bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thrombus formation on bioprosthetic aortic valves
Authors: Bing R , Andrews J , Williams M , Clark T , Semple S , Van Beek E , Lucatelli C , Sellers S , Leipsic J , Tavares A , Stephens A , Koglin N , Dweck M , Newby D 
Published: November 2020

Abstract

Background
18F-GP1 is a novel radiotracer with a high affinity for the platelet glycoprotein IIb/IIIa receptor. Subclinical bioprosthetic valve thrombus has been postulated as a trigger for accelerated valve degeneration.

Purpose
To determine the feasibility of 18F-GP1 positron-emission tomography-computed tomography (PET-CT) for the detection of subclinical bioprosthetic aortic valve thrombus.

Methods
(i) Explanted degenerated aortic valve prostheses underwent histology and imaging. (ii) In a prospective observational study, patients with bioprosthetic aortic valve replacement (AVR) underwent echocardiography and 18F-GP1 PET-CT. Valves were assessed for hypoattenuating leaflet thickening (HALT), hypo-attenuation affection leaflet motion (HAM) and GP1 uptake.

Results
(i) GP1 correlated with thrombus on explanted valves (Figure). (ii) The first 6 patients (Table) were asymptomatic and had normally functioning surgical bioprostheses on echocardiography. At a median of 166 (range 122–189) days post-AVR, no patients had HALT or HAM on CT. There was avid focal GP1 uptake on the leaflets of all 6 patients which appeared most prominent along the leaflet edges (Figure). Only one patient had focal uptake in the valve frame, remote from the leaflets. In a separate cohort undergoing 18F-GP1 PET-CT for other conditions, there was no uptake on normal, native aortic valves (n=8).

Conclusion
For the first time, we demonstrate that 18F-GP1 PET-CT is a highly sensitive method of assessing platelet activation on bioprosthetic aortic valves. Despite the absence of CT evidence, early thrombus appeared to be a universal finding on recently implanted valve prostheses. The biological and clinical implications of subclinical bioprosthetic aortic valve thrombus have yet to be established.
GP1 uptake in AVR

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Diabetes and hemodialysis are important factor for decrease coronary flow reserve even in the patients with normal myocardial perfusion
Authors: Umemoto N , Imaoka T , Inoue S , Itou R , Oshima S , Sakakibara T , Shimizu K , Ishii H , Murohara T 
Published: November 2020

Abstract

Background
In clinical setting, patients with traditional coronary risk factors are at high risk for coronary artery disease (CAD). Such patients who complain chest discomfort are usually performed nuclear myocardial perfusion (MP) test. We sometimes find patients whose PET result shows normal MP and abnormal coronary flow reserve (CFR). However, there are limited data about the predictors for decreased CFR. In the view of describe above, we have investigated the parameters for decreased CFR in the patients without MP abnormality.

Methods and results
From 20th April 2013 to 21st December 2018, we performed 2,930 13N- ammonia PET for suspected CAD. After excluding the follows; 966 patients with repeated test, 54 patients with incomplete data, one patient missed, we investigated 1,909 eligible patients' data. We performed least square to identify the factors decreased CFR. Hemodialysis (HD), age, prior revascularization, diabetes (DM) and body mass index (BMI) were independent risk factor for decreased CFR in all population. On the other hand, HD, age, DM, hypertension and BMI were independent risk factor for decreasing CFR in patients without MP abnormality. According to the result of least square methods, we classified all patients into four groups; without DM/ without HD group, with DM/ without HD group, without DM/ with HD group and with DM/ with HD group. The value of CFR in each group were as follows: without DM/ without HD group (median, 1st quartile-3rd quartile; 2.88, 2.21–3.52), with DM/ without HD group (2.65, 2.00–3.38), without DM/ with HD group (2.29, 1.67–2.95) and with DM/ with HD group (1.97, 1.43–2.68). There were statistically significant intergroup differences. The value of CFR in the patients without MP abnormality were as follows: without DM/ without HD group (3.04, 2.47–3.65), with DM/ without HD group (2.98, 2.40–3.61), without DM/ with HD group (2.52, 2.10–3.08) and with DM/ with HD group (2.38, 1.86–2.97). Even in the patients without MP abnormality, there were also statistically significant intergroup differences.

Conclusion
According to our 13N-ammonia PET data analysis, DM and HD were important and independent factors for decreased CFR. Even in the patients without MP abnormality, DM and HD were important factor for decreased CFR.

