bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3654Location of the coronary origins in transposition patients following anatomical repair: Implications for invasive coronary angiography and intervention
Authors: Constantine A H , Segura T , Nicol E , Kempny A H , Rafiq I , Barradas Pires A , Barracano R , Gatzoulis M A , Rubens M , Semple T , Dimopoulos K 
Published: October 2019

Abstract

Background
Surgical repair of transposition of the great arteries (TGA) is most commonly via the arterial switch operation (ASO). This involves translocation of the aorta and pulmonary trunk, typically with anastomosis of the branch pulmonary arteries anteriorly (LeCompte manoeuvre) and re-implantation of the coronary arteries onto the posterior neo-aorta. As such, the position of the coronary ostia may differ from their expected locations.

Purpose
To use ECG-gated CT angiography to describe the anatomic position of coronary ostia in post-switch TGA patients guiding potential catheter interventions in this population.

Methods
All post ASO patients who underwent CT imaging between 2008–2018 were identified. Patients with complex anatomy such as double outlet right ventricle were excluded. The positions of the coronary ostia were measured in degrees from vertical on a double-oblique reconstruction in the aortic valve plane. Ostium positions were compared to those of patients with no congenital heart disease via Watson's two-sample test of homogeneity for circular data. Angular dispersion was compared between groups via the Wallraff test. P<0.05 indicated statistical significance.

Results
Of 206 adult patients with TGA and ASO followed in our adult congenital heart disease centre, 38 (18.4%) had CT imaging available for analysis during the study period (mean age 24±6.8, 75% male).
The control group consisted of 15 patients investigated for chest pain (mean age 54±15.1, 73% male). In the control group, the right and left coronary ostia arose at a mean angle of −19 and +125 degrees from vertical (figure 1a). This was significantly different to the mean ASO coronary ostia clustered at mean angles of −70 and +29 degrees from vertical (Watson p<0.001) (figure 1b, with stenosis at the left coronary anastomosis).
There was no significant difference in spread of left ostia (Rho 0.9 vs 0.99, p=0.12), but right ostia were significantly more variable in ASO patients than controls (0.71 vs 0.96, p=0.003).
Figure 1

Conclusions
Coronary ostial positions in the neo-aorta of post-ASO patients differ significantly from those of normal controls, with considerable variability, especially in right coronary position. CT can demonstrate coronary ostia in 3D space and derive appropriate tube angles to guide catheterisation in post-operative congenital cardiac patients, optimise catheter selection, reduce catheterisation tome, radiation and contrast dose.
P3663Prevalence of infective endocarditis in patients with a left-sided heart valve prosthesis: a nationwide study
Authors: Ostergaard L , Voldstedlund M , Andersen C O , Schonheyder H C , Lemming L , Valeur N , Sogaard P , Andersen P S , Skov R , Gill S , Torp-Pedersen C , Mortensen R N , Lauridsen T K , Dahl A , Kober L 
Published: October 2019

Abstract

Background
Increasing attention has been given to patients with blood stream infection (BSI) and the concurrent prevalence of infective endocarditis (IE). However, there exist a gap in knowledge on the prevalence of IE among patients with a left-sided heart valve prosthesis and BSI.

Purpose
To examine the prevalence between different BSI and IE in patients with a left-sided heart valve prosthesis.

Methods
By linking Danish nationwide registries, we were able to identify patients with a left-sided prosthetic heart valve and first-time BSI of interest (Enterococcus faecalis, Staphylococcsus aureus, streptococci species (spp.), and coagulase negative staphylococci [CoNS]) in the period of 2010–2016. Concurrent admission for IE was identified from the Danish National Patient Registry in a period of up to 14 days after the BSI.

