bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anti-interleukin 1 agents for the treatment of recurrent pericarditis
Authors: Imazio M , Andreis A , Piroli F , Lazaros G , Lewinter M , Klein A , Brucato A 
Published: October 2021

Abstract

Background
Corticosteroid-dependent and colchicine-resistant recurrent pericarditis (RP) is a challenging management problem, in which conventional anti-inflammatory therapy (nonsteroidal anti-inflammatory drugs, colchicine, corticosteroids) is unable to control the disease. Recent data suggest a potential role for anti-interleukin-1 (IL-1) agents for this condition.

Purpose
This study was designed to assess the safety and efficacy of anti-IL-1 agents in this setting.

Methods
We performed a systematic review and meta-analysis of randomised controlled trials and observational studies assessing pericarditis recurrences and drug-related adverse events in patients receiving anti-IL-1 drugs for pericarditis.

Results
The meta-analysis assessed 7 studies including 397 pooled patients with RP. The median age was 42 years, 60% were women and the aetiology was idiopathic in 87%. After a median follow-up of 14 months (IQR,12–39), patients receiving anti-IL-1 agents (anakinra or rilonacept) had a significantly reduction in pericarditis recurrences (incidence rate ratio 0.06, 95% CI 0.03 to 0.14, see figure), compared with placebo and/or standard medical therapy. Anti-IL-1 agents were associated with increased risk of adverse events compared with placebo (risk ratio (RR) 5.38, 95% CI 2.08 to 13.92): injection-site reactions occurred in 15/41 (36.6%) vs. none (RR 14.98, 95% CI 2.09 to 107.09), infections occurred in 13/51 (25.5%) vs. 3/41 (7.3%; RR 3.65, 95% CI 1.23 to 10.85). Anti-IL-1 agents were not associated with increased risk of severe adverse events.

Conclusions
In patients with RP, anti-IL-1 agents (anakinra and rilonacept) are efficacious for prevention of recurrences, without severe adverse events.

Funding Acknowledgement
Type of funding sources: None.
Echocardiography-computed tomography fusion imaging: a new approach for congenital heart disease
Authors: Fournier E , Batteux C , Mostefa-Kara M , Cohen S , Van Aerschot I , Meliani A , Guirgis L , Sigal-Cinqualbre A , Provost B , Roussin R , Zoghbi J , Belli E , Hascoet S 
Published: October 2021

Abstract

Introduction
Diagnosis, management and surgical decision making in children and adults with congenital heart disease are based on echocardiography. One of the most recent developments in cardiac imaging is “fusion” of different imaging modalities. Our objective was to evaluate the feasibility of imaging fusion between computed tomography (CT) and 3D trans-thoracic echocardiography (TTE) in children and adults with congenital heart disease.

Methods
Fourteen patients with congenital heart disease who had a CT and a 3D TTE (9.5 years [2.7–15.7], 57% male, BSA 0.9 m2 [0.6–1.7]) were prospectively included for their usual monitoring in our center. Congenital heart disease was classified as simple (n=4, 29%), moderate (n=4, 29%) or complex (n=6, 42%). A full-volume 3D heart acquisition on three cycles was performed using a VividTM E95 GE. Image fusion between CT and TTE was done using General Electrics (GE) Fusion Software. Steps required for images importation, for fusion process (alignment, landmarks, superposition), navigation and analysis were described.

Results
Fusion imaging between 3D TTE and CT was successful for all patients and superposition was good with a median scored at 8.5/10. Median total time required to complete the fusion process was 735 seconds [628–1163], without significant difference according to the degree of complexity of the cardiopathy. Landmarks were significantly placed differently from the reference landmarks in complex congenital heart disease. For complex cardiopathy, navigation into the heart at the same time with multiple modalities demonstrate its interest, for diagnosis or for planning surgery.

Conclusion
We have investigated the feasibility and the accuracy of imaging fusion between 3D TTE and CT in a varied population of patients with congenital heart disease, from children to adult. These advances allow simultaneous visualization of intracardiac structures and may help in understanding the complex anatomy of congenital heart disease, without limitations in terms of age, weight or type of congenital heart disease.

