bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined Near-Infrared Spectroscopy and Intravascular Ultrasound Imaging of Pre-Existing Coronary Artery Stents
Authors: Madder Ryan D. , Khan Mohsin , Husaini Mustafa , Chi Margaret , Dionne Sarah , VanOosterhout Stacie , Borgman Andrew , Collins J. Stewart , Jacoby Mark 
Published: September 2018

Background—
Neoatherosclerosis is an emerging phenomenon in which lipid-rich plaques (LRPs) develop within pre-existing stents. This study was undertaken to describe near-infrared spectroscopy (NIRS) and intravascular ultrasound findings in pre-existing stents and to compare NIRS findings in pre-existing stents, in which an increased lipid signal has been speculated to indicate neoatherosclerosis, and NIRS findings in a control group of freshly implanted stents, in which any lipid signal originates from fibroatheroma under the stent.

Methods and Results—

At the site of LRP detected by NIRS in a cohort of pre-existing stents, intravascular ultrasound was used to determine the presence of neointimal tissue. The lipid-core burden index and maximum lipid-core burden index in 4 mm were measured within stented segments. Findings were compared between pre-existing stents and a control group of freshly implanted stents. Among 60 pre-existing stents implanted 5.5±4.0 years earlier, NIRS detected LRP in 33%. At the site of LRP, intravascular ultrasound found no neointimal tissue in 35% of cases. NIRS findings in pre-existing stents were indistinguishable from those of freshly implanted stents (lipid-core burden index: 50±72 versus 42±58;
P
=0.40 and maximum lipid-core burden index in 4 mm: 156±184 versus 155±203;
P
=0.69).

Conclusions—
The detection of LRP in a pre-existing stent by NIRS alone is not reliable evidence of neoatherosclerosis, as the lipid signal may originate from fibroatheroma underlying the stent. By identifying the presence or absence of neointimal tissue at the site of LRP detected by NIRS, intravascular ultrasound may provide some insight into the potential source of the lipid signal in pre-existing stents.

Registration Information—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01694368.
Coronary Calcification and Plaque Vulnerability
Authors: Ong Daniel S. , Lee Jay S. , Soeda Tsunenari , Higuma Takumi , Minami Yoshiyasu , Wang Zhao , Lee Hang , Yokoyama Hiroaki , Yokota Takashi , Okumura Ken , Jang Ik-Kyung 
Published: September 2018

Background—
Spotty superficial calcium deposits have been implicated in plaque vulnerability based on previous intravascular imaging studies. Biomechanical models suggest that microcalcifications between 5 and 65 µm in diameter can intensify fibrous cap stress, promoting plaque rupture. However, the 100- to 200-µm resolution of intravascular ultrasound limits its ability to discriminate single calcium deposits from clusters of smaller deposits, and a previous optical coherence tomographic investigation evaluated calcifications within a long segment of artery, which may not truly reflect the mechanics involved in potentiating focal plaque rupture.

Methods and Results—

Detailed optical coherence tomographic assessment of coronary calcification at the culprit plaque (10-mm length) was performed in 53 patients with acute ST-segment–elevation myocardial infarction mediated by plaque rupture and 55 patients with stable angina pectoris. The number and longitudinal length of individual calcium deposits were recorded. Cross-sectional images were analyzed every 1 mm for calcium arc and depth, and these quantitative parameters were used to define individual deposits as spotty, large, and superficial. There was no significant difference between ST-segment–elevation myocardial infarction mediated by plaque rupture and stable angina pectoris groups in the number of total (
P
=0.58), spotty (
P
=0.87), or large calcium deposits (
P
=0.27). Minimum calcium depth was similar between groups (
P
=0.27), as was the number of superficial deposits (
P
=0.35 using a 65-µm depth threshold and
P
=0.84 using a 100-µm depth threshold).

Conclusions—
The number and pattern of culprit plaque calcifications did not differ between patients presenting with ST-segment–elevation myocardial infarction mediated by plaque rupture versus stable angina pectoris. The optical coherence tomographic assessment of coronary calcification may not be a useful marker of local plaque vulnerability as previously suspected.

Registration Information—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01110538.
Left Atrial Structure and Function Across the Spectrum of Cardiovascular Risk in the Elderly
Authors: Gonçalves Alexandra , Hung Chung-Lieh , Claggett Brian , Nochioka Kotaro , Cheng Susan , Kitzman Dalane W. , Shah Amil M. , Solomon Scott D. 
Published: September 2018

Background—
Although left atrial (LA) enlargement is a recognized risk factor for adverse cardiovascular outcomes, emerging evidence supports the importance of LA function. We examined LA emptying fraction (LAEF) across the spectrum of cardiovascular disease burden in a large cohort of elderly adults living in the community.

