bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract 18729: Prosthetic Valve Positioning - Not a Static Question
Authors: Hall Hurst M 
Published: March 2022

A 65-year-old female with a history of bicuspid aortic valve s/p AVR with a Medtronic Hall mechanical valve presented with chest pain. Her recent history was notable for one week of intermittent substernal chest pain present when lying in the left lateral position. Initial ECG, obtained during an episode of chest pain, revealed 2 mm ST segment depression in the anterolateral leads and ST segment elevation in lead aVR. The ECG changes normalized with cessation of her chest pain. Laboratory evaluation showed an INR of 3.5 (on warfarin), and normal cardiac biomarkers. Chest imaging, including CT angiography, was unremarkable. Physical examination demonstrated a normal jugular venous pressure, a mechanical second heart sound, and a II/VI crescendo-decrescendo systolic murmur at the right upper sternal border. Transthoracic echocardiography (TTE) revealed normal biventricular systolic function and a mechanical valve in the aortic position, associated with mild aortic regurgitation.
Valve fluoroscopy revealed an aortic monoleaflet mechanical prosthesis with normal opening and closing angles in the supine position, but with closing restriction when in the left lateral decubitus position (closing angle 46 degrees, associated with recurrent chest pain and ischemic ECG changes). Transesophageal echocardiography (TEE) showed moderate aortic stenosis, mild aortic regurgitation, and multiple linear echodensities on the aortic prosthesis. These echogenicities were felt to represent thrombi, and the patient was treated with 5 doses of tPA and intravenous heparin. Subsequent TEE and valve fluoroscopy revealed improved prosthetic leaflet motion in supine and lateral decubitus positions.
This case describes an unusual presentation of mechanical aortic valve thrombosis. The contiguous association of the mechanical valve with the coronary ostia can contribute to ischemic complications, in this case positionally induced. It also highlights the value of timely valve fluoroscopy and the consideration of patient maneuvers to delineate valve function. Current guidelines support the use of thrombolytic therapy for small, left-sided thrombi, with recent literature suggesting that slowly infused low-dose tPA provides the optimal risk-benefit profile.
Abstract 19159: Performance of T1 Mapping Cardiac Magnetic Resonance Imaging as Compared to Biventricular Endomyocardial Biopsy in Patients With Suspected Myocarditis
Authors: Lurz Philipp , Luecke Christian , Foehrenbach Felix , Frank Clara , Eitel Ingo , Sandri Marcus , Boudriot Enno , de Waha Suzanne , Klingel Karin , Kandolf Reinhard , Schuler Gerhard , Thiele Holger , Gutberlet Matthias 
Published: March 2022

Background:
The diagnostic performance of cardiac magnetic resonance (CMR) imaging in suspected myocarditis is still limited. Recently, CMR T1 mapping has been suggested to yield excellent diagnostic accuracies in patients with suspected myocarditis as compared to healthy controls. However, the true diagnostic performance of T1 mapping when compared to endomyocardial biopsy (EMB) in patients with a variety of pathologies is till unknown and was therefore assessed in this study.

Methods and Results:
Within the final analyses, 129 consecutive patients with suspected acute or chronic myocarditis were included. Patients had to fulfill indications for CMR imaging according to the JACC White consensus paper.

All patients underwent biventricular EMB, cardiac catheterization for exclusion of coronary artery disease, and MRI on a 1.5 Tesla tomography (Intera, CV, Philips Medical Systems, Best, the Netherlands).
The CMR protocol included standard Lake-Louise (LL) parameters as well as native and post contrast T1 mapping using a modified Look-Locker inversion recovery sequence. Patients were divided into 2 groups according to duration of symptoms: patients with acute symptoms ≤14 days and those with chronic symptoms >14 days.
The diagnostic performance of LL criteria, native T1 and extracellular volume fraction (ECV) is summarized in the table. In patients with acute symptoms, native T1 yielded best diagnostic performance (81%) followed by ECV (75%), whereas accuracy of LL was found to be inadequate (60%). In patients with chronic symptoms, neither imaging technique or criteria yielded sufficient diagnostic accuracies.

