SAT0044 ADIPOCYTOKINE FLUCTUATES WITH INFLAMMATORY MARKERS OR DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS FROM FIVE-YEAR DATA OF TOMORROW STUDY

Background:

Leptin and adiponectin have been thought to be adipocytokines that promote or suppress inflammation, respectively.

Objectives:

The aim of this study was to investigate the relationship between adipocytokine and inflammatory markers or disease activity in patients with rheumatoid arthritis (RA) by using 5-year data of TOMORROW study which is a cohort study and started from 2010.

Methods:

We evaluated inflammatory markers, disease activity score (DAS)-CRP, medication and levels of adipocytokines in 202 patients with RA (mean age, 58.6 y; medication with biological agents, 54.9%) and 202 age- and sex-matched healthy volunteers (controls; mean age, 57.4 y). We eventually compared leptin or adiponectin concentrations in 183 RA patients and 190 controls from 2010 (BL) to 2015 (5Y) and investigated the relationship between adipocytokines and CRP or DAS in patients by using Spearman correlation analysis.

Results:

The levels of leptin and adiponectin in patients were significantly higher than controls at all time points. Adiponectin level of patients significantly increased from BL to 5Y compared to controls (Table 1). In patients, adiponectin showed significant negative correlation with CRP at both of BL and 5Y (BL:R=-0.174, 5Y:R=-0.240; p<0.05), however, not with DAS at BL and 5Y. Leptin positively correlated with CRP at 5Y(R=0.207; p<0.05), but not with CRP at BL or DAS at any time. Adiponectin levels at BL and 5Y were significantly higher in biologics users at BL and significantly increased from BL to 5Y compared to patients without biologics. No association between leptin levels and the use of biologics (Table 2).

Conclusion:

The level of adiponectin in RA patients with continuous treatments for 5 years increased, and the trend was more pronounced in biologics users. These results might indicate that adiponectin is a cytokine involved in anti-inflammatory effects.

Disclosure of Interests:

Kenji Mamoto: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Yuko Sugioka: None declared, Masahiro Tada: None declared, Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

AB0215 EARLY IMPROVEMENT OF THE POWER DOPPLER SIGNAL CAN PREDICT TO CONTINUE THE BIOLOGICAL DMARDS AFTER 1 YEAR

Background:

In rheumatoid arthritis (RA), biologics treatment is one of the effective treatment options. On the other hand, the effects of biologics cannot be obtained satisfactorily in all patients, and there are some cases in which treatment is interrupted due to ineffective or adverse events. However, the useful predictive markers of the biologics have not been found in the early phase of treatment in RA. Recently, ultrasound (US) has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA.

Objectives:

In this study, we investigated whether continuation of biologics treatment can be predicted by ultrasonographic findings in the early phase.

Methods:

Fifty-four RA patients who started the first biologics from September 2016 to December 2018 were included. All the patients were performed clinical examination, blood tests and US examination of hand and foot at baseline, 4, 12, 24, 36 and 52 weeks. US examination was performed on MCP joints, PIP joints, wrist and MTP joints.

Results:

Among 54 cases, 42 cases were able to continue treatment until one year later, and the continuation rate was 80.8%. Of the 12 patients who discontinued first biologics treatment, 5 were changes to other biologics due to inadequate response, 4 were their wishes, and 3 were adverse events. Multiple regression analysis was performed with treatment continuation as the dependent variable and improvement of CRP, MMP-3, DAS28-CRP, grayscale score and power Doppler score in 4 weeks as explanatory variables. Only improvement of power Doppler score was extracted as a significant predictor (p = 0.045). In the continuation group, the improvement of the power Doppler signal at week 4 was 36% compared with the baseline, compared with 10% in the discontinuation group.

Conclusion:

The early improvement of power Doppler signal in 4 weeks could be a predictive factor for the continuation of 1-year biological treatment.

References:

[1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46.

[2]Atzeni F, Talotta R, Masala IF, Bongiovanni S, Boccassini L, Sarzi-Puttini P. Biomarkers in Rheumatoid Arthritis. Isr Med Assoc J. 2017;19:512-6.

Table 1.

Multivariate regression analysis of predictive factors for continuation of biologics treatment in 1-year.

Improvement ratio of 0 to 4 weeksbetaP valueCRP-0.1220.465MMP-30.2280.103DAS28 CRP0.2800.103Ultrasound grey scale score-0.3420.119Ultrasound power Doppler score0.4420.045

Acknowledgments:

We thank Emi Yamashita, Yuko Yoshida, Asami Fujii and Shingo Washida who performed ultrasound examination.

Disclosure of Interests:

Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kenji Mamoto: None declared, Yutaro Yamada: None declared, Koji Mandai: None declared, Shohei Anno: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

FRI0051 RHEUMATOID ARTHRITIS PATIENTS WITH HIGH DISEASE ACTIVITY AND TREATED WITH HIGH DOSE GLUCOCORTICOID FREQUENTLY FALL: NINE YEARS OF THE TOMORROW STUDY

Background:

Falling is a multicausal phenomenon resulting from complex interactions between intrinsic and extrinsic or environmental factors. Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at increased risk of falling. However, little is known about the exact properties of risk factors for falling in patients with RA. Recently, the disease activity of RA has been more satisfactorily controlled by the ‘‘treat-to-target’’ strategy, including the use of biologics. Given this new era, it is important to accurately estimate the incidence of falling in patients with RA and to elucidate contributing risk factors.

Objectives:

The objective of this study was to evaluate the incidence of falling and associated risk factors in 208 patients with RA and in age- and sex-matched 205 controls (Co) who participated in the TOMORROW (TOtalManagementOfRisk factors inRheumatoid arthritis patients to lOWer morbidity and mortality) study, a 10-year cohort study that started in 2010 in Japan. This research was conducted using TOMORROW study data for 9 years.

