bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 1516: Does A Normal Coronary Angiography Really Mean A Good Prognosis In Patients With Acute Coronary Syndromes?
Authors: Dudek Dariusz , Depukat Rafal , Chyrchel Bernadeta , Siudak Zbigniew , Dziewierz Artur , Rzeszutko Lukasz , Legutko Jacek , Dubiel Jacek S 
Published: July 2021

Introduction: Coronary angiography remains gold standard for diagnosis of coronary artery disease (CAD) and acute coronary syndrome (ACS). Among patients (pts) referred to cath-lab with diagnosis of ACS exists a subgrup presenting symptoms of myocardial ischaemia and no criticial coronary lesions in angiography. The long-term outcome is not well established and managing treatment for such patients is still challenging.
Aim: Evaluation of clinical outcome and received pharmacotherapy in pts with ACS and no significant coronary lesions.
Methods: We collected data of consecutive pts admitted to cath-lab between July 2004 and June 2006 with diagnosis of ACS and coronary angiography considered as normal or near-normal (lesions under 50% of stenosis assessed visually). We analyzed demographic data, angiographic, electrocardiographic and laboratory tests results. During long-term follow-up received treatment, major adverse cardiac events were assessed.

Results: One hundred eight pts (56 females; mean age 58.5 +/−13.5 years) admitted to cath-lab with diagnosis of acute myocardial infarction (38%) or unstable angina (62%) had normal or near normal coronary angiography. Mean LVEF was 52.6 +/− 12.9%, prevalence of CAD risk factors was: hypertension 72.2%, hypercholesterolemia 51.8%, diabetes mellitus 13.0%. The treatment administered during the hospitalization and follow-up is shown in table

. During the mean follow-up of 16.5 months (range 6–30 months) all-cause mortality rate was 9.3%, cardiovascular mortality rate was 7.4%, repeat hospitalization for cardiovascular reasons 20.4%.

Conclusions: Long-term outcome of patients with ACS and nonobstructive coronary angiography is not as benign as it is commonly thought. These patients have high rate of major adverse cardiac events and rehospitalization for cardiovascular reasons. They also are not receiving therapy directed at aggressive antiatherosclerotic therapy with statins, ACE-I and b-blockers.

Treatment administered during the hospitalization, at discharge and during the follow-up
Abstract 1520: Are Contemporary Patients Hospitalized with Acute Coronary Syndrome Being Discharged on Intensive Lipid Lowering Therapy?: An Analysis Of 22, 807 Hospitalizations In GWTG-CAD
Authors: Deedwania Prakash C , Fonarow Gregg C , Cannon Christopher P , Dai David 
Published: July 2021

Background: Based on the documented benefits of intensive lipid lowering therapy (LLT) with statins in patients with acute coronary syndrome (ACS) guidelines recommend intensive LLT in ACS patients. However, little information is available regarding application of these guidelines in hospitalized ACS patients.
Methods: The Get With The Guidelines database was analyzed for all ACS hospitalizations from 07/2005 to 04/2007 at 329 hospitals across the USA of which 277 sites reported the dose of LLT. Intensive LLT was defined as that expected to provide a >50% reduction in LDL: atorvastatin 40/80 mg, rosuvastatin 20/40 mg, simvastatin 80 mg, and any statin combined with ezetimibe. All other LLTs were considered less intensive therapy.
Results: Of 60,453 ACS hospitalizations, 84.4% eligible were discharged on LLT. LLT dosing was available in 22,807 (37.7%). Of these patients only 8400 (36.8%) of ACS patients were treated at time of discharge with intensive LLT, whereas 63.2% were discharged on less intensive LLT. Comparison of demographic characteristic and clinical features revealed that older age and female gender were associated with use of less intensive LLT whereas patients undergoing PCI with a stent and history of smoking were more likely to receive intensive LLT. Admission LDL level was modestly predictive of more intensive LLT.
Conclusions: In this large cohort of contemporary ACS patients, close to two-thirds of eligible patients were not discharged on intensive LLT. Age and gender appear to be significant contributors to less intensive LLT. These findings emphasize the ongoing need for implementation of current guidelines for intensive LLT in ACS patients.
Abstract 1525: High Density Lipoprotein Cholesterol is Protective Against the Development of Cardiac Rhythm Disturbances in the Non-ST Segment Elevation Acute Coronary Syndrome
Authors: Kalayeh Nick , Kahn Yosef , Yarkoni Alon , Gonzalez Francisco J , Loli Akil , Cardello Frank , Halligan Robert E , Gerkin Richard , Desser Kenneth B 
Published: July 2021