Conclusion:
In patients with acute symptoms and suspected myocarditis, T1 mapping provides a useful tool for the confirming or rejecting the diagnosis of myocarditis and is superior to LL criteria. In contrast, native T1 and extracellular volume fraction demonstrated unsatisfying diagnostic accuracies in patients with chronic symptoms.
Abstract P074: Time to First Treatment Modification Among New Statin Users
Authors: Burke James P , Paoli Carly J , McPheeters Jeffrey , Gandra Shravanthi R , Simpson Ross J 
Published: March 2022

The benefits of lipid lowering therapy (LLT) include reductions in all-cause mortality and fatal CV disease. Studies have shown high rates of LLT discontinuation and poor persistence.
This study examined time to treatment modification and types of treatment modifications among patients initiating statin and ezetimibe therapy.
This retrospective claims-based study used medical, pharmacy and enrollment data from a large US health plan. Patients had commercial or Medicare Advantage Part D (MAPD) coverage from 1/1/07 to 12/31/12 and were followed for the earlier of 3 years, disenrollment or 12/31/13 (index date= date of first statin and/or ezetimibe use). Treatment modifications included switching, subtraction, dose escalation or reduction, augmentation, reduction, and discontinuation. Patients were assigned to one of three mutually exclusive cohorts: secondary CVD prevention, high risk primary prevention, and primary prevention. Arteriosclerotic cardiovascular disease (ASCVD) was also identified. The first episode of care was defined as the time from the index date to the first treatment modification (episode 1) and subsequent therapy modifications (episodes 2-4) were also examined.
The sample included 662,540 patients (mean age 57.4 years, 52.5% male, 19.2% MAPD). Overall mean time to first modification was 341.9 days (SD=333.7; median=200.0). Mean and medians were similar across cohorts but decreased with each subsequent episode of care. Discontinuation at 42.0% (with 70.5% restarting) was the most common treatment modification in the ASCVD cohort followed by switching (10.4%) and statin dose increase (10.3%). The other cohorts followed a similar pattern.
Patients remained on their index therapy for a substantial period of time. Surprisingly, there was little difference across risk groups. Initial choice of statin therapy by physician and patient may represent an opportunity to limit unnecessary statin and/or ezetimibe therapy modifications and to improve adherence.
Abstract P150: Dietary Patterns and Fractures in Postmenopausal Women: Results From the Women’s Health Initiative Observational Study
Authors: Haring Bernhard 
Published: March 2022

Objective:
To determine whether adherence to dietary patterns assessed by the alternative Mediterranean diet score (aMED), the Healthy Eating Index (HEI) 2010, the Alternate Healthy Eating Index (AHEI) 2010 or the Dietary Approach to Stop Hypertension (DASH) diet score is associated with hip or total fractures in postmenopausal women.

Methods:
The Women’s Health Initiative Observational Study (WHI-OS) prospectively followed 90,014 postmenopausal women. Food frequency questionnaires were used to assess adherence to established healthy eating patterns at baseline. Incident total and hip fractures were queried annually. We excluded toe, finger, sternum and clavicle fractures as total fracture events since these fractures are less likely related to osteoporosis. Associations of first incident fractures with dietary patterns were estimated using covariate-adjusted Cox proportional hazards models.

Results:
During a median follow-up of 15.9 years, we documented 2,121 hip fractures and 28,718 self-reported total fractures. In multivariable analyses, adhering to aMED was associated with a lower risk for hip fractures (HR
Q5
= 0.80, 95% CI, 0.66, 0.97; p
trend
= 0.02) but not for total fractures (HR
Q5
= 1.01, 95% CI, 0.95, 1.07; p
trend
= 0.77). Greater adherence to HEI-2010 or DASH was inversely related to hip fracture risk (p
trend
= 0.02 and 0.03, respectively) but not to total fracture risk (p
trend
= 0.15 and 0.47, respectively). The AHEI-2010 was not associated with total or hip fractures.

Conclusions:
Higher aMED, HEI-2010 or DASH dietary scoring was associated with lower risk for hip fractures. These results support that following a healthy dietary pattern is one cornerstone to maintain bone health in postmenopausal women.

Table. Hazard Ratios (95% CI) for hip fractures and total fractures by quintiles of dietary pattern in the Women’s Health Initiative Observational Study
1

*Model 1 adjusted for age, race/ethnicity and body mass index.
** Model 2 model adjusted for age, race/ethnicity, body mass index, smoking status, physical activity, self-reported health, diabetes status, history of fracture at age ≥ 55, physical function score, number of chronic medical conditions, number of psychoactive medications and use of HT, bisphosphonates, calcitonin and SERM.

