bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 4226: Elevated Levels of Lp(a) Predict Coronary Atherosclerosis as Detected by Coronary Artery Calcium Scanning with Computed Tomography
Authors: Akram Kamran , Kasim Manoefris , Voros Szilard 
Published: July 2021

INTRODUCTION Lipoprotein (a) [Lp(a)] has been established as an independent cardiac risk factor. There is considerable variation among different races and the association between Lp(a) and coronary artery calcium (CAC) is unknown in Asians.
METHODS 104 patients (pts) from Jakarta, Indonesia underwent CAC scoring and measurements of various biomarkers including Lp(a) (DAIICHI Pure Chemicals, Japan). Lp(a) >20mg/dl were defined as abnormal; CAC was expressed as Agatston score. Lp(a) values were not normally distributed and Kruskal-Wallis test and median values were used to test Lp(a) levels across CAC ranges (0, 1–100, 101– 400, >400). ROC curve analysis tested the performance of Lp(a) to predict presence of any CAC.
RESULTS 53/104 (51%) pts had an abnormal Lp(a) level. Clinical characteristics were similar between the two groups (60% male, 14% DM, 57% HTN, 30% smoker). Pts with abnormal Lp(a) had higher mean total cholesterol (220±48 vs. 199±147, p=0.01), LDL (147±40 vs. 130±38, p =0.02) and Lp(a) level (10.2±5.2 vs. 40.8±5.2, p=0.001) but similar HDL (46±10 vs. 45±9, p=NS) and triglyceride (154±113 vs. 145±95, p=NS) levels. Lp(a) was a good test in predicting presence of CAC as evidenced by an area under the curve (AUC)=0.7 with the optimal cut-point of >17mg/dl (sensitivity 73%, specificity 73%, p<0.001). Kruskal-Wallis analysis showed median Lp(a) levels to be significantly higher across rising CAC ranges: 0=41.5, 1–100=54.9, 101– 400=62.1, >400=64 mg/dl (p=0.026). After adjusting for the above clinical characteristics and biochemical markers in a multivariate logistic regression model Lp(a) levels remained a significant predictor of CAC (p=0.007).
CONCLUSION This is the first study to demonstrate a significant relationship between Lp(a) levels and presence of CAC in an Asian population.
Abstract 4274: Retrograde Ascending Aortic Dissection During or After Thoracic Aortic Stent-Graft Placement- Insights from the European Registry on EVAR Complications (EUREC)
Authors: Eggebrecht Holger , Thompson Matt , Rousseau Herve , Czerny Martin , Lönn Lars 
Published: July 2021

Background: Thoracic endovascular aortic repair (TEVAR) is increasingly applied in the treatment of aortic dissections and aneurysms. Single center reports have addressed retrograde ascending aortic dissection (rAAD) as a potentially lethal complication unique to TEVAR. We used data from a European multi-center registry to determine possible etiological factors and outcomes of this dreadful complication.
Methods: So far 15 European sites and 1 Chinese center are contributing to the European Registry on EVAR Complications (EUREC) which is an open, independent, ongoing multi-center registry. Between 01/1998 and 05/2008 these centers performed a total of 3074 TEVAR procedures.
Results: 33 rAAD cases (56.3±11.6 yrs, 20 males) were reported (incidence 1.1%). Indications for TEVAR were: acute type B dissection (n=17), chronic dissection (n=10), thoracic aneurysm (n=4), and aortic ulcer (n=1). 20 procedures were performed as emergency TEVAR. Stent-grafts with proximal bare springs were used in 26/33 (79%) cases. Additional balloon inflations were performed in 6 (18%) cases. rAAD occurred intraoperatively (n=5, 15%), during the index hospitalization (n=7, 21%), and during follow-up (n=21, 64%). 9 (27%) patients were asymptomatic, the remaining patients presented with acute chest pain (n=11, 33%), syncope (n=10, 30%), or sudden death (n=5, 15%). Emergency or elective surgical repair was performed in 19 and 4 patients, respectively. Conservative therapy was chosen in the remaining 10 patients. Outcome was fatal in 14/33 (42%) patients. The most probable cause of rAAD as reported by the investigators was stent-graft induced in 58%, procedure related in 9%, and underlying undiagnosed aortic disease in 15% of patients. In 16/33 patients direct evidence of stent-graft induced rAAD was obtained by surgery or necropsy.
Conclusion: Although the incidence of rAAD was low (1.1%) in the present EUREC analysis, it was associated with significant mortality (42%). Patients undergoing TEVAR for type B dissection appeared to be most prone rAAD. As suspected, the majority of rAAD cases was associated with the use of proximal bare spring stent-grafts and in almost half of the patients direct evidence of stent-graft induced injury was obtained from surgery or necropsy.
Abstract 4337: Best Outcome Predictor Post Myocardial Infarction: Can Blood Glucose Defeat Left Ventricular Ejection Fraction?
Authors: Monteiro Silvia , Antonio Natalia , Lourenço Carolina , Teixeira Rogério , Batista Rui , Jorge Elisabete , Saraiva Fátima , Monteiro Pedro , Gonçalves Lino , Freitas Mário , Providência Luís 
Published: July 2021

