bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deterioration of peripheral microvascular tissue perfusion after transcatheter aortic valve implantation (TAVI) measured by 2D near-infrared spectroscopy (NIRS)
Authors: Herbrand T , Baasen S , Veulemans V , Kelm M , Busch L 
Published: November 2020

Abstract

Background
The data on the effect of transcatheter aortic valve implantation (TAVI) on peripheral microcirculation is scarce. Therefore, in this study, we investigate the changes of peripheral microvascular tissue perfusion before and after TAVI measured by a 2D near-infrared spectroscopy (NIRS) camera. NIRS allows measurement of hemoglobin oxygen saturation (StO2) in the blood perfusing the volume tissue under scrutiny.

Methods
In this prospective, single center study, patients with symptomatic, severe aortic stenosis either planned for elective TAVI procedure or elective cardiac catheterization were included. 2-D StO2 maps of all distal extremities (i.e. hand/foot) were acquired before and after TAVI by using a NIRS camera; macrovascular function of the tibial and forearm arteries was assessed by Doppler ultrasound with spectral analysis including ankle-brachial index (ABI) and applanation tonometry.

Results
26 subjects (19 male, age 83±6 years) undergoing TAVI procedure and 5 subjects (4 male, age 76±10) undergoing cardiac catheterization were included in this trial. In the group undergoing TAVI procedure, 5 patients had diabetes mellitus (19%), one of whom was insulin-dependent, 3 patients had a history of peripheral artery disease (12%) and 1 patient had a history of smoking (4%). TAVI procedure was successful without major complications in all cases.Mean peripheral StO2 decreased significantly on all extremities after TAVI, i.e. right hand (from 71±14% to 61±16%; p=0.01), left hand (from 70±12 to 62±16%; p=0.03), right foot (from 70±11% to 61±15%; p&lt;0.01) and left foot (from 66±15% to 58±14%; p=0.03). ABI did not change after TAVI (right ABI baseline mean 1.08±0.2; Δ0.06; left ABI baseline 1.05; Δ0.05). Macrovascular function of the forearm and tibial arteries did not deteriorate as measured by Doppler ultrasound. Furthermore, aortic mean pressure (from 108±21 mmHg to 87±13 mmHg; p=0.002) and augmentation index (from 34±8 mmHg to 24±8 mmHg; p&lt;0.001) decreased significantly while subendocardial viability ratio (from 128±22 to 147±7; p&lt;0.001), a marker for coronary microvascular function, improved significantly after TAVI. In the group undergoing cardiac catheterization, there were no statistically significant changes in macro- or microvascular function.

Conclusion
This is, to our knowledge, the first study investigating the effect of peripheral microvascular tissue perfusion measured by NIRS after TAVI. Our results show that peripheral microvascular tissue perfusion was significantly deteriorated after TAVI procedure.
StO2 before and after TAVI procedure

Funding Acknowledgement
Type of funding source: None
Complex antithrombotic therapy and bleeding risk in patients with peripheral arterial disease
Authors: Tseng A , Bhatt S , Girardo M , Liedl D , Wennberg P , Shamoun F 
Published: November 2020

Abstract

Introduction
Antiplatelet therapy is the cornerstone of treatment for many atherosclerotic vascular pathologies including peripheral arterial disease (PAD). Patients with PAD often have comorbid conditions that require complex antithrombotic therapy, i.e. combined antiplatelet and anticoagulation.

Methods
All adult patients undergoing ankle brachial index (ABI) measurements were included in the study. ABI values between 1.00 and 1.40 were considered normal, and values below 1.00 or above 1.40 were considered PAD. Demographic, comorbidity and outcome data were obtained using diagnostic codes from the electronic health record. Three medication classes were analyzed: aspirin, non-aspirin oral antiplatelets (e.g. P2Y12 inhibitors) and oral anticoagulants (warfarin and the direct oral anticoagulants). Medication use was determined for patients who had been on a medication for at least one year. Cox proportional hazard analysis for the time to first bleeding event was analyzed. Bleeding was defined as any bleeding requiring medical evaluation (including clinically-relevant non-major bleeding and major bleeding).

