bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a Continuous Quality Improvement Program in a High-Volume Clinical Echocardiography Laboratory
Authors: Samad Zainab , Minter Stephanie , Armour Alicia , Tinnemore Amanda , Sivak Joseph A. , Sedberry Brenda , Strub Karen , Horan Seanna M. , Harrison J. Kevin , Kisslo Joseph , Douglas Pamela S. , Velazquez Eric J. 
Published: September 2018

Background—
The management of aortic stenosis rests on accurate echocardiographic diagnosis. Hence, it was chosen as a test case to examine the utility of continuous quality improvement (CQI) approaches to increase echocardiographic data accuracy and reliability. A novel, multistep CQI program was designed and prospectively used to investigate whether it could minimize the difference in aortic valve mean gradients reported by echocardiography when compared with cardiac catheterization.

Methods and Results—

The Duke Echo Laboratory compiled a multidisciplinary CQI team including 4 senior sonographers and MD faculty to develop a mapped CQI process that incorporated Intersocietal Accreditation Commission standards. Quarterly, the CQI team reviewed all moderate- or greater-severity aortic stenosis echocardiography studies with concomitant catheterization data, and deidentified individual and group results were shared at meetings attended by cardiologists and sonographers. After review of 2011 data, the CQI team proposed specific amendments implemented over 2012: the use of nontraditional imaging and Doppler windows as well as evaluation of aortic gradients by a second sonographer. The primary outcome measure was agreement between catheterization- and echocardiography-derived mean gradients calculated by using the coverage probability index with a prespecified acceptable echocardiography–catheterization difference of <10 mm Hg in mean gradient. Between January 2011 and January 2014, 2093 echocardiograms reported moderate or greater aortic stenosis. Among cases with available catheterization data pre- and post-CQI, the coverage probability index increased from 54% to 70% (
P
=0.03; 98 cases, year 2011; 70 cases, year 2013). The proportion of patients referred for invasive valve hemodynamics decreased from 47% pre-CQI to 19% post-CQI (
P
<0.001).

Conclusions—
A laboratory practice pattern that was amenable to reform was identified, and a multistep modification was designed and implemented that produced clinically valuable performance improvements. The new protocol improved aortic stenosis mean gradient agreement between echocardiography and catheterization and was associated with a measurable decrease in referrals of patients for invasive studies.
Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction
Authors: Freed Benjamin H. , Daruwalla Vistasp , Cheng Jeanette Y. , Aguilar Frank G. , Beussink Lauren , Choi Andrew , Klein David A. , Dixon Debra , Baldridge Abigail , Rasmussen-Torvik Laura J. , Maganti Kameswari , Shah Sanjiv J. 
Published: September 2018

Background—
Left atrial (LA) enlargement is associated with adverse events in heart failure with preserved ejection fraction (HFpEF). However, the role of LA mechanics (ie, LA strain measures) in HFpEF has not been well studied. We hypothesized that in HFpEF, reduced (worse) LA strain is a key pathophysiologic abnormality and is a stronger correlate of adverse events than left ventricular or right ventricular longitudinal strain.

Methods and Results—

We evaluated baseline LA function in 308 patients with HFpEF who were followed up longitudinally for adverse outcomes. All patients underwent speckle-tracking echocardiography for measurement of left ventricular longitudinal strain, right ventricular free wall strain, and LA booster, conduit, and reservoir strains. The clinical and prognostic significance of left ventricular, right ventricular, and LA strain measures was assessed by regression analyses. The mean age was 65±13 years, 64% were women, 26% had atrial fibrillation, and LA enlargement was present in the majority of patients (67%). Decreased LA reservoir strain was associated with increased pulmonary vascular resistance (
P
<0.0001) and decreased peak oxygen consumption (
P
=0.0001). Of the left ventricular, right ventricular, and LA strain measures, LA reservoir strain was the strongest correlate of adverse events and was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted hazard ratio per 1-SD decrease in LA strain, 1.54; 95% CI, 1.15–2.07;
P
=0.006).

Conclusions—
Abnormal indices of LA mechanics (particularly LA reservoir strain) are powerful clinical and prognostic factors in HFpEF. Unloading the LA and augmentation of LA function may be important future therapeutic targets in HFpEF.

