bluuebunny/crossref_metadata_2025_split huggingface dataset:
P947Combining the ankle-brachial index with novel waveshape-based methods improves peripheral artery disease classification
Authors: Bachler M , Haumer M , Hametner B , Mayer C C , Glantschnig K , Wassertheurer S 
Published: October 2019

Abstract

The Ankle Brachial Index (ABI) is the most commonly used method for the investigation of peripheral artery disease (PAD) in clinical settings, but has a low sensitivity for detecting PAD in asymptomatic patients. It is calculated only based on the systolic blood pressure in the limbs and ignores the shape of the pressure waves. Therefore, we investigated a novel method focusing on waveform changes by analyzing and comparing synchronous pulse wave recordings of all four extremities.
In this study, pulse waves of 44 patients (28M/16F, age 65 (SD 10) years, ABI 0.89 (SD 0.13)) measured at rest on all four limbs simultaneously using the AngE Pro 4 system (Sonotechnik Austria Angio Experience GmbH, Austria) were investigated. The patients Fontaine stage was used as a benchmark. A novel parameter based on pairwise wave shape differences, i.e., the root mean square of the differences (RMSD), was tested for its capability to correctly classify the patients Fontaine stage. Furthermore, the results were compared and combined with ABI measurements.
Of the 44 patients, 7 were in Fontaine stage 0 (no PAD) and 37 in stage 2 (claudication). In univariate analysis, ABI showed significant discrimination power (AUC ROC = 0.86, p<0.01), but was surpassed by the RMSD with a discrimination power beyond ABI (AUC ROC = 0.95, p<0.001, see figure). Furthermore, logistic regression revealed statistical independence of ABI and RMSD, indicating that they reflect different aspects of the measurements. Therefore, combining these two measures, multivariate classification results in a far superior classifier (AUC ROC = 0.98, p<0.001, see figure).

In this study, the novel waveshape-based method RMSD, used to classify stages of PAD, showed better discrimination power than ABI. Furthermore, statistical independence allowed for the combination of ABI and RMSD, resulting in a far superior classification of PAD Fontaine stages. Since, using the appropriate equipment, both parameters can be measured simultaneously and in an automated way, the results are promising for assisting PAD classification in the future.

Acknowledgement/Funding
This work was partly supported by the program “Bridge” by the Austrian Ministry for Transport, Innovation and Technology BMVIT. PWA4PAD FFG No. 858509
P949Early QW duration, depth and area in prediction of reperfusion success in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention - a CMR study
Authors: Topal D 
Published: October 2019

Abstract

Background
Pathological Q-wave (QW) in the electrocardiogram (ECG) before primary percutaneous coronary intervention (primary PCI) is a strong prognostic marker in patients with ST-segment elevation myocardial infarction (STEMI). However, current QW criteria are either not clinical applicable or have a lack of diagnostic performance. Furthermore, the term “pathological” QW is debatable given that even patients with large pathological QW do have substantial myocardial salvage index. Accordingly, we evaluated the association between QW duration, depth, area (QW morphology) and non-viable myocardium, myocardial salvage index as well as microvascular obstruction (myocardial salvage index and microvascular obstruction are considered reperfusion success) using cardiac magnetic resonance imaging (CMR).

Methods
A total of 516 patients with their first STEMI had obtained an ECG before primary PCI and an additional CMR performed acute at day 1 (interquartile range [IQR], 1–1) and at follow-up at day 92 (IQR, 89–96). The largest measurable QW in ECG was used for analysis of QW morphology. A new QW criteria (Copenhagen QW criteria) composite of duration and depth as well as a new QW area criteria were made using ROC-analysis, and were compared with modified Minnesota criteria.

Results
The QW morphology was strongly associated to all CMR endpoints (p≤0.0001) and showed a strong linear correlation with final infarct size, final transmurality and final myocardial salvage index (p≤0.0001). The diagnostic performance of QW morphology, Copenhagen QW criteria and QW area criteria was over-all comparable to the modified Minnesota criteria in prediction of non-viable myocardium.

Conclusion
QW morphology in STEMI patients has a strong linear association with reperfusion success. The larger final infarct size, final transmurality or lower final myocardial salvage index the larger QW morphology. Hence, it is suggested that the term pathological is not used as a dichotomous condition in patients with STEMI but rather evaluated on the basis of extent.

