bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathological Remodeling of Mitral Valve Leaflets from Unphysiologic Leaflet Mechanics after Undersized Mitral Annuloplasty to Repair Ischemic Mitral Regurgitation
Authors: Sielicka Alicja , Sarin Eric L. , Shi Weiwei , Sulejmani Fatiesa , Corporan Daniella , Kalra Kanika , Thourani Vinod H. , Sun Wei , Guyton Robert A. , Padala Muralidhar 
Published: December 2018

Background
Undersized ring annuloplasty is a commonly used surgical repair for ischemic mitral regurgitation, in which annular downsizing corrects regurgitation, but alters valve geometry and elevates tissue stresses. In this study, we investigated if unphysiological leaflet kinematics after annuloplasty might cause pathogenic biological remodeling of the mitral valve leaflets, and if preserving physiologic leaflet kinematics with a better technique can moderate such adverse remodeling.

Methods and Results

Twenty‐nine swine were induced with ischemic mitral regurgitation, and survivors were assigned to groups: 7 underwent annuloplasty, 12 underwent annuloplasty with papillary‐muscle approximation, 6 underwent papillary‐muscle approximation, and 3 were sham controls. Pre‐and post‐surgery leaflet kinematics were measured, and valve tissue was explanted after 3 months to assess biological changes. Anterior leaflet excursion was unchanged across groups, but persistent tethering was observed with annuloplasty. Posterior leaflet was vertically immobile after annuloplasty, better mobile with the combined approach, and substantially (
P
=0.0028) mobile after papillary‐muscle approximation. Procollagen‐1 was higher in leaflets from annuloplasty compared with the other groups. Heat shock protein‐47 and lysyl oxidase were higher in groups receiving annuloplasty compared with sham. α‐
SMA
was elevated in leaflets from animals receiving an annuloplasty, indicating activation of quiescent valve interstitial cells, paralleled by elevated transforming growth factor‐β expression.

Conclusions
This is the first study to demonstrate that surgical valve repairs that impose unphysiological leaflet mechanics have a deleterious, pathological impact on valve biology. Surgeons may need to consider restoring physiologic leaflet stresses as well as valve competence, while also exploring pharmacological methods to inhibit the abnormal signaling cascades.
Relationship Between Electrocardiographic Findings and Cardiac Magnetic Resonance Phenotypes in Arrhythmogenic Cardiomyopathy
Authors: De Lazzari Manuel , Zorzi Alessandro , Cipriani Alberto , Susana Angela , Mastella Giulio , Rizzo Alessandro , Rigato Ilaria , Bauce Barbara , Giorgi Benedetta , Lacognata Carmelo , Iliceto Sabino , Corrado Domenico , Perazzolo Marra Martina 
Published: December 2018

Background
The new designation of arrhythmogenic cardiomyopathy defines a broader spectrum of disease phenotypes, which include right dominant, biventricular, and left dominant variants. We evaluated the relationship between electrocardiographic findings and contrast‐enhanced cardiac magnetic resonance phenotypes in arrhythmogenic cardiomyopathy.

Methods and Results

We studied a consecutive cohort of patients with a definite diagnosis of arrhythmogenic cardiomyopathy, according to 2010 International Task Force criteria, who underwent electrocardiography and contrast‐enhanced cardiac magnetic resonance. Both depolarization and repolarization electrocardiographic abnormalities were correlated with the severity of dilatation/dysfunction, either global or regional, of both ventricles and the presence and regional distribution of late gadolinium enhancement. The study population included 79 patients (60% men). There was a statistically significant relationship between the presence and extent of T‐wave inversion across a 12‐lead
ECG
and increasing values of median right ventricular (
RV
) end‐diastolic volume (
P
<0.001) and decreasing values of
RV
ejection fraction (
P
<0.001). The extent of T‐wave inversion to lateral leads predicted a more severe
RV
dilatation rather than a left ventricular involvement because of the leftward displacement of the dilated
RV
, as evidenced by contrast‐enhanced cardiac magnetic resonance. A terminal activation delay of >55 ms in the right precordial leads (V1‐V3) was associated with higher
RV
volume (
P
=0.014) and lower
RV
ejection fraction (
P
=0.053). Low
QRS
voltages in limb leads predicted the presence (
P
=0.004) and amount (
P
<0.001) of left ventricular late gadolinium enhancement.

