bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic evaluation of patients with sickle cell disease. A study based on Etendar Cohort
Authors: d'Humieres T , Savale L , Inamo J , Damy T , Lionnet F , Loko G , Derumeaux G , Humbert M , Bartolucci P 
Published: November 2020

Abstract

Background
Echocardiography is the main non-invasive screening tool for pulmonary hypertension (PH) in Sickle Cell Disease (SCD), but relies mostly on the tricuspid regurgitation velocity (TRV) assessment, without distinction between pre and postcapillary patterns.

Purpose
Using Etendard Cohort data, the aim of this study was to refine echocardiographic assessment of PH in SCD patients.

Methods
The French Etendard Study is a prospective cohort initially designed to assess the prevalence of PH among 398 SCD participants. We analyzed echocardiography data of the 96 Etendard patients who underwent Right Heart Catheterization (RCH), because of a TRV≥2.5m/s, and compared them to invasive haemodynamic measurements. Based on RHC results, patients were classified as follows: Absence of pulmonary hypertension if mean pulmonary arterial pressure (mPAP) was &lt;25mmHg. Precapillary PH if mPAP≥25mmHg and pulmonary-capillary wedge pressure (PCWP) ≤15mmHg. Postcapillary PH if mPAP≥25mmHg and PCWP &gt;15mmHg.

Results
PH was found in 24/96 patients with 11 precapillary and 13 postcapillary. In addition to TRV, multivariate analysis identified indexed left atrial volume (LAVind) and lateral E' wave velocity (E'lat) as independent echocardiographic predictors of PH (OR=1.06 and 0.6 respectively, p&lt;0.01). LAVind and E'lat showed good correlation with mPAP (R=0.51 and R=0.40 respectively and p&lt;10–3 for both) and had good accuracy to predict PH with an optimal cut-off of 48ml/m2 for LAVind (AUC=0.78, Se=81% and Sp=75%) and 12cm/s for E'lat (AUC=0.8, Se=72% and Sp=79). Using the association of a TRV≥3m/s or a TRV [2.5; 2.9] m/s with LAVind&gt;48ml/m2 and E'lat&lt;12cm/s, we could predict PH with a PPV of 68% and NPV of 90%.
Moreover, comparing echocardiography data of pre and post-capillary PH patients, we observed that Pulmonary acceleration time (PAcT) was different in the two groups (104±22ms vs. 160±21ms, p&lt;0.001) with an excellent accuracy for the differentiation of both phenotypes (AUC=0.95, optimal cut-off=115ms, Se=100% and Sp=78%). PAcT correlated with pulmonary vascular resistance (PVR) assessed by RHC (R=0.34, p=0.001) but not with mPAP (R=0.1, p=0.2) and a PAcT&gt;115ms ruled out pre-capillary PH with a NPV of 97%.

Conclusion
Echocardiography can accurately estimates the probability of PH in SCD patients with an integrated approach using TRV, LAVind and E'lat. In addition, among patients with suspected PH, measuring PAcT as a PVR surrogate allows a good differentiation between pre and post-capillary phenotypes. We propose a new echocardiographic algorithm for the diagnosis of PH in SCD that could be a true assistance in referring patients for RHC.
TTE Algorithm for PH in SCD

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Funded by the French Ministry of Health and Assistance Publique–Hôpitaux de Paris
Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis in a large international audit
Authors: Semb A.N.N.E , Rollefstad S , Sexton J , Kitas G , Van Riel P , Crowson C , Graham I , Ikdahl E 
Published: November 2020

Abstract

Background
The cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) is comparable to that of patients with diabetes mellitus (DM). Although several studies have indicated high prevalence's of DM in RA patients, little is known about how this affects their CVD risk.

Objectives
To examine indications for, and use of antihypertensive treatment (a-HT) and lipid-lowering therapy (LLT) in RA patients with DM (RA-DM) and RA patients without DM (RAwoDM). Further, to compare the prevalence of various types of CVD across RA-DM and RAwoDM.

