bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster No. 017 Cardioembolic Stroke at Prosthetic valve endocarditis
Authors: Hoxha Eneida , Rista Elvana , Kuka Somida , Collaku Ledio , Musabelliu Jona , Djamandi Jorida , Gjata Margarita 
Published: October 2022

Abstract

Background
Embolic events are frequent and life-threatening complications of infective endocarditis (IE), related to the migration of cardiac vegetations. Risk of embolism is very high in IE, with embolic events occurring in 20–50% of patients. The brain and spleen are the most common sites of embolism in left-sided IE. Stroke is a severe complication and is associated with increased morbidity and mortality rates.

Case presentation
A 73-year-old male presented to the Emergency Department, in May 2022 with right hemiparesis, aphasia and fever (38°C). He reported of a two day history of recurrent fever. His pre-existing comorbities included Diabetes Mellitus, Arterial Hypertension, and Atrial Fibrillation on anticoagulation therapy with Acenocoumarole and INR levels within normal range. His past medical history was significant for an Aortic Valve Replacement, in September 2021 and a subsequent hospitalization in January 2022 with Prosthetic Valve Endocarditis. At the time, he presented with recurrent fever up to 38.8°C, no significant findings in the transthoracic echocardiogram (TTE) and positive blood cultures for Enterococcus faecalis. He was started on antibiotic therapy.
Laboratory and imaging studies in his latest admission revealed a cardioembolic stroke.

Conclusion
Infective endocarditis can present with a wide variety of symptoms and early diagnosis can be challenging. Establishing the diagnosis early in the course of the disease, would enable a prompt implementation of empiric antibiotic therapy, potentially preventing serious complications. Keeping a high index of suspicion when evaluating patients at high risk for IE, might lead to more favorable outcomes of major complications associated with it.
Oral Presentation No. 019 Bi-directional cross talk between coagulation, fibrinolysis and inflammatory pathways in patients with ST-segment elevation myocardial infarction
Authors: Kanji Rahim , Gue Ying X , Farag Mohammed F , Mutch Nicola J , Gorog Diana A 
Published: October 2022

Abstract

Background
Impaired endogenous fibrinolysis is a risk factor for recurrent cardiovascular events in patients with acute coronary syndrome (ACS). Ongoing inflammation is also an adverse prognostic risk factor. While inflammatory markers are elevated in patients presenting with ST-segment elevation myocardial infarction (STEMI), whether there is a direct relationship between markers of inflammation at presentation, and the effectiveness of endogenous fibrinolysis in this setting, is unclear.
Our study aimed to assess the relationship between markers of inflammation, coagulation and fibrinolysis, in patients with STEMI.

Material and methods
We conducted a prospective, observational study in consecutive patients presenting with STEMI. Blood was drawn on admission after dual antiplatelet therapy loading, but before administration of anticoagulants. The sample was immediately tested to assess endogenous fibrinolysis using the point-of-care Global Thrombosis Test. In addition, blood samples were tested for leucocyte and neutrophil count, neutrophil-to-leucocyte ratio (NLR), platelet-to-leucocyte ratio (PLR), fibrinogen, standard coagulation markers and high sensitivity C-reactive protein (hs-CRP).

Results and conclusions
The cohort consisted of 129 patients (aged 66 ± 13 years, 78% male). Whole blood endogenous fibrinolysis time correlated with fibrinogen (r = 0.300, P = 0.001) and hs-CRP (r = 0.236, P = 0.011). Hs-CRP correlated with fibrinogen (r = 0.631, P &lt; 0.001). There was no relationship between whole blood lysis time and leucocyte count, NLR, PLR, international normalised ratio or activated partial thromboplastin time.
The effectiveness of endogenous fibrinolysis in whole blood is related to fibrinogen and hs-CRP levels. Our findings strengthen the evidence for bi-directional cross talk between coagulation, fibrinolysis and inflammatory pathways, providing mechanistic insights that could help guide pharmacological strategies to treat hypofibrinolysis.
Poster No. 020 Increasing transvalvular gradient related to effectiveness of endogenous fibrinolysis in patients with severe aortic stenosis
Authors: Kanji Rahim , Panoulas Vasileios F , Duncan Alison , Davies Simon W , Luscher Thomas F , Mirsadraee Saeed S , Arachchillage Deepa R J , Gorog Diana A 
Published: October 2022

Abstract

Background
Patients with severe aortic stenosis (AS) are at risk of both bleeding and thrombotic events. The high shear and flow rates across the stenotic aortic valve (AV) degrade von Willebrand factor high molecular weight multimers increasing bleeding risk, but can also lead to platelet activation. The overall effect on thrombotic and endogenous fibrinolytic status remains unclear. We aimed to assess the relationship between AS severity and thrombotic and fibrinolytic profile.

