bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5555Predictors of systemic embolisms in a large cohort of left ventricular noncompaction patients
Authors: Casas G , Oristrell G , Limeres J , Sao-Aviles A , Barriales R , Garcia-Pavia P , Diez C , Zorio E , Villacorta E , De Antonio M , Garcia-Pinilla J M , Valverde M , Evangelista A , Ferreira-Gonzalez I , Rodriguez-Palomares J F 
Published: October 2019

Abstract

Background
Left ventricular noncompaction (LVNC) is associated with an increased risk of systemic embolisms (SE). However, incidence and risk factors are not well established.

Purpose
To evaluate the rate of SE in LVNC and describe risk factors.

Methods
LNVC patients were included in a multicentric registry. Those with SE were considered for the analysis.

Results
514 patients with LVNC from 10 Spanish centres were recruited from 2000 to 2018. During a median follow-up of 4.2 years (IQR 1.9–7.1), 23 patients (4.5%) had a SE. Patients with SE (Table 1) were older at diagnosis, with no differences in gender and had similar cardiovascular risk factors. They were more frequently under oral anticoagulation (OAC). Besides, they had a more reduced LVEF, and more dilated LV and left atrium (LA). Late gadolinium enhancement (LGE) was more frequent, altogether suggesting a more severe phenotype.
Patients with SE had non-significantly higher rates of hospitalization for heart failure (33% vs 24%, p=0.31) and atrial fibrillation (35% vs 19%, p=0.10). In multivariate analysis, only LA diameter was an independent predictor of SE (OR 1.04, p=0.04). A LA diameter>45 mm had an independent 3 fold increased risk of SE (OR 3.04, p=0.02) (Image 1).
Table 1 Systemic embolisms (n=23) No systemic embolisms (n=491) p Men, n (%) 15 (65) 289 (56) 0.52 Median age at diagnosis (IQR), yr 60 (48–76) 48 (30–64) 0.02 Median follow up (IQR), yr 5.9 (3.1–7.8) 4.2 (1.8–7.1) 0.18 Hypertension, % 8 (33) 118 (24) 0.31 Diabetes mellitus, % 3 (14) 39 (8) 0.41 OAC, % 19 (83) 118 (24) 0.01 LVEF (SD), % 37 (15) 48 (17) 0.01 LVEDD (SD), mm 58 (11) 54 (10) 0.04 LVESD (SD), mm 45 (13) 38 (11) 0.01 LA diameter (SD), mm 46 (9) 39 (9) 0.01 LVEDV CMR (SD), mL 193 (75) 163 (70) 0.12 LVESV CMR (SD), mL 121 (64) 85 (64) 0.04 LGE, % 9 (40) 88 (18) 0.04

Conclusions
LVNC carries a moderate mid-term risk of SE, which appears to be irrespective of atrial fibrillation and associated with age, LV dilatation and systolic dysfunction and mainly LA dilatation. This subgroup of patients should be considered for oral anticoagulation in primary prevention.
P5569Effective regurgitant oriffice area vs vena contracta method as predictors of outcomes in severe tricuspid regurgitation
Authors: Garcia Martin A , Hinojar R , Gonzalez Gomez A , Pascual Izco M , Plaza Martin M , Alonso Salinas G , Hernandez Jimenez S , Monteagudo J M , Casas Rojo E , Moya Mur J L , Jimenez Nacher J J , Ruiz Leria S , Barrios Alonso V , Zamorano J L , Fernandez Golfin C 
Published: October 2019

Abstract

Background
There is no gold standard echocardiographic method to evaluate tricuspid regurgitation (TR) severity. ESC guidelines recommend using a combination of several methods. The purpose of this study was to compare the prognostic value of the two most commonly used methods for the evaluation of the TR: Effective regurgitant orifice area (EROA) method and biplane vena contracta (VC) method.

