bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1759Elevated NT-pro BNP predicts Heart Failure re-hospitalizations after an acute coronary syndrome
Authors: Martinez Rey-Ranal E , Cordero A , Moreno M J , Bertomeu Gonzalez V , Moreno Arribas J , Pomares A , Torroba G , Bertomeu Martinez V 
Published: October 2019

Abstract

Background
NT pro-BNP is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF) and, also, with acute coronary syndrome (ACS). Nonetheless, there is scarce evidence on the predictive capacity of NT pro-BNP for HF re-admission after an ACS.

Objective
To test whether elevated values of NT pro-BNP can predict subsequent hospitalizations for HF in patients discharged after an ACS.

Methods
We performed a prospective study of all patients discharged after an ACS in a single center. HF re-admission was analysed by competing risk regression, taking all-cause mortality as a competing event, and results are presented as sub-Hazard Ratio (sHR); recurrent hospitalizations were tested by negative binomial regression and results are presented as incidence risk ratio (IRR).

Results
We included 1,679 patients, mean age 70.1 (29.7) year, 71.9% males, 41.4% STEMI and mean GRACE score 151.7 (44.4). Median NT pro-BNP was 948.2 pg/ml (IQ range 274.5–2923) and patients were divided in <300U (27.0%), 300–600 pg/ml (13.4%), 600–1000 pg/ml (10.8%) and >1000 pg/ml (46.7%) A total of 132 (5.9%) died within hospitalization and follow-up was available 98% of the patients, with a median follow-up of 33 months (IQ range 16–59). A total of 220 patients (13.1%) had at least one hospital re-admission of HF and 126 (7.5%) had more than one re-hospitalization for HF. Patients with NT pro-BNP had higher un-adjusted HF re-admissions (22.2% vs. 4.4%; p<0.01). Cardiovascular mortality increased significantly in each category of NT pro-BNP (3.8%; 8.0%; 7.7%; 18.5%) as well as all-cause mortality (0.1%; 12.4%; 11.6%; 25.3%), first HF readmission (2.7%; 7.1%; 5.5%; 23.5%); patients with NT pro-BNP had higher rates of recurrent HF readmissions: 11.6/1000 vs. 2.4/1000 patients/years (p<0.01). Multivariate analyses, adjusted by age, gender, GRACE score, left ventricle ejection fraction, revascularization and medical treatments at discharge, identified that NT pro-BNP >1000 pg/ml was associated to HF re-hospitalization (sHR: 2.60 95% CI 1.12–5.95) and recurrent hospitalizations (IRR: 1.10 95% CI 1.04–1.14).

Conclusions
NT pro-BNP >1000 pg/ml is an accurate risk factor for first and recurrent HF rehospitalisations after an ACS.
P1774Genetic heterogeneity and clinical outcomes of non-compaction cardiomyopathy
Authors: Vaikhanskaya T , Kurushka T V , Sivitskaya L N , Liaudanski A , Danilenko N G 
Published: October 2019

Abstract

The clinical outcomes of non-compaction cardiomyopathy (NCM) range from mild-symptomatic to progressive HF, arrhythmias, thromboembolism, and SCD.

Objective
The genetic spectrum and clinical outcomes of verified NCM were investigated.

Methods
The study enrolled 72 unrelated pts (aged 39.2±14.1 years; 43/59.7% male; LVEF 44.7±13.2%) with morphological signs of non-compaction myocardium, confirmed by any three accepted criteria: Echo (Jenni and Stöllberger), MRI (Petersen and Jacquier). During the follow-up 59,7±16,2 months, diagnosis of NCM has been revised by supporting diagnostic elements based on clinical evidence: a family history of cardiomyopathy, coexisting neuromuscular disorders, abnormal 12-lead ECG findings, presence of arrhythmias, heart failure or thromboembolic events. After exclusion 19 cases with isolated asymptomatic and reversible (athletic/peripartum) LVNC, a group (53 persons) for NGS (174 genes) was formed. All variants considered as pathogenic and likely pathogenic were confirmed by a Sanger sequencing.