Methods:

We evaluated the incidence of falling by self-administered questionnaire every year and confirmed them by medical records. We also collected information about general health status, body composition including bone mineral density, lean body mass, fat mass and laboratory data. We compared the frequency of the incidence of falling in RA patients and Co for 9 years and analyzed risk factors for falling.

Results:

A total of 157 patients with RA (mean age: 57.1 ± 12.5 years, female: 84.7%, mean disease duration 13.9 ± 12.0 years) and 169 Co (mean age: 57.6 ± 12.5 years, female: 84.0%) completed 9 years observation. The rate of individuals who fell did not differ between two groups (RA: 66.9%, Co: 59.2%, p=0.19). However, number of falls was higher in RA than Co (0.35 vs 0.21/person-year, p=0.03). Multivariate logistic regression analysis adjusted for age, sex and BMI, revealed that RA was not a risk factor for the incidence of falling (OR: 1.36, 95%CI: 0.8-2.32, p=0.26) and the history of falling was a risk factor for the incidence of falling (OR: 3.27, 95%CI: 1.78-7.0, p<0.001). Multivariate linear regression analysis adjusted for age, sex and BMI, revealed that mHAQ (β=0.17, p=0.04), mean DAS28-CRP over 9 years (β=0.19, p=0.02) and mean dosage of glucocorticoid over 9 years (β=0.18, p=0.03) were the risk factors for number of falls (table 1).

Table 1.

Multivariate linear regression analysis of risk factors associated with number of falls sustained by patients RA.

RAN=157Number of fallsβpAt the entryAnti-CCP antibody (U/mL)0.0160.835RF (IU/ml)0.0200.803History of falling0.1030.201DAS28-CRP0.0780.333mHAQ0.1690.039Dose of GC (mg/day)0.0280.7239 yearsAverage DAS28-CRP0.1850.024Average dose of GC (mg/day)0.1790.025

RA, rheumatoid arthritis; CCP, cyclic citrullinated peptide; RF, Rheumatoid factor; DAS28-CRP, disease activity score 28 with C-reactive protein; mHAQ, modified Health Assessment Questionnaire; GC, glucocorticoid.

Conclusion:

There was no difference in the incidence of falling between RA and Co. However, number of falls was significantly higher in RA group. High disease activity and higher dosage of glucocorticoid were the risk factors for number of falls among RA patients.

References:

[1]C Armstrong et al, Ann Rheum Dis 2005;64:1602–1604

[2]M Hayashibara et al, Osteoporos Int 2010;21:1825–1833

Acknowledgments:

We wish to thank Atsuko Kamiyama, Tomoko Nakatsuka and all participants in this study.

Disclosure of Interests:

Shohei Anno: None declared, Yuko Sugioka: None declared, Kenji Mamoto: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Masahiro Tada: None declared, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

FRI0098 ASSOCIATION BETWEEN THE SEROLOGIC STATUS OF ISOTYPE-SPECIFIC AUTOANTIBODIES AND THERAPEUTIC EFFICACY IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH ABATACEPT: A PROSPECTIVE ULTRASOUND COHORT STUDY IN JAPAN

Background:

The presence of anti-cyclic citrullinated protein antibodies (ACPA) and anti-carbamylated protein (anti-CarP) antibody is specific for rheumatoid arthritis (RA). Recently, it was reported that the serological status of ACPA is associated with the therapeutic response of the T-cell co-stimulation blocker abatacept (1, 2). However, it is currently unclear whether the serological status of each isotype levels of these autoantibodies before treatment introduction or the changes during treatment are associated with the therapeutic response of abatacept.

Objectives:

To evaluate longitudinal changes in the isotypes of ACPA and anti-CarP in RA patients treated with abatacept, and associations between the baseline serological status/ these changes and clinical response/ ultrasonographic response.

Methods:

This study is part of an ongoing non-randomized multicenter prospective cohort study of patients with active RA who received biological or targeted DMARD therapy at 13 participating rheumatology centers from the Kyushu region of Japan since June 2013 (3). As of the present report, we enrolled 43 consecutive Japanese patients with active RA who have introduced treatment with abatacept and had finished the first 12-month observation period. We evaluated disease activity by clinical composite measure and ultrasound score at baseline, 3, 6, 9 and 12 months. In ultrasound of bilateral hands from 22 sites, the findings obtained by gray-scale (GS) and power Doppler (PD) assessments were graded on a semi-quantitative scale from 0 to 3 and the sum of GS or PD scores was used as the total GS or PD score. The serum levels of IgG/IgM/IgA-type of ACPA and anti-CarP were measured by the ELISA method in Leiden University Medical Center. We evaluated the association between serologic status of autoantibodies and clinical /ultrasonographic therapeutic efficacy.

Results:

The median age was 72 years, and the disease duration was 54 months. Methotrexate was concomitant in 22 (51%). Sixteen (37%) patients had a history of previous use of biological DMARDs. Nineteen (44%) and 23 (54%) patients achieved SDAI remission and PD remission (total PD score =0) at 12 months, respectively. The serum levels of all isotypes of ACPA/anti-CarP significantly decreased at 12 months from baseline. The reduction of IgM-ACPA level significantly correlated with the reduction of SDAI (rs=0.33, p=0.031) and total PD score (rs=0.49, p=0.0007). Both clinical and ultrasonographic therapeutic responses were better in patients with the detectable IgM-ACPA at baseline than in patients without that (Figure): the reduction of SDAI (p=0.0078) and that of total PD score (p=0.0079) were significantly larger in the former than in the latter. All isotype of anti-CarP did not associate with therapeutic response.

Conclusion:

Treatment of abatacept induced to the reduction of the autoantibody levels. The IgM-ACPA level at baseline and the change in IgM-ACPA associated with both clinical and ultrasonographic therapeutic response in patients treated with abatacept. IgM-ACPA, compared with usual IgG-ACPA, better reflects the treatment response of abatcept in patients with RA

References:

[1]Ann Rheum Dis. 2016;75:709, 2) RMD Open. 2018;4:e000564, 3)Arthritis Care Res (Hoboken). 2018;70:1719.