Results
A total of 1,465 patients with BSI were included (1,319 patients with an aortic valve prosthesis [82.6% bioprosthetic] and 146 patients with a mitral valve prosthesis [48.6% bioprosthetic]). Among the included patients, 244 had E. faecalis (median age: 78.3 years, 77.0% male), 301 had S. aureus (median age: 76.9 years, 69.1% male), 401 had streptococci spp. (median age: 78.0 years, 69.1% male) and 519 had CoNS (median age: 76.4 years, 64.2% male). The percentage of patients with a diagnosis of IE in relation to the BSI was 44.3%, 33.6%, 34.4%, and 7.9% for E. faecalis, S. aureus, streptococci spp., and CoNS, respectively. No difference in the overall results was seen by type of valve prosthesis, sex, or age group.
Percentage of patients with endocarditis

Conclusion
In patients with a left-sided heart valve prosthesis, IE was diagnosed in almost half of the patients with E. faecalis, in 1/3 with S. aureus or streptococci spp. and in 1 in 12 with CoNS BSI. Future studies may try to explain why some microbes are more likely to cause prosthetic heart valve endocarditis, than others are.
P3673Electroanatomical mapping of right atrium in patients with pulmonary hypertension
Authors: Fingrova Z , Havranek S , Ambroz D , Jansa P , Linhart A 
Published: October 2019

Abstract

Introduction
Atrial fibrillation (AF) and related atrial tachycardia (AT), including cavotricuspid isthmus dependent atrial flutter (AFL), are a known complication of pulmonary hypertension (PH). Catheter ablation is an established method of treatment of selected patients with heart rhythm disorders. The aim of the work was to evaluate arrhythmogenic substrate in the right atrium (RA) of the group of patients who underwent catheter ablation with electroanatomical mapping.

Methods
The findings in electroanatomical mapping with contact force of RA were evaluated in a group of 22 patients (16 men, median and scattering age 73, range 45–87 years) indicated for catheterization ablation for AFL or other right-sided AT. During electroanatomical mapping, 8 patients had sinus rhythm and 14 patients had AF or AT (all AT with cycle length under 350 ms). Areas with reduced atrial electrogram voltages (AEGM) <0.1 mV in sinus rhythm or <0.04 in AF or AT, existence of double and fragmented potentials were identified.

Results
Out of the 22 patients, 3 patients had hypoxic PH, 13 individuals had chronic thromboembolic PH (7 undergoing surgical treatment) 4 patients had idiopathic PH and 2 patients had combined PH. The median mean pulmonary arterial pressure was 44 (range 22 - 72) mmHg. The median RA CARTO volume was 225 (range 151–383) ml. Out of all patients, 2 subjects manifested scattering of the surface proportion RA with a defined reduced voltage over 10% (maximum 15%).
Six subjects had surface proportion with defined reduced voltage in interval 1–9% and 14 subjects had scattering below 1% of total surface area of RA. The predominant localizations of pathological AEGMs was the area adjacent to the vena cava superior and posterior portion of RA between caval veins. Regular finding in patients following surgical treatment of thromboembolic PH was a scar after atriotomy.
Arrhythmogenic substrate in right atrium

Conclusion
Dilatation of RA is present in all PH patients. However, the proportion of tissue with reduced AEGM voltage in RA does not appear to be extensively high in this population.
P3682Myocardial structural abnormalities in nonischemic patients presenting with ventricular arrhythmias
Authors: Dello Russo A , Della Rocca D , Gasperetti A , Casella M , Basso C , Bianchini L , Fassini G , Riva S , Moltrasio M , Ribatti V , Tundo F , Zucchetti M , Carbucicchio C , Natale A , Tondo C 
Published: October 2019

Abstract

Background
The diagnosis of concealed cardiomyopathies in patients with ventricular arrhythmias (VAs) is one of the major challenging issues faced by physicians.

Purpose
We aimed at reporting the cardiomyopathic substrate in patients with recurrent arrhythmias of ventricular origin.

Methods
Consecutive patients with unexplained VAs underwent a complete diagnostic work-out, including endomyocardial biopsy (EMB).

