bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1807Manifestations and outcome of cardiac sarcoidosis - does gender matter?
Authors: Simonen P , Lehtonen J , Kupari M 
Published: October 2019

Abstract

Background
Sarcoidosis is characterized by the formation of inflammatory epithelioid-cell granulomas in various organs with cardiac involvement as its most ominous manifestation. A female preponderance in the prevalence of cardiac sarcoidosis (CS) is well known but other possible gender differences remain poorly studied.

Purpose
We set out to evaluate gender-related differences in the manifestations and long-term outcome of CS.

Methods
We reviewed the history, diagnostic procedures, details of treatment and outcome of 158 consecutive patients with histologically confirmed CS diagnosis between 1988 and 2017 at our hospital. Follow-up data were collected up to the end of 2018.

Results
The study population consisted of 51 men and 107 women (68%). At presentation, men were younger than women (mean age 47 years vs 51 years, p=0.045) and had more often a history of pre-existing extracardiac sarcoidosis (25% vs 10%, p=0.013). Isolated CS remained less common in men even after the complete diagnostic process (50% vs 75%, p=0.001). The main presenting CS manifestations were atrioventricular block, ventricular tachyarrhythmias and heart failure in 39%, 30% and 18% of men vs in 54%, 23% and 17% of women, respectively (p=0.183). Left ventricular ejection fraction at presentation averaged 49±11% in men and 49±13% in women (p=0.845). Troponin T was elevated more often in men at the presentation (46% vs 26%, p=0.024). At magnetic resonance imaging, pathological myocardial late gadolinium enhancement was observed in 87% of men and 84% of women (p=0.615). Myocardial “hot spot” at 18-F fluorodeoxyglucose positron emission tomography was also equally common (87% in men, 92% in women, p=0.468). An intracardiac cardioverter-defibrillator was implanted in 78% of men and 75% of women (p=0.693) and nearly all patients (99%, no gender difference) received immunosuppressive therapy. During the mean follow-up of 64 months, 10 of 51 men versus 30 of 107 women either died of a cardiac cause, suffered an aborted sudden cardiac death or underwent transplantation. The composite event-free survival did not differ between genders (Figure 1. Log-rank p=0.852).

Conclusions
Two thirds of CS patients are women. At disease presentation, women are older than men and their sarcoidosis is more often isolated to the heart but the clinical manifestations, diagnostic findings and long-term outcome are comparable in the two genders.
P1813Impact of cardiac MRI imaging on detection rates of myocarditis
Authors: Morgenstern A , Mikolich B , Morgenstern D , Mikolich J R 
Published: October 2019

Abstract

Background
The Lake Louise Criteria for the diagnosis of myocarditis by cardiac MRI (CMR) was published in 2009 (JACC April 2009; 53(17): 1475–1487) utilizing T2 STIR, “early” gadolinium enhancement (EGE) and late gadolinium enhancement (LGE). In 2012, our CMR unit adopted a chest pain protocol to enhance detection of inflammatory heart disease, using all 3 pulse sequences. In 2017, T1 relaxing mapping and T2 relaxation mapping were added to the chest pain protocol.

Purpose
This study was designed to assess the impact of pulse sequence changes in the CMR chest pain protocol on the detection rate of myocarditis.

Methods
An institutional cardiac imaging database was queried for all patients with chest pain who underwent a CMR study from 2009 thru 2018. The number of newly diagnosed cases of myocarditis per year was computed, based on the prevailing CMR diagnostic criteria at that time. The detection rate of new myocarditis cases per year, was calculated by dividing the number of new cases by the total of CMR studies performed for evaluation of chest pain, during each calendar year.

Results
Of the 4,946 patients in the cardiac imaging database, 2,126 patients underwent CMR imaging for complaints of chest pain. Detection rates of myocarditis by year are shown in Figure 1. Prior to inclusion of T1 STIR pulse sequences, CMR detection of myocarditis was nearly nil. Use of T2 STIR imaging allowed for an increased rate of myocarditis detection. However, addition of T1 mapping and T2 mapping in 2017 resulted in another increase in myocarditis detection rates from baseline.
Figure 1. Detection rate of myocarditis.

