bluuebunny/crossref_metadata_2025_split huggingface dataset:
P2753Anticoagulation control and all-cause death in patients with operated valvular heart disease with and without atrial fibrillation receiving vitamin K antagonists
Authors: Zulkifly H , Pastori D , Lip G Y H , Lane D 
Published: October 2019

Abstract

Introduction
Good quality of anticoagulation in patients with valvular heart disease (VHD) is needed to reduce ischaemic complications. There is limited evidence on factors affecting anticoagulation control in patients implanted with mechanical or tissue prosthetic valve(s).

Objective
To examine quality, factors affecting anticoagulation control and all-cause death in VHD patients with and without atrial fibrillation (AF) receiving a vitamin K antagonist (VKA) oral anticoagulant. The relationship between INR control with all-cause death and ≥1 adverse clinical events (ACE) [thromboembolism, bleeding, cardiovascular hospitalisation and all-cause death] were explored.

Methods
Anticoagulation control of 456 VHD patients [164 (36%) with AF and 290 (64%) without AF] referred to a hospital-based anticoagulation clinic were assessed retrospectively by time in therapeutic range (TTR) (Rosendaal) and percentage of INRs in range (PINRR) for a median of (IQR) 6.2 years (3.3–8.5). VHD was defined by the presence of mechanical or tissue prosthetic valve at either the mitral or aortic site or both.

Results
Mean (SD) age 51 (14.7), 64.5% male, mean (SD) CHA2DS2-VASc score 2.0 (1.4), 96.1% mechanical prosthesis and 64% aortic valve replacement. VHD patients with AF had lower mean TTR and PINRR, lower proportion of optimal TTR (i.e.≥70%) despite similar number of INR tests compared to VHD patients without AF [Table 1]. Predictors of poor TTR on multivariate logistic regression analysis were female sex, AF and anaemia/bleeding history. Significantly higher proportions of VHD patients with AF died [Table 1]. More deaths (13.1% vs. 4.1%; p=0.011) and ≥1 ACE (42.7% vs. 27.6%; p=0.006) were seen in VHD patients with TTR <70% vs. TTR≥70%, respectively.
Table 1 N (%) Total (N=456) AF (N=164) No AF (N=290) p-value Mean (SD) TTR 58.5 (14.6) 55.7 (14.2) 60.1 (14.6) 0.002 TTR ≥70% 98 (21.5) 23 (14.0) 75 (25.7) 0.004 Mean (SD) PINRR 50.1 (13.8) 47.4 (13.5) 51.6 (13.7) 0.002 Mean (SD) INR tests 96.2 (55.3) 100.7 (58.8) 93.7 (53.1) 0.19 All-cause death 51 (11.2) 34 (20.7) 17 (5.8) <0.001 AF: Atrial fibrillation; IQR: interquartile range; PINRR: percentage of INRs in range; SD: standard deviation; TTR: Time in therapeutic range.

Conclusion
The quality of anticoagulation in VHD patients with AF was low. The presence of AF, anaemia/bleeding history and female sex independently predicted poor TTR. All-cause death was more common in VHD patients with AF and poor TTR. Closer INR monitoring is needed especially in VHD patients with AF to improve anticoagulation control and prevent adverse clinical outcomes.

Acknowledgement/Funding
Kementerian Pendidikan Malaysia and Universiti Teknologi MARA for PhD study but not directly for work under consideration
P2755Acute kidney injury risk calculator in patients with infective endocarditis
Authors: Pisaryuk A , Povalyaev N , Sorokina M , Teterina M , Kotova E , Goreva L , Balatskiy A , Karaulova Y , Efremovtseva M , Milto A , Kobalava Z 
Published: October 2019

Abstract

Background
Kidney involvement in IE has a huge contribution in failure of the treatment. Frequency of kidney lesions is still high. There are several risk calculators for prognosing embolic events, perioperational mortality, 6-month mortality, but there is none for prognosing kidney events in IE.

