bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6178The optimal point of CT-FFR measurement in comparison with invasive FFR
Authors: Miyajima K , Motoyama S , Sarai M , Kawai H , Takahashi H , Muramatsu T , Naruse H , Ishii J , Ozaki Y 
Published: October 2019

Abstract

Background
Currently, invasive fractional flow reserve (FFR), has become a gold standard to select patients requiring revascularization. Coronary computed tomography angiography (CTA) -derived FFR (FFRCT/CT-FFR) can be used for the management of coronary artery disease, which would be a gatekeeper of invasive coronary angiography. In most of the previous report to evaluate the diagnostic performance of FFRCT/CT-FFR, FFRCT/CT-FFR value was measured at the same point as the invasive FFR. Clinically, FFRCT/CT-FFR should be measured without the information of invasive FFR. However, optimal measurement point for CT-FFR has not been established yet.

Purpose
To assess the optimal measurement point of CT-FFR in comparison with invasive FFR as a gold standard.

Methods
CTA images scanned at 70–99% of R-R interval with 320 slice CT were screened. In the de-novo lesions with invasive FFR data were included in this study. Since calcified lesions could affect CT-FFR value, severe calcified lesions on CTA were excluded from the analysis. The CT-FFR analysis was performed by 2 cardiologists blinded to the results of the invasive FFR using a standard desktop computer and dedicated software. CT-FFR values could be provided at any point from ostium of coronary artery to the distal with vessel diameter of 1.8mm. To determine the optimal point for measurement of CT-FFR, CT-FFR values were obtained at 3 points in each coronary artery; 1) at the same point as invasive FFR; 2) lowest CT-FFR at distal point of coronary artery; 3) at 2.0 cm distal to the lesion. The diagnostic performance at each point was compared with invasive FFR.

Results
Fifty vessels of 44 patients (average age 68 years, male were 32) were included. Average Agatston score was 279.4. There was significant correlation between CT-FFR at each point and invasive FFR. CT-FFR at the same point as invasive FFR showed the good correlation with invasive FFR (R=0.641, 95% CI= 0.041–0.127, p<0.0001). Compared to the lowest CT-FFR at distal (R=0.608, 95% CI= 0.069–0.160, p<0.0001), CT-FFR at 2.0 cm distal to the lesion (R=0.604, 95% CI= 0.007–0.061, p<0.0001) revealed better correlation with invasive FFR. Sensitivity, specificity, positive and negative predictive value at each point were 92.8 / 93.3 / 81.8; 75.0 / 57.1 / 94.2; 61.9 / 48.2 / 60.0; and 96.0 / 95.2 / 84.6, respectively. Diagnostic accuracy showed that CT-FFR at 2cm distal to the lesion (0.84) was similar to CT-FFR at the same point as invasive FFR (0.80), and it was better than far distal (0.68) to detect invasive FFR derived ischemia.

Conclusions
CT-FFR was feasible to detect invasive FFR derived ischemia at the same point.
CT-FFR at 2.0 cm distal to the lesion showed higher diagnostic performance compared with CT-FFR measured at the far distal. CT-FFR measurement at 2.0 cm distal to the lesion would be a optimal position clinically.
P6181The association of coronary lumen volume to left ventricle mass ratio with myocardial blood flow and fractional flow reserve
Authors: Van Diemen P A , Schumacher S P , Bom M J , Driessen R S , Everaars H , Stuijfzand W J , Raijmakers P G , Van De Ven P M , Min J K , Leipsic J A , Knuuti J , Boellaard P R , Van Rossum A C , Danad I , Knaapen P 
Published: October 2019

Abstract

Background
A low coronary lumen volume to left ventricle mass ratio (V/M) derived from coronary computed tomography angiography (CCTA) has been proposed as a factor contributing to impaired myocardial blood flow (MBF) even in the absence of obstructive coronary artery disease (CAD).

Objective
To elucidate the association of V/M with non-invasively obtained MBF parameters by means of [15O]H2O positron emission tomography (PET), as well as its correlations with invasively measured fractional flow reserve (FFR), overall and specifically in vessel with non-obstructive CAD.

Methods
This is a substudy of the PACIFIC trial, in which 208 patients underwent CCTA, and [15O]H2O PET prior to invasive coronary angiography (ICA) in conjunction with 3 vessel FFR measurements. Patient specific V/M was calculated for 152 patients. Matched vessel specific hyperemic MBF (hMBF), coronary flow reserve (CFR), FFR, and patient specific V/M were available for 431 vessels. The median V/M (20.71 mm3/g) was used to divide the study population into a group with a low V/M (<20.71 mm3/g) and a high V/M (≥20.71 mm3/g). Non-obstructive CAD was defined as a ≤50% stenosis grade on ICA.