Introduction: Ventricular dysfunction in acute myocardial infarction (AMI) is a recognized predictor of in-hospital and post-discharge morbidity and mortality. Recently, admission hyperglycaemia has also been considered an important marker of poor prognosis in this patient population.
Aim: To compare the predictive value of left ventricular dysfunction with admission glycaemia (GLY) on prognosis of AMI patients and to identify independent predictors of 1-year major acute cardiac events (MACE) and mortality.
Population and methods: Retrospective analysis of 583 consecutive patients admitted to a single coronary care unit for AMI. Patients were followed during twelve months after AMI. Re-hospitalization by worsening heart failure, non programmed revascularization, new ACS and death were considered as MACE.
Results: After multivariate analysis, age, previous diabetes, necrosis markers, and low ejection fraction (EF) were independent predictors of 1-year mortality, while PCI performance and admission GLY, in addition to parameters listed before were independent predictors of MACE at 1-year of follow-up. We then compared, by multivariate regression analysis, the predictive value of admission GLY and EF in this population. The receiver-operator curves showed that both parameters were equally predictive of both short and long-term MACE and mortality.
Conclusion: In this population, admission GLY was as predictive of outcome as EF, a well recognized and strong prognosis determinant post-AMI. This fact, never before described, underlies the importance of metabolic abnormalities and its control in the prognosis of AMI patients.
Abstract 4342: The RethinQ Trial Echocardiographic Sub Study: Insights from Analysis of TDI Data on Mechanical Dyssynchrony in a Randomized Clinical Trial of Cardiac Resynchronization Therapy in Narrow QRS Patients with Heart Failure
Authors: Grimm Richard , Beshai John , Nagueh Sherif , Baker James , Beau Scott , Greenberg Steven , Pires Luis , Tchou Patrick 
Published: July 2021

Tissue Doppler Imaging (TDI) of myocardial velocities is the method of choice to characterize mechanical dyssynchrony (MD) in the failing heart. TDI identified candidates for the RethinQ trial, a prospective, randomized, multicenter, double-blind, parallel-controlled trial evaluating the efficacy of Resynchronization Therapy (CRT) in pts with EF <35%, NHYA class III, QRS <130 ms and MD by TDI. Peak MVO
2
at 6 months was the primary endpoint. The purpose of this study was to determine whether:

degree of MD by TDI and opposing wall delay (OPWD) correlated with outcome;

resynchronization by TDI parameters of MD was achieved by CRT; and

if other TDI parameters of MD were predictive of outcome.

Methods: A retrospective analysis of prospectively acquired echo data. Pts underwent an echo exam at baseline and 6 months which included color TDI enabling determination of the OPWD ≥65 ms required for enrollment into the trial. Other recognized parameters of MD such as the pre-ejection period (PEP) and 12 segment standard deviation of time-to-peak myocardial velocity were collected but not part of the selection criteria used to randomize pts to CRT. For the purpose of this analysis responders (R) were defined by improved MVO
2
and reduction in LVESV> 15%. All echo data was adjudicated by a Core Lab.