INTRODUCTION: Many studies have demonstrated that reduced high-density lipoproteins (HDL) levels and elevated triglyceride (TG)/HDL ratio correlate with the development of chronic ischemic heart disease. The role of HDL and the development of cardiac rhythm disturbances in the non-ST segment elevation acute coronary syndrome (ACS) is unclear.
HYPOTHESIS: We assessed the hypothesis that HDL might be protective against development of cardiac rhythm disturbances. Additionally, any protective effect was compared with TG/HDL and LDL/HDL in this setting.
METHODS: A total of 6881 patients who presented during 2000–2003 with non-ST segment elevation ACS had fasting lipid panels collected within the first 24 hours of admission. Patients were followed for the development of rhythm disturbances of up to 6 years after initial presentation, with a mean of 1269 days. These patients were further separated into diabetic and nondiabetic groups.
RESULTS: After adjustment for ischemic heart disease, congestive heart failure, stroke, peripheral vascular disease, hypertension, low density lipoprotein cholesterol, triglycerides, age, and body mass index, higher HDL levels were found to be independently protective against developing atrial fibrillation and other cardiac rhythm disturbances. TG/HDL and LDL/HDL were also protective of cardiac arrhythmias but not with the same power as low HDL (HDL > 31mg/dl, HR = 3.69, 95% CI=3.01– 4.53, P < 0.05).
CONCLUSIONS: Based on the above results, patients with lower HDL levels during hospitalizations with non-ST segment elevation ACS have a greater chance of developing cardiac rhythm disturbances independent of other risk factors. Although higher TG/HDL and LDL/HDL are also predictive, lower HDL is associated with highest OR for the development of cardiac arrhythmia among diabetic and non-diabetic patients with non-ST elevation with ACS.
Abstract 1527: Impact Of Glomerular Filtration Rate On Outcome In Consecutive Patients With Stemi In Clinical Practice: Results Of The Acos-registry
Authors: Gitt Anselm K , Wienbergen Harm , Towae Frank , Gottwik Martin G , Senges Jochen 
Published: July 2021

Background: Patients with renal failure have a higher cardiovascular morbidity and mortality. Little is known about the impact of renal failure on the acute outcome of ST-elevation myocardial infarction (STEMI) in clinical practice.
Methods: Between 2000 and 2002 a total of 8303 consecutive patients with STEMI were enrolled into the multicenter ACOS-registry in Germany. We examined the impact of the glomerular filtration rate (GFR) on hospital outcome in clinical practice. GFR was calculated using the Cockroft-Gault-Formula.
Results: Patients with reduced GFR were older, more often female, more often had prior myocardial infarctions and coronary interventions, a higher prevalence of concomitant diseases and a worse TIMI-risk score. than patients with GFR >90 ml/min. Patients with impaired GFR did receive acute reperfusion therapy significantly less often. After adjustment for these differences by multivariate regression analysis, renal failure was associated with significant higher hospital mortality (GFR 30–59 ml/min: OR 2.38; GFR < 30 ml/min: OR 5.18, p<0.01).
Conclusion: In consecutive STEMI-patients severe renal failure (GFR<30 ml/min) was independently associated with a more than 5-fold increased hospital mortality in clinical practice.
Abstract 1616: Intermediate Dose of Pentaglobin Eradicates Effectively Inflammation in Parvo B19 and Adenovirus Positive Myocarditis
Authors: Maisch Bernhard , Haake Hendrik , Schlotmann Nadine , Pankuweit Sabine 
Published: July 2021

152 consecutive patients with myocarditis according to the quantitative World Heart Federation Criteria (> 14 infiltrating cells/mm
2
by endomyocardial biopsy(EMB)) were analysed for cardiotropic agents. In 90 pts parvoviruses B19 (59,5%) and in 36 pts adenoviruses (23,8%) were assessd by PCR as causative viral pathogens. All virus positive patients were treated with 10 g/day Pentaglobin® i. v.(enriched IgG, IgA and IgM preparation, Biotest) at day 1 and 3. After six months all patients were reevalutated clinically, 73 patients (48%) in addition by EMB.

