bluuebunny/crossref_metadata_2025_split huggingface dataset:
4306Hemodynamic correlates of tricuspid annular pulmonary systolic excursion (TAPSE)/systolic pulmonary arterial pressure (SPAP) ratio in heart failure with reduced ejection fraction
Authors: Bandera F , Ghizzardi G , Agnifili M , Pizzocri S , Boveri S , Alfonzetti E , Saviano M , Giammarresi A , Bedogni F , Guazzi M 
Published: October 2019

Abstract

Background
The TAPSE/SPAP ratio has gained a role as an easy-to-use surrogate of right ventricle-to-pulmonary circulation (RV-PC) coupling, showing a strong prognostic significance in heart failure (HF) patients. The hemodynamic determinants of TAPSE/SPAP ratio, as assessed by invasive approach, have not been fully elucidated.

Aim
To identify the right heart hemodynamic variables correlated with TAPSE/SPAP in a HF with reduced EF (HFrEF) cohort, at rest and during exercise.

Methods
24 HFrEF patients (age 67±11 years LV EF 27±7) underwent to rest and exercise echocardiography and performed right heart catheterization within 24 hours. Bivariate correlations between TAPSE/SPAP ratio (at rest and exercise), right heart hemodynamic variables, RV systolic function and NTproBNP have been explored.

Results
TAPSE/SPAP ratio at rest showed a moderate correlation with pulmonary artery wedge pressure (PAWP: r=0.432; p=0.039), pulmonary artery pressures (PAP systolic: r=0.474; p=0.026; PAP diastolic: r=0.434; p=0.043; mPAP: r=0.476; p=0.025), pulmonary vascular resistance and compliance (r=0.475; p=0.041), while a stronger correlation was identified with right atrial (RAP systolic: r=0.571; p=0.017; RAP diastolic: r=0.675; p=0.006) and right ventricular pressures- in particular diastolic ones (RVP systolic: r=0.584; p=0.004; RAP diastolic: r=0.646; p=0.002). No significant correlation was found with NTproBNP and RV 3D EF. Exercise TAPSE/SPAP ratio significantly correlated with right atrium (RAP systolic: r=0.564; p=0.036) and right ventricle systolic pressures only (RVP systolic: r=0.765; p<0.001).
TAPSE/PAPS correlation graphics

Conclusions
TAPSE/SPAP ratio at rest showed a stronger correlation with invasively derived diastolic right heart pressure rather than pulmonary vascular bed pressures. A similar correlation was also observed for exercise TAPSE/SPAP ratio. This tight correlation with RV, rather than vascular pressures, supports the significance of the ratio as a marker of RV adaptation to vascular overload.
P3097Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction
Authors: Backhaus S J , Kowallick J T , Stiermaier T , Lange T , Koschalka A , Navarra J L , Lotz J , Kutty S , Bigalke B , Gutberlet M , Hasenfuss G , Thiele H , Eitel I , Schuster A 
Published: October 2019

Abstract

Background
Data on sex-specific outcomes following myocardial infarction (MI) are inconclusive with some evidence suggesting association of female sex and increased major adverse clinical events (MACE). Since underlying mechanisms remain elusive, we aimed to quantify the underlying phenotype using cardiovascular magnetic resonance (CMR) quantitative deformation imaging and tissue characterisation.

Methods
Amongst 8 centres across Germany, 795 ST-elevation MI (STEMI) patients underwent post-interventional CMR imaging. CMR feature-tracking (FT) was performed in a blinded core-laboratory. Left ventricular function was quantified using ejection fraction (LVEF) and global longitudinal/circumferential/radial strains (GLS/GCS/GRS). Left atrial function was assessed by reservoir (εs), conduit (εe) and booster pump function (εa). Tissue characterisation included infarct size (IS), microvascular obstruction (MO), area at risk and myocardial salvage index (MSI). Primary endpoint was the occurrence of major adverse clinical events (MACE) within 1 year.

Results
Female sex was associated with increased MACE (HR 1.96, 95% CI 1.13–3.42, p=0.017) but not independently of baseline confounders (p=0.526) with women being older, more often diabetic and hypertensive (p<0.001) and of higher Killip-class (p=0.010). Tissue characterisation was similar between sexes. Women showed impaired atrial (εs p=0.011, εe p<0.001) but increased systolic ventricular mechanics (GLS p=0.001, LVEF p=0.048). Ventricular strain was associated with MACE irrespective of all univariate significant baseline characteristics (GLS HR 1.08, 95% CI 1.01–1.16, p=0.036 and GCS HR 1.07, 95% CI 1.00–1.14, p=0.040).