Registration Information—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01030991.
Evaluation of Aortic Blood Flow and Wall Shear Stress in Aortic Stenosis and Its Association With Left Ventricular Remodeling
Authors: von Knobelsdorff-Brenkenhoff Florian , Karunaharamoorthy Achudhan , Trauzeddel Ralf Felix , Barker Alex J. , Blaszczyk Edyta , Markl Michael , Schulz-Menger Jeanette 
Published: September 2018

Background—
Aortic stenosis (AS) leads to variable stress for the left ventricle (LV) and consequently a broad range of LV remodeling. The aim of this study was to describe blood flow patterns in the ascending aorta of patients with AS and determine their association with remodeling.

Methods and Results—

Thirty-seven patients with AS (14 mild, 8 moderate, 15 severe; age, 63±13 years) and 37 healthy controls (age, 60±10 years) underwent 4-dimensional-flow magnetic resonance imaging. Helical and vortical flow formations and flow eccentricity were assessed in the ascending aorta. Normalized flow displacement from the vessel center and peak systolic wall shear stress in the ascending aorta were quantified. LV remodeling was assessed based on LV mass index and the ratio of LV mass:end-diastolic volume (relative wall mass). Marked helical and vortical flow formation and eccentricity were more prevalent in patients with AS than in healthy subjects, and patients with AS exhibited an asymmetrical and elevated distribution of peak systolic wall shear stress. In AS, aortic orifice area was strongly negatively associated with vortical flow formation (
P
=0.0274), eccentricity (
P
=0.0070), and flow displacement (
P
=0.0021). Bicuspid aortic valve was associated with more intense helical (
P
=0.0098) and vortical flow formation (
P
=0.0536), higher flow displacement (
P
=0.11), and higher peak systolic wall shear stress (
P
=0.0926). LV mass index and relative wall mass were significantly associated with aortic orifice area (
P
=0.0611,
P
=0.0058) and flow displacement (
P
=0.0058,
P
=0.0283).

Conclusions—
In this pilot study, AS leads to abnormal blood flow pattern and peak systolic wall shear stress in the ascending aorta. In addition to aortic orifice area, normalized flow displacement was significantly associated with LV remodeling.
Optical Coherence Tomography Findings in Bioresorbable Vascular Scaffolds Thrombosis
Authors: Cuculi Florim , Puricel Serban , Jamshidi Peiman , Valentin Jérémy , Kallinikou Zacharenia , Toggweiler Stefan , Weissner Melissa , Münzel Thomas , Cook Stéphane , Gori Tommaso 
Published: September 2018

Background—
Everolimus-eluting bioresorbable vascular scaffolds have been developed to improve late outcomes after coronary interventions. However, recent registries raised concerns regarding an increased incidence of scaffold thrombosis (ScT). The mechanism of ScT remains unknown.

Methods and Results—
The present study investigated angiographic and optical coherence tomography findings in patients experiencing ScT. Fifteen ScT (14 patients, 79% male, age 59±10 years) occurred at a median of 16 days (25%–75% interquartile range: 1–263 days) after implantation. Early ScT (<30 days) occurred in 8 cases (53%). Possible causal factors in these patients included insufficient platelet inhibition in 2 cases and procedural factors (scaffold underexpansion, undersizing, or geographical miss) in 4 cases. No obvious cause could be found in 2 early ScT. In late (>1 month) and very late (>1 year) ScT (respectively, 5 and 2 cases), 5 scaffolds showed intimal neovessels or marked peristrut low-intensity areas. Scaffold fractures were additionally found in 2 patients, and scaffold collapse was found in 1 patient with very late ScT. Extensive strut malapposition was the presumed cause for ScT in 1 case. One scaffold did not show any morphological abnormality. Thrombectomy specimens were analyzed in 3 patients and did not demonstrate increased numbers of inflammatory cells.

Conclusions—
The mechanisms of early ScT seem to be similar to metallic stents (mechanical and inadequate antiplatelet therapy). The predominant finding in late and very late ScT is peristrut low-intensity area.
Comparison of Cardiovascular Risk Factors for Coronary Heart Disease and Stroke Type in Women
Authors: Leening Maarten J. G. , Cook Nancy R. , Franco Oscar H. , Manson JoAnn E. , Lakshminarayan Kamakshi , LaMonte Michael J. , Leira Enrique C. , Robinson Jennifer G. , Ridker Paul M , Paynter Nina P. 
Published: September 2018

Background
Cardiovascular risk factors have differential effects on various manifestations of cardiovascular disease, but to date direct formal comparisons are scarce, have been conducted primarily in men, and include only traditional risk factors.

