bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dobutamine Stress Echocardiography Ischemia as a Predictor of the Placebo-Controlled Efficacy of Percutaneous Coronary Intervention in Stable Coronary Artery Disease
Authors: Al-Lamee Rasha K. , Shun-Shin Matthew J. , Howard James P. , Nowbar Alexandra N. , Rajkumar Christopher , Thompson David , Sen Sayan , Nijjer Sukhjinder , Petraco Ricardo , Davies John , Keeble Thomas , Tang Kare , Malik Iqbal , Bual Nina , Cook Christopher , Ahmad Yousif , Seligman Henry , Sharp Andrew S.P. , Gerber Robert , Talwar Suneel , Assomull Ravi , Cole Graham , Keenan Niall G. , Kanaganayagam Gajen , Sehmi Joban , Wensel Roland , Harrell Frank E. , Mayet Jamil , Thom Simon , Davies Justin E. , Francis Darrel P. 
Published: November 2019

Background:
Dobutamine stress echocardiography is widely used to test for ischemia in patients with stable coronary artery disease. In this analysis, we studied the ability of the prerandomization stress echocardiography score to predict the placebo-controlled efficacy of percutaneous coronary intervention (PCI) within the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina).

Methods:
One hundred eighty-three patients underwent dobutamine stress echocardiography before randomization. The stress echocardiography score is broadly the number of segments abnormal at peak stress, with akinetic segments counting double and dyskinetic segments counting triple. The ability of prerandomization stress echocardiography to predict the placebo-controlled effect of PCI on response variables was tested by using regression modeling.

Results:

At prerandomization, the stress echocardiography score was 1.56±1.77 in the PCI arm (n=98) and 1.61±1.73 in the placebo arm (n=85). There was a detectable interaction between prerandomization stress echocardiography score and the effect of PCI on angina frequency score with a larger placebo-controlled effect in patients with the highest stress echocardiography score (
P
interaction
=0.031). With our sample size, we were unable to detect an interaction between stress echocardiography score and any other patient-reported response variables: freedom from angina (
P
interaction
=0.116), physical limitation (
P
interaction
=0.461), quality of life (
P
interaction
=0.689), EuroQOL 5 quality-of-life score (
P
interaction
=0.789), or between stress echocardiography score and physician-assessed Canadian Cardiovascular Society angina class (
P
interaction
=0.693), and treadmill exercise time (
P
interaction
=0.426).

Conclusions:
The degree of ischemia assessed by dobutamine stress echocardiography predicts the placebo-controlled efficacy of PCI on patient-reported angina frequency. The greater the downstream stress echocardiography abnormality caused by a stenosis, the greater the reduction in symptoms from PCI.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02062593.
HIV Infection Is Associated With Variability in Ventricular Repolarization
Authors: Heravi Amir S. , Etzkorn Lacey H. , Urbanek Jacek K. , Crainiceanu Ciprian M. , Punjabi Naresh M. , Ashikaga Hiroshi , Brown Todd T. , Budoff Matthew J. , D’Souza Gypsyamber , Magnani Jared W. , Palella Frank J. , Berger Ronald D. , Wu Katherine C. , Post Wendy S. 
Published: November 2019

Background:
People living with human immunodeficiency virus (HIV+) have greater risk for sudden arrhythmic death than HIV-uninfected (HIV–) individuals. HIV-associated abnormal cardiac repolarization may contribute to this risk. We investigated whether HIV serostatus is associated with ventricular repolarization lability by using the QT variability index (QTVI), defined as a log measure of QT-interval variance indexed to heart rate variance.

Methods:
We studied 1123 men (589 HIV+ and 534 HIV–) from MACS (Multicenter AIDS Cohort Study), using the ZioXT ambulatory electrocardiography patch. Beat-to-beat analysis of up to 4 full days of electrocardiographic data per participant was performed using an automated algorithm (median analyzed duration [quartile 1–quartile 3]: 78.3 [66.3–83.0] hours/person). QTVI was modeled using linear mixed-effects models adjusted for demographics, cardiac risk factors, and HIV-related and inflammatory biomarkers.

