bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 2509: Do Systemic Risk factors Impact the Composition of Coronary Plaques as Measured by IVUS-RF analysis? Results from the Global VH Registry on Whole Vessel Analysis
Authors: Philipp Sebastian , Böse Dirk , Wijns William , Marso Steven P , Schwartz Robert S , König Andreas , Lerman Amir , Carlier Stephane G , Serruys Patrick W , Erbel Raimund 
Published: July 2021

Background: Cardiovascular risk factors have an impact on coronary atherosclerosis evolution. However, there is only limited information about the relationship between risk and atherosclerotic plaque as measured invasively by Intravascular Ultrasound Radiofrequency (IVUS-RF) analysis. The Aim of this study was to assess the impact of cardiovascular risk factors not only on overall coronary plaque volume but on coronary plaque composition.
Methods: 990 patients from 42 centers were enrolled in the prospective, multicenter, non randomized, global VH-IVUS registry. Coronary lesions were measured by conventional and IVUS-VH parameters using 20MHz Intravascular Ultrasound catheter. The four IVUS-VH plaque components (Dense Calcium-DC, Necrotic Core-NC, Fibrous tissue-F, Fibro Fatty-FF) were analyzed in every recorded frame. The results were expressed as mean cross-sectional areas, and percentage of total plaque volume. Risk factor assessment included correlation with family history of myocardial infarction, past or current smoking, diabetes mellitus, hypertension, and laboratory measurements.

Results: Patients with diabetes have an increased relative amount of NC (6.47±0.28% vs. 5.86±0.14%, p=0.037) and DC (4.58±0.27% vs. 3.90±0.14%, p=0.017), Patients with hypertension have an increased relative amount of FF, DC (4.35±0.16% vs. 3.57±0.17%, p=0.02) and NC (6.24±0.17% vs. 5.60±0.19%, p=0.01). Compared with patients with LDL cholesterol 160 mg/dl had higher plaque volume (342.1±26.2mm
3
vs. 318.6±10.7mm
3
). Linear Regression Analysis showed a correlation between the level of HDL and F (r=−0.149, p<0.01), FF (r=−0 –106, p< 0.01), and NC (r=−0.90, p<0.05). The level of LDL correlated with F (r = 0.110, p < 0.01). Patients with prior MI have an increased percentage of F (30.03±0.59 % vs. 28.20±0.37 %, p<0.009). Smoking had no relevant effect on plaque composition.

Conclusion: IVUS-RF analysis detects marked differences in coronary plaque depending on the risk factor profile with particular focus on lipid levels. Patients with greater amounts of necrotic core were associated with hypertension, myocardial infarction, and low HDL. This may have implications for prognosis and systemic treatment of patients with coronary artery disease.
Abstract 2611: Transcatheter Valve Insertion A Model Of Enlarged Right Ventricular Outflow Tracts
Authors: Basquin Adeline , Boudjemline Younes 
Published: July 2021

Background: Transcatheter pulmonary valve insertion has recently emerged as an alternative to surgery. To extend the indications to patients with large right ventricular outflow tract (RVOT), we previously developed an intravascular device that reduces the diameter of the main pulmonary artery (MPA) allowing the insertion of available valved stents. We report its use in a model of animals with enlarged RVOT and pulmonary valve incompetence (PVI).
Methods and Results: 33 sheep were included. They first underwent surgical MPA enlargement. We then intended to implant percutaneously a reducer followed by the insertion of a valve. Three animals died during interstage. The remaining were sacrificed acutely (group 1, n=6), after a mean follow-up of 1 (group 2, n=12) and 2 months (group 3, n=12). Animals from chronic groups were equally divided into 2 subgroups according to the difference between diameters of the device inserted and MPA (A: < 5-mm, B: ≥ 5-mm). Reducers were inserted successfully (n=30). One embolized after its insertion (Group 3A). A valved stent could be implanted in all animals but one which experienced a balloon ruptured during its inflation leading to incomplete expansion and death of the animal. Six animals had pulmonary regurgitation after valve insertion. Five of them (Group A, n=5; Group B, n=1) had downsizing of the reducer.
Conclusion: Pulmonary valve insertion is possible through a transcatheter technique using a PA reducer. Oversizing of this device reduces the risk of embolisation and paraprosthetic leak.
Abstract 2654: Differential Local versus Systemic Gene Expression Profiling in Acute Coronary Syndromes
Authors: Akhmedov Alexander , Yonekawa Keiko , Wyss Christophe , Corti Roberto , Kucher Nils , Landmesser Ulf , Alibegovic Jasmina , Maier Willibald , Luscher Thomas 
Published: July 2021