Acknowledgments:

We have acknowledged for all the members of Kyushu multicenter rheumatoid arthritis ultrasound prospective observational cohort study group.

Disclosure of Interests:

Shin-ya Kawashiri Grant/research support from: This work was supported by Bristol-Myers Squibb and Ono Pharmaceutical. co., Yushiro Endo: None declared, Ayako Nishino: None declared, Toshimasa Shimizu: None declared, Yukitaka Ueki: None declared, Nobutaka Eiraku: None declared, Akitomo Okada: None declared, Naoki Matsuoka: None declared, Tamami Yoshitama: None declared, Hideki Nakamura: None declared, Mami Tamai: None declared, Tomoki Origuchi: None declared, Rene Toes: None declared, Thomas Huizinga Grant/research support from: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Consultant of: Ablynx, Bristol-Myers Squibb, Roche, Sanofi, Atsushi Kawakami: None declared

THU0138 AGEING IN RA PATIENTS DETERIORATED MODIFIED HEALTH ASSESSMENT QUESTIONNAIRE (MHAQ) OVER A 7-YEAR PERIOD INDEPENDENTLY FROM DISEASE ACTIVITY

Background:

Recent advances of treatment for rheumatoid arthritis (RA) realizes us to set the treatment goal as remission. As the results, health assessment questionnaire (HAQ) has been also becoming better in these years. On the other hand, progress in ageing has been a major issue in Japan, including the patients with RA. which is thought as one of the factors affecting HAQ.

Objectives:

To evaluate the impact of ageing on HAQ in RA patients.

Methods:

The data of 208 RA patients used in this study was collected over a 7-year period from 2010 to 2017 as part of a prospective cohort study (TOMORROW Study: UMIN000003876) that included RA patients and age- and sex-matched volunteers recruited through mass media as controls. The data of RA patients included anthropometric, blood test data, disease activity score28-CRP (DAS28) and modified HAQ (mHAQ), together with baseline (BL) characteristics. The course of mHAQ for 7 years were analyzed by repeated measure ANOVA, and association between the changes of mHAQ at year-7 from BL (ΔmHAQ) and BL factors were analyzed by multiple regression analysis.

Results:

Two hundred and eight RA patients (153 women; mean age 58.1 years) were enrolled in the present study. Modified HAQ decreased significantly over the 7-year study period in RA patients. When the patients were stratified into 3 groups (lower than 2.7, between 2.7 and 4.1, over 4.1) by DAS28 at BL, mHAQ of the patients with high disease activity (DAS28: over 4.1) at BL was significantly worse than other groups (p=0.018; repeated measure ANOVA). There was no interaction between time and 3 groups (p=0.118; repeated measure ANOVA). Multiple regression analysis with ΔmHAQ as the outcome variable and ACPA, age, BMI, CRP, DAS28, MMP-3 at BL as independent variables revealed that age (p=0.034) and DAS28 (p=0.042) were independently related with ΔmHAQ.

Conclusion:

Ageing in RA patients impacted worsening of mHAQ over a 7-year period independently from disease activity. On assessing mHAQ in elderly RA patients, we must consider the age as well as the disease activity.

Disclosure of Interests:

Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Yuko Sugioka: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Masahiro Tada: None declared, Kenji Mamoto: None declared, kazuki Orita: None declared, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

AB0235 DENOSUMAB INCREASE THE BONE MINERAL DENSITY REGARDLESS OF DISEASE ACTIVITY, THE BIOLOGICAL DISEASE-MODIFYING ANTIRHEUMATIC DRUGS, THE CONCOMITANT TYPE OF VITAMIN D, AND PRETREATMENT OF OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Osteoporosis is one of the major comorbidities in patients with rheumatoid arthritis (RA). There are a lot of evidence that denosumab increase bone mineral density (BMD) in patients with osteoporosis. However, there are few reports investigated the influence of denosumab in patients with RA.

Objectives:

We evaluated the BMD change in patients with RA treated denosumab and assessed the effect of various factors, such as disease activity, biological disease-modifying anti-rheumatic drugs (bDMARDs) use, concomitant medications of osteoporosis and pretreatment of osteoporosis.

Methods:

This study included 140 consecutive RA patients (135 female, mean age was 70.6 ± 8.6 years) who fullfilled the criteria of osteoporosis and treated with denosumab. BMD at the lumbar spine, proximal femoral and femoral neck were evaluated by dual energy X-ray absorptiometry at baseline and one year after treatment. We evaluated the influence of disease activity, bDMARDs use, the concomitant type of vitamin D and pretreatment of osteoporosis for BMD change.

Results:

BMD change at the lumbar spine, proximal femoral and femoral neck were 5.9% (p<0.01), 4.0% (p<0.01), and 1.2% (p=0.36) durling one year. There were no differences in improvement ratio of BMD between each parameters (fig 1). Disease activity: 75 patients in remission or low disease activity and 65 patients in moderate or high disease activity were 6.4 vs 5.3% (p=0.91), 3.0 vs 5.1% (p=0.73), 2.0 vs 0.3% (p=0.1). bDMARDs: 45 patients with bDMARDs (anti-tumor necrosis factor inhibitors (TNF): 23, tocilizmab (TCZ): 13, abatacept (ABT): 7, Tofacitinib: 2) and 93 patients without bDMARDs were 6.0 vs 5.8% (p=0.31), 4.3 vs 4.1% (p=0.57), -0.2 vs 1.8% (p=0.18). Type of vitamin D: 47 patients taking active form vitamin D and 60 patients taking native form vitamin D were 5.5 vs 6.8% (p=0.82), 3.1 vs 3.8% (p=0.93), 0.4 vs 1.9% (p=0.14). Pretreatment of osteoporosis: 74 patients with pretreatment of osteoporosis (bisphosphonate:58, teriparatide:16) and 66 patients without pretreatment of osteoporosis were 6.9 vs 5.4% (p=0.41), 0.9 vs 4.0% (p=0.22), 2.0 vs 1.2% (p=0.68). Moreover, BMD change were not different in bDMARDs type, 5.0, 6.4, 0.5% in TNF group, 4.8, 0.7, -1.9% in TCZ group, 9.7, 4.9, 0.2% in ABT group (TNF vs TCZ: p=0.83, 0.98, 0.81, TNF vs ABT: p=0.83, 0.41, 0.97, TCZ vs ABT: p=0.98, 0.43, 0.9). There were no difference between bisphosphonate and teriparatide (6.2 vs 6.9%: p=0.49, 4.8 vs 0.9%: p=0.35, 0.9 vs 2.0%: p=0.49).