Results
In all, 40,144 patients were included in the analysis (mean age 66±15, 43% female). Patients with PAD were more likely to be on double therapy (one antiplatelet with anticoagulation) (28% vs 19%) and triple therapy (dual antiplatelet with anticoagulation) (10% vs 4%). Unadjusted hazard ratios for bleeding risk showed increased risk of bleeding for patients with PAD (1.18, 95% confidence interval [CI]: 1.08–1.29), though the association is no longer present after adjustment for antithrombotic therapy. Adjusting for age, sex and PAD class, compared to no antithrombotic therapy, there was increased risk of bleeding for monotherapy (1.91, 95% CI: 1.61–2.26), double therapy (3.40, 95% CI: 2.89–4.00) and triple therapy (5.00, 95% CI: 4.21–5.96). Among medications, aspirin and anticoagulant use was independently associated with the greatest increase in risk of bleeding.

Conclusion
Patients in PAD are at increased risk of bleeding secondary to antithrombotic therapy. Complex antithrombotic therapy with double or triple therapy confer additional bleeding risk, particularly regimens containing aspirin and oral anticoagulants.

Funding Acknowledgement
Type of funding source: None
Effects of liraglutide and semaglutide on stroke subtypes in patients with type 2 diabetes: a post hoc analysis of the LEADER, SUSTAIN 6 and PIONEER 6 trials
Authors: Strain W.D , Holst A.G , Rasmussen S , Saevereid H.A , James M.A 
Published: November 2020

Abstract

Introduction
Diabetes is an independent risk factor for stroke, with approximately a two-fold excess risk in people with versus those without diabetes. Accumulating evidence suggests glucagon-like peptide-1 (GLP-1) analogues (including liraglutide and semaglutide) may reduce the risk of stroke in patients with type 2 diabetes (T2D).

Purpose
We examined the effect of liraglutide and semaglutide on stroke and its subtypes based on pooled data from LEADER, SUSTAIN 6 and PIONEER 6.

Methods
LEADER (NCT01179048), SUSTAIN 6 (NCT01720446) and PIONEER 6 (NCT02692716) were global randomised cardiovascular (CV) outcomes trials of liraglutide, subcutaneous semaglutide and oral semaglutide, respectively, in patients with T2D at high CV risk. In this post hoc analysis, we evaluated the effect of these GLP-1 analogue treatments (pooled) on time to first occurrence of all strokes and subtypes of stroke. Ischaemic stroke was subcategorised according to the TOAST classification, based on aetiology by an external blinded reviewer. A Cox proportional hazards model stratified by trial with pooled treatment as a factor was used to examine treatment effects.

Results
Across the three trials, 216/7907 (2.7%) patients in the GLP-1 analogue group and 262/7913 (3.3%) in the placebo group had a stroke. The risk of first occurrence of all strokes was significantly reduced in the GLP-1 analogue versus placebo group (HR 0.82, 95% CI 0.68–0.98; p=0.030). Treatment effects were consistent across stroke subtypes: ischaemic (HR 0.84, 95% CI 0.69–1.02; p=0.08), haemorrhagic (HR 0.72, 95% CI 0.42–1.22; p=0.22) and undetermined (HR 0.71, 95% CI 0.32–1.60; p=0.41; Figure 1). Across TOAST subcategories, there was a trend that GLP-1 analogue treatment had the greatest benefit versus placebo in small vessel occlusion strokes compared with large artery disease or cardioembolic strokes; however, no statistically significant effects were found in any subcategory.

Conclusion
In this post hoc analysis of the LEADER, SUSTAIN 6 and PIONEER 6 trials, GLP-1 analogue treatment reduced the risk of stroke in patients with T2D and high CV risk, with an indication using TOAST criteria of the strongest effect on stroke caused by small vessel occlusion.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novo Nordisk A/S. WDS is supported by the NIHR Exeter Clinical Research Facility. MAJ is supported by the NIHR SW Peninsula Applied Research Collaboration. This abstract does not necessarily reflect the views of the NIHR, the Exeter Clinical Research Facility, the NHS or the UK Department of Health.
Machine learning for predicting fractional flow reserve based on optical coherence tomography in intermediate coronary stenosis
Authors: Cha J.J , Son T.D , Ha J , Kim J.S , Hong S.J , Ahn C.M , Kim B.K , Ko Y.G , Choi D , Hong M.K , Jang Y 
Published: November 2020

Abstract

Background
Machine learning approaches using intravascular optical coherence tomography (OCT) to predict fractional flow reserve (FFR) have not been previously investigated. The objective of the study was to evaluate a machine learning method to estimate FFR based on intravascular OCT images in intermediate coronary lesions.