Introduction: Monocytes and leucocytes (WBC) play a key role in acute coronary syndromes (ACS). We hypothesized that gene expression profiling of WBC from the site of coronary occlusion in direct comparison with peripheral WBC from patients with ACS might reveal genetic patterns involved in plaque rupture.
Methods: Thrombi (Thr) were aspirated during primary percutaneous coronary intervention (PCI), snap-frozen, and stored at −80°C. Peripheral blood leukocytes (PBL) from the same patients were extracted and treated accordingly. Total RNA was isolated from thrombi and PBL. The quality and quantity of the isolated RNA was determined using bioanalyzer and nanodrop devices. The cDNA was prepared using a primer mix and reverse transcriptase, followed by fragmentation and biotinilation. Biotin-labeled single-stranded cDNA samples were hybridized to Affymetrix GeneChip Human Genome U133 Plus 2.0 arrays. An Affymetrix GeneChip Scanner was used to measure the fluorescent intensity emitted by the labelled target.

Results: Gene expression profiles of Thr and PBL from 4 patients during PCI were assessed by Affymetrix human genome U133 Plus 2.0 arrays (54′675 probe sets). 653 different genes were locally upregulated in Thr compared to PBL as defined by a more than 8-fold difference in expression and statistical significance (p≤0.01). Genes for proteins of inflammation, thrombosis, endothelial activation, extracellular matrix remodelling, and scavenger receptors were highly upregulated at the site of coronary occlusion (examples see table 1

).

Conclusion: The local gene expression profile in WBC from thrombi differs significantly from the pattern in PBL, reflecting the regulatory and effective role of these cells in plaque rupture and thrombosis. This study identifies the upregulation of genes encoding for a host of established and new pathways involved in inflammation, uptake of oxidized LDL, and coagulation, that might play a crucial role in ACS.

Table 1
Abstract 2803: Clinical Utility of Magnetic Resonance Imaging of Patients with Permanent Pacemakers and Implantable-Cardioverter Defibrillators at 1.5 Tesla
Authors: Nazarian Saman , Hansford Rozann , Roguin Ariel , Zviman Menekhem M , Lardo Albert C , Calkins Hugh , Berger Ronald D , Bluemke David A , Halperin Henry R 
Published: July 2021