Conclusion
Atrial function is reduced in women following STEMI, while ventricular systolic function is increased. This may reflect ventricular diastolic failure with systolic compensation, which is independently associated with MACE and may add to sex-specific prognosis evaluation.

Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
P3106Atrial fibrillation is not associated with the responses to exercise training in heart failure patients with preserved ejection fraction
Authors: Hamazaki N , Masuda T , Kamiya K , Matsuzawa R , Nozaki K , Ichikawa T , Tabata M , Maekawa E , Fukaya H , Yamaoka-Tojo M , Matsunaga A , Ako J 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is known as a common arrhythmia in heart failure patients with preserved left ventricular ejection fraction (HFpEF). Several studies have reported that HFpEF patients with AF show lower exercise tolerance and poorer prognosis as compared with those with sinus rhythm (SR). On the other hand, exercise training is documented to improve peripheral muscle function and exercise tolerance in HFpEF patients. However, the relationship between AF status and outcomes due to exercise training is still unclear in these patients.

Purpose
We aimed to investigate the influence of AF on the responses to outcomes with exercise training in HFpEF patients.

Methods
We studied 426 patients with HFpEF who received 5-month cardiac rehabilitation including exercise training during hospitalization and after hospital discharge. As clinical characteristics, we obtained body mass index, disease aetiology, comorbidity conditions, blood examination and echocardiographic variables from medical records. We also measured isometric quadriceps strength (QS) and 6-minute walk distance (6MWD) as peripheral muscle strength and exercise tolerance, respectively. The QS and 6MWD were assessed at hospital discharge as the baseline and 5 months later. AF status was determined by the presence on electrocardiogram at baseline 6MWD or medical history of AF during hospitalization. In statistical analysis, we compared baseline clinical characteristics, QS and 6MWD between the rhythm status (SR group or AF group). We also examined the changes in QS and 6MWD from baseline to the 5-month observation period (ΔQS and Δ6MWD) and compared them between the 2 groups using analysis of covariance with adjustment for baseline clinical confounding factors.

Results
At baseline, 289 patients (68%) were in SR, and 111 patients (26%) had AF. The AF was associated significantly with older age (P<0.001) and lower levels of estimated glomerular filtration rate (P=0.013), QS (P<0.001) and 6MWD (P<0.001) at baseline. The QS increased significantly from 25.2±11.0 kg at baseline to 30.8±13.0 kg after 5-month cardiac rehabilitation in the SR group, and from 21.1±8.3 kg to 26.0±9.4 kg in the AF group (P<0.001, respectively). The 6MWD also increased significantly from 394.8±129.2 to 463.5±133.5 meters in the SR, and from 343.7±107.9 to 403.0±114.5 meters in the AF (P<0.001, respectively). There were no significant differences in ΔQS and Δ6MWD between the SR and AF groups even after adjustment for clinical confounding factors including baseline QS or 6MWD (Figure).

Conclusions
The AF status in HFpEF patients was associated with older age, lower peripheral muscle function and also lower exercise tolerance at baseline, but not associated with the responses to exercise training.

Acknowledgement/Funding
JSPS KAKENHI JP16K16442
P3109Coronary vulnerable plaque development is promoted by multidirectional wall shear stress
Authors: Hoogendoorn A , Kok A M , Hartman E M J , Chiastra C , Casadonte L , Coenen A , Korteland S , Van Der Heiden K , Gijsen F , Duncker D J , Van Der Steen A F W , Wentzel J 
Published: October 2019

Abstract

Aim
Wall shear stress (WSS) has been widely associated with plaque development and destabilization. However, the multidirectionality of WSS, induced by the pulsatile nature of blood flow in combination with the arterial geometry, is rarely taken into account. The purpose of this study was to investigate the influence and predictive value of five (multidirectional) WSS parameters for coronary plaque progression and composition.

Methods
Familial hypercholesterolemic pigs (n=10, castrated male, 3 years old) were put on a high-fat diet and underwent imaging (near infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), optical coherence tomography (OCT) and CT) of the three main coronary arteries at baseline and 10/12 months follow-up. IVUS-based lumen contours were combined with the centerline of artery as extracted from CT to obtain a 3D reconstruction of the coronary artery. Local flow velocity measurements were combined with the 3D-geometry of the coronary arterial lumen to calculate five multidirectional WSS parameters including: time average wall shear stress (TAWSS), oscilatory shear index (OSI), relative residence time (RRT), trans wall shear stress (TransWSS), cross flow index (CFI). For the analysis, arteries were divided into 3mm/45° sectors (n=3627). Per vessel each segment was classified as low, mid or high for each WSS metric based on the average value in the sector. Changes in wall thickness (WT) and plaque composition were assessed with NIRS-IVUS and OCT, and histology and related to the local (multidirectional) WSS.