Materials and methods
In a prospective, observational study, thrombotic and thrombolytic status was assessed in venous blood taken from patients with severe AS using the Global Thrombosis Test. This point-of-care technique measures the time for occlusive thrombus formation under high shear (OT), and the time for spontaneous lysis of the thrombus (LT). We related these parameters to indices of AS severity.

Results and conclusions
Our cohort comprised of 86 patients (age 79 ± 9 years, 58% male), of whom 25% were on single and 28% on dual antiplatelet medication, 47% on no antithrombotic therapy, and 1% on oral anticoagulation.
Lysis time was inversely related to AV peak (r = −0.242, P = 0.04) and mean (r = −0.286, P = 0.012) gradients. The severity of AS, by gradient or valve area, was not related to OT, although OT was inversely related to platelet count (r = −0.248, P = 0.029). Heterogeneity in antithrombotic medications may have masked a relationship between AS severity and OT.
We report that increasing severity of AS is related to more effective endogenous fibrinolysis, which may contribute to the increased propensity to bleeding.
Poster No. 025 Survival in octogenarians receiving implantable cardiac defibrillators: a single centre experience
Authors: Paray Nitish Behary , Spinthakis Nikolaos , Jeelani Mohammad Saddam , Kuriakose Jebby 
Published: October 2022

Abstract
Although the efficacy of implantable cardiac defibrillator (ICD) in preventing sudden cardiac death is well established in studies, patients ≥ 80 years are poorly represented, causing a paucity of data on outcomes in this subgroup.
In our single-centre retrospective study, data pertaining to patients &gt; or = 80 years of age at device implant (n = 95) between January 2010 and January 2022 was extracted from device databases and clinical notes. Categorical variables were compared using Fisher's exact test. A Kaplan-Meier survival analysis with logrank test was performed. A Multivariable Cox Hazard regression model was used to analyse survival adjusting for QRS duration, left ventricular ejection fraction and device type.
Mean age of the cohort was 83.1 ± 3 years, with 85% (n = 81) being male. 73% (n = 69) of the population had ischaemic cardiomyopathy and 43% (n = 41) met the primary prevention indications. Median survival time post device implantation was 27 months. Survival at 5 years was 80%. The difference in survival rates between primary and secondary prevention groups was not statistically significant. Inappropriate shocks were delivered in 2 patients while 14 patients were successfully treated with appropriate therapy. Complications were encountered in 9% (n = 9) of cases, with a fatal outcome on one occasion.
ICD therapy is a well-tolerated intervention and may confer survival benefits in elderly patients, provided careful selection criteria are implemented. Advanced chronological age alone should not unduly influence the decision for ICD selection for survival benefit. There is an imperative for greater representation of this cohort in future trials.
Poster No. 026 Prognostic value of cardiac biomarkers in acute pulmonary embolism: can it add something?
Authors: Duarte Fabiana , Inês Barradas M , Oliveira Luís , Dos Santos Inês Coutinho , Machado Carina , Dourado Raquel , Tavares Anabela , Martins Dinis 
Published: October 2022

Abstract

Background
Acute pulmonary thromboembolism (PE) is a life-threatening disease. Cardiac biomarkers like lactate, NT-proBNP and troponin I have been reported to predict prognosis of acute PE however, the prognostic importance of these factors on long-term mortality is not known.

Objectives
To assess the prognostic role of biomarkers lactate, NT-proBNP and troponin I in acute PE.
Methods: We retrospectively assessed 131 consecutive patients diagnosed with acute PE. Prognostic impact of both lactate, NT-proBNP and troponin was assessed.