Background: Magnetic resonance imaging (MRI) offers excellent soft tissue resolution and is the preferred imaging modality for diagnosis of musculoskeletal, neurological and many thoracic and abdominal conditions. While MRI is currently unavailable for millions of patients because of the presence of implantable cardiac devices, we and others have previously reported the safety of noncardiac and cardiac MRI at 1.5T using a protocol that incorporates device selection and programming and limits the estimated specific absorption rate of MRI sequences. In this study we report the clinical utility of MRI in implantable cardiac device recipients.
Methods: One hundred and eighty six patients with devices shown to be MRI safe by in vitro phantom and in vivo animal testing underwent 228 MRI studies. Pacing mode was changed to “asynchronous” for pacemaker-dependent patients and to “demand” for others. Magnet response and tachyarrhythmia functions were disabled. Blood pressure, ECG, oximetry, and symptoms were monitored. Efforts were made to limit the system-estimated whole-body average specific absorption rate to 2.0 W/kg (successful in >99% of sequences) while maintaining the diagnostic capability of MRI.
Results: No episodes of inappropriate inhibition or activation of pacing were observed. There were no significant differences between baseline and immediate or long-term sensing amplitudes, lead impedances, or pacing thresholds. The diagnostic yield of alternative testing was 19% in 47 patients who underwent ultrasound, nuclear imaging or computed tomography prior to MRI. In contrast, diagnostic questions were answered in 95% of MRI studies.
Conclusions: The diagnostic benefits of MRI significantly outweigh the theoretical risks in patients with implanted cardiac devices when appropriate safety measures are implemented.
Abstract 2844: Preload Augmentation by Leg Elevation is Helpful in Triaging the Patients with Grade 1 Diastolic Dysfunction
Authors: Choi Eui-Young , Kim Sung-Ai , Rhee Sang Jae , Her Ae Young , Shim Chi Young , Ha Jong-Won , Chung Namsik 
Published: July 2021

Grade 1 diastolic dysfunction (DD) is a spectrum of a variety of conditions.
Objectives: We sought to investigate whether the responses of mitral inflow and annular velocity to leg elevation can provide additional information regarding triaging patients with grade 1 DD. One hundred fifty-four consecutive patients with hypertension with abnormal left ventricular (LV) relaxation on Doppler mitral inflow (early (E)/late (A) mitral inflow velocity <0.75 or deceleration time > 240 ms) were enrolled. Patients with LV ejection fractions less than 50%, a previous history of ischemic heart disease, inducible regional wall motion abnormality, valvular or myocardial disease, or any other volume overloading diseases were excluded. After resting evaluation, echo-Doppler measurements were performed during passive leg elevation and symptom-limited graded bicycle exercise. Patients were divided into two groups according to resting E/E’: Group I (E/E’<15) and II (E/E’≥15, n=23). Group I subjects were further subdivided into IA (persistent E/E’ <15, n=112) and IB (change to E/E’≥15, n=19) according to response to leg elevation. Group II had lower systolic (S’), early (E’), and late (A’) diastolic annular velocity, and diastolic reserve index to exercise (E’xΔE’50W) and higher LV elastance index (E/E’/stroke volume) than that of group IA; there was no significant difference compared to group IB. Group IB had more female predominance, older age, lower E’, higher diastolic elastance index, and higher E/E’ at 25W and 50W exercise accompanied by lower exercise capacity compared to group IA. Preload augmentation by leg elevation might provide additional information in triaging patients with grade 1 DD.
Abstract 2866: The Ross-Yacoub Operation For Aneurismal Autograft Roots: A Strategy To Preserve Autologous Pulmonary Valves And Normal Quality Of Life
Authors: Luciani Giovanni Battista , Viscardi Francesca , Pilati Mara , Prioli Maria Antonia , Faggian Giuseppe , Mazzucco Alessandro 
Published: July 2021

