bluuebunny/crossref_metadata_2025_split huggingface dataset:
P3630Coronary angiography and percutaneous coronary intervention post implantation of a transcatheter aortic valve
Authors: Perrin N , Frei A , Fassa A , Juan J F , Rigamonti F , Roffi M , Frangos C , Mock S , Noble S 
Published: October 2019

Abstract
When treating younger patients with longer life expectancy, the likelihood of having to perform a subsequent coronary angiogram and PCI during follow-up post transcatheter aortic valve implantation (TAVI) is increased. The aim of our study was to assess the feasibility and characteristics of the post TAVI coronary angiogram.
We interrogated our prospective single center TAVI database to analyze data from patients who underwent a coronary angiogram or PCI post TAVI. Between August 2008 and January 2019, 405 consecutive TAVI were performed in our institution with a 30-day, 6-month and yearly follow-up.
Among 405 procedures, 18 coronary angiograms with 9 PCI (RCA 2; LM 3; LAD 3, LCX 1) were performed in 17 patients post TAVI. The mean age of patients was 78.1±7.5 years (3 women), with a mean STS score of 5.6±3.4%. Five patients had a history of prior CABG. The transcatheter heart valves implanted were 6 CoreValve, 8 Evolut R, 1 Evolut Pro and 2 Edwards Sapien. The valve sizes were 31mm (n=3), 29mm (n=6), 26mm (n=3) and 23mm (n=5). The indication for the coronary angiogram was acute coronary syndrome for 8 procedures (1 STEMI, 7 NSTEMI) and stable angina for the remaining 10 procedures. The mean time between TAVI and coronary angiogram was 519±332 days (189–1093 days). Femoral and radial approach was used in, respectively, 11 and 7 (right: 5, left: 2) procedures with one cross-over needed from right transradial to transfemoral. Out of 33 attempted ostia cannulations, there were 2 failures (both involving the RCA), and 31 successes classified as selective (RCA: 7, LM: 9), borderline selective (RCA: 3, LM: 2) and non-selective but sufficient for diagnosis (RCA: 3, LM: 7), using standard catheters (average number of catheter used to cannulate RCA: 1.2±0.8 and LM: 1.7±1.1 [min. 1 and max. 4]). All planned PCI were successful with the treatment of 11 stenosis including 2 multivessel lesions. In 44% of the treated arteries, the use of a GuideLiner catheter (Vascular Solutions Inc) was required to cannulate the ostium.
In conclusion, coronary angiogram post TAVI was needed in 4.2% of our cohort during follow-up. Overall, LM ostia cannulation was successful in 100% of the cases and we failed to cannulate 13.3% of RCA ostia. All PCI were successful with the need of a guiding cathteter extension in 44% of the procedures.
P3633Should we continue to routinely revascularize patients during valve surgery in optimal medical therapy era?
Authors: Dias Ferreira Reis J P , Strong C , Roque D , Morais L , Mendonca T , Modas P D , Farto E Abreu P , Almeida M , Cacela D , Morais C , Mendes M , Cruz Ferreira R , Bravo Baptista S , Raposo L , Ramos R 
Published: October 2019

Abstract

Background
Optimal management of stable obstructive coronary artery disease (CAD) in patients (pts) undergoing heart valve surgery remains controversial. The aim of the present study is to evaluate the effective prognostic role of CABG in pts undergoing valve surgery who had concomitant CAD.

Methods
We conducted a retrospective multicenter survival analysis using multivariable Cox models and Kaplan-Meier curves of consecutive pts undergoing valve surgery with or without concomitant CABG between January 2015 and February 2017.