Results
Half of the pigs developed lumen intruding, complex, lipid-rich plaques. In these pigs, coronary segments exposed to low baseline levels of TAWSS exhibited a significantly larger plaque growth per month compared to regions with either mid or high TAWSS (p<0.05, see figure). Furthermore, plaque growth correlated positively with the multidirectional WSS metrics OSI, RRT and CFI, with high multidirectionality resulting in the largest plaque growth (see figure). The positive predictive values (PPV) of the WSS metrics for plaque presence (WT>0.5mm) at follow up were 50% (low TAWSS), 48% (high OSI), 49% (high RRT), 47% (high CFI) and 43% (high transWSS). The PPVs for the presence of a fibroatheroma observed with histology were 61% (low TAWSS), 58% (high OSI), 61% (high RRT), 59% (high CFI) and 49% (high transWSS).
Plaque growth vs. multidirectional WSS

Conclusions
This study shows that both low and multidirectional WSS promote the development of large and complex coronary atherosclerotic plaques with vulnerable characteristics. The high predictive values for fibrous cap atheroma development demonstrate the potential of multidirectional WSS metrics as a predictive clinical marker for vulnerable disease.

Acknowledgement/Funding
ERC- starter grant (grant agreement 310457)
P3110Tyrosine kinase inhibitor nilotinib increases atherosclerosis burden in ApoE knock-out mice
Authors: Detriche G , Zhang Y , Esposito B , Rea D , Messas E , Mirault T , Ait Oufella H 
Published: October 2019

Abstract

Background
In 2001, imatinib, the 1st generation tyrosine kinase inhibitor (TKI), dramatically improved the treatment and survival of the patients with chronic myeloid leukemia (CML). However, the emergence of imatinib-resistant patients led to the development of 2nd generation TKIs. Nilotinib demonstrated increased efficacy to control CML disease over imatinib and is now recommended as first-line therapy. But arterial occlusive adverse events (AOE) occurs in patients treated with nilotinib and not with imatinib. Mechanisms leading to AOE with nilotinib is not well understood. AOE are dominated by ischemic heart disease and lower extremity arterial disease. Moreover, we demonstrated that CML patients with cardiovascular risk factors are at high risk to rapidly develop AOE with nilotinib.

Purpose
To evaluate the impact of nilotinib in a pre-clinical model of atherosclerosis.

Methods
ApoE Knock-Out mice (8-week-old) were treated with either placebo (N=10), imatinib (IMA) 200mg/kg/day (N=10) or nilotinib (NILO) 100mg/kg/day (N=10) by daily feeding and a high-fat diet for 12 weeks. Heart and aorta were harvested after sacrifice, for histology staining and immunochemistry. Splenocytes were cultured from collected spleens, and Interleukin (IL) 12p70 and IL10 measured by ELISA.

Results
Mice treated with nilotinib showed an increase of atherosclerotic plaque size at the aortic sinus level: 462.1x103 μm2 vs. 344.4x103 μm2 with imatinib or 394.9x103 μm2 with placebo (p<0.05) and at the thoracoabdominal aorta level (p<0.05). Plaques had greater infiltration of macrophages: 33.0±3.4% with nilotinib vs. 7.3±1.3% with imatinib and 12.6±1.1% with placebo (p<0.001) and a larger necrotic nucleus 33.0±3.4% with nilotinib vs. 7.3±1.3% with imatinib or 12.6±1.1% with placebo (p<0.001). Nilotinib modulated the systemic immune response by increasing IL-12p70 and by decreasing IL-10 production by splenocytes after stimulation by LPS-IFNγ whereas IL10 increase was observed with imatinib.
Plaque size (aortic sinus)

Conclusion
Nilotinib has a pro-atherogenic effect in a pre-clinical model of atherosclerosis and increases the monocyte/macrophage pro-inflammatory response. Further experiments are required to identify pathways activated by nilotinib.
P3114Protective effect of SOCS1-based therapy in experimental abdominal aortic aneurysm
Authors: Bernal Uribe S , Lopez-Sanz L , Melgar A , La-Manna S , Jimenez-Castilla L , Prieto I , Martin-Ventura J L , Blanco-Colio L , Gomez-Guerrero C 
Published: October 2019

