bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral Presentation No. 093 Assessing different noncoding RNAs as markers of platelet reactivity
Authors: Gutmann Clemens , Barwari Temo , Schulte Christian , Singh Bhawana , Theofilatos Konstantinos , Joshi Abhishek , Zampetaki Anna , Chan Melissa V , Armstrong Paul C , Kiechl Stefan , Willeit Johann , Warner Timothy D , Mayr Manuel 
Published: October 2022

Abstract

Background
Antiplatelet therapy (APT) has improved cardiovascular outcomes, but some patients develop thrombosis despite APT. Adjusting APT to platelet reactivity with conventional platelet reactivity tests has proven unsuccessful. Many circulating noncoding RNAs (ncRNAs) are derived from platelets and could serve as novel platelet function markers.

Material and methods
Platelet reactivity was assessed using light transmission aggregometry (LTA) in the Bruneck 2015 study (N = 338), using the agonists arachidonic acid, adenosine diphosphate, collagen, TRAP-6 amide and U46619. LTA platelet releasates were then used for RT-qPCR of five platelet-enriched microRNAs, three circular RNAs and two long non-coding RNAs. Platelet-poor plasma (PPP) was used as negative control.

Results and conclusions
Platelet agonists induced aggregation and ncRNA release, with aspirin takers (N = 155) showing lower ncRNA release than individuals not on aspirin (N = 183). Agonist responsiveness differed among ncRNAs, with miR-150 being hyperresponsive to adenosine diphosphate and miR-21 being hyperresponsive to arachidonic acid, whereas other ncRNAs were most strongly released to collagen, suggesting a selective release mechanism. In individuals not on aspirin, the inflammation markers C-reactive protein and granulocyte counts correlated positively with platelet-derived ncRNAs in PPP, while they correlated inversely with platelet-derived ncRNAs in releasates. These correlations were not present in aspirin takers. Higher PPP levels and lower releasate levels of platelet-derived ncRNAs in inflammation suggest platelet exhaustion ex vivo due to platelet pre-activation in vivo.

Funding sources
British Heart Foundation, VASCage (Centre for Promoting Vascular Health in the Ageing Community) of the Austrian Research Promotion Agency FFG (COMET program - Competence Centers for Excellent Technologies).
Poster No. 106 Can we optimize d-dimer cut off value to predict pulmonary embolism in covid-19 patients?
Authors: Fernandes Rafaela , Ferreira Joana Moura , Alves Ana Rita , Almeida Gabriela , Lopes Vanessa , Cunha Gil , Costa Gonçalo , Monteiro Eric , Guimarães Joana , Fernandes Diogo , Gomes Ana Rita , Rosa João Borges , Campos Gustavo , Campos Diana , Loureiro Carolina , Almeida José Paulo , Martinho Sofia , Martins Paulo , Gonçalves Lino 
Published: October 2022

Abstract

Background
Covid-19 is associated with an increased risk of pulmonary embolism (PE) therefore, should the cut off d-dimer value be adjusted for these patients?

Material and methods
Retrospective and observational study to understand if there is a d-dimer cut-off that could guide clinics to perform a thoracic computed tomography angiography (CTA) in patients with covid-19. The population was covid-19 patients admitted to covid-19 dedicated wards of a University Hospital Centre for one year.

Results and conclusions
725 (52%) patients with covid-19 had a d-dimer value dosed during the first 5 days of the disease. Those, 63 (9%) did a CTA with a diagnosis of 16 (25%) PE. Gender was equally represented, median age was 70 years (ID = 3.49) and the majority (94%) survived. Thirteen (81%) patients with PE had a d-dimer value above 2500 ng/mL (OR = 9.244, 95% CI 2.248–9.837), with 7 (54%) with values over 10000 ng/mL, but in 3 (9%) it was under 1500 ng/mL. Seventy-three (63%) of patients with a d-dimer over 1500 ng/mL did not had a thoracic CTA performed. In our population PE was not a frequent outcome. The results are influenced by the low number of thoracic CTA performed because, even tough the cut-off d-dimer value used at our hospital to perform a thoracic CTA to exclude PE is 1500 ng/mL, most patients with that d-dimer value did not take the exam and so PE could not be excluded. Although in most PE cases the d-dimer value was above 2500 ng/mL, the results of our study cannot verify if that is a better cut-off value.
Oral Presentation No. 107 Achieving higher efficacy without compromising safety with Factor XI inhibitors versus low-molecular-weight heparin for the prevention of venous thromboembolism in major orthopedic surgery – Systematic Review and Meta-Analysis
Authors: Presume João , Ferreira Jorge , Ribeiras Regina , Mendes Miguel 
Published: October 2022

Abstract

Background
In recent years, many important advances have been seen in anticoagulation therapy. However, bleeding risk is still a major concern. Factor XI inhibition has emerged as a potential advantageous target to minimize this risk.

