bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3133Single parasternal long axis echocardiography by briefly trained health workers using handheld devices for detection of rheumatic heart disease: a prospective study of diagnostic accuracy
Authors: Francis J , Fairhurst H , Kaethner A , Whalley G , Ryan C , Dos Santos J , Reeves B , Wheaton G , Horton A , Marangou J , Francis L , Hardefeldt H , Davis K , Engelman D , Remenyi B 
Published: October 2019

Abstract

Introduction
Echocardiographic screening can detect rheumatic heart disease (RHD) in high-risk populations,but is limited by reliance on highly-trained experts and equipment. We sought to determine the diagnostic utility of an ultra-abbreviated single parasternal-long-axis-sweep of the heart (SPLASH) echocardiography protocol to detect RHD, performed by briefly-trained health workers.

Methods
In Timor-Leste and Northern Australia, individuals aged 5–20y were offered school-based echocardiographic screening. Health workers completed online modules followed by one-week of practical training, logging 50 echocardiograms prior to study. The index test was SPLASH, performed and reported by health workers using handheld GE V-scan devices. The index test was abnormal if any mitral or aortic regurgitation was detected. The reference test was a comprehensive echocardiogram, performed by an echocardiographers or cardiologist on a GE Vivid-Q, reported according to World Heart Federation criteria. The diagnostic accuracy of the index test was determined.

Results
2590 subjects underwent index and reference tests. Prevalence of definite RHD was 3.2% (83/2590). Sensitivity and specificity of index test were 0.75 (95% CI 0.64–0.83) and 0.77 (95% CI 0.75–0.78) respectively for detection of any definite RHD, and 0.91 (95% CI 0.74–0.98) and 0.76 (95% CI 0.74–0.78) respectively for detection of moderate or severe RHD.

Conclusion
Health workers using SPLASH detected the vast majority of moderate and severe RHD cases, but lacked sensitivity for detection of mild RHD. Further analysis is underway to evaluate the learning curve and other performance indicators of health workers performing and interpreting echocardiograms. This will allow refinement of SPLASH protocol and augmentation of health worker training to increase detection rates and accuracy for future population screening initiatives.

Acknowledgement/Funding
Heart Foundation Australia Vanguard Grant, Menzies HOT-NORTH pilot project grant, Snow Foundation, Rotary, Bawinanga Aboriginal Corporation, Mala'la
P3135Tricuspid valve dysfunction caused by transvenous lead extraction. Can we predict this complication?
Authors: Polewczyk A , Nowosielecka D , Tomaszewski A , Brzozowski W , Szczesniak Stanczyk D , Tulecki L , Tomkow K , Czjkowski M , Jachec W , Kutarski A 
Published: October 2019

Abstract

Background
Accidental damage of tricuspid apparatus is known complication of TLE procedure risk factors of this complication remain unknown.

Purpose
The goal of this study was to search factors which can predict damage of tricuspid apparatus during TLE.

Methods
Between 2006 and 2018 we performed 2002 TLE procedures using conventional mechanical sheaths. 3366 leads (mean implant duration 95,2 months) were removed due to non-infective indications in 62,0%. Tricuspid valve function was examined with preoperative and post-operative TTE and during monitoring of procedure. Patients with incomplete TV function evaluation were excluded from the study. Three groups of patients were compared

Results
TLE procedure brings risk (7%) of different degree damage or tricuspid leflet or even chordae tendinae (2%). The detailed results are presented in the table.

Conclusions
TLE using conventional mechanical sheaths is effective but brings risk of extraction related tricuspid valve dysfunction. Main risk factor of this complication seems to be implant dwell time, number of leads presence of abandoned leads and lead loop in the heart remaining in conflict with tricuspid valve.
P3141Transvenous lead extractions in patients on continuous flow left ventricular assist device support
Authors: Starck C T , Eulert-Grehn J J , Lanmueller P , Potapov E , Falk V 
Published: October 2019

Abstract

Objectives
The outcomes of transvenous lead extractions in patients with left ventricular assist device support and a cardiac implantable electronic device (CIED) are not well studied. The purpose of this study was to examine the feasibility and safety of transvenous lead extraction in this patient cohort.