Results
Overall, a higher percentage of vessels with an abnormal hMBF (34% vs. 19%, p=0.009), lower FFR values (0.93 [interquartile range: 0.85–0.97] vs. 0.95 [0.89–0.98], p=0.016), and a higher number of positive FFR values (20% vs. 9%, p=0.004) were observed among vessels in the low V/M group. Furthermore, a weak correlation between V/M, global hMBF (R=0.179, p=0.027), and global CFR (R=0.163, p=0.045) as well as a weak significant association with vessel specific hMBF (p=0.027), and FFR (p<0.001) was observed (figure 1). V/M was not independently predictive of vessels specific MBF parameters or FFR. Among vessels with non-obstructive CAD (361 vessels), an abnormal hMBF tended to be more frequently observed in vessels with a low patient specific V/M (21% vs. 13%, p=0.056). Globally, there was no correlation between V/M and hMBF nor CFR. Patient specific V/M tended to be weakly associated with vessel specific hMBF (p=0.083) and was associated with FFR (p=0.027) (figure 1). Lastly, patient specific V/M tended to be independently predictive of FFR in this specific group.

Conclusion
Overall, vessels with an abnormal hMBF, and positive FFR measurements were more frequently observed in patients with a low V/M compared to those with a high V/M. Furthermore, V/M weakly correlated with global hMBF as well as with CFR and was associated with vessel specific hMBF and FFR. However, there was no correlation between V/M and global nor vessel specific blood flow parameters in the absence of obstructive CAD, notwithstanding a weak association of V/M with FFR within this group was noted.
P6183Diagnostic performance of coronary computed tomography angiography-derived fractional flow reserve in patients with acute myocardial infarction and moderate non-culprit coronary stenosis
Authors: Jablonkai B , Ahres A , Ruboczky G , Nagybaczoni B , Oze A , Balogh Z S D , Schrancz A , Astrid A , Szilveszter B , Kolossvary M , Simon J , Merkely B , Maurovich-Horvat P , Andrassy P 
Published: October 2019

Abstract

Background
Revascularisation of significant non-culprit coronary lesions (NCL) may improve clinical outcome in patients with myocardial infarction and multi vessel disease, however management of moderate NCLs is still controversial. Dobutamine stress echocardiography (DSE) and invasive fractional flow reserve (FFR) are accepted methods to detect myocardial ischemia, nevertheless coronary CT angiography-derived fractional flow reserve (CT-FFR) is a new modality, which has not been widely investigated to date in patients with NCLs.

Purpose
Our aim was to determine the diagnostic performance of CT-FFR compared to DSE and invasive FFR.

Methods
In this prospective trial, DSE, FFR and CT-FFR were performed in every patient with MI and at least one moderate NCL (30–70% diameter stenosis by visual assessment). New or worsening wall motion abnormality in at least two contiguous myocardial segments on DSE, and FFR value<0.8 in invasive FFR and CT-FFR as well were determined as abnormal. In comparison, DSE and FFR were regarded as reference standard methods.

Results
Between March of 2017 and December of 2018, 51 patients (58.2±10.4 years, 74.5% male) were enrolled and 71 NCLs (40 LAD, 13 LCx, 18 RCA) were investigated. Dobutamine stress echocardiography, FFR and CT-FFR were positive in 30.9%, 32.3% and 22.5% of all lesions, respectively. FFR values were higher with CT-FFR compared to invasive FFR (0.85±0.11 vs. 0.83±0.08, p<0.05). Compared to DSE, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of CT-FFR were 40.9%, 85.7%, 56.2%, 76.3% and 71.8%, respectively. The same values were 39.1%, 85.4%, 56.2%, 74.5% and 70.4% compared to invasive FFR, respectively. Correspondence of CT-FFR with DSE (k=0.29) and with FFR (k=0.27) was weak.

Conclusion
This is the first study that compares the three modalities in the evaluation of moderate NCLs. Our results demonstrated moderate diagnostic accuracy, excellent specificity, poor sensitivity and PPV and acceptable NPV of CT-FFR compared to DSE and FFR. At this stage, CT-FFR is probably not accurate enough to determine revascularisation strategy of moderate NCLs as a single non-invasive method.
P6187Multicentre diagnostic performance of on-site workstation CT derived fractional flow reserve
Authors: Ihdayhid A R , Fujimoto S , Motoyama S , Comella A , Kato E , Miyajima K , Isa M , Kamo Y , Sarai M , Kawai H , Arakita K , Hislop-Jambrich J , Cameron J , Seneviratne S , Ko B 
Published: October 2019

Abstract

Background
On-site workstation based computed tomography derived fractional flow reserve (CT-FFR) is an emerging method to assess vessel specific ischaemia in coronary artery disease (CAD). Global data on its diagnostic performance when compared with CT coronary angiography (CTA) is limited.