Conclusions

The study results indicated that electrocardiographic abnormalities predict the arrhythmogenic cardiomyopathy phenotype in terms of severity of
RV
disease and left ventricular involvement, which are among the most important determinants of the disease outcome.
Myocardial Oxygen Consumption and Efficiency in Patients With Cardiac Amyloidosis
Authors: Clemmensen Tor Skibsted , Soerensen Jens , Hansson Nils Henrik , Tolbod Lars Poulsen , Harms Hendrik J. , Eiskjær Hans , Mikkelsen Fabian , Wiggers Henrik , Andersen Niels Frost , Poulsen Steen Hvitfeldt 
Published: December 2018

Background

This study evaluated myocardial oxygen consumption (MVO
2
) and myocardial external efficiency (MEE) in patients with cardiac amyloidosis (CA). Furthermore, we compared MEE and MVO
2
in subjects with light chain amyloidosis versus transthyretin (ATTR) amyloidosis.

Methods and Results

The study population comprised 40 subjects: 25 patients with confirmed CA and 15 control subjects. All subjects underwent an
11
C‐acetate positron emission tomography. Furthermore, the CA patients underwent comprehensive echocardiography and right heart catheterization during a symptom‐limited, semi‐supine exercise test. MEE was calculated from
11
C‐acetate positron emission tomography as the ratio of left ventricular (LV) stroke work and the energy equivalent of MVO
2
. Myocardial work efficiency was calculated as echocardiography‐derived work pressure product divided by three‐dimensional LV mass. CA patients had significantly lower LV‐ejection fraction (54±13% versus 63±4%,
P
<0.05) and LV‐global longitudinal strain (LVGLS) (12±4% versus 19±2%,
P
<0.0001) and a more restrictive filling pattern (E/e′‐ratio 18 [12–25] versus 8 [7–9],
P
<0.0001) than controls. MEE was severely reduced (13±5% versus 22±5%,
P
<0.0001) whereas total MVO
2
was higher (18±6 mL/min versus 13±3 mL/min,
P
<0.01) in CA patients than controls. MEE decreased with increasing New York Heart Association symptom burden (
P
<0.0001). We found a good relationship between MEE and peak exercise systolic performance (LVGLS:
R
2
=0.60,
P
<0.0001; myocardial work efficiency:
R
2
=0.48,
P
<0.0001; cardiac index:
R
2
=0.52,
P
<0.0001) and between MEE and myocardial blood flow (
R
2
=0.44,
P
<0.0001).

Conclusion

Myocardial oxidative metabolism is disturbed in CA patients with increased total MVO
2
and reduced MEE. MEE correlated significantly with echocardiographic derived systolic parameters such as myocardial work efficiency and LVGLS that might be used as surrogate MEE markers.
Adjudicated Heart Failure in HIV‐Infected and Uninfected Men and Women
Authors: Feinstein Matthew J. , Steverson Alexandra B. , Ning Hongyan , Pawlowski Anna E. , Schneider Daniel , Ahmad Faraz S. , Sanders Jes M. , Sinha Arjun , Nance Robin M. , Achenbach Chad J. , Christopher Delaney J. A. , Heckbert Susan R. , Shah Sanjiv J. , Hanna David B. , Hsue Priscilla Y. , Bloomfield Gerald S. , Longenecker Chris T. , Crane Heidi M. , Lloyd‐Jones Donald M. 
Published: December 2018

Background

HIV is associated with elevated risk of heart failure (
HF
). Despite poor agreement between automated, administrative code–based
HF
definitions and physician‐adjudicated
HF
, no studies have evaluated incident adjudicated
HF
for people living with
HIV
(
PLWH
).

Methods and Results

We analyzed
PLWH
and uninfected controls receiving care in an urban medical system from January 1, 2000, to July 12, 2016. Physicians reviewed data from medical records to adjudicate
HF
diagnoses. We used multivariable‐adjusted Cox models to analyze incident
HF
for
PLWH
versus controls and
HIV
‐related factors associated with incident
HF
. We also analyzed the performance of automated versus physician‐adjudicated
HF
definitions. Incident adjudicated
HF
occurred in 97 of 4640
PLWH
(2.1%; mean: 6.8 years to
HF
) and 55 of 4250 controls (1.3%; mean: 6.7 years to
HF
; multivariable‐adjusted hazard ratio: 2.10; 95% confidence interval, 1.38–3.21). Among
PLWH
, higher
HIV
viral load (
hazard ratio
per log
10
higher time‐updated viral load: 1.22; 95%
confidence interval,
1.11–1.33) was associated with greater
HF
risk and higher
CD
4+ T cell count was associated with lower
HF
risk (
hazard ratio
per 100 cells/mm
3
higher time‐updated
CD
4 count: 0.80; 95%
confidence interval,
0.69–0.92). In exploratory analyses, the most accurate automated
HF
definitions had sensitivities of 67% to 75% and positive predictive values of 54% to 60%.