Funding Acknowledgement
Type of funding sources: None. Validation of fusion imagingNavigation in fusion imaging
Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in ebstein anomaly
Authors: Devara J , Iftikhar M , Goda A , Shaik L , Katta R , Egbe A , Connolly H 
Published: October 2021

Abstract

Background
Certain factors such as left ventricular (LV) geometry and loading conditions affect the validity and reliability of LV ejection fraction (LVEF) as a true measure of LV contractility. LV global longitudinal strain (LVGLS) is less sensitive to these factors, and it has superior prognostic performance in patients with acquired heart disease. The purpose of this study was to determine the clinical implications of using LVGLS (instead of LVEF) as the measure of LV systolic function in adults with Ebstein anomaly given the inherent abnormalities of LV geometry and preload in this population.

Methods
Retrospective cohort study of 673 adults with Ebstein anomaly (2003–2018). We hypothesized that LVGLS had a stronger correlation with heart failure indices and transplant-free survival compared to LVEF.

Results
Compared to LVEF, LVGLS had stronger correlations with cardiac index (r=0.46 vs r=0.21, p=0.007), glomerular filtration rate (r=0.57 vs r=0.19, p&lt;0.001), and NT-proBNP (r=−0.64 vs r=−0.41, p=0.01). Of 673 patients, 514 (76%) had normal LV systolic function (LVGLSNormal-LVEFNormal), 87 (13%) had subclinical LV dysfunction (LVGLSLow-LVEFNormal) and 66 (10%) had overt LV dysfunction (LVGLSLow-LVEFLow). Compared to the overt LV dysfunction group, the subclinical LV dysfunction group had similar 10-year transplant-free survival (64% vs 63%, p=0.6), but were less likely to be on heart failure therapy (12% vs 82%, p&lt;0.001). LVGLS (but not LVEF) was the independent predictor of transplant-free survival

Conclusions
LVGLS provided more robust risk stratification and prognostication than LVEF in patients with Ebstein anomaly, and patients with low LVGLS had reduced transplant-free survival regardless of LVEF. The use of LVGLS (rather than LVEF) as the measure of LV systolic function has important clinical implications with regards to initiation of medical and surgical therapies.

Funding Acknowledgement
Type of funding sources: None.
Hematologic abnormalities as a marker of cirrhosis after Fontan completion
Authors: Scandinaro A , Haider M , Saef J , Farwati M , Allende D , Ghobrial J , Zahka K , O'Shea R , Fares M 
Published: October 2021

Abstract

Background
More patients with functioning single ventricle are living into adulthood due to improved survival with the Fontan procedure. Therefore, screening and detection of late-stage complications such as Fontan Associated Liver Disease (FALD) has become increasingly important to improve outcomes. The role of hematologic abnormalities as a marker of cirrhosis in this population is evolving.

Purpose
We aimed to evaluate the value of hematologic parameters in predicting the presence of cirrhosis in the context of FALD.

Methods
This was a retrospective study of patients after Fontan completion who underwent liver biopsy between 2007 and 2019 at our institution. Biopsy slides were evaluated for the presence of cirrhosis by a single pathologist. Laboratory testing was recorded within 12 months of the liver biopsy. Univariable analysis was conducted with an alpha level of 0.05 for hypothesis testing.

Results
A total of 31 Fontan patients with liver biopsies were identified, of whom 7 patients were found to have cirrhosis (Table 1). Compared to patients with no cirrhosis on biopsy, cirrhotic patients tended to have lower hematologic counts including absolute lymphocyte count (0.78 vs 1.02, p=0.019), hemoglobin (12.5 vs 15.1, p=0.018), and platelets (131 vs 194, p=0.025). Notably, the MELD-XI score (Model for End-stage Liver Disease excluding INR) as well as its individual components, creatinine and total bilirubin, were not different between the groups.

Conclusion
Our data suggests that hematologic parameters including absolute lymphocyte count might be of value in predicting cirrhosis on liver biopsy following Fontan completion. Further research to validate these findings in other cohorts is warranted.