Purpose
To evaluate the on-site multicentre diagnostic performance of reduced-order CT-FFR at detecting vessel specific ischaemia.

Method
This is a retrospective pooled analysis of 141 patients (204 vessels) with suspected CAD enrolled from 3 global centres who underwent CTA, onsite CT-FFR and invasive FFR. On-site CT-FFR was performed using a reduced order model on a standard desktop computer with dedicated software. The per vessel diagnostic performance of CT-FFR (≤0.8) for vessel specific ischemia (FFR≤0.8) was compared with CTA (≥50% stenosis).

Results
Mean age was 65.8±9.9, 70.7% were male. FFR significant stenosis was present in 34.3% (70/204) of vessels. Pearson correlation of CT-FFR for invasive FFR was 0.52, P<0.001. Bland Altman analysis demonstrated a mean difference of 0.06±0.15 (95% limits of agreement −0.22 to 0.35). Per vessel diagnostic accuracy, sensitivity and specificity of CT-FFR and CTA were 79.9% vs 53.5%; 78.6% vs 85.7%; 80.6% vs 35.9% respectively. Diagnostic performance as assessed by area under the receiver operator curve (AUC) for CT FFR was superior to CTA (0.82 [95% CI 0.76–0.88] vs 0.61 [0.55–0.67]; P<0.001).

Conclusion
On-site workstation CT-FFR demonstrated high per vessel diagnostic performance and was superior when compared with CTA in assessment of vessel specific ischaemia as assessed by invasive FFR in a multicentre setting.
P6202Serum sitosterol levels and ABCG5 and ABCG8 genetic mutations among Japanese dyslipidemic subjects
Authors: Kojima N , Tada H , Kawashiri M , Takamura M 
Published: October 2019

Abstract

Background
Sitosterolemia, which is caused by ABCG5 or ABCG8 genetic mutations, is involved with marked increased concentrations of cholesterol as well as non-cholesterol plant sterols including sitosterol. Assessments of serum sitosterol level is critical to discriminate this disease from familial hypercholesterolemia (FH), which exhibits similar phenotypes except for elevated sitosterol levels. However, no prior data exist regarding the optimal cutoff value of serum sitosterol predicting the presence of sitosterolemia with double pathogenic mutations in ABCG5 or ABCG8 genes.

Methods
We retrospectively investigated consecutive 253 Japanese dyslipidemic subjects (mean age = 47.02 yr, male = 48.6%) with the assessments of serum sitosterol level as well as the presence of ABCG5 or ABCG8 genetic mutations in our institute since 2009 to 2018. Exome lesions of those 2 genes were sequenced, and pathogenicity of the identified genetic variants were determined using standard variant filtering schema, including minor allele frequency, in silico annotation tools. We divided the subjects into 3 groups based on the number of pathogenic mutations in ABCG5 or ABCG8 genes. We compared serum lipid values, including LDL cholesterol as well as serum sitosterol among those groups, and tried to determine the optimal cutoff value discriminating patients of sitosterolemia with double mutations from others.

Results
We identified 11 individuals with sitosterolemia with double mutations, 27 individuals with a single mutation, and 215 individuals without any mutations. Distribution of serum sitosterol exhibited skewed to the right (Figure). There was no significant correlation between serum sitosterol and other lipids, including LDL cholesterol. As expected, serum sitosterol level of patients with sitosterolemia exhibited significantly higher than those of any other groups (52.0 vs. 7.9 μg/ml, p=2.22×10–6, 52.0 vs. 2.8 μg/ml, p=2.275×10–8). 15 μg/ml was the optimal cut-off value, the sensitivity and specificity of which were 100%, and 99.6%, respectively.
Histgram of serum sitosterol

Conclusion
We suggest the cutoff sitosterol value of 15 μg/ml predicting the presence of sitosterolemia with double pathogenic ABCG5 or ABCG8 genetic mutations.
P6207Polypill to improve adherence in cardiovascular secondary prevention: a real challenge in real practice
Authors: Merino Argos C , Dalmau Gonzalez-Gallarza R , Velez Salas A , Castro Conde A , Martinez Marin L A , Caro Codon J , Rodriguez Sotelo L , Marco Clement I , Martin Polo L , Rosillo Rodriguez S O , Lopez-Sendon Hentschel J L 
Published: October 2019

Abstract

Background
Poor adherence is a barrier to optimal secondary cardiovascular prevention. The need for a polymedication, the cost of some drug therapies and the silent evolution of some cardiovascular conditions are often related to poor adherence. A fixed-dose polypill strategy (AAS, ACEi and statin) has emerged as a possibility to improve adherence in cardiovascular prevention and therefore improve outcomes. Nevertheless, the complexity of cardiovascular disease patients' drug therapy regimes and the need for titration of doses in order to reach the goals, makes it difficult to introduce a fix-dose polypill.