Methods
Consecutive asymptomatic patients with significant TR (moderate to severe or severe by echocardiography) evaluated in the Heart Valve Clinic between 2015–2018 were included.
TR severity was evaluated by a combination of several methods, including EROA method and biplane VC method, using EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.

Results
A total of 70 patients were included (mean age was 74±8 years, 71% females). According to aetiology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). During a median follow up of 18 months [IQR: 4–28], 35% of the patients reached the combined end-point (n=16 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died).
Patients with events showed a larger EROA (0.55 vs 0.40 p: 0.036) but no significance different was found in VC (8.03 vs 7.80 p: 0.27). Among both parameters, the tricuspid EROA was the only prognostic factor of the combined endpoint (EROA, HR 24.22 [1.54–380.86], p=0.023; VC, HR 1.022 [0.882–1.183]. A value of EROA of 0.42 reached the best accuracy to predicted poor outcomes (p<0.01).

Conclusion
Among the two most commonly used methods for the evaluation of the TR, EROA was the only method that obtained prognostic value during follow-up.
P5575Acute left ventricular mechanics changes after TAVR: the afterload concept revisited
Authors: Procopi A , Procopi N , Collet J P , Barthelemy O , Leprince P , Choussat R , Isnard R 
Published: October 2019

Abstract

Background
Recent studies have emphasized the prognostic value of mild left ventricular ejection fraction (LVEF) impairment in severe aortic stenosis. However, despite adaptive mechanisms to pressure overload, subtle impaired systolic function could be worsened by increased afterload and partly reversible immediately after its correction.

Objectives
The aim was to evaluate the short terms effects of transcatheter aortic valve replacement (TAVR) on LV systolic function assessed by global longitudinal strain (GLS). We hypothesized that abrupt decrease of LV afterload after TAVR could lead to immediate improvement of LV systolic function.

Methods
Patients referred to our Department for TAVR were included from January 2018 to July 2018 in this observational prospective single center study. Transthoracic echocardiography (TTE) was performed immediately before and 1–5 days after TAVR by the same operator and reviewed in a blind fashion.

Results
35 symptomatic patients with severe aortic stenosis referred for TAVR (age 84±5 y, 18 male, NYHA 2–3, orifice area 0.7±0.2 cm2, LVEF 66±13%, GLS −15.1±4.7%) were included. Only 9/35 (26%) had a LVEF ≤60%. Overall, no significant change in LVEF (65±14%; p=0.55) or GLS (−16.1±4.8%; p=0.11) occurred immediately after TAVR despite a dramatic decrease in transoartic mean pressure gradient (44±15 mm Hg versus 6±3 mmHg; p<0.0001). However in the subgroup of patients with LVEF ≤60%, a significant increase in GLS after TAVR was observed (−9.6±4.1% versus −12.1±3.3%; p=0.0039).
Improvement in GLS according to the LVEF

Conclusion
Following TAVR, an early improvement in LV systolic function assessed by GLS was observed only in patients with pre-existing mild LV systolic dysfunction. Further studies should evaluate whether this improvement is associated with better long term outcome.
P5577Preoperative transaortic pressure gradient predicts renal functional improvement after transcatheter aortic valve implantation in patients with chronic kidney disease
Authors: Oyabu K , Jujo K , Konami Y , Otsuki H , Tanaka K , Isomura S , Domoto S , Yamaguchi J , Niinami H , Hagiwara N 
Published: October 2019

Abstract

Introduction
Transcatheter aortic valve implantation (TAVI) theoretically increases renal blood flow through increasing cardiac output by relieving aortic valvular obstruction of blood flow from left ventricle, resulting in a renal functional recovery in patients with severe aortic valve stenosis (AS). However, procedural steps of TAVI including contrast use potentially damages renal medulla and may deteriorate renal function.

Purpose
The aim of this study was to investigate renal functional change and clarify preoperative predictors for renal functional improvement after TAVI in chronic kidney disease (CKD) patients with severe AS.