Acknowledgement/Funding
Rigshospital Research Fund
P952Choosing an effective methods for assessing the results of percutaneous coronary interventions in post-myocardial infarction patients
Authors: Rustamova Y , Azizov V , Dzhahangirov T , Imanov G , Maximkin D A , Faibushevich A 
Published: October 2019

Abstract

Aim
To evaluate the effectiveness of cardiac magnetic resonance (CMR) and stress-echocardiography in the assessment of long-term results of percutaneous coronary interventions (PCI) in post-MI patients with dysfunctional myocardium.

Methods
112 patients were participated in the study. Inclusion criteria: myocardial infarction in previously; angina II-III functional class (CCS); multivessel coronary disease (SYNTAXscore I <32); the presence of segments with abnormality left ventricular local contractility; chronic heart failure I-III functional class (NYHA); left ventricular ejection fraction (LVEF) is less than 45%. All patients underwent stenting of the coronary arteries in the zone of viable myocardium. Only drug-eluting stents were implanted in coronary arteries. Long-term results were followed up 18 months after PCI in all patients. All patients underwent stress-echocardiography and CMR for visualization of myocardium after PCI.

Results
On average, initially accounted for 2.12±0.74 segments with abnormality kinetic per patient according CMR, whereas, according to stress echocardiography, the average number of segments was 1.96±0.42. The average difference was 0.16 segment [0.11–0.18; 95% CI, p=0.003]. In the postoperative period, after 18 months, there was a significant decrease a segments with abnormality kinetics in the zone of hibernated myocardium, from 2.12 to 1.08, according to CMR (the average difference was 1.04 segment) [0.98–1.1; 95% CI, p<0.01], and from 1.96 to 0.98 according to stress-echocardiography (the average difference was 0.98 segments) [0.94–0.99; 95% CI, p=0.023]. There is a significant discrepancy between the number of identified segments with abnormality kinetics using CMR and stress- echocardiography. There was a significant decrease in the transmurality index from 0.42 to 0.31 (according to CMR). The difference was 0.11 [0.09–0.14; 95% CI, p<0.05]. At the same time, recovery of myocardial function was clearly manifested in patients with a trasmurality index of 0.3–0.5, whereas with a transmurality index of more than 0.5, reliable recovery of myocardial function was not observed.

Conclusion
CMR allows a more objective analysis of the results of PCI in patients with dysfunctional myocardium, as compared with the stress-echocardiography method.

Acknowledgement/Funding
Russian Academic Excellence Project 5-100
P953Comparison of the original and updated ACTION risk scores for predicting in-hospital and one-year mortality in patients with acute myocardial infarction undergoing primary PCI
Authors: Jelic D , Mehmedbegovic Z , Milasinovic D , Dedovic V , Zobenica V , Zaharijev S , Radomirovic M , Asanin M , Vukcevic V , Stankovic G 
Published: October 2019

Abstract

Background
The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With The Guidelines (GWTG) AMI mortality model and risk score (ACTION) were introduced in 2011 to predict in-hospital mortality. In 2016 score was updated to enable a more accurate assessment, but, up-to-date, external validation in direct comparison was not performed.

Purpose
We aimed to externally validate and compare the prognostic value of original and updated ACTION score for in-hospital and one-year mortality.

Method
From a prospective electronic registry of a high-volume catheterization laboratory in a period from January 2009 to December 2017, a total of 5615 consecutive patients who underwent pPCI were available for analysis. For each patient, original (O-) and updated (U-) ACTION scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality (follow-up available for 91%) were assessed. Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively.