Objectives
We conducted a systematic review and meta-analysis of current evidence on factor XI inhibitors for thromboprophylaxis in major orthopedic surgery.

Methods
We performed a systematic search of electronic databases (Pubmed, CENTRAL, and Scopus) until May of 2022. Studies were considered eligible if they were RCTsevaluating factor XI inhibitors in thromboprophylaxis vs. low-molecular-weight heparins (LMWH). For analysis purposes, we considered efficacy (Venous Thromboembolism [VTE], symptomatic VTE) and safety (major and clinically relevant non-major [CRNM] bleeding events; major bleeding events; blood transfusion necessities; adverse events; major adverse events) outcomes.

Results
Overall, 4 RCTs were included, with a total of 2269 patients, 372 VTE events, and 50 major or CRNM bleeding events. Regarding efficacy outcomes, factor XI inhibitors were associated with a significant reduction in the incidence of VTE events (OR 0.50; 95%CI [0.36, 0.69]). Concerning safety outcomes, factor XI inhibitors significantly reducedmajor or CRNM bleeding events (OR 0.41 [0.22; 0.75]). It was also associated with a lower percentage of patients needing a blood transfusion, despite not meeting statistical significance (OR 0.69; 95%CI [0.32; 1.48]). Incidence of adverse events and major adverse events were similar between groups.

Conclusion
Factor XI inhibitors showed a significant reduction in the incidence of VTE and bleeding events among patients submitted to major orthopedic surgery.
Poster No. 108 Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis
Authors: Presume João , Gomes Daniel , Ferreira Jorge , Albuquerque Francisco , Almeida Manuel Sousa , Uva Miguel Sousa , Aguiar Carlos , Mendes Miguel 
Published: October 2022

Abstract
Double antiplatelet therapy (DAPT) with both aspirin and P2Y12 inhibitors in patients with STEMI has been shown to be associated with better clinical outcomes. Yet, there is uncertainty regarding the optimal timing for its initiation. This study is a systematic review and meta-analysis of the current evidence on pretreatment with P2Y12 inhibitors in patients with STEMI submitted to primary percutaneous coronary intervention (PCI).
We performed a systematic search of electronic databases Pubmed, CENTRAL and Scopus until April/22. Studies were considered eligible if they were comparing P2Y12 inhibitor upstream administration vs. downstream use in patients with STEMI submitted to PCI. Studies with patients treated with fibrinolysis or medical therapy only were excluded. Outcomes were assessed at the shortest follow-up available.
Out of 2336 articles, 18 studies were included (3 RCT and 17 non-RCT), with a total of 79300 patients (52439 in the pretreatment arm). Pretreatment was associated with a reduction in definite stent thrombosis (OR 0.59 [0.37–0.94]), all-cause death (OR 0.77 [0.60–0.97]) and cardiogenic shock (OR 0.60 [0.48–0.75]). It was also associated with lower incidence of TIMI flow &lt; 3 pre-PCI (OR 0.78 [0.67–0.92]). However, it was not associated with a significant reduction in recurrent MI (OR 0.93 [0.57–1.52]). Regarding safety outcomes, pretreatment was not associated with higher risk of major bleeding events (OR 0.83 [0.75–0.92]).
Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with better pre-PCI coronary perfusion, lower risk for definite stent thrombosis, cardiogenic shock, and all-cause mortality. No sign of potential harm from this approach was encountered.
Poster No. 111 Therapeutic Options and Outcomes in Mid Aortic Syndrome A systematic review and meta-analysis
Authors: Van Kimmenade Roland R J , Cortenbach Kimberley , Yosofi Bahram , Rodwell Laura , Meek Jelena , Patel Ritesh , Prakash Siddharth , Riksen Niels , Jenniskens Sjoerd , Dirven Mark , de Ruiten Marco 
Published: October 2022

Abstract

Objective
Mid-Aortic Syndrome (MAS) is narrowing of the distal thoracic and/or abdominal aorta with congenital, inflammatory or idiopathic aetiology. If untreated, prognosis is poor due to hypertensive complications yet follow-up data are sparse. The aim of this study was to investigate hypertension during follow-up after medical, endovascular, and surgical therapy.