Methods and Results—

We studied 1142 participants in the Atherosclerosis Risk in Communities (ARIC) study who were in sinus rhythm, free of valvular disease, and had acceptable quality 3-dimensional echocardiograms (mean age, 76±5 years; 59% women). We determined the cross-sectional correlates of LAEF and compared LAEF among elderly adults without cardiovascular disease or cardiovascular risk factors (n=201), those with hypertension (n=734), and those with overt heart failure (HF; n=207). In multivariable analysis, lower LAEF was associated with higher LA volumes and worse left ventricular systolic and diastolic functions. Elderly participants free of cardiovascular disease or risk factors had smaller LA volumes than those with hypertension (LA volume max/ body surface area 30.2±6.6 versus 33.0±9.0 mL/m
2
;
P
=0.001), but similar LAEF (55.2±10.3% versus 53.8±11.5%, respectively;
P
=0.357). Participants with HF had higher LA volume (39.8±13.3 mL/m
2
) and worse LAEF (47.6±14.6%) than participants with hypertension or participants free of cardiovascular disease or risk factors (all
P
<0.001).

Conclusions—
In a community-based cohort, LA function was impaired in participants with prevalent HF, but there were no significant differences in LA function between participants with hypertension and those with free of cardiovascular disease or risk factors, despite greater LA size in the former.
Proton Pump Inhibitors, Platelet Reactivity, and Cardiovascular Outcomes After Drug-Eluting Stents in Clopidogrel-Treated Patients
Authors: Weisz Giora , Smilowitz Nathaniel R. , Kirtane Ajay J. , Rinaldi Michael J. , Parvataneni Rupa , Xu Ke , Stuckey Thomas D. , Maehara Akiko , Witzenbichler Bernhard , Neumann Franz-Josef , Metzger D. Christopher , Henry Timothy D. , Cox David A. , Duffy Peter L. , Brodie Bruce R. , Mazzaferri Ernest L. , Mehran Roxana , Stone Gregg W. 
Published: September 2018

Background—
Certain proton pump inhibitors (PPIs) interfere with clopidogrel metabolism, potentially attenuating P2Y12 receptor inhibition. Previous observational and randomized trials report conflicting results regarding the clinical significance of this pharmacological interaction. We examined the interaction between concomitant administration of PPI and clopidogrel on platelet reactivity and clinical outcomes in the large-scale, prospective Assessment of Dual AntiPlatelet Therapy With Drug-Eluting Stents study.

Methods and Results—

On-treatment P2Y12 platelet reactivity testing was performed using the VerifyNow assay after clopidogrel loading and successful drug-eluting stent implantation at 11 sites in the United States and Germany. PPIs were prescribed at the discretion of treating physicians; patients were followed for 2 years. High platelet reactivity was defined as P2Y12 reactivity units >208. Of 8582 enrolled patients, 2697 (31.4%) were taking a PPI at the time of coronary intervention. After adjustment for differences in baseline characteristics, PPI use was independently associated with high platelet reactivity (odds ratio, 1.38: 95% confidence interval, 1.25–1.52,
P
=0.0001). A total of 2162 (25.2%) patients were prescribed a PPI at hospital discharge. In a propensity-adjusted multivariable analysis, discharge PPI use was independently associated with increased risk for postdischarge major adverse cardiac events (cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) at 2-year follow-up (hazard ratio, 1.21; 95% confidence interval, 1.04–1.42,
P
=0.02).

Conclusions—
In patients treated with clopidogrel after successful drug-eluting stents implantation, the concomitant administration of PPI was associated with high platelet reactivity and a greater rate of adverse outcomes during long-term follow-up. Additional studies are warranted to determine the risk–benefit ratio of PPIs in patients with drug-eluting stents treated with clopidogrel.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00433966.
One-Year Clinical and Computed Tomography Angiographic Outcomes After Bioresorbable Vascular Scaffold Implantation During Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction
Authors: Widimsky Petr , Petr Robert , Tousek Petr , Maly Martin , Linkova Hana , Vrana Jiri , Hajsl Martin , Budesinsky Tomas , Lisa Libor , Kocka Viktor 
Published: September 2018

Background—
Bioresorbable vascular scaffolds (BVS) represent promising new technology, but data on their long-term outcomes in ST-segment–elevation myocardial infarction (STEMI) setting are missing. The aim was to analyze 1-year clinical and computed tomographic angiographic outcomes after BVS implantation in STEMI.