Conclusions
Detection rates of myocarditis using CMR were improved by using T2 STIR pulse sequences, per the initial Lake Louise Criteria. Further enhancement of myocarditis detection rates is achieved by addition of T1 and T2 mapping. These CMR impact data provide additional support for the adoption of the recently modified Lake Louise Criteria (JACC Dec 2018; 72(24): 3158–3176).
P1824Aortic wall shear stress in bicuspid aortic valve disease - 10-year follow-up
Authors: Hanigk M , Burgstaller E , Latus H , Shehu N , Zimmermann J , Martinoff S , Hennemuth A , Ewert P , Stern H , Meierhofer C 
Published: October 2019

Abstract

Introduction
Bicuspid aortic valve (BAV) disease leads to deviant complex helical flow patterns in the aorta - especially in the mid-ascending (AoA) part. In association with congenital BAV, aortic wall alterations such as aortic dilatation and dissection may occur. Among others, wall shear stress (WSS) could be one parameter to contribute to the prediction of the long-term outcome of patients with BAV. 4D-flow in cardiovascular magnetic resonance has been established as a valid method to estimate WSS.

Purpose
The aim of this study is to reevaluate WSS and comparing it to values generated in the same patient cohort with bicuspid aortic valve disease in 2008. No one of the above had aortic dilation in 2008 but proven helical flow pattern. The long term follow-up study might show changes in WSS over the period of ten years.

Methods
Ten complete 4D flow datasets of patients (age at follow-up: median 34.5 years; range 19–41 years) with bicuspid aortic valve disease without enlargement of the aorta were obtained in 2008 and reevaluated in 2018/2019 in the same patient collective. Mean WSS values were calculated with identical specific software tools. All data were analyzed by two experienced investigators.

Results
Aortic diameters at the level of the mid AoA did not change significantly in the 10-year period. The WSS values were lower in 2018 at all levels of the ascending aorta (Table 1). Indexed aortic diameters at the level of the mid ascending aorta did not change, median difference 0.06 cm/m2 (range −0.1 cm/m2 to 0.2 cm/m2; p=0.28), absolute values of indexed AoA diameters in 2018/2019 ranged from 1.27 cm/m2 to 2.2 cm/m2 (median 1.76 cm/m2).
Table 1 WSS magnitudinal [N/m2] 2008 (n=10) 2018 (n=10) Median difference p-value median range median range Level aortic bulb 0.95 0.80–1.46 0.42 0.34–0.82 −0.53 <0.01 Level mid ascending aorta 0.72 0.40–0.98 0.39 0.34–0.59 −0.33 <0.01 Level brachiocephalic trunc (BCT) 0.71 0.38–1.03 0.40 0.37–0.61 −0.31 <0.01

Conclusions
Indexed AoA diameters in BAV disease did not change significantly over a 10-year period. WSS of AoA was less compared to values generated in 2008. This might be explained by a slight alteration in hemodynamic flow patterns by the aging aorta, but not by changes of the aortic diameters. Possibly a drop of WSS in BAV could serve as a marker for a benign long term course.
P1825The characteristics of type A acute aortic dissection in patients with out-of-hospital cardiopulmonary arrest analyzed by computed tomography
Authors: Takeuchi S , Yoshino H , Yamaguchi Y , Soejima K 
Published: October 2019

Abstract

Background/Introduction
Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality rates, and is reported to have a 1–2% fatality rate per hour after onset. Therefore, many cases with AAD are considered to be included in patients with out-of-hospital cardiopulmonary arrest (OHCPA). However at this time, there is a lack of documentation of these cases.

Purpose
In this study, we investigated the characteristics of Stanford type A AAD (TAAD) cases between OHCPA cases and survival cases using acute phase CT.

Methods
An acute phase CT scanning was performed on consecutive patients with OHCPA transported to our hospital in order to estimate the causes of cardiopulmonary arrest (CPA). Based on our emergency outpatient databases, we retrospectively reviewed the acute phase CT findings of OHCPA TAAD cases and survival TAAD cases diagnosed at our hospital during the same period.

