bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5679Utility of late iodine enhancement computed tomography with image subtraction in the evaluation of cardiac resynchronization therapy response
Authors: Pezel T , Mika D , Laissy J P , Moubarak G 
Published: October 2019

Abstract

Background
Despite the impressive results of the large CRT trials, it has been observed that, on an individual basis, about 30% of patients fail to respond to cardiac resynchronization therapy (CRT). The evaluation of left ventricular (LV) dyssynchrony, myocardial scar, and coronary venous anatomy by image subtraction in Late Iodine Enhancement Computed Tomography (LIE-CT) has the potential to comprehensively characterize non-responders.

Purpose
To assess the feasibility and the utility of image subtraction in LIE-CT in CRT patients and compare findings between responders and non-responders.

Methods
Monocentric prospective study of CRT patients at least 6 months after implantation who underwent post-procedural CT between March and October 2018. CRT-responders were defined as patients with an absolute increase in LV ejection fraction >5%.
CT-derived residual global and segmental dyssynchrony metrics, extent and location of myocardial scar, coronary venous anatomy, and position of LV lead relative to scar and segment of latest mechanical contraction were analyzed.

Results
Among the 29 patients (mean age 71±12 years; 72% men), 18 were responders (62%). All CT metrics evaluating residual dyssynchrony such as wall motion indexand wall thickness indexwere worse in non-responders (p<0.0001 for both). In LIE-CT, predictive factors of CRT-non-response were an LV lead localized in an region of myocardial scar (p=0.0007), in a region with akinesia or dyskinesia (p=0.007), and with myocardial thickness <6mm (p=0.002). Percentage of fibrosis of the myocardial mass and the presence of fibrosis in postero-lateral region were not predictive of CRT-non-response (p=0.9 and p=0.3, respectively). Of the 11 non-responder patients, 8 (73%) had at least one other coronary venous branch visualized by CT; and among those, 3 (38%) were located in an non-akinetic area with late segmental contraction.
Wall Motion and LIE-CT

Conclusion
Image subtraction in LIE-CT in patients who had CRT is feasible and allows better characterization of CRT-non-responders, who have a greater amount of residual dyssynchrony than responders. Distribution of fibrosis in relation to the LV lead and presence of alternative venous branches may help patient management.
P5681Improved electrical performance/stability of a novel active fixation coronary sinus lead compared to passive fixation leads: a multi-centre study
Authors: Gerontitis D , Wardley J , Chapman M , Zegard A , Sammut E , Bates M , Waddingham P , Diab I , Chow A , Leyva F , Turley A , Williams I , Ullah W 
Published: October 2019

Abstract

Background
A novel active fixation coronary sinus (CS) lead, Attain Stability, has been released in a bipolar and quadripolar configuration, with the hypothesis it will improve targeted lead positioning and stability independent of vessel anatomy.

Purpose
To compare implant procedure parameters and electrical performance/stability of a novel active fixation lead with passive fixation CS leads.

Methods
This was a retrospective study involving 6 major UK cardiac centres. Patients who received active leads were compared with passive lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macro/micro-displacements, defined as displacements requiring repositioning procedures, or an increase in threshold≥0.5 volts or pulse width≥0.5msec, or a change in pacing polarity). Multivariate analysis was performed to establish predictors of the primary outcome, assessing fixation mechanism (active or passive), number of poles (quad or bipolar), contributing hospital and follow-up duration.

Results
736 patients were included (241 with active leads, 495 with passive leads). There were no group differences in the baseline characteristics with respect to age, gender, EF, NYHA class, and co-morbidities, P>0.05 for all. The primary endpoint rate was 31% (74/241) in the active and 43% (213/495) in the passive fixation group (P=0.002). 6 patients in the active group and 14 in the passive group required CS lead repositioning procedures. The results of the multivariate analysis are presented in the Table. The use of active leads was associated with a significant reduction in lead displacements, odds ratio 0.62 (95% CI 0.43–0.9), P=0.012. There were differences in favour of passive compared with active leads in procedure duration, 120 [96–149] minutes vs 128 [105–155] minutes (P=0.011), and fluoroscopy time, 17 [11–26] minutes vs 18.5 [13–27] minutes (P=0.028). The median duration of follow up was similar (active vs passive): 31 [17–47] weeks vs 34 [16–71] weeks, (P=0.052).
Odds Ratio (95% Confidence Interval) P-value Active fixation CS lead 0.62 (0.43–0.9) 0.012 Quadripolar (rather than Bipolar) lead 1.26 (0.75–2.11) 0.376 Follow-up Duration (weeks) 1.005 (1.001–1.008) 0.025 Also included in the model: contributing hospital, which was significant.

