bluuebunny/crossref_metadata_2025_split huggingface dataset:
Direct oral anticoagulants versus left atrial appendage closure in elderly patients (&gt;80) with atrial fibrillation: results from a propensity matched analysis in real-life patients
Authors: Caneiro B , Raposeiras-Roubin S , Abu Assi E , Estevez-Loureiro R , Gonzalez-Ferreiro R , Bastos Fernandez G , Diego Nieto A , Cruz Gonzalez I , Rodes Cabau J , Iniguez Romo A 
Published: November 2020

Abstract

Introduction
Information comparing left atrial appendage closure (LAAC) to direct oral anticoagulation therapy (DOAC) is scarce.

Purpose
Our aim is to compare the clinical outcomes between LAAC and DOACs of an elderly population (over 80 years-old).

Methods
We retrospectively collected 1144 patients with atrial fibrillation over 80 years old from three different tertiary hospitals. 970 patients have received DOACs and 174 patients have undergone LAAC. We have performed a propensity score matching analysis (PSM), with a caliper of 0.2. After propensity score with matching analysis, 58 patients received DOACs alone and 58 patients treated with LAAC with similar baseline risk factors, comorbidities and risk scores were selected. Outcomes of DOACs and LAAC were assessed by Cox regression.

Results
Both groups had similar cardiovascular risk factors with more proportion of diabetic and hypertensive patients among LAAC group (37.4% and 90.2%, respectively vs 20.3% and 70.3%). Patients undergoing LAAC had more frequently history of bleeding, anemia or previous cancer. CHA2DS2VASC score was also significantly higher in these patients. During a median follow-up of 2.0 years (range 0.9–3.5) event rate for the combined endpoint of death, bleeding and embolic events was 24.9%. 81 embolic events were recorded (27 patients had transient ischemic attacks and 52 were diagnosed of stroke and only 2 patients with pulmonary embolism and 2 more with peripheral embolic events). 131 bleedings were recorded with 1,5% of intracranial bleeding. After propensity score matching, no differences regarding the primary composite endpoint were found (HR 1.05, 95% CI 0.15–7.51; p=0.955). Bleeding events were more frequent in LAAC group, especially during the first three months, thereafter rates become similar in both groups with no statistically significant differences (HR 1.79, 95% CI 0.73–4.41; p=0.205) (Figure 1). We calculate the time to first bleeding for LAAC 0.9±1.3 vs 1.7±1.3 on DOACs. Mortality was numerically greater in patients on DOACs (31,8%) vs LAAC (26,4%). However, this finding did not reach statistical significance (HR 0.70, 95% CI 0.33–1.47; p=0.343).

Conclusions
LAAC has no differences in terms of embolic events, bleeding events and mortality compared to DOACS in a population of elderly patients over 80 years-old. In our population, LAAC is a strategy as safe and effective as DOACs and represents an alternative to consider in real life patients older than 80 years.
Figure 1

Funding Acknowledgement
Type of funding source: None
Initial and long-term antithrombotic therapy after left atrial appendage closure with the WATCHMAN
Authors: Ledwoch J , Sievert K , Boersma L , Bergmann M , Ince H , Kische S , Pokushalov E , Schmitz T , Schmidt B , Gori T , Meincke F , Protopopov A , Betts T , Mazzone P , Sievert H 
Published: November 2020

Abstract

Background
Evidence regarding post-procedural antithrombotic regimes other than used in randomized trials assessing percutaneous left atrial appendage (LAA) closure is limited.

Purpose
The present work aimed to compare different antithrombotic strategies applied in the real-world EWOLUTION study.

Methods
A total of 998 patients with successful WATCHMAN implantation at 47 centers were available for the present analysis. The composite ischemic endpoint of stroke, TIA, systemic embolism and device thrombus as well as the bleeding endpoint defined as at least major bleeding according to BARC were assessed during an initial period (from implant until first medication change) and long-term period (from first change until up to 2 years).