Results
Of 1,011 consecutive patients with OHCPA, except for exogenous death from 1 January 2015 to 31 December 2017, 934 patients underwent CT examination in the acute phase. Based on the clinical course and CT findings, 71 of the 934 patients (7.6%) were diagnosed with AAD. Out of 71 AAD patients, 66 were TAAD patients, and all of these patients were enrolled in the OHCPA group. On the other hand, 41 patients were registered as the survival group during the same period. These patients were diagnosed as TAAD and were admitted to our hospital without falling into CPA. Increased Age (78±8 years old vs 69±13 years old, P<0.01), visible intimal flap (63.6% vs 41.5%, P=0.043), bloody pericardial effusion (72.7% vs 26.8%, P<0.01), hemothorax (24.2% vs 0%, P<0.01) were significant in patients with the OHCPA group compared with the survival group. In addition, 56 patients with OHCPA (84.8%) had at least one of massive bloody pericardial effusion or massive hemothorax. Using multivariate logistic regression analysis, increased age and bloody pericardial effusion were both found to be independent factors related to OHCPA.

Conclusion
In this study, it is thought that the main characteristics of the CT findings with OHCPA due to TAAD are a rupture of the aorta into the pericardial cavity or thoracic cavity.
P1826Computational fluid dynamic analysis of acute aortic dissection
Authors: Numata S , Keiichi I , Yamazaki S , Kanda K , Yaku H 
Published: October 2019

Abstract

Background
Mechanism of acute aortic dissection still is not well understood. It is very difficult to predict where, when, and how acute aortic dissection occurs. This time we focused on blood flow velocity (FV), wall shear stress (WSS), and oscillatory shear index (OSI) which is three dimensional fluctuations of WSS inside ascending aorta. It is well recognized that a higher or lower WSS may cause intimal dysfunction, which could result in the progression of atherosclerosis. Furthermore, because of the non-slip boundary mechanical equilibrium of forces, WSS will separate the inner and outer layers of the aorta. This sheer force could stress the medial tissue and result in degeneration. OSI has been reported as important hemodynamic parameter that is highly associated with the progression of atherosclerosis by inducing radical oxygen production of the endothelial cells. Therefore, OSI may be more closely associated with the degeneration of the media in comparison with WSS. This time FV, WSS, and OSI was evaluated using computational fluid dynamics to identify the location of acute aortic dissection entry.

Method
Using computed tomography data of three patients (Case A, B, C) who had acute aortic dissection, each three pre-dissection aorta model was made. Computer simulation images of four dimensional pulsatile blood flow was made and pulsatile cardiac flow from one cardiac cycle was simulated. A three-dimensional movie was made to evaluate FV, WSS, and OSI. One normal size aorta was evaluated as a control.

Results
In control, blood flow inside ascending aorta was laminar, on the contrary, spiral flow was observed in three dissection cases. FV was slightly higher in dissection case (control: 0.56m/s, A: 0.77m/s, B: 1.05m/s, C: 0.35m/s). Maximum WSS in ascending aorta was 3.24Pa in control. In dissection cases, there was patchy high (A: 18.6Pa, B: 25.6Pa, C: 4.0Pa,) WSS lesion in ascending aorta. In case A and B, these patchy high lesions are close to the entry site. In all three dissection case, OSI was high around entry site.
Figure 1

Conclusion
According to our computer simulation, patchy high WSS and high OSI lesion is related with acute dissection entry site at the ascending aorta.

Acknowledgement/Funding
None
P1827Maximum systolic flow deceleration rate in the false lumen by 4D-flow MRI is associated with aortic dilatation in patients with chronic descending aorta dissection
Authors: Ruiz Munoz A , Guala A , Dux-Santoy L , Teixido-Tura G , Sao-Aviles A , Granato C , Lopez-Sainz A , Servato M L , La Mura L , Galian L , Casas G , Gonzalez-Alujas T , Ferreira I , Evangelista A , Rodriguez-Palomares J F 
Published: October 2019

Abstract

Introduction
Patent false lumen (FL) in aortic dissection has been associated with poor prognosis mainly due to aortic expansion. Although morphologic variables have been related to aortic dilatation as expression of high pressure in the FL, they do not reflect flow characteristics. We propose the maximum systolic flow deceleration rate (MSDR) in the FL, quantified by 4Dflow, assuming that flow should be strongly decelerated during systole under high pressure.