Results
Ninety-seven patients were enrolled (76.3% male, age 39.7±13.3 yrs). The presenting arrhythmic manifestation was aborted cardiac arrest in 30 (30.9%) patients, sustained ventricular tachycardia (VT) in 9 (9.3%), nonsustained VT in 15 (15.5%) and frequent premature ventricular complexes in 43 (44.3%). Overall, 350 biopsies were collected (3.6/patient). The incidence of procedure-related complications was 5.1% (n=5): 4 major complications (1 rupture of a tricuspid chorda tendinea w/o hemodynamic impairment, 1 dissection of right external iliac artery treated with stent, 1 thrombotic occlusion of left superficial femoral artery which required surgical treatment, 1 TIA) and 1 minor complication (groin hematoma) occurred. The final diagnosis was arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) (n=41; 42.3%), followed by myocarditis (n=20; 20.6%), dilated cardiomyopathy (n=6; 6.2%), cardiac sarcoidosis (n=6; 6.2%), and myocarditis in ARVD/C (n=5; 5.1%). Among the 25 patients whose final diagnosis was consistent with myocarditis, an acute stage of the disease was documented in 7 (7.2%), while a chronic myocarditis in 18 (18.5%). Additionally, according to medical history and diagnostic workout, in 2 of the 6 patients the dilated cardiomyopathy had a likely post-inflammatory etiology. Absence of myocardial abnormalities was documented in 15 (15.5%) patients: this group included 1 case of methadone-induced torsade de pointes. The remaining 4 (4.1%) patients were diagnosed with a cardiac hypertrophy (n=2, 2.1%, secondary to exercise or Fabry disease), a dilated mitochondrial cardiomyopathy (n=1, 1.0%), a dilated cardiomyopathy in Emery-Dreifuss muscular dystrophy (n=1; 1.0%).

Conclusion
In our series, approximately 45% of patients with unexplained VAs had a final diagnosis of ARVD/C.
P3694Discordant criteria in moderate aortic stenosis patients: prognostic implications
Authors: Pio S M , Amanullah M R , Sin K Y , Ajmone Marsan N , Ding Z P , Ewe S H , Delgado V , Bax J J 
Published: October 2019

Abstract

Background
The frequency of discordant mean valve gradient (MG) and aortic valve area (AVA) in patients with moderate aortic stenosis (AS) has not been investigated.

Objectives
Determine the occurrence of discordant gradient in patients with moderate AS (defined by MG <20 mmHg), and how these patients compare with concordant gradient moderate AS (MG >20 mmHg) in terms of patients' characteristics and the impact on long term prognosis.

Methods
Based on the echocardiographic findings at the time of diagnosis of moderate AS (valve area >1.0 and ≤1.5 cm2), they were re-classified into discordant or concordant gradients, MG <20 mmHg or >20 mmHg, respectively. The clinical endpoint was all-cause mortality.

Results
Of 522 patients with moderate AS, 95 (18.2%) had discordant gradient moderate AS (MG <20 mmHg). Patients with discordant mean gradient were older, had higher prevalence of previous myocardial infarct, larger left ventricular (LV) end-diastolic volume index, lower LV ejection fraction (EF), stroke volume index and higher LV filling pressure. Compared to patients with concordant gradients, these patients had higher mortality rates (57.9% vs 46.6%, p=0.05) and lower aortic valve replacement rates (33.7% vs 54.9%, p<0.001) during a median follow-up of 6.2 [IQR 3.2–9.0] years. The results of Cox regression analysis are shown on the table.
Cox proportional hazard analysis All-cause mortality Univariate analysis Multivariate analysis Hazard ratio (95% CI) P value Hazard ratio (95% CI) P value Age (per 1 year increase) 1.05 (1.03–1.06) <0.001 1.04 (1.02–1.06) <0.001 Diabetes (yes/no) 1.34 (1.03–1.74) 0.031 1.33 (0.97–1.82) 0.072 Previous myocardial infarction (yes/no) 1.73 (1.29–2.34) <0.001 1.01 (0.70–1.46) 0.980 eGFR <60 ml/min/1.73m2 (yes/no) 2.15 (1.68–2.76) <0.001 1.71 (1.25–2.33) 0.001 Left ventricular hypertrophy (yes/no) 1.74 (1.31–2.30) <0.001 1.50 (1.07–2.09) 0.018 Indexed LA volume (per 1 mL/m2 increase) 1.005 (1.001–1.009) 0.008 1.006 (1.001–1.012) 0.040 Tricuspid regurgitation >moderate (yes/no) 2.02 (1.29–3.16) 0.002 1.36 (0.73–2.54) 0.337 Discordant moderate AS (yes/no) 1.81 (1.34–2.45) <0.001 1.42 (1.01–2.01) 0.049 AS, aortic stenosis; CI, confidence interval; eGFR, estimated glomerular filtration rate; HR, hazard ratio; LA, Left atrial.