Results
The antithrombotic medication chosen in the initial phase was dual antiplatelet therapy (DAPT) in 60%, oral anticoagulation (OAC) in 27%, single antiplatelet therapy (SAPT) in 7% and no medication in 6%. In the long-term phase SAPT was used in 65%, DAPT in 23%, no therapy in 8% and OAC in 4%. No significant differences were found between the groups regarding the ischemic endpoint both in the initial period (Kaplan-Meier estimated rate 2.9% for DAPT vs. 4.3% for OAC vs. 3.9% for SAPT or no therapy; p=0.97) and in the second period (4.2% for SAPT vs. 1.8% for DAPT vs. 3.5% for no therapy; p=0.36). With respect to bleeding events the only difference was found in the initial phase with a higher incidence in patients under SAPT or no therapy (1.0% for DAPT vs. 0.8% for OAC vs. 7.4% for SAPT or no therapy; p=0.01). No differences in bleeding complications were observed during the second period (2.6% for SAPT vs. 2.9% for DAPT vs. 2.2% for no therapy; p=0.88).

Conclusions
Tailored antithrombotic treatment using even very reduced strategies such as SAPT or no therapy showed no significant differences regarding ischemic complications after LAA closure.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boston Scientific
Incidence and predictors of postoperative ischaemic stroke after coronary artery bypass grafting in the United States
Authors: Mohamed W , Hirji S , Mohamed M , Percy E , Braidley P , Chung J , Aranki S , Mamas M.A 
Published: November 2020

Abstract

Background
Postoperative acute ischemic stroke (AIS) is a catastrophic complication of coronary artery bypass grafting (CABG). There is limited data on the incidence and outcomes of AIS complicating CABG in the contemporary era, and whether these have changed over the years.

Purpose
To study the incidence and outcomes of postoperative AIS in a nationally representative cohort of CABG procedures over a 12-year period and examine predictors of AIS in patients undergoing CABG.

Methods
The National Inpatient Sample was used to identify all adult patients (&gt;18 years old) who underwent CABG in the United States between January 2004 and September 2015. Multivariable logistic regression was performed to examine the associations between postoperative AIS and in-hospital mortality and identify predictors of AIS after CABG, expressed as odds ratios (OR) with corresponding 95% confidence intervals (CI).

Results
A total of 2,569,597 CABG operations were analysed. The incidence of postoperative AIS was 1.8% (n=47,279) in the overall cohort increasing from 1.2% in 2004 to 2.3% in 2015 (p&lt;0.001). Significantly higher rates of AIS were observed amongst patients with atrial fibrillation (AF) and those undergoing non-elective or concomitant valve operations over the study period (see Figure). Patient risk profiles increased over time in both AIS and no-AIS cohorts, with higher Charlson comorbidity scores observed amongst AIS patients. AIS was independently associated with increased odds of in-hospital mortality (OR 3.03, 95% CI 2.93, 3.13) and prolonged hospital stay (∼6 more days) and a higher hospitalisation cost (∼$80,000 more) (p&lt;0.001 for all). Several factors were predictors of AIS including age&gt;60 years (61–70 years: OR 1.33, 95% CI 1.29, 1.37; 71–80 years: OR 1.49, 95% CI 1.44, 1.54; &gt;80 years: OR 1.42, 95% CI 1.37, 1.48), female sex (OR 1.33, 95% CI 1.31, 1.36) and AF (OR 1.14 95% CI 1.12, 1.16) (p&lt;0.001 for all). In contrast, on-pump CABG was not an independent predictor of stroke (OR 1.01, 95% CI 0.94, 1.09) (p=0.784).

Conclusion
In this nationally representative study, we have shown that the rates of postoperative stroke following CABG have increased over time in line with complexity of patient risk profiles. The present findings emphasise the need for further work on strategies to reduce the risk of postoperative stroke after CABG.
Trends of postoperative AIS (2004-2015)

Funding Acknowledgement
Type of funding source: None
Perioperative use of renin-angiotensin system inhibitors and short-term outcomes in patients undergoing cardiac surgery
Authors: Vieira De Melo R.M , Azevedo D.C , Danziato L.N , Fernandes M.T.C.F , Alcantara L.F.C , Barbosa M.H.F , Conceicao F.S , Santos Junior S.C.R , Viana T , Figueirero C.S , Passos L.C.P 
Published: November 2020

Abstract

Background
Controversy exists about whether preoperative angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB) therapy is associated with adverse outcomes after cardiac surgery. Current guidelines stated that it is uncertain about the safety of the preoperative administration of this medications because of the potential deleterious consequences of perioperative hypotension

Purpose
To determine the effect of preoperative therapy with ACEi or ARB on short-term outcome after cardiac surgery.