Methods
Twenty-nine patients with a patent FL after aortic dissection (no Marfan syndrome) and with a follow-up of at least 3 years underwent a contrast-enhanced 4D-flow MR. FL acceleration was calculated during the cardiac cycle in a sub-volume of the descending aorta (5 cm around the level of the pulmonary bifurcation). MSDR was determined as the maximum minus the minimum acceleration in systole over the corresponding time interval (Figure 1a). Aortic growth rate (GR) was defined as the difference between final and initial aortic diameters obtained by angio-CT over the period of follow-up. Population was divided into tertiles based on GR.

Results
Demographic, clinical variables or basal aortic diameter did not show differences among GR groups (Table 1). MSDR was statistically different in patients with a GR <1mm/year (group 1) compared to fast-dilating patients (groups 2, 3) (Figure 1c). MSDR showed a positive linear correlation with GR resulting in a Pearson's correlation of 0.481 (p=0.008) (Figure 1b).
Table 1. Demographic and other variables Tertile 1 Tertile 2 Tertile 3 p-value Age (year) 63.4 (±13.5) 62.5 (±13.6) 64.6 (±6.7) 0.902 BSA (m2) 2.0 (±0.2) 1.8 (±0.2) 1.9 (±0.1) 0.213 Men 6 (86%) 4 (57%) 4 (100%) 0.210 Hypertension 4 (66%) 5 (71%) 4 (100%) 0.438 Atherosclerosis 1 (17%) 1 (14%) 0 (0%) 0.699 Initial diameter 45.0 (±7.69) 36.0 (±4.2) 37.0 (±6.5) 0.078 Final diameter 49.5 (±6.74) 44.9 (±5.7) 59.2 (±9.8) 0.049* Follow-up (year) 11.8 (±8.79) 7.9 (±3.3) 8.1 (±4.0) 0.921 Aortic GR (mm/year) 0.3 (±0.3) 1.2 (±0.3) 2.6 (±1.0) 0.001* MSDR (cm/s3) 1212 (±468) 2411 (±1034) 2558 (±1098) 0.005* Values are mean (±SD) or n (%).

Conclusion
MSDR of flow in the FL derived from 4D-flow RM is related to GR of dissected descending aorta. It is useful to discriminate mild vs. significant aorta enlargement and identify patients who may benefit from earlier therapy.
P1828Aortic calcification detected by computed tomography and aortic vulnerable plaques: aortic angioscopy study
Authors: Kojima K , Ebuchi Y , Migita S , Morikawa T , Mineki T , Tamaki T , Akutsu N , Murata N , Kitano D , Sudo M , Fukamachi D , Takayama T , Hiro T , Hirayama A , Okumura Y 
Published: October 2019

Abstract

Background
Aortic calcification is associated with atherosclerotic risk factors and an increased risk of death and cardiovascular disease. However, the relationships aortic calcification and aortic plaque instability are not yet elucidated. Recently, some reports showed non-obstructive aortic angioscopy seemed to visualize atherosclerotic changes of aortic wall more clearly compared with computed tomography (CT). The purpose of this study was to evaluate whether aortic calcification is associated with aortic vulnerable plaques in patients with cardiovascular disease.

Methods
We investigated 60 consecutive patients with confirmed or suspected coronary artery disease who underwent both aortic angioscopy and CT. The AC volume (ACV) was measured using the volume-rendering method by extracting the area >130 HU within the whole aorta. ACV index (ACVI) was defined as ACV divided by the body surface area. We evaluated the number of ruptured plaque (RP), ulceration and fissure by aortic angioscopy in the whole aorta. We excluded 4 hemodialysis patients. All patients were divided into the median value of ACVI.