Methods
A total of 88 consecutive severe AS patients with CKD (grade >3) who underwent TAVI from 2015 to 2018 was enrolled in this observational study. They were divided into two groups depending on their renal functional improvement after TAVI that was defined as more than 10% increase in estimated glomerular filtration rate (eGFR) at discharge from their preoperative level.

Results
Among the whole candidates, 49 patients (55.7%) were improved their renal function. Patients with the lowest preoperative eGFR achieved the highest increase in eGFR after TAVI (CKD grade >4: +22.7±23.7%, Figure). Patients in the Improved group had lower hemoglobin level, higher mean transaortic pressure gradient (TAPG), and higher aortic valve gradient before TAVI, compared to those in the Non-improved group. However, contrast volume during the procedure was not significantly different between the groups. Multivariate logistic regression analysis revealed that high mean TAPG and low left ventricular ejection fraction (LVEF) before TAVI were independent predictors for the improvement of renal function (odds ratio (OR): 1.04, 95% confidence interval (CI): 1.00–1.08; OR: 0.94, 95% CI: 0.89–0.99, respectively), even after the adjustment of baseline eGFR level and hemoglobin level that were statistically significant on univariate logistic regression analysis. Receiver Operating Characteristic (ROC) curve showed the cut-off level of preoperative mean TAPG in renal functional improvement after TAVI as 47.0 mmHg (Sensitivity: 47.9%, Specificity: 79.5%, area under the curve: 0.62).
Correlation between CKDgrade and ΔeGFR

Conclusions
Preoperative high mean TAPG may predict renal functional improvement after TAVI in patients with deteriorated renal function. This non-invasive predictor may help clinicians to consider to perform TAVI in a challenging case with severe CKD.
P5578Integrated approach in assessment of valvular calcification activity in aortic stenosis
Authors: Murtazalieva P , Ryzhkova D , Irtyuga O , Zhiduleva E , Malev E , Moiseeva O 
Published: October 2019

Abstract

Introduction
Calcification is the key pathological process in aortic stenosis (AS) development. Circulating biomarkers and nuclear imaging methods could characterize the valvular calcification activity.

Purpose
To compare diagnostic values of serum fetiun A level and PET/CT with 18F NaF in assessment of aortic valve calcification.

Methods
88 pts with asymptomatic AS were included: 39pts with tricuspid aortic valve (TAV) and 49 pts with bicuspid aortic valve (BAV). ECHO was performed at baseline and in 16.6±4.2 months. At start serum level of fetuin A was measured by ELlSA in all pts and PET/CT with 18F NaF was performed in 60 of these pts (29 TAV pts and 31 BAV pts). Maximum standardized uptake value (SUV) was measured within circular region of interest (ROI) of 3.52 square millimeters that was drawn around areas of maximal 18F-NaF uptake in the valve. Blood-pool activity was estimated using maximum SUV within the same ROI, which was drawn on the left atrium. Ratio between maximum tissue and background SUV (TBR) was calculated. CT calcium scoring was performed using dedicated software.

Results
Pts with TAV were significantly older then BAV pts (62.4±5.3 yrs vs 55.9±8.4 yrs, p=0.003). TAV and BAV groups were comparable in AS severity by ECHO (peak aortic jet velocity (Vmax): 3.1±0.6 m/s vs 3.1±0.7 m/s, p=0.72). Both groups did not differ in valvular calcification degree (Agatston score 1433.9±1327.9 vs 1617.7±1404.5, p=0.59) and 18F-NaF uptake level (TBR 1.6±0.3 vs 1.6±0.5, p=0.64). Agatston score and TBR max 18F NaF were associated with AS severity measured by Vmax (r=0.58; p<0.0001 and r=0.46; p<0.0001 respectively). Fetuin A was significantly lower in pts with BAV compared to TAV pts (307.4±55.1 vs 342.6±78.2, p=0.02). The sensitivity and the specificity of fetuin A level in predicting of AS progression were 67% and 66%, respectively (AUC = 0.644 [95% CI: 0.527–0.750], p=0.04) with a cut-off value of 313.4 ng/ml. In BAV pts for cut-off value 313.4 ng/ml sensitivity and specificity were 81.8% and 59.4% respectively (AUC = 0.719 [95% CI: 0.561–0.845], p=0.006). There was no association revealed between fetuin A level and Agatston score, TBR 18F NaF.

