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1. Direct Fabrication of Electronic Circuits on Wooden Surfaces

Author

Florian Egger, David Schiller, Thomas Stockinger, Claudia Pretschuh, Uwe Müller, and Martin Kaltenbrunner

Subjects
electronics, physical vapor deposition, screen‐printing, surface functionalization, wood, Technology (General), T1-995, Science
Abstract

Abstract Equipping otherwise passive surfaces with electronic functionality enables advanced interactive robotics, consumer products, sensor skins, and structural health monitoring. Concurrently, the rapidly growing number of electronic devices fuels the search for sustainable materials and processes that aid in reducing electronic waste. Wood is CO2‐neutral, omnipresent in the construction industry, in furniture, musical instruments, or packaging, yet so far, its potential for direct integration with electronics remains largely unexplored. Complications arise as traditional methods of equipping wood with electronics often compromise structural integrity and thus limit applications requiring load‐bearing capabilities. Here, seamless fabrication methods that allow the direct enhancement of wooden surfaces with electrically conducting structures, sensors, and microelectronic components based on screen printing of conducting inks or physical vapor deposition of thin metal films in conjunction with laser engraving are presented. Such electronic circuits imperceptibly operate on the surface of structural elements or as parts of decorative wooden furniture. These types of electronic wooden surfaces enable touch‐sensing applications, monitoring temperature, or the curing of varnishes without compromising functionality and mechanical stability. This multidisciplinary approach opens up new avenues for the development of smart wooden structures with embedded electronics, revolutionizing the way it is monitored, controlled, and interacted with wood‐based constructions.

Published
2024
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2. Cardiovascular risk of veterans' football: An observational cohort study with follow-up.

Author

Florian Egger, Tilman Schilling, Sybille Baumann, Tim Meyer, and Jürgen Scharhag

Subjects
Medicine, Science
Abstract

BackgroundThe cardiac stress for veteran football players during match is considerable. In this specific elderly population, the kinetics of exercise-induced cardiac troponin I (cTnI) and B-Type natriuretic peptide (BNP) could potentially be related to cardiovascular risk factors (CVRF) and cardiovascular disease and are therefore be investigated for their usefulness as an complement to established screening measures.MethodscTnI and BNP was measured in 112 veteran football players (age: 51 ± 10 years) within 30 minutes pre- and post-match. Players with elevated cTnI (cTnI-positive) and a control group (out of the 112 veteran players) with normal cTnI (cTnI-negative) underwent cardiac follow-up 4.2 ± 3.5 months post-match, comprising history, resting and stress ECG (including 30 minutes pre- and post cTnI and BNP), and echocardiography.ResultsIn 33 players (29%) cTnI and in 6 players BNP (5%) exceeded the upper range limit for increased risk of myocardial damage (cTnI ≥ 5 ng/l) and myocardial wall stress (BNP ≥ 100 pg/ml) post-match, respectively. No correlation was observed between Δ cTnI (pre- vs. post-match) and the number of CVRF (r = -0.06, p = 0.50). Follow-up was conducted in 62 players (31 cTnI-positive and 31 cTnI-negative players) of which 6 (10%, 3 cTnI positive and 3 cTnI negative players) had cardiac abnormalities (hypertrophic cardiomyopathy n = 2, coronary artery disease n = 2, coronary artery anomaly n = 1, hypertensive heart disease n = 1).ConclusionVeterans' football matches elicit increases in BNP and particularly cTnI in a considerable number of players. However, these biochemical alterations do not indicate acute cardiac damage as evidenced by follow-up. Routine determination of cardiac biomarkers is unlikely to improve cardiovascular screening in veteran football players.

Published
2024
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3. A video-based analysis of situations bearing the risk of respiratory disease transmission during football matches

Author

Oliver Faude, Simon Müller, Sebastian Schreiber, Jonas Müller, Lukas Nebiker, Florian Beaudouin, Tim Meyer, and Florian Egger

Subjects
Medicine, Science
Abstract

Abstract We aimed to analyze the number and type of contacts involving the risk of respiratory disease transmission during football match play. We analysed 50 matches from different playing levels. Two reviewers evaluated the contacts of all players in each match. We focused on between-player contacts, crowding, actions with potentially increased aerosol and droplet production and within-player hand-to-head contacts. We categorized the duels with direct contact into frontal and other ones and measured contact duration. The number of between-player contacts were similar between playing levels (median 28.3 [IQR 22.6, 33] contacts per player-hour). Frontal contacts summed up to 8% of all contacts. Contacts involving the head occurred less than once per player and match with none lasting longer than 3 s. Crowding included between two and six players and the duration was mostly less than 10 s. Aerosol and droplet producing activities were three to four times more frequent in adult compared to youth players. Our results suggest that the risk of respiratory pathogen transmission is low during football matches. This conclusion is based on the finding that most close contact situations are of short duration and on the fact that it is an outdoor sport.

Published
2022
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4. Dwarfs on the Shoulders of Giants: Bayesian Analysis With Informative Priors in Elite Sports Research and Decision Making

Author

Anne Hecksteden, Sabrina Forster, Florian Egger, Felix Buder, Ralf Kellner, and Tim Meyer

Subjects
Bayesian statistics, individual response, cold-water immersion, methodology, replicate crossover, Sports, GV557-1198.995
Abstract

While sample sizes in elite sports are necessarily small, so are the effects that may be relevant. This conundrum is complicated by an understandable reluctance of athletes to comply with extensive study requirements. In Bayesian analyses, pre-existing knowledge (e.g., from sub-elite trials) can be formally included to supplement scarce data. Moreover, some design specifics for small sample research extend to the extreme case of a single subject. This provides the basis for actionable feedback (e.g., about individual responses) thereby incentivising participation. As a proof-of-concept, we conducted a replicated cross-over trial on the effect of cold-water immersion (CWI) on sprint performance recovery in soccer players. Times for 30 m linear sprint and the initial 5 m section, respectively, were measured by light gates before and 24 h after induction of fatigue. Data were analysed by Bayesian and by standard frequentist methods. Informative priors are based on a published metaanalysis. Seven players completed the trial. Sprint performance was 4.156 ± 0.193 s for 30 m linear sprint and 0.978 ± 0.064 s for the initial 5 m section. CWI improved recovery of sprint time for the initial 5 m section (difference to control: −0.060 ± 0.060 s, p = 0.004) but not for the full 30 m sprint (0.002 ± 0.115 s, p = 0.959), with general agreement between Bayesian and frequentist interval estimates. On the individual level, relevant differences between analytical approaches were present for most players. Changes in the two performance measures are correlated (p = 0.009) with a fairly good reproducibility of individual response patterns. Bayesian analyses with informative priors may be a practicable and meaningful option particularly for very small samples and when the analytical aim is decision making (use / don't use in the specific setting) rather than generalizable inference.

Published
2022
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5. COVID-19 in German Competitive Sports: Protocol for a Prospective Multicenter Cohort Study (CoSmo-S)

Author

Andreas Michael Niess, Manuel Widmann, Roman Gaidai, Christian Gölz, Isabel Schubert, Katty Castillo, Jan Philipp Sachs, Daniel Bizjak, Shirin Vollrath, Fritz Wimbauer, Azin Vogel, Karsten Keller, Christof Burgstahler, Anne Quermann, Arno Kerling, Gerald Schneider, Jonas Zacher, Katharina Diebold, Maximilian Grummt, Claudia Beckendorf, Johannes Buitenhuis, Florian Egger, Andreas Venhorst, Oliver Morath, Friedrich Barsch, Klaus-Peter Mellwig, Julian Oesterschlink, Jan Wüstenfeld, Hans-Georg Predel, Peter Deibert, Birgit Friedmann-Bette, Frank Mayer, Anja Hirschmüller, Martin Halle, Jürgen Michael Steinacker, Bernd Wolfarth, Tim Meyer, Erwin Böttinger, Marion Flechtner-Mors, Wilhelm Bloch, Bernhard Haller, Kai Roecker, and Claus Reinsberger

Subjects
COVID-19, exercise, SARS-CoV-2, athletes, return to sport, myocarditis, Public aspects of medicine, RA1-1270
Abstract

Objective: It is unclear whether and to what extent COVID-19 infection poses health risks and a chronic impairment of performance in athletes. Identification of individual health risk is an important decision-making basis for managing the pandemic risk of infection with SARS-CoV-2 in sports and return to play (RTP).Methods: This study aims 1) to analyze the longitudinal rate of seroprevalence of SARS-CoV-2 in German athletes, 2) to assess health-related consequences in athletes infected with SARS-CoV-2, and 3) to reveal effects of the COVID-19 pandemic in general and of a cleared SARS-CoV-2 infection on exercise performance. CoSmo-S is a prospective observational multicenter study establishing two cohorts: 1) athletes diagnosed positive for COVID-19 (cohort 1) and 2) federal squad athletes who perform their annual sports medical preparticipation screening (cohort 2). Comprehensive diagnostics including physical examination, laboratory blood analyses and blood biobanking, resting and exercise electrocardiogram (ECG), echocardiography, spirometry and exercise testing added by questionnaires are conducted at baseline and follow-up.Results and Conclusion: We expect that the results obtained, will allow us to formulate recommendations regarding RTP on a more evidence-based level.

Published
2022
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6. Twenty-four-hour time dependency of clopidogrel effects in patients with acute coronary syndromes: The CiCAD-Study

Author

Susanne Claudia Gruber, Matthias Karl Freynhofer, Martin Willheim, Thomas Werner Weiss, Florian Egger, Wolfgang Hübl, and Kurt Huber

Subjects
circadian variability, clopidogrel, diurnal variability, platelet function testing, platelet turnover, reticulated platelets, Diseases of the blood and blood-forming organs, RC633-647.5
Abstract

Long-term evidence shows an increased risk of cardiovascular events in the morning hours and recent studies in aspirin-treated patients have shown increased platelet reactivity at the end of the dosing interval. Similar pharmacodynamic analyses of adenosine-diphosphate (ADP) receptor inhibitors are scarce. We therefore investigated changes in clopidogrel-dependent platelet function and activation over 24 h and whether enhanced platelet turnover might explain diurnal variability of platelet function and activation. Twenty-one patients after acute coronary syndromes (ACS) on maintenance doses of clopidogrel (75 mg) and aspirin (100 mg) Once per day (OD) were included. Blood was collected at five time points in 24 h. Platelet function and activation was analyzed by vasodilator-stimulated phosphoprotein-phosphorylation (VASP-P), Verify Now, multiple electrode aggregometry (MEA), and platelet PAC-1 and P-selectin (P-sel) expression. Additionally, platelet count, mean platelet volume (MPV), and reticulated platelet fraction (RPF) were analyzed. There was significant diurnal variability of clopidogrel effects as documented with VASP-P, Verify Now, and PAC-1 and P-sel (all p

Published
2019
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7. Contemporary use of P2Y12-inhibitors in patients with acute coronary syndrome undergoing percutaneous coronary intervention in Austria: A prospective, multi-centre registry.

Author

Maximilian Tscharre, Florian Egger, Matthias Machata, Miklos Rohla, Nadia Michael, Manuel Neumayr, Robert Zweiker, Johannes Hajos, Christopher Adlbrecht, Markus Suppan, Wolfgang Helmreich, Bernd Eber, Kurt Huber, and Thomas W Weiss

Subjects
Medicine, Science
Abstract

BACKGROUND:To this day, there is no data concerning guideline adherence on P2Y12-inhibitors in Austria. Prasugrel and ticagrelor have been shown to be superior to clopidogrel in the treatment of acute coronary syndromes (ACS). However, recent data from European registries showed a reluctant prescription policy with rates of clopidogrel at discharge ranging from 35 to 55%. METHODS:In this prospective, multi-centre registry we assessed prescription rates of P2Y12-inhibitors in patients with ACS in four Austrian PCI centres. Parameters associated with the use of clopidogrel have been evaluated in multivariate logistic regression. RESULTS:Between January and June 2015, 808 patients with ACS undergoing PCI were considered for further analysis. 416 (51.5%) presented with STEMI and 392 (48.5%) with NSTE-ACS. Mean age was 65.7 ± 12.4 and 240 (30.9%) were female. Twenty-eight (3.5%) died during the hospital stay. At discharge, 212 (27.2% of all patients) received clopidogrel, 260 (32.2%) prasugrel and 297 (36.8%) ticagrelor, while 11 (1.4%) did not receive any P2Y12-inhibitor. Of those patients, who were discharged with clopidogrel, 117 (55.2%) had no absolute contraindication against a more potent P2Y12-inhibitor. Diagnosis of NSTE-ACS (p

Published
2017
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8. Interindividual Variation in the Relationship of Different Intensity Markers-A Challenge for Targeted Training Prescriptions.

Author

Florian Egger, Tim Meyer, and Anne Hecksteden

Subjects
Medicine, Science
Abstract

Training intensities are frequently prescribed as relative workloads based on a single reference value (e.g. maximum oxygen uptake). However, exercise-induced physical strain is multifaceted and large interindividual variability in intensity markers has been reported for constant load exercise with standardized relative intensity. This questions the accuracy of (univariate) relative intensities in targeting specific training stimuli. The present trial aims to investigate interindividual variability in the relationship of strain indicators using interpolated performance curves derived from constant load tests at different workloads. This approach enables the prediction of other indicators based on a chosen reference and subsequent comparison of predictive accuracy between group-based and individualized regression models.15 competitive cyclists completed a stepwise incremental cycling test followed by 5 constant load tests with the same absolute workloads as in the stepwise incremental test. The highest of theses workloads which yielded a lactate (BLa) steady state was repeated enabling estimation of intraindividual variability. From constant load tests, the courses of BLa relative to the respective reference value (e.g. %VO2peak) were interpolated by polynomial regression. Variability between individual regression curves was analyzed by mixed modeling. Predictive accuracy was estimated as the sum of squared differences between predicted and observed values.The proportion of total variation in the course of BLa relative to the respective reference parameter accounted for by subject identity ranged between 36 and 51%. A significant increase in predictive accuracy was observed for VO2peak and HRmax, respectively, as predicting parameters.These results are in support of a multivariable, individualized approach to intensity prescriptions when aiming at accurately targeted perturbations of homeostasis.