Methods
Data from both OCT- and wire-based FFR methods were obtained for lesions of the left anterior descending artery in 125 patients. Based on the total number of lesions, training and testing groups were partitioned at a ratio of 5:1. For the training group, 36 features, including 16 clinical and lesion characteristics, and 21 OCT features, were used to model machine learning-FFR. machine learning-FFR values were then derived for the testing group and compared with wire-based FFR values in terms of a diagnosis of ischemia (FFR &lt;0.8).

Results
Clinical and lesion characteristics and OCT features between the training and testing groups were similar. During the machine learning modeling of the training group, six important features of machine learning-FFR were identified: minimal luminal area, percentage of the stenotic area, lesion length, proximal luminal area, pre-procedural platelet count, and hypertension. machine learning-FFR values showed a good correlation (r=0.853, P&lt;0.001) with wire-based FFR values (Figure 1A). The diagnostic power of an FFR value less than 0.8, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of machine learning-FFR values for the testing group were 85.7%, 100%, 100%, 77.8%, and 90.5%, respectively (Figure 1B). Additionally, OCT-based machine learning-FFR values showed a good diagnostic accuracy compared with other image-based FFR values.

Conclusions
The OCT-based machine learning-FFR method can be used to simultaneously acquire information on both image and functional modalities using one invasive procedure, suggesting that it may be used to optimize treatments for intermediate coronary artery stenosis, as well as save time and cost.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Funded by the Korean government (MSIT) (no. 2017R1A2B2003191)
Discrepancy between RFR and FFR based decision on revascularization – is coronary microcirculatory dysfunction responsible?
Authors: Niewiara L , Guzik B , Szolc P , Zmudka K , Legutko J 
Published: November 2020

Abstract

Introduction
Confirmation of significant ischemia is crucial for proper management of coronary artery disease. Non-hypaeremic indices along with fractional flow reserve are endorsed by current guidelines to prove ischemia. However some discrepancies between hyperaemic and non-hyperaemic decision on revascularisation is present in significant percentage of cases.

Aim
Aim of our study was to determine frequency of coronary microcirculatory dysfunction in patients with discrepant RFR and FFR measurements compared to concordant group.

Methods
Resting full cycle ratio (RFR) was measured in 69 left anterior descending arteries, all patients had symptoms of chronic coronary syndromes (CCS II-III). Cut-off values for ischemia detection were ≤0.80 for FFR and ≤0.89 for RFR. Coronary microcirculatory dysfunction (CMD) was defined as CFR &lt;2.0 or IMR ≥25 according to current guideline.

Results
Discrepancy between FFR and RFR decision on revascularisation was present in 18 (26.1%) of cases. Mean age of patients was 65 (SD=8.5), all patients were similar in terms of diabetes, prior MI or hypertension and statin use (p=NS for all comparisons). Group with discordant RFR and FFR results had higher prevalence of CMD compared to patients with concordant result (44.4% vs 21.6% respectively, p=0.004), however median values of CFR and IMR were similar (see table).

Conclusions
• Patients with discrepant results have more frequently coronary microcirculatory dysfunction.
• Coronary microcirculatory dysfunction should be further investigated as it could explain discrepancies between RFR and FFR based decision on revascularisation.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Jagiellonian University statutory grant
Correlations between fractional flow reserve and a novel non-hyperemic index: resting full-cycle ratio in patients with an ambiguous coronary artery stenosis
Authors: Szolc P , Niewiara L , Guzik B , Horszczaruk G , Podolec J , Kleczynski P , Zmudka K , Buksinska-Lisik M , Mamcarz A , Legutko J 
Published: November 2020

Abstract

Background
Fractional flow reserve (FFR) measurement has been the gold standard for invasive assessment of coronary ischemia. Resting full cycle ratio (RFR) is a new non-hyperemic index used to define physiologic significance of coronary artery stenosis. However, there are limited data available to establish optimal cut-off value of RFR for decision making on revascularization.

Aim
The aim of our study was to assess optimal cut-off value of RFR at which to predict FFR of 0.8.