Conclusion:

Denosumab improved BMD in patients with RA independently regardless of disease activity, bDMARDs, the concomitant type of vitamin D and pretreatment of osteoporosis.

References:

[1]Y Nakamura et al, Arch Osteoporos: 2017; 12:80.

[2]K Kaneko et al, Journal of Experimental Orthopaedics: 2019; 6:41.

[3]T Suzuki et al, Therapeutics and Clinical Risk Management: 2018; 14:453–459.

Acknowledgments:

We wish to thank Atsuko Kamiyama, Tomoko Nakatsuka, Masato Uematsu and all participants in this study.

Disclosure of Interests:

Shohei Anno: None declared, Tadashi Okano Grant/research support from: AbbVie, Eisai, Mitsubishi Tanabe Pharma Corporation and Nipponkayaku, Speakers bureau: AbbVie, Asahikasei, Astellas Pharma Inc, Ayumi Pharmaceutical, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiich Sankyo, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma, Ono Pharmaceutical, Pfizer, Sanofi, Takeda Pharmaceutical, Teijin Pharma and UCB, Kentaro Inui Grant/research support from: Janssen Pharmaceutical K.K., Astellas Pharma Inc., Sanofi K.K., Abbvie GK, Takeda Pharmaceutical Co. Ltd., QOL RD Co. Ltd., Mitsubishi Tanabe Pharma, Ono Pharmaceutical Co. Ltd., Eisai Co.,Ltd.,, Speakers bureau: Daiichi Sankyo Co. Ltd., Mitsubishi Tanabe Pharma, Janssen Pharmaceutical K.K., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., Ono Pharmaceutical Co. Ltd., Abbvie GK, Pfizer Inc., Eisai Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Tatsuya Koike Grant/research support from: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Speakers bureau: AbbVie, Astellas Pharma Inc, Bristol-Myers Squibb, Chugai Pharmaceutical, Eisai, Janssen, Lilly, Mitsubishi Tanabe Pharma Corporation, MSD, Ono Pharmaceutical, Pfizer, Roche, Takeda Pharmaceutical, Teijin Pharma, and UCB, Hiroaki Nakamura Grant/research support from: Astellas Pharma Inc. and Asahi Kasei Pharma Co.

Characteristics of Chronic Obstructive Pulmonary Disease Patients with Pulmonary Hypertension Assessed by Echocardiography in a Three-Year Observational Cohort Study

Background

Pulmonary hypertension (PH) is a major comorbidity of chronic obstructive pulmonary disease (COPD). However, the association of PH detected by echocardiography and COPD-related outcome in longitudinal follow-up has not been elucidated. In this study, we aimed to investigate the relationship between clinical characteristics of COPD patients with PH detected by echocardiography and various outcome parameters such as COPD exacerbation and health status over a three-year observation period.

Methods

In this observational study, we analyzed patients with COPD who underwent chest computed tomography and echocardiography at baseline (n = 183).

Results

The prevalence of PH was 21.9% (40 patients). The median estimated systolic pulmonary artery pressure in patients with PH was 38.8 mmHg. COPD patients with PH were older, had a lower body mass index, scored worse in the COPD Assessment Test and St. George's Respiratory Questionnaire, and exhibited a lower diffusing capacity of the lung for carbon monoxide in comparison to patients without PH. In computed tomography images, the percentages of low-attenuation areas (LAA%) and interstitial abnormalities were higher in COPD patients with PH than in those without PH. Higher values for LAA% (LAA ≥ 30%) and interstitial abnormalities independently increased the risk of PH. The ratio of main pulmonary diameter to aortic artery diameter was significantly correlated with estimated systolic pulmonary artery pressure. In the follow-up analysis, the frequency of exacerbations in three years was significantly higher in patients with PH compared to patients without PH.

Conclusion

In this study, we identified the clinical characteristics of COPD patients with PH detected by echocardiography. The presence of PH assessed by echocardiography was related to future COPD exacerbations and closely related to radiographical emphysema.

Robust weak antilocalization due to spin-orbital entanglement in Dirac material Sr3SnO

The presence of both inversion (P) and time-reversal (T) symmetries in solids leads to a double degeneracy of the electronic bands (Kramers degeneracy). By lifting the degeneracy, spin textures manifest themselves in momentum space, as in topological insulators or in strong Rashba materials. The existence of spin textures with Kramers degeneracy, however, is difficult to observe directly. Here, we use quantum interference measurements to provide evidence for the existence of hidden entanglement between spin and momentum in the antiperovskite-type Dirac material Sr3SnO. We find robust weak antilocalization (WAL) independent of the position of EF. The observed WAL is fitted using a single interference channel at low doping, which implies that the different Dirac valleys are mixed by disorder. Notably, this mixing does not suppress WAL, suggesting contrasting interference physics compared to graphene. We identify scattering among axially spin-momentum locked states as a key process that leads to a spin-orbital entanglement.

