bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortic tortuosity index as a predictor of type A aortic dissection
Authors: Scalbert F , Milleron O , Para M , Raffoul R , Pellenc Q , Alkhoder S , Rouzet F , Nataf P , Ou P , Jondeau G 
Published: November 2020

Abstract

Introduction
The risk ok type A aortic dissection (AAD) depends on the degree of aortic wall's alteration, which can result in dilatation or tortuosity. The estimate of this risk relies solely on the evaluation of the diameter of the ascending aorta.

Purpose
The purpose of this study is to evaluate the presence and importance of aortic tortuosity in patients with type A aortic dissection.

Method
Postoperative CT scans of patients with type A aortic dissection were compared with CT scans from controls matched for gender and age. After 3D reconstruction, total length (actual distance along aortic center line = Ltot) and geometric length (length of a straight line between start and end of the aortic segment = Lgeo) were measured to calculate the tortuosity index (TI = Ltot / Lgeo).

Results
Ltot, Lgeo and TI from different aortic segments of the AAD group were higher than in the control group. Ltot and TI of the whole aorta (from aortic valve to bifurcation) were greater in patients with type A aortic dissection (527.7±46.1 mm vs. 475.8±39.7, p&lt;0.0001; and 2.05±0.24 vs. 1.98±0.21, p=0.002 respectively). Total length and TI were greater after exclusion of the ascending part, and a value of this TI &gt;1.3 identifies AAD patients with an accuracy of 74.8% (AUC = 0.792, p&lt;0.0001). TI is altered by risk factors for aortic dissection: it increases with hypertension and age but not by tobacco use, and TI decreases in diabetes.

Conclusions
Type A aortic dissection is associated with longer aorta and increased aortic tortuosity. This index may help recognize patients at risk for type A aortic dissection.
Calculation of tortuosity indexes

Funding Acknowledgement
Type of funding source: None
Bicuspid aortic valve disease associates with abnormal wall shear stress, viscous energy loss, and pressure drop within the ascending thoracic aorta
Authors: Geeraert P , Jamalidinan F , Bristow M , Lydell C , Howarth A.G , Fedak P.W.M , White J.A , Garcia J 
Published: November 2020

Abstract

Introduction
We use 4D Flow MRI to (1) investigate the effects of bicuspid aortic valve (BAV) disease on downstream pressure drop (PD), wall shear stress (WSS), and viscous energy loss (EL) in the ascending aorta (AAo) and (2) explore the associations between AAo diameter and PD, WSS, and EL.

Hypothesis
BAV patients show increased PD, WSS, and EL in the AAo compared to age-matched controls

Methods
32 healthy controls (41±15 y, 10 female) and 53 BAV patients (44±16 y, 19 female) underwent cardiac MRI at 3T, inclusive of cine imaging and 4D flow. Cross sections were placed along segmented aortas at the: left ventricular outflow tract (LVOT), sinuses of Valsalva (SOV), mid-ascending aorta (MAA), and proximal to first aortic branch (AA1). Locations were analyzed for (i) net flow, (ii) aortic diameter (normalized to BSA), (iii) systolic PD (referenced to LVOT), (iv) systolic EL (measured within LVOT-AA1 volume and normalized by LVOT net flow; mW/mL), and (v) systolic WSS. Sub-vectors of WSS, axial (WSSax) and circumferential (WSScirc), were also analyzed.

Results
In comparison to controls, BAV patients showed greater PD (e.g. MAA: 9.5±8.0 vs. 2.8±2.4mmHg; p&lt;0.01), EL (0.09±0.05 vs. 0.04±0.01 mW/mL; p≤0.01), and WSScirc (e.g. MAA: 0.3±0.1 vs. 0.2±0.06 Pa; p≤0.01) throughout the AAo (Table 1 and Fig. 1). BAV patients exhibited significantly lower WSS and WSSax only at the SOV. In univariate analyses, AAo diameter was inversely correlated with WSS (R=−0.32, p&lt;0.01) and WSSax (R=−0.51, p≤0.01). In multivariate analyses, AAo diameter was associated with WSS (β=−0.36, p&lt;0.01) and WSSax (β=−0.26, p&lt;0.01).