Methods
The cohort was derived from the SUrvey of cardiovascular disease Risk Factor in patients with Rheumatoid Arthritis (SURF-RA), which was performed in 53 centres/17 countries in 5 world regions (West and East Europe; North and Latin America; and Asia) from 2014 - 2019. Indication for a-HT was defined as: 1) systolic/diastolic blood pressure (BP) ≥140/90 mm Hg, 2) self-reported hypertension, and/or 3) current use of a-HT. Indication for LLT was defined according to ESC guidelines. CVD risk estimates (by SCORE) were multiplied by 1.5 according to EULAR recommendations. Target treatment targets for BP and lipids were defined according to ESC guidelines applicable at the time data were recorded.

Results
Presence of comorbid DM was available in 10 602 (73.1%) of the 14 503 RA patients included in SURF-RA, of whom 75 and 1262 patients reported DM type 1 and type 2, respectively (total 1337 patients, 12.6%). Although less often current smokers, RA-DM patients were more often previous smokers, male sex and had higher body mass index compared to RAwoDM (p&lt;0.0001 for all). a-HT (84.7% vs 62.3%) and LLT (100% vs 47.2%) were more frequently indicated in RA-DM than in RAwoDM patients (p&lt;0.0001 for both). RA-DM were more likely than RAwoDM to receive a-HT on indication (60.4% vs 57.6%, p&lt;0.0001), while the difference in LLT use on indication was not significantly different (45.7% vs 42.5%, p=0.06). Moreover, RA-DM compared to RAwoDM patients had more often reached treatment goals when on a-HT (60.7% vs 54.1%, p&lt;0.0001) and LLT (62.8% vs 48.9%, p&lt;0.0001). Finally, the risk of all recorded established CVD (coronary heart disease, stroke, peripheral artery disease and atrial fibrillation) was increased by a factor of 2 to 3 in RA-DM compared to RAwoDM (Figure).

Conclusion
The effect of RA and comorbid DM on CVD risk appears to be additive. While CVD preventive medications are more often indicated in RA-DM than in RAwoDM patients, they are also more likely to receive such therapy and to reach CVD preventive treatment goals. The latter finding may be due to more developed CVD preventive care in DM compared to RA patients. Improved CVD preventive systems for patients with RA are warranted.
CVD in RA patients with and without DM

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Lilly
Is female gender associated with worse outcomes after percutaneous coronary intervention of left main coronary artery?
Authors: Skorupski W.J , Grygier M , Grajek S , Pyda M , Mitkowski P , Araszkiewicz A , Skorupski W.A , Siniawski A , Jankiewicz S , Lesiak M , Kaluzna-Oleksy M 
Published: November 2020

Abstract

Introduction
Left main coronary artery (LM) disease is a life-threatening condition, so the invasive treatment is crucial for the survival of the patients. There is still controversy regarding whether female sex is associated with worse outcomes after percutaneous coronary intervention (PCI) of LM.

Purpose
Our aim was to examine gender-based differences in patients after LM PCI.

Methods
Consecutive 459 patients (mean age: 68.4±9.4 years) in whom PCI of LM was performed (between January 2015 and June 2018) were included in the study. The clinical and angiographic data of these patients including short and long-term outcomes has been analyzed.

Results
The whole group consisted of 112 (24.4%) women and 347 (75.6%) men. Compared with men, women were older (69.9±8.9 vs 67.9±9.5; p=0.04), had higher prevalence rates of diabetes (43.8% vs 33.4%; p=0.048) and hypertension (92% vs 79.1%; p&lt;0.01). Renal failure (42% vs 32.3%; p=0.061) was found insignificantly more often in women, frequency of other comorbidities did not differ statistically. Women were more often disqualified from bypass surgery (19.6% vs 11.8%; p=0.036) and more often required complex stenting techniques (29.2% vs 18.7%; p=0.028). SYNTAX Score and Euroscore II did not differ statistically between the genders. All periprocedural complications (8.9% vs 8.4%; p=0.85) and the frequency of periprocedural myocardial infarction (6.3% vs 4%; p=0.330) did not differ among the groups. We observed higher all-cause mortality in men group (19.1% vs 24.3%; p=0.041) at a median follow-up of 808 days (range 367 to 1616 days).