Weight of salivary gland ultrasonography compared to other items of the 2016 ACR/EULAR classification criteria for Primary Sjögren's syndrome

OBJECTIVE

Major salivary gland ultrasonography (SGUS) is widely used for the diagnosis of primary Sjögren's syndrome (pSS). Our objective was to assess the contribution of SGUS compared to other items of the 2016 ACR/EULAR pSS classification criteria, based on expert opinion.

METHODS

A secure web-based relational database was used by 24 experts from 14 countries to assess 512 realistic vignettes developed from data of patients with suspected pSS. Each vignette provided classification criteria items and information on history, clinical symptoms and SGUS findings. Each expert assessed 64 vignettes, and each vignette was assessed by 3 experts. A diagnosis of pSS was defined according to at least 2 of 3 experts. Validation was performed in the independent French DiapSS cohort of patients with suspected pSS.

RESULTS

A criteria-based pSS diagnosis and SGUS findings were independently associated with an expert diagnosis of pSS (P < 0.001). The derived diagnostic weights of individual items in the 2016 ACR/EULAR criteria including SGUS were as follows: anti-SSA, 3; focus score ≥ 1, 3; SGUS score ≥ 2, 1; positive Schirmer's test, 1; dry mouth, 1; and salivary flow rate < 0.1 mL/min, 1. The corrected C statistic area under the curve for the new weighted score was 0.96. Adding SGUS improves the sensitivity from 90.2 % to 95.6% with a quite similar specificity 84.1% versus 82.6%. Results were similar in the DiapSS cohort: adding SGUS improves the sensitivity from 87% to 93%.

CONCLUSION

SGUS had similar weight compared to minor items, and its addition improves the performance of the 2016 ACR/EULAR classification criteria.

A Targeted Genetic Association Study of the Rare Type of Osteomyelitis

Chronic nonbacterial osteomyelitis is a rare bone disorder that can be found in the jaw. It is often associated with systemic conditions, including autoimmune deficiencies. However, little is known about how the genetic and immunologic background of patients influences the disease. Here, we focus on human leukocyte antigen (HLA), killer cell immunoglobulin-like receptors (KIRs), and their specific combinations that have been difficult to analyze owing to their high diversity. We employed a recently developed technology of simultaneous typing of HLA alleles and KIR haplotype and investigated alleles of the 35 HLA loci and KIR haplotypes composed of centromeric and telomeric motifs in 18 cases and 18 controls for discovery and 472 independent controls for validation. We identified an amino acid substitution of threonine at position 94 of HLA-C in combination with the telomeric KIR genotype of haplotype tA01/tB01 that had significantly higher frequency (>20%) in the case population than in both control populations. Multiple logistic regression analysis based on a dominant model with adjustments for age and sex revealed and validated its statistical significance and high predictive accuracy (C-statistic ≥0.85). Structure-based analysis revealed that the combination of the amino acid change in HLA-C and the telomeric genotype tA01/tB01 could be associated with lower stability of HLA-C. This is the first case-control study of a rare disease that employed the latest sequencing technology enabling simultaneous typing and investigated amino acid polymorphisms at HLA loci in combination with KIR haplotype.

M2 Phenotype Macrophages Colocalize with Schwann Cells in Human Dental Pulp

Macrophages are immune cells with high plasticity that perform many functions related to tissue injury and repair. They are generally categorized as 2 functional phenotypes: M1 (proinflammatory) and M2 (anti-inflammatory and prohealing). To investigate the role of macrophages in human dental pulp, we examined the localization and distributional alterations of macrophages in healthy dental pulp as well as during the reparative process of pulp capping with mineral trioxide aggregate (MTA) and in cariously inflamed pulp of adult human teeth. We also quantified the populations of M1/M2 macrophages in healthy dental pulp by flow cytometric analysis. CD68⁺CD86⁺ cells (M1 phenotype) and CD68⁺CD163⁺ cells (M2 phenotype) were 2.11% ± 0.50% and 44.99% ± 2.22%, respectively, of 2.96% ± 0.41% CD68⁺ cells (pan-macrophages) in whole healthy dental pulp. Interestingly, M2 phenotype macrophages were associated with Schwann cells in healthy pulp, during mineralized bridge formation, and in pulp with carious infections in vivo. Furthermore, the M2 macrophages associated with Schwann cells expressed brain-derived neurotrophic factor (BDNF) under all in vivo conditions. Moreover, we found that plasma cells expressed BDNF. Coculture of Schwann cells isolated from human dental pulp and human monocytic cell line THP-1 showed that Schwann cells induced M2 phenotypic polarization of THP-1 cell-derived macrophages. The THP-1 macrophages that maintained contact with Schwann cells were stimulated, leading to elongation of their cell shape and expression of M2 phenotype marker CD163 in cocultures. In summary, we revealed the spatiotemporal localization of macrophages and potent induction of the M2 phenotype by Schwann cells in human dental pulp. M2 macrophages protect neural elements, whereas M1 cells promote neuronal destruction. Therefore, suppressing the neurodestructive M1 phenotype and maintaining the neuroprotective M2 phenotype of macrophages by Schwann cells may be critical for development of effective treatment strategies to maintain the viability of highly innervated dental pulp.

Factor Xa inhibitors for preventing recurrent thrombosis in patients with antiphospholipid syndrome: a longitudinal cohort study

OBJECTIVE

The objective of this study was to clarify the efficacy and safety of factor Xa inhibitors for antiphospholipid syndrome patients in real world utilization.

METHODS

This is a retrospective cohort study comprised of all consecutive patients with antiphospholipid syndrome in our department over a period of 28 years. Patients treated with factor Xa inhibitors were extracted from the cohort. As a control group, patients treated with warfarin were selected from the same cohort with matched age, gender, coexistence of systemic lupus erythematosus, and the presence of antiplatelet therapy, after which we used a propensity score for each of the risk factors as an additional covariate in multivariate Cox proportional hazard regression. The primary endpoint was set as thrombotic and hemorrhagic event-free survival for five years.