Results
Mortality rates for in-hospital and one-year mortality were 4.2% and 9.6%, respectively. Both scores showed good model calibration as assessed by the H-L test and very good discriminative power for in-hospital and one-year mortality as assessed by C-statistics (Table 1 & Figure 1).
Net reclassification index (NRI=1.06) showed that 48% of patients with in-hospital event and 58% without event, had their risk recalculated with U-ACTION with Integrated Discrimination Improvement slope 9.1% higher than in first model.
Table 1 Risk score H-L H-L p value AUC 95% CI p value AUC 95% CI Significant p value O-ACTION 9.4 0.3 0.829 0.819 to 0.839 p<0.0001 0.781 0.769 to 0.792 p<0.0001 U-ACTION 10.9 0.2 0.918 0.911 to 0.925 0.838 0.827 to 0.848
Figure 1

Conclusion
Updated ACTION score enables better prediction of in-hospital and one-year mortality in patients undergoing pPCI for acute myocardial infarction, thus it can be used preferentially over the original ACTION score for assessment of short and long-term mortality risks of this population.
P962Follow-up of protected high-risk percutaneous coronary intervention with microaxial Impella pump. Results from the retrospective German Impella Registry
Authors: Baumann S , Werner N , Al-Rashid F , Schaefer A , Bauer T , Sotoudeh R , Bojara W , Shamekhi J , Sinning J.-M , Becher T , Eder F , Akin I 
Published: October 2019

Abstract

Background
Percutaneous coronary intervention (PCI) presents a relevant alternative to coronary bypass surgery for the treatment of patients with complex coronary artery disease and high perioperative risk. By temporary implantation of a percutaneous ventricular assist devices (pVAD) interventionalists attempt to anticipate the hemodynamic risk of those high-risk patients in a so-called protected PCI. The Impella® system presents the currently most common device for protected PCI and could show hemodynamic stability in earlier trials.

Methods
This study is a retrospective, observational multi-center registry of ten hospitals in Germany. We included patients undergoing protected high-risk PCI with Impella® support. The primary endpoint was defined as major adverse cardiac events (MACE) during a 180-day follow-up and consisted of all-cause mortality, myocardial infarction (MI) and stroke.

Results
Six of the participating hospitals performed a follow-up. In total, 157 patients (80.3% male; mean age 71.8±10.8 years) were included in the present study. Prior to PCI, median left ventricular ejection fraction was 39.0% (25.0%-50.0%) and median SYNTAX-Score I was 33.0 (24.0–40.5). The 180-day follow-up was available for 149 patients (94.9%). Eight patients (5.1%) were lost to follow-up. During the follow-up period, 34 patients (22.8%) suffered from a MACE. A total of 27 patients (18.1%) died. Nine patients (6.0%) sustained a MI, while 4 patients (2.7%) had a stroke.
Kaplan-Meier curves for primary endpoint

Conclusions
Patients undergoing protected high-risk PCI with Impella® support show a good 180-day clinical outcome regarding rates of MACE and mortality. However, a head-to-head comparison of Impella supported patients to protected PCI with other pVADs is pending.

Acknowledgement/Funding
S.B., N.W., F.A.-R., J.-M.S., A.S., R.S., I.A. receive consulting fees/honoraria from Abiomed (Danvers, MA, USA).
P965Prevalence, management strategies and outcomes of patients with coronary chronic total occlusions
Authors: Guo L , Wu J , Zhong L , Huang R C 
Published: October 2019

Abstract

Background
Percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTOs) remains among the biggest challenges in interventional cardiology. However, limited data exist regarding the clinical outcomes of the three potential therapeutic strategies of PCI, coronary artery bypass grafting (CABG), and medical therapy (MT).

Aims
The aim of this study was to compare the clinical outcomes of CTO patients according to the initial treatment strategy.

Methods and results
Consecutive patients with at least one coronary CTO from January 2007 to December 2016 in our center were included and categorized as managed either by PCI, CABG, or MT. Propensity-score matching was also performed to adjust for baseline characteristics. The primary outcome was a major adverse cardiac event (MACE), such as cardiac death, myocardial infarction (MI), or target vessel revascularization (TVR). A total of 1655 patients with 1944 CTOs were enrolled in this study. The overall CTO prevalence was 10.5%. A CTO was treated by MT in 800 (48.3%) patients and PCI in 734 (44.4%), while 121 (7.3%) underwent CABG. The median overall follow-up duration was 3.6 (interquartile range = 2.1 to 5.0) years. Patients referred for MT had a higher incidence of MACE (28.0% vs. 17.3% and 12.4%, respectively; all p<0.001) and TVR (16.9% vs. 10.6% and vs. 7.4%, respectively; p<0.001 and = 0.005, respectively) than those managed by PCI and CABG. After propensity-score matching analysis, the rate of PCI was lower than that of MACE (19.2% vs. 28.9%, hazard ratio [HR] = 0.62, 95% confidence interval [CI] = 0.45–0.85, p=0.003) and TVR (HR = 0.53, 95% CI = 0.35–0.79, p=0.002) when compared with MT. There was no significant difference in the prevalence of MACE (18.5% vs. 23.1%, HR = 0.76, 95% CI = 0.53–1.09, p=0.126) or cardiac death (0.51; 0.23–1.15, 0.098) between the successful PCI and MT groups.