Funding Acknowledgement
Type of funding sources: None.
Isolated exercise-induced pulmonary hypertension is associated with clinical worsening and poorer immunological control in hiv patients
Authors: Madonna R , Fabiani S , Morganti R , Forniti A , Menichetti F , De Caterina R 
Published: October 2021

Abstract

Background and aim
Exercise-induced pulmonary hypertension (Ex-PH), due to impaired pulmonary vascular and right ventricular (RV) contractile reserve on effort, may represent the earliest sign of pulmonary arterial hypertension (PAH), which may develop in Human immunodeficiency virus (HIV) patients with poor disease control. We investigated its association with clinical determinants of immunological status, virological control, and response to antiviral therapy in HIV patients at risk for PAH.

Methods
In 31 consecutive HIV patients with either low (n=29) or intermediate probability (n=3) of PH at rest, we evaluated the association of isolated ExPH with: time to HIV diagnosis, CD4+ T cell count, clinical progression to AIDS, development of resistance to antiretroviral therapy (ART), HIV RNA levels (copies/mL), time to onset of ART, current use of protease inhibitors, combination of ART with boosters (ritonavir e cobicistat), virological response to ART, ART discontinuation. Isolated ExPH at stress echocardiography (ESE) was defined as absence of PH at rest and systolic pulmonary arterial pressure (sPAP) &gt;45 mmHg or a raise of &gt;20 mmHg during low-intensity exercise (while not exceeding a cardiac output of 10 l/min).

Results
20% of the enrolled population developed ExPH. ExPH was inversely associated with CD4+ T cell count (p=0.047), time to HIV diagnosis (p=0.014) and time to onset of ART (p=0.041) compared to patients without ExPH. Patients with ExPH had greater worsening of functional class than patients without ExPH (p&lt;0.001). ExPH and AIDS showed a non-statistically significant trend of direct association (p=0.093). However, AIDS patients had an increase in pulmonary vascular reserve index (PVRI) compared to patients without ExPH (p=0.020) at rest echocardiography. We also observed an inverse correlation between the time to onset of ART with right atrium area (r=−0.411, p=0.022) and indexed right atrial volume (r=−0.102, p=0.009).

Conclusions
Isolated ExPH associates with clinical worsening and poorer immunological control in HIV patients. The assessment of ExPH by ESE may help identify subgroups of HIV patients with a propensity to develop subclinical impairment of pulmonary circulation following poor control of HIV infection.

Funding Acknowledgement
Type of funding sources: None.
Safety and efficacy of percutaneous catheter-directed treatment for intermediate-high risk pulmonary embolism
Authors: Rumiz Gonzalez E , Vilar Herrero J V , Escriva G M , Vidal Urrutia V , Fernandez Cisnal A , Cubillos Arango A , Nunez Villota J , Berenguer Jofresa A , Sanchis Fores J , Valero Picher E 
Published: October 2021

Abstract

Background
Pulmonary embolism (PE) is globally the third most frequent acute cardiovascular syndrome, ranking high among the causes of cardiovascular mortality. Systemic thrombolytic therapy (STT) permits prompt reperfusion after pulmonary obstruction, nevertheless this treatment carries by itself an inherent risk of major bleeding events. Development of new therapies and interventions that allow us to achieve early lung reperfusion along with a reduced risk of bleeding are necessary.

Purpose
The aim of this study was to evaluate the safety and efficacy of percutaneous catheter-directed treatment (PCDT) on intermediate-high risk PE patients with high bleeding risk or contraindication for STT.

Methods
We consecutively included all patients with intermediate-high risk PE undergoing PCDT in two university hospitals. Clinical, echocardiographic and hemodynamic variables (pre and post PCDT) were collected, as well as major adverse cardiac and bleeding events during follow-up.

Results
Between February 2018 and January 2021, we included 30 consecutive patients admitted with intermediate-high risk PE who underwent PCDT. Median age was 60 years, interquartile range (IQR) 51–72, and 41% were women. 14 patients (46.6%) presented an absolute contraindication for STT, which was the main reason for performing PCDT. Catheter-directed local thrombolysis (CDLT) was performed in 27 (90%) patients and mechanical fragmentation-aspiration was performed in 12 (40%) of them. We observed a significant reduction in mean pulmonary artery pressure (mPAP, mmHg) after PCDT: 40±13 vs. 25±12, p&lt;0.001; as well as in NT-proBNP concentrations (pg/ml) 48 hours post-PCDT: 4791±1077 vs. 2311±680, p=0.002, (Figure 1). Echocardiographic parameters of right ventricular (RV) dysfunction also experienced a significant improvement 72 hours post-PCDT: TAPSE (mm) 15±2 vs. 22±3, p=0.001, (Figure 2); basal RV diameter (mm) 51±4 vs. 41±2, p=0.001. During a median follow-up of 13 months, IQR (8–22), 1 patient died from non-cardiac cause and no patient presented a bleeding event.