Conclusion
Discrepant aortic mean gradient in moderate AS is not uncommon and occurs more often in older patients, with higher LV filling pressure and lower EF and stroke volume index. The lower gradient values lead to underestimation of AS severity, and is associated with greater cardiac extra-valvular damage and higher mortality.
P3696Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: an echocardiographic and computed tomography study
Authors: Altes A , Sochala M , Attias D , Dreyfus J , Toledano M , Macron L , Renard C , Truffier A , Guerbaai R A , Ennezat P V , Graux P , Tribouilloy C , Marechaux S 
Published: October 2019

Abstract

Background
Acceleration time to ejection time ratio (AT/ET) prolongation is associated with increased mortality in patients with aortic stenosis (AS).

Purpose
To identify the determinants associated with increased AT/ET.

Methods
The relationships between AT/ET ratio, clinical and Doppler echocardiographic variables of interest in the setting of AS were studied in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (EF), with Computed Tomography – Aortic Valve Calcium (CT-AVC) score studied in a subgroup of 342 patients.

Results
In univariate analysis, AT/ET ratio did correlate with aortic peak velocity (Vmax, r=0.57, p<0.0001), mean pressure gradient (MPG, r=0.60, p<0.0001), aortic valve area (AVA, r=−0.50, p<0.0001) and CT-AVC score (r=0.24, p<0.0001). An AT/ET ratio had a good accuracy to predict an aortic peak velocity ≥4 m/s, a MPG≥40 mmHg, or an AVA≤1.0 cm2, with an optimal cut-off value of 0.34. By multivariate linear regression analysis, presence of AS-related symptoms, decreased LV stroke volume index, LVEF, systolic blood pressure (SBP), absence of diabetes mellitus, and increased LV mass index, relative wall thickness, and Vmax were independently associated with increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC, CT-AVC score was independently associated with increased AT/ET ratio (P<0.05).

Conclusion
AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond hemodynamic and anatomic severity of AS influence AT/ET ratio including LV geometry, function and SBP. These findings should be considered when assessing AT/ET in patients with AS and preserved LVEF.

Acknowledgement/Funding
Local funding
P3697A reappraisal of bioprosthetic aortic valve failure related to structural valve degeneration
Authors: Le Tourneau T , Cueff C , Guerma L , Guimbretiere G , Piriou N , Warin-Fresse K , Capoulade R , Serfaty J M , Veziers J , Senage T , Roussel J C 
Published: October 2019

Abstract

Background
Structural valve degeneration (SVD) remains a major complication of aortic bioprostheses.

Purpose
We aimed to assess the mode of SVD leading to bioprosthetic aortic valve failure (BVF) in a large series of patients.

Methods
Between 2010 and 2017, we prospectively enrolled 261 consecutive patients with BVF related to SVD. All patients underwent a clinical work-up. Explanted bioprostheses were analysed for assessing the mechanism of SVD.