Background: Prevalence of autograft dilatation late after the Ross procedure is increasing. To define feasibility and outcome of autograft valve-sparing root reoperation, a 14-year clinical experience was reviewed.
Methods: One-hundred-twenty-five late survivors after the Ross procedure (7.0±1.9, 0.5–14 years) had cross-sectional clinical and echocardiographic examination. End-points were freedom from autograft dilatation (Ø>4 cm), from root reoperation, from root replacement and functional outcome after valve-sparing reoperation.
Results: Autograft dilatation was found in 33 (26%) patients (freedom of 46±12% at 14 years):12 (10%) patients had aortic aneurysm (>5.0 cm). Age at Ross was 22.6±8.8 years, diagnosis was AI in 9, AS in 1, mixed in 2; 10 had bicuspid aortic valve and 3 prior cardiac operations. All, but one (cylinder inclusion), had undergone root technique. Risk factors for root reoperation were younger age (p=0.04), prior operation (p=0.01), root technique (p=0.001). Nine of 12 had reoperation for aneurysm at 7.8±1.8 years after the Ross procedure, 3 are scheduled. During this study, 2 additional patients underwent root reoperation 12.6 years after Ross procedure done abroad. Two patients had root replacement and 9 (82%) remodelling with autograft-valve preservation (7 Yacoub, 2 sinotubular junction/ascending aorta): all survived. Severe AI, but not root diameter, was associated with failure to preserve the valve (p=0.015). Fourteen-year freedom from root reoperation was 80±8% and from full root replacement 96±3%. Up to 6 years (mean 3.1±1.5) after reoperation, all pts are in NYHA class I and medication-free: 8/9 patients have mild AI or less, while 1 required valve replacement 51 months after remodeling. One patient carried out an uncomplicated pregnancy 3 years after Ross-Yacoub operation.
Conclusions: Root reoperation with pulmonary valve preservation is feasible in most patients with autograft aneurysm, allowing for maintenance of normal quality of life. Referral of patients with dilated root for surgery prior to onset of severe valve insufficiency increases likelihood of pulmonary valve-sparing. Mid-term functional behaviour of remodelled autograft roots is rewarding, however continued observation is warranted.
Abstract 3031: Repeat Revascularisation following Multivessel Sirolimus-eluting Stent Implantation: Indications and Long-term Follow-up From the Arterial Revascularisation Therapies Study Part 2 (ARTS-II)
Authors: Kukreja Neville , Serruys Patrick , Ramcharitar Steve , Tanimoto Shuzou , Onuma Yoshinobu , de Bruyne Bernard , Colombo Antonio , Macaya Carlos , Richardt Gert , Fajadet Jean , Hamm Christian , Schuijer Monique , Pieters Magdaleen , Stoll Hans-Peter 
Published: July 2021

Objectives: Although coronary-artery bypass grafting (CABG) has been considered the gold standard of treatment for multivessel coronary artery disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may be an alternative: the ARTS-II trial found that after 3 years, the major benefit of CABG was a decreased need for repeat revascularization. We reviewed the angiographic findings in all patients from ARTS-II who required repeat revascularization to investigate their prognosis and to establish the reasons for repeat revascularization in these high risk complex patients, including the relative contributions of procedural complications, neointimal hyperplasia, stent thrombosis, geographical miss and disease progression.
Methods: There was no routine angiographic follow-up in ARTS-II. All intercurrent angiograms within 3 years were reviewed. Patients requiring CABG due to index procedural complications or procedural failure were excluded (n = 8). The angiographic indications for repeat revascularization were categorized into target lesion revascularization (TLR), target vessel-non target lesion revascularization (TV-nonTLR) or non-target vessel revascularization (non-TVR). Patients undergoing TLR were further categorized into instent restenosis (ISR) according to the Mehran classification, stent edge restenosis (SER) or definite stent thrombosis (ST).
Findings: Within 3 years of the initial treatment, 81/607 patients required 103 repeat revascularizations to treat 150 lesions. These repeat revascularizations were classified as TLR in 74% of lesions, TV-nonTLR in 22% and non-TVR in 4%. The cases of TLR were due to ISR in 59%, SER in 25% and ST in 17%. The majority of ISR cases were Mehran Class IC (focal, body). ISR accounted for 42% of all repeat revascularizations, whilst ST accounted for 11%.
Conclusion: Repeat revascularization was due to ISR or ST in approximately half of the lesions; the remainder were due to either incomplete lesion coverage or disease progression. Hard clinical endpoint outcomes of patients stratified by the type of repeat revascularization will be presented at the meeting.
Abstract 3035: Sirolimus-eluting Stents Compared With Bare Metal Stents or Coronary Artery Bypass Grafting in Patients with Multivessel Disease including Involvement of the Proximal Left Anterior Descending Artery: Analysis of the Arterial Revascularization Therapies Study part 2 (ARTS-II)
Authors: Kukreja Neville , Serruys Patrick , de Bruyne Bernard , Colombo Antonio , Macaya Carlos , Richardt Gert , Fajadet Jean , Hamm Christian , Schuijer Monique , Pieters Magdaleen , Stoll Hans-Peter 
Published: July 2021