Materials/Methods
209 patients with verified IE (DUKE 2009, 2015), hospitalized from 2010 to 2018, were included in the study. Kidney function was assessed using CKD-EPI formula. AKI was diagnosed according to current guidelines (KDIGO 2012). Clinical, hematological and echocardiographic features were analysed to look for predictors of AKI. To create a simple risk calculator independent predictors obtained from log-regression analysis were used. The risk formula was derived using the coefficients: Pr(Y) = 1/[1 + exp(−XB)] where Pr(Y) = prognosed risk of AKI, XB = coef1*predictor1 + ... + logit-regression constant.

Results
AKI was presented in 66% cases and mainly was I (41%) and III (37%) stages. Predictors for AKI were established: MRSA OR 8.0 (95% CI 1.01–68.48; p=0.054), emergence or worsening of the HF sympthoms OR 2.83 (95% CI 1.27–6.32; p=0.011), gentamycin OR 2.71 (95% CI 1.33–5.53, p=0.006), history of CAD OR 2.35 (95% CI 1.05–5.27) p=0.038, WBC at admission >11.5x109/l OR 1.07 (95% CI 1.01–1.13), duration of hospitalization >20.7 days OR 1.03 (95% CI 1.01–1.05) p=0.005, C-reactive protein >90 mg/l OR 1.01 (95% CI 1.01–1.02) p=0.001.
Simple risk calculator Coef OR Indicator MRSA 2.0755 8 0 Emergence or worsening of the heart failure sympthoms 1.04041 2.83 0 Gentamycin 0.3640833 2.71 1 History of coronary artery disease 0.8542633 2.35 1 White blood count at admission 0.0691979 1.07 13 Duration of hospitalization 0.0308953 1.03 2 C-reactive protein 0.0075288 1.01 180 Constant −3.275098 0.0378132 Logit 0.259795900 P 0.564586119 Scaling parameter 100 Points 56 Result 56

Conclusions
A simple risk calculator for AKI is developed for patients with IE.
P2761Assessment of perioperative mortality risk in patients with infective endocarditis undergoing cardiac surgery: performance of the EuroSCORE II, PALSUSE, STS risk score for IE and modified AEPEI score
Authors: Brizido C , Madeira S , Oliveira P , Silva C , Gama F F , Lopes P , Strong C , Marques M , Neves J P , Mendes M 
Published: October 2019

Abstract

Introduction and aim
Infective endocarditis (IE) is a complex and heterogeneous disease which might lead to cardiac surgery. For such cases, several perioperative risk predictive tools have emerged. We aimed to validate the recently developed PALSUSE, STS risk score for IE and modified AEPEI score and to compare their performances with the established EuroSCORE II.

Methods
We retrospectively accessed 128 patients from a single center registry who underwent heart surgery for active infective endocarditis between January 2007 and November 2014. Discrimination and calibration of models were assessed by receiver operating characteristic curve analysis and Hosmer-Lemeshow test.

Results
Perioperative mortality was 16.4% (n=21). The median EuroSCORE II, PALSUSE, STS risk score for IE and modified AEPEI score were 6.6% [IQR 3.5–18.2], 5 [IQR 3–7], 25 [IQR 16–32] and 1 [IQR 0–1.8], respectively. Discriminative power was numerically higher for EuroSCORE II (AUC of 0.83, 95% CI, 0.75–0.91) followed by STS risk score for IE (AUC of 0.75, 95% CI 0.64–0.86), PALSUSE (AUC of 0.74, 95% CI 0.64–0.86) and modified AEPEI (AUC of 0.68, 95% CI 0.57–0.788) – figure 1. The Hosmer-Lemeshow test showed good calibration for EuroSCORE II (p=0.08) and STS risk score for IE (p=0.03) but not for PALSUSE (p=0.65), modified AEPEI (p=0.12).
Figure 1

Conclusion
All scores adequately stratified peri-operative risk in active infective endocarditis, however EuroSCORE II in the overall comparison performed better in this population. Heterogeneity of performance of risk scores in different cohorts of infective endocarditis highlights the complexity of this disease.
P2766Increased right ventricular burden in patients with chronic thromboembolic disease
Authors: Jervan O , Gleditsch J , Rashid D N M , Ghanima W , Steine K 
Published: October 2019

Abstract

Introduction
Patients with chronic thromboembolic disease (CTED) have residual perfusion defects after pulmonary embolism (PE) but not increased pulmonary artery (PA) pressure. These patients suffer from functional limitation and have a higher risk of venous thromboembolism recurrence.