Results
From 1196 consecutive pts undergoing valvular surgery in 3 portuguese centers, 257 (21.5%) were found to have obstructive CAD (55.6% male, mean age 74±8 y.o., mean follow-up time 16±8 months, aortic valve disease 78.8%). No coronary revascularization (R) was attempted in 177 pts, complete R was achieved in 40 and R was anatomically incomplete in the remaining 40 pts. Age (75 vs 77.3 y.o.; p=0.202), multivessel disease (46.3% vs 53.8%, p=0.270), aortic valve disease (91.0% vs 92.5%, p=0.683), left ventricular ejection fraction <40% (11.8% vs 19.4%, p=0.272) were comparable between nonrevascularized and revascularized pts; SYNTAX score was low and also similar in both groups (7±12 vs 7±5, p=0.856). Left main disease (8.5% vs 17.5%, p=0.034) and EUROSCORE IIrisk score (2.3±2 vs 3.2±2, p=0.011) was higher for those with any revascularization. Non-revascularized pts had significantly lower all-cause mortality at follow up than those with any R (10.2% vs 21.2%, p=0.016). However, both in-hospital (4% vs 7.5%, p=0.230) and cardiovascular mortality (6.9% vs 7.1%, p=1.00) were similar. In a multivariate analysis, independent predictors for all-cause mortality were: any surgical R (HR 4.52, CI95% 2.09–9.78), baseline atrial fibrillation (HR 2.51, CI95% 1.07–5.90), left main disease (HR 3.153, CI95% 1.26–7.90) and peripheral artery disease (HR 2.95, CI95% 1.036–8.421). All-cause mortality for pts with obstructive CAD was higher than in pts with no CAD (13.6% vs 6.2, p<0.001). Interestingly, however, after multivariable adjustment, complete R was not found to be protective as compared to no R (HR 0.79, IC 0.31–2.06, p=0.633)
Kaplan-Meier Plots

Conclusion
Significant CAD is associated with worse outcomes in pts undergoing valve surgery. In this study, standard angiographically-guided R was not associated with improved results. Randomized controlled trials are needed to further assess risk stratification and the role of coronary R of stable CAD in this setting.
P3649Analysis of clinical and angiographic parameters as predictors of recurrent vasospastic angina
Authors: Park J.-H , Yoon G.-S , Choi S.-H , Beak Y S , Kwan S W , Woo S I , Kim D.-H , Kwan J , Park S D 
Published: October 2019

Abstract

Background
Patients with vasospastic angina (VA) may have recurrent chest symptoms and life-threatening arrhythmias. Despite regular medications, many VA patients experience recurrent episodes of VA. In this study, we evaluate clinical and angiographic predictors of recurrent VA.

Patients and methods
From January 2010 to May 2018, a total of 858 patients who underwent ergonovine provocation test were retrospectively reviewed. We excluded the patients who had negative results of provocation test, follow up duration less than 1 month and poor medication compliance. The recurrent-VA group consisted of patients who were re-hospitalized, visited the emergency room, or had repeated coronary angiographies because of chest pain.

Results
A total of 858 patients who underwent ergonovine provocation tests between January 2010 to May 2018 were retrospectively reviewed. Of them, 162 (mean follow-up duration, 3.0 years) were eligible for our study. The patients were divided into two groups: recurrent-VA (n=33, 20.4%) and stable-VA groups (n=129, 79.6%). Compared with the stable-VA group, the recurrent-VA group consisted mostly of men (93.9% vs. 75.2%, P=0.01), and had low LDL-cholesterol levels (93±27 mg/dl vs. 108±31 mg/dl, P=0.01). In the angiographic findings, a degree of coronary artery disease (CAD) and the site and number of spasm-positive vessels showed no difference between the two groups. Nicorandil was more frequently prescribed at discharge in the stable-VA group (15.2% vs. 35.7%, P=0.02). In the multivariate analysis, the male sex (odds ratio [OR], 5.87; 95% confidence interval [CI], 1.31–26.22; P=0.02) and non-use of nicorandil (OR, 3.51; 95% CI, 1.25–9.84; P=0.01) were the independent predictive factors in the recurrent-VA group. In the Kaplan-Meier analysis, men who did not use nicorandil (n=85, 52.5%) had higher incidences of recurrent angina compared to the other group (n=77, 47.5%). (30.6% vs. 6.6%; p<0.001).
Univariate and multivariate analysis Refractory VA (n=33) Stable VA (n=129) Odds ratio [95% CI] P value univariate Odds ratio [95% CI] P value multivariate Age <56 years, n (%) 20 (66) 58 (44) 1.88 [0.86–4.10] 0.11 NA NS Male sex, n (%) 31 (93.9) 97 (75.2) 5.11 [1.15–22.56] 0.03 5.87 [1.31–26.22] 0.02 Smoking, n (%) 17 (51.5) 46 (35.7) 1.91 [0.88–4.14] 0.09 NA NS No AMI presentation, n (%) 11 (33.3) 25 (19.4) 2.08 [0.89–4.84] 0.08 NA NS Troponin-I >0.86 ng/ml, n (%) 2 (7.1) 3 (2.7) 2.74 [0.43–17.27] 0.08 NA NS LDL-C <105 mg/dl, n (%) 21 (63) 58 (49) 1.81 [0.81–4.01] 0.14 NA NS No use of nicorandil, n (%) 5 (15.2) 46 (35.7) 3.10 [1.12–8.58] 0.02 3.51 [1.25–9.84] 0.01
Kaplan-Meier curves