Published
2016
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9. Effects of Sodium Bicarbonate on High-Intensity Endurance Performance in Cyclists: A Double-Blind, Randomized Cross-Over Trial.

Author

Florian Egger, Tim Meyer, Ulf Such, and Anne Hecksteden

Subjects
Medicine, Science
Abstract

BackgroundWhile the ergogenic effect of sodium bicarbonate (BICA) on short-term, sprint-type performance has been repeatedly demonstrated, little is known about its effectiveness during prolonged high-intensity exercise in well-trained athletes. Therefore, this study aims to examine the influence of BICA on performance during exhaustive, high-intensity endurance cycling.MethodsThis was a single-center, double-blind, randomized, placebo-controlled cross-over study. Twenty-one well-trained cyclists (mean ± SD: age 24±8 y, BMI 21.3±1.7, VO2peak 67.3±9.8 ml·kg-1·min-1) were randomly allocated to sequences of following interventions: oral ingestion of 0.3 g·kg-1 BICA or 4 g of sodium chloride (placebo), respectively. One h after ingestion subjects exercised for 30 min at 95% of the individual anaerobic threshold (IAT) followed by 110% IAT until exhaustion. Prior to these constant load tests stepwise incremental exercise tests were conducted under both conditions to determine IAT and VO2peak. Analysis of blood gas parameters, blood lactate (BLa) and gas exchange measurements were conducted before, during and after the tests. The main outcome measure was the time to exhaustion in the constant load test.ResultsCycling time to exhaustion was improved (pConclusionThe results suggest that ingestion of BICA may improve prolonged, high-intensity cycling performance.Trial registrationGerman Clinical Trials Register (DRKS) DRKS00006198.

Published
2014
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10. Risk of SARS-CoV-2 transmission from on-field player contacts in amateur, youth and professional football (soccer)

Author

Tim Meyer, Barbara Gärtner, Oliver Faude, Florian Egger, and Sebastian Schreiber

Subjects
football, medicine.medical_specialty, Adolescent, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Physical Therapy, Sports Therapy and Rehabilitation, Football, preventive medicine, law.invention, law, medicine, Humans, Orthopedics and Sports Medicine, Symptom onset, Original Research, Preventive healthcare, Football players, SARS-CoV-2, COVID-19, General Medicine, soccer, infection, Transmission (mechanics), Athletes, Family medicine, Football soccer, Psychology, human activities, Amateur
Abstract

ObjectiveTo investigate the risk of transmission among potentially infectious SARS-CoV-2-positive football players while participating in training or matches at amateur, youth and professional levels.MethodsBetween August 2020 and March 2021, football players who tested positive for SARS-CoV-2 and participated in matches or training during the period of potential contagiousness were identified through media search (professional level) and a nationwide registry in Germany (amateur and youth level) to determine symptoms, source of infection and hygiene measures adopted. The definition of potentially infectious players was based on the time of a positive PCR testing and symptom onset. Transmission-relevant contacts on the pitch were evaluated through doubly reviewed video analysis.ResultsOut of 1247 identified football matches and training sessions (1071 amateur and youth level, 176 professional level), 104 cases (38 training sessions, 66 matches) with 165 potentially infectious players were detected. Follow-up PCR testing at the professional level (44 cases) revealed no transmission. At the amateur and youth level, the combination of partial PCR testing (31 of 60 cases) and symptom monitoring within 14 days post-exposure (46 of 60 cases) identified 2 of 60 matches in which follow-up infections occurred that were attributed to non-football activities. This is consistent with the video analysis of 21 matches demonstrating frontal contacts were ConclusionOn-field transmission risk of SARS-CoV-2 in football is very low. Sources of infections in football players are most likely not related to activities on the pitch.