Conclusions
PCDT for intermediate-high risk PE is safe and effective, producing an early reduction in mPAP, in prognostic biomarkers such as NT-proBNP, as well as an early improvement of classic echocardiographic parameters of RV dysfunction.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Radial versus femoral approach for rotational atherectomy – technical aspects and procedural outcomes
Authors: Bargon S , Achenbach S , Gaede L , Troebs M , Marwan M , Ammon F , Ferstl P , Schacher N 
Published: October 2021

Abstract

Background
Rotational atherectomy (RA) is a well-established therapy for the treatment of heavily calcified coronary lesions. While the radial approach has evolved into the gold-standard for standard percutaneous coronary intervention (PCI), RA is still often performed via a femoral approach. Concerns over guiding size, sheath size, the delivery of the burr as well as the need for a temporary pacemaker play a role in that decision.

Methods
This retrospective analysis includes all patients undergoing RA from 03/2013 to 06/2019 at one institution. We sought to investigate the procedural outcome and the influence of the percutaneous approach.

Results
A total of 228 patients were planned to undergo RA. Based on operator preference, RA was attempted via the radial approach (RAD) in 78 (34.2%) patients and via the femoral approach (FEM) in 150 (65.8%) patients. The procedure failed in 2.6% (RAD 1.3% vs. FEM 3.3%, p=0.359) due to crossing failure of either the RotaWire (n=5) or the burr (n=1).
The left anterior descending was the most frequently treated vessel in the radial group and significantly more often targeted in comparison to the femoral group (LAD: RAD 44.6% vs. FEM 26.5%, p=0.004). All other vessels were similarly often treated in both groups (LM: RAD 13.3% vs. FEM 17.3%, p=0.414; LCX: RAD 15.7% vs. FEM 23.5%, p=0.155; RCA: RAD 25.3% vs. FEM 31.5%, p=0.315; Bypass: RAD 1.2% vs. FEM 1.2%, p=0.984). RAD-RA was significantly more often performed with a 6F sheath in comparison to FEM-RA (RAD 47.4% vs. FEM 16.7%, p&lt;0.001). A 7F sheath was used in 52.6% of the cases for RAD-RA (men: 85.4%, women: 14.6%, p=0.176) and is therefore the most frequently chosen sheath size within that group. A 7F or 8F sheath was used in 75.3%, respectively 8.0% of the cases in the FEM group (7F: p&lt;0.001; 8F: p=0.010 compared to RAD). There were no significant differences regarding the burr sizes (RAD 1.43±0.17mm vs FEM 1.41±0.18mm, p=0.442).
Whereas the placement of a temporary pacemaker was equal in both groups (RAD 20.8% vs. FEM 30.8%, p=0.110), the femoral group showed a higher number of patients with any back-up pacing, permanent or temporary (RAD 24.7% vs. FEM 39.0%, p=0.031). There were no significant differences in terms of fluoroscopy time (RAD 00:24:65±00:12:48 vs. FEM 00:28:33±00:17:05, p=0.180) and the volume of contrast medium (RAD 217.2±96.3ml vs. FEM 192.9±86.0ml, p=0.118). Moreover, procedural complications (RAD 17.9% vs. FEM 18.0%, p=0.992) and access site related complications (RAD 6.4% vs. FEM 10.0%, p=0.363) occurred equivalently in both groups.

Conclusion
This analysis shows that RA via radial access is as safe and successful as via femoral access. Despite the more frequent use of 6F sheaths, burr sizes did not differ. Additionally, neither fluoroscopy time nor contrast volume indicated a higher complexity of the RAD approach.