Funding Acknowledgement
Type of funding source: None
Right ventricular morphology and function analysis in moderately preterm-born young adults
Authors: Mohamed A , Lamata P , Williamson W , Alsharqi M , Tan C.M.J , Burchert H , Huckstep O , Suriano K , Francis J , Leal Pelado J , Monteiro C , Neubauer S , Levy P.T , Leeson P , Lewandowski A.J 
Published: November 2020

Abstract

Background
Previous studies have shown that prematurity leads to altered right ventricular (RV) geometry and performance with persistent impairments in RV systolic function in young adulthood. It is unknown to what extent pulmonary physiology impacts these findings.

Purpose
To better quantify known alterations in RV morphology and function in preterm-born young adults and to determine to what extent these changes are influenced by the pulmonary circulation.

Methods
A total of 101 normotensive preterm-born (n=47, mean gestational age 32.8±3.2 weeks) and term-born (n=54) young adults were recruited. Echocardiography and cardiovascular magnetic resonance (CMR) imaging were performed to characterise RV morphology, RV function, pulmonary hemodynamics and RV-pulmonary arterial vascular (PA) coupling. CMR cine images were used to create a 3D computational atlas of the RV geometry and principal component analysis was undertaken to identify the key modes of shape variation. Spirometry was performed to assess lung function.

Results
RV CMR revealed a higher absolute and indexed RV mass (P&lt;0.05) and lower ejection fraction (54.90±5.17 versus 57.48±4.39%, P=0.008) in young adults born preterm. RV end-diastolic areas and volumes for CMR and echocardiography were lower in preterm-born compared to term-born young adults (P≤0.001). Principal component analysis of the computational atlas defined the anatomical modes of the RV geometry, with mode 1 accounting for 25.3% of the population variance. Preterm and term cohorts showed significant differences (P&lt;0.001) in mode 1, which represented a smaller and shorter RV cavity in the preterm group (Figure 1). Measurements of RV function by echocardiography, including RV fractional area of change (FAC) and tricuspid annular plane systolic excursion (TAPSE), were lower in preterm-born compared to term-born adults (P&lt;0.05). Despite lower pulmonary artery acceleration times (PAAT) in those born preterm (141.1±15.1 versus 159.2±21.6msec, P&lt;0.001), indicating increased pulmonary vascular resistance, the RV remained coupled to its pulmonary circulation (TAPSE/PAAT: 0.13±0.02 versus 0.14±0.03m/sec, P=0.153). Reduced RV performance in preterm-born individuals remained significant when adjusting for pulmonary function parameters (P&lt;0.05).

Conclusions
Multimodality cardiac imaging demonstrated that moderately preterm-born young adults exhibit structural and functional RV alterations, independent of lung physiology. Their RV remains hemodynamically coupled to its pulmonary circulation despite higher RV afterload, lower RV function and altered morphology.
Figure 1. Statistical shape model of the RV

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Association between near-infrared spectroscopy defined lipid rich plaque and pericoronary adipose tissue inflammation on computed tomography angiography
Authors: Yamaguchi M , Hoshino M , Nogami K , Ueno H , Misawa T , Sumino Y , Hada M , Kanaji Y , Sugiyama T , Yonetsu T , Kakuta T 
Published: November 2020

Abstract

Background
A recent study has shown that lipid-rich plaque (LRP) detected by near-infrared spectroscopy (NIRS) is a significant predictor of future adverse events. Pericoronary adipose tissue inflammation (FAI; fat attenuation index) evaluated by computed tomography angiography (CTA) has also been reported to be linked with cardiac events. The relationship between NIRS-defined LRP and FAI remains to be determined.

Methods
A total of 82 de novo culprit lesions in 82 patients with chronic coronary syndromes (CCS) who underwent perprocedural CTA and NIRS was retrospectively studied. FAI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation) of pericoronary adipose tissue. Plaque morphology was assessed by coronary CTA and grey-scale intravascular ultrasound (IVUS). NIRS-defined LRP was defined as a maximum lipid core burden index (LCBI) in 4 mm ≥400. Relationship between NIRS-defined LRP, CTA/grey-scale IVUS findings, and FAI was assessed. Univariate and multivariate logistic regression analyses were performed to determine the predictors for NIRS-derived LRP.