Results: Degree of dyssynchrony pre implant (OPWD > 65, > 80, > 100ms) did not impact response to CRT. Both R and Non responders (NR) exhibited a decrease in OPWD at 6 months though R had a greater median change than NR -33(−29+42) ms vs 0(−3+45) ms, p=0.01. When pts exhibited OPWD ≥65ms, 12 segment standard deviation ≥34ms and PEP > 100ms there was a trend toward being able to identify R to CRT pre implant. 18/65 (28%) pts receiving CRT and meeting all 3 MD criteria were categorized as R vs. 6/47 (13%) not receiving CRT, p=0.052.
Conclusions: Analysis of the echo TDI data revealed that degree of MD did not impact outcome, improvement of dyssynchrony was achieved with CRT and a combination of OPWD≥65ms, 12 segment standard deviation ≥34ms and pre ejection period > 100ms showed promise in predicting improvement in pts with narrow QRS, low EF and MD.
Abstract 4386: Single-Center Experience in Large Cohort of Patients with Pulmonary Arterial Hypertension Related to Congenital Heart Disease over 15 years: Effect of New Therapies
Authors: Apostolopoulou Sotiria C , Tsoutsinos Alexandros , Kiaffas Maria , Laskari Cleo V , Rammos Spyridon 
Published: July 2021

Introduction: The aim of this study was to define the epidemiology, clinical parameters and 15-year follow-up of a large single-center cohort of patients with pulmonary arterial hypertension (PAH) related to congenital heart disease (CHD) and to evaluate the effect of emerging therapeutic strategies in this population.
Methods: All patients diagnosed with PAH related to CHD between 1993 and 2008 were studied and clinical, echocardiographic, maximal and submaximal exercise as well as hemodynamic data were recorded.
Results: A total of 60 pts aged 21 ± 14 (0.1–51) years at diagnosis were included in the study. Of these, 44 (73%) had unrestrictive mixing lesions and Eisenmenger syndrome and the rest non-mixing lesions, mainly repaired CHD. Of this population, 24 (40%) were <18yrs and the remainder adults at diagnosis at our institution. Seven (12%) pts in WHO Class II received no therapy, 45 (75%) pts in Class II-III monotherapy (34 bosentan with 1 discontinuation after corrective surgery, 6 sildenafil, 5 sitaxsentan) with clinical and exercise improvement. Due to deterioration, 6 (10%) pts received addition of sildenafil after 3±1 years of bosentan monotherapy and 2 (3%) pts addition of epoprostenol after 1 year of the above combination therapy. Over 6±4 (1–15) years of follow-up, 49 (82%) pts remained stable on no or monotherapy, 4 pts (7%) deteriorated after 1–5 years monotherapy but stabilized on combination therapy and 7 (12%) pts died (3 from intractable right heart failure despite escalation of therapy and 4 suddenly while on therapy). The unrestrictive mixing group had 2 (4%) and the non-mixing group 5 (33%) deaths respectively.
Conclusions: Long-term improvement and stabilization is possible in pts with PAH related to CHD with either monotherapy or combination therapy in case of deterioration overtime while on treatment. Death in this population may be sudden or due to intractable right heart failure, while survival is significantly better in pts with unrestrictive mixing. Larger long-term registry studies are needed to evaluate survival and clinical condition of these pts in the current treatment era and to improve medical management of this population.
Abstract 4388: In-Vivo Pulmonary Vascular Stiffness Obtained from Color M-Mode Tissue Doppler Imaging and Pressure Measurements Predicts Clinical Outcomes Better than Indexed Pulmonary Vascular Resistance in Pediatric Patients with Pulmonary Arterial Hypertension
Authors: Hunter Kendall S , Lanning Craig J , Kirby K Scott , Ivy D Dunbar , Shandas Robin 
Published: July 2021

