bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 2948: Evidence of Coronary Microvascular Dysfunction in patients with Systemic Inflammatory Diseases
Authors: Recio-Mayoral Alejandro , Rubens M B , Kaski J C , Harari O , Camici P G 
Published: July 2021

Purpose: Accelerated coronary disease is a leading cause of morbidity and mortality in patients (pts) suffering from immune-mediated inflammatory diseases (IMID), such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). We tested the hypothesis that inflammation, in the absence of conventional cardiovascular risk factors, could result in coronary microvascular dysfunction (CMD) which is known to precede atherosclerosis in large vessels in pts with cardiovascular risk factors.
Methods: Myocardial blood flow (MBF, ml/min/g) was measured using positron emission tomography at rest and during i.v. adenosine (140 μg/Kg/min) in 8 SLE and 10 RA pts aged 47 ± 8 years without conventional cardiovascular risk factors and in 18 age and gender matched controls. In pts multislice (64 slices) CT coronary angiography was performed to exclude coronary stenoses.

Results: Mean disease duration was 18 ± 11 and 14 ± 6 years in RA and SLE respectively. There was no difference in resting MBF between pts and controls (1.27 ± 0.25 vs 1.11 ± 0.23; p=0.06). However, adenosine MBF was diffusely reduced in pts compared with controls (2.72 ± 0.84 vs 4.20 ± 0.75; p<0.0001) (Figure

). Coronary flow reserve (CFR; adenosine/resting MBF) was significantly reduced in pts (2.24 ± 0.74) compared with controls (4.00 ± 0.83; p<0.0001). Six pts showed ECG changes during adenosine stress and had a more severe reduction in CFR (1.73 ± 0.88) compared with those without ECG changes (2.49 ± 0.54; p<0.006).

Conclusions: Patients with IMID and without conventional cardiovascular risk factors have evidence of CMD which can result in reductions of CFR severe enough to cause myocardial ischemia.
Abstract 3044: The Preoperative Utilization of Levosimendan (Preoperative Optimization) Reduced Mortality and Low Output Syndrome After Cardiac Surgery in Patients With Low Ejection Fraction (EF<25%).
Authors: Levin Ricardo L , Degrange Marcela A , Porcile Rafael , Salvagio Flavio , Blanco Norberto , Botbol Livio A 
Published: July 2021

Background: Patients with low ejection fraction (EF<25%) present high-risk of mortality and development of low output state (LOS) after cardiac surgery. The objective of this research was to evaluate the preoperative use of the calcium sensitizer Levosimendan (Levo) in patients with EF<25%, underwent open heart surgery. Thirty-day mortality and development of postoperative LOS were the primary end-points of the study.
Methods: Patients with EF<25% and hemodynamic parameters of LOS (cardiac index<2.2 L/min/m2 and pulmonary artery occlusion pressure>15 mm Hg), underwent coronary bypass surgery between 12/01/2002 and 02/01/2007 were randomized to: preoperative infusion of Levo 0.1 mcg/Kg/min, 24 hours before surgery (Levo group-preoperative optimization), or placebo (Control group). LOS postoperative was defined for the same hemodynamic variables. A P value < 0.05 was considered significant
Results: Two-hundred and twenty one patients fulfilled the inclusion criteria, being randomized 111 of them to Levo, and 110 patients to placebo. Both groups were comparable in their general and surgical characteristics. No withdrawal of Levo was required during the preoperative administration, with 8 patients showing hypotension episodes which was resolved with fluid infusions. There were not ventricular arrhythmias, supraventricular arrhythmias (with heart rate over 125) or preoperative ischemic events. The 30-day mortality was 3 patients in the Levo group (2.7%) versus 12 patients in the Control group (10.9%, P value 0.001, OR 0.23, IC95 0.05– 0.90). Seven patients in the Levo group developed postoperative LOS (6.3%) against 20 patients in the Control group (18.2%, P value <0.001, OR 0.30, IC95 0.11– 0.80)
Conclusion: The preoperative optimization with Levosimendan reduced the operative mortality and the development of postoperative LOS in patients with EF<25% underwent open heart surgery. The infusion was safety no needing to withdraw it in any case. These findings could represent a new strategy to reduce the operative risk in this group of patients.:
Abstract 3340: Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention Predicts Left Ventricular Remodeling in Patients with Acute Myocardial Infarction
Authors: Yamamuro Atsushi , Akasaka Takashi , Kaji Shuichiro , Tamita Koichi , Katayama Minako , Kinoshita Makoto , Ehara Natsuhiko , Oda Tomoyuki , Kitai Takeshi , Yamane Takafumi , An Yasumori , Kim Kite , Tani Tomoko , Tanabe Kazuaki , Morioka Shigefumi , Kihara Yasuki 
Published: July 2021