Purpose
In this study we wanted to explore if CTED patients had signs of increased PA pressure and right heart burden by echocardiography

Methods
Inclusion criteria were history of PE, age 18–75 years and PE diagnosed 6–72 months prior to inclusion. Patients with left ventricular systolic or diastolic heart failure, valvular disease, chronic pulmonary disease and chronic thromboembolic pulmonary hypertension were excluded. All patients underwent echocardiography with standard and novel methods and ventilation/perfusion (VQ)-scan. The echocardiographic examinations were blinded to the result of the VQ-scan. VQ-scan were analyzed according to the European Association of Nuclear Medicine-criteria, and deemed either positive or negative. Data are presented as mean ± SD or median ± IQR as appropriate. Independent sample t-test or Mann-Whitney U test was used for the primary statistical analysis. Multiple linear regression was used to adjust for age, BMI and systolic blood pressure.

Results

Table 1 VQ negative (n=58) VQ positive (n=20) p-value Adjusted Age (years) 59±8 67±6.5 0.71 Time since PE event (months) 37±19 33±17 0.42 Pulmonary artery acceleration time (ms) 145±22 119.5±26 <0.001 <0.001 Pulmonary artery diameter (mm) 21±3.3 25±3.6 <0.01 <0.01 TAPSE (mm) 25.7±3.6 24.9±4.0 0.45 RV (right ventricle) S' (cm/s) 12.7±2.3 12.8±2.7 0.78 RV isovolumic relaxation time (ms) 33±23.9 50±22 <0.01 <0.01 RV myocardial performance index 0.36±0.10 0.44±0.15 0.04 0.02 Tricuspid regurgitation maximum velocity (m/s) 2.3±0.3 2.7±0.4 <0.001 <0.001 LV (left ventricle) ejection fraction (%) 62.5±4.2 61.3±6.0 0.41 E/A 1.02±0.26 0.90±0.23 0.09 E/e' 6.8±2.0 6.5±2.2 0.75 E/A: ratio between transmitral pulsed doppler peak early (E) diastolic and atrial (A) velocity; E/e': ratio between E and peak early velocity (e') by tissue velocity.
Figure 1 (error bars - mean and 95% CI)

Conclusion
Patients with CTED after PE have increased PA pressure and impaired RV systolic and diastolic function compared to those without residual perfusion defects. These findings indicate that CTED patients should be more thoroughly followed up.
P2777Natural history and long-term prognosis of stroke types in urban and rural China: a 9-year prospective study of 0.5 million adults
Authors: Chen Y , Wright N , Clarke R , Kartsonaki C , Turnbull I , Guo Y , Zheng B , Li L , Chen Z 
Published: October 2019

Abstract

Background
Stroke is a major cause of premature death and disability worldwide. However, relatively little is known about the natural history and long-term prognosis following stroke in many low and middle income countries, including China.

Methods
The prospective China Kadoorie Biobank recruited 512,000 adults (59% women, mean age 51 years) from 10 (5 urban, 5 rural) areas in China during 2004–08. Information about death and hospitalisation for specific causes was collected by linkage with mortality registries and nationwide health insurance systems. During a 9-year follow-up, 45,732 incident cases of stroke (∼92% confirmed by neuroimaging) were recorded among individuals without prior vascular disease at baseline. The adjusted 28-day case-fatality rates and long-term cumulative risks of recurrent stroke, major vascular events, and mortality following first-ever stroke were estimated by stroke types.