Conclusion
In this large, multi-centre study, active fixation Attain Stability CS leads demonstrated superior electrical performance/stability compared with passive fixation leads, with minimal increases in implant procedure and fluoroscopy times.

Acknowledgement/Funding
None
P5986Clinical outcomes of age in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Replacement
Authors: Munoz-Garcia E , Munoz-Garcia M , Munoz Garcia A J , Carrasco-Chinchilla F , Dominguez-Franco A J , Alonso-Briales J H , Hernandez-Garcia J M , Jimenez-Navarro M F , Gomez-Doblas J J 
Published: October 2019

Abstract

Transcatheter Aortic valve Replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement for patients considered at high or prohibitive operative risk. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes in according to age. The aim of this study was to determine the survival and the clinical outcomes on based of age. after TAVR with the CoreValve prosthesis.

Methods
From April 2008 to December 2017, the CoreValve and Sapiens 3 prosthesis were implanted in 667 patients with symptomatic severe aortic stenosis with deemed high risk on base to age, <80 years and ≥80 years old

Results
The mean age in patients <80 compared with ≥80 years, was 73.6±7 vs. 83.4±2.8 years and the logistic EuroSCORE and STS score were 16.3±11% vs. 18.1±11%. In-hospital mortality was 3.4%, and the combined endpoint of death, vascular complications, myocardial infarction, majopr bleeding or stroke had a rate of 18.3%. The late mortality (beyond 30 days) was 40.5%. When compared both groups, there were no differences for the presence of threatening bleeding 3.5% vs. 3.6% (HR = 1.033 [IC95% 0.452–2.360], p=0.557), myocardial infarction4.2% vs. 2.9% (HR = 0.67 [IC95% 0.290–1,530], p=0.0.226), stroke 8.9% vs. 9.4% (HR = 1.067 [IC95% 0.625–1.821], p=0.814) and mortality 44.5% vs. 41.1% (HR=0.971388 [IC95% 0.639–1.188], p=0.214) and there was difference in between groups in hospitalizations for heart failure 13.8% vs. 7.7% (HR = 1.374 [IC95% 1.037–1.821], p=0.008. Survival at 1, 2, 3, 4, 5 were similar in both groups (86.9% vs. 89.8%, 78.4 vs. 78.3%, 65.5 vs. 72.5%, 57.9% vs. 62.8% and 51.1 vs. 52.8%>; log Rank 0.992, p=0.319), respectively, after a mean follow-up of 43.9±27 months.

Conclusions
TAVR is associated with significant survival benefit throughout 3.2 years of follow-up. Survival during follow-up was similar in patients with <80 compared with ≥80 years old.
P6144Trends of mortality in patients with acute coronary syndromes submitted to urgent myocardial revascularization procedures in Brazil
Authors: Moreira H , Bittar N A , Venancio I M , Silva N T , Lima A M S , Souza M R 
Published: October 2019

Abstract

Background
Acute Coronary Syndromes (ACS) are the most common and life-threatening manifestation of cardiovascular diseases. This disease burden along with progress in cardiovascular technology has led to substantial growth in the number of cardiovascular procedures performed in ACS management. In Brazil, there are no contemporary data about in-hospital mortality related to urgent myocardial revascularization procedures.

Purpose
To describe trends in mortality in patients with ACS who underwent urgent myocardial revascularization procedures in Brazil, between 2008 and 2016.

Methods
Data on hospital admission and in-hospital mortality were obtained from the database of the Brazilian Public Health System (DATASUS) over a nine-years period (2008–2016). All admissions due to ACS were identified using standard ICD codes. Additionally, data about percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) performed as an urgency were retrieved. Trend analyses over the period were performed using Poisson regression.

Results
Between 2008 and 2016, 472,810 urgent myocardial revascularization procedures were performed, of which 370,018 (78.3%) were PCI and 102,792 (21.7%) were CABG. The in-hospital mortality in patients with ACS submitted to PCI was 3.4%, and 6.8% among those submitted to CABG. There was an increase in the number of PCI procedures from 26,929 in 2008 to 53,542 in 2016 (98%), although the mortality remained stable (3.3% to 3.6%, respectively). CABG procedures also raised 77%, from 9,535 in 2008 to 12,262 in 2016, but the observed related mortality decreased from 8.0% to 6.3%, respectively. However, disparities among Brazilian geographical regions were noted: in 2016, mortality among ACS patients who underwent urgent PCI was lower in Southeast (3.2%) and higher in the Northeast Region (5.9%). The Southeast Region also presented the lowest CABG related mortality (5.7%), whereas the Midwest had the higher death rates (7.8%).

