bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3704Silent ischemic brain lesion detected in patients with subclinical paroxysmal atrial fibrillation
Authors: Kishima H , Mine T , Fukuhara E , Ashida K , Ishihara M 
Published: October 2019

Abstract

Background
Long-lasting atrial fibrillation (AF) has been reported to be associated with an increased risk of dementia, independent of clinical stroke. However, the mechanisms or association in patients with subclinical paroxysmal AF (S-PAF) remain unclear. We evaluated whether S-PAF is associated with silent ischemic brain lesion (S-IBL), one of causes of dementia.

Methods
We studied 46 patients (35 male, 68±15 yrs) without a history of stroke/transient ischemic attack and AF, who implanted insertable cardiac monitoring (ICM) for unexplained syncope (n=33) or embolic stroke of undetermined source (ESUS) (n=13). All patients underwent cerebral magnetic resource imaging (c-MRI), and S-IBL was defined as infarction, lacuna and microbleeds. The lesions in an acute stage were excluded in patients with ESUS.

Results
AF was detected in 15/46 patients (11 with unexplained syncope and 4 with ESUS) during follow-up of 7.0±6.6 months, and S-IBL was observed in 18/46 patients (9 infarction, 8 lacuna, or 8 microbleeds). Univariate analysis revealed that higher prevalence of AF (61% vs. 14%, p=0.0015), elder age (73±10yrs vs. 65±16yrs, p=0.0445), dyslipidemia (67% vs. 25%, p=0.007), structural heart disease (44% vs. 14%, p=0.0383), and larger left atrium diameter (41±6 mm vs. 37±5 mm, p=0.0267) were related to S-IBL. On multivariate analysis, prevalence of AF was independently associated with S-IBL (p=0.0070, OR 13.4, 95% CI 1.945–155.813). When receiver-operating-characteristics (ROC) curve analysis and prevalence of AF were used to detect S-IBL, the area under the ROC curve was 0.7341 (sensitivity: 61.1%, specificity: 85.7%).

Conclusion
Subclinical paroxysmal AF is associated with silent ischemic brain lesion and might cause to dementia.
P3714Cerebral blood flow and cognitive functioning in the heart-brain axis
Authors: Leeuwis A E , Hooghiemstra A M , Bron E E , Brunner-La Rocca H P , Kappelle L J , Van Oostenbrugge R J , Greving J P , Niessen W J , Van Buchem M A , Van Osch M J P , Van Rossum A C , Prins N D , Biessels G J , Barkhof F , Van Der Flier W M 
Published: October 2019

Abstract

Background
Recent studies suggest that cardiovascular disease and dementia are closely related, which led to the concept of a “heart-brain axis”. Dysfunction in any component of the heart-brain axis could be a risk factor for the development of brain damage and consequently to the development of cognitive impairment. In the Heart-Brain study, we focus on vascular cognitive impairment (VCI), symptomatic carotid occlusive disease (COD) and heart failure (HF) as three extreme phenotypes of haemodynamic dysfunction in different components of the heart-brain axis (i.e. heart – carotids – brain). We compared values of cerebral blood flow (CBF), measured with arterial spin labeling (ASL) between patients with HF, COD and VCI and investigated the association between CBF and cognitive functioning.

Methods
We included 442 participants (129 VCI; 75 COD; 124 HF; and 114 controls) from the Heart-Brain Study (67±9 yrs; 38% F; MMSE 28±2). We used 3T pseudo-continuous ASL to estimate whole-brain and regional partial volume-corrected CBF. Using a standardized neuropsychological assessment, we measured global cognitive functioning and four cognitive domains. Compound z-scores were constructed for each cognitive domain. We investigated associations using linear regression analyses, adjusted for age, sex, education, center and diagnosis. Subsequently, we stratified for diagnosis.

Results
Whole-brain and regional CBF values were lowest in patients with COD, followed by VCI and HF, compared to controls. Global cognitive functioning was lowest in patients with VCI, followed by COD and HF, compared to controls. Overall, we found hardly any association between whole-brain or regional CBF values and cognitive functioning (standardized beta [stb] = 0.00–0.10, p>0.05). Subsequent stratification for diagnosis showed no association between whole-brain or regional CBF and cognitive functioning in any participant group.

Conclusions
Our results suggest that reduced CBF is not the major explanatory factor underlying impaired cognitive functioning in patients with disorders along the heart-brain axis. The predisposition of cognitive impairment in these patients is likely to be driven by other (haemodynamic) mechanisms than CBF.

