tbuckley/cabot-search huggingface dataset:
Abstract 18720: Multi Center, Prospective, Randomized, Single Blind, Consecutive Enrollment Evaluation a Novolimus-Eluting Coronary Stent System with Bioabsorbable Polymer Compared to a Zotarolimus-Eluting Coronary Stent System: 12- Month Clinical and 6-Month Angiographic and IVUS Results: the EXCELLA BD Study
Authors: Alexandre Abizaid, Joachim Schofer, Roberto Botelho, Stefan Verheye, Ricardo Costa, Luiz Fernando Tanajura, Katsuhisa Waseda, Lynn Morrison, Sara Toyloy, Peter Fitzgerald
Journal: Circulation (2012)

Aims: To evaluate the safety and effectiveness of the Elixir DESyne TM BD Novolimus Eluting Coronary Stent System (CSS) with a bioabsorbable polymer compared to the Endeavor Zotarolimus Eluting Coronary Stent System through the assessment of clinical, angiographic, and IVUS endpoints. Method and Results: 149 patients were randomized 3:1, either to the Elixir DESyne BD Novolimus Eluting CSS loaded with 5mcg per mm of stent length of Novolimus, a sirolimus metabolite, eluted via a bioabsorbable polylactide-based polymer, or to the Endeavor Zotarolimus-eluting CSS loaded with 10mcg per mm of stent length of Zotarolimus eluted via a durable phosphoryl choline polymer. All patients were analyzed for the primary endpoint of in-stent late lumen loss (LLL) assessed by QCA at 6 months. Moreover, all patients underwent evaluation for the secondary endpoints including the Device-orientated Composite Endpoint (DoCE) defined as: cardiac death, MI not clearly attributable to a non-intervention vessel, and clinically-indicated target lesion revascularization; clinically-indicated Target Vessel Revascularization (TVR), and stent thrombosis at 1, 6, 9, and 12 months and annually through 5 years. Lesions were also evaluated for angiographic endpoints at 6 months including: in-segment LLL, percent diameter stenosis, minimal lumen diameter post-procedure and at 6 months, and angiographic binary restenosis (ABR) (≥50%). A subset of patients underwent intravascular ultrasound (IVUS) evaluation including percent (%) neointimal obstruction at 6 months. The study met the primary endpoint demonstrating both non-inferiority and superiority of the DESyne BD compared to the control (0.12±0.15 vs 0.67±0.47, p&lt;0.001), additionally, in-stent ABR was significantly lower for DESyne BD (0% vs 7.9%, p=0.003). Excellent clinical results at 6 months were demonstrated for both devices. Clinical results through 12 months and additional angiographic and IVUS results will be presented. Conclusion: Clinical results through 12 months and complete angiographic and IVUS results will be presented.
Abstract 18690: Association Between Plasma Total Testosterone and Major Adverse Cardiovascular Events in Hypertensive Patients
Authors: Nikolaos Ioakeimidis, Charalambos Vlachopoulos, Konstantinos Aznaouridis, Dimitrios Terentes-Printzios, Athanasios Aggelis, Mahmoud Abdelrasoul, Aggelos Aggelakas, Alexandros Synodinos, George Lazaros, Christodoulos Stefanadis
Journal: Circulation (2012)

Objective: Androgen deficiency confers an independent risk for cardiovascular events and total mortality. Hypertension, a major contributory factor to the development of cardiovascular disease, has also been associated with increased prevalence of low testosterone. We investigated whether low androgen concentration predicts major adverse cardiovascular events (MACE) in middle-aged hypertensive patients without clinical atherosclerosis. Methods: MACE in relation to total testosterone (TT) were analyzed with proportional hazards models in 228 patients (mean age 56 years). Results: During a mean follow-up of 44 months, 19/228 participants (8.3%) experienced a MACE. Compared to patients who did not experience MACE, hypertensive subjects who developed MACE had lower TT concentration (3.9±0.7 ng/ml vs 4.6±1.5 ng/ml, P&lt;0.01) and a higher prevalence of hypogonadism (36% versus 16%, P=0.025). The study population was divided into tertiles according to the TT levels (low tertile 4.9 ng/ml). TT concentration was associated with MACE and the differences between the tertiles were significant (Mantel log-rank test: 8.372; p&lt;0.01). Subjects in the lowest TT tertile (&lt;4.0 ng/ml) had a threefold higher risk of MACE compared to those in the highest tertile (&gt;4.9 ng/ml, adjusted HR 3.14, P=0.035). A TT plasma level of 5.04 ng/ml was associated with a negative predictive value (ability to “rule out” MACE) of 97.2 %. Addition of TT to standard risk factors model yielded correct patient reclassification to higher or lower risk category by 38.8 % (P=0.033). Conclusion: Our results show that plasma testosterone is associated with increased risk for a MACE in hypertensive patients. Low endogenous androgen concentration improves risk prediction when added to standard risk factors and may represent a valuable biomarker of prediction of cardiovascular disease risk in these patients.