Objectives: Although Coronary Artery Bypass Grafting (CABG) has been the historical gold standard treatment for patients with multivessel disease, the ARTS-II trial found no differences in survival or overall adverse events between sirolimus-eluting stents (SES) and the surgical arm of ARTS-I. Nevertheless, previous data have suggested that patients with disease of the proximal left anterior descending artery (pLAD) may derive particular benefit from CABG. We therefore investigated the 3-year clinical outcomes in all patients in ARTS-I and ARTS-II with pLAD (AHA segment 6) involvement.
Methods: Patients in ARTS-II with disease of the pLAD (289/607, 48%) were compared with 187/600 (31%) bare metal stent (BMS) patients (ARTS-I PCI) and 206/605 (34%) surgical patients (ARTS-I CABG) with pLAD involvement from ARTS-I. The primary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE). Secondary endpoints included all-cause mortality, the composite of death, stroke or myocardial infarction and the need for repeat revascularization.
Findings: Complete 3-year follow-up was available for 99.6% of patients in ARTS-I and ARTS-II. The ARTS-II pLAD subgroup had better survival than both ARTS-I subgroups (ARTS-II 98.6% vs. ARTS-I PCI 95.7%, p = 0.048 and vs. ARTS-I CABG 94.7%, p = 0.01) and lower rates of the hard clinical composite endpoint of death or nonfatal myocardial infarction (ARTS-II 3.1% vs. ARTS-I PCI 9.6%, p = 0.002 and vs. ARTS-I CABG 9.7%, p = 0.002). Although the ARTS-I CABG patients had a lower need for repeat revascularization than ARTS-II (5.5% vs. 13.3%, p = 0.005), the overall composite adverse event rates (death, myocardial infarction, stroke or any repeat revascularization) were not significantly different between the ARTS-I CABG and ARTS-II patients (15.1% vs. 18.1%, p = 0.4). After 1 year, the SES patients had a reduction in the composite endpoint of death/CVA/MI (vs. ARTS-I PCI RR 0.27, 95% CI 0.11– 0.63 and vs. ARTS-I CABG RR 0.31, 95% CI 0.13– 0.74), although this was not statistically significant after 3 years.
Conclusion: In this historical, non-randomized evaluation, SES had favorable outcomes compared to CABG or BMS in patients with multivessel coronary disease including involvement of the pLAD.
Abstract 4357: Soluble ST-2 Concentrations to Predict Sudden Cardiac Death in Stable Heart Failure Patients
Authors: Bayes-Genis Antoni , Pascual-Figal Domingo , Vazquez-Garcia Rafael , Bonet-Marques Rosa , Puig-Domingo Teresa , Cinca-Coscollola Joan , de Luna Antoni Bayes , Snider James V , Ordonez-Llanos Jordi 
Published: July 2021

Background & Aim: The soluble form of the ST2 receptor (sST2) is released, like B-natriopeptides, by cardiomyocytes in response to mechanical overload. sST2 has been shown useful for predicting short- and long-term risk in heart failure (HF). Sudden cardiac death (SCD) is a poorly predictable HF-complication; we previously showed that NT-proBNP and left atrial size (LA) were prognostic of SCD in a cohort of stable HF patients. Since NT-proBNP and sST2 share some common features, we evaluated the role of sST2 to predict SCD in HF.
Patients & Methods: A 1:2 case:control design was used. Ninety-nine stable HF patients were included and followed during 3 years (942±323 days); 36 suffered SCD (Cases) and 63 survived (Controls). Cases and Controls were matched by age (66±11 years), sex (83% male) and LVEF (mean: 29%). NT-proBNP and sST2 were measured by immunoassays in serum/ plasma samples collected at inclusion; clinical information was recorded at inclusion and during follow-up.