Results:

Mean (SD) age was 60.1 (11.9) years among HIV– and 54.2 (11.2) years among HIV+ participants (
P
<0.001), 83% of whom had undetectable (<20 copies/mL) HIV-1 viral load (VL). In comparison with HIV– men, HIV+ men had higher QTVI (adjusted difference of +0.077 [95% CI, +0.032 to +0.123]). The magnitude of this association depended on the degree of viremia, such that in HIV+ men with undetectable VL, adjusted QTVI was +0.064 (95% CI, +0.017 to +0.111) higher than in HIV– men, whereas, in HIV+ men with detectable VL, adjusted QTVI was higher by +0.150 (95% CI, 0.072–0.228) than in HIV– referents. Analysis of QTVI subcomponents showed that HIV+ men had: (1) lower heart rate variability irrespective of VL status, and (2) higher QT variability if they had detectable, but not with undetectable, VL, in comparison with HIV– men. Higher levels of C-reactive protein, interleukin-6, intercellular adhesion molecule-1, soluble tumor necrosis factor receptor 2, and soluble cluster of differentiation-163 (borderline), were associated with higher QTVI and partially attenuated the association with HIV serostatus.

Conclusions:
HIV+ men have greater beat-to-beat variability in QT interval (QTVI) than HIV– men, especially in the setting of HIV viremia and heightened inflammation. Among HIV+ men, higher QTVI suggests ventricular repolarization lability, which can increase susceptibility to arrhythmias, whereas lower heart rate variability signals a component of autonomic dysfunction.
Effect of Alirocumab on Stroke in ODYSSEY OUTCOMES
Authors: Jukema J. Wouter , Zijlstra Laurien E. , Bhatt Deepak L. , Bittner Vera A. , Diaz Rafael , Drexel Heinz , Goodman Shaun G. , Kim Yong-Un , Pordy Robert , Reiner Željko , Roe Matthew T. , Tse Hung-Fat , Montenegro Valdovinos Pablo Carlos , White Harvey D. , Zeiher Andreas M. , Szarek Michael , Schwartz Gregory G. , Steg Philippe Gabriel ,   For the ODYSSEY OUTCOMES Investigators
Published: November 2019

Background:
Lowering of atherogenic lipoproteins, including low-density lipoprotein cholesterol (LDL-C), reduces the risk of ischemic stroke. However, concerns have been raised about very low LDL-C levels and a potential increased risk of hemorrhagic stroke. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome and elevated atherogenic lipoproteins, despite intensive statin therapy, targeting LDL-C levels of 25 to 50 mg/dL and avoiding sustained LDL-C <15 mg/dL. This prespecified analysis was designed to assess the effect of alirocumab on ischemic and hemorrhagic stroke. We hypothesized that for patients treated with alirocumab there would be a reduction in risk of ischemic stroke without increasing hemorrhagic stroke, irrespective of baseline LDL-C and of history of cerebrovascular disease.

Methods:
Patients were randomized to alirocumab or placebo 1 to 12 months after acute coronary syndrome. The risk of nonfatal or fatal ischemic or hemorrhagic stroke was evaluated, stratified by baseline LDL-C concentration and history of cerebrovascular disease. A potential association of very low achieved LDL-C with alirocumab treatment at month 4 and subsequent hemorrhagic stroke was assessed.

Results:

Median follow-up was 2.8 years. In total, 263 ischemic and 33 hemorrhagic strokes occurred. Alirocumab reduced the risk of any stroke (HR, 0.72 [95% CI, 0.57−0.91]) and ischemic stroke (HR, 0.73 [95% CI, 0.57−0.93]) without increasing hemorrhagic stroke (HR, 0.83 [95% CI, 0.42−1.65]). In total, 7164 (37.9%), 6128 (32.4%), and 5629 (29.7%) patients had a baseline LDL-C of <80, 80 to 100, and >100 mg/dL, respectively. The treatment effect on stroke appeared numerically greater for patients with higher baseline LDL-C, but there was no formal evidence of heterogeneity (
P
interaction
=0.31). The effect of alirocumab on stroke was similar among 944 patients (5.0%) with a history of previous cerebrovascular disease and among those without a history of cerebrovascular disease (
P
interaction
=0.37). There was no apparent adverse relation between lower achieved LDL-C and incidence of hemorrhagic stroke in the alirocumab group.