Abstract 18802: Differential Chamber and Cell-specific Expression of MicroRNAs in Experimental Heart Failure
Authors: Yu Chen, Kristin Dawson, Chia-Tung Wu, Reza Wakili, Xiaobin Luo, Stefan Kääb, Dobromir Dobrev, Stanley Nattel
Journal: Circulation (2012)

Background: Heart failure (HF) causes differential remodeling of left atrium (LA) vs left ventricle (LV), with much more prominent fibrosis in LA. Fibroblasts (FB) are central in fibrotic responses, with microRNAs (miRs) important regulators. This study determined the profile of miR expression changes underlying LA/LV remodeling, as well as FB/cardiomyocyte (CM) selectivity during the development of experimental HF. Methods: HF was induced in dogs by ventricular tachypacing (240 bpm) for 0 (CTL), 12, 24 hrs, 1 and 2 wks (n=5-12/group). FB and CMs were freshly isolated from LA and LV of each dog. Gene expression was assessed by qPCR. MiRs were selected based on preliminary microarray data. Results: HF changed the expression of 7/10 miRs in FB, while they were unchanged in CMs (miR-29b, miR-26a/b, miR-1, miR-208b and miR-133a/b, Table 1). Of these, FB selective miRs decreased only in LA (miR-29b decreased by ∼65%* and miR-26a/b by ∼57%*-79%*** beginning at 12 hrs), while the CM selective miRs decreased in both LA and LV (miR-1 by ∼37%-93%**, miR-208b by ∼67%-91%*), or only in LV (miR-133a/b by ∼77%***-89%***). MiRs downregulated in LA target multiple ECM genes, which showed LA-predominant increases in FB: miR-29b targets COL1A1 (increased by ∼11-fold*** from 1 wk) and COL3A1 (increased by ∼4.7-fold*** from 1 wk). MiR-29b and miR-208b both target fibrillin1 (increased by ∼1.9-fold** at 2 wks). MiR-1 may also participate in ECM remolding as it targets fibronectin1 (increased by ∼4.8*-14***-fold from 1 wk). The expression of miR-208a, miR-30a and miR-21 changed in both atrial FB and CMs, with smaller or nonsignificant changes in ventricular cells (Table 1), suggesting that these miRs play roles both in FB and CMs. Conclusions: Experimental HF causes greater FB-selective miR and ECM changes in LA compared to LV. The FB expression-profiles of ECM-targeting miRs in LA, accompanied by related ECM expression changes, implicate miRs in HF related LA-selective structural remodeling.
