bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 898: Can Angiography With Synchrotron Radiation And A High Sensitivity Receiver Make Lower Doses Of Contrast Medium Possible?
Authors: Konishi Taisuke , Matsushita Shonosuke , Hyodo Kazuyuki , Sugimori Haruhiko , Tokunaga Chiho , Enomoto Yoshiharu , Kanemoto Shinya , Watanabe Yutaka , Hiramatsu Yuji , Sakakibara Yuzuru 
Published: July 2021

Introduction: Contrast-induced nephropathy (CIN) is a serious complication associated with angiography and interventional angioplasty. Increased doses of contrast medium are a major risk factor of CIN. It was assumed that the occurrence of CIN could be decreased by reducing the dose of contrast medium. We investigated the effects of a new high resolution and high contrast angiographic system on the application of diluted contrast medium.
Method: Contrast medium was diluted to 32% (a stock solution), 24%, 16%, 12%, 8%, and 4%. Angiography of the hindlimb in rats using a synchrotron radiation and HARP receiver were performed with each concentration of contrast medium (n=5, respectively). The characteristics of synchrotron radiation are high photon density (10,000 times that of conventional X-rays) and straightness of the beam, which lead to high resolution (26 micrometer/pixel). A HARP Receiver is a high sensitivity image capturing system, which was developed by NHK Sci & Tech Res Lab (Tokyo, Japan). It is about 100 times more sensitive than conventional CCD cameras. Each angiographic image was evaluated by 256 grayscale intensity using graphic software NIH Image. The availability of each image as angiography was determined by the judgment of 5 independent cardiologists respectively.
Results: In 256 grayscale, the minimum visible contrast distance for identifying vessels was 10. The value of each image in different concentrations of contrast medium was as follows: 4%: 14+/−12, 8%: 22+/−10, 12%: 23+/−18, 16%: 25+/−11, 24%: 28+/−11, 32%: 40+/−10. Vessels are identified from 4% to 32%. Availability as angiography was confirmed from 8% to 32% by common assent.
Conclusions: The angiographic system using synchrotron radiation and a HARP receiver was able to take angiographic images with as low as 8% contrast medium. This may lead to beneficial effects in patients who cannot undergo sufficient angiography and interventional angioplasty due to renal dysfunction.
Abstract 2016: Levosimendan Infusion in Patients with Myocardial Infarction and High Systemic Vascular Resistance
Authors: Tsagalou Eleftheria P , Anastasiou-Nana Maria , Ntalianis Argyrios , Lazaris Nikolaos , Bonios Michail , Kaldara Elisavet , Tseliou Eleni , Katsaros Fotis , Nanas John 
Published: July 2021

Background: Levosimendan, a novel inodilator, has been shown to improve hemodynamic function in patients with decompensated heart failure with preserved arterial blood pressure. Data on its use in patients with cardiogenic shock are scarce. The present series describes the 24-h hemodynamic effects of levosimendan as add-on therapy in patients with cardiogenic shock.
Methods: Levosimendan was administered for 24 hours (dose ranging from 0.05 to 0.2μg/kg/min), in addition to catecholamines, in 25 patients who suffered from cardiogenic shock after acute myocardial infarction. Hemodynamic measurements were performed at baseline (prior to levosimendan infusion) and at 24 hours after initiation of levosimendan.
Results: Hemodynamic improvement was evident only in patients (Group 1, n=13) with increased systematic vascular resistance (SVR>18Wood). Levosimendan administration increased the cardiac index ( 2.1±0.4 l/min/m2 from 1.5±0.3l/min/m2, p=0.002) and cardiac power (0.645±0.179W from 0.462±0.164W, p=0.022) and decreased SVR (21±6.7Wood from 23±5Wood, p=0.001) and pulmonary cappillary wedge pressure (16±11mmHg from 23±5mmHg, p=0.059). On the other hand, patients with low systemic vascular resistance (SVR<19Wood)) (Group B, n=12 ) did not have hemodynamic improvement with levosimendan administration.
Conclusions: Levosimendan infusion added to catecholamines in patients with cardiogenic shock after myocardial infarction exerts hemodynamic benefit only in the subgroup of patients with high SVR.
Abstract 2197: The Multi-System Effect of Exercise Training During Prolonged Bed Rest Deconditioning: An Integrated Approach to Countermeasure Development for the Heart, Lungs, Muscle and Bones
Authors: Hastings Jeffrey , Pacini Eric , Krainski Felix , Shibata Shigeki , Jain Manish , Snell Peter , Fu Qi , Palmer Michael D , Creson Daniel , Levine Benjamin D 
Published: July 2021