Design and methods
A meta-analysis of case series and reports, focusing on the incidence of hypertension during the follow-up of juvenile (0–17 years) and adult MAS patients after medical, endovascular or surgical therapy. Search queries were performed in PubMed, Embase, and Web of Science; eligible articles underwent quality control. Descriptive statistics were reported based on available data, individual patient data meta-analyses were performed using a one-stage approach, accounting for clustering by case series or decades of reporting for case reports. For the meta-analysis, missing outcome and aetiology data were multiply imputed.

Results
The number of juveniles and adults who underwent endovascular therapy (33.7% versus 27.3%; P = .42) and surgery (52.2% versus 58.0%; P = .46) was similar. At baseline, 92.4% of juveniles and 87.5% of adults were hypertensive, decreasing to 23.2% and 24.1% during a follow-up of 23 (juveniles) and 18 (adults) months. In juveniles, after endovascular therapy more hypertension was found compared to surgery (38.1% versus 10.8%; P = .020). Meta-analysis demonstrated a trend for hypertension after endovascular therapy in juveniles, whereas hypertension was more prevalent following surgery in adults compared to endovascular therapy or medication.

Conclusions
Complications and hypertension in MAS during follow-up were more common in juveniles after endovascular treatment, whereas surgery in adults was associated with more hypertension.
Poster No. 113 Case report: the challenges in diagnosing congenital double-chambered left ventricle in adults
Authors: Lu Mengfei , Appiah Joseph , Lim-Cooke Mae-Sing 
Published: October 2022

Abstract

Background
Double-chambered left ventricle is a congenital condition that rarely presents in adulthood. This case report illustrates the common cardiac imaging modalities and presents the diagnostic challenges.

Material and method
Clinical history and cardiac imaging was obtained using electronic systems and E-letters. Literature search was performed using PubMed with keywords including double-chambered ventricle and congenital heart disease.

Discussion
A 76-year-old female presented with breathlessness, her transthoracic echocardiogram (TTE) showed severely impaired bi-ventricular function. An incidental echogenic structure was identified and treated initially as a left ventricular (LV) thrombus. Follow-up cardiac magnetic resonance (CMR) with perfusion confirmed the LV apical mass, but thought was more in keeping with a tumour. Further investigations with a gated cardiac Computerised Tomography (CT) and a review of the original CMR demonstrated appearances that were consistent with a developmental congenital double-chambered left ventricle rather than a false aneurysm or thrombus. This was confirmed on repeat CMR and with enhancement and transoesophageal echocardiogram (TOE) on 3D reconstruction. A discussion between Cardiologist and Cardiac Surgeons concluded that she is unlikely to benefit from any surgical intervention. The patient has since had significant improvement in LV function with medical therapy.

Conclusions
This report highlights an interesting case where congenital double-chambered left ventricle can act as a mimic for left ventricular thrombus or tumour. Current cardiac imaging modalities can be used in combination to achieve the diagnosis. It also demonstrates that pharmacological therapy alone is an adequate treatment to manage the symptoms of severely impaired bi-ventricular function in these patients.
Poster No. 117 rs12526196 polymorphism in CCN2 gene is an independent risk factor for ascending thoracic aortic aneurysm
Authors: Rodríguez Isabel , Tejera-Muñoz Antonio , Del Río-García Álvaro , Mohamedi Yamina , Fernández María Martín , Chiminazzo Valentina , Suárez-Álvarez Beatriz , López-Larrea Carlos , Ruiz-Ortega Marta , Rodrigues-Díez Raúl 
Published: October 2022

Abstract

Background
The Cellular Communication Network Factor-2 (CCN2/CTGF) has been traditionally described as a downstream mediator of other profibrotic factors including transforming growth factor (TGF)-ß and Angiotensin II. However, recent evidence from our group demonstrated the direct role of CCN2 in maintaining aortic wall homeostasis and, in addition, the development of acute and lethal aortic aneurysm induced by Angiotensin II in absence of CCN2 in mice. In order to translate these findings to humans, we evaluated the potential association between three polymorphisms in the CCN2 gene and the presence of thoracic aortic aneurysm (TAA).

Material and methods
69 patients with TAA and 297 controls were genotyped for rs6918698, rs9402373 and rs12526196 polymorphisms related to CCN2 gene.Multivariable logistic regression models were performed.

Results and conclusions
While no associations were found between rs6918698 and rs9402373 with TAA development, patients carrying the C allele from rs12526196 polymorphism have a higher probability of suffering TAA compared to patients with TT genotype, independently of other risk factors such as sex, age, hypertension, type of valvulopathy and presence of bicuspid aortic valve (OR = 3.17; 95% CI = 1.30–7.88;P = 0.011). This study extrapolates to humans the relevance of CCN2 in aortic aneurysm observed in mice and postulate, for the first time, a protective role to CCN2 in aortic aneurysm pathology. Our results encourage future research to explore new variants, polymorphisms or mutations, in the CCN2 gene that could be predisposing to TAA development.