Abstract 18727: Right Ventricular Pressure Overload is More Important than Volume Overload in Producing Contralateral Ventricular Dysfunction: A Congenital Heart Disease Model
Authors: Arpit Agrawal, Ari Cedars
Journal: Circulation (2012)

Intro: It is known that right ventricular (RV) contractile failure predisposes the left ventricle (LV) to failure. Animal models in an acute setting indicate this phenomenon is due predominantly to RV volume overload causing both changes in LV geometry and suboptimal LV filling. We investigated the relative importance of chronic RV pressure versus volume overload in producing LV dysfunction using d-transposition of the great vessels with an atrial switch (TGA, RV pressure overload) and repaired tetralogy of Fallot with severe pulmonary valve insufficiency (ToF, RV volume overload) as model systems. Methods: We performed a single center retrospective analysis of cardiac magnetic resonance imaging (MRI) data. All adult patients with TGA and ToF who had useful MRI data were screened. Included ToF patients had pulmonary insufficiency without residual pulmonary or infundibular stenosis. Included TGA patients had mild or less aortic or tricuspid regurgitation. We assessed MRI derived LV and RV volume measurements. Correlations were assessed using Pearson’s correlation coefficient. Differences between correlation coefficients were assessed using a Fischer r to z transformation. Results: 32 TGA and 46 ToF patients met enrollment criteria with 35 and 72 MRIs respectively having data adequate for analysis. The groups were similar in terms of sex (58 versus 51% male) and age (29.6 +/- 6.0 versus 31.0 +/- 9.7) respectively. Patients with TGA demonstrated a strong correlation between RV and LV systolic function based on ejection fraction (EF) r=0.75. They also demonstrated a strong correlation between RV end-diastolic volume indexed to body surface area (EDVi) and LV EF (r=-0.56). Although there was a trend toward increased RV EDVi in patients with ToF (119ml/m2 versus 101ml/m2 for TGA p=0.11), ToF patients had a weaker correlation between RV and LV EF (r=0.46; p=0.02 compared to TGA) and a very weak correlation between RV EDVi and LV EF (r=-0.21). Conclusions: The present data indicate that in the chronic setting, RV pressure rather than volume overload is of greater importance in producing LV dysfunction, implicating shared muscle fibers, neurohumoral milieu, or relative unloading of the LV as playing a greater role in this process.
Abstract 18767: Preoperative Echocardiographic Predictors of Left Ventricular Remodeling After Surgical Correction of Mitral Regurgitation Caused by Leaflet Prolapse
Authors: Jimmy MacHaalany, Julie Parenteau, Isaïe-Nicolas Dubois-Sénéchal, Mathieu Bernier, Olivier Costerousse, Olivier F Bertrand, Kim O'Connor, Michelle Dubois, Pierre Voisine, Mario Sénéchal
Journal: Circulation (2012)

Background: This study sought to determine whether preoperative echocardiography analysis before mitral valve surgery is predictive of postoperative left ventricular dysfunction in patients undergoing valve surgery for severe mitral regurgitation caused by leaflet prolapse. Methods: In 72 consecutive patients without coronary artery disease undergoing valve repair (n=29, 40%) or replacement (n=43, 60%), preoperative, early postoperative (1-2 days) and late postoperative (4.5 ± 2.5 months and 18 ± 8.0 months) echocardiographic parameters, including left ventricular (LV) dimensions, volumes and ejection fractions (EF) were measured. Patients were stratified and analysed in 3 different groups according to their respective baseline LVEF (group 1: EF ≥ 60, group 2: EF = 45-59%, group 3: EF &lt; 45%). Results: Over a mean follow-up period of 546 ± 244 days, our cohort’s echocardiographic parameters showed the following reductions from baseline: LVEF: 56% ± 8 to 53% ± 9 (p&lt;0.0001), LV end-diastolic dimension: 58.0mm ± 8.0 to 47.0mm ± 5.0 (p&lt;0.0001) and LV end-systolic dimension: 41.0mm ± 8.0 to 33.0mm ± 6.0 (p&lt;0.0001) respectively. Subgroup analysis revealed that only those with LVEF ≥ 60% recovered to a completely normal EF. Additionally, two-third of the observed changes in LV diameters and volumes occurred in the first 6 months. No difference in remodelling parameters was seen during the follow-up period between patients who underwent mitral valve replacement versus mitral valve repair. Finally, multivariate analysis demonstrated that pre-operative LVEF is an independent predictor of a poor post-operative LVEF (OR = 1.504 [1.249 - 1.966; p&lt;0.0001]). Conclusions: In patients with pure severe mitral regurgitation due to leaflet prolapse, significant positive LV remodelling can be expected irrespective of patient’s baseline EF. Remodelling is more important in the first 6 months after surgery but is usually progressive and occurs over a long follow-up period (≥ 12 months); however, only those with baseline EF ≥ 60% will usually recover to a normal EF. This reinforces our understanding that contemplation of early surgical intervention for severe mitral regurgitation secondary to leaflet prolapse will most likely yield a favourable effect on LV remodelling.