Results
The delay from surgery to SVD diagnosis was 8.5±3.3 (1.7 to 21.4) years, 10 years after exclusion of a specific type of bioprosthesis. Of the 261 SVD patients, 150 (57%) had mainly a stenotic type, and 111 (43%) a regurgitant type. In regurgitant SVD bioprosthesis was more frequently porcine (19 vs 7%, P=0.002), prosthesis diameter was larger (23.2±2.5 vs 21.6±1.9 mm; P<0.0001), severe mismatch was less frequent (6 vs 17%, P=0.005), cardiovascular risk factors and especially diabetes, obesity and hypertension were less frequent, patients were more often in NYHA class 3–4 (64 vs 49%; p=0.015), Nt-pro BNP was significantly higher (P<0.0001), and diuretic treatment was more frequent (73 vs 61%, P=0.04). Bioprostheses were explanted during redo surgery in 112 (43%) patients. Of these 112 bioprostheses, moderate to severe calcifications were present in 94 (83.9%) and was the main cause of either stenotic (n=64, 57.1%) or regurgitant SVD. A cusp tear (n=46) accounted for 41.1% of the explanted SVD. A perforation, a recent thrombus or a delamination process were occasionally identified. Structural degeneration developed with minimal calcification in 18 (16.1%) bioprostheses.

Conclusion
Structural valve degeneration remains a matter of concern in current practice with a mean delay of 8 to 10 years after surgery. Beside classical SVD with extensive calcification process other types of SVD can be observed with minimal calcification.
P3701Short-term decrease of left atrial size predicts clinical outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement
Authors: De Rosa R , Murray M.-I , Schranz D , Mas-Peiro S , Esmaeili A , Zeiher A M , Fichtlscherer S , Vasa-Nicotera M 
Published: October 2019

Abstract

Background
Increased left atrium (LA) size is a hallmark of severe aortic stenosis (AS) and is associated with adverse patients' cardiovascular outcome. Whether transcatheter aortic valve replacement (TAVR) may lead to a decrease in LA size is not known. Aim: We investigated whether TAVR results in a short-term decrease in LA size and whether such decrease may predict patients' clinical outcome.

Methods
104 consecutive patients with severe symptomatic AS and dilated LA undergoing TAVR were enrolled. LA volume was assessed by echocardiography before and shortly after TAVR (median time: 7 days). Composite rate of death and hospitalization for acutely decompensated heart failure (HF) was recorded and clinical status was assessed through NYHA- class evaluation at 12 months median follow-up.

Results
After TAVR, 49 patients (47%) demonstrated a decrease in LA volume. Despite a similar baseline NYHA class, patients with decrease in LA size had significant better improvement in clinical status respect to patients with unvaried LA size (NYHA post: 1.2±0.6 vs 1.8±1.1, p=0.001; NYHA reduction: −1.6±0.9 vs −0.9±1.0, p=0.002, respectively). Moreover, these patients had a significantly reduced rate of death or HF-hospitalization (4 vs 29%, p=0.001) and a significantly longer event-free-survival from Kaplan-Meier curves (p=0.003). COX regression analysis showed that, among echocardiographic parameters, decrease in LA-size was an independent predictor of clinical outcome (HR: 0.149, CI: 0.034–0.654, p=0.012).

Conclusions
The lack of decrease in LA size shortly after TAVR is associated with significantly higher rates of death and HF-hospitalization, as well as with impaired improvement in clinical status during long-term follow-up.
P3702Aortic stenosis and inappropriate myocardial hypertrophy: is there a difference related to gender?
Authors: Bettega M , Rosa V E E R , Accorsi T A D A , Cordeiro Fernandes J R C F , Spina G S P , Sampaio R O S , Santis A S A L , Tarasoutchi F T 
Published: October 2019

Abstract

Introduction
Degenerative aortic valve presents distinct patterns according to gender. Inappropriate myocardial hypertrophy in response to severe aortic stenosis (AS) and their clinical repercussions is of recent interest.

Purpose
To evaluate the influence of gender on the pattern of ventricular remodelling in patients with AS and inappropriate ventricular hypertrophy.

Methods
Retrospective study, analysing clinical and echocardiographic characteristics of 145 patients, between 2008 and 2018, with severe aortic stenosis and inappropriate ventricular hypertrophy, defined as septal wall thickness greater than 14 mm.