Published
2021

11. Initial Invasive or Conservative Strategy for Stable Coronary Disease

Author

Maron D. J., Hochman J. S., Reynolds H. R., Bangalore S., O'Brien S. M., Boden W. E., Chaitman B. R., Senior R., Lopez-Sendon J., Alexander K. P., Lopes R. D., Shaw L. J., Berger J. S., Newman J. D., Sidhu M. S., Goodman S. G., Ruzyllo W., Gosselin G., Maggioni A. P., White H. D., Bhargava B., Min J. K., John Mancini G. B., Berman D. S., Picard M. H., Kwong R. Y., Ali Z. A., Mark D. B., Spertus J. A., Krishnan M. N., Elghamaz A., Moorthy N., Hueb W. A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T. D., Szwed H., Doerr R., Keltai M., Selvanayagam J. B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N. O., Harrell F. E., Rockhold F. W., Broderick S., Bruce Ferguson T., Williams D. O., Harrington R. A., Stone G. W., Rosenberg Y, ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, Aira Contreras, Ajit Kumar, V K Kumar, Akemi Furukawa, Akshay Bagai, Akvile Smigelskaite, Alain Furber, Alain Rheault, Alaine Melanie Loehr, Alan Rosen, Albert Varga, Albertina Qelaj, Alberto Barioli, Aldo Russo, Alec Moorman, Alejandro Gisbert, Aleksandra Fratczak, Aleksandras Laucevicius, Alena Kuleshova, Alessandro Sionis, Alexander A Sirker, Alexander M Chernyavskiy, Alexandra Craft, Alexandra Vazquez, Alexandre Ciappina Hueb, Alexandre S Colafranseschi, Alexandre Schaan de Quadros, Alexandre Tognon, Ali Alghamdi, Alice Manica Muller, Aline Nogueira Rabaça, Aline Peixoto Deiro, Alison Hallam, Allegra Stone, Allison Schley, Almudena Castro, Alvaro Rabelo Ales, Amanda Germann, Amanda O'Malley, Amar Uxa, Amarachi Ojajuni, Amarino C Oliveira Jr, Amber B Hull, Ambuj Roy, Amer Zarka, Amir Janmohamed, Ammani Brown, Ammy Malinay, Amparo Martinez Monzonis, Amy J Richards, Amy Iskandrian, Amy Ollinger, Ana D Djordjevic-Dikic, Ana Fernández Martínez, Ana Gomes Almeida, Ana Paula Batista, Ana Rita Francisco, Ana S Mladenovic, Ana Santana, Anam Siddiqui, Anastasia M Kuzmina-Krutetskaya, Andras Vertes, Andre S Sousa, Andre Gabriel, André Schmidt, Andrea M Lundeen, Andrea Bartykowszki, Andrea Lorimer, Andrea Mortara, Andrea Pascual, Andreia Coelho, Andreia Rocha, Andrés García-Rincón, Andrew G Howarth, Andrew J Moriarty, Andrew Docherty, Andrew Starovoytov, Andrew Zurick, Andrzej Łabyk, Andrzej Swiatkowski, Andy Lam, Anelise Kawakami, Angela Hoye, Angela Kim, Angelique Smit, Angelo Nobre, Anil V Shah, Anja Ljubez, Anjali Anand, Ankush Sachdeva, Ann Greenberg, Ann Luyten, Ann Ostrander, Anna Di Donato, Anna Cichocka-Radwan, Anna Fojt, Anna Plachcinska, Anna Proietti, Anna Teresinska, Anne Marie Webb, Anne Cartwright, Anne Heath, Anne Mackin, Anong Amaritakomol, Anong Chaiyasri, Anoop Chauhan, Anoop Mathew, Anthony Gemignani, Anto Luigi Andres, Antonia Vega, Antonietta Hansen, Antonino Ginel Iglesias, Antonio Carlos Carvalho, Antonio Di Chiara, Antonio Serra Peñaranda, Antonio Carvalho, Antonio Colombo, Antonio Fiarresga, Anupama Rao, Aquiles Valdespino-Estrada, Araceli Boan, Areef Ishani, Ariel Diaz, Arijit Ghosh, Arintaya Prommintikul, Arline Roberts, Arnold H Seto, Arnold P Good, Arshed Quyyumi, Arthur J Labovitz, Arthur Kerner, Arturo S Campos-Santaolalla, Arunima Misra, Ashok Mukherjee, Ashok Seth, Ashraf Seedhom, Asim N Cheema, Asker Ahmed, Atul Mathur, Atul Verma, Audrey W Leong, Axel Åkerblom, Axelle Fuentes, Aynun Naher, Badhma Valaiyapathi, Baljeet Kaur, Bandula Guruge, Barbara Brzezińska, Barbara Nardi, Bartosz Czarniak, Bebek Singh, Begoña Igual, Bela Merkely, Belen Cid Alvarez, Benjamin J Spooner, Benjamin J W Chow, Benjamin Cheong, Benoy N Shah, Bernard de Bruyne, Bernardas Valecka, Bernhard Jäger, Beth A Archer, Beth Abramson, Beth Jorgenson, Bethany Harvey, Betsy O'Neal, Bev Atkinson, Bev Bozek, Bevin Lang, Bijulal Sasidharan, Bin Yang, Bin Zhang, Binoy Mannekkattukudy Kurian, Bjoern Goebel, Bob Hu, Bogdan A Popescu, Bogdan Crnokrak, Bolin Zhu, Bonnie J Kirby, Brandi D Zimbelman, Brandy Starks, Branko D Beleslin, Brenda Hart, Brian P Shapiro, Brian McCandless, Brianna Wisniewski, Brigham R Smith, Brooks Mirrer, Bruce McManus, Bruce Rutkin, Bruna Edilena Paulino, Bruna Maria Ascoli, Bryn Smith, Byron J Allen, C Michael Gibson, C Noel Bairey Merz, Calin Pop, Cameron Hague, Camila Thais de Ormundo, Candace Gopaul, Candice P Edillo, Carísi A Polanczyk, Carita Krannila, Carla Vicente, Carl-Éric Gagné, Carlo Briguori, Carlos Peña Gil, Carlos Alvarez, Carly Ohmart, Carmen C Beladan, Carmen Ginghina, Carol M Kartje, Caroline Alsweiler, Caroline Brown, Caroline Callison, Caroline Pinheiro, Caroline Rodgers, Caroline Spindler, Carolyn Corbett, Carrie Drum, Casey Riedberger, Catherine Bone, Catherine Fleming, Catherine Gordon, Catherine Jahrsdorfer, Catherine Lemay, Catherine Weick, Cathrine Patten, Cecilia Goletto, Cezary Kepka, Chandini Suvarna, Chang Xu, Chantale Mercure, Charle A Viljoen, Charlene Wiyarand, Charles Jia-Yin Hou, Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar Bermudez, Eapen Punnoose, Edgar L Tay, Edgar Karanjah, Edoardo Verna, Eduardo Hernandez-Rangel, Edward D Nicol, Edward O McFalls, Edward T Martin, Edyta Kaczmarska, Ekaterina I Lubinskaya, Elena A Demchenko, Elena Refoyo Salicio, Eli Feen, Elihú Durán-Cortés, Elisabeth M Janzen, Elise L Hannemann, Elise van Dongen, Elissa Restelli Piloto, Eliza Kaplan, Elizabeta Srbinovska Kostovska, Elizabeth Capasso-Gulve, Elizabeth Congdon, Elizabeth Ferguson, Elizaveta V Zbyshevskaya, Ellen Magedanz, Ellie Fridell, Ellis W Lader, Elvin Kedhi, Emanuela Racca, Emilie Tachot, Emily DeRosa, Encarnación Alonso-Álvarez, Eric Nicollet, Eric Peterson, Erick Alexánderson Rosas, Erick Donato Morales, Erin Orvis, Ermina Moga, Estelle Montpetit, Estevao Figueiredo, Eugene Passamani, Eugenia Nikolsky, Eunice Yeoh, Evgeniy I Kretov, Ewa Szczerba, Ewelina Wojtala, Expedito Eustáquio Ribeiro Silva, F Marin Ortuño, Fabio R Farias, Fabio Fimiani, Fabrizio Rolfo, Fa-Chang Yu, Fadi Hage, Fadi Matar, Fahim Haider Jafary, Fang Feng, Fang Liu, Fatima Ranjbaran, Fatima Rodriguez, Fausto J Pinto, Fauzia Rashid, Federica Ramani, Fei Wang, Fernanda Igansi, Filipa Silva, Filippo Ottani, Fiona Haines, Firas Al Solaiman, Flávia Egydio, Flavio Lyra, Florian Egger, Fran Farquharson, Frances Laube, Francesc Carreras Costa, Francesca de Micco, Francesca Bianchini, Francesca Pezzetta, Francesca Pietrucci, Francesco Orso, Francesco Pisano, Francis Burt, Francisca Patuleia Figueiras, Francisco Fernandez-Aviles, Francois Pierre Mongeon, Frans Van de Werf, Franziska Guenther, Fraser N Witherow, Fred Mohr, Frederico Dall'Orto, Fumiyuki Otsuka, G De La Morena, G Karthikeyan, Gabor Dekany, Gabor Kerecsen, Gabriel Galeote, Gabriel Grossmann, Gabriel Vorobiof, Gabriela Sanchez de Souza, Gabriela Guzman, Gabriela Zeballos, Gabriele Gabrielli, Gabriele Jakl-Kotauschek, Gail A Shammas, Gail Brandt, Gang Chen, Gary E Lane, Gary J Luckasen, Gautam Sharma, Gelmina Mikolaitiene, Gennie Yee, Georg Nickenig, George E Revtyak, George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona Niedzwiecka, J David Knight, Jacek Kusmierek, Jackie M White, Jackie Chow, Jacob Udell, Jacqueline E Tamis-Holland, Jacqueline Fannon, Jacquelyn A Quin, Jacquelyn Do, Jaekyeong Heo, Jakub Maksym, James E Davies, James H O'Keefe Jr, James J Jang, James Cha, James Harrison, James Hirsch, James Stafford, James Tatoulis, Jamie Rankin, Jan Henzel, Jan Orga, Jana Tancredi, Janaina Oliveira, Jane Burton, Jane Eckstein, Jane Marucci, Janet P Knight, Janet Blount, Janet Halliday, Janetta Kourzenkova, Janitha Raj, Jan-Malte Sinning, Jaqueline Pozzibon, Jaroslaw Drozdz, Jaroslaw Karwowski, Jason D Glover, Jason Loh Kwok, Jason T Call, Jason Linefsky, Jassira Gomes, Jati Anumpa, Javier J Garcia, Javier Courtis, Jay Meisner, K Jayakumar, Jayne Scales, Jean E Denaro, Jean Michel Juliard, Jean Ho, Jeanette K Stansborough, Jean-Michel Juliard, Jeanne Russo, Jeannette J M Schoep, Jeet Thambyrajah, Jeff Leimberger, Jeffery A Breall, Jeffrey A Kohn, Jeffrey C Milliken, Jeffrey Anderson, Jeffrey Blume, Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima Euathrongchit, Jyotsna Garg, K Manjula Rani, K Preethi, Kaatje Goetschalckx, Kai Eggers, Kamalakar Surineni, Kanae Hirase, T R Kapilamoorthy, Karen Calfas, Karen Gratrix, Karen Hallett, Karen Hultberg, Karen Nugent, Karen Petrosyan, Karen Swan, Karolina Kryczka, Karolina Wojtczak-Soska, Karolina Wojtera, Karsten Lenk, Karthik Ramasamy, Katarzyna Łuczak, Katarzyna Malinowska, Kate Pointon, Kate Robb, Katherine Martin, Kathleen Claes, Kathryn Carruthers, Kathy E Siegel, Katia Drouin, Katie Fowler-Lehman, Kavita Rawat, Kay Rowe, Keiichi Fukuda, Keith A A Fox, Ken Mahaffey, Kendra Unterbrink, Kenneth Giedd, Kerrie Van Loo, Kerry Lee, Kerstin Bonin, Kevin R Bainey, Kevin T Harley, Kevin Anstrom, Kevin Chan, Kevin Croce, Kevin Landolfo, Kevin Marzo, Keyur Patel, Khaled Abdul-Nour, Khaled Alfakih, Khaled Dajani, Khaled Ziada, Khaula Baloch, Khrystyna Kushniriuk, Kian-Keong Poh, Kim F Ireland, Kim Holland, Kimberly Ann Byrne, Kimberly E Halverson, Kimberly Elmore, Kimberly Miller-Cox, Kiran Reddy, Kirsten J Quiles, Kirsty Abercrombie, Klaus Matschke, Konrad Szymczyk, Koo Hui Chan, Kotiboinna Preethi, Kozhaya Sokhon, Krissada Meemuk, Kristian Thygesen, Kristin M Salmi, Kristin Newby, Kristina Wippler, Kristine Arges, Kristine Teoh, Krystal Etherington, Krystyna Łoboz-Grudzień, Krzysztof W Reczuch, Krzysztof Bury, Krzysztof Drzymalski, Krzysztof Kukuła, Kuo-Tzu Sung, Kurt Huber, Ladda Douangvila, Lance Sullenberger, Larissa Miranda Trama, Laszlone Matics, Laura Drew, Laura Flint, Laura Keinaite, Laura Sarti, Laurel Kolakaluri, Lawrence M Phillips, Lawrence Friedman, Lawrence Phillips, Lazar Velicki, Leah Howell, Leandro C Maranan, Leanne Cox, Ledjalem Daba, Lei Zhang, Lekshmi Dharmarajan, Leo Bockeria, Leonardo Pizzol Caetano, Leonardo Bridi, Leonid L Bershtein, Leszek Sokalski, Li Hai Yan, Li Li, Lia Nijmeijer, Lidia Sousa, Lihong Xu, Lihua Zhang, Lili Zhang, Lilia Schiavi, Lilian Mazza Barbosa, Lillian L Khor, Lina Felix-Stern, Linda L Hall, Linda M Hollenweger, Linda Arcand, Linda Davidson-Ray, Linda Schwarz, Lindsey N Sikora, Lingping Chi, Lino Patricio, Liping Zhang, Lisa Chaytor, Lisa Hatch, Lisa McCloy, Lisa Wong, Liselotte Persson, Lixin Jiang, Liz Low, Ljiljana Pupic, Loïc Bière, Lorenzo Monti, Lori Christensen, Lori Pritchard, Loriane Black, Lori-Ann Desimone, Lori-Ann Larmand, Lorraine McGregor, Louise Morby, Louise Thomson, Luc Harvey, Luciana de Pádua Baptista, Lucilla Garcia, Ludivine Eliahou, Ludmila Helmer, Luis F Smidt, Luis Bernanrdes, Luis Guzman, Luiz A Carvalho, Luyang Xiong, Lynette L Teo, Lynn M Neeson, Lynne Winstanley, M Barbara Srichai-Parsia, M Quintana Giner, M Sowjanya Reddy, M Valdés Chávarri, M Grazia Rossi, Maarten Simoons, Maayan Konigstein, Maciej Lesiak, Maciej Olsowka, Mafalda Selas, Magalie Corfias, Magdalena Madero Rovalo, Magdalena Łanocha, Magdalena Miller, Magdalena Misztal-Teodorczyk, Magdalena Rantinella, Magdy Abdelhamid, Magnolia Jimenez, Mahboob Alam, Mahevamma Mylarappa, Mahfouz El Shahawy, Mahmoud Mohamed, Mahmud Al-Bustami, Majo X Joseph, Malgorzata Frach, Małgorzta Celińska-Spodar, Malte Helm, Manas Chacko, Mandy Murphy, Manitha Vinod, Manjula Rani, Manu Dhawan, Manuela Mombelli, Marcel Weber, Marcello Galvani, Marcelo Jamus Rodrigues, Marcia F Dubin, Marcia F Werner Bayer, Marcin Szkopiak, Marco Antonio Monsalve, Marco Bizzaro Santos, Marco Magnoni, Marco Marini, Marco Sicuro, Marco Zenati, Marcos Valério Coimbra Resende, Marek Roik, Margalit Bentzvi, Margaret Gilsenan, Margaret Iraola, Margot C 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Jr, Matthew Budoff, Matthew Jezior, Matthew Luckie, Matthias Friedrich, Mauren P Haeffner, Maximilian Tscharre, Max-Paul Winter, Mayana Almeida, Mayil S Krishnam, Mayuri Patel, Meenakshi Mishra, Megan Manocchia, Meghana Kakade, Melanie J Munro, Melissa D Chaplin, Melissa LeFevre, Mervyn Andiapen, Michael A Gibson, Michael B Rubens, Michael C Turner, Michael D Shapiro, Michael W Lee, Michael Berlowitz, Michael Davidson, Michael Mack, Michael McDaniel, Michael Mumma, Michal Wlodarczyk, Michel G Khouri, Michel S Slama, Michele Rawlins, Michelle M Bonner, Michelle M Seib, Michelle Chang, Michelle Crowder, Michelle Dixon, Michelle Mayon, Michelle McEvoy, Michelle Yee, Miguel M Fernandes, Miguel Nobre Menezes, Miguel Souto Bayarri, Miguel Barrero, Mikhail T Torosoff, Milan R Dobric, Milan Dobric, Milica Nikola Dekleva, Milind Avdhoot Gadkari, Millie Gomez, Min Tun Kyaw, Miriam Brooks, Miroslav Stevo Martinovic, Mitchel B Lustre, Mohammad Tariq Vakani, Mohammad El-Hajjar, Mohammed Al-Amoodi, Mohammed Hussain, Mohammed Saleem, Moisés Blanco-Calvo, Moisés Jiménez-Santos, Mona Bhatia, Monica Rosca, Monika Laukyte, Montserrat Gracida Blanca, Montserrat Vila Perales, Mouaz H Al-Mallah, Moysés de Oliveira Filho, Mpiko Ntsekhe, Muhamed Saric, Mulei Chen, Myriam Brousseau, Myrthes Emy Takiuti, Nada Cemerlic-Adjic, Nadia Asif, Nadia Gakou, Nafisa Hussain, Nana O Katamadze, Nancy L Clapp, Nancy Aedy, Nandita Nataraj, Nanette K Wenger, Naomi Uchida, Nasrul Ismail, Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira Mokhtar, Noppon Taksaudom, Nor Asiah Basri, Nora Marchelletta, Norma Hogg, Nungshi Jungla, Nuno Ferreira, Oksana A Lubyanaya, Olga B Nikolaeva, Olga Cañavate, Olga Sobrino, Olga Walesiak, Olga Walter, Olga Zdończyk, Olivia J Lim, Olivia Anaya, Olivia Mancilla, Olivier Dubourg, Olugbenga Bello, Omar Almousalli, Omar Thompson, Oni Olurinde, Or Harel, Osama Raheem, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, P Christian Schulze, Pachara Panpunuan, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Julian, Pamela Ouyang, Pamela Sigel, Pamela Woodard, Panpan Zhou, Paola Emanuela Poggio, Paola Smanio, Paolo Calabro, Paramjit Jeetley, Pascal Goube, Patricia K Nguyen, Patricia Alarie, Patricia Arakelian, Patricia Arsenault, Patricia Blaise, Patricia Brito, Patricia Cowper, Patricia Endsley, Patricia Mieses, Patrick B Alexander, Patrick Donnelly, Patrick Wilmot, Patrycja Lebioda, Paul C Gordon, Paul Der Mesropian, Paul Galiwango, Paul Hauptman, Paul Kennedy, Paula Beardsley, Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, 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Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, 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S.G., Ruzyllo W., Gosselin G., Maggioni A.P., White H.D., Bhargava B., Min J.K., John Mancini G.B., Berman D.S., Picard M.H., Kwong R.Y., Ali Z.A., Mark D.B., Spertus J.A., Krishnan M.N., Elghamaz A., Moorthy N., Hueb W.A., Demkow M., Mavromatis K., Bockeria O., Peteiro J., Miller T.D., Szwed H., Doerr R., Keltai M., Selvanayagam J.B., Gabriel Steg P., Held C., Kohsaka S., Mavromichalis S., Kirby R., Jeffries N.O., Harrell F.E., Rockhold F.W., Broderick S., Bruce Ferguson T., Williams D.O., Harrington R.A., Stone G.W., Rosenberg Y, and ISCHEMIA Research Group: Joseph Ricci, A Tello Montoliu, A I Robero Aniorte, Abbey Mulder, Abhay A Laddu, Abhinav Goyal, Abhishek Dubey, Abhishek Goyal, Abigail Knighton, Abraham Oomman, Adam J Jaskowiak, Adam Kolodziej, Adam Witkowski, Adnan Hameed, Adriana Anesini, Afshan Hussain, Agne Juceviciene, Agne Urboniene, Agnes Jakal, Agnieszka Szramowska, Ahmad Khairuddin, Ahmed Abdel-Latif, Ahmed Adel, Ahmed Aljzeeri, Ahmed Kamal, Ahmed Talaat, Aimee Mann, 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Charles Y Lui, Charles