Conclusion
In our real-life cohort of patients, complex LM procedures and comorbidities were more frequent in women. There was no significant difference in short-term results between two genders, although in our real-life study we observed higher long-term all-cause mortality in men. Our results suggest that female gender in LM PCI is not a predictor of adverse outcomes. Further studies are required to determine the optimal revascularization modality in women.
Long-term follow-up

Funding Acknowledgement
Type of funding source: None
Sex differences in the rates of incident and recurrent coronary heart disease and all-cause mortality
Authors: Peters S , Colantonio L , Chen L , Bittner V , Farkouh M , Dluzniewski P , Poudel B , Muntner P , Woodward M 
Published: November 2020

Abstract

Background
Women have lower age-specific rates of incident coronary heart disease (CHD) than men. However, it remains unclear whether women maintain the same advantage once they have had a cardiac event.

Purpose
To assess whether sex differences in the rates of cardiac events and all-cause mortality among individuals without a history of CHD persist following a myocardial infarction (MI).

Methods
We identified 171,897 women and 167,993 men &lt;65 years of age with commercial health insurance and ≥66 years of age with government health insurance through Medicare who had a MI hospitalization between 2015 and 2016 in the US. These beneficiaries were matched to 687,588 women and 671,972 men without a history of CHD based on age and calendar year. Beneficiaries were followed until December 2017 for the occurrence of MI, CHD, heart failure, and all-cause mortality (Medicare only).

Results
The age-standardized rates of MI per 1,000 person-years were 4.5 in women and 5.7 in men without a history of CHD (multivariable-adjusted hazard ratio [HR] [95% confidence interval] of female sex: 0.64 [0.62; 0.67]) and 60.2 in women and 59.8 in men with a history of MI (HR: 0.94 [0.92, 0.96]) (Figure 1). Rates of CHD events in women vs. men were 6.3 vs. 10.7 among those without CHD (HR: 0.53 [0.51, 0.54]) and 84.5 vs. 99.3 among those with MI (HR: 0.87 [0.85, 0.89]). Heart failure hospitalization rates in women vs. men were 9.3 vs. 6.6 for those without CHD (HR: 0.93 [0.90, 0.96]) and 114.9 vs. 97.9 among those with MI (HR: 1.02 [1.00, 1.04]). All-cause mortality rates in women vs. men were 63.7 vs. 59.0 among those without CHD (HR: 0.72 [0.71; 0.73]) and 311.6 vs. 284.5 among those with a MI (HR: 0.90 [0.89, 0.92]).

Conclusion
The women advantage against MI, CHD, heart failure and all-cause mortality is considerably attenuated following a MI, suggesting that a prior MI puts women at almost the same high-risk of subsequent events as men.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This work was funded by an industry/academic collaboration between Amgen Inc. and University of Alabama at Birmingham.
Gender difference in long-term clinical outcomes after percutaneous coronary intervention
Authors: Choi J.H , Lee S.H , Choi J.M , Jang Y.J , Choi K.H , Lee J.M , Park T.K , Yang J.H , Song Y.B , Hahn J.Y , Choi S.H , Gwon H.C , Lee S.H 
Published: November 2020

Abstract

Background
The comparative gender-specific outcome after PCI in real-world practice is limited. We investigated the gender difference in the 5-year outcome after percutaneous coronary intervention (PCI).