Results
Women were 42% of the patients, with higher mean age compared to men (75.23±12.78 vs 70.01±12.59 years, p=0.01), lower body surface (1.68±0.17 vs 1.94±0.68 m2, p=0.004), lower ventricular volumes (94.33±32.88x3856±23.81 vs 122.68±43.24x50.34±28.10 ml/m2, p<0.001), increased LV wall thickness (0.65±0.19 vs 0.58±0.10, p<0.001). There were no differences in LV mass (163.22±37.92 vs 170.51±39.08g, p=0.26), septal wall thickness (16.08±1.63 vs 15.71±1.02mm, p=0.24), posterior wall thickness (13.35±1.63 vs 13.67±1.58mm, p=0.23), left ventricular ejection fraction (61.31±10.36 vs 58.92±10.33%, p=0.17), indexed aortic valve area (0.41±0.10 x 0.39±0.08 cm/m2, p=0.23), medium transaortic gradient (57.50±16.42 x 55.08±17.11mmHg, p=0.39), BNP (896.28±1432.44 x 591.09±1007.71pg/ml, p=0.365) and troponin I (7.17±26.36 x 1.01±2.64 mcg/L, p=0.29). The difference between the septum and posterior wall indexed to the body surface was significantly higher in women (1.60±1.06 x 1.10±0.83 mm/m2, p=0.02), as well as the septal wall thickness indexed by the body surface (9.60±1.40 x 8.48±1.30 mm/m2, p<0.001).

Conclusions
Septal wall thickness indexed by body surface and difference between septum and the posterior wall in ventricles with smaller volumes suggest that myocardial hypertrophy in response to severe AS is more severe in women than in men. Since inappropriate myocardial hypertrophy is a predictor of outcomes in AS, it is possible that the optimal timing for valve replacement should be earlier in women.
P3703Frequency of undiagnosed atrial fibrillation in patients presenting with acute ischemic cerebrovascular stroke
Authors: Hassan Abdelnabi M , Almaghraby A , Oz T , Saleh Y , Badran H 
Published: October 2019

Abstract

Introduction
Acute ischemic cerebrovascular stroke (CVS) can be the first clinical manifestation of atrial fibrillation (AF), that is why large-scale screening programs for AF are currently implemented especially in individuals more than or equal 65 years old. Yet, to date, cost-effectiveness data have relied on assumptions of stroke rates observed in patients with established AF, while the true incidence rates of undiagnosed AF presenting as a stroke remain unknown.

Purpose
To estimate the incidence of patients with no history of AF who are presented with acute ischemic CVS and are found to be in AF at the time of presentation or developed atrial fibrillation during the hospital stay.

Methods
A retrospective analysis of all patients admitted with acute CVS to a tertiary care stroke specialized center in the period from 01/01/2014 till 31/12/2017.
Ischemic CVS is confirmed by either multislice computed tomography (MSCT) or magnetic resonance imaging (MRI) of the brain.
AF is documented by electrocardiography (ECG) that is made at admission or during hospital stay. Patients with history of AF on rate or rhythm-control therapy were excluded from the study.

Results
Of the 3299 patients admitted by acute ischemic CVS, 707 (21.43%) patients had history of AF and they were on medical rate or rhythm control therapy and thus were excluded from the study.
Of the remaining 2592 patients eligible for the study, 1666 (64.27%) were males with a mean age of 56.06 years (±16.01).
Regarding ECG, 2313 (89.24%) patients were in sinus rhythm and other non-AF rhythms and 211 (8.14%) presented with AF rhythm and 68 (2.62%) developed AF during their hospital stay with a cumulative incidence of (10.76%).
Table 1. Baseline patient characteristics and ECG data (n=2592) Risk factors n=2592 Hypertension 1849 (71.33%) Diabetes Mellitus 925 (35.69%) Smoking 1445 (55.75%) ECG data   Non-AF 2313 (89.24%)   AF on admission 211 (8.14%)   AF in hospital 68 (2.62%)   Total AF 279 (10.76%)
Undiagnosed AF in acute ischemic CVS

Conclusion
The incidence of undiagnosed atrial fibrillation in patients presented with acute cerebrovascular stroke is significantly high. Implementation of good screening programs can significantly reduce the risk of disabilities and morbidities.