We propose to prevent the cardiac atrophy and orthostatic intolerance associated with prolonged bed rest using rowing ergometry/resistance training with aggressive volume loading on the day of testing. We hypothesize that prevention of cardiac atrophy will forestall cardiovascular deconditioning, leading to preserved exercise capacity and orthostatic tolerance. Twenty-four healthy subjects, ages 20 –55, were enrolled with 8 randomized to training (EX), 8 with training and volume loading (VOL), and 8 as sedentary (SED) controls. Testing included maximal upright exercise, orthostatic tolerance via graded lower body negative pressure (LBNP), cardiac MRI, as well as invasive cardiac pressure-volume measurements, performed at baseline and at the end of 5 weeks of 6° head down bedrest. Upright exercise capacity was preserved with training as measured by peak workrate and VO2max (EX/VOL: pre 195±46W, 34±7 ml/kg/min; post 202±42W, 33±4 ml/kg/min) but deteriorated in SED group (pre 171±55W, 34±8 ml/kg/min; post 145±51W, 27±7 ml/kg/min). MRI derived mass (% change: +6.3±9.9% EX/VOL vs. −5.5±3.7% SED) was increased by training. Exercise training appears to preserve LV chamber compliance (stiffness constants: EX/VOL: pre= 0.035±0.021, post = 0.036±0.029; SED: pre= 0.020±0.011, post = 0.028±0.007). Training also preserves hemodynamic variables measured at −40mmHg of LBNP, including stroke volume (EX: pre 44±12; post 38±9 ml, VOL: pre 49±30; post 45±29 ml, SED: pre 35±5; post 24±8 ml ). These preliminary data support our hypothesis that an optimized training program consisting of dynamic and resistance exercise can prevent part of the multisystem atrophy and orthostatic intolerance associated with prolonged bed rest. This defines a specific countermeasure that is practical, safe, and effective against the cardiovascular, muscle and bone deconditioning associated with prolonged bed rest. This information is relevant not only for astronauts exposed to long duration spaceflight, but also for patients with chronic reductions in physical activity, and those with disease processes that alter cardiac stiffness such as obesity, hypertension, heart failure or ischemic heart disease, plus normal aging and osteoporosis.
This research has received full or partial funding support from the American Heart Association, AHA South Central Affiliate (Arkansas, New Mexico, Oklahoma & Texas).
Abstract 2457: Predictors of Resistant Hypertension in an Eight Year Follow-Up Study of an Unselected Sample of Adult Male Population in Italy
Authors: Barbato Antonio , Galletti Ferruccio , D’Elia Lanfranco , Ippolito Renato , Iacone Roberto , Venezia Antonella , Cappuccio Francesco Paolo , Siani Alfonso , Barba Gianvincenzo , Strazzullo Pasquale 
Published: July 2021