Results
NIRS-defined LRP was observed in 35 (42.6%) patients. Maximum LCBI showed modest correlations both with FAI (r=0.29, p-value=0.007) and CT-derived remodeling index (r=0.51, p&lt;0.001). Receiver operating characteristic (ROC) curve analysis revealed that the best cut-off values of FAI and CT-derived remodeling index for predicting NIRS-defined LRP were −70.7 (AUC: 0.65, 95% CI: 0.53–0.71, P&lt;0.05) and 1.11 (AUC: 0.74, 95% CI: 0.63–0.86, P&lt;0.01), respectively. Multivariate logistic regression analysis showed FAI ≥−70.7 (odds ratio [OR]: 4.27; 95% CI: 1.28–14.3; p-value = 0.02) and CT-derived remodeling index (OR: 10.7; 95% CI: 2.99–32.2; p-value &lt;0.001) were independent predictors of the presence of NIRS-defined LRP, whereas there was no statistically significant and independent predictor of IVUS-derived factors for NIRS-defined LRP. When stratified according to the presence or absence of FAI ≥−70.7 and CT-derived remodeling index ≥1.11, 93% of the lesions showed NIRS-derived LRP when both factors were present, and NIRS-derived LRP was safely ruled out (88%) when both factors were absent.

Conclusions
FAI of the culprit lesion in CCS was an independent predictor of NIRS-defined LRP, supporting the notion that local pericoronary adipose tissue inflammation may correlate to the presence of LRP. Comprehensive assessment of coronary CTA including FAI evaluation may provide a highly accurate information with high sensitivity and specificity for identifying high risk lesions potentially leading to future cardiac events.

Funding Acknowledgement
Type of funding source: None
Inflammation of conduction tissue in patients with arrhythmic phenotype of myocarditis
Authors: Frustaci A , Verardo R , Alfarano M , Agnes G , Chimenti C 
Published: November 2020

Abstract

Background
Manifestation of arrhythmias in otherwise normal heart suggests a possible compromise of conduction tissue. It, however, remains, usually, a supposition with limited therapeutical implications.

Purpose
Reporting histology of inflammation/infection of conduction tissue as a cause of arrhythmic phenotype of myocarditis.

Material and methods
Among 420 patients with a biopsy proven myocarditis diagnosed from 2009 to 2019, 42 presented with an arrhythmic phenotype and normal cardiac anatomy and function (LVEF &gt;50%). Of the latter, 12 subjects (28.5%; M 9; F 3; mean age 44,75±14.9 years) had included in a left ventricular endomyocardial biopsy sections of conduction tissue (CT). CT was identified by recognition of morphological Aschoff and Monckeberg criteria and positive immunostaining for HCN4. CT inflammation was defined by ≥7 CD3+ T lymphocytes with focal necrosis of adjacent cells. Cause of CT inflammation was investigated by polymerase chain reaction (PCR) of 2 frozen endomyocardial samples, immunohistochemistry for the identified viral antigens and for Tall like receptor 4 (TLR4).

Results
Four pts presented with non-sustained ventricular tachycardia (nsVT), seven pts with sustained (S) VT, 1 died during hospitalization because of ventricular fibrillation (VF). Inflammatory involvement of CT was documented in all 12 pts. PCR was positive for Influenza A virus in 2 pts and HHV2 in 1 with positive CT immunostaining for related antigens. In the remaining 8 pts negative PCR for viral genomes and overexpression of TLR4 suggested an immune-mediated pathway of CT inflammation. Pts with Influenza A myocarditis and CT infection responded to tamiflu (1 cp bid for 5 days) with ECG normalization while the pt with HHV2 infection died.
The 8 pts with virus-negative myocarditis and TLR4 overexpession were treated with steroids and azathioprine based on TIMIC protocol. Seven of them had no more repetitive ventricular ectopic beats at Holter of 2 weeks follow-up.

Conclusions
Arrhythmic phenotype of myocarditis is caused by elective inflammation/infection of CT. Molecular characterization of CT damage may bring to pharmacologic control of arrhythmias in up to 75% of cases.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Project ERA-CVD “Transnational Research Projects on Cardiovascular Diseases”
Sequencing candidate genes in African American and Hispanic/ Latino probands with early-onset Atrial Fibrillation
Authors: Chalazan B , Mol D , Sridhar A , Ornelas-Loredo A , Darbar F , Qiao V , Alzahrani Z , Chen Y , Ellinor P , Darbar D 
Published: November 2020

Abstract

Introduction
Mutations in cardiac ion channels, structural proteins and signaling molecules have been identified in European whites with early-onset AF (EOAF). However, it remains unclear if genetic variation also contributes to the etiology of EOAF in ethnic minorities.

Purpose
To determine the prevalence of disease causing variants in candidate AF genes in African American and Hispanic/Latino probands with EOAF.