Background: Studies using the Doppler guidewire have shown that coronary flow velocity (CFV) pattern in recanalized infracted arteries predicts recovery of regional left ventricular (LV) function, in-hospital complications, and long-term cardiac events. However, the relationship between the CFV pattern after reperfusion and serial changes in LV volumes is not clear. We postulated that the quantitative CFV measurement immediately after successful percutaneous coronary intervention (PCI) might be associated with the LV remodeling. To test this hypothesis, we prospectively analyzed the LV remodeling according to CFV parameters measured by the Doppler guidewire in patients with acute myocardial infarction (AMI).
Methods: Consecutive 211 patients with first-time anterior AMI underwent successful PCI (<50% residual stenosis with TIMI flow grade 2–3) and coronary flow measurement with the Doppler guidewire. The CFV spectrum provided the following parameters: time-averaged peak velocity (cm/s), systolic peak velocity (cm/s), and diastolic deceleration time (ms). Left ventriculograms obtained immediately after PCI and 6 months after the infarction were analyzed to measure the end-diastolic volume index and end-systolic volume index. The LV remodeling was defined as an increase in end-diastolic volume index ≥20%.
Result: The optimal cutoff values to predict LV remodeling (defined as 6-month LV dilation ≥20%) were 20 cm/s for time-averaged peak velocity, 0 cm/s for systolic peak velocity and 550 ms for diastolic deceleration time (sensitivity=0.63, specificity=0.56; sensitivity=0.76, specificity=0.85; and sensitivity=0.85, specificity=0.85, respectively). Systolic peak velocity and diastolic deceleration time correlated to the LV end-diastolic volume index obtained 6 months after AMI(r= −0.67; p<0.001 and r= −0.78; p<0.001, respectively).
Conclusions: The CFV pattern appears to be an accurate predictor of LV remodeling even in patients who received successful PCI in the left anterior descending coronary artery immediately after AMI. This index, therefore, identifies a subset of patients at-risk.
Abstract 3380: Levosimendan Improves Right Ventricular Function In Cardiogenic Shock Following Myocardial Infarction
Authors: Russ Martin A , Christoph Arnd , Carter Justin , Prondzinsky Roland , Schlitt Axel , Lemm Henning , Winkler Matthias , Buerke Michael 
Published: July 2021

Background: Levosimendan, a novel inodilator, has been shown to improve hemodynamic function in acute heart failure and cardiogenic shock following acute myocardial infarction. Limited data are available on its use in patients with impaired right ventricular function. We hypothesised that levosimendan, due to its vasodilating and positiv inotropic profile, could ameliorate right ventricular hemodynamic function in critically ill patients with cardiogenic shock following myocardial infarction.
Methods: Patients (n=25) with cardiogenic shock received initial conventional inotropic therapy after reperfusion of infarct related artery. After insufficient hemodynamic improvement patients received levosimendan (2μg/kgbw/h) over 24 hours. Hemodynamic measurements were routinely performed initially i.e., − 24 hours, at baseline (prior to levosimendan infusion) at 3 hours, 24 and 48 hours after start of levosimendan infusion using a Swan-Ganz thermodilution catheter.
Results: With conventional catecholamine therapy (i.e., norepinephrine and/or dobutamine) we observed only marginal change of right ventricular perfomance parameters. In contrast, upon levosimendan infusion there was a significant decrease in pulmonary vascular resistance, while right ventricular Cardiac Power Index, a new measure of right ventricular performance similar to left ventricular CPI, significantly increased. Central venous pressure did not change which makes a significant dependency on preload unlikely.
Conclusion: Levosimendan infusion in patients with cardiogenic shock following acute MI and PCI seems to improves substantially and persistently right ventricular hemodynamic parameters, superior to conventional catecholamine therapy. Further studies addressing the benefit of levosimendan in right ventricular failure like in cardiogenic shock due to right myocardial infarction or acute pulmonary embolism are warranted.