RESULTS

Among 206 patients with antiphospholipid syndrome, 18 had a history of anti-Xa therapy (five rivaroxaban, 12 edoxaban, one apixaban). Fourteen out of 18 patients on anti-Xa therapy had switched to factor Xa inhibitors from warfarin. Event-free survival was significantly shorter during anti-Xa therapy than that during warfarin therapy (hazard ratio: 12.1, 95% confidence interval: 1.73-248, p = 0.01) ( Figure 1(a) ). Similarly, event-free survival in patients treated with factor Xa inhibitors was significantly shorter compared with controls (hazard ratio: 4.62, 95% confidence interval: 1.54-13.6, p = 0.0075). In the multivariate Cox proportional hazard model, event-free survival in patients with anti-Xa therapy remained significantly shorter (hazard ratio: 11.9, 95% confidence interval: 2.93-56.0, p = 0.0005).

CONCLUSIONS

Factor Xa inhibitors may not be recommended for antiphospholipid syndrome.

P2691Excimer laser coronary angioplasty can achieve favorable clinical outocomes for in-stent restenosis lesion with neoatherosclerosis

Background

Recent reports revealed that residual area stenosis (% AS) ≤30% after lesion preparation is a suitable predictor for target lesion revascularization (TLR) after drug-coated balloon (DCB) treatment for in-stent restenosis (ISR). Excimer laser coronary angioplasty (ELCA) can obtain larger lumen area and may be more useful for lesion preparation than plain old ballooning (POBA). On the other hands, it has been reported that in-stent neoatherosclerosis (NA) is major cause of restenosis. It is unclear the correlation between NA of ISR and the effect of ELCA. Thus, we compared the influence of NA which was evaluated by optical coherence tomography (OCT) on % AS for ISR treatment between ELCA and DCB (ELCA) group and POBA and DCB (non-ELCA) group and their clinical outcome.

Methods

We enrolled 58 consecutive ISR lesions which were treated by OCT guidance between July 2014 and July 2018 in our hospital. The lesions were divided into NA and non-NA lesions according to OCT findings. In each lesion, we compared post procedural % AS and % AS change which was calculated by the difference between pre and post procedural % AS between ELCA and non-ELCA groups. In addition, we compared 8-month major advance cardiac events (MACE) defined by composite of binary restenosis and target lesion revascularization (TLR) between ELCA and non-ELCA group in NA lesions.

Results

There were 19 NA (33.3%) and 39 non-NA lesions. In NA lesions, ELCA group can obtain significantly lower % AS (p=0.02) and significantly larger % AS change (p<0.01) than non-ELCA group, but in non-NA lesions, % AS and %AS change were similar between ELCA and non-ELCA groups (table). In 8-month clinical outcome, non-ELCA group experienced MACE twice as much as ELCA group did. (31% vs 17%)

Results of %AS NA lesions (n=19) P value non-NA lesions (n=39) P value ELCA group (n=6) non-ELCA group (n=13) ELCA group (n=17) non-ELCA group (n=22) Post %AS (%) 2±21 26±25 0.02 7±29 23±19 0.07 %AS change (%) 71±15 38±19 <0.01 56±29 44±17 0.11

Conclusion

Although neoatherosclerosis is correlated with refractory restenosis, ELCA can improve residual area stenosis in neoatherosclerosis lesions and can achieve better clinical outcomes for in-stent neoatherosclerosis.

P3385Difference of vascular healing after percutaneous coronary intervention between 4 kinds of new generation drug-eluting stents: an optical coherence tomography analysis

Background

New generation drug eluting stents (DES) have improved target vessel failure as compared with early generation DES and bare metal stent. Contemporary several new generation DES are different each other regarding strut thickness and drug and polymer type. A little is known about which stent induces a more favorable vascular healing at follow up.

Purpose

In this study, we compared the vascular healing at 8-month follow up by optical coherence tomography (OCT) between 4 different kinds of new generation DES.

Methods

We enrolled 112 consecutive patients (121 lesions) who underwent PCI using 4 kinds of new generation DES including biodegradable-polymer everolimus-eluting stents (BP-EES), biodegradable-polymer sirolimus-eluting stents (BP-SES), durable-polymer everolimus-eluting stents (DP-EES) and durable-polymer zotarolimus-eluting stents (DP-ZES) and who underwent 8-month follow up angiogram and OCT between July 2016 and April 2018. We compared the OCT parameters including percentage of covered struts, uncovered struts, well-apposed and uncovered struts, malapposed strut and mean neointimal hyperplasia (NIH) thickness between them.

Results

BP-EES consisted of 29 lesions, BP-SES consisted of 25 lesions, DP-EES consisted of 38 lesions and DP-ZES consisted of 29 lesions. A total of 734 frames with 5163 struts in BP-EES, 481 frames with 4214 struts in BP-SES, 783 frames with 6119 struts in DP-EES and 583 frames with 4708 struts in DP-ZES were analyzed. As shown in a table, mean NIH thickness was significantly higher in BP-EES and BP-SES. Thus, we compared the OCT parameters between durable-polymer (DP) group including DP-ZES and DP-EES and biodegradable-polymer (BP) group including BP-EES and BP-SES. The percentage of uncovered struts was significantly lower and mean NIH thickness was significantly higher in BP group than DP group.