Conclusions
Male sex and non-use of nicorandil were independent predictors of recurrent VA.
P3680Baseline hemodynamics and its effect on survival in patients with idiopathic versus CTD-associated pulmonary arterial hypertension: data from the Swedish Pulmonary Arterial Hypertension Register
Authors: Hjalmarsson C , Radegran G , Kjellstrom B , Kylhammar D , Soderberg S , Bartfay S E , Hesselstrand R 
Published: October 2019

Abstract

Background
Patients with CTD-APAH have a worse prognosis than those with IPAH, despite having lower pulmonary vascular resistance at diagnosis.

Purpose
To compare the effect of baseline hemodynamics on one-year survival in incident CTD-APAH patients and IPAH patients.

Methods
Patients with IPAH and CTD-APAH reported to the SPAHR between January 2008 and December 2018 were analyzed. Clinical data, hemodynamic parameters, lung transplantation, and survival were extracted from SPAHR. The relation between baseline hemodynamics and one-year survival was assessed by Cox proportional regression.

Results
There was no difference in age, WHO-FC, and 6MWD. IPAH patients had more often hypertension and diabetes; CTD-APAH patients had worse DLCO. No difference was found regarding kidney function, atrial fibrillation, stroke, and thyroid dysfunction. For details regarding hemodynamics, see Table 1.
One-year survival was similar in IPAH (84%) and CTD-APAH (82%, n.s.). After adjustment for age and gender, the only hemodynamic parameters that independently predicted survival were mRAP (CTD-APAH 1.06; 1.01–1.13, p=0.046 vs. IPAH 1.08; 1.01–1.15, p=0.048) and trans-pulmonary gradient, TPG (CTD-APAH 1.04; 1.01–1.07, p=0.008 vs. IPAH 1.02; 1.01–1.04, p=0.026).
Patient characteristics at diagnosis IPAH (n=311) CTD-APAH (n=204) p-value Age (years) 63±16 65±13 NS Female gender (%) 57 79 <0.001 WHO-FC III (%) 73 67 NS Hypertension (%) 50 38 0.014 Diabetes (%) 27 11 <0.001 6MWD (m) 288 (180–382) 260 (180–393) 0.474 DLCO (%) 45 (31–62) 38 (31–49) 0.002 Hemoglobin (g/L) 147 (134–158) 131 (121–144) <0.001 NTproBNP (ng/L) 1750 (758–4124) 1250 (351–3449) 0.003 mPAP (mmHg) 48 (41–55) 38 (31–45) <0.001 mRAP (mmHg) 8 (5–11) 6 (3–10) <0.001 PVR (WU) 9.4 (7.0–12.3) 6.8 (4.5–10.3) <0.001 CI (L/min/m2) 2.2 (1.8–2.6) 2.5 (2.0–3.0) <0.001 SvO2 (%) 60 (54–66) 64 (57–71) <0.001

Conclusion
Despite having better hemodynamic profile at baseline, CTD-APAH patients had similar one-year survival to IPAH patients; mRAP and TPG were independent predictors of survival in both groups.
P3681Apparent sex differences in risk of life-threatening events in arrhythmogenic cardiomyopathy are related to exercise habits
Authors: Rootwelt C , Lie Ø.H , Dejgaard L A , Edvardsen T , Haugaa K H 
Published: October 2019

Abstract

Background
Arrhythmogenic cardiomyopathy (AC) is an inheritable heart disease characterized by high risk of ventricular arrhythmias and exercise intolerance. Male sex is associated with higher risk of life-threatening events. However, this may be challenged by the fact that men exercise more than women.