Abstract 18775: Low Levels of Omega-3s In Hispanics Due to Genetic and Dietary Factors Can be Significantly Improved with a Highly Bioavailable Omega-3 Free-fatty Acid Formulation
Authors: Michael Davidson, Robert Superko, John Sninsky, David Ross, Sandra Ferber, Judith Johnson, Douglas Kling
Journal: Circulation (2012)

Background: Hispanic Americans have low fish consumption compared to non-Hispanics. In addition to dietary intake, LC-PUFA plasma levels are affected by FADS1 gene polymorphisms. FADS1 genes code for desaturases that convert MC-PUFAs (linoleic, alpha-linoleic acid) to LC-PUFAs (arachidonic acid (AA), eicosapentaenoic acid (EPA)). The single nucleotide polymorphism (SNP), rs174546 in the FADS1 gene has previously been shown to be associated with variations in plasma EPA and AA and triglycerides levels . The present study evaluated the prevalence of the rs174546 SNP genotypes (CC, CT, TT) and corresponding plasma EPA, DHA and AA levels after treatment with an omega-3 free-fatty acid (FFA) formulation in a population of healthy Hispanic volunteers. Methods: Forty six Hispanic participants in a statin pharmacokinetic study received 40 mg of simvastatin with and without a 4g daily dose of omega-3 FFA (primarily EPA and DHA ) for two weeks in a cross over study. Plasma samples were collected prior to and at the end-of-treatment in the omega-3 FFA arm for analysis of EPA, DHA, and AA. Results: Prior to treatment the Hispanic population had a higher prevalence of TT homozygotes (41%) compared to CC homozygotes (24%) corresponding to significantly different levels of EPA (CC=18 ug/mL; CT=11 ug/mL; TT=7 ug/mL, p &lt;0.0001) and AA (CC=266 ug/mL; CT=202 ug/mL; TT=167 ug/mL, p &lt;0.0001) across genotypes. In response to Omega-3 FFA therapy a substantial increase in EPA was observed, with the largest percent increase in the TT genotype (TT:1054%, CT:573%, CC:253%, p&lt;0.0001). Baseline plasma DHA levels were low suggesting comparable dietary fish intake and changes were similar across genotypes (CC:39%, CT:55%, TT:67%, p=0.2134). Conclusion: In contrast to other ethnicities, the T allele in FADS1 polymorphism, rs174546 is the major allele in Hispanics and the TT genotype is associated with low levels of EPA. This difference in LC-PUFA levels can be exacerbated with low dietary omega-3 intake and may explain the high prevalence of hypertriglyceridemia in Hispanics. Our data suggests that treatment with a highly bioavailable omega-3 FFA may result in significant improvement in omega-3 levels in the Hispanic population.