Methods
We performed a retrospective single-center analysis of patients with a left ventricular assist device and a CIED undergoing a transvenous lead extraction procedure. Between October 2014 and November 2018 we overall performed transvenous lead extractions (TLE) of 622 leads in 286 patients. During this time period we performed transvenous lead extractions In 34 patients (mean age 60.9±9.4 years; 32 male, 2 female) with different continuous flow left ventricular assist devices (LVAD). A total of 91 leads were targeted for extraction in these LVAD patients. Indication for extraction was infection in 79.4% (n=27; systemic infection=15 (44.1%), local pocket infection n=12 (35.3%)) and lead failure in 20.6% (n=7). Mean lead implant duration was 80.7 (1–252) months. 55 pacemaker leads and 36 ICD leads (30 dual coil, 6 single coil) were extracted.

Results
Complete procedural success could be achieved in 86 of 91 leads (94.5%). In 79.1% (n=72) a locking stylet and a compression coil, in 73.6% (n=67) a bidirectional rotational extraction sheath was used. No operative mortality and no major complications were observed. 30-day mortality was 5.9% (n=2). Minor complications occurred in 7 patients (20.6%), mainly consisting of bleeding complications: pocket hematoma (n=5; 14.7%) and hematothorax (n=1; 2.9%).

Conclusions
Patients on continuous flow left ventricular assist device support represent a challenging population in many regards, especially considering the altered coagulation system and device associated infection management. TLE procedures in LVAD patients are feasible and safe, however associated with an increased risk for postoperative bleeding complications.
P3342Prevalence of patients with paroxysmal supraventricular tachycardia (PSVT) in the United States
Authors: Sacks N , Cyr P , Green S , Healey B , Preib M , Wood D , Pokorney S 
Published: October 2019

Abstract

Background/Introduction
PSVT is a sporadic, sudden and recurring tachycardia that can be difficult to diagnose. Estimates based on an initial healthcare encounter may underestimate PSVT prevalence because patients may have multiple encounters before definitive diagnosis.

Purpose
To estimate the prevalence of PSVT patients in the US using longitudinal data.

Methods
Retrospective study that used demographic, enrollment and claims data from Truven MarketScan® (age <65y) and Medicare Limited Dataset (age≥65y) databases from 2008–2016. All individuals continuously enrolled in their health plans for 5 years were included; PSVT patients were required to have claims with a PSVT diagnosis (ICD-9: 427.0; ICD-10: I47.1) on 2+ outpatient visits, 1+ inpatient admission or 1+ ED visit. The 9-year period prevalence was calculated as the number of PSVT patients /number of individuals observable for 5 continuous years, and the 9-year prevalence from the study population was projected to the U.S. population by sex and age (<18, 18–34, 35–44, 45–54, 55–64, ≥65) using 2010–2016 U.S. census data.

Results
Of 18,057,297 study patients, 86,630 met criteria for PSVT. Projected to the US population, prevalence estimates ranged from 1,749,358 in 2010 to 1,967,532 in 2016. Prevalence rates increased with age, from 0.871/1,000 (<18y) to 5.031/1,000 (45–54y) and 21.881/1,000 (≥65y). Prevalence rates were higher for females in all age groups, except the <18y cohort, but the difference in prevalence between female and male patients decreased with age. Relative rates of PSVT were more than twice as high for females age 18–44y, while prevalence rates were 1.3 to 1.6 times higher in females age 45y and above (Table).
Prevalence of PSVT in the US by Age and Gender, 2010–2016 Age Prevalence/1,000 [Female; Male] US Population (Year) Projected Prevalence (US) <18 0.871 [0.898; 0.845] 323,127,513 (2016) 1,967,532 18–34 2.268 [3.023; 1.440] 320,896,618 (2015) 1,930,746 35–44 3.313 [4,340; 2.147] 318,563,456 (2014) 1,892,923 45–54 5.031 [6.058; 3.845] 316,204,908 (2013) 1,855,256 55–64 7.761 [8.663; 6.727] 313,998,379 (2012) 1,818,690 65+ 21.881 [24.480; 18.329] 311,663,358 (2011) 1,777,397 Total 4.798 [5.823; 3.668] 309,348,193 (2010) 1,749,064

Conclusions
Based on insurance claims data, PSVT affected 1.7–2 million individuals in the U.S. annually between 2010 and 2016. Prevalence rates were higher in older individuals and females, with much higher rates for females ages 18–44y relative to males. Estimates that rely on a single medical encounter may underestimate PSVT prevalence.
P3343Association of minority status with mortality and hospital readmission in patients with ischemic cardiomyopathy in the STICH trial
Authors: Pires J M , Brown D L 
Published: October 2019

Abstract

Background
Racial and ethnic minorities with coronary artery disease (CAD) suffer worse outcomes than their non-minority counterparts, including increased mortality and hospital readmissions. Proposed explanations include impaired access to care, reduced quality of care, comorbidity burden and medication access. Study of the outcomes of minorities in randomized controlled trials (RCT) allows controlling for some of these factors.