Conclusions
Despite comparable valve calcification activity measured by PET/CT with 18F NaF in TAV and BAV pts, decreased circulating fetuin A was observed only in BAV pts, that may be related to different underlying pathophysiological mechanisms. Low serum fetuin-A level was associated with progression of AS, particularly in BAV pts.

Acknowledgement/Funding
Grant of Russian Foundation for Basic Research No. 18-015-00016
P5583Micro-movement during transcatheter aortic valve implantation with a contemporary self-expandable prosthesis
Authors: Hellhammer K , Piayda K , Veulemans V , Afzal S , Hennig I , Makosch M , Polzin A , Kelm M , Zeus T 
Published: October 2019

Abstract

Background
Precise positioning of the prosthesis is a crucial step during transcatheter aortic valve implantation. In some cases, contemporary self-expandable prostheses show micro-movement (MM) during the final phase of release.

Purpose
We aimed to establish a definition for MM, evaluated the incidence of MM using the CoreValve Evolut RTM, investigated potential risk factors for MM and the associated clinical outcomes.

Methods
MM was defined as movement of the prosthesis of at least 1.5 mm from its position directly before release compared to its final position. Patients were grouped according to the occurrence (+MM) or absence (-MM) of MM. Baseline characteristics, imaging data and outcome parameters in accordance with the updated valve academic research consortium (VARC-2) criteria were retrospectively analyzed.

Results
We identified 258 eligible patients. MM occurred in 31.8% (n=82) of cases with a mean magnitude of 2.8±2.2 mm in relation to the left coronary cusp and 3.0±2.1 mm to the non-coronary cusp. Clinical and hemodynamic outcomes were similar in both groups. The mean pressure gradient was effectively reduced after TAVI (-MM vs. +MM: 7±3.4 mmHg vs. 8±3.9 mmHg, p=0.326) with consistency over a follow-up period of at least three months (-MM vs. +MM: 6.7±3.7 mmHg vs. 7.9±8.4 mmHg, p=0.168). At three months follow-up most of the patients presented with no aortic regurgitation (-MM vs. +MM: 64% vs. 67.9%, p=0.569). Mild aortic regurgitation was observed in 34.2% of the -MM group and in 29.5% of the +MD group (p=0.414). Moderate aortic regurgitation occurred in 1.9% of all patients with no differences between groups (-MM vs. +MM: 1.9% vs. 2.6%, p=0.662). Patients with MM presented with a more symmetric calcification pattern (-MM vs. +MM: 27.3% vs. 40.2%; p=0.037) and a larger aortic valve area (-MM vs. +MM: 0.6 cm2 ± 0.3 vs. 0.7 cm2 ± 0.2; p=0.014), which was found to be a potential risk factor for the occurrence of MM in a multivariate regression analysis (OR 3.5; 95% CI: 1.1–10.9; p=0.032)

Conclusion
MM occurred in nearly one third of patients and did not affect clinical and hemodynamic outcome. A larger aortic valve area was the only independent risk factor for the occurrence of MM.
P5594Comparison of non-vitamin K antagonist oral anticoagulants versus vitamin K antagonist on changes in pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension
Authors: Hosokawa K , Abe K , Tsutsui H 
Published: October 2019

Abstract

Background/Introduction
Chronic thromboembolic pulmonary hypertension (CTEPH) requires a lifelong anticoagulation therapy. However, the efficacy or safety of non-vitamin K antagonist oral anticoagulants (NOACs) have not been established in CTEPH.

Purpose
We aimed to evaluate the effects of NOACs on the changes in pulmonary vascular resistance (PVR) and their adverse events such as bleeding and clinical worsening in CTEPH.