Cannan, Charles Cornet, Charlotte Pirro, Chataroon Rimsukcharoenchai, Chen Wang, Cheng-Ting Tsai, Chen-Yen Chien, Cheryl A Allardyce, Chester M Hedgepeth, Chetan Patel, Chiara Attanasio, Chih-Hsuan Yen, Chi-Ming Chow, Ching Min Er, Ching-Ching Ong, Cholenahally Nanjappa Manjunath, Chris Beck, Chris Buller, Christel Vassaliere, Christian Hamm, Christiano Caldeira, Christie Ballantyne, Christina Björklund, Christine R Hinton, Christine Bergeron, Christine Masson, Christine Roraff, Christine Shelley, Christophe Laure, Christophe Thuaire, Christopher Kinsey, Christopher McFarren, Christopher Spizzieri, Christopher Travill, Chun-Chieh Liu, Chung-Lieh Hung, Chunguang Li, Chun-Ho Yun, Chunli Xia, Ciarra Heard, Cidney Schultz, Clare Venn-Edmonds, Claudia P Hochberg, Claudia Wegmayr, Claudia Cortés, Claudia Escobar, Cláudia Freixo, Claudio T Mesquita, Clemens T Kadalie, Colin Berry, Constance Philander, Corine Thobois, Costantino Costantini, Courtney Page, Craig Atkinson, Craig Barr, Craig Paterson, Cristina Bare, Cynthia Baumann, Cynthia Burman, Dalisa Espinosa, Damien Collison, Dan Deleanu, Dan Elian, Dan Gao, Dana Oliver, Daniel P Vezina, Daniel O'Rourke, Daniele Komar, Danielle Schade, Darrel P Francis, Dastan Malaev, David A Bull, David E Winchester, David P Faxon, David Booth, David Cohen, David DeMets, David Foo, David Schlichting, David Taggart, David Waters, David Wohns, Davis Vo, Dawid Teodorczyk, Dawn Shelstad, Dawn Turnbull, Dayuan Li, Dean Kereiakes, Deborah O'Neill, Deborah Yip, Debra K Johnson, Debra Dees, Deepak L Bhatt, Deepika Gopal, Deepti Kumar, Deirdre Mattina, Deirdre Murphy, Delano R Small, Delsa K Rose, Dengke Jiang, Denis Carl Phaneuf, Denise Braganza, Denise Fine, Derek Cyr, Desiree Tobin, Diana Cukali, Diana Parra, Diane Camara, Diane Minshall Liu, Diego Adrián Vences, Diego Franca de Cunha, Dimitrios Stournaras, Dipti Patel, Dongze Li, Donna Exley, Dorit Grahl, Dragana Stanojevic, Duarte Cacela, Dwayne S G Conway, E Pinar 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George J Juang, Gerald Fletcher, Gerald Leonard, Gerard Patrick Devlin, Gerard Esposito, Gergely Ágoston, Gervasio Lamas, Geza Fontos, Ghada Mikhail, Gia Cobb, Gian Piero Perna, Gianpiero Leone, Giles Roditi, Gilles Barone-Rochette, Girish Mishra, Giuseppe Tarantini, Glenda Wong, Glenn S Hamroff, Glenn Rayos, Gong Cheng, Gonzalo Barge-Caballero, Goran Davidović, Goran Stankovic, Gordana Stevanovic, Grace Jingyan Wang, Grace M Young, Graceanne Wayser, Graciela Scaro, Graham S Hillis, Graham Wong, Grazyna Anna Szulczyk, Gregor Simonis, Gregory Kumkumian, Gretchen Ann Peichel, Grzegorz Gajos, Gudrun Steinmaurer, Guilherme G Rucatti, Guilherme Portugal, Guilhermina Cantinho Lopes, Guillem Pons Lladó, Gunnar Frostfelt, Gurpreet S Wander, Gurpreet Gulati, Gustavo Pucci, Hafidz Abd Hadi, Haibo Zhang, Haitao Wang, Halina Marciniak, Han Chen, Hanan Kerr, Hani Najm, Hanna Douglas, Hannah Phillips, Hao Dai, Haojian Dong, Haqeel Jamil, Harikrishnan Sivadasanpillai, Harry Suryapranata, Hassan Reda, Hayley Pomeroy, Heather Barrentine, Heather Golden, Heather Hurlburt, Heidi Wilson, Helen C Tucker, Helene Abergel, Hemalata Siddaram, Hermine Osseni, Herwig Schuchlenz, Hesong Zeng, Hicham Skali, Hilda Solomon, Hollie Horton, Holly Hetrick, Holly Little, Holly Park, Hongjie Chi, Hossam Mahrous, Howard A Levite, Hristo Pejkov, Huajun Li, Hugo Bloise-Adames, Hugo Marques, Hui Zhong, Hui-Min Zhang, Humayrah Hashim, Hung-I Yeh, Hussien El Fishawy, Ian Webb, Iftikhar Kullo, Igor O Grazhdankin, Ihab Hamzeh, Ikraam Hassan, Ikuko Ueda, Ileana L Pina, Ilona Tamasauskiene, Ilse Bouwhuis, Imran Arif, Ina Wenzelburger, Inês Zimbarra Cabrita, Ines Rodrigues, Inga H Robbins, Inga Soveri, Ingela Schnittger, Iqbal Karimullah, Ira M Dauber, Iram Rehman, Irena Peovska Mitevska, Irene Marthe Lang, Irina Subbotina, Irma Kalibataite-Rutkauskiene, Irni Yusnida, Isabel Estela Carvajal, Isabella C Palazzo, Isabelle Hogan, Isabelle Roy, Ishba Syed, Ishita Tejani, Ivan A Naryshkin, Ivana Jankovic, Iwona 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Jeffrey Kanters, Jeffrey Lorin, Jeffrey Moses, Jelena J Stepanovic, Jelena Celutkiene, Jelena Djokic, Jelena Stojkovic, Jenne M Jose, Jenne Manchery, Jennifer A Mull, Jennifer H Czerniak, Jennifer L Stanford, Jennifer Gillis, Jennifer Horst, Jennifer Isaacs, Jennifer Langdon, Jennifer Thomson, Jennifer Tomfohr, Jennifer White, Jen-Yuan Kuo, Jeremy Rautureau, Jerome Fleg, Jessica Berg, Jessica Rodriguez, Jessica Waldron, Jhina Patro, Jia Li, Jiajia Mao, Jiamin Liu, Jian'an Wang, Jianhua Li, Jianxin Zhang, Jie Qi, Jihyun Lyo, Jill Marcus, Jim Blankenship, Jing Zhang, Jingjing Liu, Jing-Yao Fan, Jiun-Yi Li, Jiwan Pradhan, Jiyan Chen, J M Rivera Caravaca, Jo Evans, Joan Garcia Picart, Joan Hecht, Joanna Jaroch, Joanna Zalewska, Joanne Kelly, Joanne Taaffe, João Reynaldo Abbud, João V Vitola, Joaquín V Peñafiel, Jocelyne Benatar, Jody Bindeman, Joe Sabik, Joel Klitch, Johann Christopher, Johannes Aspberg, John D Friedman, John F Beltrame, John F Heitner, John Joseph Graham, John R Davies, John Doan, John Kotter, John Kurian, John Mukai, John Pownall, Jolanta Sobolewska, Jon Kobashigawa, Jonathan L Goldberg, Jonathan W Bazeley, Jonathan Byrne, Jonathan Himmelfarb, Jonathan Leipsic, Jonean Thorsen, Jorge F Trejo Gutierrez, Jorge Escobedo, Jorik Timmer, José A Ortega-Ramírez, José Antonio Marin-Neto, Jose D Salas, Jose Enrique Castillo, Jose Francisco Saraiva, José J Cuenca-Castillo, Jose L Diez, José Luis Narro Villanueva, José Luiz da Vieira, José M Flores-Palacios, Jose Ramon Gonzalez, Jose Seijas Amigo, Jose Fragata, Josep Maria Padró, Josheph F X McGarvey Jr, Joseph Hannan, Joseph Sacco, Joseph Sweeny, Joseph Wiesel, Josephine D Abraham, Joshua P Loh, Joy Burkhardt, Joyce R White, Joyce Riestenberg-Smith, Judit Sebo, Judith L Meadows, Judith Wright, Judy Mae Foltz, Judy Hung, Judy Otis, Juergen Stumpf, Jui-Peng Tsai, Julia S Dionne, Julia de Aveiro Morata, Julie Bunke, Julie Morrow, Julio César Figal, Jun Fujita, Jun Jiang, Junhua Li, Junqing Yang, Juntima 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Natalia S Oliveira, Natalia de Carvalho Maffei, Natalie Spitzer, Natasha C Putnam, Naved Aslam, Neamat Mowafy, Neeraj Pandit, Neeraj Parakh, Nevena Garcevic, Ngaire Meadows, Nhi N Tran, Nicholas Danchin, Nicki Lakeman, Nicola Johnston, Nicolas W Shammas, Nicole Saint Vrestil, Nicole Deming, Nier Zhong, Niket Patel, Nikola N Boskovic, Nikolaos Karogiannis, Nikos Werner, Nina Johnston, Ning Zhang, Ning Zhou, Niree Hindoyan, Nirmal Kumar, Nitika Chadha, Nitish Naik, Nodira Aripova, Noloyiso Mtana, Nona A Eskelson, Noor Syamira Mokhtar, Noppon Taksaudom, Nor Asiah Basri, Nora Marchelletta, Norma Hogg, Nungshi Jungla, Nuno Ferreira, Oksana A Lubyanaya, Olga B Nikolaeva, Olga Cañavate, Olga Sobrino, Olga Walesiak, Olga Walter, Olga Zdończyk, Olivia J Lim, Olivia Anaya, Olivia Mancilla, Olivier Dubourg, Olugbenga Bello, Omar Almousalli, Omar Thompson, Oni Olurinde, Or Harel, Osama Raheem, Oscar Méndiz, Óscar Prada-Delgado, Oz Shapira, P Christian Schulze, Pachara Panpunuan, Pal Maurovich-Horvat, Pallav Garg, Paloma Moraga, Pam Singh, Pamela Julian, Pamela Ouyang, Pamela Sigel, Pamela Woodard, Panpan Zhou, Paola Emanuela Poggio, Paola Smanio, Paolo Calabro, Paramjit Jeetley, Pascal Goube, Patricia K Nguyen, Patricia Alarie, Patricia Arakelian, Patricia Arsenault, Patricia Blaise, Patricia Brito, Patricia Cowper, Patricia Endsley, Patricia Mieses, Patrick B Alexander, Patrick Donnelly, Patrick Wilmot, Patrycja Lebioda, Paul C Gordon, Paul Der Mesropian, Paul Galiwango, Paul Hauptman, Paul Kennedy, Paula Beardsley, Paula García-González, Paulo Cury Rezende, Paulo Ricardo Caramori, Pavel S Kozlov, Pedro Canas Silva, Pedro Gabriel Melo Barros E Silva, Pedro Píccaro de Oliveira, Pedro Carvalho, Pedro Modas, Pedro Rio, Peeyush Jain, Peiyu He, Peter A McCullough, Peter H Stone, Peter M Pollak, Peter Douglass, Peter Henriksen, Peter OKane, Peter Ong, Philip Jones, Philip Rogal, Philippe Généreux, Philippe Menasche, Philippe Rheault, Phoebe Goold, Pierre Gervais, Pierre Michaud, Pilar Calvillo, Ping Chai, Piotr Jakubowski, Piotr Pruszczyk, Piotr Slomka, Piyamitr Sritara, Poay-Huan Loh, Poonam Sonawane, Pouneh Samadi, Pragnesh P Parikh, Prakash Deedwania, Pranav M Patel, Praneeth Polamuri, Pratiksha Sharma, Precilia Vasquez, Preeti Kamath, Prince Thomas, Priyadarshani Arambam, Puja K Mehta, Purvez Grant, Pushpa Naik, Qi Zhong, Qian Zhao, Qiang Zhou, Qianqian Yuan, Qin Yu, Qingxian Li, Qiulan Xie, Qiutang Zeng, R J Vindhya, R James Gerlach, Rachel King, Rada Vučić, Radmila Lyubarova, Radoslaw Pracon, Raewyn Fisher, Rafael Beyar, Rafael Diaz, Rafael Selgas, Raffaele Bugiardini, Raffaele Fanelli, Raisa Kavalakkat, V S Rajalekshmi, Rajat S Barua, Rajeev Menon, Rajesh Gopalan Nair, Rajesh Francis, Rajiv Narang, Rakesh Yadav, Ralph Alan Huston, T Ramakrishnan, Ramesh de Silva, Rami El Mahmoud, Ramiro Carvalho, Ramon de Jesús-Pérez, Ramona Stevens, Ran Leng, Ranjan Kachru, Ranjit Kumar Nath, Raquel Sanchez, Raven R Dwyer, Raven Lee, Ray Wyman, Raymond C Wong, Raymond W Little, Raymundo Ocaranza Sanchez, Rebecca J Wimmer, Rebecca Bariciano, Rebecca Otis, Rebekah R Herrmann, Reem Yunis, Reinette Hampson, Renato Abdala Karam, Renee C Hessian, Renee Kaneshiro, Reshma Ravindran, Reto Andreas Gamma, Reyna Bhandari, Reza Arsanjani, Ricardo L Lopes, Ricardo Mendes Oliveira, Ricardo Costa, Richa Bhatt, Richard F Davies, Richard H J Trimlett, Richard Goldweit, Rik Hermanides, Rine Nakanishi, Rinu R Sidh, Risha Patel, Rita Coram, Rizwan A Siddiqui, Rob S Beanlands, Robert J Hamburger, Robert K Riezebos, Robert M Donnino, Robert Bojar, Robert Chilton, Robert Guyton, Robert Henderson, Robert Kornberg, Robert Leber, Robert Mao, Robert Stenberg, Roberta P Santos, Roberto René Favaloro, Roberto Amati, Rodolfo G S D Lima, Rodrigo J Cerci, Rogerio Tumelero, Rohit Tandon, Roma Tewari, Romalisa Miranda-Peats, Ron Wald, Ronald A Mastouri, Ronald G Morford, Ronald G Schwartz, Ronald P Pedalino, Rongrong Hu, Ronnell A Hansen, Ronny A Cohen, Rory Hachamovitch, Rosa Homem, Rosa Sandonato, Rosane Laimer, Rosann Gans, Roxanne Yost, Roy Mathew, Rubén Baleón-Espinosa, Ruben Ramos, Rubine Gevorgyan, Rui Ferreira, Rui Jing, Ruth Pérez-Fernández, S K Dwivedi, S Ramakrishnan, Saadat Khan, Sabahat Bokhari, Sabu Thomas, Sadath Lubna, Sajeeda Parveen Khan, Sajeev Chakanalil Govindan, Saket Girotra, Saleem Kassam, Sallie Canada, Salvador Cruz-Flores, Samaa Mohamed, Samantha Ly, Sameh El Kaffas, Samia Massalha, Sampoornima Setty, Samuel Nwosu, Sandeep Seth, Sandeep Singh, Sander R Niehe, Sandra M Rivest, Sandra S Zier, Sandra Ahoud, Sandy Carr, Sanjay Ganapathi, Sanjay Shetty, Sanjeev Sharma, Santa Jimenez, Santhosh Satheesh, Santiago A Garcia, Sara Fernandez, Sara Karlsson, Sara Salkind, Sara Temiyasathit, Sarah Medina Rodriguez, Sarah Beaudry, Sarah Hadjih, Sarah Williams, Sarah Zahrani, Sarju Ralhan, Sasa Hinic, Sasko Kedev, Satinder Singh, Satoshi Yasuda, Satvic Cholenahally Manjunath, Sau Lee, Scott M Kaczkowski, Scott Kinlay, Sean W Hayes, Sebastian Sobczak, Senait Asier, Sergey A Sayganov, Seth I Sokol, Shaheen Pandie, Shaiful Azmi Yahaya, Shamir Mehta, Shao-Ping Nie, Sharad Chandra, Sharder Islam, Sharon Tai, Sheetal Rupesh Karwa, Sheri Ussery, Sheromani Bajaj, Sherron C Crook, Shigeyuki Nishimura, Shintaro Nakano, Shirin Heydari, Shiv Kumar Choudhary, Shivali Patel, Shobana Ganesan, Shruti Pandey, Shuyang Zhang, Shweta Hande, Siddharth Gadage, Sik-Yin V Tan, Silvia Zottis Poletti, Silvia Riera, Silvia Valbuena, Simon Walsh, Simona Maspoli, Simone Savaris, Si-Ting Feng, So Yang Cho, Solomon Yakubov, Songlin Zhu, Songtao Wang, Sonia Guerrero, Sonika Gupta, Sonja Salinger Martinovic, Sonya Brons, Sorin Brener, Sothinathan Gurunathan, Souheil Saba, Soundarya Nayak, Sowjanya Reddy, Srinivasa Potluri, Sriram Sudarshan, Srun Kuanprasert, Stacie Van Oosterhout, Stamatios Lerakis, Stanley E Cobos, Stefan C Bertog, Stefan M Simović, Stefan Weikl, Stefano Di Marco, Stefano Provasoli, Stephanie A Tirado, Stephanie C Boer, Stephanie M Lane, Stephanie Ferket, Stephanie Kelly, Stephanie Wasmiller, Stephen H McKellar, Stephen P Hoole, Stephen Fremes, Stephen Preston, Steve Leung, Steven A Fein, Steven J Lindsay, Steven P Sedlis, Steven Giovannone, Steven Michael, Steven Weitz, Stijn van Vugt, Subhash Banerjee, Sudhir Naik, Suellen Hosino, Sukie Desire, Sukit Yamwong, Suku T Thambar, Sulagna Mookherjee, Suman Singh, Sundeep Mishra, Sunil Kumar Verma, Supap Kulthawong, Supatchara Khwakhong, Surendra Naik, Suresh Babu, Surin Woragidpoonpol, Suryaprakash Narayanappa, Susan Derbyshire, Susan Gent, Susan Mathus, Susan Milbrandt, Susan Moore, Susan Regan, Susan Stinson, Susan Webber, Susana Silva, Susanna Stevens, Susanne Gruensfelder, Suthara Aramcharoen, Suvarna Kolhe, Suzana Tavares, Suzanne Arnold, Suzanne Welsh, Svetlana Apostolovic, Swapna Kunhunny, Ta-Chuan Hung, Taissa Zappernick, Tali Sharir, Talita Silva, Tamara Colaiácovo Soares, Tapan Umesh Pillay, Tarun K Mittal, Tatiana Trifonova, Tauane Bello Duarte, Tauqir Huk, Téodora Dutoiu, Terrance Chua, Terry Weyand, Thabitha Charles, Theodoros Kofidis, Theresa McCreary, Thierry Lefevre, Thippeekaa Arumairajah, Thitipong Tepsuwan, Thomas J Mulhearn, Thomas M Meyer, Thomas P Rocco, Thomas R Downes, Thomas Crain, Thomas Haldis, Thomas Mathew, Thomas Redick, Thounaojam Indira Devi, Thuraia Nageh, Tia Cauthren, Tiago Silva, Tiffany Little, Tijana Andric, Tina Harding, Titus Lau, Tiziana Formisano, Tiziano Moccetti, Tomasz Ciurus, Tomasz Mazurek, Tomasz Tarchalski, Toshiyuki Nagai, Tri Tran, Tricia Youn, Trish Tucker, Trudie Milner, Tuhina Bose, Tushar Kotecha, Udo Sechtem, Uma S Valeti, Umberto Cucchini, Umesh Badami, Upendra Kaul, V K Bahl, V S Narain, Valentina Casali, Valeria Godoy, Valerie Robesyn, Vamshi P Priya, Vandana Yadav, Vera McKinney, Veronica De Lenges, Veronica Tinnirello, Vicente Miro, Victor Navarro, Victoria Gumerova, Victoria Hernandez, Vidya Seeratan, Vijay Kumar, Vikentiy Y Kozulin, Viktoria Bulkley, Vilmar Veiga Jr, Vincent Setang, C P Vineeth, Virginai Pubull Nuñez, Virginia Fernández-Figares, Vitor Gomes, Viviana Gabriel, Viviane Dos Santos, Viviane Almeida, Vlad A Iliescu, Vladan Mudrenovic, Vladimir Dzavik, Vojislav L Giga, Walter Enrique Mogrovejo, Wan Xian Chan, Wanda C Marfori, Wanda Parker, Warangkana Mekara, Wassim Nona, Wayne Old, Wayne Pennachi, Weerachai Nawarawong, Wei Chen, Wei Su, Weibing Xing, Wei-Ren Lan, Wenda Crawford, Wendy L Stewart, Wendy Drewes, Wenhua Lin, William B Abernethy, William D Salerno, William F Fearon, William Vergoni, William Weintraub, Winnie C Sia, Wlodzimierz J Musial, Xacobe Flores-Ríos, Xavier Garcia-Moll Marimon, Xi Su, Xiang Ma, Xiangqiong Gu, Xiao Wang, Xiaomei Li, Xiaowei Yao, Xin Fu, Xin Su, Xin Zeng, Xinchun Yang, Xiuhong Li, Xuehua Fang, Xutong Wang, Yaming Geng, Yan Yan, Yanek Pépin-Dubois, Yanfu Wang, Yang Wang, Yanmeng Tian, Yaping Huang, Yechen Han, Yesenia Zambrano, Yi-Hsuan Yang, Ying Tung Sia, Yining Yang, Yitong Ma, Yolayfi Peralta, Yongjian Wu, Yu Kunwu, Yu Zhao, Yudong Peng, Yueh-Hung Lin, Yulan Zhao, Yumei Dong, Yunhai Zhao, Yutthaphan Wannasopha, Yvonne Taul, Zakir Sahul, Zalina Kudzoeva, Zbigniew Kalarus, Zeljko Z Markovic, Zhen Huang, Zheng Ji, Zhenyu Liu, Zhou Yue, Zhulin Zhang, Zhuxi Li, Zile Singh Meharwal, Ziliang Bai, Zixiang Yu, Zohra Huda, Zoltan Davidovits