Purpose
The purpose of the current study was to evaluate the impact of minority status on mortality and hospital readmission in patients enrolled in the Surgical Treatment for Ischaemic Heart Failure (STICH) trial.

Methods
STICH was a multicenter, international RCT of patients with an ejection fraction (EF) of 35% or less and CAD amenable to coronary artery bypass graft surgery (CABG) who were randomized to undergo CABG plus medical therapy or medical therapy alone. Median follow-up was 9.8 years. Minority status was defined by self-reported black race or Hispanic ethnicity. Optimal medical therapy (OMT) was the combination of at least 1 antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The primary outcomes of interest were mortality and hospital readmission. Separate Cox proportional hazards models were constructed to examine the independent associations between minority status and mortality and readmission.

Results
Of 1212 patients randomized, 421 (35%) were members of a minority. CABG was the treatment assignment in 52.5% of minority participants whereas 47.5% were randomized to medical therapy (P=0.27). Minority patients were significantly younger than non-minority patients (57.8 vs 61.6 years, P=0.003). Sex, smoking status, and the prevalence of diabetes, hypertension, stroke and chronic kidney disease did not differ between minority and non-minority patients. Fewer minority patients had hyperlipidemia (49% vs. 66%, P<0.001), prior MI (72% vs 80%, P=0.003), atrial fibrillation (8.1% vs. 15%, P=0.001) or prior percutaneous coronary intervention (9% vs. 15%, P=0.004). Minority patients were less often on OMT at 30 days (56% vs. 66%, P=0.001), 1 year (70% vs. 76%, P=0.048) and 5 years (66% vs. 75%, P=0.002). Crude mortality rates were lower in minority patients (57% vs. 65%, P=0.004). However, minority status was independently associated with an increased hazard of mortality (HR 2.3, 95% CI: 1.5–2.5, P<0.001) but had no effect on rehospitalization (HR 1.01, 95% CI: 0.78–1.31, P=0.97).

Conclusion
Despite being a low risk population, minority status in the STICH trial was associated with a 2.3-fold increased hazard of mortality in patients with ischaemic cardiomyopathy. Additional research is urgently needed to delineate and address the causes of disparate outcomes among minority patients.
P3349RHAPSODY: a pivotal phase 3 trial to assess efficacy and safety of rilonacept, an interleukin 1 alpha and beta blocker, in patients with recurrent pericarditis
Authors: Imazio M , Klein A , Brucato A , Cremer P , Lewinter M , Abbate A , Lin D , Martini A , Beutler A , Chang S , Crugnale S , Fang F , Gervais A , Perrin R , Paolini J F 
Published: October 2019

Abstract

Background
Recurrent pericarditis (RP) is managed with nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CS), and colchicine; up to 15% of pericarditis patients experience multiple recurrences. Interleukin 1 (IL-1) is an important cytokine in the pathophysiology of RP. Rilonacept (KPL-914) is a recombinant fusion protein which binds IL-1α and IL-1β. An ongoing Phase 2 study of rilonacept demonstrated improvements in RP symptoms and inflammation.

Purpose
To evaluate the efficacy and safety of subcutaneous (SC) rilonacept in patients with RP in a Phase 3, randomized, placebo-controlled trial.

Methods
RHAPSODY is a double-blind, placebo-controlled, randomized-withdrawal trial; ∼50 patients will be enrolled (Figure). Patients (≥12 y) must present with at least a third pericarditis episode (all etiologies except infectious and malignant) characterized by a pain score ≥4 on the 11-point Numeric Rating Scale (NRS) and C-reactive protein (CRP) ≥1 mg/dL at screening. Patients may be receiving stable doses of analgesics, NSAIDs, colchicine, and/or CS. After a loading dose (320 mg SC in adults and 4.4 mg/kg SC in children), all patients will receive weekly rilonacept (160 mg SC in adults and 2.2 mg/kg SC in children) during the run-in period. Patients able to taper and discontinue concomitant pericarditis medications and achieve clinical response (mean daily NRS score ≤2.0 during the 7 days before randomization and CRP level ≤0.5 mg/dL) will be randomized 1:1 in a blinded fashion to continued rilonacept or matching placebo weekly SC injections. Investigators may choose different treatments for pericarditis recurrences based on patient clinical status, including bailout rilonacept, while maintaining the blind to prior treatment assignment. The primary efficacy endpoint is time to pericarditis recurrence (adjudicated by an independent committee) in the randomized-withdrawal portion of the study. Secondary efficacy endpoints are the proportion of patients maintaining a clinical response, percentage of days with NRS pain score ≤1, and percentage of patients with no-to-minimal pericarditis symptoms based on patient global assessment. Safety evaluations include adverse events monitoring, physical examinations, and laboratory tests.
Figure 1