Methods and Results—

PRAGUE-19 is a prospective multicenter single-arm study enrolling consecutive STEMI patients undergoing primary percutaneous coronary intervention (pPCI) with intention-to-implant BVS. A total of 343 STEMI patients were screened during 15 months enrollment period, and 70 patients (mean age 58.6±10.3 and 74% males) fulfilled entry criteria and BVS was successfully implanted in 96% of them. All patients were invited for clinical and computed tomographic angiographic control 1 year after BVS implantation. Restenosis was defined as ≥75% area stenosis within the scaffolded segment. Three events were potentially related to BVS: 1 in-stent restenosis (treated 7 months after pPCI with drug-eluting balloon), 1 stent thrombosis (treated 2 weeks after pPCI by balloon dilatation—this patient stopped all medications after pPCI), and 1 sudden death at home 9 months after pPCI. Four other patients had events definitely unrelated to BVS. Overall, 1-year mortality was 2.9%. Computed tomographic angiography after 1 year was performed in 59 patients. All BVS were widely patent, and binary restenosis rate was 2% (the only restenosis mentioned above). Mean in-scaffold minimal luminal area was 7.8±2.6 mm
2
, area stenosis was 20.1±16.3%, minimal luminal diameter was 3.0±0.6 mm, and diameter stenosis was 12.8±11.1%.

Conclusions—
BVS implantation in STEMI is feasible and safe and offers excellent 1-year clinical and angiographic outcomes.
Statins Reduce Abdominal Aortic Aneurysm Growth, Rupture, and Perioperative Mortality: A Systematic Review and Meta‐Analysis
Authors: Salata Konrad , Syed Muzammil , Hussain Mohamad A. , de Mestral Charles , Greco Elisa , Mamdani Muhammad , Tu Jack V. , Forbes Thomas L. , Bhatt Deepak L. , Verma Subodh , Al‐Omran Mohammed 
Published: September 2018

Background

There are no recognized pharmacological treatments for abdominal aortic aneurysms (
AAA
), although statins are suggested to be beneficial. We sought to summarize the literature regarding the effects of statins on human
AAA
growth, rupture, and 30‐day mortality.

Methods and Results

We conducted a systematic review and meta‐analysis of randomized and observational studies using the Cochrane
CENTRAL
database,
MEDLINE
, and
EMBASE
up to June 15, 2018. Review, abstraction, and quality assessment were conducted by 2 independent reviewers, and a third author resolved discrepancies. Pooled mean differences and odds ratios with 95% confidence intervals were calculated using random effects models. Heterogeneity was quantified using the I
2
statistic, and publication bias was assessed using funnel plots. Our search yielded 911 articles. One case‐control and 21 cohort studies involving 80 428 patients were included. The risk of bias was low to moderate. Statin use was associated with a mean
AAA
growth rate reduction of 0.82 mm/y (95% confidence interval 0.33, 1.32,
P
=0.001, I
2
=86%). Statins were also associated with a lower rupture risk (odds ratio 0.63, 95% confidence interval 0.51, 0.78,
P
<0.0001, I
2
=27%), and preoperative statin use was associated with a lower 30‐day mortality following elective
AAA
repair (odds ratio 0.55, 95% confidence interval 0.36, 0.83,
P
=0.005, I
2
=57%).

Conclusions

Statin therapy may be associated with reduction in
AAA
progression, rupture, and lower rates of perioperative mortality following elective
AAA
repair. These data argue for widespread statin use in
AAA
patients.

Clinical Trial Registration

URL
:
www.crd.york.ac.uk
. Unique identifier:
CRD
42017056480.
Remote Ischemic Preconditioning Acutely Improves Coronary Microcirculatory Function
Authors: Lau Jerrett K. , Roy Probal , Javadzadegan Ashkan , Moshfegh Abouzar , Fearon William F. , Ng Martin , Lowe Harry , Brieger David , Kritharides Leonard , Yong Andy S. 
Published: September 2018

Background
Remote ischemic preconditioning (RIPC) attenuates myocardial damage during elective and primary percutaneous coronary intervention. Recent studies suggest that coronary microcirculatory function is an important determinant of clinical outcome. The aim of this study was to assess the effect of RIPC on markers of microcirculatory function.

