Steelepruitt0019

Despite the overall neutral results of the GLOBAL-LEADERS trial, results from a prespecified subgroup analysis showed that patients from Western Europe had a significantly lower rate of the primary endpoint when treated with ticagrelor monotherapy. Therefore, we aimed to examine the regional disparities in patients' baseline characteristics and their response to ticagrelor monotherapy.

Patients' baseline characteristics and the treatment effects of ticagrelor combined with aspirin for 1month, followed by ticagrelor monotherapy for 23-months versus 12-months of standard dual antiplatelet therapy (DAPT) were compared according to participating countries. The primary endpoint was a composite endpoint of all-cause death or new Q-wave myocardial infarction at two years.

Significant variances in patients' baseline characteristics were found between participating countries. The primary endpoint varied significantly according to the country (P

=0.027). Patients from France (1.6% versus 5.2%, HR 0.31, 95%CI 0.13-0.73) and The Netherlands (2.4% versus 4.8%, HR, 0.50, 95%CI 0.26-0.94) had lower rates of the primary endpoint when allocated to ticagrelor monotherapy, compared with the standard DAPT regimen. Of the 26 baseline and post-randomization factors explored, variance in the rate of complex PCI between countries was identified as the top contributor to this regional interaction.

Patients' baseline characteristics varied between participating countries in the GLOBAL-LEADERS trial. There is a significant regional variance in the treatment effect of ticagrelor monotherapy, which could partly be explained by the differences in complex PCI being performed.

ClinicalTrials.gov (NCT01813435).

ClinicalTrials.gov (NCT01813435).

Accurate non-invasive estimation of right atrial pressure (RAP) is essential to assess volume status and optimize therapy in heart failure (HF). This study aimed to evaluate the utility of right atrial reservoir strain (RASr) assessed by speckle-tracking echocardiography to identify elevated RAP in HF and compare diagnostic performance with estimated RAP employing inferior vena cava size and collapsibility (RAP

), in addition to RA area.

Association between RASr and invasive RAP (RAP

) was examined in 103 HF subjects that underwent standard echocardiography with speckle-tracking strain analysis directly followed by right heart catheterization. The discriminatory ability of RASr to identify RAP

>7mmHg was evaluated and compared with RAP

and RA area.

RASr demonstrated association with RAP

(β=-0.41, p<0.001) and was an independent predictor when adjusted for potential confounders (β=-0.25, p<0.001). Further, RASr showcased strong discriminatory ability to identify subjects with RAP

>7mmHg (AUC=0.78; 95% CI 0.68-0.87; p<0.001). At a cut-off value of -15%, RASr displayed 78% sensitivity and 72% specificity to identify elevated RAP

In comparison, RAP

(AUC=0.71; 95% CI 0.61-0.81; p<0.001) demonstrated 89% sensitivity and 32% specificity with high false positive rate. RA area (AUC=0.66; 95% CI 0.55-0.76, p=0.005) displayed 64% sensitivity and 53% specificity.

RASr demonstrates good ability to identify elevated RAP and relatively stronger diagnostic performance when compared with conventional non-invasive measures. RASr may be useful as a novel noninvasive estimate of RAP in HF management.

RASr demonstrates good ability to identify elevated RAP and relatively stronger diagnostic performance when compared with conventional non-invasive measures. RASr may be useful as a novel noninvasive estimate of RAP in HF management.

Long-term outcomes of cardiac implantable electronic devices (CIEDs) are ill-defined in adult congenital heart disease (ACHD).

To assess outcomes of transvenous (TV) and epicardial (EPI) CIEDs in ACHD.

A retrospective review of CIEDs implanted in patients >18yrs. followed at the Ahmanson/UCLA ACHD Center was performed. Patients were grouped by implant approach. Primary outcomes included time to CIED dysfunction, lead dysfunction and unplanned CIED reintervention.

Over a 27-year period, 283 CIEDs (208 TV, 75 EPI) were implanted in 260 ACHD patients. Dysfunction developed in 77 CIEDs (50 TV, 27 EPI) for which 62 underwent unplanned reintervention (47 TV, 15 EPI). Time to CIED dysfunction and unplanned reintervention did not differ by implant approach; however lead dysfunction was greater for EPI vs TV (HR 2.0, 95% CI 1.2-3.2, p=0.01). Independent predictors of lead failure included cyanosis (HR 2.6, 95% CI 1.1-6.3; p=0.03), implant indication other than bradycardia (HR 3.3, 95% CI 1.6-6.5; p<0.01), right-sided Maze operation (HR 2.5, 95% CI 1.3-5.0; p=0.01), and unipolar lead design (HR 4.5, 95% CI 1.8-11.5; p<0.01). Importantly, EPI vs TV approach was not associated with lead dysfunction after adjusting for baseline covariates (HR 0.6, 95% CI 0.6-4.3; p=0.3).

Overall CIED system dysfunction and reinterventions are similar, whereas lead dysfunction is greater among EPI than TV devices. R428 Patient and procedural differences, rather than EPI vs TV implant approach alone, appear to drive CIED lead outcomes in the ACHD population.

Overall CIED system dysfunction and reinterventions are similar, whereas lead dysfunction is greater among EPI than TV devices. Patient and procedural differences, rather than EPI vs TV implant approach alone, appear to drive CIED lead outcomes in the ACHD population.

Left bundle branch block (LBBB) is usually associated with structural myocardial diseases progressively leading to left ventricular (LV) dysfunction. We sought to determine the mechanical implications of LBBB (as defined based on Strauss' criteria) by Cardiovascular Magnetic Resonance (CMR).

We included consecutive patients referred to CMR to assess the structural cause of LBBB. CMR scans consisted of cine, stress perfusion, and late gadolinium enhancement (LGE) sequences. Myocardial deformation was assessed by tissue tracking analysis; LGE was quantified using the full width at half maximum method. We included 86 patients [63% male, 70years (60-72)] with mean QRS duration 150±13msec. A structural disease was identified on CMR in 53% of patients (ischemic heart disease, IHD, 31%; non-ischemic heart disease, NIHD, 22%), while LBBB-related septal dyssynchrony (SD) was the only abnormality in 47%. LGE was found in 42% of patients. LVEF and myocardial deformation were impaired. Despite similar ECG characteristics, myocardial strain differed significantly between IHD, NIHD and SD patients, and patients with SD showed less impaired myocardial deformation.