Method
In this family-based study, probands of African and Hispanic descent with EOAF (defined as AF ≤65 years) were prospectively enrolled in a clinical-DNA biorepository and underwent targeted sequencing for 60 AF candidate genes. Variants were filtered at 20X read depth and clinically evaluated with American College of Medical Genetics and Genomics and Association for Molecular Pathology (ACMG/AMP) as well as the Association for Clinical Genomic Science (ACGS) criteria for disease-causing mutations.

Results
Among 227 EOAF probands with mean (SD) age of AF 51.0 (9.9) years, 132 (58.0%) were men and 148 (65.0%) African American and 79 (35.0%) Hispanic/Latino. Sequencing 60 candidate AF genes revealed 90 variants that met filtering criteria and underwent clinical evaluation. We identified 16 (7.0%) EOAF probands with a likely pathogenic or pathogenic variant with the majority being loss of function (62.5%) and located in the TTN gene (50.0%). We confirmed a family history of AF in 24 probands (10.6%) and 6 families with &gt;1 affected member a variant of unknown significance (VUS) in genes encoding for a sodium channel (SCN10A), potassium channel (KCNE5), sarcomeric proteins (MYH6, TTN) and atrial natriuretic peptide (NPPA) co-segregated with AF.

Conclusion
Gene sequencing in African American and Hispanic/Latinos probands with EOAF identified a small percentage of disease causing variants in patients with EOAF. Our findings not only represent important progress toward molecular phenotyping of EOAF, but also provides insight into the underlying pathophysiology toward targeted mechanism-based therapies for AF in ethnic minorities.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): American Heart Association
Serum interleukin-17A/interferon-gamma ratio as a predictor for the severity of atrial low voltage in atrial fibrillation: from FIB-MARK study
Authors: Kawaji T , Ono K , Aizawa T , Kato M , Yokomatsu T , Miki S , Kimura T 
Published: November 2020

Abstract

Background
Atrial fibrosis is hallmark of structural remodeling in atrial fibrillation (AF), but the inflammatory mechanism remains unclear. The purpose of the present study was to identify the specific inflammatory biomarkers to atrial fibrosis evaluated by atrial low voltage (LV) in AF patients for clarification of the mechanism.

Methods
Forty inflammatory biomarkers were quantified in 16 consecutive AF patients measured left atrial low voltage during catheter ablation.

Results
Median %LV area was 17%. In Pearson's correlation analysis, interleukin (IL)-17A and interferon (IFN)-γ was the most significant positive and negative correlation with %LV (R=0.35 and 0.43, P&lt;0.001). Furthermore, there was a significant correlation between IL-17A/IFN-γ ratio and %LV (R=0.65, P=0.007). The area under the receiver operator characteristics curve of IL-17A/IFN-γ ratio for significant LV (%LV &gt;10% as a reference standard) was 0.88. IL-17A/IFN-γ ratio was significantly higher in patients with significant LV than those without (1.41 versus 0.97, P=0.01), Furthermore, the sensitivity, specificity, and accuracy for detecting significant LV were 60%, 100%, and 75.0% at the cutoff value of 1.3. The event free survival from recurrent atrial tachyarrhythmias was not significantly different between patients with and without IL-17A/IFN-γ ratio &gt;1.3 (83.3% versus 80.0% at 1-year, P=0.81).

Conclusions
Among inflammatory biomarkers, IL-17A/IFN-γ ratio was a significant predictor for the severity of left atrial low voltage n AF patients. Further study is needed to reveal the association between IL-17A and IFN-γ for development of fibrosis in AF.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI GrantNumber JP19K17594
The obesity paradox in patients with atrial fibrillation: an insight from the Gulf SAFE registry
Authors: Li Y.G , Bai J , Domek M , Alsheikh-Ali A , Almahmeed W , Shehab A , Sulaiman K , Asaad N , Liu S.W , Zubaid M , Lip G.Y.H 
Published: November 2020

Abstract

Background
The prognostic role of obesity among patients with atrial fibrillation (AF) is unclear.

Methods
A total of 1804 patients with AF had body mass index (BMI) measures from the Gulf survey of atrial fibrillation events (Gulf SAFE) registry were implied. A multivariable model was established to investigate the role of obesity on clinical outcomes, including stroke or systemic embolism, bleeding, admission for heart failure (HF) or AF, all-cause mortality and composite event.

Results
559 (31.0%) patients were identified as obesity (BMI over 30kg/m2). In multivariable analyses, obesity was associated with reduced risks of stroke/systematic embolism (hazard ratio [HR] 0.40, 95% confidence interval [CI] 0.18–0.89), major or clinical relevant bleeding (HR 0.44, 95% CI 0.26–0.74), HF admission (HR 0.61, 95% CI 0.41–0.90) and composite outcome (HR 0.65, 95% CI 0.50–0.84). Higher BMI was associated with lower risks of stroke/systemic embolism, bleeding, admission for HF, all-cause mortality, and composite outcomes as were demonstrated by accumulated incidence of events and restricted cubic splines.