Conclusions
BAV patients demonstrate significantly increased PD, EL, and WSScirc in the AAo, and an inverse association between AAo diameter and WSS measures.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Alberta Health Services
Arterial wall stiffness in patients with abdominal aortic aneurysms and concomitant coronary artery disease
Authors: Ikonomidis I , Rafouli-Stergiou P , Katsiki N , Kadoglou N , Vlachos S , Thymis J , Parissis J , Moulakakis K , Kakisis J 
Published: November 2020

Abstract

Introduction
Pulse wave velocity (PWV) is a valid, clinically feasible marker of arterial stiffening, and a strong predictor of outcomes. In patients with abdominal aortic aneurysms (AAA) alterations in arterial wall composition and inflammation were proposed as possible contributors to increased arterial stiffness.

Purpose
The present study aimed to compare aortic elastic properties in patients with abdominal aortic aneurysms (AAA), with or without coronary artery disease (CAD), as well as healthy individuals.

Methods
A total of 130 patients with AAA, eligible for interventional repair, and 30 healthy individuals, comprising the control group (HC), were evaluated. Study groups did not differ in anthropometrical characteristics and CV risk factors. Presence of CAD was identified by coronary angiography. Aortic PWV (aPWV) was measured using the Arteriograph method.

Results
aPWV was found considerably higher in AAA patients compared to HC group (11.5±2.9 vs. 7.3±1.6 m/s, p&lt;0.001), after adjustment for age, sex and mean arterial pressure (MAP). Interestingly, among patients with AAA, those with concomitant CAD (n=41) had higher aPWV than those without CAD (12.5±2.9 vs. 11.0±3.0 m/s, p=0.03), after adjustment for age, sex and MAP. In receiver-operator-curve (ROC) analysis, the area under the curve (AUC) of aPWV for the prediction of CAD presence in the AAA study group was 0.72 [95% confidence interval (CI): 0.55–0.84, p=0.03]. According to this, the best cut-off was a value of aPWV above 12.8 m/s (78% sensitivity and 73% specificity). This cut-off was identified as a significant predictor of CAD presence in the AAA study population according to univariate logistic regression analysis (OR=2.51, 95% CI: 1.79–5.19, p=0.02). After adjustment for age, sex, dyslipidemia, smoking and MAP in multivariate logistic regression analysis, the cut-off aPWV level remained independently associated with the presence of CAD (OR=1.64, 95% CI: 1.19–4.08, p=0.03).

Conclusion
The co-existence of CAD and AAA is characterized by a greater arterial stiffness. This finding supports a role of measuring arterial stiffness markers when evaluating AAA patients' cardiovascular risk and selecting endovascular stents with more favorable elastic properties. Further studies are needed to explore whether aPWV values could be used to as a screening tool to detect CAD or to guide treatment in AAA patients.

Funding Acknowledgement
Type of funding source: None
Prevalence, specialized ambulatory care and guideline-recommended therapy of peripheral vascular diseases in Germany
Authors: Rammos C , Petrikhovich O , Mahabadi A , Steinmetz M , Lortz J , Hering R , Schulz M , Rassaf T 
Published: November 2020

Abstract

Background
Cardiovascular diseases are the leading causes of death in the industrialized world. In addition to coronary heart disease, PAD defines morbidity and is associated with increased mortality. Guideline-recommended therapy and specialized ambulatory care is essential for optimal treatment. Knowledge of the treatment structures, contact with dedicated specialists and pharmacotherapy in the outpatient area are essential for improving treatment, reducing symptoms and finally improve mortality in this high-risk population.

Methods
The study is based on the ambulatory claims data of the panel doctors services according to § 295 SGB V and drug prescription data according to § 300 SGB V. The prevalence of PAD in Germany (medical diagnoses of PAD ICD I70.2–9) was analyzed by age and gender-specific characteristics with a timeframe of 10 years (2009–2018). In addition, the current ambulatory care structure was examined subdivided by vascular specialist (vascular surgeons or angiologists) and primary care physicians (internal medicine or general practitioners). Additionally, the prescription of guideline-recommended pharmacotherapy like statins and antiplatelet inhibitors was analyzed for the years 2009–2016.

