bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6464Acute pulmonary embolism in Argentina. CONAREC XX registry
Authors: Cigalini I M , Scatularo C E , Jauregui J C C , Ortego J I , Cornejo D , Bernal M I , Aboy J M , Burgos L M , Dominguez J M , Visconti M , Garcia Zamora S , Igolnikof D B , Bonorino J M , Zaidel E J , Thierer J 
Published: October 2019

Abstract

Background
Pulmonary embolism (PE) represents the third cause of cardiovascular death and one of the leading causes of preventable in-hospital mortality. However, there is lack of information about this entity in our country.

Purpose
To describe baseline characteristics, in-hospital evolution and treatments among patients (P) admitted for acute PE in Argentina.

Methods
A prospective multicentric registry of P with acute PE was conducted in 75 academic centers between October 2016 and November 2017. Conventional analysis was used for descriptive and comparative statistics, with a p value <0.05 considered as significant. Cross audit was performed at 20% of participating centers.

Results
We included 684 consecutive P with an average age of 63,8 years (SD 16,8), with slight majority of female sex (57%). PE was the reason for admission in 484 (71%) of the cases; 68% of those others who developed PE as a complication during hospital stay were under adequate venous thromboembolism prophylaxis. The most frequent predisposing factors were obesity (34%), recent hospitalization (34%), transient rest (30%) and active cancer (22%). Multislice computed tomography was the diagnostic method of choice (81%). An echocardiogram was performed in 625 P (91%), showing right ventricular dilatation or dysfunction in 41% and 35% of the cases, respectively. After initial diagnosis, P were stratified as low risk (24%), intermediate-low risk (34%), intermediate-high risk (27%) and high risk (15%).
Anticoagulation was indicated in 661 (97%), mainly with low-molecular-weight heparins (LMWH) (59%) as initial strategy. Reperfusion with either thrombolytics or mechanical therapies was performed in 91 (13%) cases. However, only 50 of the 102 P who presented with hemodynamic instability received any reperfusion therapy (49%). Overall in-hospital mortality was 12%, mainly related to PE (51%), with significant differences according to risk stratification (p<0,01) (Figure 1).
579 out of 601 survivors received anticoagulants at discharge: 60% vitamin K antagonists, 21% LMWH and 19% direct oral anticoagulants (49% Rivaroxaban, 34% Apixaban and 17% Dabigatran).
Mortality according risk stratification

Conclusions
PE presents with high in-hospital mortality in our setting mainly due to the embolic event. This finding could be related to a low use of reperfusion therapies in P with hemodynamic instability, reflecting low adherence to guideline recommendations even in academic centers. This issue should be taken into consideration to improve PE prognosis in Argentina.
P6471Pronostic impact of significant valvular disease in long-term survivors of out-of-hospital-cardiac arrest
Authors: Rodriguez L , Caro-Codon J , Rey-Blas J R , Rosillo S O , Gonzalez O , Martinez L A , Garcia De Veas J M , Casas B , Iniesta A M , Ruiz J , Rial V , Merino C , Armada E , Lopez-Sendon J L , Lopez-De-Sa E 
Published: October 2019

Abstract

Background
There is scarce evidence about the prevalence and clinical relevance of moderate to severe valvular heart disease (VHD) in survivors of out of hospital cardiac arrest (OHCA).

Purpose
To determine whether VHD influence prognosis of OHCA survivors.

Methods
All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA and surviving until hospital discharge were included. All patients received targeted-temperature management according to our local protocol. Univariate and multivariate Cox-proportional hazard models were employed.

Results
A total of 201 patients were included in the analysis. Mean age was 57.6±14.2 years and 168 (83.6%) were male. Eighteen patients (9.0%) had moderate or severe VHD during index admission (Table 1). Patients with VHD were less frequently of male sex, [11 (61.1%) vs 157 (85.8%), p=0.014], experienced less acute coronary syndrome-related arrhytmias [2 (11.1%) vs 85 (46.5%), p=0.005], and had a lower pH at hospital admission (6.9±1.6 vs 7.2±0.15, p=0.008). During a median follow-up of 40.3 (18.9–69.1) months, patients with VHD showed higher mortality [7 (38.9%) vs 28 (15.3%), p=0.004] and more heart failure-related admissions [7 (38.9%) vs 15 (8.2%), p<0.001]. Only five patients received surgical or percutaneous treatment for VHD during follow-up, with no deaths in this subgroup. Moderate or severe VHD proved to be an independent predictor of global cardiovascular events and specifically heart failure episodes (Figure 1).
Table1 Variable With valvular disease Without valvular disease p value Age, mean±DS, years 63.5±13.2 57.0±14.1 0.066 Hypertension, n (%) 12 (66.7) 95 (51.9) 0.231 Diabetes, n (%) 5 (27.8) 24 (13.1) 0.149 Dyslipidaemia, n (%) 7 (38.9) 79 (43.2) 0.726 Smokin habit, n (%) 4 (22.2) 90 (49.2) 0.045 Witnessed cardiac arrest, n (%) 18 (100) 175 (95.6) 1.000 Time from CA to ROSC, mean±DS, minute 19.1±7.5 21.2±13.1 0.506 Shockable rhythm, n (%) 13 (72.2) 163 (89.1) 0.055 LVEF at hospital discharge (%) 42.8±12.1 46.9±14.6 0.254
Figure 1