Purpose
To assess whether the sex differences in arrhythmic outcome in AC-patients are driven by sex differences in exercise exposure.

Methods
We included AC-patients diagnosed between 1997 and 2017 in a longitudinal cohort study. We assessed exercise habits during the preceding 3 years before inclusion, and exercise dose was expressed as metabolic equivalent hours per week (MET-hours/week). Life-threatening events were defined as sustained ventricular tachycardia, aborted cardiac arrest or appropriate therapy from an implantable cardioverter-defibrillator at the time of diagnosis and prospectively during follow-up.

Results
We included 170 AC-patients (52% probands, 44% female, age 41±16 years). Males had higher exercise doses than female patients (36 [IQR, 14 to 54] vs. 12 [IQR, 8 to 22] MET-hours/week; P<0.001). Fifty-seven patients (34%) had previous life-threatening events, and 45 (26%) had life-threatening events during 5.7 (IQR, 2.8 to 9.4) years of follow-up. Male sex seemed to be a marker of previous life-threatening events (OR 2.0 [95% CI, 1.0 to 3.8]; P<0.05), but not when adjusted for exercise dose (Adjusted OR 1.3 [95% CI, 0.6 to 2.7]; P=0.44). Male sex also seemed to be a predictor of life-threatening events during follow-up (HR 2.0 [95% CI 1.0 to 3.9]; P=0.04) (Figure, left panel), but not when adjusted for exercise dose (Adjusted HR 1.5 [95% CI 0.8 to 3.0]; P=0.26) (Figure, right panel).

Conclusions
Sex differences in arrhythmic risk in AC were attributable to higher exercise doses in male AC-patients. This highlights the importance of exercise assessment in these patients, and challenges the current opinion of male sex as a risk factor in itself. Risk stratification based on sex may underestimate the risk of physically active female AC-patients.

Acknowledgement/Funding
This study was supported by Center for Cardiological Innovation funded by the Norwegian Research Council
P3686A novel desmin gene variant as an important cause of biventricular arrhythmogenic cardiomyopathy
Authors: Protonotarios A , Quinn E , Dalageorgou C , Futema M , Akhtar M M , Asimaki A , Ashworth M , Savvatis K , Syrris P , Elliott P M , Lopes L R 
Published: October 2019

Abstract

Introduction
Arrhythmogenic Cardiomyopathy (AC) is typically caused by mutations in the desmosomal genes, however non-desmosomal genes have been increasingly implicated. Desmin gene (DES) mutations have been previously reported in AC, but in many cases there are insufficient data to support their pathogenicity.

Purpose
We assessed our AC cohort for DES gene mutations and describe the clinical phenotype associated with a recurring variant present in 3 unrelated families.

Methods
Genetic testing was performed using next-generation sequencing for 41 genes in a total of 138 AC probands with a definite diagnosis of AC based on the revised 2010 Task Force diagnostic criteria. All candidate variants were confirmed using Sanger sequencing. Clinical and genetic cascade screening were expanded to the first-degree relatives of the probands. Retained tissue from deceased individuals was used for genetic testing. All living mutation carriers underwent clinical assessment including physical examination, 12-lead ECG, signal-averaged ECG, echocardiography, cardiac magnetic resonance imaging (MRI) and 24h Holter-monitoring.