Results
Out of 131 patients with acute PE, the median age was 67.6 ± 15.3 years and 71.0% were female. Mean follow-up was 44.8 ± 37.3 months. Overall in-hospital mortality was 8.4%, 30-day mortality 13.0% and 1-year mortality 20.6%.
Twenty-six patients (19.8%) had a recent hospitalization and 21 (16.0%) a medical history of active cancer.
ROC curves shown that lactate has a good discriminatory power for in-hospital mortality, with an area under the curve (AUC) of 0.84 and p-value 0.001, unlike NT-proBNP (AUC 9.45, p-value 0.76) and troponin (AUC 0.64, p-value 0.12). Serum lactate equal or superior to 2.05 mmol/L were associated with higher in-hospital mortality (odds ratio [OR] 23.1, 95% confidence interval (CI) 2.8–187.7), when compared with lower levels. The impact of this parameter was independent of hypotension, tachycardia or active neoplasia (p-value 0.006, OR 21.3, 95% CI 2.4–187.3).

Conclusions
This study revealed that lactate has a better discriminatory power when compared to NT-proBNP and troponin in predicting prognosis in acute PE patients. Its routinely addition to current stratification tools could be of interest.
Poster No. 044 Cardiovascular risk factors and coronary heart disease in the young – a single centre analysis
Authors: Gonçalves Carolina Miguel , Cabral Margarida , Carvalho Mariana , Vazão Adriana , Fernandes Sara , Carvalho Rita , Saraiva Fátima , Morais João 
Published: October 2022

Abstract

Background
Cardiovascular events in the young appear to be increasing. Conversely, this is not the tendency reported in older adults. Identifying risk factors is of the uttermost importance to improve cardiovascular prevention.

Material and methods
Retrospective, single-centre analysis of patients with less than 45 years and suspected coronary heart disease who were subjected to cardiac catheterization in our centre during a 5-year period.

Results and conclusions
A total of 171 patients were included with a median age of 42 ± 6 years of which 82% were male. Overweight (73%), smoking (61%) and dyslipidemia (42%) were the most prevalent cardiovascular risk factors. Coronary heart disease was diagnosed in 67% of patients. After univariate analysis, gender (P = 0.049), age (P = 0.005), smoking (P = 0.032), low-density lipoprotein cholesterol (P = 0.005) and total cholesterol (P = 0.003) were significantly associated with disease in coronary angiography. After multivariate logistic regression, only age (OR = 1.123; CI 95% [1.036–1.217]; P &lt; 0.005) and low-density lipoprotein cholesterol (OR = 1.016; CI 95% [1.004–1.028]; P = 0.009) remained as independent factors of coronary heart disease.
It is known that awareness regarding a healthy lifestyle should be raised in the general population. As several modifiable risk factors have an impact on cardiovascular disease, there is an urgent need to improve primary prevention. Conversely, a more thorough investigation is needed in the cases where no significant coronary disease is found.
According to our analysis, age and low-density lipoprotein cholesterol appear to have a stronger relevance in this young population.
Poster No. 052 The Influence of the CYP2C9 polymorphisms on the treatment with clopidogrel: combined data from the POPular Genetics & POPular AGE trials
Authors: Van Den Broek W W A , Mani N , Azzahhafi J , Berg J Ten 
Published: October 2022

Abstract

Background
The CYP2C9-enzym plays a role in the metabolization of clopidogrel. In patients treated with clopidogrel, carriage of a CYP2C9 loss-of-function (LoF) allele has been associated with attenuated pharmacokinetics leading to a diminished pharmacodynamic response and increased risk for stent thrombosis.

Material and methods
We aimed to determine the effect of the CYP2C9*2 and *3 LoF-alleles on thrombotic events and clopidogrel treatment discontinuation. A post-hoc analysis was performed in patients with available CYP2C9 genotype status included in the POPular Genetics and POPular Age trials, which enrolled patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, respectively. The primary thrombotic outcome was a composite of cardiovascular death, myocardial infarction or stroke.

Results
The CYP2C9 genotype was available in 2,257 patients, of which 878 were treated with clopidogrel (352 [40%] CYP2C9 LoF-allele carriers and 526 [60%] CYP2C9 LoF-allele noncarriers). There were no significant differences between CYP2C9 LoF-allele carriers and noncarriers for the combined thrombotic outcome (6.3% vs. 5.9%, HR 1.17 [0.67–2.03], P = 0.58), and the individual thrombotic outcomes. No differences were seen in clinically relevant bleeding (Bleeding Academic Research Consortium [BARC] 2–5 bleeding) as well as major bleeding (BARC 3 or 5 bleeding). Discontinuation rates for clopidogrel due to side-effects were numerically lower in CYP2C9 LoF carriers compared noncarriers (1.4% vs. 3.2%, HR 0.54 [0.26–1.13], P = 0.10), however this difference was not statistically significant.