Acknowledgement/Funding
We acknowledge the support of the Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation (CVON 2012-06 Heart Brain Connection), Du
P3716Increased two-year cerebrovascular event rate in patients with bilateral high carotid tempratures
Authors: Benetos G , Toutouzas K , Oikonomou G , Koutagiar I , Karmpalioti M , Barampoutis N , Davlouros P , Siores E , Sfikakis P , Tousoulis D 
Published: October 2019

Abstract

Introduction
The association of carotid plaque inflammation with cerebrovascular events is a matter of rigorous research. Microwave Radiometry (MWR) allows in vivo noninvasive measurement of the internal temperatures of tissues, reflecting inflammation.

Purpose
To investigate whether increased carotid temperatures in patients with documented coronary artery disease (CAD) are associated with cerebrovascular events.

Methods
Consecutive patients with significant CAD from three tertiary centers were included in the study. Maximum carotid plaque thickness was assessed in all carotids by ultrasound. ΔT by MWR was assigned as the temperature difference (maximal minus minimum) along the carotid artery. ΔT ≥0.90°C was assigned as high ΔT. All patients were followed-up clinically for two years and all strokes were adjudicated by an independent committee. Transient ischemic attacks were excluded.

Results
In total 300 patients were included in the study. High ΔT temperatures bilaterally were measured in 47 patients (15.7%). Three patients (1.0%) suffered a stroke, including one fatal. Stoke rate was 4.3% in the group with bilateral high ΔT and 0.4% in non-high ΔT group (p=0.02). In Kaplan-Meier plot patients with bilateral high ΔT showed higher stroke rate (log-rank p=0.004, figure)

Conclusions
Bilateral high carotid temperatures are associated with increased two-year stroke rate. The potential value of the present finding in risk stratification of intermediate carotid stenosis mandates further investigation.
P3732Proportion of acute ischaemic strokes attributable to cardiac causes in an all-comer population of young patients
Authors: Bahl R , Kubiak M , Yusoff S , Van Wyk A , Nagaratnam K , Ruparelia N 
Published: October 2019

Abstract

Introduction
The incidence of stroke in young patients is increasing and is associated with significant morbidity, mortality and socioeconomic cost. Identifying potential underlying causes is central to their overall management to reduce recurrence and improve long-term outcomes. A proportion of these patients are found to have an underlying cardiac cause including atrial fibrillation (AF), patent foramen ovale (PFO) or an intracardiac source of embolus. This area has recently gained greater interest with evidence demonstrating a significant reduction in recurrent ischaemic events following PFO closure. The identification of these patients however, requires extensive investigation and has implications relating to cardiology resources. Outside of clinical trials the true incidence of these patients in a “real-world” population is poorly defined.

Purpose
The aim of this study was to determine the proportion of strokes attributable to cardiac causes in young patients presenting with ischaemic stroke.

Methods
The Sentinel Stroke National Audit Programme (SSNAP) database of a large UK stroke service was used to identify patients ≤55 years old presenting with stroke between 1/1/15 and 31/12/17. Clinical letters, imaging reports and laboratory reports were reviewed. Patients were then categorised by cause of stroke using the Trial of Acute Stroke Treatment (TOAST) criteria. Cardiac causes of stroke were defined as: AF, PFO and intracardiac source of embolus. Patients presenting with a haemorrhagic stroke or where an alternate diagnosis to stroke was more likely were excluded.

Results
During the study period, 206 patients were identified as having suffered a stroke. 35 patients were excluded resulting in a final study population of 171 patients (Figure). 24% (41/171) were identified as having a cardiac cause of stroke including 9.4% (16/171) PFO, 8.8% (15/171) intracardiac source of embolus and 5.8% (10/171) atrial fibrillation. 50.3% (86/171) were thought to have other causes: 24.6% (42/171) small vessel disease; 9.4% (16/171) large artery atherosclerosis; and 16.4% (28/171) other determined aetiology including 5.1% (8.8/171) with arterial dissection. 25.7% (44/171) presented with a stroke but with no clear underlying cause found.
Causes of stroke in young patients

Conclusion
A high proportion (24%) of strokes in young patients were found to be likely secondary to a cardiac cause. With the significant benefit of intervention (medical or procedural) in this patient group, the resource provision allocated to this population does appear to be warranted and further demonstrates the importance of close interdisciplinary links between cardiologists and stroke physicians.
P3738Clinical outcomes after early vs new generation TAVR device deployment
Authors: Kalinczuk L , Chmielak Z , Zielinski K , Mintz G S , Dabrowski M , Kumor M , Jastrzebski J , Skowronski J , Motyl D , Siodmiak A , Pregowski J , Michalowski I , Demkow M , Hryniewiecki T , Witkowski A 
Published: October 2019

Abstract

Background
Whether newer generation devices influence early and long-term outcomes post-TAVR in a real life setting is unknown.