Introduction: Pulmonary vascular stiffness (PVS) is increasingly recognized as an important component of right ventricular afterload in patients with pulmonary arterial hypertension (PAH). In adult and pediatric PAH populations, stiffness has also been shown to improve prediction of mortality and outcomes, respectively. Despite these promising findings, methods to determine PVS clinically remain limited. Here we examine the ability of a minimally-invasive method to quantify proximal PVS in a pediatric PAH population, and hypothesize this measurement will offer better disease outcomes prediction over indexed pulmonary vascular resistance (PVRI), the current gold standard.
Methods: Color M-mode Tissue Doppler Images of the right pulmonary artery (RPA) were obtained using ultrasound during right-heart catheterization of 36 individuals undergoing reactivity testing (n=86) who ranged in age from 1 month to 19 yrs (mean = 6.5±5.2 yrs, 19 males). These measurements yielded RPA diameter and intravascular pressure, from which an estimate of the circumferential elastic (Young’s) modulus (E), the continuum component of stiffness, was derived. Echo imaging added only 5 minutes to the procedure. Follow up was obtained in 19 patients (mean = 4.9±4.7 yrs, range 1 month to 16 yrs, 9 males) at a median time of 15 months (range 1–26 months). Cumulative logistic regression was used to relate continuous values of E and PVRI to three outcomes categories: improvement; stable (no change); or worsening. These were determined from change in WHO score from initial assessment to follow up.
Results: E had better correlation to pulse pressure (PP) (R2=0.61) compared to mean pressure (R2=0.43); this agrees with other findings of PP as a good proxy of stiffness. E displayed substantially better correlation (R2L=0.49) to outcomes compared to PVRI (R2L=0.33). In more practical terms, E wrongly predicted outcome only once (5%), compared to four errors by PVRI (21%), and offered clearer prognosis in an additional 3 individuals; thus 37% of the group would benefit from such improved prediction.
Conclusion: We conclude that elastic modulus is a measure of proximal vascular stiffening and most importantly offers superior outcomes prediction compared to pulmonary vascular resistance.
Abstract 4496: Percutaneous Coronary Intervention in Stable Coronary Heart Disease: Value of Nt-Probnp for Stratification of Long-Term Risk
Authors: Carmo Pedro , Aguiar Carlos , Ferreira Jorge , Raposo Luis , Goncalves Pedro , Almeida Manuel , Teles Rui , Figueira Joao , Machado Francisco , Silva Aniceto 
Published: July 2021

Purpose: N-terminal fragment of the B type-natriuretic peptide (NT-proBNP) is an established tool for assessing acute dyspnoea and stratifying risk in heart failure, acute coronary syndromes (ACS), and stable coronary heart disease (SCHD). The aim of this study was to determine the value of NT-proBNP in predicting long-term risk of patients (Pts) submitted to elective percutaneous coronary intervention (PCI) in the setting of SCHD.
Methods: We prospectively studied 291 Pts (age 64.3±9.6 years, 64 female) with SCHD submitted to successful elective PCI, and determined NT-proBNP immediately before PCI. Pts were divided into 2 groups according to NT-proBNP level: group T3 formed by Pts with NT-proBNP level in the highest tertile and group T1+T2 formed by all remaining Pts. The study endpoint was time to the first occurrence of death (D) or non-fatal myocardial infarction (MI) during the mean follow-up of 568 ± 322 days. Multivariable analyses were performed to adjust the prognostic value of NT-proBNP for the effects of factors known to influence NT-proBNP (age, gender, renal function, body mass index) and of other potential predictors of outcome (cardiovascular risk factors, prior cardiovascular events, left ventricular ejection fraction, and PCI characteristics).
Results: NT-proBNP ranged from 5 pg/ml to 104 pg/ml in the 1st tertile (T1), 105 pg/ml to 358 pg/ml in the 2nd tertile (T2), and 364 pg/ml to 33.991 pg/ml in the 3rd tertile (T3). During follow-up, 8 Pts died and 11 suffered a non-fatal MI. NT-proBNP was significantly higher in Pts who experienced an adverse outcome (440 pg/ml [inter-quartile range, 104 –1712] vs 174 pg/ml [inter-quartile range, 78 – 460) in Pts with uneventful follow-up; P= 0.007). An NT-proBNP level ≥364 pg/ml was associated with a higher endpoint rate (13.4% vs 3.1% in group T1+T2) and independently predicted outcome: adjusted hazard ratio 3.11, 95% CI, 1.15– 8.37, P=0.025. The sensitivity, specificity, predictive positive value, and negative predictive value for the criterion NT-proBNP ≥364 pg/ml were 68.4%, 69.1%, 13.4%, and 96.9%, respectively.
Conclusion: In the setting of SCHD, the level of NT-proBNP is a powerful prognostic marker even after successful PCI.
Abstract 4688: The Impact of Marfan Syndrome on Arterial Stiffness and Endothelial Function: The Role of Matrix Metalloproteinases
Authors: Brilli Stella , Tousoulis Dimitris , Antoniades Charalambos , Hatzis George , Ioakeimidis Nikos , Vlachopoulos Charalambos , Papazoglou Georgia , Papageorgiou Nikos , Stefanadi Elli , Stefanadis Christodoulos 
Published: July 2021