Methods
A retrospective study. nationwide PCI registry. All PCI performed in Korea in year 2011 (N=48,783). Outcomes adjusted with age and propensity for clinical characteristics were compared. Primary outcome was 5-year cumulative incidence of major adverse clinical event (MACE) consisting of all-cause death, revascularization, shock, or stroke.

Results
In unadjusted analysis, women (N=15,710) were older (69.7±9.7 versus 62.0±11.1 year) and had higher frequency of comorbidities including hypertension, hyperlipidemia, and diabetes compared to men (N=33,073) (p&lt;0.001, all). Women had higher 5-year cumulative incidence of MACE than men (41.9% versus 37.2%; hazard ratio [HR] 1.16, 95% confidential interval [CI] 1.12–1.19; p&lt;0.001). In propensity score-matched 14,462 pairs, women had lower 5-year mortality risk (40.7% versus 46.0%, HR 0.85, 95% CI 0.82–0.88, p&lt;0.001). The lower 5-year MACE risk in women was consistent in subgroup analyses of age, risk factors, and clinical diagnosis including angina or acute myocardial infarction (p&lt;0.05, all). The risk of all-cause death, revascularization, and shock were also lower in women than men (p&lt;0.05, all) but the risk of stroke was not different between women and men.

Conclusions
The apparent worse outcome in women can be explained by older age and more common comorbidities in women. After adjusting these disadvantages, women had better outcome after PCI than men. Our result suggests presence of the reversal paradox in the gender-specific outcome following PCI.
Women vs men, 5 year outcome

Funding Acknowledgement
Type of funding source: None
Sex-differences in outcomes after PCI or CABG for left main disease: from the DELTA registries
Authors: Moroni F , Beneduce A , Giustino G , Breite I , Park S.J , Daemen J , Morice M.C , Nakamura S , Meliga E , Cerrato E , Makkar R , Valgimigli M , Mehran R , Colombo A , Chieffo A 
Published: November 2020

Abstract

Background
Women have worse outcomes than men after PCI, with some studies suggesting a lower mortality of CABG vs PCI in females.

Purpose
To assess the outcomes of CABG and PCI according to sex in a large registry population of patients with unprotected left main coronary artery (ULMCA) disease.

Methods
The DELTA and DELTA 2 registries are two multicentric, prospective registries evaluating the outcomes of subjects undergoing coronary revascularization for ULMCA disease.

Results
Total population was 6253 patients, 27% women. Table 1 shows baseline clinical characteristics. Median follow up was of 880 days. Women undergoing CABG had lower incidence of death, myocardial infarction (MI) or cerebrovascular accidentc (CVA) (HR 0.53, 95% CI 0.35–0.79) and a lower risk of death (HR 0.40, 95% CI 0.24–0.67). No significant differences were observed in men (Figure 1A). SIgnificant interaction was observed between sex and revascularization strategy for both outcomes (p&lt;0.01-Figure 1B). CABG was associated with lower risk of target-vessel and target-lesion revascularization consistently inwomen and men (pint=0.49 and pint=0.89, respectively–Figure 1B).

Conclusions
In women undergoing coronary revascularization for ULMCA disease, CABG is associated to lower risk of death, MI or CVA. Further dedicated studies are needed to determine the optimal revascularization strategy in women with ULMCA disease.
Figure 1

Funding Acknowledgement
Type of funding source: None
Comparison between different diagnostic scores for the diagnosis of familial hypercholesterolemia: assessment of their diagnostic accuracy in comparison with genetic testing
Authors: Boccatonda A , Rossi I , D'Ardes D , Cocomello N , Perla F.M , Bucciarelli B , Di Rocco G , Del Ben M , Angelico F , Guagnano M.T , Cipollone F , Bucci M 
Published: November 2020

Abstract

Background
The Dutch Lipid Clinic Network Score (DLCN) is a useful score to guide the physician to the diagnosis of familial hypercholesterolemia (FH). However, some concerns have been pointed out about its diagnostic accuracy in pediatric population; so, other scores such as Simon Broome (SB) and US MedPed Program have been tested and currently used.