Results
Forty-nine (likely) pathogenic variants were identified in 38/71,7% carriers (gene positive pts), including 27/50,9% pts with single variant and 11/20,8% pts with complex genotypes. The most prevalent mutations involved genes were TTNtv (11), MYBPC3 (8), LMNA (4), then MYH7 (3), and two each ILK, HCN4, LAMP2, RAF1, SDHA, RYR2. One mutation is found in the genes TAZ, HADHA, ACTC1, ACTN2, MYH6, DSP, SLC25A4, FBN1, BAG3, SCN5A, TBX20. Clinical features and adverse outcomes during follow-up were compared between groups of the gene-positive and gene-negative pts.
Combined adverse clinical outcomes were taken as composite endpoints: death due to HF, SCD, HTx, life-threatening VTA (VT/VF, successful resuscitation, ICD discharges). To analyze composite endpoints, a multivariate regression analysis was performed with step-by-step exclusion. As a result, a prognostic model was constructed (R=0.89; R2=0.78; F=32.9; p<0.ehz748.05261) and independent predictors of adverse outcomes were identified: gene-positivity (β=0.45; p=0.ehz748.05261), 6MWT (β=−0.30; p=0.0002), PQ interval (β=0.23; p=0.0008), syncope history (β=0.29; p=0.ehz748.05263), mTWA (β=0.23; p=0.0005), LVDD (β=0.27; p=0.0001) and RVEF (β=−0.40; p=0.ehz748.05261). As a strongest factor of adverse outcome was gene-positivity, Kaplan-Meier survival curves were constructed. According to the Cox F-criterion (F=24.9) a high level of significance of differences to achieving combined endpoints in the groups (p=0.0001) was determined.

Conclusions
These results show that NCM is basically a genetic disease with significant heterogeneity and predominant TTNtv mutations; the patients with (likely) pathogenic variants have a worse prognosis with an increased risk for the composite end point of death, transplantation, and defibrillator implantation. Genetic evaluation is an important for prediction and subsequent management NCM pts considering genetic status.
P1784Dismal outcomes and high societal burden of mitral valve regurgitation in France in the recent era
Authors: Messika Zeitoun D , Vahanian A V , Candolfi P C , Gilard M G , Iung B I , Mesana T M , Enriquez-Sarano M E S 
Published: October 2019

Abstract

Background
Mitral regurgitation (MR) is the most common heart valve disorder worldwide. The contrast between the large burden of MR and the overall low number of performed mitral valve surgery suggest a marked undertreatment of MR patients. Large and comprehensive contemporary data assessing the management and outcome of patients with MR as well as the societal burden of the disease at the Nationwide level are currently lacking.

Methods
Based on a French mandatory administrative hospital-discharge database, we collected all admissions in France both in public and private hospitals in 2014 and 2015 with MR as primary or secondary code. Patients with infective endocarditis, congenital or rheumatic disease were excluded. Cost were calculated for patients admitted in public hospitals.

Results
In 2014–2015, 107,412 patients with MR were admitted in France in 1238 public and private hospitals; 74,098 patients (69%) presented with primary MR (PMR) and 33,314 patients (31%) with secondary MR (SMR). Overall 8,676 patients (8%) were operated on (81% PMR) within 1 year and 98,736 (92%) were conservatively managed and constituted our study population. Mean age was 77±15 years (50% were ≥80 years and 12% ≥90 years) and 53% were female. Most of the patients presented with comorbidities and Charlson Index was ≥2 in 53% of the population. In-hospital and one-year mortality were 4.1% and 14.3% respectively. Readmission were very common and one-year mortality/readmission all cause, and one-year mortality / CHF readmission rates were 67% and 34% respectively and increased with age, Charlson Index, CHF at presentation and SMR etiology but events rate remained notably high in the PMR subset (64% and 28% respectively). The total annual cost in public hospitals (initial hospitalisation and readmissions) was 325,716,311 euros. When only readmissions for heart failure were considered (43% of all readmissions), total annual cost was 202,904,869 euros.

Conclusion
In this large administrative contemporary nationwide database, 1) MR was a common reason for admission and affected an elderly population with frequent comorbidities, 2) less than 10% of patients were offered any intervention, 3) MR was associated with high mortality and readmissions rates in all subsets; 4) MR represented a major societal burden with an extrapolated annual cost between 250 and 400 million euros. These finding highlight the critical need to develop strategies to improve the overall management and outcomes of patients with both primary and secondary MR.

Acknowledgement/Funding
Edwards Lifesciences
P1785Whole exome sequencing unravels new genes associated with mitral valve prolapse
Authors: Van Wijngaarden A , Hiemstra Y L , Koopmann T T , Ruivenkamp C A L , Aten E , Bax J J , Delgado V , Barge-Schaapveld D Q C M , Ajmone Marsan N 
Published: October 2019

Abstract

Background
Several studies have suggested a familial clustering of mitral valve prolapse (MVP), especially for Barlow disease (BD), which is regarded as the effect of genetic or developmental errors. However, the genetic etiology of MVP, in particular BD, is largely unknown. So far only three genes have been identified: FLNA, DCHS1 and PLD1.