Conclusions
Carriage of the CYP2C9 *2 or *3 LoF-alleles did not show an association with an increased thrombotic risk in patients treated with clopidogrel.

Funding
ZonMW.
Poster No. 071 Application of artificial intelligence in coronary CT angiography:a potential gatekeeper strategy?
Authors: Viegas José Miguel , Reis João Ferreira , Teixeira Rita , Jacinto Sofia , Mendonça Tiago , Ramos Ruben , Marques Hugo , Figueiredo Luísa , Earls James , Ferreira Rui Cruz 
Published: October 2022

Abstract

Introduction
Medical artificial intelligence (AI) is rapidly developing and moving from the research field to daily clinical practice. AI algorithms have demonstrated high performance and computational efficiency, reducing the degree of manual input and processing time.

Objectives
This study aimed to determine the impact of an AI-enabled coronary computed tomography angiography (CCTA) analysis for comprehensive evaluation in patients (P) with suspected coronary artery disease (CAD).

Methods
We analysed 100 CCTA exams from a cohort of symptomatic P with mild-to-moderately abnormal non-invasive ischemia test. Stenosis severity was assessed by level III experts (manual evaluation, MEv). A novel AI-based software tool (automatic evaluation, AEv) was also used to quantify coronary stenosis and characterize plaque phenotype. In P later referred for invasive coronary angiography (ICA), diagnostic and revascularization yields of MEv and AEv were compared.

Results
100P, 52% male, mean age 68 ± 10 years, one-third had typical angina. Prevalence of obstructive CAD determined by MEv and AEv was 25% and 21%, respectively, with a significant association between both assessments (P &lt; 0.001).
Based upon MEv, referring physician decided to proceed to ICA in 22P (21P with significant stenosis). For those undergoing ICA,13P also had obstructive CAD established by AEv. Diagnostic yields for MEv and AEv-guided ICA was 82% and 60%, and revascularization yields 73% and 60%, respectively.
AEv atherosclerosis quantification revealed significant differences between P who did not undergo ICA, P referred for ICA without significant stenosis and P with obstructive CAD on ICA: total (126 vs. 312 vs. 518 mm3, P &lt; 0.001), calcified (23 vs. 197 vs. 222 mm3, P &lt; 0.001), non-calcified (71 vs. 112 vs. 252 mm3, P &lt; 0.001) and low-density plaque volume (1.1 vs. 3.0 vs. 4.4 mm3, P = 0.042).

Conclusion
A diagnostic strategy using AI-based analysis of coronary stenosis severity on CCTA had a similar performance compared to MEv. In addition, risk prediction can be enhanced by AI assessment of plaque composition. This study is an example of the potential role of AI in the CCTA workflow.
Poster No. 072 The profile of rhythm disorders in women with ischemic heart disease in a Romanian hospital
Authors: Andrada Irimie Diana , Dumitru Zdrenghea , Florina Fringu , Ioachim Popescu Mircea , Dana Pop 
Published: October 2022

Abstract

Background
In Europe, the mortality secundary to ischemic heart disease is an important cause of death among women. Rhythm disorders are frequently encountered in the context of this pathology. The aim of the study is to evaluate the profile of rhythm disorders in women with microvascular and obstructive coronary heart disease.

Materials and methods
We included in the study a number of 150 patients with ischemic heart disease documented by coronary angiography, with an average age of 63.24 ± 10.09 years, admited in the Cardiology Department of the Clinical Rehabilitation Hospital, Cluj-Napoca, Romania. The diagnosis of ischemic heart disease was established according to the recommendations of the 2019 ESC guideline.

Results
66.6% of patients presented with microvascular angina, and 33.33% with obstructive coronary heart disease. Women with microvascular angina were younger (61.07 ± 9.68 vs. 67.60 ± 9.55 years). Atrial arrhythmias were the most frequent arrhythmias diagnosed - 64.66%. The percentage of rhythm disorders was similar in the two groups, without statistically significant differences: atrial fibrillation (21 vs. 22%), other supraventricular arrhythmias (39 vs. 52%), ventricular extrasystoles (42 vs. 44%), sustained/nonsustained ventricular tachycardia (4 vs. 4%). This finding shows us that not only obstructive coronary artery disease, but also microvascular angina presents an arrhythmogenic risk. At the same time, there were no significant differences regarding the administration of antiarrhythmics, namely amiodarone and betablockers in the two forms of ischemic heart disease.