Results
An increase of PAD diagnosis was observed with a maximum in 2018 with 2.280.000 patients in Germany. The rise of PAD patients strongly correlates with increased age (age group 50–59: 243.000, age group 60–69: 533.000, age group 70–79: 735.000, age group 75–79: 438.000, age group 80–89: 710.000) and more commonly affects males (55%) than females (45%). Access to vascular specialist was low for all age groups with only 11% of patients receiving care from vascular surgeons and only 9% from angiologists. However, 99% received care by a primary care physician.
The prescription of lipid-lowering drugs and platelet aggregation inhibitors in the current analysis period from 2009–2016 is insufficient, with only 46% receiving statins and 29% receiving antiplatelets and 15% oral anticoagulation,

Conclusion
There are relevant differences in age and gender-specific prevalence of PAD in Germany. In addition to the regular care provided by primary care physicians, PAD patients are in need for specialized vascular care. Guideline recommended prescriptions are alarmingly low in PAD patients. There is a clear need to improve the treatment algorithms in the high-risk PAD population.

Funding Acknowledgement
Type of funding source: None
The impact of hyperuricemia on all patients and low-BMI patients after endovascular treatments: from I-PAD registry
Authors: Nagae A , Kato T , Ebisawa S , Saigusa T , Okada A , Motoki H , Kuwahara K 
Published: November 2020

Abstract

Background
Hyperuricemia (≥7.0 mg / dl) is known to be one of the risks of arteriosclerosis. For a long time, it has been said that metabolic syndrome and high-BMI has been implicated to hyperuricemia and also that it's a consequence of those patient background, not a cause of arteriosclerosis. Now, the accumulation of data about hyperurisemia is still not enough. Also the importance of secondary prevention for patients after endovascular treatment (EVT) is still unclear too.

Purpose
To investigate the impact of hyperuricemia on prognosis of all patients and low-BMI patients after EVT.

Methods
From July 2015 to July 2016, 335 consecutive PAD patients who performed EVT were enrolled in I-PAD registry. And we divided them into 2 groups; with hyperuricemia or not, and analyzed them. In addition to that, among them, we selected 245 low-BMI patients (&lt;25) and divided them into 2 groups; with hyperuricemia or not, and analyzed them. The primary end point was all-cause-death and the secondary endpoint was MACLE (Major Adverse Cardiovascular and limbs Events) at 3-years.

Result
At 3 years in the patients group with hyperuricemia, overall survival and freedom from MACLE were significantly lower (57.7% vs 83.4% P=0.0012; 30.3% vs 68.6% P=0.0095) than the group without hyperuricemia. Even among the low-BMI patients, in the patients with hyperuricemia, overall survival and freedom from MACLE were significantly lower (55.2% vs 77.1% P=0.003; 48.2% vs 69.9% P=0.002) than the patients without hyperuricemia at 3 years.

Conclusion
In this study, the prognosis of patients after EVT with hyperuricemia was worse than the patient without. And even among the low-BMI patients, The prognosis after EVT with hyperuricemia was worse than the patient without.

Funding Acknowledgement
Type of funding source: None
Prognosis and cause of death in patients with left atrial appendage thrombus treated with or without anticoagulation therapy
Authors: Kagawa E , Kato M , Oda N , Kunita E , Nagai M , Yamane A , Kobayashi Y , Shiota H , Osawa A , Kobatake H , Takeuchi M , Dote K 
Published: November 2020

Abstract

Background
Thrombus in left atrial appendage (LAA) is associated with cardiogenic ischemic stroke; however, little is known about prognosis of patients with LAA thrombus detected by transoesophageal echocardiography (TOE).

Purpose
This study is to investigate the prognosis of patients with LAA thrombus and their cause of death.

Methods
Between 2005 and 2016, the patients who were performed TOE in our hospital were enrolled in this retrospective observational study. Five-year stroke free and survival curves were constructed by Kaplan-Meir method and cause of death were assessed.