Methods
The RFR and FFR values were recorded during invasive coronary angiography in vessels with angiographic stenosis 40–70% according to visual assessment. Maximum hyperemia for FFR measurement was achieved with adenosine iv. infusion at 140 μg/kg/min. Left main disease, acute myocardial infarction and systolic left ventricular dysfunction (EF &lt;40%) were the main exclusion criteria.

Results
We evaluated 332 vessels, including 189 (56.9%) left anterior descending arteries, 77 (23.2%) left circumflex arteries and 66 (19.9%) right coronary arteries. Median diameter stenosis as assed by QCA was 45% (IQR 40; 50). Median RFR and FFR values were 0.90 [IQR 0.85; 0.94] and 0.86 [IQR 0.81; 0.92] respectively, with significant correlation (p&lt;0.001, Figure 1, panel A). Optimal cut-off value for RFR to detect FFR 0.80 was 0.90 with area under the curve of 90.3%, sensitivity of 81.4% and specificity 88.0% (Figure 1, panel B).

Conclusions
Our data confirm RFR cut-off value ≤0.90 as an optimal threshold to detect ischemic lesions with good sensitivity and specificity in comparison to FFR assessment. Further research is necessary to assess outcomes of RFR-guided revascularization strategy.
Figure 1. RFR–FFR correlation and ROC analysis

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Jagiellonian University statutory grant
Transulnar Aproach for PCI after failed ipilateral TRA: 2 sheaths in same arm, is it safe?
Authors: Zafirovska Taleska B , Jovkovski A , Vasilev I , Taravari H , Petkoska D , Kedev S 
Published: November 2020

Abstract

Aims
To assess the feasibility and safety of transulnar access (TUA) after failure to cross through ipsilateral radial access (TRA), with two sheaths placed in same arm (RA and UA).

Methods and results
All consecutive patients, with TUA due to inability to cross from ipsilateral TRA in the period from March 2011 until December 2017 were included in the study.
Pre-procedural wrist artery angiography was performed in all patients through radial and afterwards ipsilateral ulnar artery. We examined clinical and procedure characteristics, access site complications and cause of failure of primary chosen TRA. Patients were followed up with a median of 4 years.
From March 2011 untill December 2017, 104 patients had a transulnar artery approach due to inability to cross from ipsilateral radial approach. Mean age of patients was 64±11 years with 48% females. 15% of patients had a PPCI intervention due to STEMI. Cause for crossover to ipsilateral TUA was due to: inability to cross an RA anomaly in 94 patients, inability to cross high degree RA spasm in 8 and in 2 patients due to dissection of the RA. Most common anomaly of the RA that caused inability to cross was full 360 degree RA loop in 53 (56%) patients.
49 Patients (47%) underwent percutaneous coronary intervention, 5 (4,8%) patients carotid artery stenting and 50 (48%) diagnostic coronary angiography through ipsilateral TUA. Procedure duration was 35±16 minutes, contrast volume 120±35 ml and fluoroscopy time was 8±6 minutes.
Access site bleeding complications were present in 7 (6.7%) patients after procedure with Type 4 EASY Score hemathoma present in 3 patients (2.8%) without further consequences. 5.7% of patients had ipsilateral RAO noted on duplex on follow up. There were no ischemic hand complications after intervention and follow up with median of 4 years.

Conclusion
Transulnar artery access due to failed ipsilateral radial access crossing is safe and feasible for angiography and PCI with low rate of complications on long term follow up.
TUA after failed TRA (2 sheaths)

Funding Acknowledgement
Type of funding source: None
Impact of a stent-less percutaneous coronary intervention strategy using directional coronary atherectomy and a drug coated balloon for left main and ostial lesions
Authors: Nakamura S , Rokutanda T , Kurokawa H , Onoue Y 
Published: November 2020

Abstract

Background
With the advent of drug eluting stents (DESs), the restenosis rate has markedly decreased. However, even with DESs, problems remain unsolved for bifurcated lesions including left main trunk (LMT) and right coronary artery (RCA) ostial lesions. In the era of directional coronary atherectomy (DCA) alone, an optimal DCA provides a significantly lower residual stenosis and lower angiographic restenosis than conventional balloon angioplasty, despite failing to reach a statistical significance for reducing late clinical events as compared to balloon angioplasty (Circulation 1998; 97:322–31.).

Purpose
This study aimed to examine the safety and effectiveness of stent-less percutaneous coronary intervention (PCI) using DCA and drug coated balloons (DCBs).