Purpose
The aim of this study was to identify genes associated with MVP using whole exome sequencing (WES).

Methods
Patients with MVP, who were classified as BD and/or had a positive family history for MVP, were referred for genetic counseling and WES. In total, 106 unrelated probands were included to identify potentially pathogenic variants in a set of 551 genes associated with cardiovascular development and/or diseases. The population databases Genome Aggregation and WES data from 110 parents of children with mental retardation were used as controls. Variants were analyzed using prediction programs, frequency in the population database and literature search. Variants were divided into the following categories: likely benign, variant of unknown significance or likely pathogenic.

Results
Thirteen percent (14/106) of the probands had a likely pathogenic variant in seven different genes: DCHS1 (1x), DSP (1x), HCN4 (2x), MYH6 (1x), TMEM67 (1x), TRPS1 (1x) and TTN (7x); the DSP, MYH6 and HCN4 variants cosegregated in affected relatives. None of the 110 parents of children with mental retardation had a likely pathogenic variant in these seven genes. In addition, 31% (33/106) of the probands harbored a variant of unknown significance in 23 different genes, including the genes DSP, FLNA, MYH6 and TTN (Fig). Remarkable, one variant of unknown significance in the FBN2 gene was shared among three unrelated probands and did not occur in population databases.

Conclusion
WES analysis conducted in probands with MVP using a large panel of genes associated with cardiac development and/or disease confirmed previously known causative genes (DCHS1) and expanded the cardiac phenotype of genes originally associated with cardiomyopathy (DSP, HCN4, MYH6 and TTN). This study is the first study that described the association between MVP and the genes DSP, MYH6 and TTN although the pathogenesis is still unknown. This high yield of likely pathogenic variants emphasizes the importance of genetic screening in MVP patients.
P1790TAVI is associated with less patient-prosthesis-mismatch than surgical aortic valve repair of severe aortic stenosis: A systematic review and meta-analysis
Authors: Abi Khalil C , Ignatiuk B , Erdem G , Chemaitely H , Barilli F , Al Suwaidi J , Kofler M , Stastny L , Jneid H , Bonaros N 
Published: October 2019

Abstract

Background
TAVI has shown to be non-inferior to surgical aortic valve replacement (sAVR) in terms of mortality for the treatment of intermediate and high-risk patients with severe aortic stenosis (AS).

Purpose
We sought to assess whether there is a difference on echocardiographic parameters up to 2 years after TAVI and sAVR

Methods
We conducted a systematic review and a random-effect model meta-analysis of randomized controlled trials that compared TAVI and sAVR. The primary outcome was post-proceduralpatient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL).

Results
We identified 5 trials with a total of 5552 participants with AS, including 2777 patients randomized to TAVI and 2775 randomized to sAVR (Figure 1). TAVI was associated with a significant 35% relative risk reduction (95% CI [0.50–0.8), p=0.005) in moderate/severe post-procedural PPM. The effect was more evident in self- than balloon-expandable valves (p=0.029). Similar results were found in terms of post procedural EOA (RR=0.53, 95% CI [0.43–0.62]), and residual gradients (RR=0.54, 95% CI [0.32–0.76]). As expected, TAVI demonstrated higher rates of moderate/severe PVL (RR=9.41, 95% CI [5.22–16.96]). The results were sustainable at 2 years as seen in pooled increased EOA (pooled mean difference 0.48, 95% CI [0.24–0.72]), and the pooled decreased residual gradients of 0.58 (95% CI [0.77–0.25]) in favor of TAVI. The incidence of moderate/severe PVL remained also lower in sAVR patients (RR=10.39, 95% CI [4.80–22.46]).
Figure 1. PRISMA flow diagram

Conclusions
Our meta-analysis suggests that TAVI is associated with a lower risk of PPM, as well as higher EOA and lower residual gradients through 2 years of follow-up. This was accompanied by a higher incidence of moderate/severe PVL compared to sAVR. Future research should focus on the effect of these echocardiographic differences on clinical outcomes.
P1791Conduction abnormalities following aortic valve intervention in patients with transthyretin cardiac amyloidosis
Authors: Zikry Deitch M , Haberman D , Lifshitz S , Tshori S , Fabricant Y , Voldarsky I , Meladin V , Gandelman G , Goland S , Swissa M , George J , Shimoni S 
Published: October 2019

Abstract

Introduction
Aortic Stenosis (AS) is the most common valvular heart disease in the Western world. Transcatheter aortic valve implantation (TAVI) is an alternative to surgical valve replacement in medium and high-risk patients. One of the most common complications after TAVI is conduction system disturbances including bundle branch block, complete heart block and need for permanent pacemaker implantation. Transthyretin cardiac amyloidosis (TTR–CA) is an increasingly recognized cause of heart failure that almost exclusively affects older adults. Diagnosis of TTR-CA in patients undergoing valvular intervention is relevant to understand their clinical outcomes and to discuss specific management.