Results
Two DES gene variants, p.Ser298Leu (n=1) and p.Leu115Ile (n=3), were identified in 4 out of the 138 probands (3%). The former coexisted with a pathogenic DSP gene mutation and has not been further evaluated. The latter is a novel variant, absent in control databases (gnomAD) and was the only variant present in 3 unrelated families (see figure). One carrier required heart transplant (A-II-1), two died suddenly (A-III-1, B-II-1) and one died of non-cardiac causes (B-I-2). Detailed clinical information was present in 8 mutation carriers (2 male, age 45±19 years). Seven (88%) had a definite diagnosis and one had a borderline diagnosis of AC. All cases (100%) had right ventricular (RV) wall motion abnormalities, 6 (75%) had a dilated RV, 6 (75%) a dilated LV and 6 (75%) had LV dysfunction (mild in 5 and severe in 1). LV late gadolinium enhancement (LGE) was present in all 6 carriers that had a cardiac MRI with a circumferential sub-epicardial distribution (see figure, case A-III-2). Non-sustained ventricular tachycardia (VT) was present in 7 (88%) and sustained VT in 2 cases (25%). The ventricular ectopic burden per 24h ranged from 426 to 10583 with a median value of 820.
Figure 1

Conclusion
Variants of the DES gene are rare causes of AC. The novel p.Leu115Ile variant seems to be prevalent in a large UK-based cohort and it causes a biventricular form of AC, with a characteristic scar pattern on MRI and severe outcomes.

Acknowledgement/Funding
Alexandros Protonotarios is supported by a BHF Clinical Research Training Fellowship no. FS/18/82/34024
P3689Association of echocardiographic progression and genetic profile in arrhythmogenic right ventricular cardiomyopathy
Authors: Guastafierro F , Hosseini S , Heiniger P S , Anwer S , Kuzo N , Hess R , Santoro F , Brunetti N D , Brunckhorst C , Duru F , Saguner A M , Tanner F C 
Published: October 2019

Abstract

Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is frequently associated with mutations in genes coding for desmosomal proteins. In this study, we investigated the association of genetic status with ARVC progression as defined by echocardiographic parameters.

Methods
We tested 62 ARVC patients for their genetic profile. Accordingly, they were grouped in mutation positive (48 (77%) patients; median age 48.5 years; 33 (69%) males), and mutation negative (14 (23%) patients; median age 45 years; 10 (71%) males). Prevalent mutations were Desmoglein-2 (DSG2) in 16 (26%), Desmoplakin (DSP) in 14 (23%), and Plakophilin-2 (PKP2) in 9 (15%) patients.

Results
At baseline, there were no significant differences in clinical characteristics between the two groups. Patients were followed-up for a median time period of 1420 days, and there was no significant difference in the duration of follow-up between the two groups (p=0.05).
In the mutation positive group, there was a significant increase in right ventricular end-diastolic area (p=0.002), right atrial short (p=0.008) and long (p=0.002) diameter, left atrial diameter (p=0.014), and a decrease in left ventricular ejection fraction (p=0.014) during follow up. Right ventricular functial parameters did not change significantly (tricuspid annular plane systolic excursion: p=0.24; fractional area change: p=0.088).
In the mutation negative group, none of the aforementioned echocardiographic findings exhibited any significant difference during follow-up: right ventricular end-diastolic area (p=0.1); right atrial short (p=0.7) and long (p=0.9) diameter, left atrial diameter (p=0.6), and left ventricular ejection fraction (p=0.3). Similarly, right ventricular functional parameters did not change significantly (tricuspid annular plane systolic excursion: p=0.77; fractional area change: p=0.80. Results are summarized in the figure.
Change in echocardiographic findings.

Conclusions
There is a strong association between echocardiographic progression of ARVC phenotype and the presence of a pathogenic mutation. Such mutations should be searched in all patients with an ARVC phenotype, and mutation positive individuals should be followed-up in shorter intervals.
P3691Intra-aortic balloon counterpulsation in takotsubo syndrome complicated by cardiogenic shock: short- and long-term results from a cohort of 2250 patients of the German-Italian-Spanish registry
Authors: Santoro F , Nunez-Gil I.-J , Stiermaier T , El-Battrawy I , Guerra F , Arcari L , Musumeci B , Novo G , Cannone M , Almendro M , Sionis A , Akin I , Thiele H , Eitel I , Brunetti N D 
Published: October 2019

Abstract

Background
Takotsubo syndrome (TTS) is featured by an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock. Intra-aortic balloon pumping (IABP) use in this setting is controversial, and few data are available from large populations. Aim of this study was therefore to evaluate short- and long-term impact of IABP on mortality in TTS complicated by cardiogenic shock.