Funding Acknowledgement
Type of funding sources: None.
Frequency and predictors of coronary angiography and percutaneous coronary intervention related stroke
Authors: Staszczak B , Malinowski K P , Siudak Z , Wanha W , Surdacki A , Wojakowski W , Legutko J , Bartus K , Bartus S , Januszek R 
Published: October 2021

Abstract

Background
Acute stroke related to percutaneous coronary interventions (PCIs) is an infrequent complication, although potentially life-threatening and often leading to serious disability, characterised by high morbidity and mortality rate. However, particular data on periprocedural complications, predictors, prognosis and the type of coronary intervention has not yet been adequately investigated.

Aim
The aim of the present study was to assess the relationship between the type of coronary procedure [coronary angiography (CA) and PCI] and incidence of stroke as well as predictors of stroke.

Material and methods
This retrospective analysis was performed on prospectively collected data gathered in the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), which covered the period between January 2014 and December 2019 and included 1,177,161 coronary procedures. Among them, 650,674 patients underwent isolated CA and 526,487 underwent PCI. Stroke was diagnosed in 157 patients (0.013%), of which 100 (0.015%) refers to patients admitted for CA and 57 (0.011%) in patients qualified for PCI. Subsequently, the mentioned groups were analysed for similarities and compared. Multivariate analysis was performed to separate predictors of stroke in patients undergoing coronary angiography and PCI.

Results
The amount of patients with periprocedural stroke was higher in a group treated with isolated CA during the analysed time. The mean age of the patients, who developed cerebral stroke, was significantly higher in the overall group (71.4±10.6 vs. 66.7±10.8; p&lt;0.001). Patients with stroke, in comparison to non-stroke group, were treated more often from femoral access for CA (p&lt;0.001) and PCI (p=0.04), they had a history of prior stroke for CA (p&lt;0.001) and PCI (p&lt;0.001) more often, and acute myocardial infarction at admission for CA (p&lt;0.001) and PCI (p=0.01). They were also more frequently transported directly to the catheterisation laboratory for CA (p&lt;0.001) and PCI (p=0.002). Predictors of periprocedural stroke, assessed by multivariate analysis for CA, are presented at Fig. 1 and for PCI at Fig. 2.

Conclusions
Based on the large national registry, PCI is associated with fewer risk factors and lower rate of periprocedural strokes than isolated CA.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Rapid pacing is an independent predictor for high implantation depth using self-expandable devices in TAVR
Authors: Veulemans V , Maier O , Piayda K , Berning K L , Binneboessel S , Polzin A , Afzal S , Dannenberg L , Horn P , Jung C , Westenfeld R , Kelm M , Zeus T 
Published: October 2021

Abstract

Background/Introduction
Optimizing valve implantation depth (ID) plays a crucial role in minimizing conduction disturbances and achieving optimal functional integrity. Until now, the impact of intraprocedural fast (FP) or rapid ventricular pacing (RP) on the implantation depth has not been investigated.

Purpose
Therefore, we aimed to 1) evaluate the impact of different pacing maneuvers on ID, and 2) identify the independent predictors of deep ID.

Methods
562 TAVR patients with newer-generation self-expandable devices were retrospectively enrolled and further separated into patients undergoing TAVR under FP (n=331; 58.9%) and RP (n=231; 41.1%). The final ID was analyzed, and the underlying functional, anatomical, and procedural conditions were evaluated by univariate and multivariate analysis.

Results
The highest ID was reached under RP in severe aortic valve calcification and valve size 26 mm. Multivariate analysis identified left ventricular outflow (LVOT) calcification (OR 0.56 [0.37–0.85], p=0.006*), a bicuspid valve (OR 0.34 [0.11–1.0], p=0.049*), valve size 26 mm (OR 0.47 [0.28–0.81], p=0.006*), and RP (OR 0.57 [0.37–0.87], p=0.010*) as independent and highly preventable predictors for deep valve deployment. Independent risk factors for deep ID were the use of a 34 mm device (OR 1.96 [1.22–3.15], p=0.005*) and mild aortic valve calcification (OR 1.62 [0.01–2.61], p=0.046*). In a model of protective factors, ID was significantly reduced with the number of protective criteria (0–2 criteria: −5.6±2.6 mm vs. 3–5 criteria: −4.5±2.0 mm; p&lt;0.0001*).

Conclusion
Data from this retrospective analysis indicate that RP is an independent predictor to reach a higher implantation depth using self-expandable devices.

Funding Acknowledgement
Type of funding sources: None.