bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 2668: Critical Role of Granzyme B in Left Ventricular Remodeling after Acute Myocardial Infarction
Authors: Kondo Hideyuki , Hojo Yukihiro , Nishimura Yoshioki , Takahashi Nozomu , Ikemoto Tomokazu , Katsuki Takaaki , Shimada Kazuyuki 
Published: July 2021

Background: Granzyme B is a member of the serine esterase family produced by cytotoxic T lymphocytes (CTLs), and has an important role in cellular apoptosis and extracellular matrix degradation. We hypothesized that granzyme B is involved in left ventricular (LV) remodeling after acute myocardial infarction (AMI).
Objectives: To elucidate the role of granzyme B in LV remodeling after AMI.
Subjects and methods: We employed 41 patients with the first AMI (mean age: 61.9±8.9 years old). We obtained peripheral blood on day 1, day 7 and day 14 after onset. Plasma levels of apoptosis-related molecules, including tumor necrosis factor α (TNFα), a soluble form of the Fas ligand (sFasL) and granzyme B were measured. We checked the activation of CTLs by flow cytometry. Patients were treated by percutaneous coronary intervention within 12 hours after onset. Successful myocardial reperfusion (TIMI flow grade 2 or 3) was accomplished in all patients. LV end-diastolic volume index (LVEDVI) was calculated on day 1 and 6 months after onset.
Results: Plasma levels of TNFα, sFasL and granzyme B increased significantly after the onset of AMI (TNFα; day 1: 1.6±0.47, day 7: 3.3±0.65, day14: 4.0±1.2 pg/ml, p<0.05, sFasL; day 1: 72±5.2, day 7: 86±6.7, day14: 95±7.3 pg/ml, p<0.05, granzyme B; day 1: 63±18.4, day 7: 283±57.8, day14: 210.9±46.3 pg/ml, p<0.001). The percentage of CD69± to CD3+ CD8+ lymphocytes was significantly increased (CD69+/CD3+ CD8+; day 1: 14.5±1.7, day 7: 15.8±1.2, day 14: 19.1±1.4%, p<0.05), suggesting that CTLs were activated after onset. Univariate regression analysis showed a significant positive correlation between plasma granzyme B level on day 14 and fold-increase in LVEDVI (r=+0.45, p<0.01). No significant correlation was observed between TNFα and changes in LVEDVI, or sFasL and changes in LVEDVI. Stepwise multivariate regression analysis showed that the plasma granzyme B level on day 14 is a significant explanatory variable for changes in LVEDVI (β = +0.53, p<0.001).
Conclusions: These results first indicate that among proapoptic molecules, granzyme B has a critical role in the progression of LV remodeling after AMI.
Abstract 2806: Whole Heart Coronary Magnetic Resonance Angiography Using 32-Channel Cardiac Coils and High Parallel Imaging Factor
Authors: Nagata Motonori , Sakuma Hajime , Ishida Nanaka , Nakajima Hiroshi , Ishida Masaki , Miyahara Masatoshi , Kato Shingo , Nakamura Mashio , Ito Masaaki , Takeda Kan 
Published: July 2021