Abstract

Introduction
Abdominal aortic aneurysm (AAA) is a multifactorial vascular disease characterized by chronic inflammation, oxidative stress and proteolytic activity in the aortic wall, which contribute to extracellular matrix degradation and aortic dilation. Altered expression and activation of Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway have been implicated in several cardiovascular diseases including atherosclerosis and aneurysm formation. Suppressors of cytokine signaling (SOCS) are key negative regulators of JAK/STAT pathway and have been considered an attractive target for therapeutic intervention.
AIM
We hypothesize that SOCS1 protein could influence AAA development by inhibiting JAK activity and, consequently, STAT activation and target gene expression. Therefore, this study investigates the effect of a SOCS1-derived synthetic peptide in a rodent model of AAA and in cultured vascular smooth muscle cells (VSMC).

Methods
Experimental AAA was induced in C57BL/6 mice (males, 12 weeks old) by transient elastase perfusion of the aorta. Mice were randomly divided into control (vehicle, i.p.) and treatment (SOCS1 peptide, 3 mg/kg/day, i.p.) groups. Fourteen days after AAA induction, mice were sacrificed, and aorta segments were collected for histology (n=10/group) and mRNA and protein expression analysis (n=8/group).

Results
Compared to the AAA control group, SOCS1-treated mice exhibited a significant decrease in aortic diameter (68±6% vs. control; p<0.005) and aortic wall thickness, (67±3% vs. control; p<0.001). Histological analyses of aortic tissues showed a higher content of VSMC (α-actin) along with reduced leukocyte infiltration (macrophages, neutrophils and T-cells) and oxidative stress markers (superoxide anion and 8-hydroxyguanosine) in SOCS1-treated mice. SOCS1 therapy also attenuated the gene expression of inflammatory cytokines (CCL2, CCL5, TNF, IFNγ) and matrix metalloproteinases (MMP2, MMP9) in aortic lesions, and altered the expression levels of macrophage M1 (ArgII, iNOS) and M2 (ArgI, CD206) polarization markers. In vitro experiments in murine VSMC revealed that SOCS1 peptide prevented the expression of cytokines and chemokines induced by non-toxic dose of elastase (5 ug/ml, 24 hours). Effects of SOCS1 treatment were accompanied by a reduction in STAT1 and STAT3 phosphorylation and gene expression, both in AAA lesions and cultured VSMC.

Conclusion
Our results suggest that SOCS1 peptide presents protective effects in experimental AAA by suppressing JAK/STAT pathway-mediated inflammation.

Acknowledgement/Funding
MINECO-FEDER (SAF2015-63696-R), ISCII (FIS-FEDER PI17/01495), Spanish Society of Arteriosclerosis.
P3129Rheumatic heart diseases screening in Bornean Malaysia: a pilot echocardiography study
Authors: Foo J H , Chong W L , Azizan Bin Abdullah M O H D , Yen C H , Liew S F , Chu C M , Ma K F , Ng K C , Liew H B 
Published: October 2019

Abstract

Background
Rheumatic heart disease is a major public health issue in developing countries including Malaysia. RHD is a preventable disease. Early detection and appropriate treatment may decrease the disease burden to the society. Rheumatic heart disease screening using portable echocardiography may improve early detection among school children in vulnerable community. This is a pilot study of rheumatic heart disease screening using Vscan among primary school students in the Bornean state of Sabah Malaysia.

Purpose
To evaluate the resources required for RHD screening, prevalence of RHD among school children and awareness among the parents and teachers.

Methods
A cohort of 211 students from a primary school were recruited in 2017–2018. Parental consents were obtained. Seven sessions were conducted at the school. Echocardiography was performed by 2–3 experienced ultrasonographers. Image interpretation as per the 2012 WHF RHD echocardiographic diagnostic criteria.

Results
Of the 211 students, 50% female, age range 7–12 year-old. Ethnic groups include Kadazandusun (87%), Rungus (2.4%), Lundayeh (2%), Chinese (2%). Overall, the average number of student scanned was 4.6 students/device/hour. There was a learning curve observed, whereby initial session only scanned 2 students/device/hour which improved to a maximum of 5.9 students/device/hour. Preliminary findings noted probable RHD among 36% (n=76) of screened subjects. Incidental diagnosis of congenital heart disease among 5 students. The suspected RHD cases were referred for formal echocardiography in the tertiary centre for confirmation. Thus far, 12 students were diagnosed with borderline RHD; the main diagnostic criteria in these cases were at least two morphological features of RHD of the MV without pathological MR or MS. Secondary prophylaxis with antibiotic, dental hygiene and patient education were given.