Methods and Results

Using data from the multi‐ethnic Women's Health Initiative Observational Study, we used a case–cohort design to compare 1731 women with incident cardiovascular disease during follow‐up to a cohort of 1914 women. The direction of effect of all 24 risk factors (including various apolipoproteins, hemoglobin A1
c
, high‐sensitivity C‐reactive protein, N‐terminal pro‐brain natriuretic peptide, and tissue plasminogen activator antigen) was concordant for coronary heart disease (CHD, defined as myocardial infarction and CHD death) and ischemic stroke; however, associations were generally stronger with CHD. Significant differences for multiple risk factors, including blood pressure, lipid levels, and measures of inflammation, were observed when comparing the effects on hemorrhagic stroke with those on ischemic outcomes. For instance, multivariable adjusted hazard ratios per standard deviation increase in non–high‐density lipoprotein cholesterol were 1.16 (95% confidence interval, 1.06–1.28) for CHD, 0.97 (0.88–1.07) for ischemic stroke, and 0.76 (0.63–0.91) for hemorrhagic stroke (
P
<0.05 for equal association). Model discrimination was better for models predicting CHD or ischemic stroke than for models predicting hemorrhagic stroke or a combined end point.

Conclusions
Cardiovascular risk factors have largely similar effects on incidence of CHD and ischemic stroke in women, although the magnitude of association varies. Determinants of ischemic and hemorrhagic stroke substantially differ, underscoring their distinct biology. Cardiovascular disease risk may be more accurately reflected when combined cardiovascular disease or cerebrovascular outcomes are broken down into different first manifestations, or when restricted to ischemic outcomes.
Genetic Variants Associated With Plasma Lipids Are Associated With the Lipid Response to Niacin
Authors: Tuteja Sony , Qu Liming , Vujkovic Marijana , Dunbar Richard L. , Chen Jinbo , DerOhannessian Stephanie , Rader Daniel J. 
Published: September 2018

Background
Niacin is a broad‐spectrum lipid‐modulating drug, but its mechanism of action is unclear. Genome‐wide association studies have identified multiple loci associated with blood lipid levels and lipoprotein (a). It is unknown whether these loci modulate response to niacin.

Methods and Results

Using data from the
AIM
‐
HIGH
(Atherothrombosis Intervention in Metabolic Syndrome with Low
HDL
/High Triglycerides and Impact on Global Health Outcomes) trial (n=2054 genotyped participants), we determined whether genetic variations at validated loci were associated with a differential change in plasma lipids and lipoprotein (a) 1 year after randomization to either statin+placebo or statin+niacin in a variant‐treatment interaction model. Nominally significant interactions (
P
<0.05) were found for genetic variants in

MVK

,

LIPC
,
PABPC
4,
AMPD
3

with change in high‐density lipoprotein cholesterol;

SPTLC
3

with change in low‐density lipoprotein cholesterol;

TOM
1

with change in total cholesterol;

PDXDC
1

and

CYP
26A1

with change in triglycerides; and none for lipoprotein (a). We also investigated whether these loci were associated with cardiovascular events. The risk of coronary disease related death was higher in the minor allele carriers at the

LIPC

locus in the placebo group (odds ratio 2.08, 95% confidence interval 1.11‐3.90,
P
=0.02) but not observed in the niacin group (odds ratio 0.89, 95% confidence interval 0.48‐1.65,
P
=0.7);
P
‐interaction =0.02. There was a greater risk for acute coronary syndrome (odds ratio 1.85, 95% confidence interval 1.16‐2.77,
P
=0.02) and revascularization events (odds ratio 1.64, 95% confidence interval 1.2‐2.22,
P
=0.002) in major allele carriers at the

CYP
26A1

locus in the placebo group not seen in the niacin group.

Conclusions
Genetic variation at loci previously associated with steady‐state lipid levels displays evidence for lipid response to niacin treatment.

Clinical Trials Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00120289.
Burden of Uncontrolled Metabolic Risk Factors and Left Ventricular Structure and Function in Patients With Type 2 Diabetes Mellitus
Authors: Jørgensen Peter Godsk , Jensen Magnus Thorsten , Biering‐Sørensen Tor , Mogelvang Rasmus , Fritz‐Hansen Thomas , Vilsbøll Tina , Rossing Peter , Jensen Jan Skov 
Published: September 2018

Background
Type 2 diabetes mellitus is closely associated with metabolic risk factors that all contribute to impairment of the left ventricle. The implications of having type 2 diabetes mellitus with well‐controlled metabolic risk factors compared to an increasing burden of uncontrolled metabolic risk factors on left ventricular structure and function are not known.

