996 Intervention / Peripheral circulation
-92a, -126, -145, and miRNA-16 was used as an internal control for real-time
PCR.
Results: Patients with neointima volume greater than 30% (ISR, n=41) were com-
pared with the control (n=212). Age and sex were similar between the 2 groups.
ISR group showed significantly higher rates of diabetes when compared to the
control (39% vs. 12%, p<0.001, respectively). More patients in the ISR group
showed initial diagnosis of acute coronary syndrome compared to the control
(68% vs. 37%, p=0.016, respectively). Baseline target lesion characteristics were
similar between the 2 groups. OCT follow-up neointima volumes were 57±29%
in the ISR group and 14±11% in the control (p<0.001). Decreases from base-
line in miRNA-24 were -0.06±0.05 in the ISR group and 0.23±0.19 in the control
(p<0.001). Changes in miRNA-17, -92a, -126, and 145 during the follow-up did
not show significant differences between the 2 groups. Homogenous type of OCT
characteristics (90%, 37 patients) was the most common finding in the ISR group.
Conclusions: Decrease in circulating miRNA-24 has been associated with the
increase in neointimal hyperplasia and has been associated with increases in
fibrous homogenous type of neointimal hyperplasia during the 9 months follow-
up.
P5439 | BEDSIDE
Prognostic impact of lipid contents on the target lesion in patients
with drug eluting stent implantation
S. Kumagai 1 , T. Amano 2 , T. Uetani 3 , K. Harada 3 , H. Ishii 1 , M. Hayashi 1 ,
D. Yoshikawa 1 , H. Ando 2 , T. Matsubara 4 , T. Murohara 1 . 1 Nagoya University
Graduate School of Medicine, Department of Cardiology, Nagoya, Japan; 2 Aichi
Medical University, Nagakute-Cho, Japan; 3 Chubu Rosai Hospital, Nagoya,
Japan; 4 Aichi Gakuin University, School of Dentistry, Department of Internal
Medicine, Nagoya, Japan
Background: Regardless of the imaging modality, lipid-rich coronary plaques
have been associated with adverse prognostic factors, but there have been few
studies on the relationship between long-term adverse outcome and target lesion
morphology.
Purpose: We sought to determine the morphologic predictors of Major Adverse
Cardiac Events (MACEs) after successful Percutaneous Coronary Intervention
(PCI) with Drug Eluting Stents (DES), using Integrated Backscatter Intravascular
Ultrasound (IB-IVUS).
Methods: Conventional and IB-IVUS were performed in 260 consecutive patients
who underwent PCI with DES. Three-dimensional analyses were performed to
determine plaque volume and the volume of each plaque component (lipid, fi-
brous, and calcification). Patients were divided into 2 groups according to the
median Lipid Volume (LV) in the target lesion.
Results: MACEs were defined as death, nonfatal myocardial infarction, and any
repeat revascularization. The median follow-up interval was 1285 days. MACEs
were observed in 64 patients (24.6%). Patients having a larger LV compared
to their counterparts had worse long-term clinical outcomes regarding mortal-
ity (3.8% vs. 0%, p=0.02) and MACEs (31.5% vs. 17.7%, p=0.008) by log-rank
test. After adjustment for confounders, diabetes (Odds Ratio (OR), 1.69; 95% CI
1.01-2.82, p=0.04) was significantly and independently associated with MACEs.
In order to additional consideration about target lesion plaque morphology, large
LV (OR, 1.95; 95% CI 1.14-3.33, p=0.02) was significantly and independently as-
sociated with MACEs.
Conclusion: The assessment of coronary plaque characteristics in the target
lesion may be useful to predict long-term outcome following successful coronary
intervention.
P5440 | BEDSIDE
Does renal artery stenting impacts left ventricle mass and function,
blood pressure values, renal function and cytokine concentration?
D. Rzeznik, T. Przewlocki, A. Kablak-Ziembicka, A. Roslawiecka, A. Kozanecki,
J. Lach, P. Podolec. John Paul II Hospital, Department of Cardiac and Vascular
Diseases, Krakow, Poland
The benefit of renal angioplasty (PTA) in patients with atherosclerotic renal artery
stenosis (RAS) is controversial. The study aimed to search for associations be-
tween echocardiographic left ventricle mass (LVM), LVM index (LVMI) and dias-
tolic function (DF), cytokines level, systolic and diastolic blood pressure (SBP,
DBP) values, as well as renal function.
Methods: A 24-hour ambulatory blood pressure monitoring, echocardiographic
LVM, LVMI and DF (Tissue Doppler septal e’ wave velocity), levels of serum cre-
atinine (CR), Neutrophil Gelatinase-Associated Lipocalin (NGAL), transforming
growth factor beta 1 (TGF-β1) and BNP were assessed in 104 (49 men) subjects,
age 64±10,6y, prior to PTA of RAS >60%, then 12 months afterwards.