Results
Of the 45,732 first-ever stroke cases reported, 80% (36,588) had IS, 17% (7440) had intracerebral haemorrhage (ICH), 2% (702) had subarachnoid haemorrhage (SAH), and only 1002 (1%) had an unspecified stroke type. The overall 28-day case-fatality following first stroke was 11%, but increased with age and was higher in those in rural than in urban areas (16% vs 6%) and in men than in women (13% vs 10%). The 28-day case-fatality was highest for ICH (47%), lowest for IS (3%) and intermediate for SAH (19%) and unspecified strokes (24%). Among those who survived beyond 28 days, 17% died (28% for ICH, 16% for IS) and 41% had a recurrent stroke (44% for ICH, 41% for IS) at 5 years. For those with first-ever IS, 91% of the subsequent recurrent strokes involved same pathological type, while for ICH, 41% of the recurrent strokes were IS.
Stroke prognosis

Conclusions
Among Chinese adults, the short- and long-term prognosis following first-ever stroke were poor, highlighting the urgent need to implement more effective treatment and secondary prevention strategies for stroke cases.

Acknowledgement/Funding
UK MRC, UK Wellcome Trust, British Heart Foundation, Cancer Research UK, The Chinese Ministry of Science and Technology, the Chinese National Science
P2789A new technique to restore shape and pattern of flow in hypoplastic aortic arch
Authors: Afifi A , Nagy M , Hosny H , Shehata N , Simry W , Raef Y , El Mozy W , Abou Gamrah M , Aguib H , Yacoub M 
Published: October 2019

Abstract

Background
There is no agreement about the best method for correcting hypoplastic aortic arch in infancy. Residual abnormalities in shape can cause late complications.

Patients and methods
We have developed and applied a new method of direct anastomosis of the descending to the ascending aorta to allow for restoration of shape, function and growth. 12 infants undergoing this technique at the age of 61±3months (range 6–28 months) underwent repeat CT 4–15 months after operation.
Pre- and post-operative arch width, height and height to width ratio were recorded for all cases. Computerized shape analysis using an in-house tool (developed in MATLAB) was used for processing the 3D segmented shapes of the aortic arch, and assessing changes in the cross-sectional area at different levels. Computational Fluid Dynamics (CFD) was used to simulate aortic flow propagation and pattern after surgery, using patient specific geometry and flow boundary conditions.

Results
The pre- and post-operative cross-sectional area along the centerline of the aorta and arch was almost normalized, Figure 1.
The pattern of flow during the cardiac cycle with a retrograde helix in the aortic arch, similar to normal, was observed in all cases with peak velocities of 1.1±0.2m/s.
Aortic Shape and flow after surgery

Conclusion
We here describe a new technique, which at least in the short term appears to normalize the size, shape and pattern of flow in the arch. Long term studies are required to establish the value of this technique.
P2792Preoperative levosimendan improves survival in patients with low cardiac output syndrome undergoing cardiac surgery: a meta-analysis of randomized controlled trials
Authors: Brockmeyer M , Lin Y , Karathanos A , Parco C , Krieger T , Heinen Y , Albert A , Kelm M , Schulze V , Wolff G 
Published: October 2019

Abstract

Background and purpose
Previous studies and meta-analyses of perioperative levosimendan to improve the outcomes of patients with low cardiac output syndrome (LCOS) undergoing cardiac surgery have given controversial results and the optimal time of infusion of levosimendan remains uncertain. We thus aimed to elucidate the risk/benefit ratio of preoperative levosimendan in a meta-analysis of randomized controlled trials (RCTs).

Methods
Online databases were searched for RCTs comparing preoperative levosimendan to placebo in patients with LCOS undergoing cardiac surgery until February 2019. Data from retrieved studies were abstracted and analyzed in a comprehensive meta-analysis. Primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction, renal failure/replacement therapy, need for inotropic therapy, need for left ventricular assist devices, ventricular arrhythmia and arterial hypotension.

Results
As a result of the online database search, six eligible RCTs with 1,326 patients were included in the meta-analysis. Preoperative levosimendan showed a significant reduction in all-cause mortality (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.29–0.83; p<0.01), renal failure/replacement therapy (OR 0.48, CI 0.29–0.80; p<0.01) and need for inotropic therapy (OR 0.24, CI 0.06–0.95; p=0.04) compared to placebo. There were no significant differences in levosimendan vs. placebo concerning the rates of myocardial infarction (OR 0.61, p=0.38), need for left ventricular assist devices (OR 0.38, p=0.1), ventricular arrhythmia (OR 0.7, p=0.33), and arterial hypotension (OR 1.28, p=0.07).