Conclusions

In a cohort with rigorous
HF
adjudication,
PLWH
had greater risks of
HF
than uninfected people after adjustment for demographics and cardiovascular risk factors. Higher
HIV
viral load and lower
CD
4+ T cell count were associated with higher
HF
risk among
PLWH
. Automated methods of
HF
ascertainment exhibited poor accuracy for
PLWH
and uninfected people.
Temperature and Precipitation Associate With Ischemic Stroke Outcomes in the United States
Authors: Chu Stacy Y. , Cox Margueritte , Fonarow Gregg C. , Smith Eric E. , Schwamm Lee , Bhatt Deepak L. , Matsouaka Roland A. , Xian Ying , Sheth Kevin N. 
Published: December 2018

Background
There is disagreement in the literature about the relationship between strokes and seasonal conditions. We sought to (1) describe seasonal patterns of stroke in the United States, and (2) determine the relationship between weather variables and stroke outcomes.

Methods and Results

We performed a cross‐sectional study using Get With The Guidelines‐Stroke data from 896 hospitals across the continental United States. We examined effects of season, climate region, and climate variables on stroke outcomes. We identified 457 638 patients admitted from 2011 to 2015 with ischemic stroke. There was a higher frequency of admissions in winter (116 862 in winter versus 113 689 in spring, 113 569 in summer, and 113 518 in fall;
P
<0.0001). Winter was associated with higher odds of in‐hospital mortality (odds ratio [OR] 1.08 relative to spring, confidence interval [
CI
] 1.04–1.13,
P
=0.0004) and lower odds of discharge home (
OR
0.92,
CI
0.91–0.94,
P
<0.0001) or independent ambulation at discharge (
OR
0.96,
CI
0.94–0.98,
P
=0.0006). These differences were attenuated after adjusting for climate region and case mix and became inconsistent after controlling for weather variables. Temperature and precipitation were independently associated with outcome after multivariable analysis, with increases in temperature and precipitation associated with lower odds of mortality (
OR
0.95,
CI
0.93–0.97,
P
<0.0001 and
OR
0.95,
CI
0.90–1.00,
P
=0.035, respectively).

Conclusions
Admissions for ischemic stroke were more frequent in the winter. Warmer and wetter weather conditions were independently associated with better outcomes. Further studies should aim to identify sensitive populations and inform public health measures aimed at resource allocation, readiness, and adaptive strategies.
Atrial Fibrillation Is Associated With Higher Overall Mortality in Patients With Implantable Cardioverter‐Defibrillator: A Systematic Review and Meta‐Analysis
Authors: Mustafa Usman , Dherange Parinita , Reddy Rohit , DeVillier Joseph , Chong Jessica , Ihsan Alarozia , Jones Ryan , Duddyala Narendra , Reddy Pratap , Dominic Paari 
Published: December 2018

Background

Implantable cardioverter‐defibrillator (
ICD
) improves survival when used for primary or secondary prevention of sudden cardiac death. Whether the benefits of
ICD
in patients with atrial fibrillation (
AF)
are similar to those with normal sinus rhythm (
NSR
) is not well established. The aim of this study is to investigate whether
ICD
patients with
AF
are at higher risk of mortality and appropriate shock therapy compared with patients with
NSR
.

Methods and Results

Literature was searched and 25 observational studies with 63 283 patients were included in this meta‐analysis. We compared the outcomes of (1) all‐cause mortality and appropriate shock therapy among
AF
and
NSR
patients who received
ICD
for either primary or secondary prevention and (2) all‐cause mortality among
AF
patients with
ICD
versus guideline directed medical therapy. All‐cause mortality (odds ratio, 2.11; 95% confidence interval, 1.73–2.56;
P
<0.001) and incidence of appropriate shock therapy (odds ratio, 1.77; 95% confidence interval, 1.47–2.13;
P
<0.001) were significantly higher in
ICD
patients with
AF
as compared to
NSR
. There was no statistically significant mortality benefit from
ICD
compared with medical therapy in
AF
patients (odds ratio, 0.69; 95% confidence interval, 0.42–1.11;
P
=0.12) based on a separate meta‐analysis of 3 studies with 387 patients.