PURPOSE Coronary MRA provides noninvasive detection of coronary artery disease (CAD) without administration of contrast medium or exposing the patient to radiation. However, use of coronary MRA in excluding patients with CAD has been limited due to lengthy imaging time. The purpose of this study was to reduce acquisition time of coronary MRA by using 32 channel cardiac coils and high parallel imaging factor, and to evaluate diagnostic performance of this method in detecting significant CAD.
METHOD AND MATERIALS Sixty-two patients with suspected CAD were studied. Free-breathing coronary MRA encompassing the entire heart was acquired by using 32-channel coils and SENSE factor of 4. After monitoring motion of the coronary artery on cine MRI, MR angiograms were acquired during diastole in 46 patients (acquisition window 82±57ms) and during systole in 16 patients (50±19ms). Coronary MRA images were interpreted by 2 observers by employing a sliding SLAB MIP method. All patients underwent X-ray coronary angiography within 4 weeks from MRA, and significant CAD was defined as a luminal diameter reduction of 50% or more by QCA. All lesions with a reference diameter of 2mm or more on X-ray angiography were included when determining the accuracy of coronary MRA.
RESULTS Acquisition of MRA was completed in all 62 patients, with the averaged imaging time of 6.1±2.6min. High SENSE factor achieved by 32-channel coils resulted in substantial reduction of imaging time by factor of >2, with the image quality score (4.6±0.2) at least equivalent to that by conventional 5-channel coils and SENSE factor of 2 (4.5±0.2). Significant CAD was observed on X-ray coronary angiography in 39 patients. MRA detected 33(85%) of 39 patients having CAD, with high specificity of 96%(22/23). All 16 patients with double- or triple-vessel diseases were detected by MRA. On a vessel based analysis, Whole-heart coronary MRA demonstrated sensitivity of 83%(49/59), specificity of 94%(119/127) and NPV of 92%(119/129).
CONCLUSION Whole-heart coronary MRA with 1.5T MR imager and 32-chennel coils permits noninvasive detection of CAD with substantially reduced imaging time and high study success rate. High NPV (>90%) indicated the value of this approach in ruling out significant CAD.
Abstract 2871: Saddle-Shaped Annuloplasty Reduces Mitral Leaflet Stress: A Real-Time 3D Echocardiographic Study
Authors: Blom Aaron S , Xu Chun , Ryan Liam P , Jackson Benjamin , Parish Landi M , Eperjesi Thomas J , Gorman Joseph H , Gorman Robert C 
Published: July 2021

Objectives: High leaflet and chordal stresses contribute to recurrent mitral regurgitation after repair procedures. We hypothesized that a saddle-shaped annuloplasty ring would reduce leaflet stress compared to a similarly sized flat annuloplasty ring. To test this hypothesis we used a novel 3D echocardiographically-based finite element modeling (FEM) technique for quantifying regional mitral valve stress.
Methods: Real-time 3D echocardiography was performed in 8 sheep before and after placement of either a 30mm flat annuloplasty (n=4) or a 30mm saddle-shaped annuloplasty. Full-volume data sets of the MV were obtained using an IE33 platform(Philips Medical Systems, Andover, Massachusetts) and exported to Cardio-View (Tomtec Imaging Systems, Munich, Germany) for image analysis. Individual leaflet data were then interpolated using Matlab (The Mathworks, Natick, Massachusetts). Triangulated leaflet surfaces were extracted and the data imported into a commercial finite element program (ABAQUS/Explicit 6.3, HKS Inc. Pawtucket, RI) to quantify regional stress distributions in all segments (P1, P2, P3 and A1, A2, A3) of the MV.
Results: Peak anterior and posterior leaflet stresses after flat annuloplasty placement were 0.20±0.001MPa and 21±0.02MPa. Peak anterior and posterior leaflet stress after saddle-shaped annuloplasty placement was 0.19±0.02MPa and 13±0.01MPa (p<0.05 for the posterior leaflet stresses)
Conclusions: Saddle-shaped annuloplasty design results in greater stress reduction in the posterior leaflet than standard flat annuloplasty rings and may, therefore, result in more durable repairs.
This research has received full or partial funding support from the American Heart Association, AHA Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).
Abstract 3045: Procedural and 30-day Outcomes Following Transcatheter Aortic Valve Implantation using the Third Generation (18F) CoreValve Revalving® System - Results from the Multicenter, Expanded Evaluation Registry 1 year after Being CE Mark Approved, on Behalf of all Actively Participating Centers
Authors: Piazza Nicolo , Grube Eberhard , Gerckens Ulrich , den Heijer Peter , Linke Alex , Luha Olev , Raimondo Angelo , Ussia Giampaolo , Wenaweser Peter , Laborde Jean-Claude , de Jaegere Peter , Serruys Patrick W. 
Published: July 2021