Aim
To test the different diagnostic and predictive accuracy between those three scores (DLCN, SM and MedPed) in relation to positivity of genetic test.

Methods
We enrolled 25 pediatric patients aged &lt;18 yo referred to our Chieti and Rome lipid clinics for the clinical suspicion of FH. We performed the genetic analysis for searching pathogenetic mutations for FH (NGS by Lipid in Code, LIPIGEN study). Differently from the others, DLCN provides a numerical data as a diagnostic score; thus, to uniform the three scores, we chose to define subjects with a DLCN score ≥6 as likely FH, while subjects with a lower value were defined as unlikely FH. Furthermore, we calculated the SB and the MedPed score, as previously demonstrated, defining the subjects as likely or unlikely FH. Therefore, we analyzed the diagnostic accuracy of those scores in relation to FH mutation data (positive or negative).

Results
We recruited 25 patients, 13 males (52%), mean age of 11.8 years. Sixteen patients (64%) resulted positive for the genetic mutation The DLCN showed a sensitivity of 43%, specificity of 66%, a positive predictive value (PPV) of 0.7 and a negative predictive value (NPV) of 0.4. SB showed a sensitivity of 68%, specificity of 55%, a PPV of 0.73 and NPV of 0.5. The MedPed score showed a sensitivity of 68%, specificity of 44%, a PPV of 0.68 and NPV of 0.44. Furthermore, we elaborated a ROC curve of low-density lipoprotein cholesterol (LDL-C) values with respect to the positivity of the FH genetic test: the value that showed the best diagnostic accuracy was 190 mg / dL (sensitivity 68.8% and specificity 75%), while the value of 116.5 mg/dL demonstrated a sensitivity of 100% but with a specificity of 11%.

Conclusions
Our work demonstrates that none of the three scores tested has an optimal diagnostic accuracy with respect to the diagnosis of FH in the pediatric population. By comparison, SB demonstrates the best sensitivity and the best specificity. In addition, the LDL-C value of 190 mg / dL provides the best diagnostic accuracy against the diagnosis of FH in the pediatric population. Further data and studies will be needed to improve the diagnostic performance of these scores, in order to refer pediatric patients to the genetic test, for an early confirmation in order to refer pediatric patients to the genetic test, for an early FH diagnosis confirmation.

Funding Acknowledgement
Type of funding source: None
Coronary artery diseases after right ventricular outflow tract reconstruction surgery
Authors: Kwon H , Bae E.J , Kim G.B , Lee S.Y , Song M.K , Lee J.R , Kim W.H , Kwak J.G , Cho S.K 
Published: November 2020

Abstract

Background
The occurrence of coronary artery disease (CAD) is unknown to date in patients who have undergone the right ventricular outflow tract (RVOT) reconstruction surgery for congenital heart disease using a bioprosthetic valve or conduit.

Purpose
We present the incidence and outcomes of CAD in patients who underwent RVOT reconstruction surgery in a single tertiary center.

Method
From April 1986 to February 2019, 544 patients underwent Rastelli operation or pulmonary valve replacement for conotruncal anomalies at the Seoul National University Children's Hospital in Korea. The patient's medical records and imaging findings were analyzed retrospectively.