Conclusions

Overall mortality and appropriate shock therapy are higher in
ICD
patients with AF as compared with
NSR
. The impact of
ICD
on all‐cause mortality in
AF
patients when compared to goal‐directed medical therapy is unclear, and randomized controlled trials are needed comparing
AF
patients with
ICD
and those who have indications for
ICD,
but are only on medical therapy.
Occurrence of Postpericardiotomy Syndrome: Association With Operation Type and Postoperative Mortality After Open‐Heart Operations
Authors: Lehto Joonas , Kiviniemi Tuomas , Gunn Jarmo , Airaksinen Juhani , Rautava Päivi , Kytö Ville 
Published: December 2018

Background

Postpericardiotomy syndrome (
PPS
) is a common complication after cardiac surgery. However, large‐scale epidemiological studies about the effect of procedure type on the occurrence of
PPS
and mortality of patients with PPS have not yet been performed.

Methods and Results

We studied the association of
PPS
occurrence with operation type and postoperative mortality in a nationwide follow‐up analysis of 28 761 consecutive patients entering coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or ascending aortic surgery. Only
PPS
episodes severe enough to result in hospital admission or to contribute as a cause of death were included. Data were collected from mandatory Finnish national registries between 2005 and 2014. Of all the patients included, 493 developed
PPS
during the study period. The occurrence of
PPS
was significantly higher after aortic valve replacement (hazard ratio, 1.97; 95% confidence interval, 1.58–2.46;
P
<0.001), mitral valve replacement (hazard ratio, 1.62; 95% confidence interval, 1.22–2.15;
P
<0.001), and aortic surgery (hazard ratio, 3.06; 95% confidence interval, 2.24–4.16;
P
<0.001), when compared with coronary artery bypass grafting in both univariable and multivariable analyses. The occurrence of PPS decreased significantly with aging (
P
<0.001). The occurrence of PPS was associated with an increased risk of mortality within the first year after the surgery (adjusted hazard ratio, 1.78; 95% confidence interval, 1.12–2.81;
P
=0.014).

Conclusions

The occurrence of
PPS
was higher after aortic valve replacement, mitral valve replacement, and aortic surgery when compared with the coronary artery bypass grafting procedure. Aging decreased the risk of
PPS
. The development of
PPS
was associated with higher mortality within the first year after cardiac or ascending aortic surgery.
GLP‐1 Is a Coronary Artery Vasodilator in Humans
Authors: Clarke Sophie J. , Giblett Joel P. , Yang Lucy L. , Hubsch Annette , Zhao Tian , Aetesam‐ur‐Rahman Muhammad , West Nick E. J. , O'Sullivan Michael , Figg Nichola , Bennett Martin , Wewer Albrechtsen Nicolai J. , Deacon Carolyn F. , Cheriyan Joseph , Hoole Stephen P. 
Published: December 2018

Background

The mechanism underlying the beneficial cardiovascular effects of the incretin GLP‐1 (glucagon‐like peptide 1) and its analogues in humans is elusive. We hypothesized that activating receptors located on vascular smooth muscle cells to induce either peripheral or coronary vasodilatation mediates the cardiovascular effect of
GLP
‐1.

Methods and Results

Ten stable patients with angina awaiting left anterior descending artery stenting underwent forearm blood flow measurement using forearm plethysmography and post–percutaneous coronary intervention coronary blood flow measurement using a pressure‐flow wire before and after peripheral
GLP
‐1 administration. Coronary sinus and artery bloods were sampled for
GLP
‐1 levels. A further 11 control patients received saline rather than
GLP
‐1 in the coronary blood flow protocol.
GLP
‐1 receptor (GLP‐1R) expression was assessed by immunohistochemistry using a specific
GLP
‐1R monoclonal antibody in human tissue to inform the physiological studies. There was no effect of
GLP
‐1 on absolute forearm blood flow or forearm blood flow ratio after
GLP
‐1, systemic hemodynamics were not affected, and no binding of
GLP
‐1R monoclonal antibody was detected in vascular tissue.
GLP
‐1 reduced resting coronary transit time (mean [
SD
], 0.87 [0.39] versus 0.63 [0.27] seconds;
P
=0.02) and basal microcirculatory resistance (mean [
SD
], 76.3 [37.9] versus 55.4 [30.4] mm Hg/s;
P
=0.02), whereas in controls, there was an increase in transit time (mean [SD], 0.48 [0.24] versus 0.83 [0.41] seconds;
P
<0.001) and basal microcirculatory resistance (mean [SD], 45.9 [34.7] versus 66.7 [37.2] mm Hg/s;
P
=0.02).
GLP
‐1R monoclonal antibody binding was confirmed in ventricular tissue but not in vascular tissue, and transmyocardial
GLP
‐1 extraction was observed.