Methods: We compared the following parameters before and after therapy: left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), shortening fraction (SF) by transthoracic echocardiography and LVEF or the left ventricular end-diastolic volume index (LVEDVI) using angiography. For exercise capacity we evaluated exercise ECG by treadmill test and clinical parameters according to the NYHA classification, before and after therapy.
Results: After Pentaglobin therapy, all patients demonstrated a significant clinical improvement of the NYHA class, of exercise capacity and of LVEF (from 54,4 to 60,0%, p<0,005) independent from the respective virus. In 52 of 73 (71%) rebiopsied pts inflammation had resolved. In 17 of the 19 rebiopsied patients (90%) with a positive PCR for ADV before therapy no more virus DNA was recovered after treatment, inflammation had resolved completely. In Parvo B 19 myocarditis inflammation had resolved in 31 of the 44 pts (70%), whereas Parvo B19 DNA was eradicated in only in 18 out of 44 pts(40%). In patients in whom both virus and inflammation were eliminated enddiastolic LV dimension decreased and EF increased significantly (p<0,001).
Conclusion: Treatment with an intermediate dose of Pentaglobin is highly effective in resolving myocardial inflammation independent of the underlying viral etiology, but it eradicates adenoviral much better than Parvo B19 infection.
Abstract 1726: Genome-Wide Cell-Specific Gene Expression Analysis Identifies the Involvement of the Adipocytokine Signalling Pathway in Atherosclerotic Plaque Rupture
Authors: Lee Kelvin , Polvikoski Tuomo , Birchall Daniel , Santibanez-Koref Mauro , Mendelow Alexander D , Keavney Bernard D 
Published: July 2021

The molecular mechanisms leading to plaque rupture are poorly understood. Genome-wide gene expression studies may reveal novel causal molecular pathways.
METHODS: Snap-frozen human atherosclerotic plaques removed at carotid endarterectomy were designated as stable or ruptured using stringent clinical, radiological and histopathological criteria. Accurate gene expression profiling of macrophages in 5 ruptured and 6 stable plaques was conducted by employing Laser Micro-Dissection to specifically isolate this cell type from the plaques. High quality RNA was amplified and hybridised to the genome-wide Affymetrix U133plus2 microarray.

RESULTS: Exploratory clustering by Principal Components Analysis showed the data to cluster into 2 distinct groups- stable and ruptured. We identified 889 statistically significant differentially expressed genes between the two groups (Fig.1

). Genes involved in lipid processing, signalling, apoptosis, immune response and extracellular matrix were found to play a role in plaque rupture. Pathway analysis identified the Adipocytokine Signalling Pathway to be the most significantly represented cell signalling pathway (p<0.0006). The microarray findings were technically validated by real-time qPCR (Pearson Correlation R=0.94) and biologically cross-validated on a larger number of samples successfully (n=25). Immunocytochemical staining confirmed the differential Leptin expression in macrophages of ruptured and stable plaques.

CONCLUSION: The involvement of Leptin and the Adipocytokine Signalling Pathway in macrophages in plaque rupture has been implicated here for the first time and may be a potential therapeutic target.

Figure 1.

Heatmap of 889 statistically significant differentially expressed genes (red for high expression, green for low expression) with the top 20 most highly expressed genes in ruptured and stable groups listed.
Abstract 1729: Objectively Measured, but Not Self-Reported, Medication Adherence Independently Predicts Event-Free Survival in Patients with Heart Failure
Authors: Wu Jia-Rong , Moser Debra K , Chung Misook , Lennie Terry A 
Published: July 2021