Methods
Single-center prospective cohort between January 2018 and December 2019. Patients were eligible if they were submitted to elective on-pump cardiac surgery and aged ≥18 years. Patients were divided into two groups according to previous use of ACEi or ARB. All preoperative demographic, clinical, and intraoperative surgical variables were collected prospectively. Outcomes of interests were intensive care unit (ICU) mortality, incidence and duration (hours) of postoperative shock (defined as the need for intravenous vasopressors or inopressors), postoperative acute kidney injury (AKI), defined as a doubling of serum creatinine, duration of mechanical ventilation (hours) and length of stay in the ICU (days). A multivariate regression was performed for categorical outcomes and Kruskal-Wallis test for non-parametric continuous variables.

Results
353 patients were evaluated in the period, 182 (51.6%) of male sex, with a mean age of 54.5 (±14.7) and STS mortality and EURO scores of 1.93 (±1.81) and 1.89 (±1.9), respectively. Coronary artery bypass grafting was the common procedure, 168 (47.6%). After multivariate regression, use of ACEi or ARB preoperatively was associated with postoperative shock: RR: 2.03, CI 1.25–3.30, p=0.004; incidence of AKI: RR: 2.84, CI 1.01–7.98, increased length of ICU stay: 4 (3–6) vs 3 (2–5), p=0.03; and increased duration of shock: 10 (0–39) vs 0 (0–24), p&lt;0.01. There was no association with the duration of mechanical ventilation: 10.5 (6–20) vs 11.0 (5–18), p=0.31 or ICU mortality: 14 (7.3%) vs 16 (10.0%), p=0,44.

Conclusions
The use of preoperative ACEi or ARBs was associated with increased incidence and duration of postoperative shock, incidence of acute kidney injury, and durations of mechanical ventilation and ICU stay.

Funding Acknowledgement
Type of funding source: None
MIDCAB vs OPCAB for severe coronary artery disease: a comparative study
Authors: Tartanus J , Mueller X , Syburra T , Von Wattenwyl R , Cuculi F , Kobza R , Matt P 
Published: November 2020

Abstract

Background/Introduction
MIDCAB (minimally invasive direct coronary artery bypass surgery) ± PCI/DES was compared to classical “off pump” coronary artery bypass surgery (OPCAB) for the treatment of severe coronary artery disease.

Purpose
We hypothesized that MIDCAB is associated with reduced perioperative morbidity and mortality.

Methods
Preoperative and postoperative clinical data were collected prospectively in 329 consecutive patients with severe coronary artery disease undergoing either a MIDCAB procedure ± PCI/DES (MIDCAB group), n=118 patients, or classical OPCAB (OPCAB group), n=211 patients, at our institution from January 2017 to July 2019. A matched analysis using the EuroSCORE II (81 patients per group) was done.

Results
The median of EuroSCORE II was 1.05 in both groups, p=1. All MIDCAB patients underwent a left-sided mini-thoracotomy and received a single LIMA-LAD graft, OPCAB patients received median 3 distal anastomoses, p&lt;0.001. Operative time was shorter in MIDCAB patients, 160min vs. 240min, p&lt;0.001. Maximum postoperative Troponin levels were lower in MIDCAB compared to OPCAB, 105 μg/l vs. 260 μg/l, p&lt;0.001. Intubation time was shorter in MIDCAB, 7.0 h vs. 9.3 h, p=0.04, as was ICU time, p=0.02. Chest tube drainage after 24 hours was lower in MIDCAB patients, 405 mL vs. 555 mL, p&lt;0.001. Transfusions of blood, platelets and fresh frozen plasma were rarely needed. Transfusion of erythrocytes were more common in OPCAB, 19%, vs. MIDCAB, 2.5%, p=0.001. A transient neurological deficit showed one (1.2%) patient in the OPCAB group, non in MIDCAB, p=0.3. A hybrid procedure was performed in 18 MIDCAB patients (22%) and 5 OPCAB patients (6.2%). In-hospital mortality was 0% in the MIDCAB group, and 1.2% in OPCAB patients, p=0.3.

Conclusions
MIDCAB is a good and safe option to treat severe coronary artery disease. MIDCAB is not only less invasive, but associated with reduced perioperative risk compared to standard OPCAB surgery even if a hybrid procedure is needed.