Background: Over 2000 transcatheter aortic valve implantations (TAVI) have been performed worldwide by means of two differing technologies. Initial reports, limited by the initial learning curve and small sample size, documented rates of procedural success and 30-day mortality in three-quarters and more than one-tenth of patients, respectively.
Objective: To describe the procedural performance and 30-day outcomes following implantation using the 18F CoreValve Revalving System (CRS) as part of the multicenter, expanded evaluation registry, 1-year after obtaining CE mark approval.
Methods: Patients with symptomatic severe aortic stenosis and logistic EuroSCORE ≥ 15%, or age ≥ 75 years, or age ≥ 65 years associated with pre-defined risk factors, and for whom a physician proctor and a clinical specialist were in attendance during the implantation and who collected the clinical data, were included.
Results: From April 2007, to April 2008, 646 patients with a mean age of 81± 6.6 years, mean aortic valve area 0.6 ± 0.2 cm2, and logistic EuroSCORE of 23.1± 13.8% were recruited. After valve implantation, the mean transaortic valve gradient decreased from 50.4 ± 16.8 to 3.2 ± 5.2 mmHg. Only one percent of patients had paravalvular aortic regurgitation ≥ grade 2. The rate of procedural success was 97%. The procedural mortality rate was 1.5%. At 30 days, the all-cause mortality rate (i.e. including procedural mortality) was 8% and the combined rate of death, stroke and myocardial infarction was 9.3%.
Conclusion: The results of this study demonstrate a high rate of procedural success and low rate of 30-day mortality in a large cohort of high-risk patients undergoing TAVI with the CRS self-expanding aortic valve prosthesis.
Abstract 3047: Management Of Procedural Complications Associated With Transcatheter Aortic Valve Implantation
Authors: Lange Ruediger , Bleiziffer Sabine , Ruge Hendrik , Mazzitelli Domenico , Schreiber Christian , Hutter Andrea , Tassani-Prell Peter , Bauernschmitt Robert 
Published: July 2021

Objective The transcatheter aortic valve implantation (TAVI) technology is rapidly evolving. The complications related to these procedures are different from those seen after conventional aortic valve replacement. Herein, we report our experience on the incidence and management of procedure-related complications in the first series of TAVI.
Methods Between 6/2007 and 6/2008, 112 patients (n=62 female, mean age 81.3±7y, mean logistic EuroScore 25.0±15.6%) underwent TAVI through either a retrograde (n=92 transfemoral, n=3 via subclavian artery, n=1 ascending aorta) or antegrade (n=16 transapical) approach at our institution. 95 CoreValve and 17 Edwards Sapien (n=17) prostheses were implanted.
Results 30-day mortality was 8.9% (n=10). Major vascular complications occurred in 19 patients (16,9%). 2 patients with iliac or femoral rupture were treated with covered stent. 14 patients with bleeding from vascular site were treated with surgical suture or prosthesis implantation. Three patients had lethal aortic root (n=2) or abdominal (n=1) aortic rupture. Cardiac tamponade occurred in 8 patients (7.1%); among these 3 were treated conservatively, 4 underwent subxyphoid puncture and one patient had thoracotomy. Valve displacement could be treated interventionally in 5 out of 6 patients, 1 patient underwent conventional surgery. In 2 patients, with extremely poor LV function, emergent institution of cardiopulmonary bypass was required during the procedure. 5 patients underwent interventional re-valving (n=2) or surgical re-replacement (n=3) due to high-grade regurgitation (n=5) or valve displacement (n=1). Pacemaker implantation due to postprocedural AV block was required in 23 patients (20.7%). Despite these complications, the overall initial procedural success was 98 % (n= 110/112).
Conclusions A significant number of complications after TAVI requires surgical treatment. Therefore, TAVI procedures should be performed in a hybrid operating room which allows for immediate surgical intervention and the rapid institution of cardiopulmonary bypass if necessary.
Abstract 3078: The Poor Prognosis of Diabetic Patients with High Ankle-Brachial Index Depends on the Presence of Masked Peripheral Arterial Disease
Authors: Aboyans Victor , Tran Minh Hoang , Salamagne Claire , Archambeaud Francoise , Criqui Michael H , Laskar Marc , Lacroix Philippe 
Published: July 2021