Background: Medication nonadherence is presumed to be related to poor clinical outcomes including emergency department (ED) visits, rehospitalization and mortality, yet this relationship has not been tested using objective adherence measures in patients with heart failure (HF). Therefore, it is unknown which objective indicators of medication adherence predict clinical outcomes and how self-reported adherence measures compare to objective measures in predicting clinical outcomes. Objective: The purpose of this study was to determine which indicators of medication adherence are predictors of event-free survival in patients with HF.
Methods: A total of 134 patients with HF (70% male, 61 ±12, 61% NYHA III/IV) were enrolled in this 6-month longitudinal predictive study. Medication adherence was measured using an objective measure, the Medication Event Monitoring System (MEMS) and self-reported adherence from the Medical Outcomes Studies Specific Adherence Scale. Four indicators of adherence were assessed by the MEMS:

dose-count, percentage of prescribed doses taken;

dose-days, percentage of days the correct number of doses taken;

dose-time, percentage of doses taken on schedule; and

therapeutic coverage, percentage of time therapeutic drug action maintained.

Events (ED visits, rehospitalization, and mortality) were obtained by patient/family interview and hospital databases.

Results: In Cox regression, three of the four MEMS indicators, dose-count, dose-day, and therapeutic coverage, predicted time to first event before and after controlling age, gender, ejection fraction, NYHA, angiotensin-converting enzyme inhibitor use, and beta-blocker use (
p
= .004, .008, and < .001, respectively). Self-report medication adherence did not predict outcomes (
p
= .402).

Conclusions: The percentage of prescribed doses taken, percentage of days the correct number of doses taken, and overall therapeutic coverage predicted event-free survival. Neither the percentage of doses taken on schedule nor self-reported adherence predicted outcomes. Healthcare providers should assess specific behaviors related to medication taking rather than a global patient self-assessment of patient adherence.
Abstract 1731: Social Support, Personal Control, and Psychological Functioning Among Individuals with Heart Failure
Authors: Taylor Melissa V , Bohachick Patricia , Sereika Susan M , Schlenk Elizabeth A , Brown Charlotte , Burke Lora E 
Published: July 2021

Heart failure places a large psychosocial burden on patients and their families. Although psychological functioning generally improves for most cardiac patients, impairment persists for a significant minority, posing a serious impediment to well-being. It has been proposed that personal resources, such as social support and coping style, facilitate adaptation to such threatening events as chronic illness, and thus impact psychological outcomes.

Purpose: The primary aim of this study was to develop and test two mediating models, drawn on an integrative stress coping framework. The models considered the complex relationships between
social support
and
personal control
and two key psychological outcomes,
depressive symptoms
and
anxiety,
in individuals coping with heart failure. Social support was hypothesized to have a direct effect on depressive symptoms (Model 1) and anxiety (Model 2),
and
an indirect effect, mediated by personal control, on these psychological outcomes.

Methods: We conducted a secondary analysis of data collected from a cross-sectional survey of patients (N = 242) between 21 and 82 years of age being treated primarily for idiopathic (55.8%) or ischemic (39.7%) cardiomyopathy. Structural equation modeling was used to test the hypotheses.
Results: Both models demonstrated good data model fit, with 52% of the variance explained for Model 1 and 38% of the variance explained for Model 2. Statistically significant estimates indicated that social support plays a key role in reducing depressive symptoms and anxiety. Notably, for each model, the mechanism whereby social support reduces psychological distress is entirely through the indirect effect, i.e., through patients’ perceived control.
Conclusions: The results provide support for existing theories that emphasize important roles of social support and personal control in improving psychological functioning among the chronically ill. This study raises the possibility that strategies designed to improve social support can be useful in reducing heart failure patients’ depressive symptomatology and anxiety. Such strategies would operate primarily through improving one’s sense of personal control. #
Abstract 1740: Risk of Proarrhythmia Following Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy
Authors: Das Saumya , Palacios Igor , Vlahakes Gus J , Picard Michael H , Sanborn Danita Y , Lowry Patricia A , Ruskin Jeremy N , Fifer Michael A , Mela Theofanie 
Published: July 2021