Methods and Results

Patients referred for cardiac catheterization and fractional flow reserve measurement were randomized to RIPC or sham. Operators and patients were blinded to treatment allocation. Comprehensive physiological assessments were performed before and after RIPC/sham including the index of microcirculatory resistance and coronary flow reserve after intracoronary glyceryl trinitrate and during the infusion of intravenous adenosine. Thirty patients were included (87% male; mean age: 63.1±10.0 years). RIPC and sham groups were similar with respect to baseline characteristics. RIPC decreased the calculated index of microcirculatory resistance (median, before RIPC: 22.6 [interquartile range [IQR]: 17.9–25.6]; after RIPC: 17.5 [IQR: 14.5–21.3];
P
=0.007) and increased coronary flow reserve (2.6±0.9 versus 3.8±1.7,
P
=0.001). These RIPC‐mediated changes were associated with a reduction in hyperemic transit time (median: 0.33 [IQR: 0.26–0.40] versus 0.25 [IQR: 0.20–0.30];
P
=0.010). RIPC resulted in a significant decrease in the calculated index of microcirculatory resistance compared with sham (relative change with treatment [mean±SD] was −18.1±24.8% versus +6.1±37.5;
P
=0.047) and a significant increase in coronary flow reserve (+41.2% [IQR: 20.0–61.7] versus −7.8% [IQR: −19.1 to 10.3];
P
<0.001).

Conclusions
The index of microcirculatory resistance and coronary flow reserve are acutely improved by remote ischemic preconditioning. This raises the possibility that RIPC confers cardioprotection during percutaneous coronary intervention as a result of an improvement in coronary microcirculatory function.

Clinical Trial Registration

URL:
www.anzctr.org.au/
. Unique identifier: CTRN12616000486426.
Culprit Plaque Characteristics in Patients With Sleep‐Disordered Breathing Undergoing Percutaneous Coronary Intervention: An Intravascular Ultrasound Study
Authors: Wada Hideki , Dohi Tomotaka , Kasai Takatoshi , Yatsu Shoichiro , Naito Ryo , Kato Yoshiteru , Okai Iwao , Iwata Hiroshi , Isoda Kikuo , Okazaki Shinya , Miyauchi Katsumi , Daida Hiroyuki 
Published: September 2018

Background

Sleep‐disordered breathing (
SDB
) is a novel cardiovascular risk factor. However, the coronary plaque characteristics of patients with
SDB
with coronary artery disease are still unclear.

Methods and Results

This study included 289 consecutive patients with coronary artery disease undergoing percutaneous coronary intervention. Plaque characteristics of the culprit lesion were assessed by preintervention intravascular ultrasound. The presence of
SDB
was defined as a 3% oxygen desaturation index of ≥15 events per hour measured by nocturnal pulse oximetry. Of 289 patients, the median 3% oxygen desaturation index was 9.6 (interquartile range, 5.1–16.6), and 88 patients (30.4%) were defined as having
SDB
. Compared with the no‐
SDB
group, the
SDB
group had a larger total atheroma volume of the culprit lesion (224.5 mm
3
versus 190.8 mm
3
,
P
=0.05). The median maximum attenuation and calcification angle were 140° and 130°, respectively. Attenuated plaque with a maximum attenuation angle >140° was more frequently observed in the
SDB
group compared with the no‐
SDB
group (34.9% versus 22.6%;
P
=0.03). However, there were no statistically significant differences between groups in the maximum calcium angle and the frequency of calcific plaques with a maximum calcium angle >130°. Multivariable logistic regression analysis showed that the presence of
SDB
was a significant predictor of a greater ultrasound attenuation angle (>140°) (odds ratio, 1.86; 95% confidence interval, 1.02–3.39;
P
=0.04).

Conclusions

SDB
was associated with larger atheroma plaque volume and a greater ultrasound attenuation, which are discriminators of plaque vulnerability. Further studies are needed to clarify the effects of
SDB
treatment on coronary plaque lesions.
Disparate Remodeling of the Extracellular Matrix and Proteoglycans in Failing Pediatric Versus Adult Hearts
Authors: Jana Sayantan , Zhang Hao , Lopaschuk Gary D. , Freed Darren H. , Sergi Consolato , Kantor Paul F. , Oudit Gavin Y. , Kassiri Zamaneh 
Published: September 2018

Background
Dilated cardiomyopathy (DCM) is a common cause of heart failure in adult and pediatric patients, but the underlying mechanism may vary in adults and children, with few studies conducted to date. The objective of the present study was to determine whether differential remodeling of the extracellular matrix contributes to the differences between pediatric and adult DCM hearts.