Methods and Results

We compared patients with type 2 diabetes mellitus (n=751) with different degrees of uncontrolled metabolic risk factors present with a control group of individuals without present uncontrolled metabolic risk factors as recommended by the World Health Organization (n=80). In patients with well‐controlled metabolic risk factors, only diastolic but neither structural nor systolic measures were impaired compared to the control group: the (early diastolic mitral inflow velocity)/(atrial diastolic mitral inflow velocity) ratio (median 0.94 [interquartile range 0.80, 1.08] versus 1.11 [0.85, 1.38],
P
<0.001), lateral early diastolic myocardial velocity at the level of the mitral annulus (mean 9.6 m/s [SD 2.5] versus 10.8 [3.5],
P
<0.001) and lateral (early diastolic mitral inflow velocity)/(early diastolic myocardial velocity at the level of the mitral annulus) (7.7 [6.5, 10.2] versus 6.3 [4.9, 7.8],
P
<0.001). With an increasing burden of uncontrolled metabolic risk factors, there were increased left ventricular mass index and wall thicknesses and impaired systolic function measured as global longitudinal strain: control group −15.9 (2.0); 0 uncontrolled risk factors −15.3 (2.4); 1 to 2 −14.6 (2.8); and ≥3 −14.0 (2.8),
P
<0.001. Within the diabetes mellitus group, there were uni‐ and multivariable associations of left ventricular measures and systolic blood pressure, body mass index, hemoglobin A
1c
, and
HDL
‐cholesterol.

Conclusions
In patients with type 2 diabetes mellitus, having well‐controlled metabolic risk factors was associated with only left ventricular diastolic impairment but not with either structural or even subtle measures of systolic function. Increasing burden of uncontrolled metabolic risk factors was associated with structural and functional impairments.
Randomized Placebo‐Controlled Trial Assessing the Effect of 24‐Week Fenofibrate Therapy on Circulating Markers of Abdominal Aortic Aneurysm: Outcomes From the FAME‐2 Trial
Authors: Pinchbeck Jenna L. , Moxon Joseph V. , Rowbotham Sophie E. , Bourke Michael , Lazzaroni Sharon , Morton Susan K. , Matthews Evan O. , Hendy Kerolos , Jones Rhondda E. , Bourke Bernie , Jaeggi Rene , Favot Danella , Quigley Frank , Jenkins Jason S. , Reid Christopher M. , Velu Ramesh , Golledge Jonathan 
Published: September 2018

Background

There is no drug therapy for abdominal aortic aneurysm (
AAA
). FAME‐2 (Fenofibrate in the Management of Abdominal Aortic Aneurysm 2) was a placebo‐controlled randomized trial designed to assess whether administration of 145 mg of fenofibrate/d for 24 weeks favorably modified circulating markers of AAA.

Methods and Results

Patients with
AAA
s measuring 35 to 49 mm and no contraindication were randomized to fenofibrate or identical placebo. The primary outcome measures were the differences in serum osteopontin and kallistatin concentrations between groups. Secondary analyses compared changes in the circulating concentration of
AAA
‐associated proteins, and
AAA
growth, between groups using multivariable linear mixed‐effects modeling. A total of 140 patients were randomized to receive fenofibrate (n=70) or placebo (n=70). By the end of the study 3 (2.1%) patients were lost to follow‐up and 18 (12.9%) patients had ceased trial medication. A total of 85% of randomized patients took ≥80% of allocated tablets and were deemed to have complied with the medication regimen. Patients’ allocated fenofibrate had expected reductions in serum triglycerides and estimated glomerular filtration rate, and increases in serum homocysteine. No differences in serum osteopontin, kallistatin, or
AAA
growth were observed between groups.

Conclusions

Administering 145 mg/d of fenofibrate for 24 weeks did not significantly reduce serum concentrations of osteopontin and kallistatin concentrations, or rates of
AAA
growth in this trial. The findings do not support the likely benefit of fenofibrate as a treatment for patients with small
AAA
s.