Funding
Research funded by ISCIII (PI20/000140, PI18/00694, PI19/00184, PI20/00639); RICORS2040-KIDNEY-DISEASE (RD21/0005/0002, RD21/0005/0017); Sara-Borrell-CD20/00042; Miguel-Servet-CP18/00106; Sociedad Española de Nefrología.
Poster No. 118 TheIL6rs1800795polymorphism is associated with ascending thoracic aortic dilatation in bicuspid aortic valve patients
Authors: Rodríguez Isabel , Junco-Vicente Alejandro , Rolle-Sóñora Valeria , Del Río-García Álvaro , Solache-Berrocal Guillermo , Morís César , Fernández María Martín 
Published: October 2022

Abstract

Antecedentes
Los pacientes con válvula aórtica bicúspide (BAV), en comparación con las personas con válvula aórtica tricúspide normal, tienen un mayor riesgo de desarrollar dilatación de la aorta ascendente (DAA). La disfunción valvular significativa no explica una complicación aórtica desafortunada y, por lo tanto, los mecanismos moleculares involucrados se encuentran bajo investigación. Uno de los procesos involucrados es la inflamación y las citocinas como la interleucina-6 están asociados con las dimensiones aórticas y con la degeneración de la matriz extracelular aórtica en modelos animales. . Por este motivo, nos propusimos analizar un polimorfismo del gen de la interleucina-6 (IL6), que regula positivamente la transcripción y traducción del gen, en pacientes con VAB.

Material y métodos
Presentamos una serie de 119 pacientes con VAB genotipados para el polimorfismo rs1800795 en la región promotora del gen IL6 . Se realizaron modelos de regresión logística multivariable.

Resultados y conclusiones
Nuestros pacientes, todos con VAB, tenían una mediana de edad de 55 años, 76,5% hombres, 29,4% fumadores, 30% dislipidémicos, 35,3% hipertensos, 12,6% diabéticos y 44% con DAA de 39 a 49 mm. Homocigotos El genotipo para el alelo C del polimorfismo IL6 fue significativamente menos frecuente en pacientes con dilatación (OR = 0,32, IC del 95% = 0,11–0,96, P = 0,035). Tras ajustar por variables de confusión como sexo, edad, hipertensión arterial y valvulopatía, los pacientes portadores del genotipo CC seguían teniendo menor probabilidad de padecer DAA (OR = 0,25; IC95% = 0,07–0,76; P = 0,02).
La identificación de individuos con predisposición genética para el desarrollo de DAA es fundamental en beneficio de un seguimiento médico más estrecho. Son necesarios más estudios para evaluar su uso en la aortopatía bicúspide.
Investigación financiada por la Sociedad Española de Cardiología; ISCIII-PI1800694; Fundación-Asturcor;Programa Severo-Ochoa.
Clinical Case 03—Coronary subclavian steal syndrome: an unusual cause of acute myocardial infarction
Authors: Pinho Ana Isabel , de Carvalho Miguel Martins , Oliveira Cátia , Santos Luís Daniel , Proença Tânia , Pinto Ricardo Alves , Amador Ana Filipa , da Costa Catarina Martins , Calvão João , Cabrita André , Marques Catarina , Nóbrega Leandro , Dias Lara , Pinto Roberto , Rodrigues Rui André , Macedo Filipe 
Published: October 2022

Abstract
A 69-year-old male presented with typical angina while showering. He had history of CABG in 2008 (left internal mammary arterial [LIMA] to the first marginal and intermediate arteries and RIMA to the LAD artery), with preserved biventricular systolic function. On physical examination, an upper-arm systolic blood pressure differential &gt;20mmHg and a decreased pulse amplitude on the left side was found. ECG revealed sinus tachycardia with RBBB, ST-segment depression and inverted T-waves in the lateral and inferior leads. Troponin and BNP levels were elevated. Echocardiogram showed reduced left ventricular ejection fraction (22%) and de novo akinesia of the inferior and posterior walls. The diagnosis of non-ST-segment elevation myocardial infarction was assumed. Coronary angiography revealed patent bypass grafts without disease and a 90% stenosis of the left subclavian artery (LSA) proximal to the ostia of the LIMA, with retrograde flow ‘stealing’ the myocardial blood supply. Ultrasound scan detected systolic reversal of flow in the left vertebral artery, suggesting subclavian-vertebral steal phenomenon. CT-angiography revealed a 14-mm stenosis with a useful lumen of 2 mm in the LSA. A percutaneous balloon angioplasty with stenting of the LSA was performed by the Vascular team, restoring the normal blood supply. Coronary subclavian steal syndrome can manifest as myocardial infarction or heart failure, due to functional LIMA graft failure by inadequate blood supply to the myocardium. Anamnesis and physical examination are fundamental in order not to miss the diagnosis. Subclavian angiography is the gold standard to confirm the diagnosis and can be performed during coronary angiography. Revascularization of the LSA is the definitive treatment. Figure 1Coronary angiography revealed chronic occluded native coronary vessels with patency and no significant disease of the bypass grafts, and high grade (90%) left subclavian artery (LSA) stenosis proximal to the ostia of the LIMA, conditioning the blood flow to the left upper limb and ‘stealing’ the myocardial blood supply because of retrograde flow in the LIMA graft.
Clinical Case 08—A challenging clinical case: acute limb ischemia as a presentation of a left ventricular thrombus in a patient with heart failure with reduced ejection fraction
Authors: Paz Driotes Daniel Eduardo , Leiva Veronica Vanesa Gomez 
Published: October 2022