Conclusions
As an initial management strategy for patients with CTOs, PCI or CABG reduced the risk of MACE (driven by TVR), as compared with MT alone on follow-up. However, successful PCI did not reduce the long-term risk of MACE or cardiac death, as compared with MT alone.

Acknowledgement/Funding
Beijing Municipal Science and Technology Project (Z1611ehz747.05590516139) and BeijingLisheng Cardiovascular Health Foundation (LHJJ20158521)
P967Combined modified balloons and Saito's modified JBT for calcified coronary birucation lesions
Authors: He J , Wang L F , Yang X C 
Published: October 2019

Abstract

Background
Bifurcation lesions are account for relatively high incidence of adverse events, especially in serious calcification and distort lesions during bifurcation stenting.

Purpose
Based on Saito's modified jailed balloon technique (M-JBT, Shigeru Saito, Modified jailed balloon technique for bifurcation lesions, Catheter Cardiovasc Interv. 2018; 92:E218–E226), fully dilatation with modified balloons was performed on calcification lesion in main branch, to observe if this combination method will facilitate bifurcation lesions stenting procedure.

Methods
For M-JBT, we followed Saito's technique. Basically, a jailed balloon (JB) is introduced into the side branch (SB), while a stent is placed in the main branch (MB) as crossing SB. The size of the JB is half of the MB stent size. While the proximal end of JB attaching to MB stent, both stent and JB are simultaneously inflated with same pressure. Kissing balloon dilatation (KBD) and/or T and protrusion (TAP) stenting are applied as needed.
Modified balloons are performed as severe calcification presented in MB.

Results
More than 50 patients and 60 bifurcations (both for selective and primary cases) underwent percutaneous coronary intervention (PCI) using this combined technique since November 2018. Procedure success was achieved in all cases. KBD was performed for a few lesions and TAP stenting was employed for 1 lesion. Occlusion of SV was not observed in any of the patients.
Illustration cases and prodedure

Conclusions
Saito's modified jailed balloon technique is safe and effective method in bifurcation stenting. Combined with modified balloons is an effective method when severe calcification presented in bifurcation lesions, especially in distort lesion (main branch or side branch) and poor position visualization situations when rewire is difficult in traditional JBT procedure.

Acknowledgement/Funding
None
P979Persistent atrial fibrillation terminated within the left atrium without recurrence at follow-up demonstrates a gradual intracardiac organization during stepwise ablation
Authors: Pithon A , Luca A , Buttu A , Vesin J M , Roten L , Kuhne M , Spiess F , Knecht S , Sticherling C , Park C I , Pascale P , Le Bloa M , Herrera C , Pruvot E 
Published: October 2019

Abstract

Introduction
We previously reported that patients (pts) with recurrence (Rec) after stepwise catheter ablation (step-CA) of persistent atrial fibrillation (pAF) exhibit high bi-atrial intracardiac dominant frequencies (DF) values before ablation, indicative of a severe bi-atrial electro-anatomical remodeling.

Purpose
Herein, we hypothesized that a gradual decrease in DF values during step-CA is associated with pAF termination and maintenance of sinus rhythm (SR) on the long term.

Method
In 40 consecutive pts (61±8 yo, sustained AF duration 19±11 months), pulmonary vein isolation (PVI) and left atrium (LA) ablation were performed until pAF termination or cardioversion. 10-sec intracardiac electrograms (EGMs) epochs were recorded before ablation (BL), during PVI and during complex fractionated atrial electrograms (CFAEs) and linear ablation (post_PVI) in the right atrial (RAA) and left atrial (LAA) appendages and in the coronary sinus (CS). DF was defined as the highest peak within the [3–15] Hz EGM spectrum. Rec was defined as any atrial arrhythmia lasting >30 sec during follow-up (FU).