Results of OCT parameters BP-EES (n=29) BP-SES (n=25) DP-EES (n=38) DP-ZES (n=29) P value BP group (n=54) DP group (n=67) P value Covered struts (%) 89.5±13.6 92.4±8.6 85.5±17.5 85.0±17.7 0.29 90.9±11.6 85.3±17.4 0.08 Uncovered struts (%) 8.8±10.8 7.1±8.7 14.5±17.5 15.0±17.7 0.14 8.0±9.9 14.7±17.4 0.03 Well-apposed and uncovered struts (%) 7.9±9.9 5.9±7.7 11.7±13.1 12.3±14.0 0.15 7.0±8.9 11.9±13.4 0.04 Malapposed struts (%) 0.8±1.6 1.3±2.2 2.7±5.8 2.7±4.7 0.33 1.0±1.9 2.7±5.3 0.07 Mean NIH thickness (μm) 102±57 121±48 78±28 88±33 <0.01 111±53 82±31 <0.01

Conclusion

The present OCT study demonstrated that delayed neointimal healing characterized by the presence of uncovered struts and lower mean NIH thickness was less common in BP group than DP gruop. Biodegradable-polymer may be more favorable than durable-polymer from the point of view of vascular healing.

103Maximum calcium thickness is a useful predictor for under expansion after post dilatation in calcified lesions: optical coherence tomographic study

Background

Several reports have revealed that stent under expansion is associated with target lesion failure and calcified lesions usually induced inadequate stent expansion. Contemporary debulking devices such as rotational/orbital atherectomy can modify severe calcified lesions before stenting. However, it is uclear which calcium parameter is most useful predictor for stent expansion in the calcified lesions. Thus, we investigated useful calcium parameters correlating with stent expansion in the calcified lesions.

Methods

We enrolled 43 consecutive calcified lesions (43 patients) who underwent optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) between September 2016 and January 2019. We evaluated the lesions treated with post dilatation by non-compliant balloon due to stent under expansion after stenting. Exclusion criteria included acute coronary syndrome, in-stent restenosis and lesions without any calcium or treated with rotational atherectomy. If there were several calcium lesions in one patient, we selected maximum calcium angle lesion. Stent expansion defined as post-PCI lumen area divided by the values predicted by the manufactures compliance charts. We compared mean reference area, pre lesion area stenosis, calcium parameters including calcium arc, maximum thickness, area and longitudinal length in pre-PCI OCT evaluations with post-PCI stent expansion at that site.

Results

Maximum calcium thickness showed significant correlation with stent expansion, while the others did not show a significant correlation with stent expansion (table). The optimal thresholds of maximum calcium thickness for the prediction of acceptable stent expansion defined by 80% of the values predicted by the manufactures compliance charts was 870mm (area under curve (AUC): 0.65) (figure).

Results of OCT parameters Univariate analysis P value Mean reference area 0.41 Pre % area stenosis 0.16 Calcium parameters   Calcium arc 0.37   Calcium maximum thickness 0.04   Calcium area 0.20   Calcium longitudinal length 0.43

Conclusion

A maximum calcium thickness<870mm is a useful predictor for acceptable stent expansion after post dilatation in calcified lesions.

P2689Irregular protrusion area is associated with incidence of cardiac events after implantation of new generation drug-eluting stents - optical coherence tomography study

Background

Several studies using optical coherence tomography (OCT) have shown that the prevalence of irregular protrusion was associated with the incidence of adverse cardiac events. However, the correlation between cardiac events and protrusion area is not well investigated.

Method

One hundred twenty-nine consecutive patients with 138 clesions with 2nd and 3rd generation drug-eluting stents (DES) which had pre-stenting and post-stenting OCT imaging between April 2016 and April 2018 were evaluated. We compared baseline characteristics, procedure findings and OCT findings including minimum stent area, protrusion type and maximum protrusion area between target lesion revascularization (TLR) group and non-TLR group.

Results

TLR occurred in 12 (9.3%) in 129 patients. The baseline characteristics and procedure findings were similar between TLR group and non-TLR group. Univariate analysis revealed that maximum irregular protrusion area was significantly larger (0.51 [0.00–0.63] vs 0.00 [0.00–0.27], p=0.036) in TLR group than non-TLR group. Receiver operating characteristic curve analysis revealed that the suitable cutoff value of maximum irregular protrusion area were 0.43mm2 for TLR. In multivariate analysis using the parameters with p value<0.10 determined by univariate analysis, maximum irregular protrusion (≥0.43mm2) and minimum stent area (MSA) were independently correlated with TLR (table).

Odd's ratio (95% CI) P value Major irregular protrusion (≥0.43mm2) 17.3 (3.63–82.6) <0.001 MSA 2.13 (1.15–3.93) 0.002

Conclusion

Major irregular protrusion (>0.43mm2) in post-stenting OCT findings may be a powerful predictor of TLR in the patients with new generation DES.

P6198Lipoprotein(a) as a potential residual risk associated with coronary lipid-rich atheroma in type2 diabetic subjects with coronary artery disease who achieved lowdense lipoprotein cholesterol<1.7mmol/l

Background

Type 2 diabetic patients with coronary artery disease (CAD) is a high-risk subjects who require intensive secondary preventive management. The current guideline recommends lowering LDL-C with a statin as a first-line therapy in diabetic patients with CAD. However, its anti-atherosclerotic efficacy is diminished compared to non-diabetic subjects. These suggest the need to further identify additional therapeutic target associated with diabetic atherosclerosis. Lipoprotein (a) [Lp (a)] is a plasma lipoprotein which consists of an LDL-like particle with apolipoprotein (a). While Lp (a) has been shown to associate with ASCVD, whether this lipoprotein promotes diabetic coronary atherosclerosis under LDL-C control with a statin remains to be fully elucidated.

Purpose

To investigate the relationship between Lp (a) and coronary lipidic atheroma by near-infrared spectroscopy (NIRS), which quantitatively measures lipidic burden in vivo.

Methods

Culprit lesions in 127 type 2 diabetic patients with CAD who already received a statin were evaluated by NIRS imaging. Maximum 4-mm lipid core burden index at culprit lesion (MaxLCBI4mm) was measured.