Subjects
Male, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Myocardial Ischemia, Coronary Disease, Coronary Artery Disease, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Coronary Angiography, ISCHEMIA Research Group, law.invention, Angina, Coronary artery disease, 0302 clinical medicine, Randomized controlled trial, law, Cardiovascular Disease, Myocardial Revascularization, 030212 general & internal medicine, Coronary Artery Bypass, 11 Medical and Health Sciences, Cardiac catheterization, General Medicine, Middle Aged, humanities, Cardiovascular Diseases, Cardiology, Female, Human, medicine.medical_specialty, Ischemia, Article, 03 medical and health sciences, Geriatric cardiology, Percutaneous Coronary Intervention, General & Internal Medicine, Internal medicine, medicine, Humans, Angina, Unstable, Aged, business.industry, Coronary Artery Bypa, Percutaneous coronary intervention, Bayes Theorem, medicine.disease, Heart failure, Quality of Life, business
Abstract

BACKGROUND: Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS: We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS: Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points; 95% CI, -4.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS: Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA ClinicalTrials.gov number, NCT01471522.).

Published
2020

12. Effects of face masks on performance and cardiorespiratory response in well-trained athletes

Author

Michael Böhm, Saarraaken Kulenthiran, Angela M. Zimmer, Andreas Venhorst, Felix Mahfoud, Dominic Blumenauer, Florian Egger, Patrick D. Fischer, Yvonne Bewarder, and Tim Meyer

Subjects
Adult, Male, medicine.medical_specialty, Blood Pressure, Athletic Performance, 030204 cardiovascular system & hematology, Incremental exercise, 03 medical and health sciences, Oxygen Consumption, 0302 clinical medicine, Heart Rate, Internal medicine, medicine, Humans, Cardiopulmonary exercise test, Watt, Original Paper, Cross-Over Studies, biology, SARS-CoV-2, Athletes, business.industry, Masks, COVID-19, Cardiorespiratory fitness, 030229 sport sciences, General Medicine, biology.organism_classification, Bicycling, Face masks, Surgical mask, Exercise Test, Cardiology, Cardiology and Cardiovascular Medicine, business, Anaerobic exercise, Respiratory minute volume
Abstract

Background During the COVID-19 pandemic, compulsory masks became an integral part of outdoor sports such as jogging in crowded areas (e.g. city parks) as well as indoor sports in gyms and sports centers. This study, therefore, aimed to investigate the effects of medical face masks on performance and cardiorespiratory parameters in athletes. Methods In a randomized, cross-over design, 16 well-trained athletes (age 27 ± 7 years, peak oxygen consumption 56.2 ± 5.6 ml kg−1 min−1, maximum performance 5.1 ± 0.5 Watt kg−1) underwent three stepwise incremental exercise tests to exhaustion without mask (NM), with surgical mask (SM) and FFP2 mask (FFP2). Cardiorespiratory and metabolic responses were monitored by spiroergometry and blood lactate (BLa) testing throughout the tests. Results There was a large effect of masks on performance with a significant reduction of maximum performance with SM (355 ± 41 Watt) and FFP2 (364 ± 43 Watt) compared to NM (377 ± 40 Watt), respectively (p ηp2 = 0.50). A large interaction effect with a reduction of both oxygen consumption (p ηp2 = 0.34) and minute ventilation (p ηp2 = 0.39) was observed. At the termination of the test with SM 11 of 16 subjects reported acute dyspnea from the suction of the wet and deformed mask. No difference in performance was observed at the individual anaerobic threshold (p = 0.90). Conclusion Both SM and to a lesser extent FFP2 were associated with reduced maximum performance, minute ventilation, and oxygen consumption. For strenuous anaerobic exercise, an FFP2 mask may be preferred over an SM.

Published
2021

13. Sports-Related Sudden Cardiac Arrest in Germany

Author

David Niederseer, Jürgen Scharhag, Karl-Heinz Tischer, Christian Schmied, Philipp Bohm, Tim Meyer, and Florian Egger

Subjects
Adult, Male, Emergency Medical Services, Resuscitation, medicine.medical_specialty, Myocarditis, Defibrillation, medicine.medical_treatment, Population, Electric Countershock, Coronary Artery Disease, 030204 cardiovascular system & hematology, Young Adult, 03 medical and health sciences, Age Distribution, 0302 clinical medicine, Germany, Humans, Medicine, Prospective Studies, Registries, 030212 general & internal medicine, Sex Distribution, education, education.field_of_study, biology, business.industry, Athletes, Incidence (epidemiology), Sudden cardiac arrest, Middle Aged, medicine.disease, biology.organism_classification, Cardiopulmonary Resuscitation, Death, Sudden, Cardiac, Ventricular Fibrillation, Emergency medicine, Etiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Sports
Abstract

Background Knowledge about causes of sports-related sudden cardiac arrest (SrSCA) may influence national strategies to prevent such events. Therefore, we established a prospective registry on SrSCA to estimate the incidence and in particular describe the etiologies of SrSCA in the general population in Germany. Methods The registration of SrSCA based upon 4 pillars: a web-based platform to record SrSCA cases in competitive and recreational athletes, media-monitoring, cooperation with the German Resuscitation Registry, and 15 institutes of forensic medicine. Results After an observation period of 6 years, a total of 349 cases was recorded (mean age 48.0 ± 12.7 years); 109 subjects survived. Most of the cases occurred during nonelite competitive or recreational sports. Bystander cardiopulmonary resuscitation (CPR) was initiated in 262 cases (75%); however, rhythm analysis and defibrillation (if indicated) was mainly performed by medical services. In patients ≤ 35 years of age, premature coronary artery disease (CAD) and sudden arrhythmic death syndrome (SADS) prevailed, followed by myocarditis. In athletes ≥ 35 years of age, CAD predominated. Conclusions Country-specific registries are necessary to define the national screening and prevention strategy optimally. In Germany, premature CAD, SADS, and myocarditis are the leading causes of SrSCA in young athletes, reinforcing the great disparity of the prevalence of cardiac diseases among different countries. Extension of on-site SCD-prevention campaigns, with training of CPR and explanation of the efficient use of automated external defibrillators (AEDs), may decrease the burden of SrSCD.

Published
2021

14. Von Willebrand Factor and ADAMTS13 and long-term outcomes in patients undergoing percutaneous coronary intervention

Author

Miklos Rohla, Kurt Huber, Matthias K. Freynhofer, Maximilian Tscharre, Florian Egger, Serdar Farhan, J Wojta, Cihan Ay, Birgit Vogel, Thomas W. Weiss, and Ioannis Tentzeris

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Myocardial Infarction, ADAMTS13 Protein, Coronary Artery Disease, Coronary artery disease, Percutaneous Coronary Intervention, Von Willebrand factor, hemic and lymphatic diseases, Internal medicine, von Willebrand Factor, Humans, Medicine, cardiovascular diseases, Myocardial infarction, Acute Coronary Syndrome, biology, business.industry, Percutaneous coronary intervention, Hematology, Middle Aged, medicine.disease, ADAMTS13, Conventional PCI, biology.protein, Cardiology, Female, business, Mace, circulatory and respiratory physiology
Abstract

Background Von Willebrand factor (VWF) and its cleaving protease a disintegrin-like and metalloprotease with thrombospondin type I repeats 13 (ADAMTS13) are pivotal mediators of thrombosis and are associated with the progression of atherosclerosis. We investigated the impact of VWF, ADAMTS13 and VWF/ADAMTS13 on long-term major adverse cardiovascular outcomes (MACE) in patients undergoing percutaneous coronary intervention (PCI). Methods We analysed 701 patients undergoing PCI between 2003 and 2006. VWF and ADAMTS13 antigen levels were measured before PCI. As primary endpoint, we investigated MACE, a composite of all-cause mortality, myocardial infarction or ischemic stroke during 8 years of follow-up. As secondary endpoint, we investigated all-cause mortality. Results Mean age was 63.8 years, 496 (70.8%) were male. Acute coronary syndrome (ACS) was diagnosed in 347 (49.5%) patients, stable coronary artery disease (SCAD) in 354 (50.5%). During follow-up 228 (32.5%) patients experienced MACE, and 161 (23.0%) died. In ACS patients, VWF was significantly associated with MACE (HR 1.402 (95%CI 1.003–1.959), p = 0.048), whereas ADAMTS13 and VWF/ADAMTS13 had no predictive value. In SCAD, neither VWF, ADAMTS13, nor VWF/ADAMTS13 correlated with MACE. VWF was significantly associated with all-cause death in ACS patients (HR 1.841 (95%CI 1.187–2.856), p = 0.006), but not in SCAD (1.394 (95%CI 0.856–2.269), p = 0.181). ADAMTS13 and VWF/ADAMTS13 were not correlated with ACS and SCAD, respectively. Conclusion VWF but not ADAMTS13 and VWF/ADAMTS13 was associated with MACE and mortality in patients with ACS but not SCAD. This finding highlights the importance of VWF as an essential marker of risk in patients with ACS.