1
AHEI-2010, Alternative Healthy Eating Index[[Unable to Display Character: &#8211;]]2010; aMED, alternate Mediterranean Diet; DASH, Dietary Approaches to Stop Hypertension; HEI-2010, Healthy Eating Index[[Unable to Display Character: &#8211;]]2010; MCI, Mild Cognitive Impairment; PD, Probable Dementia. Quintile 1 (Q1) represents the least healthy quintile, whereas quintile 5 (Q5) represents the healthiest quintile.
Abstract P303: Early Changes in Vascular Structure and Function after Bariatric Surgery in an Appalachian Population
Authors: Grogg Kristin A , DeVallance Evan , Lemaster Kent , Hull Robert , Tabone Lawrence , Chantler Paul , Frisbee Stephanie 
Published: March 2022

Obesity is associated with an elevated risk of cardiovascular disease, metabolic disease, and cardiac mortality. Reactive oxygen species and inflammation in an obese individuals are among a number of suspected driving forces behind obesity’s detrimental health effects. These factors can elevate cardiovascular risk by causing impairments in cardiovascular structure and function. It is hypothesized that gastric bypass surgery will lead to near immediate reversal of metabolic deviations and rapid weight reduction, in addition to remodeling and improvements in arterial function as weight is lost.
Patients that meet protocol inclusion criteria are invited to join the study during their 1 week pre-operative clinical appointment. At this time patients are consented and instructed to lie supine for 10 minutes of quite relaxation. Patients then begin a sequence of non-invasive examinations starting with a 12-lead electrocardiogram, followed by an echocardiogram, carotid artery ultrasound, radial applanation tonometry, and endothelial function analysis using EndoPAT technology. Upon completion of the non-invasive procedures a blood sample is taken for analysis.
Preliminary results on 12 study subjects suggests the following. As hypothesized, body weight had decreased (pre: 131.8 ±5.6 to post: 125 ±5.2 kg) along with BMI (pre: 45.2 ±2.3 to post: 42.9 ± 2.2) and waist circumference (pre: 122.1 ±5.0 to post: 111.9 ± 3.2 cm) at the 1-week time point. Decrease in body size and weight was aided by a reduction in low-density lipoprotein (pre: 127 ±6.2 to post: 113 ±4.5 mg/dL). In addition, a number of improvements to the cardiovascular system were also marked at the 1-week time point. Estimated left ventricular end systolic pressure and direct measure of left ventricular end systolic volume (pre: 66 ±4 to post: 55 ±3 mmHg) declined post-GBS. This is in consort with an increase in contraction rate (dP/dt pre: 672 ±54 post: 737 ±46, p<0.01), a reduction in LV ejection time (pre: 291 ±10 to post: 211 ± 30ms), and a decrease in myocardial oxygen demand (PTIs pre: 2346 ±120 post: 2194 ±107 area/min, p<0.05). Similar improvements in augmentation index can be seen in assessments of peripheral vessels. Independent of brachial artery blood pressure, central systolic blood pressure (pre: 112 ± 4 to post: 105 ±2 mmHg, p=0.08), augmentation index (pre: 16 ±3 to post: 8 ±3, p=0.06), an indirect measure of arterial stiffness, and central augmentation pressure (pre: 4.9 ±1.1 to post: 2.5 ±0.9 mmHg, p=0.06) tended to decrease 1-week post GBS. The data suggests that vascular changes are happening in the early stages of recovery, prior to dramatic weight loss, thus suggesting vascular changes are a result of an alternate surgical benefit. In conclusion, the preliminary results of this study suggest noteworthy cardiovascular improvements post-gastric bypass surgery, yet prior to significant weight loss.
Abstract 20950: An Intrinsic Mechanism for a Gain in Proteasome Activity Preserving Cardiac Function
Authors: Trogisch Felix , Koser Franziska , Jungmann Andreas , Müller Oliver , Hecker Markus , Drews Oliver 
Published: March 2022