Background: Marfan syndrome is characterised by high risk of aortic dissections and increased cardiovascular risk. However, the impact of Marfan syndrome on endothelial function and arterial stiffness is unclear, while the role of matrix metalloproteinases is unknown. We examined the impact of Marfan syndrome on the elastic properties of the arterial tree, and vascular endothelial function, and we evaluated the potential role of matrix metalloproteinases in these effects.
Methods: The study population consisted of 17 subjects with Marfan syndrome, aged 26.6±2.3 years old, with BMI 20.5±1.03Kg/m2 and 22 healthy individuals matched for gender, age (26.4±0.78 years old, p=NS) and BMI (22.4±0.86 Kg/m2). Arterial stiffness was evaluated by measuring carotid-femoral pulse wave velocity (PWV), while augmentation pressure and augmentation index (AIx) were also determined, as measures of arterial wave reflections. Endothelial function was evaluated by determining flow mediated dilation (FMD) in the brachial artery while matrix metalloproteinase 9 (MMP-9) levels were determined by ELISA.
Results: Patients with Marfan syndrome had significantly lower pulse pressure in the radial artery (41.0±1.07mmHg) compared to controls (51.3±4.4mmHg). In addition, patients had higher AIx (17.6±2.4%) and augmentation pressure (5.44±0.65mmHg) compared to controls (7.72±3.43% and 2.41±1.14mmHg respectively, p<0.05 for both). However, the difference in PWV between patients and controls did not reach statistical significance (6.33±0.33 vs 5.96±0.23m/s respectively, p=NS). Patients with Marfan syndrome had lower FMD (2.05±1.13%) and higher plasma MMP-9 (827±70ng/ml) compared to controls (6.8±2.3% p<0.05 and 326±50ng/ml, p<0.01).
Conclusions: Marfan syndrome is associated with increased MMP-9 levels, as well as with elevated augmentation index and augmentation pressure compared to healthy individuals, matched for age, gender and body mass index. Moreover, flow-mediated dilation is also impaired in these subjects. These findings suggest that Marfan syndrome directly affects the elastic properties and endothelial function of the arterial tree, with matrix metalloproteinases being important mediators in the pathophysiology of this syndrome.
Abstract 4830: The Effects of Stem Cells on C-Kit Up-Regulation and Cell-Cycle Reentry of Neonatal Cardiomyocytes are Mediated by IGF-1 Receptor Activation
Authors: Yu Xi-Yong , Geng Yong-Jian , Li Xiao-Hong , Deng Chun-Yu , Lin Shu-Guang , Yang Tong , Song Yao-Hua , Li Yangxin 
Published: July 2021