Hemodynamic Parameters With Catecholamine Teatment and Additional Levosimendan
Abstract 3432: Patients with Upper Extremity Arterial Disease Have Similar Major Adverse Clinical Events as Those with Lower Extremity Arterial Disease
Authors: Chi Yung-Wei , Woods T. Cooper 
Published: July 2021

Introduction: Upper extremity arterial disease, although it occurs less frequently compared to lower extremity arterial disease, negatively impacts one’s lifestyle. Most studies on peripheral arterial disease have been focused on the lower extremities and the clinical impact of upper extremity arterial disease remains less well known.
Hypothesis: Patients with upper extremity arterial disease have similar major adverse cardiovascular events (MACE) as those with lower extremity arterial disease.
Methods: Sixty-seven consecutive patients with upper extremity arterial studies and 359 consecutive patients with lower extremity arterial studies performed in 2004 by an accredited vascular laboratory were followed for at least 2 years. MACE including death, stroke, transient ischemic attack (TIA), myocardial infarction (MI) and unstable angina (USA) were tabulated and compared between the 2 groups. Final results were adjusted for diabetes mellitus, hypertension, hyperlipidemia, smoking status, and renal insufficiency. One-tailed t test was used.
Results: Eight events (28%) occurred in 29 patients with abnormal upper extremity arterial study compared to 24 events (21%) in 112 patients with abnormal lower extremity arterial study, p=NS. Five events (13%) occurred in 38 patients with normal upper extremity arterial study compared to 8 events (28%) in those with abnormal upper extremity arterial study, p=0.02. Twenty events (8%) occurred in 247 patients with normal lower extremity arterial study compared to 24 events (21%) in those with abnormal lower extremity arterial study, p<0.0001.
Conclusion: Patients with upper extremity arterial disease defined by abnormal upper extremity arterial study have similar MACE to those with lower extremity arterial disease (28% versus 21%, p=NS). In addition, those with either upper or lower extremity arterial disease have statistically more MACE than those without disease.

Major Adverse Clinical Events
Abstract 3489: Presence of Thoracic Aorta Calcification Predicts All Cause Mortality Independent of Traditional Cardiovascular Risk Factors and Coronary Artery Calcification
Authors: Nasir Khurram , Budoff Matthew J , Shaw Leslee J , Callister Tracy Q , Rumberger John , Sarwar Orakzai , Raggi Poalo , Berman Daniel , Blumenthal Roger S 
Published: July 2021

Background: Recent guidelines have suggested that presence of coronary artery calcium (CAC) is an independent marker of adverse cardiovascular disease (CVD) events and mortality. However the predictive value of thoracic aorta calcification (TAC) that can be additionally identified without further scanning during assessment of CAC is unknown.
Method: We followed a cohort of 8418 asymptomatic individuals (mean age: 53 ± 10 years, 69% men) undergoing cardiac risk factor evaluation and coronary calcium testing with electron-beam CT for median period of 5.0 years. Multivariable Cox proportional hazards models were developed to predict all-cause mortality obtained from the National Death Index with presence of TAC.

Results: 141 (2%) all cause deaths were recorded. Overall survival was 96.7% and 98.8% for subjects with and without detectable TAC (p < 0.0001). As compared to those with absent TAC (reference group) the hazard ratio for mortality for subjects with TAC was 3.07 (95% CI: 2.20 – 4.38) in unadjusted analyses (table

). After taking into account age, gender and CVD risk factors the association was reduced to 1.77 (95% CI: 1.11–2.29). The association of TAC with mortality remained statistically significant even after taking into account CAC (table

), although TAC appeared to predict events more strongly in the absence of CAC (HR: 2.81; 95% CI: 1.17– 6.79, p = 0.02) than with CAC > 0 (HR: 1.39; 95% CI: 0.93–2.08, p = 0.10). However the interaction term between TAC and CAC for mortality was not significant (p = 0.23).

Conclusions: Presence of TAC was associated with all-cause mortality in our study. This relationship was independent of conventional CVD risk factors and CAC.

Hazard Ratio for All Cause Mortality with Presence of Thoracic Aorta Calcification
Abstract 3574: Unsuspected Left Ventricular Wall Motion Abnormalities Identified by Cardiovascular Magnetic Resonance in a Free-Living Population: Lessons from the Framingham Heart Study
Authors: Tsao Connie W , Gona Philimon , Salton Carol J , Danias Peter G , Blease Susan , Albert Mark G , Levy Daniel , O’Donnell Christopher J , Manning Warren J , Yeon Susan B 
Published: July 2021

INTRODUCTION: Resting left ventricular (LV) wall motion abnormalities (WMAs) are associated with significant morbidity and mortality. We hypothesized that unsuspected resting WMAs would be present in a healthy population and applied cardiovascular magnetic resonance (CMR) to characterize the prevalence of these in a free-living population.
METHODS: 1794 subjects in the Framingham Heart Study Offspring Cohort (844M, 65±9 yrs) underwent cine CMR in short-axis, 2-ch, and 4-ch planes. Wall motion was scored using a standard 17-segment model with a 5-point scale. Global and regional (Ant, Sept, Inf, Lat) wall motion score indices (WMSI=wall motion score/# segments) were calculated with a WMSI>1 considered abnormal. LV ejection fraction (EF) and mass index (LVMI) were measured from the short axis stack. Adjudicated clinical events [CE; a history of coronary heart disease (CHD) or congestive heart failure (CHF)] were assessed.