Published
2020

15. Does playing football (soccer) lead to SARS-CoV-2 transmission? - A case study of 3 matches with 18 infected football players

Author

Oliver Faude, Sebastian Schreiber, Tim Meyer, Florian Egger, and Barbara Gärtner

Subjects
Adult, 2019-20 coronavirus outbreak, Adolescent, viruses, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Applied psychology, Viral transmission, Football, Physical Therapy, Sports Therapy and Rehabilitation, law.invention, Young Adult, law, Soccer, Humans, Orthopedics and Sports Medicine, Retrospective Studies, Football players, SARS-CoV-2, COVID-19, Transmission (mechanics), Tourism, Leisure and Hospitality Management, Match play, Football soccer, Psychology, human activities
Abstract

The risk of viral transmission of SARS-CoV-2 associated with football (soccer) training and match play is unknown. Therefore, studies on infection-relevant contacts in football are of utmost importance.A retrospective video-based analysis was performed over 3 matches with 18 SARS-CoV-2 positive players (age: 17.6 ± 3.1 years; 2 professional, 2 semi-professional and 14 youth academy players) during the pre-season in August and September 2020 in Germany. Repeated RT-PCR tests were performed in 5 of 6 teams and pre-match RT-PCR tests in 4 of 6 teams. The last RT-PCR test ranged between 5 - 14 days post-match. The most important result was that no case of virus transmission was found as documented by RT-PCR tests (and symptom monitoring up to 14 days post-match). Physical contact between contagious and non-infected players never lasted longer than 3 seconds each and the position of players during duels was almost exclusively laterally or behind each other.In conclusion, very low risk of SARS-CoV-2 transmission during football match play has been documented. Nevertheless, due to the observational retrospective design of the study, which was based on ethical reasons, inconsistent RT-PCR testing should be regarded as limitation and larger studies are needed to confirm a low probability of virus transmission.

Published
2022

16. Effects of Medical Face Masks on Physical Performance in Patients With Coronary Artery Disease or Hypertension

Author

Patrick Fischer, Dominic Blumenauer, Florian Egger, Sven Fikenzer, Angela Zimmer, Saarraaken Kulenthiran, Ulrich Laufs, Yvonne Bewarder, Michael Böhm, and Felix Mahfoud

Subjects
Hypertension, Masks, COVID-19, Humans, Coronary Artery Disease, Prospective Studies, Physical Functional Performance, Cardiology and Cardiovascular Medicine
Abstract

In this randomized, prospective monocentric study, 40 subjects with coronary artery disease or hypertension (cardiovascular disease [CVD] group) were assigned to either surgical mask (SM) or class 2 filtering facepiece mask (FFP2). They performed cycle ergometry exercise tests with progressive intensity until exhaustion with the assigned mask and another test with no mask (NM) in random order. A control group of 10 healthy subjects randomly performed 3 exercise tests with NM, SM, and FFP2, respectively. Blood pressure, heart rate, 12-lead electrocardiogram, exertion, shortness of breath, and capillary blood gases from the earlobe were documented. Across all groups, exercise testing with face masks resulted in a significantly reduced peak power output in watts compared with testing with NM (CVD group: SM vs NM: -5.0 ± 7.0%, p = 0.005; FFP2 vs NM: -4.7 ± 14%, p = 0.03; control group: SM vs NM: -6.8 ± 4.4%, p = 0.008; FFP2 vs NM: -8.9 ± 6.3%; p = 0.01) without differences in hemodynamic parameters, such as maximum heart rate and systolic blood pressure. Wearing an FFP2 compared with NM resulted in significant higher carbon dioxide partial pressure (CVD group: FFP2: 36.0 ± 3.2 mm Hg vs NM: 33.3 ± 4.4 mm Hg, p = 0.019; control group: FFP2: 32.6 ± 2.8 mm Hg vs NM: 28.1 ± 1.7 mm Hg, p0.001) with corresponding differences in hydrogen carbonate and base excess, but not to a clinically critical extent. In conclusion, exercise testing with SM and FFP2 resulted in a significant reduction of peak power output without differences in hemodynamic parameters in subjects with preexisting CVD and in healthy subjects.

Published
2021

17. Dwarfs on the Shoulders of Giants: Bayesian Analysis With Informative Priors in Elite Sports Research and Decision Making

Author

Anne, Hecksteden, Sabrina, Forster, Florian, Egger, Felix, Buder, Ralf, Kellner, and Tim, Meyer

Abstract

While sample sizes in elite sports are necessarily small, so are the effects that may be relevant. This conundrum is complicated by an understandable reluctance of athletes to comply with extensive study requirements. In Bayesian analyses, pre-existing knowledge (e.g., from sub-elite trials) can be formally included to supplement scarce data. Moreover, some design specifics for small sample research extend to the extreme case of a single subject. This provides the basis for actionable feedback (e.g., about individual responses) thereby incentivising participation. As a proof-of-concept, we conducted a replicated cross-over trial on the effect of cold-water immersion (CWI) on sprint performance recovery in soccer players. Times for 30 m linear sprint and the initial 5 m section, respectively, were measured by light gates before and 24 h after induction of fatigue. Data were analysed by Bayesian and by standard frequentist methods. Informative priors are based on a published metaanalysis. Seven players completed the trial. Sprint performance was 4.156 ± 0.193 s for 30 m linear sprint and 0.978 ± 0.064 s for the initial 5 m section. CWI improved recovery of sprint time for the initial 5 m section (difference to control: -0.060 ± 0.060 s

Published
2021

18. Is diversity harmful? - Mixed-brand cardiac implantable electronic devices undergoing magnetic resonance imaging

Author

R. Kriz, T. Puntus, Florian Egger, M. Nuernberg, David Zweiker, J. Koch, Kurt Huber, C Koenig, and P. Hellebart

Subjects
medicine.diagnostic_test, business.industry, Physiology (medical), media_common.quotation_subject, medicine, Magnetic resonance imaging, Electronics, Cardiology and Cardiovascular Medicine, business, Diversity (politics), media_common, Biomedical engineering
Abstract

Funding Acknowledgements Type of funding sources: None. Introduction Many patients with cardiac implantable electronic devices (CIED) need to undergo magnetic resonance imaging (MRI). However, a significant proportion has a CIED system in place that has not been classified "MRI-conditional" because of generators and leads from different brands ("mixed-brand" group), although the individual components per se are MRI-conditional. There is only limited data available concerning the outcome of these patients with "mixed-brand" CIED systems undergoing MRI. Purpose To analyse complications or adverse effects in "mixed-brand" CIED patients undergoing MRI, compared to patients with a fully "MRI-conditional" CIED system. Methods A retrospective single-centre study was performed, including patients undergoing MRI between January 2013 until May 2020. Short- and long-term outcomes were compared between both groups. We defined the primary endpoint as death or any adverse event necessitating hospitalization or CIED revision in association with the MRI examination. Secondary endpoints were the occurrence of any surrogate for beginning device or lead failure or patient discomfort during MRI. Results A total of 227 MRI examinations, including 10 thoracic MRIs, were carried out in 158 patients, with a range of 1-9 MRIs per patient. Mean age was 73 years and 52 (32.9%) patients were female. We identified 38 patients undergoing 54 procedures in the "mixed-brand" group and 89 patients undergoing 134 MRI procedures in the "MRI-conditional" group. In 31 patients undergoing 39 MRI examinations the MRI-conditionality could not be determined. "Mixed-brand" patients were older than MRI-conditional patients (mean 77 vs. 72 years, p = 0.003). The primary endpoint occurred in 0% in the "mixed-brand" group and in 2.2% in the "MRI conditional" group (p = 1.000). Complications were as follows: Two patients had first diagnosed atrial fibrillation directly associated with the procedure, of whom one additionally had a transient CIED dysfunction. No patient in the "mixed-brand" group and three patients (3.4%) in the "MRI conditional" group met the secondary endpoints (p = 0.554). In patients with undeterminable MRI conditionality the complication rate was similar (0% for both the primary and secondary endpoints). Conclusion The complication rate of CIED patients undergoing MRI was low. There was no signal for increased risk of adverse events in patients with a CIED without MRI certification due to mixed brands systems compared to patients with "MRI-conditional" CIED systems.

Published
2021

19. Lower pacemaker implantation rates for atrioventricular block during COVID-19

Author

T. Puntus, David Zweiker, Florian Egger, R. Kriz, P. Hellebart, M. Nuernberg, J. Koch, and Kurt Huber

Subjects
2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), medicine.disease, Acute cardiovascular disease, Sick sinus syndrome, Pacemaker implantation, Time frame, Physiology (medical), Anesthesia, Medicine, AcademicSubjects/MED00200, Cardiology and Cardiovascular Medicine, business, Device Therapy - Antibradycardia Pacing, Atrioventricular block
Abstract

Funding Acknowledgements Type of funding sources: None. Introduction The first wave of the COVID-19 crisis was associated with a reduction of patients presenting with acute cardiovascular disease. However, there is only limited data showing the trend of pacemaker implantations and their indications. Purpose To evaluate pacemaker implantations before, during and after the first COVID-19 wave, stratified by indication. Methods We analysed the weekly rates of pacemaker implantation at our centre during the first national lockdown for COVID-19 at the between 16 March 2020 and 29 April 2020 (weeks 12-17 / 2020), compared to the implantation rates 6 weeks before (weeks 6-11 / 2020), 6 weeks afterwards (weeks 18-23 / 2020), and the same time frame in 2017-2019. To reduce bias due to postponed planned procedures, we stratified pacemaker implantations into the following groups: total implantations (including box changes), new pacemaker implantations, implantation due to AV block, implantation due to supraventricular conduction disturbances, and other implantations. Results The total number of total weekly implantations was reduced from 10.7 (weeks 6-11 / 2020) to 4.2 (weeks 12-17 / 2020; -60.1%, p = 0.02). We found no significant reduction in the same time frame in 2017-2019 (6.5 vs. 6.1 per week, p = 0.29). We found a similar effect in "new" pacemaker implantations (8.5 vs. 3.2 per week, -62.7%, p = 0.02) and AV block (5.0 vs. 1.5 per week, -70%, p = 0.03). There was no reduction in pacemaker implantation due to sick sinus syndrome (2.5 vs. 0.8 per week, -66.7%, p = 0.12) and other indications (1.0 vs. 0.8 per week, -16.7%, p = 0.86). In the six following weeks (18-23 / 2020), the total numbers (6.0 per week) and indications other than AV block rose to baseline (p > 0.05), but patients with AV block were still less prevalent (1.7 per week, p = 0.04). Conclusion The reduction of total and new pacemaker implantations during the COVID-19 lockdown was mainly based on a reduced pacemaker implantation rate for AV block. This effect persisted even after the national lockdown. This analysis implies that a significant number of patients with AV block may have avoided medical contact during and after the lockdown and therefore have experienced increased mortality.

Published
2021

20. Impact of On-Site Cardiac Surgery on Clinical Outcomes After Transfemoral Transcatheter Aortic Valve Replacement

Author

Florian Egger, David Zweiker, Matthias K. Freynhofer, Verena Löffler, Miklos Rohla, Alexander Geppert, Serdar Farhan, Birgit Vogel, Jürgen Falkensammer, Johannes Kastner, Philipp Pichler, Paul Vock, Gudrun Lamm, Olev Luha, Albrecht Schmidt, Daniel Scherr, Matthias Hammerer, Uta C. Hoppe, Edwin Maurer, Michael Grund, Thomas Lambert, Wolfgang Tkalec, Thomas Sturmberger, Eduard Zeindlhofer, Martin Grabenwöger, Kurt Huber, Peter Smetana, Emil Wessely, Herbert Hammerl, Afshin Assadian, Anton Bambazek, Klaus Osinger, Robert Maier, Heinrich Mächler, Wolfgang Marte, Helmut Brussee, Christoph Holzinger, Christoph Hörmann, Christoph Schuschnig, Peter Gerner, Rainald Seitelberger, Erika Prinz, Wilfried Wintersteller, Christian Punzengruber, Elisabeth Lassnig, Alexander Kypta, Jürgen Kammler, Clemens Steinwender, Joseph Aichinger, Peter Siostrzonek, and RS: CARIM - R2.01 - Clinical atrial fibrillation

Subjects
Logistic euroscore, medicine.medical_specialty, Transcatheter aortic, medicine.medical_treatment, SOCIETY, IMPLANTATION TAVI INSIGHTS, VALVULAR HEART-DISEASE, 030204 cardiovascular system & hematology, TAVR, STENOSIS, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, medicine, MANAGEMENT, 030212 general & internal medicine, business.industry, on-site cardiac surgery, valvular heart disease, aortic stenosis, transfemoral, Perioperative, medicine.disease, Surgery, Cardiac surgery, Stenosis, EDWARDS SAPIEN, REGISTRY, Propensity score matching, Cardiology and Cardiovascular Medicine, business, TASK-FORCE
Abstract

OBJECTIVES This study sought to investigate the outcome of high-risk and inoperable patients with severe symptomatic aortic stenosis undergoing transfemoral transcatheter aortic valve replacement (TAVR) in hospitals with (iOSCS) versus without institutional on-site cardiac surgery (no-iOSCS).BACKGROUND Current guidelines recommend the use of TAVR only in institutions with a department for cardiac surgery on site.METHODS In this analysis of the prospective multicenter Austrian TAVI registry, 1,822 consecutive high-risk patients with severe symptomatic aortic stenosis undergoing transfemoral TAVR were evaluated. A total of 290 (15.9%) underwent TAVR at no-iOSCS centers (no-iOSCS group), whereas the remaining 1,532 patients (84.1%) were treated in iOSCS centers (iOSCS group).RESULTS Patients of the no-iOSCS group had a higher perioperative risk defined by the logistic EuroSCORE (20.9% vs. 14.2%; pCONCLUSIONS Patients undergoing transfemoral TAVR in hospitals without iOSCS had a significantly higher baseline risk profile. After propensity score matching short-and long-term mortality was similar between centers with and without iOSCS. (c) 2018 by the American College of Cardiology Foundation.