Abstract 64: Ability of Bystanders to Appropriately Provide Rescue Breathing in the Setting of a Chest Compression--Only CPR Campaign for Sudden Cardiac Arrest
Authors: Ashish R Panchal, Tyler F Vadeboncoeur, Uwe Stolz, Daniel W Spaite, Robert A Berg, Arthur B Sanders, Karl B Kern, Alyson Welch, Bentley J Bobrow, Gordon A Ewy
Journal: Circulation (2011)

BACKGROUND: For sudden collapse from out-of-hospital cardiac arrest (OHCA) in adults, bystander chest compression-only CPR (COCPR) results in equivalent or better survival compared with conventional CPR with rescue breathing. However, patients who arrest from a non-cardiac cause may also receive COCPR even though rescue breathing might benefit them. We sought to determine whether lay rescuers appropriately provided COCPR or conventional CPR depending on the suspected etiology of OHCA. METHODS: Analysis of a statewide, Utstein-style registry of adult OHCA during a large-scale campaign endorsing COCPR for adults who suddenly collapse. The relationship between bystander CPR (both COCPR and conventional CPR), presumed arrest etiology, and survival to hospital discharge were evaluated. Means and 95% confidence intervals (CI) were calculated. FINDINGS: A total of 7,652 adult OHCAs not witnessed by EMS were analyzed from 10/04 to 09/10. After exclusion of non-lay bystanders and arrests in medical facilities, presumed cardiac etiology and non-cardiac etiology OHCA totaled 4,913 and 1,202, respectively. The presumed specific non-cardiac etiologies were non-cardiopulmonary (e.g. overdose, suicide, subarachnoid hemorrhage) (57%), trauma (27%), and respiratory (16%). All-rhythm survival was 7.0% (CI: 6.3 - 7.8) for cardiac etiologies and 3.3% (CI: 2.3 - 4.3) for non-cardiac (p&lt;0.001). Bystander CPR was provided for 33% (CI: 31.4 - 34.1) of victims with presumed cardiac causes versus 28% (CI: 25.6 - 30.7) for non-cardiac causes (p=0.002). Presumed respiratory causes of OHCA had a much lower proportion of COCPR (8.3%, CI: 4.4 - 12.2) than cardiac causes (18.0%, CI: 16.9 - 19.1, p&lt;0.001). Survival for non-cardiac cases was: 4.4% (CI 0.9 - 7.8) for conventional CPR, 3.5% (CI: 0.9 - 6.0) for COCPR, and 3.1% (CI: 2.0 - 4.3) for no CPR (p = 0.66). CONCLUSIONS: In the setting of a large-scale, statewide public health campaign endorsing lay rescuer COCPR for adults who suddenly collapse and are not breathing normally, bystanders were much less likely to perform COCPR on OHCA victims who might benefit from rescue breathing. Furthermore, when COCPR was performed on presumed non-cardiac cause arrest victims, there was no demonstrable negative impact on survival.
Abstract 18745: Triglyceride-Rich High-Density Lipoprotein Composition as Residual Risk Biomarker of Coronary Artery Disease Including Reduced eGFR and Pre-diabetes
Authors: Atsushi Nohara, Akihiro Inazu, Tohru Noguchi, Takeshi Inoue, Mika Mori, Chiaki Nakanishi, Masakazu Kawashiri, Kunimasa Yagi, Junji Kobayashi, Masakazu Yamagishi, Hiroshi Mabuchi
Journal: Circulation (2012)

Beyond LDL, HDL is the urgent target for atherosclerosis; few data exist regarding how compositional changes in HDL can affect coronary artery disease in which the anti-atherogenic quality of HDL is not simply defined by the plasma HDL-C level. Therefore, we determine the roles of HDL composition, closely related with VLDL metabolism, in angiographically evaluated coronary artery disease. Methods: A total of 365 patients (202 males, mean age of 58±13) suspected coronary artery disease were enrolled, and coronary stenosis index (CSI) was estimated with angiography in 210 patients (134 males, mean age of 61 ± 11). Fasting lipid profiles without lipid drugs at least 4 weeks were analyzed by ultracentrifugation, and free cholesterol, cholesterol