Background: A high ankle-brachial index (ABI >1.40) is associated with poor prognosis. An underlying peripheral arterial disease (PAD) is frequent in diabetic patients with high ABI, although it cannot be adequately diagnosed by the ankle pressure measurement, due to stiff arteries. We hypothesized that in diabetic patients, the poor cardiovascular disease (CVD) prognosis associated with high ABI would depend on the coexistence of masked PAD.
Methods: We reviewed the data of 403 consecutive diabetic patients who had a Doppler assessment of their lower limbs between 1999 and 2000. They were classified as “normal” when Doppler waveform patterns (DWP) were normal and ABI within the 0.91–1.39 range, “PAD only” in case of ABI ≤0.90, “stiff only” if ABI ≥1.40 with normal DWP, and “mixed disease” when ABI ≥1.40 with abnormal DWP. Patients were followed until 04/2008. The primary endpoint was the occurrence of any of the following events: death, stroke or myocardial infarction.

Results: The patients (age: 65.6 ± 13.2 yrs, 54.6% females; 90.2% type-2 diabetes) were classified as “normal” (14.4%), “PAD only” (48.4%), “stiff only” (16.4%) and “mixed disease” (20.8%). During a mean follow-up of 6.5 years, the event-free survival curves of “PAD only” and “mixed disease” groups showed poorer prognosis than the “stiff only” and “normal” groups (figure

). In a model adjusted for age, sex, diabetes type and duration, traditional CVD risk factors, renal failure and CVD history, only the presence of PAD was significantly associated with the primary endpoint (OR: 3.36 (1.25 – 4.44), p=0.008).

Conclusions: In diabetic patients with high ABI (>1.40), only those with an associated PAD have a poorer prognosis.
Abstract 3092: Risk Associated with Sports Competition: Is Lacrosse Really a Uniquely Dangerous Sport?
Authors: Maron Barry , Doerer Joseph J , Haas Tammy S , Hodges James S , Estes N. A , Link Mark S 
Published: July 2021

Background. Sudden deaths in young competitive athletes are tragic events having great personal impact on physicians and lay communities. These deaths occur in a wide variety of sports due largely to unsuspected cardiovascular disease or commotio cordis. Lacrosse is now the most rapidly growing sport in the U.S., presently with 500,000 competitors. The risks specifically associated with participation in lacrosse have been the subject of substantial media attention, implying that this sport may be unsafe relative to other youth sports. However, systematically assembled data in this regard are not available.
Methods. The U.S. Sudden Death in Young Athletes Registry, 1980 –2008, was accessed and 22 sudden deaths (including 4 survivors of cardiac arrest) were identified in high school and college competitive lacrosse participants.
Results. Ages were 13–22 years (mean 17±2y); all were male. Nineteen athletes died on the athletic field and 3 during sedentary activities. Ten of the 22 athletes died of non-penetrating blunt blows to the chest (i.e., commotio cordis), including 4 goalies who were wearing standard chest protectors. Another 10 athletes collapsed suddenly due to either documented or presumed cardiovascular disease (e.g., most commonly hypertrophic cardiomyopathy, long QT syndrome, mitral valve prolapse), and 2 incurred subarachnoid hemorrhage from blows to the head. The overall mortality rate associated with lacrosse was 1.39 deaths/100,000 person-years, and lower than a variety of other sports including baseball, basketball, and football (p=0.07), as well as hockey (p=0.1). Deaths due to commotio cordis were more frequent in lacrosse (0.63 deaths/100,000 person years) than in all other competitive sports (p<0.0001) with the exception of hockey (p=0.7).
Conclusions. Sudden deaths in young high school and college lacrosse participants are rare relative to the number of athletes involved, and are caused disproportionately by commotio cordis. These findings underscore the importance of (and represent an impetus to) developing more effective chest protection for young people in this popular and growing competitive sport.
Abstract 4069: Refusal to Seek Medical Care for Symptoms Prior to Sudden Cardiac Death
Authors: Rosenfeld Anne G , Daya Mohamud , Christensen Vivian , Rawson Rebecca 
Published: July 2021