Methods and Results
Explanted hearts were procured from adult (age, 46–61 years) and pediatric (age, 2–8) patients with DCM‐related heart failure and nonfailing control hearts. Fibrillar and nonfibrillar extracellular matrix (proteoglycans, glycosaminoglycans, glycoprotein), their regulatory enzymes (matrix metalloproteinases, disintegrin and metalloproteinases, and disintegrin and metalloproteinases with a thrombospondin domain), and their inhibitors (tissue inhibitor of metalloproteinases) were assessed. Pediatric DCM hearts exhibited less fibrosis compared with adult DCMs. Total glycosaminoglycans increased similarly in both DCM groups but exhibited a significantly lower affinity for transforming growth factor‐β in adult DCMs versus pediatric DCMs, resulting in increased bioavailability of transforming growth factor‐β1 and a significantly higher activity of the Smad2/3 pathway in adult DCMs. Glycosylated biglycan and versican, and cleaved thrombospondin‐1 increased in both DCMs. Protein expression of disintegrin and metalloproteinases with thrombospondin domains (‐1, ‐2, ‐4, ‐7) and disintegrin and metalloproteinases (‐12, ‐15, ‐17, ‐19) were altered differently in pediatric and adult control and failing hearts. Total matrix metalloproteinase activity increased in both DCMs. Tissue inhibitor of metalloproteinase levels were altered similarly with heart failure in both age groups, and only tissue inhibitor of metalloproteinase 3 decreased in both DCM groups.

Conclusions
Differential remodeling of glycosaminoglycans in pediatric DCMs versus adult DCMs could underlie the enhanced activation of the transforming growth factor‐β pathway, leading to more fibrosis in adult DCM hearts. The distinct remodeling of the fibrillar and nonfibrillar extracellular matrix between pediatric and adult DCM hearts highlights a distinct pathophysiological basis for these cohorts.
Partnering Research, Education, and Operations via a Cool Season Severe Weather Soundings Program
Authors: Sherburn Keith D. , Parker Matthew D. , Davenport Casey E. , Sirico Richard A. , Blaes Jonathan L. , Black Brandon , McLamb Shaelyn E. , Mugrage Michael C. , Rackliffe Ryan M. 
Published: October 2018

AbstractRecent research has improved our knowledge and forecasting of high-shear, low-CAPE (HSLC) severe convection, which produces a large fraction of overnight and cool season tornadoes. However, limited near-storm observations have hindered progress in our understanding of HSLC environments and detection of severe potential within them. This article provides an overview of a research project in central North Carolina aimed toward increasing the number of observations in the vicinity of severe and nonsevere HSLC convection. Particularly unique aspects of this project are a) leadership by student volunteers from a university sounding club and b) real-time communication of observations to local National Weather Service Forecast Offices. In addition to an overview of sounding operations and goals, two case examples are provided that support the potential utility of supplemental sounding observations for operational, educational, and research purposes.
NCAR’s Real-Time Convection-Allowing Ensemble Project
Authors: Schwartz Craig S. , Romine Glen S. , Sobash Ryan A. , Fossell Kathryn R. , Weisman Morris L. 
Published: October 2018

AbstractBeginning 7 April 2015, scientists at the U.S. National Center for Atmospheric Research (NCAR) began producing daily, real-time, experimental, 10-member ensemble forecasts with 3-km horizontal grid spacing across the entire conterminous United States. Graphical forecast products were posted in real time to the Internet, where they attracted a large following from both forecasters and researchers across government, academia, and the private sector. Although these forecasts were initially planned to terminate after one year, the project was extended through 30 December 2017 because of the enthusiastic community response. This article details the motivation for the NCAR ensemble project and describes the project’s impacts throughout the meteorological community. Classroom and operational use of the NCAR ensemble are discussed in addition to the diverse application of NCAR ensemble output for research purposes. Furthermore, some performance statistics are provided, and the NCAR ensemble website and data visualization approach are described. We hope the NCAR ensemble’s success will motivate additional experimental forecast demonstrations that transcend current operational capabilities, as forward-looking forecast systems are needed to accelerate operational development and provide students, young scientists, and forecasters with glimpses of what future modeling systems may look like. Additionally, the NCAR ensemble dataset is publicly available and can be used for meaningful research endeavors concerning many meteorological topics.