Results
Among the 1263 study patients, LAA thrombus was detected in 146 (12%) patients. The patients with LAA thrombus were elder (74 y [66–79 y] vs. 70 y [62–76 y], P&lt;0.001), than those without LAA thrombus, respectively. The prevalence of male sex (67% vs. 69%, P=0.63) were similar between the 2 groups. The prevalence of CHA2DS2-VASc score ≥2, d-dimer (1.7 mcg/ml [0.9–3.5 mcg/ml] vs. 0.8 mcg/ml [0.5–2.2 mcg/ml], P&lt;0.001), and plasma brain natriuretic peptide (315 pg/ml [128–515 pg/ml] vs. 126 pg/ml [47–284 pg/ml], P&lt;0.001) were higher in the patients with LAA thrombus than those without (89% vs. 78%, P=0.003). The LAA velocity was slower in the patients with LAA thrombus than those without (23 cm/s [15–34 cm/s] vs. 51 cm/s [35–72 cm/s], P&lt;0.001). The prevalence of receiving anticoagulation therapy before (34% vs. 24%, P=0.01) and after (98% vs. 66%, P&lt;0.001) TOE 1 month were higher in the patients with LAA thrombus than those without. The 5-year stroke free rate was lower in the patients with LAA thrombus than those without (82% vs. 93%, P&lt;0.001); however, the 5-year survival were similar between the 2 groups (84% vs. 84%, P=0.93) (Figure). The cause of death as ischemic stroke was only 7% (1/14) and 3% (3/94), (P=0.43); the cardiac cause (14% vs. 43%, P=0.07) and the malignancy (35% vs. 29%, P=0.75) were the frequent cause of death in the patient with LAA thrombus and those without, respectively.

Conclusions
The patients who were detected thrombus in the LAA had higher incidence of ischemic stroke; however, the 5-y survival were similar. The ischemic stroke was not major cause of death in the patients with and without LAA thrombus. The higher rate of receiving anticoagulation therapy may be one of the causes of the discrepancy.
Figure 1

Funding Acknowledgement
Type of funding source: None
Hyperemic hemodynamic characteristics of serial coronary lesions assessed by pressure pullbacks gradients (PPG) index
Authors: Candreva A , Sonck J , Nagumo S , Gallinoro E , Di Gioia G , Kodeboina M , Mizukami T , Bartunek J , De Bruyne B , Collet C 
Published: November 2020

Abstract

Introduction
The evaluation of functional significance in serial coronary lesions is crucial for achieving optimal clinical outcomes. In this setting, fractional flow reserve (FFR) measurements with pullback pressure recording can be helpful in assessing lesion functional significance.

Purpose
To describe the functional characteristics of angiography-defined serial coronary lesions using FFR-derived motorised pullback tracings, and to describe the Pullback Pressure Gradients (PPG) index - in these lesions.

Methods
Prospective, multicentre study with independent core laboratory analysis. Patients undergoing coronary angiography due to stable angina were enrolled. Serial lesions were defined angiographically as the presence of 2 or more narrowings with visual diameter stenosis &gt;50% separated at least by 3 times the reference vessel diameter in the same coronary vessel. Continuous IV adenosine-FFR measurements were obtained using a motorised device at a speed of 1 mm/s. Pullback curves were assessed to determine the presence of focal step-ups (FFR &gt;0.05 units over 20 mm). In addition, the PPGindex was computed for all vessels. PPGindex values close to 0 define functional diffuse disease whereas values close to 1 define focal disease.

Results
From a total of 159 vessels (117 patients), 25 vessels were adjudicated as presenting serial lesions (mean PPGindex 0.48±0.17, range 0.26–0.87). Two focal pressure step-ups were observed in 40% of the cases (n=10; mean PPGindex 0.59±0.17), whereas 8% of the vessels presented a progressive pressure losses (n=2; mean PPGindex 0.27±0.01). In the remaining 52% of the cases, a single pressure step-up was recorded (n=13; mean PPGindex 0.44±0.12; ANOVA p-value = 0.01). The PPGindex independently predicted the presence of two focal pressure step ups.

Conclusion
Hyperemic FFR curves in tandem stenoses revealed high prevalence of functional diffuse CAD. Two pressure step-ups occurred in less than half of the vessels. High PPG-Index identified vessels with two focal pressure drops. FFR tracings and the PPGindex provide a more objective CAD evaluation, which can lead to changes in the therapeutic approach.