Objectives
Occult amyloid may account for the frequent need for pacemakers among TAVR patients. We aimed to assess the correlation between intervention induced conduction abnormalities and the need for a pacemaker insertion and the presence of TTR-CA.

Methods
The study population included patients who had aortic valve intervention between 2011–2018. The patients underwent Tc99m-PYP scan using SPECT technology which has been shown to be valid for the diagnosis of TTR-CA. We examined the rate of conduction disorders and the need for a permanent pacemaker from patient files at the time of hospitalization and during a 24-month follow-up.

Results
The study population included 86 patients, mean age 78±6 years, 55% women. Twenty-nine (33%) of the participants were diagnosed as positive (VAS 2 and 3) for transthyretin cardiac amyloidosis. There were no differences in baseline characteristics with regard to age, gender, risk factors, hemoglobin and renal function between patients positive and negative for TTR CA. Conduction disorders were seen in 35 (40%) patients. Patients with TTR CA had a statistically higher prevalence of conduction disorders. Forty-two percent of TTR CA positive patients underwent peri-procedural permanent pacemaker implantation compared to 28% peri-procedural pacemaker implantations in the negative group (p=0.043). Development of a new left bundle branch block during the follow-up period was observed in 14.1% of all patients. There was a statistically significant higher rate in the positive group compared to TTR CA negative group (39.1% vs 10.9% p=0.03).

Conclusions
We observed a high prevalence of occult TTR-CA in older adults with aortic stenosis who underwent TAVI. We also found a high prevalence of conduction abnormalities following TAVI in patients with TTR CA. These findings suggest a need for more careful observation for possible conduction abnormalities and requirement for pacemaker insertion in these patients.

Acknowledgement/Funding
None
P1792Delirium after transcatheter aortic valve implantation (TAVI) under general anaesthesia: incidence, predictors and relation to long-term survival
Authors: Van Der Wulp K , Van Wely M H , Van Heijningen L , Van Bakel B M A , Schoon Y , Verkroost M W A , Gehlmann H R , Van Garsse L A F M , Vart P , Olde Rikkert M G M , Kievit P C , Morshuis W J , Van Royen N 
Published: October 2019

Abstract

Background
Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) are at risk of postoperative delirium (POD). Prospectively collected data on delirium after TAVI are scarce.

Purpose
Aim of this study is to report the incidence and risk factors of POD after TAVI under general anaesthesia. Also we assessed the relation of POD with clinical outcome and short- and long-term survival.

Methods
POD was assessed prospectively in all consecutive patients treated with TAVI in our centre between 2008 and 2017, according to the Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV criteria. TAVI was performed under general anaesthesia in all patients. Outcome was reported according to the updated VARC2-criteria. Survival status was checked by consulting the Municipal Civil Registries.

Results
POD was observed in 16.5% (116/703) of all patients. Stroke and new onset of atrial fibrillation were more often observed in patients with POD (6.9% vs. 1.9%, p=0.007 and 12.1% vs. 5.1%, p=0.005, respectively). Independent preoperative predictors of POD were prior delirium (OR 2.56 [95% CI: 1.52–4.31], p<0.001), aortic valve area (AVA)<0.75 cm2 (OR 2.39 [1.53–3.74], p<0.001), age (1.08 [1.04–1.12], p<0.001) and BMI (0.94 [0.90–0.99], p=0.018). POD was the strongest independent predictor of long-term mortality (HR 1.91 [1.36–2.70], p<0.001) and was associated with impaired 30-day survival (92.2% vs. 96.8%, p=0.034) as well as 5-year survival (40.0% vs. 50.0%, p<0.001).
Survival: Delirium vs No Delirium

Conclusion
One-in-six patients suffered from POD after TAVI under general anaesthesia. Prior delirium and more calcified aortic valve were the strongest independent predictors of POD. POD was the strongest predictor of long-term mortality and was associated with impaired short- as well as long-term survival.
P1796Adults with congenital heart disease have impaired calf muscle oxygenation compared to control subjects
Authors: Sandberg C , Crenshaw A G , Elcadi G H , Christersson C , Hlebowicz J , Thilen U , Johansson B 
Published: October 2019

Abstract

Background
Peripheral muscle factors are presumed to be important contributors to the reduced exercise capacity in congenital heart disease (CHD), but the mechanisms are poorly understood.