Conclusions
In this contemporary analysis based on national public health data, there was an increase in the number of urgent myocardial revascularization procedures in patients hospitalized for ACS in Brazil. Despite stable death rates in patients undergoing PCI, CABG-related mortality decreased significantly. Due to the heterogeneity of results among the different geographical Regions of the country, there are still opportunities to improve these national results.
P6152Incremental prognostic utility of functionally non-significant coronary stenosis in patients undergoing coronary computed tomogram angiography
Authors: Alashi A , Huttcenteno E , Schoenhagen P , Popovic Z B , Cremer P , Kalahasti V , Jellis C , Renapurkar R , Rodriguez L L , Flamm S D , Desai M Y 
Published: October 2019

Abstract

Background
In patients with suspected coronary artery disease (CAD) who underwent coronary computed tomographic angiography (CCTA), the prognostic value of nonobstructive stenosis is not entirely understood.

Aims
We sought to assess the long-term incremental prognostic utility of functionally non-significant CAD in patients without known prior CAD who underwent CCTA.

Methods
We included 2142 consecutive patients (51±14 years, 53% men) without prior documented CAD who underwent CCTA between 2008–2016 (excluding anomalous coronaries and functionally significant CAD). Traditional risk factors were recorded and pretest likelihood of CAD was calculated. All epicardial coronary arteries were classified as follows: No plaque, minimal luminal irregularities (<25%), mild (25–49%) stenosis and moderate (50–69%) stenosis. All moderate stenoses were confirmed to be not functionally significant by follow-up stress testing/invasive angiography with fractional flow reserve assessment. Plaque was characterized as noncalcified, calcified or mixed. High-risk plaque features (spotty calcification, napkin ring, low attenuation plaque and positive remodeling) were recorded. During follow-up, a composite of death or myocardial infarction was recorded.

Results
188 (9%) patients had low, 1712 (80%) had intermediate and 242 (11%) patients had high pre-test likelihood of CAD. 45%, 10%, 52% and 22% had hypertension, diabetes, Dyslipedimia and history of smoking respectively. Breakdown of CAD severity was: 1197 (56%) none, 480 (22%) minimal, 267 (13%) mild and 198 (9%) moderate stenoses. 82 (4%) had noncalcified, 245 (11%) had calcified and 618 (29%) had mixed plaque. 465 (22%) had high-risk plaque features. At 6±3 years, 90 (4%) patients had composite events (68 deaths) and 24 (1%) needed coronary revascularization >90 days post-CCTA. 880 (41%) were on statins post-CCTA. Results of multivariable Cox Survival Analysis are shown in Figure 1A. Kaplan-Meier survival curves for a) more severe CAD and b) high-risk plaque features (vs. not) are shown in Figure 1B and C. Longer-term event rates for increasing CAD were 2.8%, 4.6%, 6% and 9.6%, respectively.

Conclusion
In mostly low/intermediate risk patients without documented CAD who underwent CCTA, a higher burden of nonobstructive coronary plaque (or presence of high-risk features) provide incremental prognostic value. Initiating statin therapy following detection of plaque on CCTA was associated with improved longer-term freedom from composite events.
P6169Ultra-low radiation 70kv-coronary computed tomography angiography with low-dose contrast media using dual source computed tomography
Authors: Komatsu S , Takahashi S , Yutani C , Takewa M , Ohara T , Kodama K 
Published: October 2019

Abstract

Background
The major concerns with coronary computed tomography angiography (CCTA) is the amount of contrast media (CM) injected and the radiation dose.

Purpose
To establish low radiation CCTA with low amount of contrast media.