Background: The determinants of resistant hypertension (RH), defined as a blood pressure (BP) persistently above goal in spite of the concurrent use of 3 antihypertensive agents of different classes, remain largely unknown. We investigated the predictors of RH in 799 participants at the Olivetti Heart Study (OHS), mean age 51.5 yrs (SD±7.2) after an average follow-up period of 8 yrs.
Methods: All participants attending the basal (1994 –95) and final (2002– 04) examination of the Olivetti Heart Study. A complete database including anthropometric, biochemical and ECG data was available for the analysis.
Results: Among the 799 participants not affected by RH at basal examination, 497 (62.2%) were normotensive and 302 (37.8%) hypertensive. After 8 years, overall 29 subjects (3.6%) developed RH. Age, BMI, waist circumference, BP, Cornell Index, serum total cholesterol and uric acid, urinary fractional sodium excretion (FENa), a marker of dietary sodium intake, and albuminuria (ALB) were significantly higher (p<0.05) in participants who developed RH compared with the others. Using a logistic regression model, after adjustment for basal antihypertensive treatment, microalbuminuria (Odds Ratio; C.I 95%: 3.2;1.1– 9.3), proteinuria (12.2; 1.9 –76.5), systolic BP (2.1;1.4 –3.3) and FENA (1.4; 1.1–1.7) remained the only independent predictors of RH.
Conclusions: Our results indicate that an early marker of organ damage (albuminuria), an elevated dietary sodium intake and a higher basal BP level were independent predictors of the development of RH in this sample of adult male population.
Abstract 2524: Long-Term (4 year) Outcome following Drug Eluting Stent Implantation versus Coronary Artery By-pass Surgery in Unprotected Left Main Coronary artery Lesions
Authors: Chieffo Alaide , Magni Valeria , Maisano Francesco , Ielasi Alfonso , Latib Azeem , Montorfano Matteo , Carlino Mauro , Sangiorgi Giuseppe M , Ferri Luca , Bassanelli Giorgio , Ferrari Angela , Godino Cosmo , Alfieri Ottavio , Colombo Antonio 
Published: July 2021

One-year outcome following drug-eluting stent (DES) implantation versus coronary artery by-pass grafting (CABG) in unprotected LMCA lesions have been previously reported from our center.
Methods and results Two hundred forty-nine consecutive patients with an unprotected LMCA stenosis electively treated (107 with PCI and DES implantation and 142 with CABG) in our Center, between March 2002 and July 2004, were analysed. Hierarchical study end points were occurrence at 4 years of: death; death and/or myocardial infarction (MI); death, MI and/or stroke; target vessel revascularization (TVR, defined as any revascularization in left coronary system); and major cardiac cerebrovascular events (MACCE). A propensity analysis was performed to adjust for baseline differences between the two cohorts. At 4 year-clinical follow-up, no difference was found between PCI and CABG in the occurrence of death (respectively 12.0% vs. 14.1%; unadjusted odds ratio- OR=0.845; 95% confidence interval-CI=0.365 to 1.890; P=0.80; adjusted OR=0.652; 95% CI=0.254 to 1.620; P=0.42). At adjusted analysis, PCI group showed a trend toward a lower occurrence of the composite endpoint of death and myocardial infarction (13.0% vs. 19.7%; adjusted OR=0.461; 95% CI=0.180 to 1.088; P=0.08). PCI was associated with a lower rate of the composite endpoint of death, MI and/or stroke (respectively 14.0% vs. 22.5%; unadjusted OR=0.519; 95% CI=0.238to 1.071; P=0.07; adjusted OR=0.431; 95% CI=0.175 to 0.971; P=0.04). Indeed, CABG was correlated to lower TVR (8.4% vs. 28% ; unadjusted OR= 5.018; 95% CI= 1.990-23.8; p=0.0001; adjusted OR= 5.928; 95% CI= 1.933 – 38.0; p= 0.0003). No difference was detected in the occurrence of MACCE ( in PCI 36.4% vs. 28.1% in CABG, unadjusted OR=1.409; 95% CI=0.798 to 2.509 P=0.259; adjusted OR=1.438; 95% CI=0.754 to 2.766; P=0.3007).
Conclusions At 4 year-clinical follow-up, in this single-center experience, there was still no difference in the occurrence of MACCE between elective PCI with DES implantation and CABG in LMCA lesions. There was an advantage of PCI in the composite endpoint of death, MI and/or stroke, while a benefit in the need for reintervention was still found in CABG. :
Abstract 2564: No Late and no Very Late Stent Thrombosis with a Drug-Eluting Stent of the Second Generation: 2 Years Results from the Randomized NOBORI-I Trial
Authors: Silber Sigmund , Chevallier Bernard , Serruys Patricl , Garcia E. , Maranon Gregorio , Suryapranata Harry , Klinieken Isala 
Published: July 2021