Funding Acknowledgement
Type of funding source: None
Valve repair in patients with infective endocarditis
Authors: Scheggi V , Olivotto I , Alterini B , Merilli I , Starnazzi F , Ceschia N , Andrei V , Stefano P.L 
Published: November 2020

Abstract

Background
Valve repair is considered the treatment of choice for native mitral and tricuspid valve regurgitation but the rate of feasibility when the defect is caused by acute infective endocarditis (IE) is debated. We report the experience of valve repair versus replacement following IE in a high-volume surgical center.

Methods
We retrospectively analyzed 351 consecutive patients (123 women) admitted to our department with definite diagnosis of IE. IE occurred on native valves in 219 patients (62%) and on prosthetic valves in 132 (38%). Among native valves, IE involved the aortic valve in 105 cases (48%), mitral valve in 97 cases (44%) and tricuspid valve in 17 (8%). Since only native mitral and tricuspid valves are elegible for surgical repair, we limited the analysis to this subset (114 patients); of them, 92 (80.7%) underwent surgery (the final cohort) and 22 were treated conservatively, 13 due to absence of surgical indication and 9 due to prohibitive surgical risk. Long-term follow-up was obtained by structured telephone interviews. Primary endpoints were mortality and freedom from recurrent endocarditis. Secondary endpoints were the postoperative incidence of major adverse events (hospitalization for any cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence).

Results
Mean age at surgery was 61.9 years (SD 14.5). Mean vegetation length was 11.6 mm (SD 8.8). Endocarditis was left-sided in 80 (87%). Among the 92 surgical patients, 58 (63%) underwent valve replacement and 34 valve repair (37%). Mortality was similar between valve repair and replacement (15 vs 12%). Adverse events rate (19% vs 16%) and relapse were not statistically different between repair and replacement procedures.

Conclusions
The present study shows that a sizeable subgroup of consecutive patients with native mitral or tricuspid IE are amenable to valve repair in expert hands. Outcome of repair in IE is comparable to valve replacement mid-term, and should be considered whenever possible, as in degenerative valve disease.

Funding Acknowledgement
Type of funding source: None
Anticoagulation and outcomes after surgical aortic valve replacement with a biological prosthesis
Authors: Angleitner P , Zinggl M , Werner P , Coti I , Mach M , Kocher A , Laufer G , Andreas M 
Published: November 2020

Abstract

Background
No strong recommendation exists regarding the use of short-term anticoagulation after surgical aortic valve replacement (SAVR) with a biological prosthesis.

Purpose
Our aim was to analyze outcomes of patients receiving warfarin versus low-molecular weight heparin (LMWH) after isolated SAVR.

Methods
We retrospectively analyzed all adult patients who underwent surgery between 2009 and 2017 at our department (n=598). Exclusion criteria included pre-operative anticoagulation, atrial fibrillation, dialysis, previous aortic valve replacement, or active endocarditis. Patients who were discharged alive were stratified according to the type of anticoagulation (warfarin, n=332, 55.5%; LMWH, n=266, 44.5%). Long-term survival during the follow-up period was analyzed (median follow-up, 5.6 years).

Results
Patients who received warfarin had significantly lower logistic EuroSCORE and were younger (Table 1). Warfarin was more frequently utilized between 2009 and 2014, whereas LMWH was more commonly used between 2015 and 2017. Kaplan-Meier curves in Figure 1 show that patients who received warfarin had significantly superior long-term survival (log-rank test: p=0.002). Multivariable Cox proportional hazards regression analysis confirmed that the use of warfarin was associated with significantly lower risk of long-term mortality when compared with LMWH (hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.34–0.74, p=0.001). Covariables in this model included logistic EuroSCORE, era, and duration of cardiopulmonary bypass.

Conclusions
The present analysis suggests that the use of warfarin is associated with significantly superior survival after SAVR with a biological prosthesis. Our findings require validation in a prospective randomized controlled trial.
Figure 1. Kaplan-Meier survival curves

Funding Acknowledgement
Type of funding source: None
Carotid wall sublayers and their association with atherosclerosis in hypertensive subjects
Authors: Carvalho-Romano L.F.R , Bonafe R.P , Paim L.R , Marques E.R , Vegian C.F.L , Schreiber R.P , Sposito A.C , Matos-Souza J.R , Nadruz W 
Published: November 2020

Abstract

Introduction
Intimal thickening is a characteristic and initial step of atherosclerosis. Carotid intima-media thickness (IMT) is considered a measure of subclinical atherosclerosis, but it can be influenced by increases not only of intima layer thickness (IT), but also of media layer thickness (MT). Hypertension is a risk factor for atherosclerosis, but may also stimulate media layer hypertrophy by increasing artery wall tension. However, little is known regarding the measures of carotid wall sublayers and their association with atherosclerosis in hypertensive subjects.