Background: Alcohol septal ablation (ASA) is a promising treatment option for patients with hypertrophic obstructive cardiomyopathy (HOCM), but the creation of myocardial infarct during the procedure has raised concern about the proarrhythmic risk of ASA. We analyzed the incidence of clinically significant ventricular tachycardia (VT) and sudden cardiac death (SCD) following ASA at our center.
Methods: A total of 97 ASAs in 88 patients were performed between 1998 and 2007 at MGH. 34 of these patients had an implantable cardiac defibrillator (ICD) or pacemaker (PPM) implanted prior to or immediately following ASA. 8 of 34 patients had prior ICD implants for either secondary (n=4) or primary (n=4) prevention for SCD. 8 patients had prior PPMs. 3 patients had implantation of ICD post-ASA and 15 patients had PPM implanted following ASA due to atrioventricular block (AVB). Clinical records as well as device data were analyzed to determine incidence of VT or SCD following ASA.
Results: There were no deaths attributable to SCD in our cohort of 88 patients (mean follow-up 35 +/− 21 months, range 4 to 70 months). 1 patient with a previous ICD for primary prevention had VT storm 6 days following ASA. 1 patient who had a cardiac arrest 11 days following the ASA (thought to be a bradycardic arrest, since he had intermittent high grade AVB post-ASA) received an ICD. Neither of these patients had subsequent detections or therapies for VT. 1 patient was upgraded to an ICD following ASA due to NSVT, and 2 patients had ICD implants for NSVT or high risk of SCD. The former had subsequent detection of NSVT 24 months after implant, and therapy for VT 3 years later. 2 patients had upgrades of their PPM to an ICD > 12 months after ASA (for positive electrophysiology studies at other centers), but had no detection or therapies during the follow-up period. No other patients had therapies for tachyrrhythmias.
Conclusion: In our experience of 97 procedures, we observed 1 episode of VT storm in the first week following ASA, 1 cardiac arrest, likely bradycardic, in the first 2 weeks after ASA, and only 1 patient with clinically significant VT years after ASA. Our data suggest that close follow-up is warranted in the 2 weeks after ASA, but that ASA does not seem to have a long-term proarrhythmic effect in patients with HOCM.
Abstract 1753: Transcriptomic based Biomarkers Contain Diagnostic and Prognostic Information about Patients with new onset Heart Failure
Authors: Heidecker Bettina , Baughman Kenneth L , Kasper Edward K , Wittstein Ilan S , Breton Elayne , Hare Joshua M 
Published: July 2021

INTRODUCTION: One of the clinical dilemmas in cardiology is to accurately diagnose the etiology of patients with new onset heart failure such as to differentiate between potentially reversible myocarditis from idiopathic dilated cardiomyopathy (IDCM). Furthermore, it is difficult to predict the clinical trajectory of patients with IDCM. We hypothesized that the transcriptomic signatures generated from endomyocardial biopsies, obtained from patients at first presentation of heart failure, could serve as novel biomarkers to distinguish between myocarditis and IDCM as well as to predict the prognosis of patients classified as having IDCM.
METHODS AND RESULTS: Endomyocardial biopsy samples were collected from 68 patients with new onset heart failure due to IDCM (n=49) and myocarditis (n=19). The average follow-up was 5 years and included information on mortality, need for left ventricular assist device (LVAD), or heart transplant. We used the U133 Plus 2.0 microarray (Affymetrix) and data analysis was performed with Significance Analysis of Microarrays (SAM) and Prediction Analysis of Microarrays (PAM). First, we identified a molecular signature of 39 genes in our training cohort (n=25 IDCM and n=8 myocarditis). When tested in independent patients (myocarditis: n=11; IDCM: n=11), this signature performed with 97% accuracy. Next, we identified a transcriptomic signature of 45 genes in a group of patients with IDCM that delineated between patients classified as having a good prognosis (event free survival > 5 years; n=18) vs a bad prognosis (death or requirement for insertion of LVAD or tx within 2 years of presentation; n=12). We tested this biomarker in independent samples and were able to predict prognosis with 87% accuracy. The transcriptomic biomarker was substantially more accurate in assigning prognosis than the Seattle Heart Failure Score (p=0.011).
CONCLUSION: Together these findings illustrate the potential utility of using transcriptomic biomarkers generated from a single endomyocardial biopsy to improve the accuracy of diagnosis and prognosis in patients with new onset heart failure. This creates novel modalities to enhance management and identification of patients at highest risk for complications of heart failure in the short term.