Background: Late (after 30 days to 1 year) and very late (after 1 year) stent thrombosis is a continuous concern for drug-eluting stents (DES) of the first generation. These stents are characterized by their durable polymer and a ,,360 degree“ elution of the antiproliferative drug not only into the vessel wall, but also into the blood stream. Therefore, the second generation Nobori stent was developed with a biodegradable polymer and a drug elution restricted only to the vessel wall (abluminal coating). The drug, Biolimus A9, is a potent antiproliferative and antiinflammatory Limus derivative.
Methods: The NOBORI-I trial was a prospective randomized study designed to compare the Nobori stent with the Taxus stent (2:1) in pats with single de-novo native coronary lesions, a vessel diameter of 2.5–3.5 mm and a lesion length below 25 mm. Predilatation was required. The primary endpoint was in-stent late lumen loss (LL) at 9 months. The study was designed as a noninferiority trial. 363 pats were enrolled in 29 sites in Europe, Asia and Australia. Clopidogrel (in addition to ASA) was recommended for at least 6 months.

Results: With an in-stent LL of 0.12 mm in the Nobori and 0.33 mm in the Taxus group (p <0.001) the primary endpoint was reached, with a significant result also for superiority. The results for late and very late stent thrombosis are depicted in the table

. Dual antiplatelet therapy was present at one year in 52% of the pats in the Nobori and in 55% of the pats in the Taxus group. After 2 years, it was maintained in 25% of the Nobori and in 20% of the Taxus pats.

Conclusions: As compared to a DES of the first generation with a durable polymer and circumferential drug release, the second generation Nobori stent with its biodegradable polymer and a drug-elution restricted to the vessel wall seems to be safer. Due to the limited power of this study regarding safety, higher number of patients are needed to corrobarate these promising findings.
Abstract 2615: Multiple Accessory Pathways in Pediatric Patients with Structural Heart Disease
Authors: Zachariah Justin P , Triedman John K , Berul Charles I , Cecchin Frank , Alexander Mark E , Mahajan Tarun , Walsh Edward P 
Published: July 2021

Pts with structural heart disease (SHD) such as Ebstein’s and certain cardiomyopathies often have multiple accessory pathways (AP’s) at mapping procedures. The goals of this study were to determine the incidence of multiple AP’s (multAP) in a large pediatric cohort undergoing electrophysiology study, contrasting pts with and without SHD, and to measure the influence of multAP on ablation outcomes.
Methods: Data from all patients (n=1089) undergoing catheter mapping and/or ablation for AP’s at Children’s Hospital Boston from 1990 through 2006 were reviewed. The AP locations were divided into segments along the septum(S), tricuspid(TV) and mitral (MV) valves. The presence of multAP was defined as two or more APs with distinct conduction characteristics mapped at least 1 cm apart. Acute ablation success was defined as elimination of all AP conduction. Recurrence was defined as return of conduction in any one or more AP’s. A total of 1229 APs (36% concealed AP) were mapped in 1089 patients (aged 12.9 ± 4yrs) with locations along TV in 18%, S in 39%, and MV in 43%. Ablation attempts (n=1306) were successful in 94% overall (92% TV, 92% S, and 97% MV), with 8% recurrence rate. A subgroup of 111 pts (10%) had multAP, involving 250 distinct APs. MultAP were significantly more common (p<0.001) among SHD pts (25%) than those without SHD (8%). Ebstein’s, AV discordance, and cardiomyopathy accounted for 28/30 (93%) of SHD pts with multAP. Ebstein’s(OR 8.7,p<0.001) and myopathic pts(OR13.3, p<0.001) were more likely to have multAP. AP locations in SHD pts shifted toward TV, driven by Ebstein’s pts. Acute ablation success did not differ between multAP and a solitary AP (91% vs. 94%, p= n.s.), though recurrence rate was higher for multAP (19% vs. 8%, p<0.001). Acute success was lower in SHD compared to those without SHD (85% vs. 95%, p<0.01), and recurrence was higher (17% vs. 8%, p<0.05). MultAP can be found in 10% of pediatric patients, and are far more common in SHD compared to those with normal hearts. Both the presence of multAP and SHD can negatively influence ablation outcomes.
Abstract 2646: Aortic Arch Plaques and Risk of Vascular Events in Subjects Without Prior Stroke
Authors: Russo Cesare , Jin Zhezhen , Sacco Ralph L , Homma Shunichi , Rundek Tatjana , Di Tullio Marco R 
Published: July 2021