Conclusion
The presence of significant VHD in survivors after OHCA is a predictor of poor outcomes. Specific management of VHD may be specially relevant in this high-risk patients and guideline-oriented therapy, including surgery and percutaneous intervention should be encouraged when indicated.
P6492Quantitative definition of severe functional mitral regurgitation - A matter of intercontinental debate
Authors: Goliasch G , Heitzinger G , Arfsten H , Pavo N , Spinka G , Mascherbauer J , Hengstenberg C , Huelsmann M , Bartko P 
Published: October 2019

Abstract

Background
Recent divergence between AHA/ACC and ESC/EACTS guidelines of the quantitative definition for severe functional mitral regurgitation (sFMR) introduced uncertainty, inconsistency and continuing debate. The relation of each threshold with long-term outcome, in patients under guideline directed therapy (GDT) remains however uncertain.

Methods
We enrolled 269 heart failure patients with reduced ejection fraction (HFrEF) and graded sFMR according to both guideline-recommendations [AHA/ACC: effective regurgitant orifice area (EROA) ≥40mm2 or regurgitant volume (RegVol) ≥60ml/beat and ESC/EACTS: EROA ≥20mm2 or RegVol ≥30ml/beat]. All-cause mortality was defined as the primary endpoint.

Result
According to AHA/ACC guidelines sFMR occurred in 17% by EROA with a median EROA of 0.5mm2 (IQR 0.4–0.6) and in 13% by RegVol with a median RegVol of 76ml/beat (IQR 69–101). According to ESC/EACTS guidelines sFMR occurred in 53% by EROA with a median EROA of 0.4mm2 (IQR 0.2–0.4)and 40% according to RegVol with a median RegVol of 51ml/beat (IQR 37–69). During 8-years follow-up, 165 patients died. We observed a significant association with outcome for sFMR according to AHA/ACC guidelines quantified by EROA (HR 1.66, 95% CI 1.13–2.43, P=0.009; Figure 1A) as well as RegVol (HR 2.02, 95% CI 1.34–3.05, P=0.001; Figure 1A). In contrast, the ESC/EACTS definition of sFMR was related with outcome exclusively if quantified by RegVol (HR 1.46, 95% CI 1.05–2.05, P=0.026; Figure 1B) but not for EROA (HR 1.30, 95% CI 0.91–1.86, P=0.15; Figure 1B).
Figue 1

Conclusion
In this contemporary HFrEF cohort under GDT there is significant association of the ACC/AHA proposed cut-off for severe FMR and long-term mortality. The ESC/EACTS definitions are associated with mortality exclusively for the RegVol. The lack of association between sFMR based on ESC/EACTS EROA cut-offs with mortality potentially results from incorporating patients where the regurgitant burden may still be compensated and has not yet become a driving force of disease progression. Contemporary definition of sFMR entails decision making for surgical/transcatheter repair. Cut-offs need to account for the competing risks of the procedure versus the potential benefit of reducing mortality. Lower thresholds may expose a significant proportion of patients to unnecessary risk of futile procedures and higher thresholds may withhold potentially life-extending therapies. The disagreement between the two guidelines does not only convey a source of uncertainty for treating physicians but also lead to inconsistent treatment allocation thereby hindering comprehensive and comparable research. Future studies need to approximate to the true nature of severe functional mitral valve disease in an attempt to facilitate a unifying definition of sFMR.
P6494Activation of focal adhesion kinase is involved in pathogenesis of aortic dissection in mice
Authors: Majima R , Aoki H , Hashimoto Y , Hayashi M , Ohno-Urabe S , Furusho A , Nishida N , Hirakata S , Fukumoto Y 
Published: October 2019

Abstract

Background
Aortic dissection (AD) is a fatal disease where the media of the aorta suddenly fail. Currently, Molecular pathogenesis of AD is unknown. Recently, we discovered that the activity of MRTF-A, a mechanosensitive transcriptional regulator, promotes AD development. The activity of MRTF-A is regulated by mechanical stress to cells, which is transduced through focal adhesion and actin dynamics. However, it is currently unknown whether the mechanotransduction mechanism is involved in AD pathogenesis.