RESULTS: WMAs were present in 143 subjects. Compared to subjects with no prior CE, those with CE (n=157) had greater prevalence of WMA (Global, 34% vs 6%; Ant, 16% vs 2%; Sept, 18% vs 3%; Inf, 28% vs 4%; Lat, 27% vs 3%; all p<0.0001) and higher Framingham Risk Score (FRS) (11±3 vs 7±4, p<0.0001). In subjects with CE, WMA was associated with higher LVMI (70±14 g/m
2
vs 59±14 g/m
2
, p<0.0001) and lower EF (53±11% vs 69±6%, p<0.0001), but not age, blood pressure (BP), or FRS. Among 1637 subjects with no CE, 90 (5.5%) had a WMA. In these subjects, WMA was associated with greater age, BP, FRS, and LVMI, and lower EF (TABLE

). In the entire (n=1794) cohort, WMAs were more prevalent in men than in women (40% vs 19% with CE; 9% vs 3% without CE, respectively, both p<0.0001).

CONCLUSIONS: In this closely followed free-living population, 5.5% of subjects have WMAs despite the absence of CE. WMAs were associated with other parameters of cardiovascular risk. The presence of WMAs among subjects without history of CHD or CHF may identify those at risk for adverse cardiovascular events.
Abstract 3643: Consciousness of Reduced Salt Diet and Actual Achievement of Salt Reduction Estimated from 24hr Urinary Na Excretions in General Populations in Japan, PRC, UK and US: The INTERMAP Study
Authors: Okuda Nagako , Ueshima Hirotsugu , Okayama Akira , Saitoh Shigeyuki , Nakagawa Hideaki , Sakata Kiyomi , Kadowaki Takashi , Curb J. David , Zhao Liancheng , Elliott Paul , Stamler Jeremiah 
Published: July 2021

OBJECTIVES: Assess the percentage of persons with consciousness of reduced salt diet (RSD) in general population samples and estimate actual differences in Na intake between RSD participants and others based on two timed 24hr urinary (24hr-U) Na excretions.
METHODS: Data from 4680 men and women ages 40 –59yr randomly selected from 17 general populations in four countries, Japan (n=1145), PRC (n=839), UK (n=501) and US (n=2195), in the International Study of Macro- and Micro-nutrients and Blood Pressure (INTERMAP). Awareness of RSD was surveyed by questionnaire. Participants provided timed 24hr-U samples twice; Na and K were measured. Means of 24hr-U Na, K excretions and Na/K ratio were compared between RSD and non-RSD participants. Values were also estimated adjusted for body weight, age and sex (multiple regression analysis).
RESULTS: RSD participants were few, 3.1% (Japan), 1.3% (PRC), 4.8% (UK) and 7.2% (US). Similarly among hypertensive (HTN) participants, 9.0% (Japan), 5.8% (PRC), 10.3% (UK) and 14.7% (US). Mean 24hr-U Na excretions (SE)(mmol) for RSD and non-RSD participants were 184.3(7.8) vs. 198.8(1.7)(p=0.129) (Japan); 191.2(19.3) vs. 228.0(3.5)(p=0.228) (PRC); 167.3(14.0) vs. 144.1(2.2)(p=0.114) (UK); and 150.9(4.7) vs. 163.5(1.3)(p=0.010) (US); adjusted Na excretions, 180.0(8.6) vs. 198.9(1.5)(p=0.031) (Japan); 172.4(27.4) vs. 228.2(3.1)(p=0.043) (PRC); 156.3(9.2) vs. 144.6(2.0)(p=0.217) (UK); 149.9(4.2) vs. 163.6(1.2)(p=0.002) (US). There were no significant differences in adjusted K excretions; Na/K ratios gave results similar to those for Na for all four countries. Adjusted Na excretions for HTN participants were significantly lower than for non-HTN participants in Japan (186.5(4.0) vs. 200.3(1.6)(p=0.002)); significant differences were not observed for other countries.
CONCLUSIONS: Only a small percent of all and of HTN participants reported following consciously RSD. While 24hr-U Na excretions tended to be significantly lower for RSD participants, total salt intakes were still high. To prevent CVD, it is important to implement salt reduction guidelines more aggressively.
Abstract 3661: “Energy Drink” Consumption Causes Increases in Blood Pressure and Heart Rate
Authors: Steinke Leah , Kalus James S , Dhanapal Vishnuprabha , Lanfear David E , Berlie Helen D 
Published: July 2021