Published
2018

21. Staying on the ball during COVID-19 pandemic: impact on training modalities in football players

Author

Michael Lauseker, Stefan Brunner, Simone Krammer, Florian Egger, Eileen Deuster, Dominik Schüttler, Tim Meyer, Julius Steffen, and Wolfgang Hamm

Subjects
medicine.medical_specialty, Football players, Modalities, Coronavirus disease 2019 (COVID-19), business.industry, education, Training (meteorology), Football, COVID-19, Physical Therapy, Sports Therapy and Rehabilitation, Workload, Training methods, Cross-Sectional Studies, Communicable Disease Control, Physical therapy, medicine, Humans, Orthopedics and Sports Medicine, business, human activities, Amateur, Pandemics
Abstract

BACKGROUND: COVID-19 pandemic has affected worldwide sports competitions and training in both amateur and professional leagues. We thus aimed to investigate changes in different training modalities in elite and amateur football players following COVID-19 lockdown in March 2020. METHODS: In this cross-sectional study we applied a Likert scale-based questionnaire with 20 items to quantify and classify time spent at standard training methods in 47 professional and 54 amateur football players from 12 Austrian clubs before and during lockdown. Additionally, McLean score was calculated to assess perceived training fatigue. RESULTS: Weekly amount of training time at endurance exercises (cycling) increased in both professional (37.5 [IQR 46.5] min/week vs. 187.5 [IQR 127.5] min/week, p

Published
2021

22. A video-based analysis of situations bearing the risk of respiratory disease transmission during football matches

Author

Oliver Faude, Simon Müller, Sebastian Schreiber, Jonas Müller, Lukas Nebiker, Florian Beaudouin, Tim Meyer, and Florian Egger

Subjects
Adult, Male, Risk, Time Factors, Multidisciplinary, Adolescent, Age Factors, Football, Videotape Recording, Risk Assessment, Young Adult, Crowding, Athletes, Humans, Contact Tracing, Child, Respiratory Tract Infections, human activities
Abstract

We aimed to analyze the number and type of contacts involving the risk of respiratory disease transmission during football match play.We analysed videos of 50 matches from different levels of play (professional, amateur, youth). Two reviewers evaluated the contacts of all players in the field of view in each match. We focused on between-player contacts (duels), crowding, actions with potentially increased aerosol and droplet production (speaking, shouting, spitting) and within-player hand-to-head contacts. We categorized the duels with direct contact into frontal (face-to-face) and other ones and measured contact duration.The number of between-player contacts were similar between playing levels (median 28.3 [IQR 22.6,33] contacts per player-hour). Frontal contacts summed up to 8% of all contacts. Contacts involving the head occurred on average less than once per player during a 90-min match with none in frontal positioning and none lasting longer than 3 s. Crowding included on average between two and six players and the duration was mostly less than 10 s. Only goal celebrations lasted more than twice as long in professionals (median 21.4 s [IQR 13.8,24.8]) and amateurs (median 18.6 s [IQR 16.3,22]) compared to youth players (median 8.9 s [IQR 0,14.8]). Aerosol and droplet producing activities were three to four times more frequent in adult compared to youth players.Our results suggest that the risk of respiratory pathogen transmission is low during football matches. This conclusion is based on the finding that most close contact situations are of short duration and on the fact that it is mainly an outdoor sport.

Published
2021

23. iSens: A Fiber-Based, Highly Permeable and Imperceptible Sensor Design

Author

Siegfried Bauer, Martin Kaltenbrunner, Thomas Stockinger, Roland Pruckner, Daniela Wirthl, Guoyong Mao, Florian Egger, Uwe Müller, Reinhard Schwödiauer, Nikita Arnold, Stepan Demchyshyn, Michael Drack, and Melanie Steiner

Subjects
Resistive touchscreen, Materials science, business.industry, Heating element, Mechanical Engineering, Capacitive sensing, Glass fiber, Mechanics of Materials, General Materials Science, Fiber, A fibers, Process engineering, business, Porous medium, Hardening (computing)
Abstract

Embedded sensors are key to optimizing processes and products; they collect data that allow time, energy, and materials to be saved, thereby reducing costs. After production, they remain in place and are used to monitor the long-term structural health of buildings or aircraft. Fueled by climate change, sustainable construction materials such as wood and fiber composites are gaining importance. Current sensors are not optimized for use with these materials and often act as defects that cause catastrophic failures. Here, flexible, highly permeable, and imperceptible sensors (iSens) are introduced that integrate seamlessly into a component. Their porous substrates are readily infused with adhesives and withstand harsh conditions. In situ resistive temperature measurements and capacitive sensing allows monitoring of adhesives curing as used in wooden structures and fiber composites. The devices also act as heating elements to reduce the hardening time of the glue. Results are analyzed using numerical simulations and theoretical analysis. The suggested iSens technology is widely applicable and represents a step towards realizing the Internet of Things for construction materials.

Published
2021
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24. P1147Complications in young ICD patients - a retrospective analysis

Author

Kurt Huber, Florian Egger, R. Kriz, David Zweiker, M Nurnberg, J. Koch, T. Puntus, and P. Hellebart

Subjects
Pediatrics, medicine.medical_specialty, business.industry, Physiology (medical), Retrospective analysis, Medicine, Cardiology and Cardiovascular Medicine, business
Abstract

Introduction In specific situations implantable cardioverter defibrillator (ICD) therapy is recommended for patients under the age of 40 years. Due to the active lifestyle of this patient population, complication rates in devices with conventional transvenous electrodes may be higher than for the remaining population. Methods The ICD-YOUNG study is a retrospective analysis of consecutive patients ≤ 40 years undergoing transvenous or subcutaneous ICD (s-ICD) implantation, device change or lead revision at our centre between July 2006 and December 2017. Rehospitalization for lead failure or device battery depletion was documented. Results Out of 586 patients undergoing ICD implantation, 35 patients (6.0%) were ≤ 40 years. Mean age was 30.0 ± 7.2 years, 48.6% were female, 37.1% received ICD therapy for primary prevention and 11.4% primarily received s-ICD. Median follow up was 7.3 (interquartile range, 1.8-12.0) years, with a lower follow up duration in s-ICD patients than conventional ICD patients (median, 2.9 vs. 9.0 years). Over the course of follow-up, 37.1% received successful anti-tachycardia therapy. 19.4% of patients in the conventional ICD group had right ventricular lead problems requiring intervention, while none of the s-ICD patients had to be revised. Time to first device change due to battery depletion and/or device upgrade was similar in young and remaining patients (median 5.4 vs 6.0 years, p = 0.23). Discussion Young patients requiring ICD have a high rate of lead problems. In most young patients, s-ICD therapy is an encouraging alternative to conventional ICD therapy with a lower lead failure rate.

Published
2020

25. Impact of platelet turnover on long‐term adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention

Author

Florian Egger, Alexander Geppert, Veronika Bruno, Wolfgang Hübl, Martin Willheim, Serdar Farhan, Matthias K. Freynhofer, Miklos Rohla, Thomas W. Weiss, Maximilian Tscharre, Johann Wojta, and Kurt Huber

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Platelet Function Tests, medicine.medical_treatment, Clinical Biochemistry, Myocardial Infarction, Coronary Artery Disease, 030204 cardiovascular system & hematology, Biochemistry, Coronary artery disease, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Internal medicine, Humans, Medicine, cardiovascular diseases, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, Mean platelet volume, Non-ST Elevated Myocardial Infarction, Aged, Proportional Hazards Models, Aspirin, Platelet Count, business.industry, Percutaneous coronary intervention, General Medicine, Middle Aged, Prognosis, medicine.disease, Clopidogrel, Stroke, Cardiovascular Diseases, Multivariate Analysis, Conventional PCI, Cardiology, ST Elevation Myocardial Infarction, Female, business, Mean Platelet Volume, Platelet Aggregation Inhibitors, Mace, medicine.drug
Abstract

Background Increased platelet turnover and high platelet reactivity are associated with short-term major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) or stable coronary artery disease (SCAD). We investigated the impact of platelet turnover on long-term MACE. Methods Consecutive patients presenting with ACS or SCAD undergoing PCI between 2009 and 2010 were included. All patients received clopidogrel and aspirin as dual antithrombotic therapy regimen. Multivariable Cox proportional hazard models were applied to assess the prognostic impact of platelet turnover (reticulated platelet count [RPC], mean platelet volume [MPV]) and function on long-term MACE, a composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. Results In total, 477 patients were eligible. Mean age was 64.3 ± 12.7 years, 68.8% were male. Median follow-up was 5.8 (IQR 4.2-6.5) years. Median RPC was 7.6 (IQR 5.6-10.4) g/L and median MPV was 10.7 (IQR 10.1-11.3) fL. In univariable analysis, RPC was associated with MACE, both as continuous (HR 1.064 [95%CI 1.021-1.111]; P = .006) and dichotomized (HR 1.693 [95%CI 1.156-2.481]; P = .006) variable. After adjustment, continuous RPC (HR 1.055 [95%CI 1.012-1.099]; P = .010) and dichotomized RPC (HR 1.716 [95%CI 1.152-2.559]; P = .007) remained significantly associated with MACE. Neither MPV nor platelet function testing was associated with long-term adverse outcome. Conclusion Increased platelet turnover is associated with long-term adverse outcome in patients with coronary artery disease undergoing PCI. Platelet turnover represents a new marker of atherothrombotic risk and might help to guide composition or duration of antiplatelet therapy.

Published
2019

27. Influence of electrical stimulation therapy on permanent pacemaker function

Author

Florian Egger, Kurt Huber, Ruxandra C. Kriz, Stefan Löfler, Helmut Kern, Fabian P Hammerle, Lukas Fiedler, Christian Hofer, and Michael Nürnberg

Subjects
medicine.medical_specialty, Pacemaker, Artificial, business.industry, food and beverages, Stimulation, Electric Stimulation Therapy, General Medicine, 030204 cardiovascular system & hematology, Intracardiac injection, 03 medical and health sciences, 0302 clinical medicine, Bilateral stimulation, Neuromuscular stimulation, Internal medicine, medicine, Cardiology, Transcutaneous Electric Nerve Stimulation, Humans, 030212 general & internal medicine, Permanent pacemaker, business
Abstract

Electrical stimulation therapy (EST) and transcutaneous electrical neuromuscular stimulation (TENS), a modality of EST, have become widely applied, accepted and effective methods for the treatment of musculoskeletal and other pain conditions. According to the rising number of permanent pacemaker (PM) wearers the number of potential candidates for EST with concomitant device implantation is growing. Contradictory recommendations exist regarding the application of EST or TENS on PM wearers. The study was carried out to evaluate the impact of EST on PM function. A full size model mimicking the electrical characteristics of the human body was used to evaluate the application of EST on permanent PM devices. Various configurations with respect to energy modality, position of the stimulation electrodes and PM device models were evaluated. Intracardiac PM electrogram tracings (iEGM) were analyzed for the interference of EST with PM function. Unilateral EST application did not cause interference with PM function in any of the configurations (0%; n = 700). On the contrary, bilateral stimulation (350 configurations in total) caused either ventricular inhibition or switch to V00 back-up pacing due to electrical interference in 165 cases (47.1%) depending on the applied stimulation parameters. The use of EST potentially interferes with PM therapy, especially if the electrodes are positioned bilaterally; however, unilateral EST application appeared to be safe in all tested configurations.

Published
2018

28. Impact of bivalirudin on mortality and bleeding complications in acute coronary syndrome patients undergoing invasive revascularization

Author

Rudolf Jarai, Serdar Farhan, Matthias K. Freynhofer, Johann Wojta, Kurt Huber, Alexander Geppert, Thomas W. Weiss, Florian Egger, Gregg W. Stone, Miklos Rohla, Adnan Kastrati, and Ioannis Tentzeris

Subjects
Male, Acute coronary syndrome, medicine.medical_specialty, medicine.medical_treatment, Postoperative Hemorrhage, 030204 cardiovascular system & hematology, Revascularization, Single Center, Antithrombins, Percutaneous coronary intervention, Anticoagulation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Prevalence, medicine, Abciximab, Humans, Bivalirudin, Hospital Mortality, 030212 general & internal medicine, Retrospective Studies, Heparin, business.industry, Hazard ratio, General Medicine, Odds ratio, Hirudins, Middle Aged, medicine.disease, Combined Modality Therapy, Peptide Fragments, Recombinant Proteins, Confidence interval, Survival Rate, Treatment Outcome, Austria, Cardiology, Female, Original Article, business, medicine.drug
Abstract

Summary Background In a retrospective analysis of a prospective single center registry we compared the use of bivalirudin, unfractionated heparin (UFH) monotherapy, UFH + abciximab in 1240 consecutive patients with acute coronary syndrome (ACS) undergoing stent implantation. Results Bivalirudin was associated with tendentially reduced in-hospital minor or major bleeding rates compared to UFH monotherapy (5.9 % vs. 9.4 % adjusted odds ratio (OR) 0.82, 95 % confidence interval CI 0.45–1.51, p = 0.53) and compared to the pooled UFH group (5.9 % vs. 11.9 %, adjusted OR 0.62, 95 % CI 0.36–1.08, p = 0.09) but with significantly lower bleeding hazards compared to UFH + abciximab (5.9 % vs. 16 %, adjusted OR 0.41, 95 % CI 0.22–0.78, p < 0.01). After 3 years of follow-up, adjusted cardiovascular mortality rates were similar between all groups, particularly between bivalirudin vs. UFH monotherapy (hazard ratio HR 1.12, 95 % CI 0.58–2.16, p = 0.73) and vs. UFH + abciximab (HR 0.91, 95 % CI 0.40–2.10, p = 0.83). Acute or subacute stent thrombosis occurred at a rate of 0.8 % with no significant differences between the groups. Conclusions This retrospective analysis in a real world situation of medium to high-risk ACS patients undergoing invasive revascularization confirmed the results of most large-scale randomized trials by demonstrating reduced bleeding rates in favor of bivalirudin vs. UFH + GPI but with no significant differences between treatment strategies for long-term all-cause and cardiovascular mortality.