Conclusions
Preoperative administration of levosimendan may improve survival in patients with low cardiac output syndrome undergoing cardiac surgery. It reduces need for inotropic medical support and renal failure/replace-ment therapy compared to placebo.
P2800Impact of plaque vulnerability on vascular response after implantation of two types of biodegradable-polymer drug-eluting stent: coronary angioscopic study
Authors: Ichikawa M , Kijima Y 
Published: October 2019

Abstract

Background
Vascular response after drug-eluting stent (DES) implantation depends not only on stent design but also on vulnerability of target coronary lesions. In this study, non-obstructive coronary angioscopy (CAS) revealed vascular response after two types of biodegradable polymer (BP) DES implantation into patients with acute coronary syndrome (ACS) or stable angina pectoris (SAP).

Methods
Eighteen Nobori BP biolimus-eluting stents (BP-BES) were successfully implanted into 15 patients (9 ACS and 9 SAP lesions). Twenty-three Ultimaster BP sirolimus-eluting stents (BP-SES) were implanted into 16 patients (6 ACS and 17 SAP lesions). At one year after stenting, CAS semi-quantified degree of neointimal stent coverage (NSC) into 4 grades (0, no coverage; 1, thin coverage; 2, thick coverage; 3, embedded in thick neointima and invisible). When NSC through a stent was composed of plural grades, CAS determined dominant, maximum and minimum NSC grades. Heterogeneity index was defined as subtraction of minimum from maximum grade. CAS also semi-quantified degree of yellow plaques (YP) into 3 grades (0, light; 1, dense; 2, glittering yellow). CAS detected presence of in-stent mural thrombi (ISMT).

Results
At one year after BP-BES implantation: 1) There was no significant difference with regards to dominant NSC between ACS and SAP lesions (1.00±0.50 vs. 0.89±0.60); 2) Heterogeneity index was greater in ACS than in SAP (1.22±0.44 vs. 0.67±0.50, P=0.02); 3) YP grade was greater in ACS than in SAP (1.89±0.33 vs. 1.00±1.00, P=0.02); and 4) We found one ISMT in ACS lesions and two ISMT in SAP lesions. At one year after BP-SES implantation: 1) There was neither significant difference between ACS and SAP lesions with regards to dominant NSC (1.67±1.21 vs. 1.53±1.01), with regards to heterogeneity index (0.50±0.55 vs. 0.35±0.49), nor with regards to YP grade (1.33±1.51 vs. 0.88±0.99); and 2) We found ISMT neither in ACS nor in SAP lesions.

Conclusions
For BP-SES implantation, vascular response at ACS lesions was similar to SAP lesions. Even one year after BP-BES implantation, however, plaque vulnerability appeared to remain in ACS lesions.
P2833Safety and efficacy of oral anticoagulation discontinuation in high thromboembolic risk patients at long term follow-up after successful atrial fibrillation ablation
Authors: Cavalli G , China P , Marras E , Corrado A , Themistoclakis S 
Published: October 2019

Abstract

Background
Current guidelines recommend the use of oral anticoagulation (OAC) after successful ablation procedure of atrial fibrillation (AF), according to patient's thromboembolic risk score. However, several observational studies demonstrated similar thromboembolic events and lower incidence of major bleedings in patients who discontinued OAC after successful AF ablation compared with those on OAC. However, data on long-term follow-up after OAC discontinuation in high thromboembolic risk patients successfully treated with AF ablation are missing.

Purpose
To evaluate the incidence of stroke/TIA and bleeding events at long term follow-up after successful AF ablation in high thromboembolic risk patients who discontinued OAC therapy (Off OAC group) compared to those who continued it indefinitely (On OAC group).