Aim
To assess impact of an early vs a new generation transcatheter heart valves (THV) on clinical outcomes (30-day and -years) in a real life scenario.

Methods
Out of 445 consecutive pts treated between 8/2009 and 10/2017 within the single-center, prospective TAVR Registry, there were 432 [median 83.0 years of age, 63.4% female] with device success (97.1%) as per VARC-2. Early generation THV included: CoreValve; Edwards SAPIEN or SAPIEN XT. Newer generation devices included: Evolut-R/-Pro; Acurate neo; Engager, SAPIEN 3; or Lotus Edge Aortic Valve System.

Results
Median follow-up was 29.3 (15.8–53.1) months with 100% 1-year follow-up. Early generation devices were deployed in 60.6% (n=262) and new devices in 39.4% (n=170). Pts treated with newer devices had more peripheral arterial disease (PAD) and more frequent PCI history (17.1% vs 8.8%, p=0.015, and 35.3% vs 26.7%, p=0.068 respectively); other demographic and clinical data were alike. Baseline aortic valve area and LV ejection fraction were similar between early and newer devices. Pre-dilation was less frequent with newer devices (41.8% vs 70.6%, p<0.001), whereas THV size, contrast volume, fluoroscopy time, radiation dose, and post-procedure aortic valve gradients were similar. Moderate PVL assessed early post-TAVR was recognized with same frequency between earlier vs newer devices (28.2% vs 28.6%). An VARC-2 safety endpoint was recognized more often among pts treated with early vs new devices (30.5% vs 21.8%, p=0.028, respectively), with more frequent: 30-day death (3.8% vs 1.8%, p=0.177), life-threatening or disabling bleeding (8.4% vs 5.3%, p=0.181), major vascular complications (20.2% vs 15.3%, p=0.121), and new permanent pacemaker implantation (22.9% vs 10.0%, p=0.001) with early devices, but similar frequencies of stroke and acute kidney injury (1.9% vs 1.8% and 3.8% vs 5.9%, respectively). The 1-year mortality rates were similar (13.4% vs 13.5%, respectively), with similar estimated midterm (1–2 years) prognosis, but worse estimated very long-term follow-up for newer THV devices (fig 1).
Figure 1

Conclusions
Newer TAVR devices with smaller delivery system size, although deployed in pts with more PAD and PCI history, are associated with less frequent occurrence of an VARC-2 safety endpoint and less frequent permanent pacemaker implantation. The 1-year and midterm (1–2 years) prognosis are similar for early and newer devices, whereas the longer follow-up could have been influenced by intrinsic pt characteristics (more frequent PAD and history of PCI).
P3745Differences in short-term outcome between early- and new-generation TAVR devices
Authors: Veulemans V , Klein K , Maier O , Wolff G , Polzin A , Westenfeld R , Jung C , Blehm A , Lichtenberg A , Kelm M , Zeus T 
Published: October 2019

Abstract

Background
For transcatheter aortic valve replacement (TAVR) morbidity- and outcome relevant factors like paravalvular aortic regurgitation, vascular access complications and the need for permanent pacemaker implantation remain key challenges. New-generation devices for TAVR have been optimized to improve clinical outcome.

Purpose
We aimed to address safety and effectiveness of new-generation TAVR devices compared with earlier generations in a single centre study.

Methods
We compared 30 days outcome of the new-generation repositionable MER (n=614) and MEP (n=90) and the balloon-expandable ES3 (n=414) valve with the last-generation self-expandable MCV (n=270) and the balloon-expandable SXT (n=103) in patients treated with TAVR between 2009 and 2018. TAVR endpoints and adverse events were defined according to the Valve Academic Research Consortium-2.