Purpose
To investigate if muscle oxygenation in the calf muscle is impaired in adults with complex CHD in comparison to controls.

Method
Seventy-four adults with complex CHD (35.6±14.3 years, females n=22) were recruited from centers specialized in adult CHD. Seventy-four age and gender matched subjects were recruited as controls. Muscle oxygenation was successfully determined using near-infrared spectroscopy on the medial portion of m. gastrocnemiusin 63 patients and 67 controls. Measurements were made at rest, during venous occlusion to estimate blood flow (BF – indicated by the slope increase of total haemoglobin, HbT), at the start of isotonic unilateral heel-lifts to exhaustion, and immediately after exercise.

Results
In comparison to controls, patients had a lower muscle saturation (StO2) at rest, albeit not statistically significant, (66±17% vs. 60±19%, p=0.07), and a lower BF (0.38±0.21 vs. 0.31±0.21 HbTx3.5sec–1, p=0.07). For exercise, compared to the controls, patients had a slower desaturation rate at exercise onset (−11.7±5.8% vs. −7.7±4.3%. StO2x3.5sec–1, p<0.001), and both a slower resaturation rate (6.1±3.8% vs. 3.9±3.7% StO2x3.5sec–1, p=0.002) and a slower half recovery time (16.8±11.1 vs. 28.6±21.2 sec, p<0.001) post exercise.

Conclusion
The lower muscle oxygenation and blood flow at rest, and the slower oxygenation kinetics during exercise may give insight to the mechanism for the reduced exercise capacity commonly found in adults with complex CHD. This finding may also provide implications for design of rehabilitation programs for these patients.
P1831Prediction of cardiovascular events by atheromatous plaques detected by non-obstructive general angioscopy: two-year results of EAST-NOGA Registry
Authors: Kakuta T , Komatsu S , Kojima K , Fujii H , Kimura S , Dai K , Kawakami H , Matsuoka H , Higuchi Y , Abe H , Inoue T , Okumura Y , Asakura M , Hirayama A , Kodama K 
Published: October 2019

Abstract

Background
Non-obstructive general angioscopy (NOGA) has revealed the intimal damages or atheromatous plaques as well as its spontaneous rupture of the aorta. Recent study revealed that plaque debris or different size of cholesterol crystals were detected in the blood above the spontaneous ruptured aortic plaque observed by NOGA and these plaque materials might cause the peripheral organ damages as the embolic source. These various morphological changes may cause the acute aortic events or atheroembolic events on the peripheral organs, such as brain, kidney, peripheral artery and so on.

Purpose
EAST-NOGA (Evaluation of AtheroSclerotic and rupture events by Non-Obstructive General Angioscopy) is a multi-center prospective observational study to assess the relationship between the findings of NOGA and future cardiovascular events.

Methods
Five hundred and seventy-seven patients with atherosclerotic cardiovascular disease who underwent NOGA study. The major cerebrocardiovascular events including cardiovascular death, non-fatal myocardial infarction, non-fatal cerebral infarction, and acute aortic syndrome were accumulated during the 2-year follow-up after NOGA study.

Results
The median number of aortic atheromatous plaques was 6 [IQR: 3–12]. A total of 514 patients were followed up (89.1%). The mean follow-up duration was 757±120 days. Major adverse cardiovascular events developed in 23 (4.5%) during 2 years follow-up. Patients with MACE and cerebral infarction, had significantly greater number of aortic atheromatous plaques (11 [5–19] vs. 6 [3–11], p<0.001, 12 [4–20] vs. 6 [3–12], p=0.014, respectively). In a univariate analysis, the number of aortic atheromatous plaques and ruptured plaque were significant predictors of MACE (HR: 1.09 95% confidence interval 1.05–1.14, p<0.001) and (HR: 1.12, 95% confidence interval 1.02–1.23, p=0.02). In a multivariate logistic analysis, the number of aortic atheromatous plaques is one of the independent predictors of MACE (HR 1.05, 95% confidence interval 1.00–1.10, p=0.032).

Conclusion
The number of atheromatous plaques identified by NOGA has a significant relation to the onset of cerebral infarction, which suggest the atheromatous plaque were vulnerable and ruptured spontaneously, then cause the aortogenic cerebral infarction. The NOGA study would be useful for predicting the futured atheroembolic events.

Acknowledgement/Funding
None