Purpose
We investigated the role of focal adhesion kinase (FAK), a signaling molecule that transduces mechanostress from focal adhesion to actin dynamics, in AD pathogenesis.

Methods
We created a mouse model of AD with a continuous infusion of beta-aminopropionitrile (150 mg/kg/day), a collagen crosslink inhibitor, and angiotensin II (1,000 ng/kg/min) (BAPN + AngII) by an osmotic pump. This model caused about 60% death in all mice due to AD rupture within 2 weeks. In this model, we examined the severity and mortality rate of aortic dissection after 2 weeks in mice administered with PND-1186, an orally available FAK inhibitor, and in those treated with vehicle (n=20 for each group). We performed immunochemical staining, immunofluorescence staining and Western blot for activated (phosphorylated) FAK (pFAK) to evaluate the activation status of FAK in the aortic tissue. We also performed transcriptome analysis of the aortic tissue in with and without PND-1186 with BAPN + AngII stimulation before AD development.

Results
Immunochemical staining revealed that FAK was inactive in normal mouse aorta, but was strongly activated in the aortic walls after AD development. Immunofluorescence staining showed that FAK was activated mainly in smooth muscle cells after AD development. Western blot analysis also revealed that FAK was activated in 3 days after BAPN + AngII infusion before AD development, followed by transient reduction at day 7, and re-activation after AD at day 14. Significantly, administration of PND-1186 resulted in a significant reduction in the severity of AD in the aortic arch (1.96±0.41 mm in vehicle group, 0.66±0.29 mm in PND group, P<0.05). In addition, survival rate improved from 36.4% to 80.0% by administration of PND-1186 (P<0.01). In immunofluorescence staining, the PND-1186 treated group showed weaker staining of pFAK. Transcriptome analysis showed that genes for hematopoiesis and immune system were suppressed in PND-1186 treated group.

Conclusions
These findings proved that FAK plays a central role in the pathogenesis of AD probably by transmitting pathological stress to the aortic wall to cause tissue destruction. We propose that FAK is a potential therapeutic target for limiting the fatal destruction of the aortic wall of AD.
P6508Percutaneous versus surgical paravalvular leak: a ten-year tertiary centre experience
Authors: Sa Mendes G , Teles R , Neves J , Trabulo M , Almeida M , Ribeira R , Abecasis J , Nolasco T , Strong C , Mendes M 
Published: October 2019

Abstract

Aims
Paravalvular leak (PVL) presents an incidence ranging from 2–17%. Open heart surgery is considered the standard treatment and there is no consensus regarding the role of percutaneous closure of non-endocarditis PVL.

Methods
Single-centre retrospective study including consecutive patients that had their PVL closed percutaneously or by surgery, after heart team agreement, between 2007 and 2018. The primary goal was to assess mortality and rehospitalizations. The secondary goals were: a) the technical success, defined as reduction in regurgitation [≥1 degree] and b) clinic and laboratorial improvement.

Results
Forty-eight patients were included (mean age of 66±13 years, 56% male), 12 submitted to percutaneous closure and 36 to surgery (74 vs 65 years, p=0,026, respectively), with similar gender distribution. 56% had an aortic PVL, with the remainder having a mitral leak, with no difference between groups. The indications were heart failure in 91% and haemolytic anaemia in 42%. A combination of both indications and NYHA heart failure functional class ≥ III were higher in percutaneous group. The severity of leak was comparable in both groups.
Patients treated percutaneously had a significant higher rate of atrial fibrillation (92% vs 42%), COPD (33% vs 3%), peripheral artery disease (58% vs 22%) and higher EuroScore II (13,1% [7,1 - 19,0 CI 95%] vs 4,1 [2,9 - 6,5 CI 95%], p=0,003).
There was no significant difference between groups with respect to all- cause mortality at 6 months, and to cardiovascular (CV) mortality and CV rehospitalization at 1-year follow-up. The technical success was lower in percutaneous group, but clinic and laboratorial results did not differ (table).
Primary and secondary [(a) tecnical success (b) clinical and laboratorial improvements] endpoints of percutaneous vs surgery paravalvular leak closure Percutaneous PVL closure Surgical PVL Closure p-value Mortality @ 6 M 17% 25% p=1.000 CV Mortality @ 12 M 25% 31% p=1.000 Rehospitalization @ 12 M 18% 21% p=0.694 Technical success (a) 75% 97% p=0.043 NYHA improvement (b) 70% 71% p=0.171 Hb improvement (b) mean Δ: 1.2±1.1 g/dl mean Δ: 1.3±2.5 g/dl p=0.737 LDH reduction (b) mean Δ: −682±828 U/L mean Δ: −473±1215 U/L p=0.577