Conclusion
This is a pilot RHD screening using portable Vscan echocardiography among primary school students in Malaysia. Our study showed it is feasible to conduct RHD screening in the field using portable Vscan. The number of students screened improved with practice. Our preliminary finding suggest RHD is prevalent in this population in Sabah, Malaysia.
P3134Variations in anterior mitral valve leaflet restriction that may lead to the erroneous diagnosis of rheumatic heart disease
Authors: Hunter L D , Monaghan M J , Lloyd G , Snyman H W , Pecoraro A J K , Doubell A F , Herbst P G 
Published: October 2019

Abstract

Introduction
Anterior mitral valve leaflet (AMVL) restriction is a prominent morphological feature of rheumatic heart disease (RHD). The World Heart Federation (WHF) criteria for echocardiographic diagnosis of RHD rely on the use of colloquial terms such as “dog-leg” to define AMVL restriction rather than a strict, reproducible definition. We recognise AMVL restriction when the tip of the leaflet is seen to point away from the interventricular septum and towards the posterior left ventricular (LV) wall at peak diastole in the parasternal long axis (PSLAX) view. This definition however risks inclusion of a finding commonly identified in our high-risk screening program (Echo in Africa- EIA) which demonstrates gradual AMVL bowing (so-called “slow-bow”) from the proximal to mid-leaflet but with free motion ('fluttering') of the tip during diastole. This is in contrast to RHD-related restriction which typically involves the distal AMVL tip only. We propose that the former is a normal variant of the AMVL and is unrelated to the RHD process, provided no concomitant morphological features of RHD are identified.

Purpose
Determine the prevalence of “slow-bow” AMVL restriction between two cohorts of schoolchildren with a documented high-and low-RHD prevalence.

Methods
Retrospective analysis of EIA data obtained from children (aged 13–18) attending two separate South African schools. The high-RHD prevalence school (HR) demonstrated a 0.8% rate of WHF “definite RHD”. The low-RHD prevalence school (LR) demonstrated no cases of WHF “definite RHD”. Cases of AMVL restriction were identified and classified according to the definitions provided above.

Results
A total of 941 screening studies (HR cohort n=577 /LR cohort n=364) were evaluated. 74 cases of AMVL restriction (12.82%, 95%, CI 10.34–15.80) were identified in the HR cohort of which 8 cases demonstrated AMVL-tip restriction (1.39%, 95%, CI 0.70–2.71) and 65 cases demonstrated “slow bow” (11.27%, 95%, CI 8.94–14.11). There were no cases of AMVL-tip restriction observed in the LR-cohort and 35 cases of “slow-bow”(9.62%, 95%, CI 7–13.08).
A. “Slow bow”; B. “Distal tip restriction”.

Conclusion
Our results support the hypothesis that “slow-bow” AMVL restriction is a common variant of the AMVL amongst South African school children and unrelated to the RHD process. Further research is required to investigate the exact mechanism underlying this form of AMVL restriction.

Acknowledgement/Funding
Edwards Lifescience EHM grant
P3137Transvenous lead extraction in patients under 30 years of age results from two high volume European centers
Authors: Jachec W , Polewczyk A , Segreti L , Bongiorni M G , Kutarski A 
Published: October 2019

Abstract

Background
Young patients are a specific group undergoing transvenous leads extraction (TLE) procedures due to different anatomy, intensive connecting tissue scar and earlier calcification.

Aim
Evaluation of results of TLE in young patients compared to adults above 30 years old
Examined Groups and Methods: 3810 patients (mean age at the time of procedure; 65,21±15,84 years old, 1301 female) who underwent TLE procedures in two high volume experienced European centers (Poland and Italy). We compared clinical and procedural factors in two groups of patients: under the age of 30 (n=172) and between 30 and 80 (n=3054) with exclusion 584 patients above 80 years old.

Results
Results are presented in Table 1.
A: p<0,05, AA; p<0,01, AAA; p<0,001, NS

Conclusion
Infective indications are less frequent in very young people. In spite of presence of simple systems in this patients the effectiveness of TLE remains lower- with documented lower rate of procedural and clinical success Young age does not influence on the appearance of major complications and procedure related death, however, the frequency of technical problems is increased due to necessity of extraction older, strongly ingrown, calcified leads. TLE in young patients is usually a big challenge and should be performed by the most experienced operators in high volume centers.