Methods
We performed a prospective study of consecutive patients attending a secondary prevention consultancy. In order to find out whether they were amenable to a polypill regime, we analyzed their drug therapy scheme and the level of control of blood pressure and LDL cholesterol.

Results
We included 302 patients, and their treatment is shown in table 1. Of the total of patients, we found that only 25 patients (8.3%) were optimal candidates for receiving a fixed-dose polypill. The reasons for not being eligible are summarized in figure 1, highlighting the need for higher statin dose or statin intolerance as the most frequent cause (79.5%), or the need for titration or combination of drugs according to the blood pressure levels.
Patients' characteristics and therapy Patients (n=392) Sex (male) 252 (83.4%) Age (mean ± SD) 60.82 (±11,33) Event (STEMI, NSTEMI, angina) 155 (51.3%), 123 (40,7%), 24 (7.9%) ACEi/ARBs 279 (72.5%) ASA 279 (92.4%) Statins (Atorvastatin 80mg, atorvastatin 40mg, rosuvastatin, other statin) 221 (73.2%), 37 (12.3%), 25 (8.3%), 17 (5.6%) Anti-arterial hypertensive combination pill 51 (16.9%) Number of drugs (mean±SD) 6.61 (±2.47) Optimal blood pressure control (<140/90 mmHg) 197 (65.2%) Optimal LDL control (<70 mg/dl) 208 (69.8%)
Causes of non-eligibility for polypill

Conclusion
Despite the fact that polypill could bring the opportunity to improve cardiovascular drug therapy adherence, the complexity of secondary prevention patients and the common need for a high dose statin makes it difficult to implement a polypill scheme in the real practice.
P6220The non-invasive coronary flow reserve predicts exercise capacity in patients undergoing cardiac rehabilitation
Authors: Meimoun P , Ghannem M , Clerc J 
Published: October 2019

Abstract

Background
The benefit of exercise on peripheral muscles is established but the exact role of the coronary microcirculation in exercise capacity after cardiac rehabilitation (CR) is unclear. Objective: Our aim was to test the relationship between non-invasive coronary flow reserve (CFR) and exercise capacity in patients undergoing CR after acute myocardial infarction (AMI).

Methods
CFR was performed by transthoracic Doppler echocardiography in the left anterior descending artery 24 h after angioplasty (CFR1) and after 20 sessions of CR program (at 4±1 months) (CFR2) in 60 consecutive patients (57±11 years, 30% women) with an anterior AMI successfully treated by primary coronary angioplasty. CFR was performed in a modified parasternal view using intravenous adenosine infusion (0.14 mg/kg/min within 2 minutes). CR program consisted of a half hour of fractioned exercise added of a half hour session of general gymnastics and body building. To test the exercise capacity, symptom limited exercise echocardiography was performed just after the CFR2, in a semi-supine position, starting at 25 watts, with 20–25 watts increments of workload every two minutes.

Results
CFR was measured successfully in all patients, and CFR2 was significantly higher than CFR1 (2.9±0.65 vs 1.9±0.4, p<0.001). Though CFR1 was correlated to left ventricular systolic function and its improvement at follow-up (all, p<0.01), CFR2 was independently related to exercise capacity (mean workload 100±30 watts, percent maximal heart rate 83±12%, no ischemia, no new wall motion abnormalities in all tests) after adjusting for age, sex, and body mass index (r=0.6, p<0.01).

Conclusion
CFR predicts exercise capacity in patients undergoing a CR program after AMI. The improvement of CFR contributes to cardiac performance.
P6239Late adverse effects of residual platinum concentrations on cardiac function in testicular cancer survivors: a 30-year follow-up study
Authors: Bjerring A W , Fossa S D , Haugnes H S , Haugaa K H , Edvardsen T , Sarvari S I 
Published: October 2019

Abstract

Background
Cisplatin-based chemotherapy (CBCT) is essential in the treatment of testicular cancer (TC), and platinum can be detected in TC survivors decades after cessation of treatment. CBCT has been implicated as a risk factor in cardiovascular morbidity and mortality.