Sudden cardiac death (SCD) is accompanied by preceding symptoms in a significant proportion of victims, with a median duration of up to 2 hours in some cases. The purpose of this study was to describe the characteristics of SCD victims with heralding symptoms who refused medical care. We conducted a secondary data analysis of interview data from witnesses of 99 cases of out-of-hospital presumed myocardial infarction death with known symptoms. Qualitative description methods were used to analyze qualitative data. Logistic regression was used to test the influence of type of symptoms (chest pain vs. non-chest pain), history of heart disease, and age on refusal of medical care. Categorization as refusal of medical care required conversation with someone where refusal was expressed verbally by the victim. There were 19 cases (19%) that refused medical care; their mean age was 72. The majority were male (16/19, 84%). Fifteen cases involved persistent refusal, defined as refusing care until collapse (range of <15 minutes to 60 hours). Four victims initially refused care and then permitted access to medical care. The suggestion for seeking medical care came from someone else in all but one case, and usually included multiple attempts. The care options offered but refused included calling 911 or a doctor, as well as going to the hospital, emergency department or a doctor’s office. Reasons for refusal of medical care (more than one reason in some cases) included stating the symptoms were due to something not urgent (n=10), other obligations (n=3), expressed dislike of hospitals or doctors (n=4), or recent medical reassurance of health status (n=7). Controlling for age, victims with chest pain vs. non-chest pain symptoms were more likely (OR = 3.56, p = .036, 95% CI = 1.09 –11.66) to refuse medical care and those with a history of heart disease were less likely (OR = .16, p = .004, 95% CI = .05–.55) to refuse medical care. Patients with chest pain and no history of heart disease are more likely to refuse advice to seek medical care. Public health messages about how to respond to cardiac symptoms should include strategies to overcome the reasons people refuse medical care.
This research has received full or partial funding support from the American Heart Association, AHA Pacific/Mountain Affiliate (Alaska, Arizona, Colorado, Hawaii, Idaho, Montana, Oregon, Washington & Wyoming).
Abstract 4175: Quantitative Assessment of Myocardial Blood Flow Using Adenosine Triphosphate Stress Multidetector-row Computed Tomography in Coronary Artery Disease
Authors: Shikata Fumiaki , Imagawa Hiroshi , Kido Teruhito , Kurata Akira , Higashino Hiroshi , Inoue Yuma , Ryugo Masahiro , Nagashima Mitsugi , Mochizuki Teruhito , Kawachi Kanji 
Published: July 2021