Conclusions:
In patients with recent acute coronary syndrome and dyslipidemia despite intensive statin therapy, alirocumab decreased the risk of stroke, irrespective of baseline LDL-C and history of cerebrovascular disease, over a median follow-up of 2.8 years. Furthermore, risk of hemorrhagic stroke did not depend on achieved LDL-C levels within the alirocumab group.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01663402.
Genetic Interleukin 6 Signaling Deficiency Attenuates Cardiovascular Risk in Clonal Hematopoiesis
Authors: Bick Alexander G. , Pirruccello James P. , Griffin Gabriel K. , Gupta Namrata , Gabriel Stacey , Saleheen Danish , Libby Peter , Kathiresan Sekar , Natarajan Pradeep 
Published: November 2019

Background:

Clonal hematopoiesis of indeterminate potential (CHIP) refers to clonal expansion of hematopoietic stem cells attributable to acquired leukemic mutations in genes such as
DNMT3A
or
TET2
. In humans, CHIP associates with prevalent myocardial infarction. In mice, CHIP accelerates atherosclerosis and increases IL-6/IL-1β expression, raising the hypothesis that IL-6 pathway antagonism in CHIP carriers would decrease cardiovascular disease (CVD) risk.

Methods:

We analyzed exome sequences from 35 416 individuals in the UK Biobank without prevalent CVD, to identify participants with
DNMT3A
or
TET2
CHIP. We used the
IL6R
p.Asp358Ala coding mutation as a genetic proxy for IL-6 inhibition. We tested the association of CHIP status with incident CVD events (myocardial infarction, coronary revascularization, stroke, or death), and whether it was modified by
IL6R
p.Asp358Ala.

Results:

We identified 1079 (3.0%) individuals with CHIP, including 432 (1.2%) with large clones (allele fraction >10%). During 6.9-year median follow-up, CHIP associated with increased incident CVD event risk (hazard ratio, 1.27 [95% CI, 1.04–1.56],
P
=0.019), with greater risk from large CHIP clones (hazard ratio, 1.59 [95% CI, 1.21–2.09],
P
<0.001).
IL6R
p.Asp358Ala attenuated CVD event risk among participants with large CHIP clones (hazard ratio, 0.46 [95% CI, 0.29–0.73],
P
<0.001) but not in individuals without CHIP (hazard ratio, 0.95 [95% CI, 0.89–1.01],
P
=0.08;
P
interaction
=0.003). In 9951 independent participants, the association of CHIP status with myocardial infarction similarly varied by
IL6R
p.Asp358Ala (
P
interaction
=0.036).

Conclusions:
CHIP is associated with increased risk of incident CVD. Among carriers of large CHIP clones, genetically reduced IL-6 signaling abrogated this risk.
REDUCE-IT USA
Authors: Bhatt Deepak L. , Miller Michael , Brinton Eliot A. , Jacobson Terry A. , Steg Ph. Gabriel , Ketchum Steven B. , Doyle Ralph T. , Juliano Rebecca A. , Jiao Lixia , Granowitz Craig , Tardif Jean-Claude , Olshansky Brian , Chung Mina K. , Gibson C. Michael , Giugliano Robert P. , Budoff Matthew J. , Ballantyne Christie M. ,   On behalf of the REDUCE-IT Investigators
Published: November 2019

Background:
Some trials have found that patients from the United States derive less benefit than patients enrolled outside the United States. This prespecified REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl - Intervention Trial) subgroup analysis was conducted to determine the degree of benefit of icosapent ethyl in the United States.

Methods:
REDUCE-IT randomized 8179 statin-treated patients with qualifying triglycerides ≥135 and <500 mg/dL and low-density lipoprotein cholesterol >40 and ≤100 mg/dL and a history of atherosclerosis or diabetes mellitus to icosapent ethyl 4 g/d or placebo. The primary composite end point was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or hospitalization for unstable angina. The key secondary composite end point was cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. A hierarchy was prespecified for examination of individual and composite end points.

Results:

A total of 3146 US patients (38.5% of the trial) were randomized and followed for a median of 4.9 years; 32.3% were women and 9.7% were Hispanic. The primary composite end point occurred in 24.7% of placebo-treated patients versus 18.2% of icosapent ethyl-treated patients (hazard ratio [HR], 0.69 [95% CI, 0.59–0.80];
P
=0.000001); the key secondary composite end point occurred in 16.6% versus 12.1% (HR, 0.69 [95% CI, 0.57–0.83];
P
=0.00008). All prespecified hierarchical end points were meaningfully and significantly reduced, including cardiovascular death (6.7% to 4.7%; HR, 0.66 [95% CI, 0.49–0.90];
P
=0.007), myocardial infarction (8.8% to 6.7%; HR, 0.72 [95% CI, 0.56–0.93];
P
=0.01), stroke (4.1% to 2.6%; HR, 0.63 [95% CI, 0.43–0.93];
P
=0.02), and all-cause mortality (9.8% to 7.2%; HR, 0.70 [95% CI, 0.55–0.90];
P
=0.004); for all-cause mortality in the US versus non-US patients,
P
interaction
=0.02. Safety and tolerability findings were consistent with the full study cohort.