Purpose
To measure carotid IMT, MT and IT and evaluate their relationship with carotid atherosclerotic plaques in hypertensive subjects.

Methods
This cross-sectional study evaluated clinical and carotid characteristics of 186 hypertensive patients (age = 61±11 years, 43% men, BMI = 30.6±6.2 kg/m2) followed at a university outpatient clinic. High-resolution images of common carotid arteries wall and plaques were obtained by ultrasonography equipped with 10MHz-13MHz transducers. IMT, MT and IT were measured using an image processing software.

Results
Mean IT, MT and IMT values were 0.267±0.060, 0.475±0.107 and 0.742±0.142 mm, respectively. IMT showed stronger correlation with MT (r=0.92; p&lt;0.001) than with IT (r=0.72; p&lt;0.001). Patients with carotid plaques (n=100; 58% of the sample) had higher age (p&lt;0.001) and carotid diastolic diameter (p=0.002) and a trend toward higher diabetes prevalence (p=0.06) than those without plaques. In logistic regression analysis adjusted for these variables, plaques showed stronger association with IT than with MT and IMT (Figure 1). In addition, IT showed greater area under the ROC curve (0.92; 95% CI 0.88–0.96) than IMT (0.79; 95% CI 0.72–0.85) and MT (0.64; 95% CI 0,56–0,72) to identify plaques.

Conclusions
MT is the main determinant of carotid IMT in hypertensive subjects. Conversely, IT showed stronger correlation and greater discriminatory value to identify atherosclerotic plaques than MT and IMT. These findings suggest that carotid IT may be a more accurate marker of atherosclerosis that MT or IMT in hypertensive subjects.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): CNPq
CMR fast-SENC segmental intramyocardial LV strain monitors decline in heart function before ejection fraction in patient with arterial hypertension
Authors: Montenbruck M , Kelle S , Esch S , Schwarz A.K , Giusca S , Korosoglou G , Steen H 
Published: November 2020

Abstract

Background
Left ventricular ejection fraction (LVEF) is commonly used to assess cardiac function for patients with chronic cardiac diseases. LVEF, like most systemic function assessments, detects dysfunction once enough damage has occurred to prevent common compensatory mechanisms from maintaining cardiac output. More sensitive metrics are being evaluated to more accurately identify subclinical regional dysfunction before cardiac remodeling results in changes in LVEF and global longitudinal strain (GLS). Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to standard CMR calculations (e.g. LVEF, volumes, mass, etc.) for patients with arterial hypertension in the absence of non-ischemic cardiomyopathy.

Methods
A single center, prospective registry of CMR scans acquired with a 1.5T scanner were evaluated for standard CMR calculations as well as fSENC scans. Intramyocardial LV & RV strain was quantified with MyoStrain software. Three short axis scans (basal, midventricular, & apical) were used to calculate peak strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3-, & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments.

Results
A total of 773 scans in 650 patients with arterial hypertension but without non-ischemic cardiomyopathies were included in the study. Patients had an average (± stdev) age of 64 (13) yrs and BMI of 28 (5) kg/m2; 24% diabetes mellitus, 10% atrial fibrillation, 15% pulmonary disease, and 39% coronary artery disease. Figure 1 shows a Box & Whisker's plot demonstrating the non-linear relationship between segmental fSENC strain (% of normal LV segments ≤−17%) versus LVEF. The progression of hypertensive heart disease was associated with reduction in septal circumferential contraction despite normal LVEF.

Conclusion
Segmental fSENC detects subclinical LV dysfunction in patients with early hypertensive heart disease before changes in LVEF. Evaluating segmental longitudinal and circumferential fSENC peak strain provides an alternative metric that shows consistent changes in cardiac function in patients with arterial hypertension.
Figure 1

Funding Acknowledgement
Type of funding source: None