Funding Acknowledgement
Type of funding source: None
Distal transradial access for coronary angiography and interventions in everyday practice: data from the TRIANGLE Registry
Authors: Schenke K , Viertel A , Prog R , Joghetaei N , Matthiesen T , Ohm N , Bott-Fluegel L , Dill T , Groenefeld G 
Published: November 2020

Abstract

Background
Transradial access has become the primary route for coronary angiography (CAG) and percutaneous coronary interventions (PCI). Recently a new puncture site more distally on the dorsal side of the hand in the area of the anatomical snuffbox has been developed.

Purpose
With this multicenter registry, we wish to demonstrate the feasibility and safety of the distal transradial access (dTRA) and assess the rate of radial artery occlusion (RAO). As an exploratory endpoint, we compared peri-interventional data between right- and left-radial access and differences between the true anatomical snuffbox (SB) and the distal- dorsal (DD) puncture site.

Methods
Between December 2018 and May 2019 we included all patients into this registry with a planned CAG or PCI via dTRA in three cardiology centers in Germany. Procedural data, puncture success, crossover rate and complications were registered. We examined proximal and distal radial artery patency by ultrasound within 48 h after removal of compression device.

Results
A total of 327 patients were enrolled (mean age: 69 years, male: 69%), in 5 cases bilateral distal puncture was performed, puncture success was high (N=316/332, 95%) and the crossover rate was low (27/332, 8%). The rate of proximal (2/332) and distal (3/332) RAO was low. Major complications were not encountered. The comparison between SB and DD site and left- and right radial access showed no significant differences (see table).
The indication for CAG in 50% of the population was acute coronary syndrome, including 28 patients with ST elevation myocardial infarction (8.4%). Overall PCI rate was 48%. PCI cases did not demonstrate a crossover rate higher than in CAG. PCI on chronic total occlusion (CTO) was performed in 16 cases including bilateral dTRA.

Conclusion
Coronary angiography and interventions via dTRA can be performed with a high rate of success and safety. This data suggests a reduced rate of RAO compared to previous reported data after cannulation via the standard forearm radial artery puncture site. Randomized studies are needed to further investigate these results.

Funding Acknowledgement
Type of funding source: None
Impact of visit-to-visit variability in blood pressure on coronary plaque as assessed by integrated backscatter intravascular ultrasound
Authors: Kato Y , Iwata A , Miura S 
Published: November 2020

Abstract

Introduction
Visit-to-visit variability (VVV) in blood pressure (BP) has been reported to be a strong predictor of cardiovascular disease. However, the association of VVV in BP and coronary plaque composition has not been fully elucidated.

Purpose
The aim of this study was to examine the relationship between VVV in BP and the tissue characteristics of coronary plaques as assessed by integrated backscatter (IB) intravascular ultrasound (IVUS) in patients with coronary artery disease (CAD).

Methods
One hundred-two consecutive patients with CAD who underwent percutaneous coronary intervention (PCI) using IVUS, and who had at least six clinic visits a year before PCI were included. We measured systolic and diastolic BP (SBP and DBP) at each visit and determined VVV in BP expressed as the standard deviation of the average BP. Gray-scale and IB IVUS examinations were performed for the culprit lesion of a coronary artery just before PCI.

Results
There were no significant associations between the average SBP or DBP and various IVUS parameters. However, VVV in SBP was positively correlated with both the percentage of atheroma volume (PAV) (r=0.227, p=0.023) and percentage of lipid volume (PLV) (r=0.532, p&lt;0.001). VVV in DBP was positively correlated with PLV (r=0.243, p=0.014), while there was no significant correlation between VVV in DBP and PAV. A multiple regression analysis showed that VVV in SBP was independently associated with PAV (p=0.036) and PLV (p&lt;0.001).

Conclusions
Larger VVV in SBP was significantly associated with an increased plaque burden and lipid composition at the culprit lesion of a coronary artery in CAD patients. The improvement of VVV in SBP may contribute to the regression and stabilization of coronary plaques.
Figure 1

Funding Acknowledgement
Type of funding source: None