Results
pAF was terminated within the LA in 70% (28/40, LT) of the pts, while 30% (12/40, NLT) were not. After a mean FU of 34±14 months, all NLT pts had a Rec, while LT pts presented a Rec in 71% (20/28, LT_rec) and remained in SR in 29% (8/28, LT_norec). Figure 1 shows: 1) a gradient in DF values measured in the LAA (panel A), RAA (panel B) and CS (panel C) with the highest values in NLT pts (red), intermediate values in LT_rec pts (yellow) and lowest DF values in LT_norec pts (green); 2) all three groups displayed a gradual intracardiac organization during LA ablation as shown by decreasing DF values (p<0.05, BL vs post_PVI), but the LT_norec pts (green) exhibited the highest relative changes in DF from BL (p<0.05, LT_norec vs NLT, Δ range: −5.31 to −9.69%).
Figure 1. Effect of ablation on DF

Conclusion
Low DF values before ablation and gradual intracardiac organization until pAF termination are associated with maintenance of SR on the long term.
P985The long-term impact of maintaining sinus rhythm on the risk for death or heart failure after catheter ablation for atrial fibrillation in a real world clinical practice
Authors: Yoshizawa T , Shiomi H , Tanaka M , Aizawa T , Yamagami S , Komasa A , Kimura T , Shizuta S 
Published: October 2019

Abstract

Background
Catheter ablation has been rapidly spread as a first line therapy for atrial fibrillation (AF). A recent randomized trial have shown that AF ablation reduces the risk of death or hospitalization for heart failure (HF). However, the impact of maintained sinus rhythm (SR) on long-term risk of death or HF hospitalization has not been adequately evaluated.

Purpose
To investigate the impact of maintaining SR by AF ablation on long-term risk of all-cause death or HF hospitalization.

Methods
The long-term clinical outcomes were compared between patients with maintained SR and those with recurrent AF using a landmark analysis in which the landmark point was set at 1.5-year after the 1st ablation.

Results
Among consecutive 1467 patients who underwent AF ablation in our institution between February 2004 and December 2017, the study population consisted of 1311 patients after excluding 150 patients because of death or lost to follow-up. Mean age was 67.9±0.3 and paroxysmal AF was 67%. Among 460 patients who had AF recurrence within 1.5 years after the 1st ablation, 328 underwent 2nd ablation. Therefore, at 1.5-year after the 1st AF ablation, 1145 patients had maintained SR rhythm (SR-group), and 166 patients had recurrent AF episodes (AF-group). During 4.7±2.4 years of follow-up, the cumulative 5-year incidence of death or HF beyond 1.5 years after the 1st ablation was 5.1% in SR-group and 15.6% in AF-group (log rank P<0.001). After adjusting for baseline confounders, the lower risk of SR-group relative to AF-group for death or HF was still statistically significant (HR: 2.05, 95% CI: 1.11–3.58, P=0.02).
Risks for a Composite of Death or HF Hazard Ratio (95% CI) Crude HR P value Adjusted HR P value AF recurrence 2.59 (1.43–4.43) 0.002 2.05 (1.11–3.58) 0.02 Age>75 years old 2.55 (1.56–4.10) <0.001 2.32 (1.39–3.81) 0.002 Female 0.85 (0.49–1.43) 0.56 0.73 (0.40–1.25) 0.26 PeAF 1.25 (0.68–2.16) 0.45 0.98 (0.52–1.75) 0.94 LSAF 1.10 (0.46–2.23) 0.82 0.70 (0.28–1.53) 0.39 LVEF>50% 0.27 (0.16–0.48) <0.001 0.57 (0.31–1.09) 0.09 Past history of HF 7.06 (4.18–11.6) <0.001 4.67 (2.51–8.41) <0.001 CKD 4.74 (2.08–9.39) <0.001 2.23 (0.94–4.69) 0.07 AF, Atrial fibrillation; PeAF, Persistent AF; LSAF; Long standing AF; HF, Heart failure; CKD, Chronic kidney disease.
Figure 1

Conclusions
Successfully maintained SR was associated with reduced long-term risk for death or HF hospitalization in real world patients undergoing AF ablation.