Cardiac remodeling and heart failure are characterized by misaligned adaptations in protein synthesis and degradation, harboring the therapeutic potential for interventional harmonization. Partial inhibition of protein degradation via the ubiquitin-proteasome system was reported to reduce acute hypertrophic remodeling as well as recover systolic function. The studies are suggestive of an inadequate gain in proteasome activity, contributing to cardiac remodeling and heart failure.
Aim was to identify a common mechanism promoting proteasome activity during cardiac remodeling and heart failure and to test whether it contributes to the pathogenesis.
Incorporation of the inducible proteasome subunit Lmp2 has been described to increase proteasome activity. In fact, it is increasingly expressed and incorporated in proteasome complexes during isoproterenol-induced hypertrophic remodeling, which is associated with a gain in proteasome activity. We found that Lmp2 is also increasingly expressed upon transverse aortic constriction and in a murine model of familial hypertrophic cardiomyopathy. Knock-out (KO) of Lmp2 in mice increased the caspase-like proteasome activity by 19% (n=5, p<0.05), but had no apparent influence on cardiac morphology or function. As predicted, lack of Lmp2 confined the regulatory capacity of proteasomes to gain activity during hypertrophic remodeling induced by isoproterenol. Unexpectedly, the restriction in additional activity did not reduce cardiac remodeling as previously described for proteasome inhibition. In contrast, lack of Lmp2 exacerbated hypertrophic remodeling and caused loss of systolic function (fractional shortening: -32% vs. wildtype, n≥8, p<0.01). Cardiomyocyte-specific expression of Lmp2 via gene transfer into adult Lmp2 KO mice completely rescued the isoproterenol-induced deterioration of cardiac remodeling and function. Interestingly, the deprived gain in proteasome activity in Lmp2 KO hearts rather affected a specific subset than the general pool of ubiquitinated proteins.
In conclusion, a gain in proteasome activity during acute cardiac remodeling is not entirely maladaptive. At least in part, it is dependent on Lmp2, controlling remodeling and preserving cardiac function.
Abstract 10478: Comprehensive Mechanical Modelling of Thoracic Endovascular Aortic Repair in Type A Aortic Dissection
Authors: Kan Xiaoxin , Yuan Xun , Salmasi M Yousuf , Moore James , Sasidharan Sumesh , athanasiou athanasios , Xu Xiao Y , Nienaber Christoph A 
Published: March 2022

Background:
Thoracic endovascular aortic repair (TEVAR) in selected proximal (Stanford type A) aortic dissection (TAAD) cases has been reported, however, the limitation and criteria for TEVAR applied in TAAD remain controversial. Virtual stent-graft (SG) deployment simulation based on the finite element method is an emerging tool that allows TEVAR to be reproduced for detailed analysis of biomechanical interaction between native vessel wall and SG device.

Methods:
A TAAD patient underwent an unsuccessful TEVAR followed by salvage open surgical repair. Pre-TEVAR CT angiogram was used to establish the 3D geometry of the dissected aorta for later analysis. Perioperative DSA was used to measure the aortic root motion and determine SG position in the simulation model. Specimen of the harvested aortic tissue was used for histological analysis and tensile test to define isotropic hyperelastic properties of the aortic wall.

Results:
Aortic root motion was decomposed into a component normal to the sinotubular junction (STJ) and a component parallel to the STJ. The largest motion was 4.14 mm in normal direction and 3.5 mm in parallel direction. The continuous motion was used to define the displacement boundary condition at the aortic root in a finite element model.

The histology revealed preserved both elastic fibres and collagen at the proximal landing zone. A small area of inflammatory infiltration was noted at the tunica externa which may related to the dissected lamella.
Tensile testing showed that the aortic wall ruptured at the stress of 250-1250 kPa while the lamella ruptured at 80-160 kPa. Simulation precisely reproduced the SG configuration after TEVAR procedure. Maximum principal stress at 301 kPa was found on the lamella during simulation, which is significantly higher than stress tolerance of the lamella.

Conclusion:
Microstructure of the lamella and aortic wall components determine the capacity in resisting SG induced focal stress. During the deployment, the proximal end of SG landed directly onto the lamella where the maximum stress exceeded the tolerance of the lamella thus causing rupture and allowing the SG to penetrate into the false lumen.
Abstract 10883: Cardiac-Oncology Prognostication and Outcomes in Female Breast Cancer Survivors
Authors: Heaton Joseph , Salanga Alyssa , Massaro Robert , Graebe Robert S 
Published: March 2022

Background:
Heart disease risk and mortality is increased in breast cancer patients. Tumor and treatment factors have not been well described for cardiac mortality prognostication. We evaluated presenting characteristics and treatment factors on cardiac mortality in breast cancer survivors.

