maximum height of ≥100 μm. Major adverse clinical outcomes were defined as death, acute myocardial infarction, acute coronary syndrome, or target lesion revascularization.

Results
Lesions with irregular protrusion were found in 56% (47/84). Compared with lesions without irregular protrusion, those with irregular protrusion had significantly higher low-density lipoprotein cholesterol (LDL-C) levels (108±31 mg/dL vs. 95±25 mg/dL, P=0.044); a tendency toward decreased use of statins (44% [19/43] vs. 67% [22/33], P=0.065); significantly larger reference vessel diameter (3.12±0.53 mm vs. 2.74±0.63 mm, P=0.004); significantly larger stent diameter (3.23±0.43 mm vs. 3.00±0.49 mm, P=0.025); a tendency toward longer total stent length (29.3±14.2 mm vs. 23.7±11.4 mm, P=0.056); significantly larger maximum balloon diameter (3.56±0.55 mm vs. 3.22±0.63 mm, P=0.010); significantly higher incidence of slow flow after stent implantation (38% [18/47] vs. 11% [4/37], P=0.006); significantly higher ΔTIMI flow from pre-stenting to post-stenting (0.4±0.6 vs. 0.1±0.3, P=0.009); significantly higher incidence of lipid-rich plaque (70% [33/47] vs. 35% [13/37], P=0.002); thin-cap fibroatheromas (TCFAs: 49% [23/47] vs. 5% [2/37], P<0.001); plaque rupture (40% [19/47] vs. 16% [6/37], P=0.018); macrophage accumulation (51% [24/47] vs. 24% [9/37], P=0.015); internal running vasa vasorum (51% [24/47] vs. 11% [4/37], P<0.001); thrombus (32% [15/47] vs. 3% [1/37], P<0.001); and a tendency higher incidence of one-year adverse clinical outcomes (12% [5/43] vs. 0% [0/33], P=0.075: log rank). The multivariable analysis showed that TCFA was an independent predictor of irregular protrusion (odds ratio 9.00, 95% CI 1.32–61.36, P=0.025).

Conclusions
Irregular protrusion on OCT was associated with high plaque vulnerability, higher LDL-C, less frequent use of statin, larger vessel diameter, longer total stent length, slow flow after stent implantation, and one-year adverse clinical outcomes.