Purpose
Our study aimed to assess the relationship between residual serum platinum concentrations and changes in cardiac function and morphology in TC survivors 30 years after CBCT.

Methods
Seventy TC survivors diagnosed and treated with CBCT (1980–1994) were recruited from the longitudinal Norwegian Cancer Study in Testicular Cancer Survivors. Serum platinum concentration was measured twenty years after CBCT. Patients were then allocated to either a high or low platinum concentration group. Echocardiography was performed in all subjects.

Results
The participants were on average 60±9 years old. There was a trend towards smaller left ventricular (LV) volumes in the high residual platinum concentration group (Table). No intergroup difference in cardiac function was found. Six (9%) participants had reduced EF (<52%) and 14 (20%) participants had reduced LV global longitudinal strain (> −18.0%), however, there was no intergroup difference. Neither cumulative cisplatin dose nor residual serum platinum concentration showed any correlation with LV or right ventricular functional parameters.
Table 1 Low residual Pt concentration >85 ng/L (n=35) High residual Pt concentration <85 ng/L (n=35) p-value Cumulative cisplatin dose, mg/m2 680±249 814±271 <0.05 Residual Pt concentration, ng/L 44±22 136±44 <0.001 3D LV end-diastolic volume, ml/m2 66±17 60±8 0.07 3D LV end-systolic volume, ml/m2 29±15 24±5 0.08 3D ejection fraction, % 57±9 59±6 0.24 LV global longitudinal strain, % −19.2±3.3 −20.0±2.0 0.26 LV global circumferential strain, % −21.1±4.2 −22.1±1.8 0.30 E/e' 10.6±4.4 9.2±2.2 0.10 TAPSE, mm 2.2±0.4 2.3±0.4 0.22 RV fractional area change, % 40±7 41±7 0.67 Data are presented as mean ± SD. The P-values were derived from the Student's t-test. LV, left ventricle; MV, mitral valve; Pt, platinum; RV, right ventricle; TAPSE, tricuspid annular plane systolic excursion.

Conclusion
Our 30-year follow-up study of testicular cancer patients could not demonstrate impact on cardiac function caused by cumulative cisplatin dose or residual serum platinum concentrations.

Acknowledgement/Funding
South-Eastern Norway Regional Health Authority
P6243Impact of coronary flow reserve as an important predictor for major adverse cardiac and cerebrovascular event in hemodialysis patients even in patients without myocardial perfusion abnormality
Authors: Umemoto N , Ooshima S , Ooshima S , Itou R , Itou R , Iio Y , Iio Y , Kajiura H , Kajiura H , Shimizu K , Shimizu K , Sakakibara T , Sakakibara T , Ishii H , Ishii H , Murohara T , Murohara T 
Published: October 2019

Abstract

Background
In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13N-ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic test for IHD. We have reported about the predictability of coronary flow reserve (CFR) in poor prognosis in HD population. Some prior studies show that low CFR predicts poor prognosis for not only cardiovascular event but also all-cause mortality. Although it is well-known that CFR is an important predictor, there are limited data about CFR of patients without myocardial perfusion (MP) abnormality. We investigated the prognostic predictability of adverse cardiac and cerebrovascular event (MACCE) in HD patients without MP abnormality.

Methods
A total 438 of HD patients who underwent 13NH3PET for suspected IHD were enrolled. All patients were underwent 13NH3PET at our facility. After we excluded patients whose summed stress score (SSS) >3, we identified 182 eligible patients. Patients were divided into two group according to the median value of CFR; low CFR group (≤2.405) and high CFR group (>2.405). We followed up them up to 4.2 years (median 2.4 years) and collected their data. We evaluated their major adverse cardiac cerebrovascular event. We performed Kaplan-Meyer analysis and multivariable cox regression models. Furthermore, we evaluated the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when CFR added into a model with established risk factors.

Results
There were intergroup difference in baseline characteristics: age, gender, prior CVD and diabetes. Kaplan-Meyer analysis shows statistically intergroup difference [log rank p=0.04, hazard ratio (HR) 0.54, 95% confidential interval (CI) 0.30–0.97]. Multivariable cox regression model for MACCE shows CFR is an independent risk factor (p=0.04, HR 0.54, 95% CI 0.30–0.97). As regarding model discrimination, all of C-index (0.82 vs 0.80, p=0.23), NRI (0.51, p<0.01) and IDI (0.03, p=0.03) were greatest in a predicting model with established risk factors plus CFR.

Conclusions
The low CFR group had poor prognosis in MACCE comparing to the high CFR group. CFR would be an independent risk factor for MACCE. Adding CFR on conventional risk factors could more accurately predict MACCE in HD patients, even in patients without MP abnormality.