Results
Logistic EuroSCORE I as predictor for risk stratification and 30-day mortality was comparable between both cohorts (27.3%±2.9 new vs 23.0%±1.4 early; p=n.s.). Compared to early-generation devices (MCV/SXT), new-generation devices (MER/MEP/ES3) had significantly higher primary device success (98.9% new vs 96.8% early; p=0.0089), lower incidence of new renal replacement therapy (2.6% new vs 6.2% early; p=0.0028), new permanent pacemaker therapy for conduction disturbances (12.8% new vs 17.0% early; p=0.0394), and disabling bleeding (1.4% new vs 4.0% early; p=0.0040). No difference could be observed concerning incidence of moderate-to-severe paravalvular leakage (4.2% new vs 5.0% early; p=n.s.), stroke (3.3% new vs 2.1% early; p=n.s.), major vascular complications (2.8% new vs 3.5% early; p=n.s.) and 30-day mortality (2.7% new vs 4.4% early; p=n.s).

Conclusion
Data from the retrospective analysis indicate higher primary device success and lower incidence of renal replacement, pacemaker therapy and disabling bleeding events in new-generation devices, although praised “hot-item” advantages like paravalvular leackage/aortic regurgitation, vascular complications and mortality remain unacknowledged.
P3764Morphological mechanisms of atrial functional mitral regurgitation in patients with atrial fibrillation
Authors: Nagaoka K , Mukai Y , Kawai S , Takase S , Sakamoto K , Inoue S , Yakabe D , Ikeda S , Chishaki A , Tsutsui H 
Published: October 2019

Abstract

Background
Atrial functional mitral regurgitation (AFMR) occurs in patients with atrial fibrillation. However, morphological mechanisms of AFMR are poorly understood.

Purpose
The purpose of this study was to examine the morphological characteristics in patients with AFMR.

Methods
Among consecutive 795 patients undergoing initial radiofrequency catheter ablation (RFCA) at our hospital, twenty-five patients with persistent AF accompanied by AFMR (≥ moderate) before RFCA (AFMR group) were studied. Age-matched 25 patients with persistent AF without MR were defined as a control group.

Results
Left ventricular ejection fraction (LVEF) was lower and left atrium volume index was larger in the AFMR group (Table). Mitral valve annulus diameter and length of anterior mitral leaflet (AML) were similar between groups, whereas length of posterior mitral leaflet (PML) was significantly shorter in the AFMR group. Smaller tethering angle of AML (γ in the figure) and shorter tethering height were significantly associated with the occurrence of AFMR, which were different from morphology of functional mitral regurgitation in patients with dilated LV. Multiple regression analysis revealed that less tenting height (p<0.05) and LA dilatation toward the posterior (p<0.01) were significantly related to AFMR.
Echocardiographic parameters AFMR (n=25) Control (n=25) P value Age, y 69±8 66±10 NS Male, n (%) 9 (36) 20 (80) P=0.001 LVEF,% 60±9 67±6 P=0.004 LAD, mm 44±5 41±7 NS LAVI, ml/m2 56±17 41±13 P<0.001 MV diameter, mm 3.9±0.4 3.8±0.5 NS α angle, ° 34±9 35±7 NS β angle, ° 48±9 50±8 NS γ angle, ° 32±5 37±5 P=0.0005 AML length, mm 3.0±0.5 3.0±0.5 NS PML length, mm 2.1±0.1 2.4±0.1 P=0.03 Tenting height, mm 1.5±0.1 1.8±0.1 P=0.02 D, mm 0.8±0.3 0.5±0.3 P=0.001 LVEF: left ventricular ejection fraction; LAD: left atrial diameter; LAVI: left atrial volume index; AML: anterior mitral leaflet; PML: posterior mitral leaftlet.

Conclusions
AFMR occurs in patients with unique morphological features, such as less tethering height and LA dilatation toward the posterior.
P3773Thromboembolic risk of heart failure with preserved, mid-range, and reduced ejection fraction in atrial fibrillation: results from the CODE-AF registry
Authors: Chung S , Kim T H , Uhm J S , Cha M J , Lee J M , Park J N M B , Park J K , Kang K W , Shim J , Kim J , Park H W , Choi E K , Kim J B , Lee Y S , Joung B 
Published: October 2019

Abstract

Purpose
Thromboembolic risk of atrial fibrillation (AF) in heart failure with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF) is not well identified. This study assessed the thromboembolic risk of AF in patients with HFpEF, HFmrEF and HFrEF.

Materials and methods
Within the CODE-AF prospective, outpatient registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation), a total of 10476 patients with non-valvular AF including 929 (8.8%) patients with HF was analyzed. Multivariable cox regression was used to evaluate the risk of thromboembolic event, including stroke, systemic embolism and transient ischemic attack. Hazard ratio (HR) was adjusted by each component of CHA2DS2-VASc risk score and the use of oral anticoagulant (OAC).