Conclusions
RHAPSODY is a pivotal Phase 3 trial evaluating the efficacy and safety of rilonacept in patients with RP using a double-blind, placebo-controlled, randomized-withdrawal design. The results of this study may inform the management of RP.

Acknowledgement/Funding
This study is sponsored by Kiniksa Pharmaceuticals, Ltd.
P3354Papillary muscle ischemia and global myocardial flow reserve: assessment by high-resolution cine imaging of 13N ammonia PET
Authors: Nakao R , Nagao M , Momose M , Kasuga N , Matsuo Y , Fukushima K , Watanabe E , Sakai A , Hagiwara N 
Published: October 2019

Abstract

Purpose
Papillary muscle ischemia (PMI) is caused by micro-vessels' occlusion in the broad endocardium because papillary muscle perfusion is supply from micro-vessels of peripheral coronary arteries and is easy to fail by the increase in peripheral vascular resistance. However, the clinical significant is not understood because PMI could not be detected by existing perfusion imaging such as SPECT and MRI. We propose the detection method of PMI using 13N-ammonia PET (NH3-PET), and investigate the association with the global myocardial flow reserve (Global-MFR) reflecting coronary microvascular dysfunction.

Methods
Data of adenosine-stress NH3-PET for consecutive 260 patients with coronary artery disease (CAD) or suspected CAD was retrospectively analyzed. Using high-resolution cine imaging derived from NH3-PET, PMI was defined as the absence of the PM accumulation at stress conditions. Myocardial flow was generated from the time activity curve of left ventricle input and myocardial uptake using 3-compartment model and the first 2 minutes' dataset of list mode images. Global-MFR was calculated by stress to rest flow ratio. Summed stress score (SSS) was used as an estimate of the extent of myocardial ischemia. 150 out of 260 patients (58%) with SSS ≥4 or with the past history of coronary artery diseases were classified as ischemic group, and 110 patients (42%) with SSS<4 were classified as non-ischemic group.

Results
PMI was seen in 68 of 260 patients (26.6%). The frequency of PMI was higher in the ischemic group than the non-ischemic group (37.8% vs. 10.1%, p<0.0001). Global-MFR was significantly lower in patients with PMI than those without (1.87±0.55 vs. 2.39±0.80, p<0.0001). In both ischemic and non-ischemic group, global-MFR was significantly reduced in patients with PMI. (Ischemic group: 1.83±0.56 vs. 2.12±0.52, p=0.0043, Non-ischemic group: 2.06±0.45 vs. 2.63±0.91, p=0.040).
Typical case of PMI

Conclusion
High-resolution cine imaging derived from NH3-PET makes it possible to detect PMI in about a quarter of patients with CAD or suspected CAD. PMI associates with reduced Global-MFR regardless of the presence of myocardial ischemia, suggesting that PMI is an important sign of early ischemia confined to the papillary muscle or the broad microvascular injury.
P3367Echocardiographic assessment of right ventricle function in patients with severe tricuspid regurgitation and correlates with outcomes
Authors: Gavazzoni M , Vizzardi E V , Castiello A C , Raddino R R , Badano L P B , Muraru M D , Metra M M 
Published: October 2019

Abstract

Background/Introduction
Speckle tracking echocardiography has been recently proposed as an accurate and sensitive measure of right ventricle (RV) function that could integrate other more conventional parameters. This tool can be important in the clinical context of severe tricuspid regurgitation (TR), since TAPSE is not fully representative of global RV function and can overestimate this in presence of severe TR.

Purpose
Evaluate the prognostic relevance of different parameters of RV structure and function derived from 2D and speckle tracking echocardiographic analysis of clinically stable patients with severe TR referred for routine follow up in the context of many etiologies of left side heart disease (secondary TR).