ester, triglycerides (TG) and phospholipids (PL) levels in each fraction were determined. Pre-diabetes was defined as fasting glucose 110-125 mg/dL or impaired glucose tolerance with 75gOGTT. Results: Mean CSI was 10.8 and median was 8.0. CSI showed weak positive association with plasma TG ( p &lt;0.05, R 2 2%), and negative association with HDL-C ( p &lt;0.01, R 2 5%). In HDL composition, HDL-TG/PL ratio showed strong positive association with CSI ( p &lt;0.0001, R 2 8%) and number of coronary vessel with significant (&gt;75%) stenosis (p&lt;0.0005, R 2 6%). HDL-TG itself was weakly associated with CSI ( p &lt;0.05, R 2 2%). HDL-TG/PL was positively associated with CETP mass ( p &lt;0.01, R 2 5%). HDL-TG/PL showed no gender difference. CSI did not show significant association with LDL-C in this study; presumably most of patients with high LDL-C levels had been treated with statins already. CSI showed strong negative associattion with eGFR ( p &lt;0.0005, R 2 9%). eGFR showed weak negative association with HDL-C, but positive association with HDL-TG/PL (both p &lt;0.05). Pre-diabetes patients showed higher CSI than normal group (14.7±13 vs. 8.9±9, p &lt;0.005), and also higher HDL-TG/PL ( p &lt;0.05). Conclusion: We propose HDL-TG/PL as residual risk biomarker also reflecting chronic kidney disease and pre-diabetes beyond LDL-C.
Abstract 18697: C-Reactive Protein Performance as a First-Line Biomarker for Cardiovascular Risk Assessment Among Healthy Women
Authors: Antonio G Laurinavicius, Fernando C Nary, Raquel ConceiÇão, Jose A Carvalho, Raul Santos
Journal: Circulation (2012)

Background: Over 20% of coronary events in women occur in the absence of traditional cardiovascular risk factors. Framingham Risk Score (FRS) limitations in assessing cardiovascular risk in this group are well known. C-Reactive Protein (hs-CRP) has been shown to correctly reclassify cardiovascular risk among women, more specifically among those ones initially categorized as at intermediate risk by FRS. However, evidence supporting hs-CRP use as a first-line test in clinical practice is lacking. We assessed hs-CRP performance in cardiovascular risk re-classification among healthy women routinely attended at a preventive medicine unit. Methods: We evaluated 1.455 consecutive asymptomatic non-diabetic women (mean age: 42 ± 7.9 years) submitted to a routine health evaluation. As part of the evaluation, FRS, hs-CRP levels and Reynolds Score were assessed.Two different models were set to re-classify cardiovascular risk initially estimated by FRS: the first one (Model A) established hs-CRP levels &gt;3&lt;10mg/dL as a cut-off to switch women from FRS “intermediate risk” to the “high risk” category; the second one (Model B) re-stratified cardiovascular risk using Reynolds Score. We studied the performance of both models in cardiovascular risk re-classification. Results: Cardiovascular risk estimated by FRS was low in 98.6% (N=1,435) of the study population; intermediate in 1.1% (N=16); and high in 0.3% (N=4). Hs-CRP &gt;3&lt;10 mg/dL was found in 197 women (13.5%). Among those with high hs-CRP levels, 196 (99,5%) presented low FRS and 1 (0,5%) intermediate FRS. Model A led to risk re-classification of one woman in 1,455 (0.07%). Reynolds score was highly concordant with FRS (p&lt;0.001), so that Model B did not significantly improve hs-CRP performance. Conclusion: Routine measurement of hs-CRP levels has minimal impact on cardiovascular risk re-classification of healthy women in clinical practice, due to the very low average cardiovascular risk of such population. Check-up protocols should not measure hs-CRP routinely in women and leave this determination as a second-line test for cardiovascular risk assessment in specific groups of individuals.