Results
Significant coronary stenosis or occlusion were observed in 19 patients (3.5%) after RVOT reconstruction surgery. Their underlying diseases were pulmonary atresia in 8, tetralogy of Fallot in 3, double outlet right ventricle with pulmonary stenosis in 3, truncus arteriosus in 2, congenitally corrective transposition of great artery in 2, and congenital aortic stenosis in 1. Mechanism of CAD was compression of coronary artery by artificial conduit or valve in 10, intraoperative coronary injury in 7, and intramural course of coronary artery in 2 patients. The median number of RVOT reconstruction surgery before the diagnosis of CAD was 2 times (interquartile range: 2–3 times). The median age at diagnosis of CAD was 15 years (interquartile range: 9.5 - 25 years). The median time to detection of the CAD from the last RVOT reconstruction surgery was 9 years (interquartile range: 3.5–12.5 years). Involved coronary artery was right coronary artery (RCA) in 10, left anterior descending coronary artery (LAD) in 7, and left main coronary artery in 2 patients. Seven (36.8%) patients had underlying congenital coronary anomalies, such as single coronary artery, intramural course of the coronary artery, and anomalous origin of the coronary artery from an abnormal sinus. One patient died due to brain injury on extracorporeal membrane oxygenator after intraoperative coronary injury. Two patients with intramural course of coronary artery and one patient with high take-off of RCA which was compressed by adjacent calcified conduit underwent surgical repair of the CAD. One patient with recurrent ventricular tachycardia needed an implantable cardioverter-defibrillator. Nine patients are on medication for heart failure. Three patients with total occlusion of RCA or LAD showed well-developed collaterals from another normal coronary artery.

Conclusion
CAD after RVOT reconstruction surgery are not common but can be fatal. Because the clinical significance of CAD and long-term prognosis are not known yet, we need to closely track the patient after RVOT reconstruction surgery. Indications for the management of the CAD should be prepared to prevent sudden cardiac death, arrhythmia, and ventricular dysfunction in these patients.

Funding Acknowledgement
Type of funding source: None
Influence of Nuss surgical operation for pectus excavatum on electrocardiogram abnormality considering anatomical severity as indicated by Haller index acquired by computed tomography and age
Authors: Funabashi N , Kobayashi Y 
Published: November 2020

Abstract

Background
Pectus excavatum (PEX) is a depression of the sternum relative to costal cartilages and sometimes depress heart anatomically which cause abnormal ECG change. Nuss operation is minimal invasive technique for PEX repair.

Purpose
We speculated this Nuss operation would improve these ECG abnormalities. We also considered the Haller index (HI) and age to these influences. HI is an anatomical severity indicator of PEX calculated from CT.

Methods
A total of 17 patients (14 male, 12±6 years), who underwent Nuss operation for PEX, underwent unenhanced CT and ECG before and after the Nuss operation.

Results
All Nuss operation was successfully performed. On CT, HI was significantly improved from 5.62±2.29 to 3.29±0.65 (P=0.0002). A P wave with a negative portion &gt;1 mm deep and &gt;40 ms duration in V1 lead, incomplete right bundle branch block (RBBB), sinus arrhythmia, and right-axis deviation of a QRS wave were diagnosed in 15, 6, 12, and 5 patients, respectively. Comparing before with after Nuss operation, there were no significant differences of the degree of electrical axis of QRS waves, the degree of electrical axis of P waves, or the PQ interval, respectively (All P=NS). Absolute values of voltage of a negative portion of the P wave in V1 lead was significantly improved after the operation (1.55±1.25 vs 0.76±0.91mm, P&lt;0.001). Among 12 patients with sinus arrhythmia, only one patient improved to that without. Among 6 patients with incomplete RBBB, only one patient improved to that without. The correlation coefficient (CC) between “values of the improvement of negative portion of the P wave in V1 lead after the operation” and “HI before operation” was 0.305 (P&lt;0.05). The CC between “absolute values of the improvement of negative portion of the P wave in V1 lead after the operation” and “age at the operation” was −0.216 (P&lt;0.05).

Conclusion
In patients with PEX, successful Nuss operation could achieve improvement of negative portion of the P wave in V1 lead positively correlated with “HI before operation” and negatively correlated with “age”. Nuss procedure would be more effective to abnormal ECG change, when anatomical severity is severer or age is younger.
Improvement of negative P wave

Funding Acknowledgement
Type of funding source: None