Results: PTA was technically successful in all patients. A significant reduc-
tion in mean SBP (135.8±19.3 vs 130.2±15; p=0.006) and DBP (76.1±11.1
vs. 73.8±9; p=0.032) was observed at 12 months. The mean LVM decreased
from 182±48g before PTA to 152.9±39g at 12-months (p<0.001). The LVMI in
women and in men decreased from 94.6±18.6g/m2 to 79.5±15g/m2 (p<0.001)
and from 104.3±22.2 to 86.2±20 g/m2 after 12-months (p<0.001). Improve-
ment in DF was seen on 12-month F-U: a septal e’ velocity increased from
5.57±1.58 to 5.94±1.8cm/s (p=0.031). The mean levels of TGF-β1, BNP, NGAL
and CR before PTA vs. at 12 months after PTA changed respectively from
19.1±32ng/mL to 15.4±15ng/mL (p=0.340), 50.4±72pg/mL to 68.1±84 pg/mL
(p=0.005), from 51.0±27ng/mL to 57.6±30ng/mL (p=0.053) and 122.0±54 to
115.0±60 (p=0.109) respectively. There was no correlation between the degree
of LVM regression and the mean SBP, DBP reduction, change of: CR, NGAL,
TGF-β1 and BNP on 12 month F-U (p=0.747, p=0.615, p=0.921, p=0.599 and
p=0.116), respectively. There was correlation between the increase in e’ veloc-
ity and DBP load change and change TGF-β1 12 month after PTA (r= -0.248,
p=0.014 and r= -0.248, p=0.027). There was correlation between the change of
CR and change with: SBP, DBP and TGF-β1 (r= 0.193, p=0.057; r=0.240, p=0.017
and r=0.342, p=0.002) respectively.
Conclusions: PTA induces regression of LVM, LVMI and decrease of SBP and
DBP. There was no correlation between the degree of LVM regression and the
mean SBP and DBP reduction. The main parameter of DF was improved after
PTA. CR, TGF-β1 levels decreased no significantly. Renal function improvement
is associated with reduction in blood pressure and decrease in marker of nefron’s
fibrosis - TGF-β1.
P5441 | BEDSIDE
The administration of a loading dose has no influence on residual
platelet reactivity during the shift from Clopidogrel to Ticagrelor
therapy in patients with ACS
G. Caiazzo 1 , S. De Rosa 1 , D. Torella 1 , S. Giampa 1 , M. Micieli 1 , E. Palella 2 ,
C. Spaccarotella 1 , A. Mongiardo 1 , E. Gulletta 2 , C. Indolfi 1 . 1 Magna Graecia
University of Catanzaro, Department of Cardiology, Catanzaro, Italy; 2 Magna
Graecia University of Catanzaro, Department of Health Sciences, Clinical
Pathology, Catanzaro, Italy
Purpose: Ticagrelor (TICA) was more efficient than clopidogrel (CLO) in prevent-
ing cardiovascular events after Acute Coronary Syndrome (ACS) in the PLATO
trial. However, it was associated with a higher incidence of non-procedure related
bleedings. Despite TICA therapy was always started with the administration of a
loading dose in the PLATO trial, the loading dose could be unnecessary in pa-
tients with ongoing CLO therapy. Aim of the present study was to verify whether
the administration of a loading dose is necessary to mantain the level of inhibition
of aggregation during the switch from ongoing CLO to TICA therapy.
Methods: Fifty consecutive patients with ACS and on CLO treatment were ran-
domly assigned to a starting dose of TICA of 90mg (Group 1) or 180mg (Group
2), on top of aspirin treatment. Platelet aggregation was measured using multiple
electrode aggregometry (MEA) at 0, 2, 6, 24 and 72h after the switch, and verified
through standard LTA aggregometry.
Results: No relevant difference in platelet aggregation between the two study
arms was observed at baseline (p=0.256). Residual platelet aggregation mea-
sured using MEA was significantly reduced in both arms 2h after the first admin-
istration of TICA (both p<0.001). Interestingly, no difference in aggregation was
found 2 hours after the switch to TICA (176±72 vs 181±60 AUmin, p=0.281).
Similar findings were confirmed with LTA.
Figure 1
Conclusions: Therapeutic switch from ongoing clopidogrel therapy to ticagrelor
without administration of a loading dose is clinically safe and is not associated
to a lower degree of inhibition in patients with ACS. Avoiding the loading dose
could be associated to a lower bleeding risk while mantaining the same level of
aggregation. Larger trials are needed to confirm data from our proof-of-concept
study.
P5442 | BEDSIDE
Percutaneous left ventricular partitioning therapy in ischemic heart
failure
M. Banovic 1 , V. Vukcevic 1 , M. Ostojic 1 , D. Bacic 1 , D. Trifunovic 1 , V. Dedovic 1 ,
A. Mladenovic 2 , Z. Markovic 2 , P. Seferovic 1 . 1 Clinical Center of Serbia, Clinic for
Cardiology, Belgrade, Serbia; 2 Clinic for Radiology, Clinical Centre of Serbia,
Belgrade, Serbia
Aim: A novel Left Ventricular (LV) partitioning device (PARACHUTE™) has been
developed to treat patients with apical dysfunction after post-anteroapical My-
ocardial Infarction (MI) and with Heart Failure (HF) symptoms. The goal of the LV
partitioning is to partition dysfunctional myocardium and decrease LV size while
improving the efficacy of LV mechanics, provide myocardial unloading and im-
prove patient clinical status.