Conclusions:
Whereas the non-US subgroup showed significant reductions in the primary and key secondary end points, the US subgroup demonstrated particularly robust risk reductions across a variety of individual and composite end points, including all-cause mortality.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01492361.
Feasibility of Pre‐Hospital Resuscitative Endovascular Balloon Occlusion of the Aorta in Non‐Traumatic Out‐of‐Hospital Cardiac Arrest
Authors: Brede Jostein Rødseth , Lafrenz Thomas , Klepstad Pål , Skjærseth Eivinn Aardal , Nordseth Trond , Søvik Edmund , Krüger Andreas J. 
Published: November 2019

Background

Few patients survive after out‐of‐hospital cardiac arrest and any measure that improve circulation during cardiopulmonary resuscitation is beneficial. Animal studies support that resuscitative endovascular balloon occlusion of the aorta (
REBOA
) during cardiopulmonary resuscitation might benefit patients suffering from out‐of‐hospital cardiac arrest, but human data are scarce.

Methods and Results

We performed an observational study at the helicopter emergency medical service in Trondheim (Norway) to assess the feasibility and safety of establishing
REBOA
in patients with out‐of‐hospital cardiac arrest. All patients received advanced cardiac life support during the procedure. End‐tidal
CO
2
was measured before and after
REBOA
placement as a proxy measure of central circulation. A safety‐monitoring program assessed if the procedure interfered with the quality of advanced cardiac life support.
REBOA
was initiated in 10 patients. The mean age was 63 years (range 50–74 years) and 7 patients were men. The
REBOA
procedure was successful in all cases, with 80% success rate on first cannulation attempt. Mean procedural time was 11.7 minutes (
SD
3.2, range 8–16). Mean end‐tidal
CO
2
increased by 1.75 kPa after 60 seconds compared with baseline (
P
<0.001). Six patients achieved return of spontaneous circulation (60%), 3 patients were admitted to hospital, and 1 patient survived past 30 days. The safety‐monitoring program identified no negative influence on the advanced cardiac life support quality.

Conclusions

To our knowledge, this is the first study to demonstrate that
REBOA
is feasible during non‐traumatic out‐of‐hospital cardiac arrest. The
REBOA
procedure did not interfere with the quality of the advanced cardiac life support. The significant increase in end‐tidal
CO
2
after occlusion suggests improved organ circulation during cardiopulmonary resuscitation.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
03534011.
<p class="HeadingRunIn"><strong>Life history and larval density of <em>Cheumatopsyche digitata</em> Mosely (Trichoptera: Hydropsychidae) in Opa Reservoir spillway, Ile-Ife, southwestern Nigeria</strong></p>
Authors: OGBOGU SYLVESTER , ADU WILLIAMS 
Published: November 2019

The life history and density of Cheumatopsyche digitata Mosely (Trichoptera: Hydropsychidae) were examined below Opa Reservoir in Ile-Ife, southwestern Nigeria. This caddisfly is the only species that occurs immediately below the impoundment auxiliary spillway where it closely associates with an aquatic bryophyte, Fontinalis sp. We collected larvae every month between July 2004 and June 2005 as long as larvae were available in the study site. The instar growth ratio was fairly constant and ranged from 1.198 to 1.402 (mean ± standard error = 1.285 ± 0.073) but mean head capsule width increased with larval development. The frequency distribution of head capsule width of larvae clustered into 5 size classes, suggesting 5 larval instars for C. digitata in the study site. Density of larvae ranged from 1,100 to 11,150 inds.m-2 (mean ± SE = 6739 inds.m-2 ± 3904.70), the highest densities occurring in October 2004 during the bloom of Fontinalis. The first larval instar appeared in July 2004. Adult emergence occurred mainly in December 2004 through January 2005 at the onset of reservoir draw-down and death of Fontinalis. These patterns indicate that C. digitata tended to show a univoltine life cycle in the study site.
<strong>The Trichoptera fauna of the Oja River (La Rioja, Spain)</strong>
Authors: VALLADOLID MARÍA , MARTÍNEZ-BASTIDA JUAN JOSÉ , ARAUZO MERCEDES 
Published: November 2019