Mesenchymal stem cells (MSCs) contribute myocardial regeneration, and the beneficial effects may be mediated by paracrine factors produced by MSCs. C-kit positive neonatal cardiomyocytes (NCMs) contribute to myocardial regeneration, but they do not give a robust regenerative response since low expression of c-kit. Cell-cycle reentry of NCMs and insulin-like growth factor (IGF-1) improve myocardial function in infarcted hearts. MSCs and NCMs were prepared from Lewis rats, and cocultured in two chambers which allowed the diffusion of secreted factors from upper chamber to lower chamber, but prevented cell contacts. MSCs secreted significant amount of IGF-1 (159.6 ± 34.4 pg/ug DNA at 24 h, 285.3 ± 28.5 pg/ug DNA at 48 h, and 358.3 ± 39.9 pg/ug DNA at 72 h), whereas the amount of IGF-1 in conditioned medium from NCMs was undetectable assessed by IGF-1 ELISA. Using flow cytometry, we found that the secreted factors by MSCs increased c-kit protein expression, which was attenuated by IGF-1 receptor neutralizing antibody (IGF-1R Ab) and phosphatidylinositol 3 (PI3) kinase inhibitor LY 294002 (NCM vs MSC/NCM vs MSC/NCM+IGF-1R Ab vs MSC/NCM+ LY294002= 1.5 ± 0.6 % vs 5.5 ± 0.3 % vs 1.9 ± 0.6% vs 2.1 ± 0.5%) assessed by flow cytometry. The cytokinesis of NCMs was increased when cocultured with MSC analyzed by calcein fluorescence intensity (3.1 ± 0.5 fold increase, p<0.02). As determined by BrdU assay, the DNA synthesis of NCMs was significantly increased when cocultured with MSC compared to NCM alone (1.8 ± 0.3 fold increase at 48 h, 2.6 ± 0.2 fold increae at 72 h), which was attenuated by IGF-1R Ab and by PI3 kinase inhibitor. To confirm the paracrine effects of MSCs are mediated by IGF-1 signaling and PI3/Akt pathway, we performed in vitro Akt kinase assay using GSK-3 fusion protein as substrate, and found that co-culture system increased the activity of Akt kinase in NCMs, and the IGF-1R Ab and PI3 kinase inhibitor dose-dependent blocked the ability of co-culture system to increase Akt kinase activity. Our results demonstrate that the paracrine effects of MSC on c-kit up-regulation and cell-cycle reentry of NCM are mediated by IGF-1R activation through PI3 kinase/Akt - mediated pathway. These findings provide a new paradigm for the biological effects of IGF-1 on myocardial regeneration.
This research has received full or partial funding support from the American Heart Association, AHA South Central Affiliate (Arkansas, New Mexico, Oklahoma & Texas).
Abstract 5584: Heart Failure Eliminates the Risk Gradient Defined by TIMI Risk Score in Non-st-segment Elevation Acute Coronary Syndromes
Authors: Gonçalves Sara S , Amador Pedro , Mendes Lígia , Seixo Filipe , Santos José F 
Published: July 2021

The TIMI Risk Score is a simple and effective tool for risk stratification in patients (pts) with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). The presence of heart failure (HF) or a low ejection fraction (EF) has also been associated with a worse outcome. We sought to evaluate the interaction of heart failure on the risk gradient defined by the TIMI Risk Score in a NSTE-ACS population. We studied 9980 pts with NSTE-ACS included in a prospective nationwide clinical registry since 2002. Pts were stratified by TIMI Risk Score in low (0 to 2), intermediate (3 and 4) and high risk (5 to 7) groups. The population was divided in two groups according to the presence or absence of HF. HF was defined as the presence of a Killip class >1 or a systolic EF <30%. In-hospital mortality or re-infarction was assessed in both groups during the index hospitalization and according to TIMI Risk Score Stratification.
Results: In-hospital mortality or re-infarction was 1,9% in low risk, 3,7% in intermediate and 6,3% in high risk pts (Qui-square trend p<0,001). The risk gradient defined by the TIMI risk score was not observed in patients without HF (Qui-Square for trend=ns). In pts with HF, the TIMI risk score maintains its predictor value (Qui-square trend=0,014), but the presence of HF identifies a higher risk subgroup. In this population, HF was a strong independent predictor for in-hospital mortality and re-infarction (OR 10,01). In NSTE-ACS pts, the presence of HF identifies the patients with higher risk for in-hospital risk and re-infarction within each TIMI Risk Score subgroup. There was no risk gradient assessed by the TIMI risk score in the absence of HF.