Methods
We retrospectively compared the changes in PVR among CTEPH patients taking vitamin-K antagonists (VKA) (n=38) and those taking NOACs (n=46) to evaluate the effectiveness of NOACs for the prophylaxis of thrombotic disease progression in CTEPH. Also, we extracted incidence of clinically relevant bleeding and clinical worsening in CTEPH as an exploratory outcome measures. Clinical worsening in CTEPH was defined as composite outcome of death from any cause, lung transplantation and worsening pulmonary hypertension that resulted in hospitalization, addition of specific drug for pulmonary hypertension, or rescue pulmonary endarterectomy or balloon pulmonary angioplasty. Clinically relevant bleeding was defined as composite major bleeding and/or clinically relevant non-major bleeding, which is defined as bleeding associated with the need for medical intervention, contact with a physician, interruption of anticoagulation therapy, discomfort or impairment of activities of daily life.

Results
The changes in PVR (VKA group; −0.17±0.82 woods unit/year, NOACs group; −0.44±0.89 woods unit/year, p=0.32) were comparable between VKA and NOACs groups. The incidence of clinical worsening in CTEPH (VKA group; 1.8% per patient-year, NOACs group; 0% per patient-year) and clinically relevant bleeding (VKA group; 2.8% per patient-year, NOACs group; 2.8% per patient-year) was comparable between the VKA and NOACs groups. D-dimer levels (VKA group; 0.58±0.22 μg/ml, NOACs group; 0.67±0.47 μg/ml, p=0.41) were also comparable between the groups.

Conclusions
Our study revealed that NOACs had a similar effectiveness in the prevention of thrombotic disease progression in CTEPH as compared with VKA. The result suggest that NOACs might have similar efficacy and safety as VKA in daily clinical practice.

Acknowledgement/Funding
Japan Agency for Medical Research and Development
P5597Impact of time from onset to operation on surgical outcomes of acute type-A aortic dissection complicated with malperfusion syndrome
Authors: Nakai C , Tsukube T 
Published: October 2019

Abstract

Introduction
To determine the timing of operation might be the most important factors for surgical outcomes of acute type A aortic dissection (AADA), we analyzed our experience managing AADA complicated by malperfusion syndrome.

Method
Between 11/10 and 2/19, 184 patients with AADA were treated surgically, including 60 patients (32.6%) presented with malperfusion. The mean age of the patients was 71.3±13.3 and female was 94 (51.1%). Prevalences of malperfusions of brain, coronary, kidney, intestine, and extremities were 30 (16.3%), 16 (8.7%), 6 (3.3%), 3 (1.6%), and 23 (12.5%), respectively. Eighty-nine patients (48.4%) were repaired within 6 hours from onset of symptoms and 95 (51.6%) repaired after 6 hours from onset. Aortic repair included total arch replacement in 69 (37.5%) patients and hemiarch in 115 (62.5%). Effect of immediate aortic repair (within 6 hours from onset) and malperfusion syndromes on surgical outcomes of the patients were analyzed.

Results
Overall 30-days-survival rate after aortic repair for AADA was 93.5% (172/184). Early mortality after repairs with malperfusion was 13.3% (8/60): 11.9% (5/42) with immediate repair, and 16.7% (3/18) repaired after 6 hours from onset (late repair). Early mortality after repairs without malperfusion was 3.2% (4/124): 2.3% (1/44) with immediate repair, and 3.8% (3/80) with late repair. Early mortality after repairs with malperfusion was significantly higher than that without malperfusion. In each groups including 184 patients after aortic repair for AADA, 60 patients with malperfusion and 124 patients without malperfusion, there was no significant difference in early mortality rate between immediate repair group and late group.