Methods
The GEIST registry is a multicenter, international registry on TTS involving 38 centers from Germany, Italy and Spain. Between 2006 and 2017, 2250 consecutive patients with TTS were enrolled.

Results
Of the 2250 patients, 211 (9%) experienced cardiogenic shock during hospitalization for TTS. Admission left ventricular ejection fraction (LVEF) was 30±15% and systolic blood pressure was 90±35 mmHg. Apical ballooning pattern was found in 77%, mid-ventricular/basal pattern in 11%, and 2% of the patients, respectively.
Forty-two patients out of 211 (19%) received IABP after coronary angiography. Patients receiving IABP compared to standard medical therapy did not differ in terms of age, gender, cardiovascular risk factors and admission LVEF.
No differences were found in term of in-hospital mortality (9.5% vs 17% p=0.35), length of hospitalization (19.3 vs 16.3 days p=0.34), need of invasive ventilation (35% vs 41% p=0.60), stroke (4.7% vs 11% p=0.17) and LV thrombus (0.5% vs 1.7%, p=0.98).
At long-term follow-up, with a median of 2 years, overall mortality in patients with cardiogenic shock and TTS was 34.1%. Mortality was not different between the IABP and the control group (33.7% vs 35.0%; p=0.85).

Conclusions
In this large multicenter observational registry, the use of IABP has no impact on mortality at short and long-term follow-up. Further studies are needed to evaluate the best therapeutic strategy in TTS complicated by cardiogenic shock.
P3698Long-term durability of transcatheter aortic valve prostheses: results of a center
Authors: Munoz-Garcia E , Munoz-Garcia M , Munoz Garcia A J , Carrasco-Chinchilla F , Dominguez-Franco A J , Alonso-Briales J H , Hernandez-Garcia J M , Gomez-Doblas J J , Jimenez-Navarro M F 
Published: October 2019

Abstract

The durability of transcatheter heart valves and long-term clinical outcomes are unknown. The aim of this study was to evaluate clinical and hemodynamic outcomes between 5 to 9 years after Transcatheter Aortic Valve Implantation (TAVI).

Methods
Between April 2008 and December 2012, 305 patients underwent TAVI for the treatment of severe symptomatic aortic stenosis with the auto-expandable prosthesis.

Results
The mean age, logistic EuroSCORE and STS score were 79.3±6.5 years, 19.4±12% and 6.6±4% respectively. Mean aortic valve gradient decreased from 48.7±15 mm Hg to 8.9±4.3 mmHg after TAVI, to 11.1±9 mm Hg at 4 years, and 22.7±12 mmHg at 5 years (p for post-TAVI trend 0.03). Mean aortic valve area increased from 0.63±0.16 cm2 to 1.57±0.3cm2 after TAVI to 1.48±0.2 at 4 years and 0.97±0.3 cm2 at 5 years (p for post-TAVI trend 0.01). Mean left ventricular ejection fraction increased from 61.1±15% to 65.5±11% after TAVI, to 58.2±17% at 4 years and 60.7±8% at 5 years (p for post-TAVI trend 0.001).
Late mortality after a mean of 4.15±2.4 years 58% and in only 34.1% patients was cardiovascular mortality. Survival rates at 1 to 9 years were at 87.5%, 79%, 73.1%, 65.6%, 55.4%, 48.2%, 41.9%, 37.3% and 35.1% respectively. At 5 years, 3 patients had severe prosthetic valve dysfunction (severe stenosis and moderate transvalvular regurgitation). Median survival time after TAVI was 6 years (95% confidence interval [CI]: 5.89 to 6.28), and the risk of death was significantly increased in patients with frailty (adjusted hazard ratio [HR]: 1.864; 95% CI: 1.204 to 2.886), p=0.001, Charlson index [HR= 1.243 (95% CI 1.148–1.346), p<0.001], and left ventricular ejection fraction [HR= 1.012; (95% CI 1.001–1.024)p=0.044].

Conclusions
Our study demonstrated favorable long-term outcomes after TAVI. Signs of prosthetic valve failure were observed in 0.97% of patients