BACKGROUND: Aortic arch plaques (AAP) are a risk factor for cardiovascular embolic events. However, the risk of vascular events associated with AAP in the general population is unclear.
AIM: To assess whether AAP detected by transesophageal echocardiography (TEE) are associated with an increased risk of vascular events in a stroke-free cohort.
METHODS: The study cohort consisted of stroke-free subjects over age 50 from the Aortic Plaques and Risk of Ischemic Stroke (APRIS) study. AAP were assessed by multiplane TEE, and considered large if ≥ 4 mm in thickness. Vascular events including myocardial infarction, ischemic stroke and vascular death were recorded during the follow-up. The association between AAP and outcomes was assessed by univariate and multivariate Cox proportional hazards models.
RESULTS: A group of 209 subjects was studied (mean age 67±9 years; 45% women; 14% whites, 30% blacks, 56% Hispanics). AAP of any size were present in 130 subjects (62%); large AAP in 50 (24%). Subjects with AAP were older (69±8 vs. 63±7 years), had higher systolic BP (146±21 vs.139±20 mmHg), were more often white (19% vs. 8%), smokers (20% vs. 9%) and more frequently had a history of coronary artery disease (26% vs. 14%) than those without AAP (all p<0.05). Lipid parameters, prevalence of atrial fibrillation and diabetes mellitus were not significantly different between the two groups. During the follow up (94±29 months) 30 events occurred (13 myocardial infarctions, 11 ischemic strokes, 6 vascular deaths). After adjustment for other risk factors, AAP of any size were not associated with an increased risk of combined vascular events (HR 1.07, 95% CI 0.44 to 2.56). The same result was observed for large AAP (HR 0.94, CI 0.34 to 2.64). Age (HR 1.05, CI 1.01 to 1.10), body mass index (HR 1.08, CI 1.01 to 1.15) and atrial fibrillation (HR 3.52, CI 1.07 to 11.61) showed independent association with vascular events. In a sub-analysis with ischemic stroke as outcome, neither AAP of any size nor large AAP were associated with an increased risk.
CONCLUSIONS: In this cohort without prior stroke, the incidental detection of AAP was not associated with an increased risk of future vascular events. Associated co-factors may affect the AAP-related risk of vascular events reported in previous studies.
Abstract 2752: Pulmonary Vein Isolation With And Without Additional Ablation Of Complex Fractionated Electrograms In Paroxysmal Atrial Fibrillation: Long-term Results Of A Prospective Randomized Study
Authors: Deisenhofer Isabel , Reents Tilko , Estner Heidi L , Fichtner Stephanie , von Bary Christian , Uecer Ekrem , Schmitt Claus , Luik Armin , Karlsruhe Klinikum , Karch Martin R , Hessling Gabriele 
Published: July 2021