Conclusions
Women with microvascular angina present significant arrhythmias, therefore they must be carefully evaluated and treated accordingly.
Oral Presentation No. 079 Quality of life in patients after pulmonary embolism. Correlation with echocardiographic and biochemical parameters
Authors: Kardakari O L , Ballas C H , Lakkas L A , Giannou S O , Stamou I L , Samara I O , Kalogeras P E , Siaravas K O , Papaioannou E F , Mpouratzis B A , Sioros S P , Lambrinou E K , Dimakopoulos G E , Konstantinidis A T H , Naka K K , Michalis L K , Katsouras C S 
Published: October 2022

Abstract

Background
Pulmonary embolism (PE) is the third most common cause of cardiovascular death worldwide, after stroke and heart attack. Our purpose was to evaluate the patient's health-related quality of life (HR-QoL) after Acute Pulmonary Embolism (APE) and its association with biochemical and novel echocardiographic parameters of assessment of right ventricle (RV).

Material and methods
Successive patients with diagnosis of APE in a tertiary hospital were included in the study. RV evaluation and biochemical markers, (including Brain Natriuretic Peptide (BNP)) were recorded during hospitalization. HR-QoL was evaluated with the Greek version of the Pulmonary Embolism Quality of Life questionnaire (PEmb-Qol), at 1 and 3 months after the APE. Repeated measures analysis was used to assess changes in the PEmb-QoL dimensions and Pearson correlations to assess the relationships between RV global longitudinal strain (RV GLS) and the dimensions of Pemb-Qol.

Results and conclusions
One hundred consecutive patients were screened; 14 patients were excluded. The study sample consisted of 86 individuals (47 women) aged 69.7 ± 13.4 (mean ± SD) years. The differences between the two time points were statistically significant (P &lt; 0.001) in all dimensions of HR-QoL. At 3 months, the dimensions of social limitations and intensity of complaints showed the highest rate of improvement. RV GLS values were correlated with quality of life in patient with APE (in 3 of the 6 dimensions of Pemb-Qol). While BNP, was related to the “intensity of complaints” dimension of Pemb-Qol,in patients with APE occurred during hospitalization for another reason (PE wasn't the cause of admission).
Oral Presentation No. 082 Pre-treatment with Dual Antiplatelet Therapy in NSTE-ACS: not always, not ever
Authors: de Almeida António Rocha 
Published: October 2022

Abstract

Background
Decision of which antithrombotic therapy strategy for non-persistent ST-segment elevation acute coronary syndromes (NSTE-ACS) remains controversial. European Cardiology Society guidelines ceased recommending pretreatment with P2Y12 receptor inhibitor in NSTE-ACS, based on Accoast Trial, which demonstrated absence of ischemic benefits and higher bleeding risk. However, sample studied didn't illustrate Portuguese reality.

Material and methods
Cohort of 2194 NSTE-ACS patients from a multicenter national registry, treated according standard of care, between 2010–2019, was compared with Accoast Trial 1996 results of patients no pretreatment sample.

Results and conclusions
There was no statistically significant difference on age, sex distribution, aspirin or antithrombin therapy. 96.5% of Portuguese sample were pretreated with dual antiplatelet therapy (DAPT). Trial's sample had median time to coronary angiography (CA) of 4.2 hours and femoral access in 57.0% and Portuguese group had a median time of 12 h-36 h till CA, and femoral access in 11.6%. Just 0.7% had urgent surgery in Portuguese sample. There was more cardiovascular caused deaths, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa bailout (9.8%) on trial sample, against only 5.0% on ours. Pretreatment group had slighter increase of TIMI major bleeding (1.8% vs. 1.4%), with median timing 3.5 days after.
Earlier CA may explain trial's absence of ischemic benefits. Later bleeding complications might be associated with DAPT strategy itself, and not with timing. Due to lack availability, surgery wasn't done before 5 days. Hence, DAPT pretreatment shouldn't be for all NSTE-ACS, nevertheless, can be valid option, according to bleeding and ischemic risk, CA timing, access, or surgery availability.