Introduction: “Energy drinks” are very popular and are used frequently, especially by young adults. Most marketed energy drinks contain high levels of caffeine and taurine. Both caffeine and taurine have been shown to have direct effects on cardiac function and hemodynamic status.
Hypothesis: We assessed the hypothesis that a commonly used energy drink alters blood pressure, heart rate and EKG parameters in healthy volunteers.
Methods: Healthy volunteers (n = 15, 53% female, 25.9 ± 5.9 years, 69.8 ± 14.8 kg) abstained from caffeine for 48 hours prior to and throughout the study period. On study day 1 (D1), blood pressure (BP), heart rate (HR) and an EKG were measured at baseline. Participants then consumed 500 mL (2 cans) of an energy drink containing caffeine (80 mg) and taurine (1000 mg) and BP, HR and EKG measurements were repeated at 30 minutes, 1, 2, 3, and 4 hours after consumption. Participants then consumed 2 cans of energy drink daily for the next 5 days (D2–D6). On day 7 (D7) the procedures followed on D1 were repeated. Average baseline measurements on days 1 and 7 were compared to maximum values during that observation period.

Results: On both D1 and D7, maximum mean systolic BP, HR and corrected QT-interval (QTc) occurred at 4 hours. Maximum diastolic BP occurred at 2 hours on D1 and D7. Baseline and maximum mean values are presented in Table 1

. Within 4 hours of energy drink consumption on D1 and D7 respectively, systolic BP increased by 7.9% (p = 0.006) and 9.6% (p < 0.001), HR increased by 7.8% (p = 0.009) and 11.0% (p < 0.001) and QTc increased by 4.5% (p = 0.368) and 5.5% (p = 0.052). Diastolic BP increased by 7.0% (p = 0.046) and 7.8% (p = 0.063) within 2 hours of energy drink consumption.

Conclusions: In conclusion, although no significant EKG changes were observed, subjects’ HR increased 5–7 bpm and systolic BP increased 10mmHg after consuming an “energy drink”. This level of change is likely clinically significant in patients with cardiac disease or those who consume such drinks regularly.

Table 1.

Baseline and Maximum Values (mean ± SD)
Abstract 3702: Anemia as an Independent Predictor of Perioperative and Long Term Cardiovascular Outcome in Patients Scheduled for Elective Vascular Surgery
Authors: Dunkelgrun Martin , Hoeks Sanne , Goei Dustin , Welten Gijs , Vidakovic Radosav , van Gestel Yvette , Schouten Olaf , van Domburg Ron , Poldermans Don 
Published: July 2021

BACKGROUND: Anemia has been shown to be an independent risk factor for adverse cardiac outcome in various populations. This study evaluated the predictive value of anemia in patients scheduled for elective vascular surgery.
METHODS: In total, 1211 patients (76% male, age 68 ± 11 yrs) were enrolled. Anemia was defined as serum hemoglobin < 13 g/dL for men and < 12 g/dL for women, as defined by WHO. Anemia was divided into tertiles to compare mild, moderate and severe anemia with non-anemic patients. Outcome measures were 30-day and 5-year cardiac events (CE) (cardiac death or myocardial infarction). Mean follow up was 3.4 ± 3.2 years. Multivariable linear and Cox regression analysis was used, adjusting for age, sex, type of surgery and baseline characteristics, including angina, myocardial infarction, heart failure, diabetes and renal failure. Data are presented as HRs, with 95% confidence intervals.

RESULTS: In total, 74 (6%) patients experienced a 30-day CE and 199 (16%) a 5-year CE. Anemia was present in 399 (33%) patients, of which 133 were mild, 133 moderate, and 133 severe anemia. The presence of anemia was associated with renal failure, diabetes and heart failure. CE free survival at 30 days and 5 years was worse for patients with anemia (Figure

). After adjustment for all clinical risk factors, the 30-day HRs for a CE per anemia group were; mild 1.8, 1.0 – 4.1, moderate 2.9, 1.4 – 6.2, and severe 7.6, 4.1–13.1, and 5-year HRs for CE per anemia group were; mild 2.2, 1.3–3.8, moderate 3.6, 2.4 –5.6, and severe 6.6, 4.6 –9.6.

CONCLUSION: The presence and severity of preoperative anemia are significant predictors of 30-day and 5-year cardiac events in patients undergoing elective vascular surgery.