Conclusions
In this high-risk population, clinical and laboratorial improvement was achieved by both methods. The percutaneous technique seems more appropriate for patients with higher risk, despite a lower technical success in the reduction of the severity of the leak.
P6510Frailty and in-hospital outcomes in percutaneous coronary interventions
Authors: Kwok C S , Achenbach S , Curzen N , Fischman D L , Savage M , Bagur R , Kontopantelis E , Martin G , Steg P G , Mamas M A 
Published: October 2019

Abstract

Background
Frailty may be an important marker for poor outcomes in percutaneous coronary intervention (PCI) and there is limited literature on outcomes based on frailty from national cohorts.

Purpose
This study evaluates the prevalence of frailty, changes in frailty over time and outcomes associated with frailty in a national American cohort of patients who underwent PCI.

Methods
The study included adults who underwent PCI in the National Inpatients Sample between 2004 and 2014. Frailty risk was determined using a validated Hospital Frailty Risk Score (HFRS) using the cutoffs <5, 5–15 and >15 corresponding to low, intermediate and high HFRS.

Results
There were 7,306,007 PCI admissions in this cohort. A total of 94.58%, 5.39% and 0.03% of admissions were for low HFRS, intermediate HFRS and high HFRS, respectively. The proportion of intermediate or high frailty risk patients increased over time from 1.9% in 2004 to 11.7% in 2014. In-hospital death increased from 1.0% with low HFRS to 13.9% with high HFRS and average length of stay increased from 2.9±3.3 days to 17.1±15.5 days from low to high HFRS. Greater frailty risk was associated with greater average inpatient cost which was $17,743±11,059, $38,824±34,809 and $56,119±49,772 for low, intermediate and high HFRS, respectively. There were increased adverse outcomes with high frailty including greater in-hospital death (OR 9.91 95% CI 7.17–13.71), in-hospital bleeding complications (OR 4.99 95% CI 3.82–6.51), in-hospital vascular complications (OR 3.96 95% CI 3.00–5.23) and in-hospital stroke (OR 10.49 95% CI 8.28–13.29) comparing high to low HFRS.

Conclusions
More than 1 in 20 patients who undergo PCI have intermediate or high risk of frailty which has significantly increased over time. There are poor outcomes and increased inpatient costs associated with greater frailty. Improvements in education of healthcare workers and increased awareness of frailty could facilitate frailty-tailored care to minimise risk of adverse outcomes and its associated costs.

Acknowledgement/Funding
Research and Development Department at the Royal Stoke Hospital, Keele University and Biosensors International
P6514Head to head comparison of a pulsatile versus continuous flow left ventricular assist device in high-risk PCI setting: iVAC2L vs. Impella 2.5
Authors: Samol A , Schmidt S , Zeyse M , Kaese S , Luani B , Wiemer M 
Published: October 2019

Abstract

Background
To compare the hemodynamic and clinical performance between iVAC2L and Impella 2.5 in high-risk PCI.

Patients and methods
In 35 patients [8 female, age 75±8 years, left ventricular ejection fraction 45±12%] high-risk PCI was performed under Impella 2.5 (n=15) or IVAC2L (n=20) use. Aortic pressure and flow was collected before and after device placement and after PCI. Blood parameters of hemolysis were collected before and after PCI.