Clinical Trial Registration

URL
:
www.anzctr.org.au
. Unique identifier:
ACTRN
12613001039774.
Cardiac Rehabilitation Participation and Mortality After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program
Authors: Beatty Alexis L. , Doll Jacob A. , Schopfer David W. , Maynard Charles , Plomondon Mary E. , Shen Hui , Whooley Mary A. 
Published: September 2018

Background
Cardiac rehabilitation (CR) is strongly recommended after percutaneous coronary intervention (PCI), but it is underused. We sought to evaluate CR participation variation after PCI and its association with mortality among veterans.

Methods and Results

Patients undergoing PCI between 2007 and 2011 were identified in the Veterans Affairs Clinical Assessment, Reporting, and Tracking database and followed up until January 25, 2017. We excluded patients who died within 30 days of PCI and calculated the percentage participating in ≥1 outpatient CR visits within 12 months after PCI. We constructed multivariable hierarchical logistic regression models for CR participation, clustered by facility. We estimated propensity scores for CR participation, matched participants and nonparticipants by propensity score, calculated mortality rates, and estimated the association with mortality using Cox proportional hazards models. Participation in CR after PCI was 6.9% (2986/43 319) and varied significantly by PCI facility (range, 0%–36%). After 6.1 years median follow‐up, CR participants had a 33% lower mortality rate than all nonparticipants (3.8 versus 5.7 deaths/100 person‐years; hazard ratio, 0.67; 95% confidence interval, 0.61–0.75;
P
<0.001) and a 26% lower mortality rate than 2986 propensity‐matched nonparticipants (3.8 versus 5.1 deaths/100 person‐years; hazard ratio, 0.74; 95% confidence interval, 0.65–0.84;
P
<0.001). Participants attending ≥36 sessions had the lowest mortality rate (2.4 deaths/100 person‐years; hazard ratio, 0.47; 95% confidence interval, 0.36–0.60;
P
<0.001).

Conclusions
CR participation after PCI among veterans is low overall, with significant facility‐level variation. CR participation is associated with lower mortality rates in veterans. Additional efforts are needed to promote CR participation after PCI among veterans.
The effect of age on vigilance: a longitudinal study with a precocial species
Authors: Beauchamp Guy 
Published: October 2018

AbstractVigilance allows prey species to detect predators before it is too late to escape. While the adaptive value of vigilance has become clearer over the years, developmental questions have attracted little attention. I explored the effect of age and group size on vigilance in a precocial species, the domestic fowl (Gallus gallus domesticus). I recorded vigilance in groups of various sizes in juveniles and one year later in adults. Vigilance decreased with group size in juveniles and to a lesser extent in adults. Juveniles tested alone showed longer feeding and vigilance bouts than adults reflecting their inexperience with predation threats and more rapid satiation, respectively. Adults in larger groups were more vigilant reflecting the need to monitor aggressive conspecifics in addition to predators. Gradual acquisition of information about risk posed by predators and conspecifics and feeding constraints influenced the expression of vigilance as a function of age in this species.
On the Inverse Relationship between the Boreal Wintertime Pacific Jet Strength and Storm-Track Intensity
Authors: Zhao Yuan-Bing , San Liang X. 
Published: October 2018

AbstractPrevious studies show that in boreal winters when the Pacific jet is extremely strong, the Pacific storm track is, however, unexpectedly weak. Using a recently developed technique, namely, the multiscale window transform (MWT), and the MWT-based localized multiscale energetics analysis, we investigate in this study the underlying mechanism of this counterintuitive phenomenon, based on ERA-40 data. It is found that most of the synoptic storms are generated at latitudes far north of the jet core, which lowers the relevance of the jet strength to the storm-track intensity, and the inverse relationship between the Pacific jet strength and storm-track intensity is mainly attributed to the internal dynamics. In the strong jet state, on one hand, the jet is narrow, and thus the jet winds at high latitudes are weak, resulting in weak baroclinic instabilities and hence reduced eddy growth rate; on the other hand, although baroclinic instabilities are strong at the jet core, inverse kinetic energy (KE) cascades are even stronger (by 43%). The resultant effect is that more eddy energy is transferred back to the background flow, leaving an overall weak storm track in a strong Pacific jet. In addition, diabatic processes are found to account for the inverse relationship: it is greatly weakened (by 25%) in the strong-core jet state. Apart from these, we also find that the role that barotropic canonical transfer plays in the inverse relationship is opposite to that in the formation of the midwinter minimum (MWM), another counterintuitive phenomenon in the Pacific storm track.