Abstract
A 57-year-old male with arterial hypertension, diabetes mellitus, ischemic heart disease and coronary bypass in 2018, was admitted to the hospital with a 1-day evolution of sudden pain of strong intensity in the lower right limb. On physical examination, lower right limb showed erythrocyanosis, multiple distal ulcers, absence of hair, distal coldness up to the level of the knee, capillary refill &gt;5 seconds, with absence of pedal and popliteal pulses. Arterial echo-Doppler of the lower right limb was performed, which reported common femoral and superficial femoral arterial insufficiency, with no flow in the distal third of the femoral, popliteal, tibial, and peroneal arteries. AngioCT of the lower limbs reported bilateral chronic arterial insufficiency with no flow from the superficial femoral artery to the popliteal and anterior tibial arteries of the right leg. A transthoracic echocardiogram was performed, which reported dilated heart disease with a left ventricular ejection fraction of 16% and an apical thrombus in the left ventricle of approximately 1.2 cm × 4.1 cm. Anticoagulation with unfractionated heparin was started, and thrombectomy of the lower right limb was evaluated, with a high probability of amputation due to irreversibility of ischemia. However, due to a high probability of surgical complications, conservative management was decided. Due to Virchow’s triad, patients with ischemic heart disease and heart failure with reduced ejection fraction are at high risk of intraventricular thrombi and subsequent embolization; therefore, the use of prophylactic anticoagulation should be considered to prevent this type of complication despite the evidence is controversial. Figure 1A. 3D reconstruction of AngioCT of the lower limbs, arterial phase, red arrow indicates occluded flow in the form of a pencil point in the proximal third of the right superficial femoral artery, suggesting arterial thombosis. B and C. 4C EchoTT with an image of a large, consolidated thrombus with well-defined edges in the apex attached to the wall running over the interventricular septum (green arrow).
Clinical Case 11—Acute multivessel coronary artery thrombi: an unusual presentation of STEMI and management dilemma in a young patient with COVID-19
Authors: Higgisson Emma , Vaughan Carl 
Published: October 2022

Abstract
Mr DC is a fit and healthy 32-year-old gentleman who presented on day 13 of his mild COVID-19 illness with sudden onset central chest discomfort, diaphoresis and vomiting following exercise. He had no past medical history, no significant cardiovascular risk factors and a normal physical exam. ECG showed ST elevation in anterior and inferior leads.
Mr DC underwent coronary angiogram which revealed a large semi-occlusive thrombus in the proximal LAD and moderate thrombus in the proximal RCA. There was no significant stenosis or plaque in any vessel. The diagnosis was therefore STEMI secondary to multivessel proximal coronary artery thrombi. We hypothesise that the patient's concurrent COVID-19 infection, hypercoagulable state post exercise and possible plaque rupture led to the development of these thrombi.
This is a very unusual case and presented a management dilemma. We decided to manage him conservatively with therapeutic heparin, dual antiplatelet therapy, bisoprolol and high dose statin therapy.
Following one week of conservative management, we performed a repeat coronary angiogram which showed complete resolution of all intracoronary thrombi and yielded an excellent angiographic result.
The patient was discharged to complete 1 year of dual antiplatelet therapy and has done very well.
Learning points include: risk factors and management options for coronary artery thrombosis, successful conservative management strategy, interval of repeat diagnostic imaging, coronary artery thrombosis associated with COVID-19 infection, the potential for mild clinical COVID-19 illness but significant cardiovascular complications, more research needed on anticoagulation and antiplatelet treatment of ACS in the context of COVID-19.