Results
Correct placement was achieved in 17 iVAC2L-patients and in 14 Impella-patients. PCI success was 97%. Support time was comparable between both groups. No early increase in aortic pressure occurred under full iVAC2L-support, but with prolonged support it increased significantly and kept higher level (Table 1). In contrast, aortic pressure increased significantly immediately under Impella, but the increase was comparable between the devices after PCI. Flow under Impella was significantly higher compared to iVAC2L (2.07±0.09l/min vs. 1.25±0.05l/min, p<0.001). In five patients (iVAC2L n=3) critical events during PCI occurred, but both devices helped to stabilise hemodynamics. After PCI, one severe bleeding in each group and one stroke after iVAC2L occurred. Haptoglobin level after Impella showed signs of hemolysis (Table 1).
Table 1 prePCI (no support) prePCI (full support) postPCI (full support) postPCI (no support) iVAC2L RRsyst Ao (mmHg, mean±SD) 123±29 125±21 142±28*§ 142±31# Impella 2.5 RRsyst Ao (mmHg, mean±SD) 137±23 148±29&% 151±22 153±22% iVAC2L RRdiast Ao (mmHg, mean±SD) 57±16 59±14 68±18* 69±18# Impella 2.5 RRdiast Ao (mmHg, mean±SD) 60±12 76±15&% 84±16* 76±17# iVAC2L RRmean Ao (mmHg, mean±SD) 81±17 83±16 97±21*§% 94±27# Impella 2.5 RRmean Ao (mmHg, mean±SD) 91±15 102±17&% 109±16* 106±17# iVAC2L Haptoglobin (mg/l, mean±SD) 1485±689 1261±648 Impella 2.5 Haptoglobin (mg/l, mean±SD) 1456±570 894±371$ iVAC2L LDH (U/l, mean±SD) 240±90 241±68 Impella 2.5 LDH (U/l, mean±SD) 220±82 252±101 Ao = Aorta. *p<0.05 prePCI (no support) vs. postPCI (full support); #p<0.05 prePCI (no support) vs. postPCI (no support); §p<0.05 prePCI (full support) vs. postPCI (full support); &p<0.05 prePCI (no support) vs. prePCI (full support); %p<0.05 iVAC vs. Impella.

Conclusion
High-risk PCI under support of both devices is feasible and safe. Aortic pressure increases with both devices but earlier under Impella. Differences in outcome and hemodynamics between the 2 devices need to be evaluated in large multi-center studies.
P6523Radial artery occlusion: predictors, methods for reducing the frequency of complications-a single center study
Authors: Ognerubov D , Tereshchenko A , Merkulov E , Provatorov S , Arutyunyan G , Ehrtman V , Silin N , Tripoten' M , Pogorelova O , Balahonova T , Samko A 
Published: October 2019

Abstract

Radial access has great advantages in terms of the frequency of complications, but it has one specific complication - radial artery occlusion (RAO). This complication often does not manifest itself in any way; however, it limits the use of access for the future interventions.

Aim
To compare methods of short and traditional hemostasis and to identify the main predictors of RAO after radial access.

Materials and methods
During the period from 2012 to 2018, 2000 patients were included in the study, which consisted of two parts: prospective - 1000 patients who underwent coronary angiography and percutaneous coronary intervention (PCI) with stable coronary artery disease, and retrospective part of the study, which included 1000 patients admitted for PCI from other clinics. In a prospective study, patients were divided into two groups: after coronary angiography and PCI, respectively (n=500 in the coronary angiography group and n=500 in the PCI group), and then randomized. Hemostatic bandages in the first group of patients (n=250) were removed after 12–24 hours, in the second group (n=250) - after 4±1 hours. When the occlusion of the radial artery was detected, all patients underwent an hour-long compression of the ipsilateral ulnar artery to recanalize acute RAO.

Results
The frequency of RAO in the retrospective part of the study was 21.8%. The frequency of RAO in the prospective part of the study was 10.2% with a traditional time hemostasis and 1.4% with a short-time compression (P<0.001). Predictors of the RAO are illustrated in table 1. Predictors of bleeding were PCI (OR 0.12, 95% CI 0.01–0.67, P=0.05) and weight (OR 1.09, 95% CI 1.02–1.18, P=0.01).
Table 1. Predictors of RAO Variables Odds ratio 95% Confidential interval Significance, P Traditional-time hemostasis 8.78 4.2–21.5 <0.001 Diabetes mellitus+smoking 18.1 12.7–26.7 <0.001 Diabetes mellitus 0.45 0.25–0.83 0.009 Body mass index 0.95 0.91–0.99 0.02 Male 1.75 1.01–3.18 0.05 Protein C 0,86 0,75–0,96 0,01

Conclusion
Careful examination of the patient for detecting RAO before and after interventions is essential. Short hemostasis with compression of the ipsilateral ulnar artery reduce the frequency of RAO. For short-time hemostasis, special attention should be paid to patients after PCI and with low BMI, as far as these factors are associated with a greater risk of bleeding after removal of the compression bandage.