Methods:
The Surveillance, Epidemiology and End Results (SEER) registry was queried for adult female patients with malignant breast cancer from 1990-2016, who survived more than 60 months.

Results:
The SEER registry identified 686,559 patients. The average patient was white (83.3%), married (58.0%), and 59.9 ± 13.3 years. The typical tumor on presentation was moderately differentiated (38.7%), localized (55.2%), ER positive (71.2%), PR positive (60.3%), and HER status unknown (87.0%). Median survival times for cardiac-specific mortality was 117 months compared to 98 months for recurring breast cancer (log rank P < 0.001). Adjusted Cox proportional hazard models in Table 1 revealed increased cardiac-specific mortality with HER positive status and increasing age. Decreased mortality was noted in married or widowed patients and after selected multimodal therapies. Race, tumor grade, and localization were not well correlated.

Conclusion:
Breast cancer survivors are at risk for heart disease and cardiac mortality. After five years, the initial tumor burden does not correlate well with cardiac outcomes. Multimodal therapy and marriage were associated with significantly reduced risk.

Table 1. Cox Proportional Hazards
Hazard ratios for cardiac-specific mortality.
Risk Stratification Guided by the Index of Microcirculatory Resistance and Left Ventricular End-Diastolic Pressure in Acute Myocardial Infarction
Authors: Maznyczka Annette M. , McCartney Peter J. , Oldroyd Keith G. , Lindsay Mitchell , McEntegart Margaret , Eteiba Hany , Rocchiccioli J. Paul , Good Richard , Shaukat Aadil , Robertson Keith , Malkin Christopher J. , Greenwood John P. , Cotton James M. , Hood Stuart , Watkins Stuart , Collison Damien , Gillespie Lynsey , Ford Thomas J. , Weir Robin A.P. , McConnachie Alex , Berry Colin 
Published: March 2022

Background:
The index of microcirculatory resistance (IMR) of the infarct-related artery and left ventricular end-diastolic pressure (LVEDP) are acute, prognostic biomarkers in patients undergoing primary percutaneous coronary intervention. The clinical significance of IMR and LVEDP in combination is unknown.

Methods:
IMR and LVEDP were prospectively measured in a prespecified substudy of the T-TIME clinical trial (Trial of Low Dose Adjunctive Alteplase During Primary PCI). IMR was measured using a pressure- and temperature-sensing guidewire following percutaneous coronary intervention. Prognostically established thresholds for IMR (>32) and LVEDP (>18 mm Hg) were predefined. Contrast-enhanced cardiovascular magnetic resonance imaging (1.5 Tesla) was acquired 2 to 7 days and 3 months postmyocardial infarction. The primary end point was major adverse cardiac events, defined as cardiac death/nonfatal myocardial infarction/heart failure hospitalization at 1 year.

Results:

IMR and LVEDP were both measured in 131 patients (mean age 59±10.7 years, 103 [78.6%] male, 48 [36.6%] with anterior myocardial infarction). The median IMR was 29 (interquartile range, 17–55), the median LVEDP was 17 mm Hg (interquartile range, 12–21), and the correlation between them was not statistically significant (
r
=0.15;
P
=0.087). Fifty-three patients (40%) had low IMR (≤32) and low LVEDP (≤18), 18 (14%) had low IMR and high LVEDP, 31 (24%) had high IMR and low LVEDP, while 29 (22%) had high IMR and high LVEDP. Infarct size (% LV mass), LV ejection fraction, final myocardial perfusion grade ≤1, TIMI (Thrombolysis In Myocardial Infarction) flow grade ≤2, and coronary flow reserve were associated with LVEDP/IMR group, as was hospitalization for heart failure (n=18 events;
P
=0.045) and major adverse cardiac events (n=21 events;
P
=0.051). LVEDP>18 and IMR>32 combined was associated with major adverse cardiac events, independent of age, estimated glomerular filtration rate, and infarct-related artery (odds ratio, 5.80 [95% CI, 1.60–21.22]
P
=0.008). The net reclassification improvement for detecting major adverse cardiac events was 50.6% (95% CI, 2.7–98.2;
P
=0.033) when LVEDP>18 was added to IMR>32.

Conclusions:
IMR and LVEDP in combination have incremental value for risk stratification following primary percutaneous coronary intervention.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02257294.