Methods
The present is a retrospective analysis of prospectively acquired echocardiographic studies including patients with severe secondary TR in the context of left side heart disease. Fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV global longitudinal strain (RVLS) and RV free-wall longitudinal strain (RVFWLS) as well as LV function were measured. As suggested in previous studies, we also aimed to explored the use in this population of: i)RVLS/pulmonary systolic arterial pressure (PASP); ii) RVFWLS (average lateral 3 segments strain)/IVSLS (average medial 3 segment strain) as index of RV-LV dependency. The composite end-point of this study included death for any cause and heart failure hospitalization.

Results
61 patients (mean age 58±20 years, 65% men), were included. After a mean follow up period of 3,6±2 years 57% of patients reached the combined end-point. At Cox regression univariate analysis a significant correlation with outcomes was found for RVend-diastolic diameter (HR 0,42, p: 0.018), right atrial area (HR: 3, p: 0.02), RVFWLS/IVSLS (HR: 0.5, p: 0.020), RVLS/PASP (HR 0.186, p: 0.039). In multivariable Cox-regression model we found that LVEF, RV dimension and RVFWLS/IVSLS were independently related to outcome; this last one parameter showed the best correlation with outcomes.

Conclusions
In asymptomatic and clinically stable patients with severe secondary TR longitudinal function of RV free wall is not related to outcomes but RV-arterial coupling and the ratio between deformation of free wall and septal wall of RV are good predictors of clinical deterioration at follow up. The last one conceptually represents the interaction between RV and LV in secondary TR and allows a real “correction” of those effects of severity of TR on the base to apex gradient of lateral wall longitudinal deformation (TR increases movement of basal segments).
P3373Predictors of dilatation of ascending aorta in patients with bicuspid aortic valve, a longitudinal multicenter study
Authors: Dentamaro I , Sao-Aviles A , Teixido G , Galian L , Gutierrez L , Gonzalez-Alujas M T , Calvo F , Sanchez V , Alegret J , Colonna P , Moreo A , Citro R , Chirillo F , Rodriguez-Palomares J F , Evangelista A 
Published: October 2019

Abstract

Introduction
The bicuspid aortic valve (BAV) is frequently associated to dilation of the ascending aorta. Some cross-sectional studies have related the aortic dilation with morphotype and valvular dysfunction. The aim of this longitudinal multicenter study was to analyze the progression of the aortic dilation and to identify its predictors.

Methods
We included 459 patients (mean age 52±17; 325 men 70.8%) with BAV, without aortic coarctation. The BAV morphotype, significant valvular dysfunction and dilation of the aortic root and ascending aorta were established by echocardiography. The patients were followed annually, with an average of 7.5±3.2 years.

Results
77% of the patients had BAV with a fusion between left and right cusps, 21% between right and non coronary cusps and 2% between left and non coronary cusps, with a raphe in 77% of these patients. Risk factors included: 35% hypertension, 20% smoking, 5% diabetes and 18% dyslipidemia. The baseline study showed a maximum root diameter of 36±6.2 mm and ascending aorta of 39±8.1 mm. In 7% the aortic root was>45 mm, while in 32% the ascending aorta>45 mm. There was no valvular dysfunction in 17% of patients, while the 8% had significant aortic stenosis and 35% significant aortic regurgitation. The annual growth of the aortic root was 0.33±0.2 mm and for the ascending aorta was 0.38±0.3 mm. At the end of follow-up, 16% of the patients had a root>45 mm and 41% an ascending aorta>45 mm. The annual progression of aortic diameters was not related to valvular morphotype, valvular dysfunction or cardiovascular risk factors. The univariate analysis showed a significant relationship between the annual growth of the aortic root and arterial hypertension (p=0.028) and the annual growth of the ascending aorta with the male sex (p=0.019), smoking (p=0.046) and significant (moderate or severe) aortic stenosis (p=0.013). Diabetes mellitus and the presence of raphe were found to be slightly protective (p=0.049 and p=0.031, respectively). In the multivariate analysis, only the male sex and significant aortic stenosis were independent predictors of dilation of the ascending aorta.

Conclusions
In patients with bicuspid aortic valve, the progression of the dilation of the aortic root is related to hypertension and the growth of the ascending aorta with the male sex and the presence of significant aortic stenosis. Both bicuspid valve morphotype, basal aortic diameter or age were not related to the progression of aortic dilation.