Introduction: The purpose of this study was to test the hypothesis that cardiac multidetector-row computed tomography (MDCT) technology can assess myocardial perfusion quantitatively using adenosine triphosphate (ATP) load technique.
Methods: Ten patients (median age 71 (range 65–79) years) who were scheduled for surgical revascularization, underwent cardiac electrocardiography-gated MDCT using ATP-load technique. The patients with unstable angina and myocardial infraction were excluded. Myocardial infarction was detected by late gadolinium enhancement MRI which was assessed before MDCT. Myocardial blood flow (MBF) was estimated from the slope of the linear regression equation with Patlak plots analysis. MBF results were compared to the presence of stenoses more than 75% on coronary angiography (CAG) and moderate to severe myocardium ischemia on stress thallium-201 myocardial perfusion scintigraphy (MPS).
Results: The overall mean MBF was 1.64±0.61 ml/g/min. Mean MBF in territories with stenosis on CAG was 0.81±0.49 ml/g/min, while mean MBF in territories without stenosis was 1.83±0.64 ml/g/min (p<0.01). Mean MBF in territories with moderate to severe ischemia on MPS was 0.76±0.49 ml/g/min, while mean MBF in territories without ischemia was 2.15±0.66ml/g/min (p<0.01). When the cut off value of MBF was set at 1.5 ml/g/min, there was good correlation between MBF vs CAG, and MBF and MPS. MBF vs CAG: sensitivity=71.4%, specificity=82.6%; MBF vs MPS: sensitivity=85.7%, specificity=87.0%.
Conclusions: This study proposed the possibility of MDCT to quantify myocardial blood flow using ATP in coronary artery disease. Our data suggested that the ATP stress MDCT has an advantage in the assessment of CAD to evaluate both coronary artery stenoses and myocardial perfusion information in one modality.
Abstract 4189: The Amount of Myocardial Fibrosis by Contrast-Enhanced Magnetic Resonance Imaging Predicts Mortality Late after Aortic Valve Replacement in Patients with Severe Aortic Valve Disease: Validation against Quantitative Histopathology
Authors: Azevedo Clerio F , Nigri Marcelo , Tarasoutchi Flávio , Pommerantzeff Pablo M , Sampaio Roney O , Parga José R , Ávila Luiz F , Spina Guilherme S , Grinberg Max , Higuchi Maria L , Rochitte Carlos E 
Published: July 2021

INTRODUCTION: Severe aortic valve disease (AVD) is characterized by progressive accumulation of interstitial myocardial fibrosis (MF). The relationship between the amount of MF and mortality after aortic valve replacement (AVR) surgery in largely unknown.
OBJECTIVES: Determine whether the quantitative assessment of MF by delayed-enhanced magnetic resonance imaging (deMRI) can predict mortality late after AVR in patients with severe AVD.
METHODS: Fifty-four patients scheduled to undergo AVR surgery were examined by cine and deMRI. From the deMRI dataset, the amount of MF was automatically determined as the sum of pixels with signal intensity (SI) above a threshold value calculated as: mean SI of total myocardium + 2SD of a remote area SI + 2SD of air SI. The remote area was manually delineated in a myocardial region free of hyper-enhancement. In addition, interstitial MF was quantified by histological analysis of myocardial samples obtained during AVR surgery and stained with picrosirius red. Patients were classified in 3 groups according to the degree of MF accumulation. A second deMRI study was performed 27 ± 22 months after surgery to assess LV functional recovery and all patients were followed for 43 ± 23 months to evaluate survival after AVR.
RESULTS: There was a good correlation between the values of MF measured by MRI and those obtained by histopathology (r = 0.69; y = −3.10x + 13.0; p < 0.0001). The amount of MF, either by MRI or by histopathology, exhibited a significant inverse correlation with LV ejection fraction before surgery (r = −0.63 e −0.67 respectively; p<0.0001). Additionally, the amount of MF displayed a significant inverse correlation with the degree of LV functional recovery after AVR (r = −0.42, p = 0.04 for histopathology; r = −0.47, p = 0.02 for deMRI). Most importantly, Kaplan-Meier analyses revealed that higher degrees of MF accumulation were associated with worse survival after AVR surgery (log-rank test: χ2=6.32; p=0.01 for histopathology; χ2=5.85; p=0.02 for deMRI).
CONCLUSIONS: DeMRI allows for the non-invasive quantification of MF with good accuracy when compared with histopathology in patients with severe AVD. Most importantly, quantification of MF can predict LV functional recovery and all-cause mortality late after AVR surgery.