Results: Cases had more often prior history of ischemic disease (72 vs 44%) and AMI (64 vs 41%), lower eGFR (54 vs 64 mL/min) and higher NYHA class (50 vs 22% in class III), LA (27 vs 23 mm/m
2
) and NT-proBNP (2873 vs 966 ng/L) than Controls (all variables, p<0.05). sST2 was higher in Cases (0.232 vs 0.121 ng/L, p=0.002) and unrelated to eGFR. ROC analysis of sST2 and NT-proBNP showed optimal cut-points to predict SCD of 0.152 and 2005 ng/L, respectively. sST2 values > 0.152 ng/L were found in 78% of Cases and 44% of Controls (p<0.001). In multivariable analysis sST2, NT-proBNP, eGFR and LA were independent predictors of SCD. When sST2 and NT-proBNP concentrations (dichotomized by the set cut-points) were analyzed combined as a single variable the OR to predict SCD raised to 21.857 (95% CI: 2.655–179.909, p=0.004). eGFR and indexed LA size were weaker predictors of SCD (OR: 1.665 and 1.157, respectively). The area under ROC of the combined variable to predict SCD was 0.869 (95% CI: 0.798 – 0.940).

Conclusions: sST2 is a novel biomarker for SCD prediction in stable HF patients. A multimarker approach using sST2 and NT-proBNP improves the identification of HF patients at high risk of SCD.
Abstract 4389: Right Ventricular Diastolic Function in Pulmonary Hypertension
Authors: Lopez-Candales Angel , Eleswarapu Ananth , Edelman Kathy 
Published: July 2021

Background
: Left ventricular diastolic dysfunction is associated with worse outcomes in patients with severe chronic elevation in pulmonary artery systolic pressures (PASP); however, little is known if right ventricular diastolic dysfunction (RVDD) is also present in these patients.

Methods
: Color M-mode to measure RV propagation velocity (Vp) and tissue Doppler imaging (TDI) of the tricuspid valve annulus (TVa) were done in 21 patients (Group I: mean age 54 ± 15, mean PASP 80 ± 31 mmHg) and in 19 healthy individuals (Group II: mean age 51 ± 14 years, PASP 30 ± 7 mmHg). All subjects were in normal sinus rhythm and normal left ventricular systolic function.

Results
: Despite elevation in PASP, Group I RV systolic function measured by both TVa excursion (2.01 ± 0.7 cm) and TVa systolic velocity (0.10 ± 0.04 cm/s) were no different than Group II (2.5 ± 0.5 cm and 0.12 ± 0.03 cm/s, respectively). Even though there was no difference in either early (0.11 ± 0.04 versus 0.13 ± 0.04 cm/s) versus late (0.15 ± 0.05 versus 0.13 ± 0.04 cm/s) diastolic velocities by TDI; a lower Vp was seen in Group I (28 ± 12 cm/s) than Group II (41 ± 15 cm/s, p < 0.01) with a significantly shorter diastolic interval (259 ± 90 versus 390 ± 80 ms, p < 0.0001). Representative color M-mode images are shown in the Figure

.

Conclusions
: Routine use of TVA TDI appears to be less useful than color M-mode to appreciate RV diastole as it shows a slower Vp with flows shifted later in diastole. In addition, these patients also demonstrate a shorter diastolic interval. Further studies are now required to prospectively assess the effects of pulmonary hypertension in clinical outcomes in patients manifesting RVDD.

Figure.

(A) Color M-mode image of a patient artery systolic pressures demonstrating predominantly early diastolic flow.
(B) Color M-mode image from a patient with pulmonary hypertension showing predominantly late diastolic flow.