Results
The mean age of patients was 68±10. The median of ACVI was 10.7 ml/m2 [3.9–22.7]. High ACVI patients had significantly greater number of RP, ulceration and atheromatous plaques detected by aortic angioscopy compared with those of low ACVI (2.2±2.7 vs 0.8±1.1, p=0.033, 1.6±1.2 vs 0.9±1.0, p=0.041, 4.0±3.1 vs 1.9±1.8, p=0.009, respectively). Furthermore, the patients without aortic calcification did not have RP at all. In a multivariate model, the number of the atheromatous plaques was independently associated with high ACVI (odds ratio 1.57, 95% confidence interval 1.07–2.69, p=0.018)

Conclusions
Aortic calcification detected by CT was related to aortic vulnerable plaques in patients with cardiovascular disease.
P1829Accumulation of advanced glycoxidation end products (AGEs) is associated with the severity of aortic stenosis in patients with concomitant type 2 diabetes
Authors: Kopytek M , Zabczyk M , Undas A , Natorska J 
Published: October 2019

Abstract

Background
Accumulation of advanced glycoxidation end products (AGEs) leads to chronic inflammation, glycation of proteins and tissue damage, particularly in patients with diabetes mellitus (DM).

Purpose
To evaluate whether increased valvular accumulation of AGEs in patients with aortic stenosis (AS) and concomitant diabetes (AS-DM) is associated with enhanced valvular inflammation, increased oxidative stress and AS progression.

Methods
We enrolled 50 patients (28 women), aged 67.2±7.9 years with severe AS (transvalvular gradients: PGmean=52.9±13.4 mmHg, PGmax=84.9±18.7 mmHg), including 30 subjects with type 2 DM (glycaemia 6.3±1.9 mM/l, glycated haemoglobin [HbA1c] 6.9±1.4%), who underwent aortic valve replacement. Valvular expression of AGEs, AGE receptors (RAGE), interleukin-6 (IL-6), prothrombin (FII), C-reactive protein (CRP), and reactive oxygen species (ROS) were evaluated ex vivo by single/double-immunostaining. The percentage of immuno-positive areas was analyzed for each valve.

Results
There were no differences with regard to age and AS severity between AS and AS-DM patients. Subjects with AS-DM had elevated valvular expression of both AGE and RAGE (41.3±15.2% and 17.6±7.1%, respectively) as compared to non-DM (9.4±3.9% and 3.4±2.4%, respectively; all p<0.001). In AS-DM patients AGE/RAGE showed co-expression in 51.5% of areas. The percentage of ROS-, CRP-, and IL-6-positive areas was elevated within AS-DM compared to AS valves (10.9±2.4%, 6±0.3%, and 5.7±1.4% vs 4.8±1.7%, 2.5±0.1%, and 1.6±0.9%, respectively; all p<0.05). Valvular expression of FII was elevated in AS-DM patients compared to those with AS (17.3±2.5% vs. 11±2%, p<0.05). In AS-DM patients the percentage of valvular AGE-positive areas correlated with HbA1c (r=0.44, p<0.05) and blood glucose levels (r=0.57, p<0,05). The amount of valvular RAGE correlated with HbA1c (r=0.63, p=0.009) but not with blood glucose levels. In AS-DM patients we found positive associations between the amount of valvular AGE and IL-6 with disease severity measured as aortic valve area (AVA; r=−0.83, p<0.0001; r=−0.64, p<0.001, respectively) and PGmax (r=0.54, p<0.05; r=0.52, p<0.05, respectively) but not with PGmean. There were no associations between PGmax/PGmean and HbA1c levels in the whole AS-DM group. However, patients with HbA1c >6.5% (n=19) or ≤6.5% (n=11) were characterized by higher PGmax and PGmean compared to those with HbA1c ≤6.5% (93.3±8.9 mmHg vs 67.5±7.2 mmHg and 63.6±6.5 mmHg vs 52±77 mmHg, respectively, all p<0.05).

Conclusions
Patients with AS-DM compared to those with AS demonstrate enhanced valvular AGEs accumulation and increased RAGE expression along with accelerated inflammation and oxidative stress. The accumulation of valvular AGE correlated with both hyperglycaemia and AS severity.