Introduction: Segmental pulmonary vein isolation (PVI) leads to elimination of paroxysmal atrial fibrillation (AF) in approximately 75% of patients. Ablation of complex fractionated atrial electrograms (CFAE) is an alternative ablation strategy. In this prospective randomized study the long-term effect of PVI alone is compared to the effect of combined PVI and CFAE ablation in paroxysmal AF.
Methods: 98 patients with paroxysmal AF (57±10 years, 74 male) were randomly assigned to PVI (48 patients) or PVI+CFAE ablation (50 patients). Additional CFAE ablation was performed in the PVI+CFAE group if AF was still inducible after PVI. Follow-up results were assessed with repetitive 7 days Holter ECG and clinical evaluation including repeat ablations.
Results: Additional CFAE ablation was performed in 30/50 (60%) patients of the PVI+CFAE group with still inducible AF after PVI. In each group, 2 patients were lost to long term follow-up. In the intention-to-treat analysis at 3 months and after 19±8 months, there was no significant difference between both groups (36/48 [75%] and 34/46 [74%] patients in the PVI and 37/50 [73%] and 40/48 [83%] of patients in the PVI+CFAE ablation group in sinus rhythm [p=0.32]). In subgroup analysis, patients actually treated with the combined PVI+CFAE ablation approach had a significantly better long-term success (25/28; 89%) than patients with still inducible AF who underwent PVI only (22/30;73%; p=0.02). In both groups repeat ablations were performed in 31% (PVI group; 15/48 patients) and 35% (PVI+CFAE group; 17/48 patients) (p=n.s). After 9 months, significantly more patients in the PVI+CFAE group experienced sustained regular atrial tachycardia than in the PVI group (6/44 versus 1/39 patients, P=0.02).
Conclusion: The combination of PVI and CFAE ablation was equally effective than PVI alone in reaching freedom of AF in the intention-to-treat analysis. During long-term follow-up, patients actually treated with combined PVI+CFAE ablation had a significantly better outcome (89% vs. 73%). However, the rate of ablation-induced regular atrial tachycardias is inreased.
Abstract 4131: ICD and Shock Experience In Dialysis Patients
Authors: Shah Anuj , Bhavnani Sanjeev , Guertin Danette , Coleman Craig , Clyne Christopher , Yarlagadda Ravi , Kluger Jeffrey 
Published: July 2021

BACKGROUND: The occurrence of ventricular arrhythmias in end stage renal disease (ESRD) patients on hemodialysis (HD) is common. There are limited data on ICD patients with ESRD on HD.
METHODS: We analyzed a prospectively collected database of patients with ICD implants at our institute. The patients with and without ESRD were compared for the baseline demographic variables, co-morbidities and outcomes, especially the rates of VT storm, total ICD therapies and all-cause mortality.

RESULTS: There are 1438 patients with ICD implantation and follow up at our institution from April 1995 to August 2007. Of these 40 (3.3%) were on hemodialysis secondary to ESRD. The mean follow up was shorter in ESRD patients (536 ± 455 vs. 886 ± 881, p − 0.05). The ESRD group was comparable to the general ICD population for age, gender distribution, ejection fraction (mean EF 28.8 ± 15 vs. 28.9 ± 14), presence of HTN, ischemic heart disease, use of Amiodarone, beta-blockers, Digoxin and incidence of implants for primary prevention (85% vs. 74%, p - NS). The ESRD group had higher incidence of Diabetes (45% vs. 26%, p - 0.01) and lower use of Ace-inhibitors (32.5% vs. 50%, p - 0.03), biventricular pacemakers (10% vs. 24.8%). The ESRD patients had significantly worse overall mortality (52.5% vs. 23.8%, p - 0.01), one year mortality (17.5% vs. 7.4%, p - 0.029)), appropriate ICD therapies (30% vs. 17%, p - 0.03) and VT storms (17.5% vs. 5.2%, p < 0.001). On Multivariate analysis, presence of ESRD was the strongest predictor of overall mortality (see table

) but not an independent predictor of one year mortality.

Conclusion: In our single center experience, the dialysis patients had significantly worse outcomes than the general ICD patients, in terms of higher mortality, ICD therapies and cluster shocks. Presence of ESRD was an independent predictor of overall survival but does not predict one year mortality.