Methods
Consecutive 60 patients (body weight ≤70mg or less and Agatston score ≤400) who were scheduled coronary computed tomography angiography were enrolled. Dual-source scanner (SOMATOM Force, Siemens, Germany) was used and CM used was Iopamidol 370mg/I (Bayer, Germany). Coronary CT angiography was performed with Turbo Flash Spiral and Sinogram Affirmed Iterative Reconstruction was done. The dose of contrast media was decided according to our original predicting system for 300HU. This study was approved by the local ethics committee and all patients gave written, informed consent. Exclusion criteria for CCTA were low Agatston score (<50), atrial fibrillation, allergy to CM, renal insufficiency (glomerular filtration rate <60 mL/min/1.73 mm2), pregnancy, congenital heart disease, low left ventricular function, and coronary artery bypass graft. All segments were evaluated using a 5-point scale: 5, excellent and easily assessable,; 4, good, mild artifacts at 1 segment and assessable; 3, evaluable, moderate artifacts on a few segments; 2, evaluable, diagnostic combined with axial images; and 1, not assessable.

Results
All patients successfully performed CCTA. Age averaged 46±15 yo (mean±S.D.) and body mass index averaged 22.5±3.0. Used CM was 12±7ml and intracoronary CT number 329±28HU. Dose-length product averaged 21.7±15.0 mGy cm and effective dose averaged 0.30±0.21mSv. Image quality averaged 4.8±0.7. CCTA with the lowest effective dose was 0.04mSv and CCTA with the lowest CM was 4ml.

Conclusions
Ultra-low dose 70kV-CCTA with low dose of contrast media can be performed using dual source computed tomography in patients with body weight ≤70mg or less and Agatston score ≤400.
P6201Beneficial effect of ezetimibe-atorvastatin combination therapy in patients with a mutation in ABCG5 or ABCG8 gene
Authors: Tada H , Nohara N A , Kawashiri M K , Takamura M T 
Published: October 2019

Abstract

Background
Use of ezetimibe on top of statin therapy has been shown to be effective to reduce LDL cholesterol level in hypercholesterolemic patients. However, little is known regarding the individual variety of the effectiveness of ezetimibe. We hypothesized that hypercholesterolemic patients with a mutation in ABCG5 or ABCG8 gene exhibit better response to ezetimibe that those without, based on the fact that ezetimibe is hyper-effective for in patients with sitosterolemia caused by ABCG5 or ABCG8 genetic mutations.

Methods
Electronical medical record were reviewed in a total of 321 hypercholesterolemic patients (baseline LDL cholesterol = 192±46 mg/dl) prescribed ezetimibe 10 mg daily on top of atorvastatin 10mg daily who had undergone genetic analysis of ABCG5 or ABCG8 gene in our institute since 2006 to 2017. Pathogenicity of the variants were determined using standard variant filtering schema, including minor allele frequency, in silico annotation tools. Patients were divided into 2 groups based on the presence of ABCG5 or ABCG8 mutation. We compared the percent reduction of LDL cholesterol as well as the achieved LDL cholesterol levels between these 2 groups.

Results
We found 26 (8%) individuals who exhibit deleterious mutations in ABCG5 or ABCG8 gene. Baseline characteristics under the atorvastatin 10mg therapy were comparable in age, gender, and LDL cholesterol level between 2 groups. Under these conditions, percent reduction of LDL cholesterol in mutation positive group was significantly larger than that of mutation negative group (28±16% vs. 39±21%, p<0.05). As a result, the achieved LDL cholesterol level in mutation positive group was significantly lower than that of mutation negative group (87±29 mg/dl vs. 72±26% mg/dl, p<0.05).

Conclusion
These results suggest that ezetimibe-atorvastatin combination therapy might be more beneficial in hypercholesterolemic patients with a mutation in ABCG5 or ABCG8 gene.
P6338Discussing prognosis with heart failure patients; the view of the cardiologist
Authors: Van Der Wal M H L , Hjelmfors L , Stromberg A , Jaarsma T 
Published: October 2019

Abstract

Background
Discussing prognosis is advocated in recent Heart Failure (HF) ESC guidelines. However, there is a lot of discussion about roles, responsibilities and timing with regard to discussing prognosis with HF patients and their family. The purpose of this study was to describe the views of cardiologists with regard to discussing prognosis with HF patients, experienced barriers and how difficult it is to have such conversations.

Methods
A total of 275 cardiologists (125 in the Netherlands; 150 in Sweden) were invited by email to participate in a survey. The questionnaire was adapted from a validated questionnaire for HF-nurses consisting of 10 items on communicating prognosis. Participants were asked to select at which time they would discuss prognosis for the first time and which barriers they experience in these discussions. Finally, they were asked to rate how difficult it is to discuss prognosis on a scale from 1 (not difficult at all) to 10 (very difficult).