Methods
From November 2017 to June 2019, a stent-less PCI for LMT and ostial lesions was performed in 32 consecutive cases (male 24/female 8; mean age 70.9±9.8). A stent-less PCI was performed using SeQuent Please™ DCB after an ATHEROCUT™ DCA, and procedural success was obtained in all cases (6 cases with LMT, 18 with left anterior descending ostial, 6 with left circumflex ostial, and 2 with RCA ostial lesions).

Results
The percent plaque area (%PA) decreased from 70.0±7.7% at baseline to 51.6±8.1% after the DCA and to 46.1±9.0% after the DCBs. All patients completed a follow up coronary angiography after 6 months and no restenosis was observed. No major adverse cardiac events occurred in any cases including target lesion revascularizations. In 29 cases that the lumen was confirmed with IVUS at 6 months of follow-up, the lumen area (LA) had expanded significantly from 8.0±2.3 mm2 at baseline (post DCBs) to 8.9±2.7 mm2 at 6 months (P=0.023, Figure 1A). Local paclitaxel may induce late lumen enlargement (LLE) after a DCA/DCB. The group in which the LA increased during the chronic phase was defined as the Increased group and the group in which the LA decreased during the chronic phase was defined as the Decreased group. When comparing the LDL-Cho level pre DCA between the two groups, the LDL-Cho level in the Increased group was significantly low (74.0±25.8 mg/dl vs. 101.0±33.6 mg/dl, P=0.050, Figure 1B).

Conclusions
Stent-less PCI using DCA and DCBs for bifurcated lesions including LMT and RCA ostial lesions was effective, safe, and useful. Furthermore, a chronic LLE effect by DCBs is expected. In addition, intensive lipid-lowering therapy may also contribute to the chronic outcome after DCA/DCBs.

Funding Acknowledgement
Type of funding source: None
Long-term efficacy and safety of newer generation ultrathin strut drug-eluting stents: a systematic review and meta-analysis
Authors: Lattuca B , Odorico X , Occean B.V , Cornillet L , Schmutz L , Ledermann B , Fabbro-Peray P , Leclercq F , Cayla G 
Published: November 2020

Abstract

Background
Recent trials have demonstrated that short-term efficacy and safety of ultrathin strut drug-eluting stents (DES) were non-inferior to contemporary stents but long-term benefit remains uncertain.

Purpose
The main objective of this meta-analysis was to evaluate efficacy and safety of ultrathin strut DES with an extended follow-up in comparison to 2nd and 3rd generations DES.

Methods
A double-blind review of randomized controlled trials (RCT) comparing ultrathin strut DES to contemporary DES was performed from MEDLINE and CENTRAL databases and from cardiological congresses. The primary efficacy endpoint was target vessel failure (TLF) defined as a composite of cardiac death, target vessel myocardial infarction (TV-MI) and target lesion revascularization (TLR) and the primary safety endpoint was occurrence of stent thrombosis (ST). Short (1 year) and long term (≥2 years) effects were estimated separately. This analysis was pre-specified in PROSPERO (CRD42019142206).

Results
The meta-analysis included 13 RCT including 19,490 patients. In short term, we found TLF decrease with ultrathin strut DES (RR 0.85, CI [0.75–0.97], p=0.01), driven by lower TV-MI (RR 0.83, CI [0.66–1.03], p=0.1) and TLR (RR 0.77, CI [0.58–1.01], p=0.1) rates, and a non-significant downward trend in ST (RR 0.85 CI [0.64–1.14]).
In long term, from the 5 trials with extended follow-up, there was no significant difference between ultrathin strut DES and thicker strut stents in rate of TLF at the longest available follow-up (RR 0.90, CI [0.76–1.06], p=0.2), despite a numerically reduction of TV-MI (RR 0.81, CI [0.61–1.08], p=0.05) and TLR (RR 0.85, CI [0.69–1.04], p=0.1) in favor of ultrathin strut stents. However, we observed a persistent numerically reduction in ST (RR 0.79, CI [0.61–1.02], p=0.01).

Conclusion
Ultrathin strut DES was associated with a lower target lesion failure rate at one year but not beyond 2-years follow-up. Nevertheless, the safety of the ultrathin strut stents was sustained over time with a numerically reduction of ST.

Funding Acknowledgement
Type of funding source: None