Conclusion
Malperfusion syndrome was independent risk factor for aortic repairs of acute type-A aortic dissection, and time from onset to operation was not directly related to better outcomes in this patient cohort.
P5605The impact of institutional case volume on the Ppognosis of ruptured aortic aneurysms: a Japanese nationwide study
Authors: Yamaguchi T , Nakai M , Sumita Y , Nishimura K , Sakata Y , Ogino H 
Published: October 2019

Abstract

Background
To improve outcome for ruptured aortic aneurysms (rAA), centralization of treatment is potentially effective. However, there is no nationwide survey for the current managements and outcomes of rAA in Japan.

Purpose
The aim of this study was to assess the volume-outcome relationship for rAA treatment using the nationwide claim-based database.

Methods
Using the Japanese Registry Of All cardiac and vascular Diseases- Diagnostic Procedure Combination database, we identified patients admitted to 564 certified teaching-hospitals with rAA between April 1, 2012 and March 31, 2015. Institutional case volume (cardiovascular surgeries per year) was categorized into quartiles (Lowest, Low, High, and Highest) and the odds ratios (ORs) for in-hospital mortality and neurological status at discharge were analyzed for each quartile.

Results
Of 7086 eligible patients, 3925 (55.4%) died in hospital. Mortality rates decreased from 69.4% in the lowest-volume to 43.8% in the highest-volume category (P<0.001). The favourable impact of institutional case volume was sustained even after adjustment for covariates (Low-volume: OR, 0.83; 95% confidence interval [CI], 0.65–1.07; P=0.147; High-volume: OR, 0.69; 95% CI, 0.54–0.89; P=0.005; and Highest-volume: OR, 0.55; 95% CI, 0.42–0.72; P<0.001 vs. Lowest-volume). Additionally, other three institutional parameters (increased aortic surgery volume, cardiovascular surgeons' volume, and certified cardiologists' volume) were consistently associated with reduced in-hospital mortality. The rate of coma at discharge was the lowest in the Highest-volume group (P<0.001).
Institutional volume and mortality

Conclusions
Increased institutional volume was associated with lower in-hospital mortality. Establishing regionally tailored systems to transfer patients to high-volume centers is needed to improve outcomes.
P5609Outcomes of chimney technique for aortic arch diseases: a single-center experience with 226 cases
Authors: Ding H Y , Zhu Y , Luo S Y , Xie E M , Liu Y , Huang W H , Luo J F 
Published: October 2019

Abstract

Objective
The aim of the present study is to report our single-center experience with chimney technique for aortic arch diseases and the early- and mid-term outcomes in these patients.

Methods
From August 2012 to October 2017, 226 patients (mean age 54±12 years; 197 men) with aortic arch diseases underwent thoracic endovascular aortic repair combined with chimney stents. Pathologies included type B aortic dissection (n=185), aortic arch aneurysm/descending thoracic aortic aneurysm (n=13), aortic arch pseudoaneurysm (n=10), penetrating aortic ulcer (n=7), intramural hematoma (n=7), and aortic rupture (n=4).

Results
The aortic stent-grafts were deployed in zone 0 (n=22), zone 1 (n=13), and zone 2 (n=191). A total of 230 chimney stents were deployed (innominate artery, n=21; right common carotid artery, n=1; left common carotid artery, n=13; left subclavian artery, n=195). The technical success rate was 84% (189/226) and immediate type Ia endoleak occurred in 37 (16%) patients. In the early-term, four patients died, of which from aortic rupture (n=1), ventricular fibrillation (n=1) or major stroke (n=2). Four major strokes occurred (two patients died and two recovered), but no reintervention was recorded. Spinal cord ischemia developed in three patients. The mean duration of follow-up was 22±16 months. Late type Ia endoleaks were recorded in two patients. Chimney stent occlusions were recorded in six patients. During follow-up, five patients died, of which from aortic rupture (n=3), cerebral hemorrhage (n=1) or rectal cancer (n=1). Two major strokes occurred (one patient died and one recovered) and reintervention performed in one case.

Conclusion
The chimney technique for aortic arch diseases is safe and feasible. And long-term follow-up observation is needed.