Results
A total of 88 cardiologists (43 Dutch; 45 Swedish; response rate 32%) participated in the study (mean age 49±10; 28% women). Most of the cardiologists (82%) stated that discussing prognosis should be discussed with all HF patients. In their view, this could be done by the own cardiologist (97%), but also by a cardiologist on the ward (72%), the HF nurse (51%) or the GP (28%). In total 47% stated that prognosis should be discussed when the patient is diagnosed and 18% answered that it should take place preferably at the first period of decompensation. Fifteen percent reported to discuss it only in case of a serious deterioration of the condition of the patient. There were no significant differences in views between Dutch and Swedish cardiologists.
Most important barriers to discuss prognosis were “cognitive problems of the patient” (69%) and “too little time to discuss the topic” (64%). Other important barriers were `the patient is not ready for it' (60%) and “fear that the patient would be worried/lose hope” (50%).
Although the mean reported difficulty in discussing prognosis was rather low (4,2±2), 34% of the cardiologists rated >6. Swedish cardiologists found it more difficult compared to their Dutch colleagues (3,7±2 vs. 4,7±2; p<0.05)

Conclusion
A considerable number of cardiologists suggested to discuss prognosis with all HF patients at the time the patient is diagnosed. Barriers to discuss this were related to the patient (cognitive problems, not ready to discuss), the organisation (lack of time) or the cardiologist (fear of making the patient worried or losing hope). Swedish cardiologists experienced discussing prognosis more difficult compared to Dutch cardiologist. Although most of the cardiologists reported that the responsible cardiologist should discuss prognosis with the patient, also other healthcare professionals (cardiologist on the ward, HF nurse, GP) could discuss this. A team approach to improve discussing prognosis with HF patients therefor seems important.
P6348Phospholamban antisense oligonucleotides drive the reversal of cardiac dysfunction and multiple heart failure parameters during murine dilated cardiomyopathy
Authors: Spaeter D , Hidalgo Gonzalez A , Elbeck Z , Yeh S T , Siga H , Damle S S , Palmer M , Kuo C , Wang Q D , Chien K R , Fritsche-Danielson R , Hansson K , Mullick A E , Knoell R 
Published: October 2019

Abstract

Background
Mice lacking muscle LIM protein (Mlp/Cspr3 −/−) develop dilated cardiomyopathy (DCM). Previous work established this model to be amenable to improvements in cardiac function by genetic ablation of phospholamban (PLN).

Purpose
To test the hypothesis that therapeutic reductions of PLN would similarly improve cardiac function, Mlp KO mice were administered an antisense oligonucleotide (ASO) targeting PLN.

Methods
Echocardiography measurements of ejection fraction (EF), end-diastolic volume (EDV) and end-systolic volume (ESV) were performed before and after treatment. In addition, global transcriptome profiling using 3'RNA-seq was performed to identify gene expression changes in diseased Mlp KO mice and following PLN ASO treatments. Mlp KO mice with ejection fraction (EF%) of less than 45% (median, 37.6%; interquartile range, 32.2–42.0%) were treated with vehicle (n=10) or PLN ASO (n=9) for 4 weeks.

Results
Three subcutaneous injections of PLN ASO were administered to Mlp KO mice resulting in 50–70% PLN reductions. Echocardiography performed at study end revealed improvements of EF (60±8 vs. 46±12%), ESV (31±11 vs. 56±21μl) and EDV (79±22 vs. 100±25μl) with PLN ASO treatment. Corrected for baseline values, PLN ASO treatment improved all echocardiographic measurements (p<0.001). Transcriptional analyses revealed that PLN ASO treatment reduced expression of heart failure related markers, such as Myh7 (−70%), Nppa (−72%), Nppb (−71%), Acta1 (−84%) and Ankrd1 (−40%), p<0.05 vs. vehicle. In addition, genes not previously known to be dysregulated in this model, Edn3 and Xirp2, were identified and shown to be reduced following PLN ASO treatment by 71% and 67%, respectively (p<0.001). Bioinformatic analysis suggested improvement of known and novel heart failure associated pathways by PLN inhibition in this model.
In conclusion, antisense inhibition of PLN reduced functional and transcriptional indices of heart failure in a DCM model. In view of the failed CUPID trials, a gene therapy approach to improve SERCA2a activity, targeting PLN with ASO may be advantageous due to a likely more robust pharmacological profile.