Methods
Patients with CHA2DS2VASC score of 2 or more at time of the ablation procedure who discontinued OAC after successful catheter ablation for AF performed between 2001 and 2018 were included in this study. OAC was discontinued in patients without atrial tachyarrhytmias recurrences after intensive monitoring, left atrial dysfunction or pulmonary stenosis.

Results
503 patients (pts), were enrolled in the study (On OAC group: 241 pts; Off OAC group: 262 pts). After a median follow up of 6.3 years, occurred 12 and 14 stroke/TIA events in the On OAC and Off OAC group, respectively (p: 0.854). Bleeding events occurred more frequently in the On OAC group compared to Off OAC group (18 vs 8 events, p: 0.025). At multivariate analysis OAC therapy was independently associated with an increased risk of major bleeding (OR: 2.92, CI95%: 1.11–7.70, p: 0.03) whereas no difference in the risk of stroke were found (OR 0.89, CI95%: 0.37–2.16, p: 0.799).

Conclusion
Discontinuation of OAC after successful AF ablation in high thromboembolic risk patients seems to be a safe and effective strategy even in a long term follow up. Prospective randomized trials are needed to confirm these results
P2837Day-case complex left atrial ablation is safe and cost-effective: experience from a UK tertiary centre
Authors: Datla S , Weight N , Lange J , Berwick K , He H , Lachlan T , Foster W , Yusuf S , Dhanjal T , Panikker S , Hayat S , Osman F 
Published: October 2019

Abstract

Background
Day-case standard catheter ablation is becoming routine. However, patients having complex left atrial ablation for atrial fibrillation (AF) or left atrial tachycardia (LAT) often stay overnight. We have been performing day-case complex left atrial ablation since 2015.

Purpose
To evaluate the safety, efficacy and cost-effectiveness of day-case complex left atrial ablation compared with those who stayed overnight.

Methods
A retrospective analysis of all consecutive complex left atrial ablations performed in a UK tertiary cardiac centre between 2010–2018. Data were collected on baseline parameters, procedure details including mapping technique, ablation strategy, immediate efficacy, and acute complications.

Results
A total of 830 complex left atrial catheter ablations were performed; mean age±SD=60±12 years, 63% male. The majority were AF ablation (n=804, 96.9%), with the rest being LAT/left-atrial flutter. Of the AF cases, 545 were paroxysmal (≤7 days), 212 persistent (>7 days) and 47 long-standing (>1yr); 98% of cases were elective. Pulmonary vein isolation was performed in all; additional LA lines were done in 163, CTI ablation in 129 and CFAEs in 33. 3D-mapping (Carto/Precision)=44.7% (with contact sensing=38.0%), PVAC=18.7%, PVI cryo-balloon=36.6%. Of the cohort 331 (39.9%) were done as day-case. Acute success= 94.9%, acute complications=4.58% (femoral site complications, n=12; pericardial effusion, n=19 (9 needing drain); stroke/cerebral embolus, n=3; phrenic nerve palsy, n=5; first degree heart block, n=1). Comparison of day-case vs non day-case revealed no significant difference in number of complications (Table 1). An overnight stay at out hospital costs £350. During the period of study our institution saved £115.850 (∼140,000 euros).
Day-case vs non day-case ablation Parameters Day-case (n=331) Non day-case (n=499) p-value Mean age ± SD (years) 61.2±11.6 59.1±11.9 0.009 Males (n, %) 205 (61.9%) 321 (64.3%) 0.484 Normal heart (n, %) 243 (73.4%) 383 (76.8%) 0.276 Paroxysmal AF (n, %) 218 (65.9%) 327 (65.5%) 0.928 Fluoroscopy time (mins) 23.8±13.9 27.0±14.5 0.001 Procedure time (mins) 150±89.6 163±68.2 0.025 % with 3D-mapping 30.8% 56.9% <0.001 Acute complications (n, %) 12 (3.63%) 26 (5.21%) 0.285

Conclusions
Day-case complex left atrial cardiac ablation is safe and effective. It is associated with good clinical outcomes and leads to significant cost savings as an overnight stay is not needed.