The Oja River (La Rioja, Spain), belonging to the Ebro River Basin (NE Spain), encloses 3 different fluvial types (Mediterranean siliceous mountain, Mediterranean calcareous mountain and Humid calcareous mountain rivers) that give rise to a great diversity in the fauna of aquatic macroinvertebrates. During the years 2003−2009 benthic macroinvertebrates (aquatic stages and adults) were sampled in 7 sites along the river (3 in siliceous stretches, 1 in humid calcareous stretch and 3 in calcareous stretches) in different seasons. We have found 54 Trichoptera taxa, belonging to 31 genera and 16 families. Hydropsychidae (10 species), Limnephilidae (7 species) and Rhyacophilidae (7 species) were the dominant families. Most of the species have wide European distribution (50%), with the Iberian endemic species (22%) and Central and Western European species (18%) being the 2nd and 3rd groups in importance. The presence of some relict species in headwaters [Thremma gallicum McLachlan, Larcasia partita Navas and Odontocerum albicorne (Scopoli)] support the inclusion of this geographical area (Sierra de la Demanda, Iberian System Mountains) in the list of European pre-Pleistocene refuges for the Trichoptera fauna.
Possible Increased Frequency of ENSO-Related Dry and Wet Conditions over Some Major Watersheds in a Warming Climate
Authors: Sun Qiaohong , Miao Chiyuan , AghaKouchak Amir , Mallakpour Iman , Ji Duoying , Duan Qingyun 
Published: November 2019

AbstractPredicting the changes in teleconnection patterns and related hydroclimate extremes can provide vital information necessary to adapt to the effects of the El Niño–Southern Oscillation (ENSO). This study uses the outputs of global climate models to assess the changes in ENSO-related dry/wet patterns and the frequency of severe dry/wet events. The results show anomalous precipitation responding asymmetrically to La Niña and El Niño, indicating the teleconnections may not simply be strengthened. A “dry to drier, wet to wetter” annual anomalous precipitation pattern was projected during La Niña phases in some regions, with drier conditions over southern North America, southern South America, and southern central Asia, and wetter conditions in Southeast Asia and Australia. These results are robust, with agreement from the 26 models and from a subset of 8 models selected for their good performance in capturing observed patterns. However, we did not observe a similar strengthening of anomalous precipitation during future El Niño phases, for which the uncertainties in the projected influences are large. Under the RCP4.5 emissions scenario, 45 river basins under El Niño conditions and 39 river basins under La Niña conditions were predicted to experience an increase in the frequency of severe dry events; similarly, 59 river basins under El Niño conditions and 61 river basins under La Niña conditions were predicted to have an increase in the frequency of severe wet events, suggesting a likely increase in the risk of floods. Our results highlight the implications of changes in ENSO patterns for natural hazards, disaster management, and engineering infrastructure.
Beyond Turnover Time: Constraining the Lifetime Distribution of Water Vapor from Simple and Complex Approaches
Authors: Sodemann Harald 
Published: November 2019

Abstract
The time water vapor spends in the atmosphere from evaporation to precipitation, termed here the water vapor lifetime, is of fundamental relevance for characterizing the water cycle, for the turnover of mass and energy, causes of precipitation extremes, and the recycling of precipitation over land. While the global average lifetime of water vapor is commonly considered as about 8–10 days, recent work indicates that the distribution of water vapor lifetimes is highly skewed, and that a large part of the water vapor could have average lifetimes of about 4–5 days. Besides calling for scrutiny of these new estimates, these findings also prompt an investigation of the factors shaping the distribution of the lifetime of water vapor. Using idealized setups and reanalysis data, I explore the influence of heterogeneity and nonstationarity on water vapor age and lifetime. The combination of nonstationarity and heterogeneity allows for short and long local lifetimes and water vapor ages, while maintaining the global average mass balance and corresponding mean water vapor lifetime. A plausibility argument based on humidity-weighted winds suggests that median lifetimes of 4–5 days are more consistent with weather system patterns in the extratropics. I propose that the median of the lifetime is more representative, since its mean value is affected by uncertainty originating from a long, thin tail. To more comprehensively understand the water vapor lifetime, methods will need to report the full lifetime distribution. Simulations with artificial water tracers could thereby provide the framework to compare different methods consistently in the future, while stable water isotopes could serve as an observational constraint.