Acknowledgement/Funding
This work was supported by the grant from the Polish National Science Center (UMO-2015/19/B/NZ5/00647 to J.N).
P1830The Relationship between Spontaneous Ruptured Aortic Plaques/Injuries and Cardiovascular
Authors: Komatsu S , Takahashi S , Yutani C , Kodama K 
Published: October 2019

Abstract

Background
Non-obstructive general angioscopy has enabled to demonstrate high incidence of various types of spontaneous ruptured aortic plaques/injuries (SRAPIs).

Purpose
The aim of the study is to clarify the relationship between SRAPI and cardiovascular risk factors.

Methods
A total of 439 consecutive patients who had or suspected coronary artery disease were performed angioscopy and were screened SRAPI from ascending aorta to iliac artery. The incidence and the number of SRAPI were analyzed. Association between the total number of total SRAP and patients' characteristics were analyzed.

Results
The total number of SRAPI detected was 2211, 10 [4,22](median [IQR]) per patient.
The numbers of high incidence of representative SRAPI, such as erosion, intramural bleeding, puff-chandelier rupture, puff rupture, fissure, flap, bleeding from fissure, and subintimal bleeding were 327, 313, 268, 262, 224, 167, 120, and 91, respectively. Stepwise multiple linear regression analysis indicated that age, smoking, HbA1c, and coronary heart disease significantly affected the numbers of overall SRAPI (Table).

Conclusions
SRAPIs were associated with cardiovascular risk factors.
P1832Myocardial injury assessed by T1 mapping after on-pump and off-pump coronary artery bypass grafting. a pre-specified analysis of mass V trial
Authors: Dallazen A R , Hueb W , Rezende P C , Boros G A B , Ribas F F , Nomura C H , Rochitte C E , Morais T , Lima E G , Martins E B , Carvalho G F , Ribeiro M O L , Serrano Junior C V , Ramires J A F , Kalil Filho R 
Published: October 2019

Abstract

Background
Myocardial structural damage may occur during coronary artery bypass grafting (CABG) surgery and is identified by the significant release of cardiac biomarkers. However, the evidence of these structural myocardial changes after CABG by current imaging methods remains unknown. To evaluate myocardial structure, we used the T1 mapping of cardiac magnetic resonance (CMR) before and after on-pump and off-pump CABG.

Methods
Patients with multivessel coronary artery disease and preserved ventricular function were included and underwent on or off-pump CABG. CMR and T1 mapping were performed using the MOLLI technique (modified Look-Locker inversion-recovery). Values of native T1 and extracellular volume fraction (ECV) were compared before and after on and off-pump procedures.

Results
Of 110 eligible patients, 34 were excluded due to the presence of new late enhancement or edema. Of 76 patients remained, 32 (42%) underwent on-pump (Group A) and 44 (58%) off-pump CABG (Group B). All baseline characteristics were similar between groups, besides the Syntax Score that was higher in Group A (25 × 21, p=0.002). For group A, native T1 before and after procedures was 1013 ms (998–1043) and 1004 ms (793–1048), p=0.19, and ECV was 26.4 (23.9–27.6) and 31.2 (27.6–33.9), p<0.001. For group B, native T1 before and after procedures was 1015 ms (970–1044) and 992 ms (867–1051), p=0.003, and ECV 27.5 (25.3–29.9) and 30.3 (26.5–34.3), p=0.02. The comparison of native T1 difference before and after procedures between groups A and B was not significant (Delta T1 −9.8 (−102 to 51.8) × −25.4 (−119 to 51,2), p=0.87. However, the difference of ECV between groups was statistically significant (ECV Delta 3.8 (2.2 to 7.1) × 1.3 (−1.1 to 4.9), p=0.039, respectively, for groups A and B.
Figure 1

Conclusion
In this sample, T1 mapping identified significant myocardial structural changes in both surgical revascularization procedures. Additionally, a marked myocardial injury generated by ECV changes were observed after on-pump CABG.