Conclusions

GLP
‐1 causes coronary microvascular dilation and increased flow but does not influence peripheral tone.
GLP
‐1R immunohistochemistry suggests that
GLP
‐1 coronary vasodilatation is indirectly mediated by ventricular‐coronary cross talk.
Relationship of Obesity to Adverse Events Among Patients With Mean 10‐Year History of Type 2 Diabetes Mellitus: Results of the ACCORD Study
Authors: Xing Zhenhua , Pei Junyu , Huang Jiabing , Peng Xiaofan , Chen Pengfei , Hu Xinqun 
Published: December 2018

Background

Recent evidence from cohort studies and meta‐analyses suggests that the obesity paradox phenomenon may exist in patients with diabetes mellitus. The goal of this study was to assess the association between adverse events and obesity by using 2 different measures of obesity, body mass index (BMI; kg/m
2
) and waist circumference, in patients with a mean 10‐year history of type 2 diabetes mellitus.

Methods and Results

We used data from the
ACCORD
(the Action to Control Cardiovascular Risk in Diabetes) study to evaluate the relationship between obesity and adverse events in patients with a mean 10‐year history of type 2 diabetes mellitus. The primary outcome of this study was all‐cause mortality. Secondary outcomes were cardiac death, nonfatal myocardial infarction, and stroke. Patients who were class
III
obese with
BMI
≥40 had the highest risk of all‐cause mortality, followed by patients with class
II
obesity, whereas overweight patients had the lowest risk. We found significant correlations between
BMI
and waist circumference (
r
=0.802). We observed that the relationships between waist circumference and primary and second end points were much like the relationships between
BMI
and primary and second end points (J‐shaped relationship for all‐cause mortality, V‐shaped relationship for cardiac death, U‐shaped relationship for nonfatal myocardial infarction, and reverse linear relationship for noncardiac death).

Conclusions

No evidence of the obesity paradox was observed in patients with a 10‐year history of diabetes mellitus. Class
III
obese patients showed the highest risk of adverse events (all‐cause mortality, cardiac death, nonfatal myocardial infarction, and noncardiac death).
BMI
and waist circumference showed similar relationships with adverse events.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
00000620.
Mortality Following Pediatric Congenital Heart Surgery: An Analysis of the Causes of Death Derived From the National Death Index
Authors: McCracken Courtney , Spector Logan G. , Menk Jeremiah S. , Knight Jessica H. , Vinocur Jeffrey M. , Thomas Amanda S. , Oster Matthew E. , St Louis James D. , Moller James H. , Kochilas Lazaros 
Published: December 2018

Background
Prior research has focused on early outcomes after congenital heart surgery, but less is known about later risks. We aimed to determine the late causes of death among children (<21 years of age) surviving their initial congenital heart surgery.

Methods and Results

This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a US‐based registry of interventions for congenital heart defects (CHD). Excluding patients with chromosomal anomalies or inadequate identifiers, we matched those surviving their first congenital heart surgery (1982–2003) against the National Death Index through 2014. Causes of death were obtained from the National Death Index to calculate cause‐specific standardized mortality ratios (SMRs). Among 31 132 patients, 2527 deaths (8.1%) occurred over a median follow‐up period of 18 years. Causes of death varied by time after surgery and severity of CHD but, overall, 69.9% of deaths were attributed to the CHD or another cardiovascular disorder, with a SMR for CHD/cardiovascular disorder of 67.7 (95% confidence interval: 64.5–70.8). Adjusted odds ratios revealed increased risk of death from CHD/cardiovascular disorder in females [odds ratio=1.28; 95% confidence interval (1.04–1.58);
P
=0.018] with leading cardiovascular disorder contributing to death being cardiac arrest (16.8%), heart failure (14.8%), and arrhythmias (9.1%). Other major causes of death included coexisting congenital malformations (4.7%, SMR: 7.0), respiratory diseases (3.6%, SMR: 8.2), infections (3.4%, SMR: 8.2), and neoplasms (2.1%, SMR: 1.9).

Conclusions
Survivors of congenital heart surgery face long‐term risks of premature mortality mostly related to residual CHD pathology, heart failure, and arrhythmias, but also to other noncardiac conditions. Ongoing monitoring is warranted to identify target factors to address residual morbidities and improve long‐term outcomes.