Results
The median age of the overall population was 68.0 (interquartile range, 60.0–75.0); 63.9% were male. The proportion of HFpEF, HFmrEF and HFrEF was 43.6%, 26.7% and 29.7%, respectively. CHA2DS2-VASc risk score was higher in HF group than no-HF group. OAC was more commonly used in HF group than no-HF group (85.2% vs. 68.9%, p<0.001). The rate of OAC usage was 85.1%, 86.6%, and 84.0% in HFpEF, HFmrEF, and HFrEF group, respectively. During follow-up period of median 14.3 months, 15 patients experienced thromboembolic event in HF group with incidence rate of 1.39 events per 100 person-years, while 94 patients did in no-HF group with 0.87 events per 100 person-years. In patients without OAC, incidence rate of thromboembolic event was 1.31, 2.77, and 6.24 events per 100 person-years in HFpEF, HFmrEF, and HFrEF, respectively. Compared with no-HF group, HF was associated with increased risk of thromboembolic event with clinical variable adjusted HR of 3.04 (95% CI, 1.12–8.26, p=0.03). Among 3 types of HF, HFrEF increased the risk of thromboembolic event (adjusted HR 7.39, 95% CI 2.15–25.44, P=0.002), while HFmrEF or HFpEF did not. Finally, in patients with optimal OAC, risk of thromboembolic event was not increased by HF or HFrEF.

Conclusion
In OAC-naïve non-valvular AF, HF was associated with increased risk of thromboembolic event. Among 3 types of HF, HFrEF increased the risk of thromboembolic event, while HFmrEF or HFpEF did not. However, in patients with optimal OAC, even HFrEF was not associated with increased risk of thromboembolic event. These results support current OAC strategy in HF patients, especially emphasizing optimal OAC in HFrEF population.

Acknowledgement/Funding
The National Research Foundation of Korea
P3778Long-term outcome of non-pharmacologial treatment of atrial fibrillation in hypertrophic cardiomyopathy: a large single-centre experience
Authors: Dinshaw L , Lemoine M , Hartmann J , Schaeffer B , Klatt N , Jularic M , Gunarwadene M , Muenkler P , Tam A , Eickholt C , Willems S , Patten M , Meyer C 
Published: October 2019

Abstract

Introduction
Atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) and is generally associated with a significant deterioration of clinical status. Non-pharmacological treatment such as surgical and catheter ablation has become an established therapy for symptomatic AF but in patients with HCM often having a chronically increased left atrial pressure and extensive atrial cardiomyopathy the long-term outcome is uncertain.

Purpose
The present study aimed to analyse the long-term outcome of AF ablation in HCM and the mechanism of recurrent atrial arrhythmias using high-density mapping systems.

Methods
A total of 65 patients (age 64.5±9.9 years, 42 (64.6%) male) with HCM undergoing AF ablation for symptomatic AF were included in our study. The ablation strategy for catheter ablation included pulmonary vein isolation in all patients and biatrial ablation of complex fractionated electrograms with additional ablation lines if appropriate. In patients with suspected atrial tachycardia (AT) high-density activation and substrate mapping were performed. A surgical ablation at the time of an operative myectomy for left ventricular outflow tract obstruction was performed in 8 (12.3%) patients. The outcome was analysed using clinical assessment, Holter ECG and continuous rhythm monitoring of cardiac implantable electric devices.

Results
Paroxysmal AF was present in 27 (41.6%), persistent AF in 37 (56.9%) and primary AT in 1 (1.5%) patients. The mean left atrial diameter was 54.1±12.5 ml. In 11 (16.9%) patients with AT high-density mapping was used to characterize the mechanism of the ongoing tachycardia. After 1.9±1.2 ablation procedures and a follow-up of 48.5±37.2 months, ablation success was demonstrated in 58.9% of patients. The success rate for paroxysmal and persistent AF was 70.0% and 55.8%, respectively (p=0.023). Of those patients with AT high-density mapping guided ablation was successful in 44.4% of patients. The LA diameter of patients with a successful ablation was smaller (52.2 vs. 58.1 mm; p=0.003).

Conclusion
Non-pharmacological treatment of AF in HCM is effective during long-term follow-up. Paroxysmal AF and a smaller LA diameter are favourable for successful ablation. In patients with complex AT the use of high-density mapping can guide ablation resulting in further ablation success in a reasonable number of patients.