Conclusion
Among patients with AF, higher BMI was associated with a more favorable prognosis.
The hazard ratio for BMI and outcomes

Funding Acknowledgement
Type of funding source: None
Pre-implantation interlead EKG heterogeneity is superior to QRS complex duration in predicting mechanical super-response and survival in patients receiving cardiac resynchronization therapy
Authors: Bortolotto A.L , Verrier R.L , Nearing B.D , Marum A.A , Araujo Silva B , Pedreira G , Tessarolo Silva F , Medeiros S.A , Sroubek J , Zimetbaum P , Chang J.D 
Published: November 2020

Abstract

Background
Reliable quantitative predictors of response to cardiac resynchronization therapy (CRT) are needed. We compared the utility of pre-implantation R-wave and T-wave heterogeneity (RWH, TWH) to standard QRS complex duration for determination of mechanical super-response and mortality risk.

Methods
Of patients who received CRT devices between 2006 and 2018 at our institution, we retrospectively analyzed resting 12-lead ECG recordings from all 155 who met class I and IIA ACC/AHA/HRS guideline-based indications and had echocardiograms before and after implantation. Super-responders (n=35) (patients with ≥20% increase in LVEF and/or ≥20% decrease in LVESD) were compared to non super-responders (n=120), who did not. RWH and TWH, i.e., interlead splay, were measured by second central moment analysis. QRS complex duration was computed from the longest interval in a representative non-premature beat.

Results
Pre-implantation RWHV1–3 (p=0.01) and TWH in all lead sets tested (p=0.004 to 0.04) were significantly lower in super-responders than in non super-responders with corresponding significance for area under the curve (AUC) (p=0.002 to 0.03). Preimplantation QRS complex duration did not differ between super-responders and non super-responders (166±3 vs. 167±2 ms, p=0.8); the AUC for QRS complex duration (0.48, p=0.74) was not significant. RWHV1–3LILII at &gt;420 μV predicted 3-year all-cause mortality (p=0.037) with a hazard ratio of 7.440 (95% CI: 1.015–54.527, p=0.048) but QRS complex duration &gt;150 ms did not predict mortality (p=0.27).

Conclusion
Pre-implantation interlead EKG heterogeneity is superior to QRS complex duration in predicting mechanical super-response to CRT and survival.
Bortolotto ESC graph

Funding Acknowledgement
Type of funding source: None
A novel cardiac signal processing system for electrophysiology procedures: early insights from the pure ep 2.0 study
Authors: Gianni C , Al-Ahmad A , Knight B , Tzou W , Santangeli P , Edzards M , Tarzia K , Lee J , Sharma A , Stephenson J , Bailey S , Horton R , Kessler D , Natale A 
Published: November 2020

Abstract

Background
Intracardiac electrogram data remain one of the primary diagnostic inputs guiding complex ablation procedures. However, the technology to collect, process, and display intracardiac signals has remained relatively unchanged for the past two decades.

Purpose
We test a new platform, the PURE EP™ 2.0 system (PEP; BioSig Technologies) for signal processing and display.

Methods
Identical electrocardiographic and intracardiac signal data were recorded during 15 AF ablation procedures from the PEP system, the signal recording system, and the 3D mapping system (Figure). The collected signals underwent blinded, controlled evaluation by three independent electrophysiologist reviewers to determine whether the PEP signals are a viable alternative to conventional sources and if it provides additional or clearer diagnostic information. Reviewers were asked to record the quality of each signal sample on a scale of 1–10 and select a rationale for their rating in a dropdown menu. Each paired signal rating was collected and unblinded for the analysis. If the reviewer rated the samples in the set within 1 point of each other, the PEP sample was deemed equivalent to the control. Using a 2+1 statistical method, the ratings from the three reviewers were then compared looking for at least two positive reviews for each PEP sample.

Results
Based on the ratings for each pair of signals, a cumulative total of 29 PEP signals out of 34 (85.3%) were rated as statistically equivalent or better for this dataset. In 35.5% of samples, the reviewers selected PEP because “more signal components were visible”.

Conclusion
The PURE EP 2.0 system is able to produce reliable and high-quality signals when compared to available standard of care systems. Further studies with larger dataset across multiple sites are needed to validate these results.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): BioSig Technologies