Results

High-intensity statin and ezetimibe were used in 13 and 14% of study subjects, respectively. Their on-treatment LDL-C level and Lp (a) were 2.0±0.7 mmol/l and 22.1±26.7 mg/dl. Despite these lipid lowering therapy, average MaxLCBI4mm was 419.6±248.2 and MaxLCBI4mm≥400 was observed in 49% of study subjects. Multivariate linear regression analysis demonstrated LDL-C and Lp (a) as independent determinants associated with MaxLCBI4mm (Table). Of note, in subjects who achieved LDL-C<1.8 mmol/l, an elevated Lp (a) level but not LDL-C predicts MaxLCBI4mmat culprit lesions (Table).

Multivariate linear regression analysis t p-value Entire subjects (n=127)   LDL-C 2.04 0.04   Lp (a) 2.88 <0.01 LDL-C <1.8 mmol/l (n=47)   LDL-C 0.45 0.66   Lp (a) 2.74 0.01

Conclusions

The association of Lp (a) with coronary lipid-rich atheroma even under guideline-recommended LDL-C control indictaes Lp (a) as an additional therapeutic target to further stabilize diabetic atherosclerosis.

P1914Relationship between myocardial injury, inflammation and early, late recurrence after pulmonary vein isolation may be different between radiofrequency catheter ablation and cryoballoon ablation

Background

High sensitive cardiac troponin I (hs-TnI), subunit of cardiac troponin complex, is a sensitive and specific marker of myocardium injury as troponin T. Several studies showed hs-TnI was associated with worse cardiovascular outcomes but relationship between serum hs-TnI level in patients with atrial fibrillation (AF) after pulmonary vein isolation (PVI) and AF recurrence remains unclear.

Methods

We enrolled 444 consecutive AF patients who underwent PVI from May 2017 to September 2018. We investigated the difference of relationship between serum hs-TnI, inflammation markers at 48 hours after PVI and early or late recurrence of AF (ERAF, <3 months and LRAF, during 1 year after PVI in patients with AF) between radiofrequency ablation (RFA) group and cryoballoon ablation (CBA) group.

Results

RFA and CBA were performed in 328 and 116 patients, respectively. There were no significant differences in patient characteristics between RFA group and CBA group. Serum hs-TnI in RFA group was significantly lower than in CBA group (1.93 ng/ml±3.28 vs 5.08 ng/ml±4.29, p<0.001), while hs-CRP was significantly higher in RFA group than CB group (1.97±2.38 mg/dl vs 1.10±0.84 mg/dl, p<0.001). The incidence of ERAF was similar between the two groups (RFA group: 26.8% and CBA group: 21.6%, p=0.262). There was no significant difference of hs-TnI and hs-CRP between patients with ERAF and without ERAF (table). In 213 patients who were followed during 1 year (PVIs were performed from May 2017 to January 2018, RFA 149 and CBA 64 patients), there was no significant association between hs-TnI, hs-CRP and incidence of LRAF (table).

TnI and CRP between RFA and CBA RFA (n=328) CBA (n=116) P value hs-TnI 1.93±3.28 5.08±4.29 <0.001 hs-CRP 1.97±2.38 1.10±0.84 <0.001 3 months follow-up RFA (n=328) CBA (n=116) ERAF (+) ERAF (−) P value ERAF (+) ERAF (−) P value hs-TnI 1.68±1.90 2.02±3.66 0.410 5.03±3.17 5.10±4.56 0.943 hs-CRP 2.23±2.65 1.88±2.27 0.238 1.01±0.84 1.13±0.85 0.524 1 year follow-up RFA (n=149) CBA (n=64) LRAF (+) LRAF (−) P value LRAF (+) LRAF(−) P value hs-TnI 1.61±1.77 1.87±2.69 0.570 4.71±2.14 5.60±5.69 0.664 hs-CRP 2.18±2.24 1.92±2.24 0.550 1.12±0.64 1.12±0.98 0.991

Conclusion

CBA may cause more myocardial injury than RFA, on the contrary RFA may cause more inflammation than CBA. These markers did not affect ERAF and LRAF after PVI.

P1736A novel calcium parameter, calcium ratio, can predict minimum lumen area in calcified lesions: optical coherence tomographic study

Background

Several reports have revealed that minimum lumen area (MLA) is associated with target lesion failure even with newer-generation drug-eluting stents, and calcified lesions usually induced inadequate lumen area because of stent under expansion. Contemporary debulking devices such as rotational/orbital atherectomy can modify severe calcified lesions before stenting. However, there are no optimal criteria to indicate necessity for calcium modification to obtain adequate acute gain. Therefore, we investigated useful calcium parameters correlating with MLA in the calcified lesions after stenting.

Methods

We enrolled 71 consecutive calcified lesions (71 patients) who underwent optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) between September 2016 and January 2019. Exclusion criteria included acute coronary syndrome, in-stent restenosis and lesions without any calcium or treated with rotational atherectomy. If there were several calcium lesions in one patient, we selected maximum calcium angle lesion. We compared mean reference area, pre lumen area and various calcium parameters including calcium arc, maximum thickness, depth, area, longitudinal length and calcium ratio that was maximum calcium thickness divided by nearest reference diameter in disease-free segments as much as possible in pre-PCI OCT evaluation with post-PCI lumen area at that site by simple and multiple regression analysis.

Results

Calcium ratio was an independent predictor for post-PCI lumen area in addition to mean reference area, while the others were not associated with post-PCI lumen area (table).

Results of OCT parameters Univariate analysis Multivariate analysis P value P value β Mean reference area <0.01 <0.01 0.69 Pre lumen area <0.01 0.08 0.15 Cacium arc <0.01 0.58 −0.06 Calcium maximum thickness 0.62 Calcium ratio <0.01 0.01 −0.21 Calcium area 0.02 0.64 0.05 Calcium longitudinal length 0.60 Calcium depth 0.09

Conclusion

The novel calcium measurement, calcium ratio, may be a useful predictor for post-PCI lumen area for calcified lesions.