Published
2016

29. Safety and efficacy of pharmacological cardioversion of recent-onset atrial fibrillation: a single-center experience

Author

R. Kriz, Florian Egger, Kilian Huber, Johannes Koch, Susanne C. Gruber, Matthias K. Freynhofer, P. Eisenburger, Thomas W. Weiss, and Johann Wojta

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Ibutilide, 030204 cardiovascular system & hematology, Amiodarone, Cardioversion, Vernakalant, Electrocardiography, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Atrial Fibrillation, medicine, Humans, Prospective Studies, Prospective cohort study, Stroke, Aged, business.industry, 030208 emergency & critical care medicine, Atrial fibrillation, General Medicine, Odds ratio, Middle Aged, medicine.disease, Treatment Outcome, chemistry, Emergency Medicine, Cardiology, Female, business, Anti-Arrhythmia Agents, Follow-Up Studies, medicine.drug
Abstract

The management of patients with recent-onset atrial fibrillation (AF) presenting at emergency departments (EDs) varies widely. Our aim was to describe the management of patients with recent-onset (48 hours) AF, to determine safety and efficacy of pharmacological cardioversion at the ED, and to evaluate the incidence of thromboembolism or death at 30 days.In a prospective, observational, single-center study, 236 subjects with recent-onset AF were consecutively enrolled from January 2011 until January 2013. Follow-up information was obtained by reviewing all available clinical records.As first-line therapy, 45.3% (n = 107) received ibutilide, 28.8% (n = 68) vernakalant, 25% (n = 59) flecainide, and 0.8% (n = 2) amiodarone, respectively. Successful cardioversion was achieved in 72.5% (n = 171) of patients after first-line therapy. There was no significant difference between treatment groups. In univariable logistic regression analysis, age (odds ratio [OR] = 1.027; 95% confidence interval [CI], 1.003-1.052; P= .03), duration of symptoms (OR = 0.968; 95% CI, 0.938-0.999; P= .045), as well as the CHA2DS2-VASc score (1 point for Congestive heart failure, Hypertension, Age between 65 and 74 years, Diabetes, Vascular disease, Sex category if female and 2 points for previous TIA/Stroke and Age ≥ 75 years) (OR = 1.237; 95% CI, 1.01-1.515; P= .04) were associated with success of pharmacological cardioversion. Within 30 days, 1 patient suffered from fatal ischemic stroke.Pharmacological cardioversion followed by discharge after a short observation period is safe. There was no significant difference between the agents used in terms of short-term safety and efficacy. Importantly, the coherence of the ED to recent guidelines regarding first-line therapy is high.

Published
2016

30. The effect of temperature and moisture on trace gas emissions from deciduous and coniferous leaf litter

Author

Florian Egger, Christine Gritsch, Sophie Zechmeister-Boltenstern, and Franz Zehetner

Subjects
Atmospheric Science, Biogeochemical cycle, 010504 meteorology & atmospheric sciences, Soil Science, Soil science, Aquatic Science, 01 natural sciences, Methane, chemistry.chemical_compound, 0105 earth and related environmental sciences, Water Science and Technology, Ecology, Moisture, Paleontology, Forestry, 04 agricultural and veterinary sciences, Nitrous oxide, Plant litter, Deciduous, chemistry, Environmental chemistry, Carbon dioxide, 040103 agronomy & agriculture, Litter, 0401 agriculture, forestry, and fisheries, Environmental science
Abstract

The forest litter layer lies at the boundary between soil and atmosphere and is a major factor in biogeochemical cycles. While there are several studies on how the litter layer controls soil trace gas emissions, litter emissions itself are less well understood, and it is still unclear how important gases respond to changing temperature and moisture. In order to assess leaf litter gas exchange, we conducted laboratory incubation experiments in which the full set of climate relevant gases, i.e., carbon dioxide (CO2), nitrous oxide (N2O), methane (CH4), and nitric oxide (NO) coming from deciduous and coniferous leaf litter were measured at five temperatures and seven moisture contents. In addition, we compared litter and soil from different origin in terms of temperature/moisture responses of gas fluxes and investigated possible interactions between the two climate factors. Deciduous litter emitted more CO2 (up to 335 mg CO2-C kg−1 h−1) than coniferous litter, whereas coniferous litter released maximum amounts of NO (207 µg NO-N kg−1 h−1). N2O was only emitted from litter under very moist and warm conditions (>70% wet weight, >10°C). CH4 emissions were close to zero. Temperature sensitivities of litter emissions were generally lower than for soil emissions. Nevertheless, wet and warm conditions always enhanced litter emissions, suggesting a strong feedback effect of the litter layer to predicted future climate change.

Published
2016

31. Activated protein C levels and outcome in patients with cardiogenic shock complicating acute myocardial infarction

Author

Rudolf Jarai, Gerlinde Zorn, Alexander Geppert, Matthias K. Freynhofer, Peter Smetana, Barbara Fellner, Florian Egger, Thomas Weiss, Kurt Huber, and Miklos Rohla

Subjects
Male, medicine.medical_specialty, Myocardial Infarction, Shock, Cardiogenic, 030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, 03 medical and health sciences, High morbidity, 0302 clinical medicine, Internal medicine, medicine, Humans, Vasoconstrictor Agents, In patient, 030212 general & internal medicine, Myocardial infarction, Severe sepsis, Aged, Interleukin-6, business.industry, Cardiogenic shock, General Medicine, Middle Aged, Prognosis, medicine.disease, Troponin, Surgery, Shock (circulatory), Acute Disease, Circulatory system, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business, Protein C, medicine.drug
Abstract

In patients with severe sepsis, low levels of activated protein C are associated with high morbidity and mortality. In an observational study we investigated whether patients with cardiogenic shock have decreased circulatory levels of activated protein C, and if these are associated with increased mortality.We measured serum activated protein C and interleukin-6 levels in 43 patients with cardiogenic shock following acute myocardial infarction and in 15 control patients with uncomplicated myocardial infarction at days 0-5 and 7 after the onset of shock/myocardial infarction.Activated protein C levels were significantly lower in patients with cardiogenic shock compared to controls. In cardiogenic shock patients, there was no difference in activated protein C levels at baseline, whereas activated protein C levels significantly declined in 28-day non-survivors at day 2, compared with 28-day survivors. Lower levels of activated protein C were associated with a higher degree of vasopressor need, whereas there was no significant association with multiple organ failure in the first days. Regarding the inflammatory response, a strong inverse correlation was observed between interleukin-6 and activated protein C levels.Patients with cardiogenic shock who did not survive up to 28 days showed a decline in activated protein C levels during the course of the disease, which was inversely correlated with interleukin-6. This study underlines sustained inflammatory mechanisms in the development and persistence of cardiogenic shock, highlighting a potential effect of anti-inflammatory interventions early during cardiogenic shock.

Published
2016

33. Twenty-four-hour time dependency of clopidogrel effects in patients with acute coronary syndromes: The CiCAD-Study

Author

Martin Willheim, Thomas Weiss, Wolfgang Hübl, Susanne C. Gruber, Florian Egger, Kurt Huber, and Matthias K. Freynhofer

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Time Factors, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Medicine, Humans, Platelet, Mean platelet volume, Acute Coronary Syndrome, Receptor, Morning, Aged, Aspirin, business.industry, Maintenance dose, Hematology, General Medicine, Clopidogrel, 030104 developmental biology, Pharmacodynamics, Cardiology, Female, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract

Long-term evidence shows an increased risk of cardiovascular events in the morning hours and recent studies in aspirin-treated patients have shown increased platelet reactivity at the end of the dosing interval. Similar pharmacodynamic analyses of adenosine-diphosphate (ADP) receptor inhibitors are scarce. We therefore investigated changes in clopidogrel-dependent platelet function and activation over 24 h and whether enhanced platelet turnover might explain diurnal variability of platelet function and activation. Twenty-one patients after acute coronary syndromes (ACS) on maintenance doses of clopidogrel (75 mg) and aspirin (100 mg) Once per day (OD) were included. Blood was collected at five time points in 24 h. Platelet function and activation was analyzed by vasodilator-stimulated phosphoprotein-phosphorylation (VASP-P), Verify Now, multiple electrode aggregometry (MEA), and platelet PAC-1 and P-selectin (P-sel) expression. Additionally, platelet count, mean platelet volume (MPV), and reticulated platelet fraction (RPF) were analyzed. There was significant diurnal variability of clopidogrel effects as documented with VASP-P, Verify Now, and PAC-1 and P-sel (all p

Published
2018

34. Reply

Author

David Zweiker, Florian Egger, and Kurt Huber

Subjects
medicine.medical_specialty, Transcatheter aortic, business.industry, medicine.medical_treatment, 030204 cardiovascular system & hematology, Cardiac surgery, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Internal medicine, Heart team, medicine, Cardiology, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business
Abstract

With great interest, we read the letter by Dr. Lozano and colleagues, as the current situation in Austria is comparable with the circumstances reported from Spain. According to a state-specific regulation, 2 of the 3 centers performing transfemoral (TF) transcatheter aortic valve replacement (TAVR)

Published
2019

35. Long-term mortality of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation for acute and stable coronary artery disease

Author

Florian Egger, Johann Wojta, Miklos Rohla, Serdar Farhan, Matthias K. Freynhofer, Thomas W. Weiss, Ioannis Tentzeris, Christoph Kleine Vennekate, Kurt Huber, and Christopher B. Granger

Subjects
Male, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Coronary Artery Disease, Revascularization, Cohort Studies, Coronary artery disease, Percutaneous Coronary Intervention, Risk Factors, Internal medicine, Atrial Fibrillation, Humans, Medicine, Sinus rhythm, Registries, Mortality, Aged, Aged, 80 and over, Aspirin, business.industry, Percutaneous coronary intervention, Atrial fibrillation, Middle Aged, Vitamin K antagonist, medicine.disease, Clopidogrel, Treatment Outcome, Cardiology, Female, Stents, Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

Patients with atrial fibrillation (AF) are of increased risk for ischemic and bleeding complications, particularly when requiring aggressive antithrombotic therapy after coronary stenting. However, data from unselected patients on long-term mortality are scarce.We analyzed 2890 patients of a single-center registry undergoing coronary stenting between 2003 and 2012, of whom 1434 patients had stable coronary artery disease (CAD), while 1456 patients presented with acute coronary syndromes (ACS). As the primary endpoint, we compared long-term all-cause mortality between patients with AF and patients in sinus rhythm.History or presence of AF was found in 146 (10.2%) patients with stable CAD and 93 (6.4%) patients with ACS. The median CHA2DS2-VASc scores were similar between stable CAD and ACS patients (4[2; 5] vs. 3[2; 5], p=0.92). Patients with AF had a significantly higher atherothrombotic risk profile and more co-morbidities. Patients undergoing PCI before 2011 received triple therapy (aspirin, clopidogrel and a vitamin K antagonist) in 25% of cases, compared to 64% of cases thereafter. Patients undergoing elective or urgent revascularization and suffering from AF had a similar 2-fold increased adjusted relative risk of death after a mean follow-up of 4.8 years (HR 1.95, 95% CI 1.27; 2.99, p0.01 for stable CAD and HR 1.95, 95% CI 1.23; 3.11, p0.01 for ACS).In a general practice setting, patients with AF had significantly increased adjusted long-term mortality than patients without AF. After publication of the consensus document of different working groups of the European Society of Cardiology in 2010, triple therapy increased markedly.

Published
2015

36. Contrast induced acute kidney injury in acute coronary syndrome patients: A single centre experience

Author

Kurt Huber, Rudolf Jarai, Alexandra Kautzky-Willer, Peter Smetana, Florian Egger, Birgit Vogel, Ioannis Tentzeris, Serdar Farhan, and Matthias K. Freynhofer

Subjects
Male, Acute coronary syndrome, medicine.medical_specialty, medicine.medical_treatment, media_common.quotation_subject, Contrast Media, Renal function, Comorbidity, 030204 cardiovascular system & hematology, Intra-Aortic Balloon Pumping, Critical Care and Intensive Care Medicine, 03 medical and health sciences, Percutaneous Coronary Intervention, 0302 clinical medicine, Predictive Value of Tests, Risk Factors, Internal medicine, medicine, Humans, Contrast (vision), Prospective Studies, 030212 general & internal medicine, Acute Coronary Syndrome, Aged, Proportional Hazards Models, media_common, business.industry, Cardiogenic shock, Acute kidney injury, Percutaneous coronary intervention, General Medicine, Acute Kidney Injury, Middle Aged, medicine.disease, Single centre, Cardiology, Kidney Failure, Chronic, Female, Cardiology and Cardiovascular Medicine, business
Abstract

The aim of the study was to investigate predictors of contrast induced acute kidney injury, in-hospital and long-term mortality in patients with acute coronary syndrome treated by percutaneous coronary intervention.We investigated 536 consecutive patients with acute coronary syndrome who underwent percutaneous coronary intervention. Contrast induced acute kidney injury was classified according to risk, injury, failure, loss of kidney function and end-stage kidney disease/acute kidney injury network (RIFLE/AKIN) criteria into those with normal kidney function, risk, RIFLE stage I and those with stage ⩾ II. We investigated in-hospital, all-cause mortality during index hospitalization and long-term all-cause mortality during the follow-up period of 94 months (interquartile 81.6-108.9 months) in adjustment with parameters of the Global Risk of Acute Coronary Events score.Patients with contrast induced acute kidney injury had worse baseline clinical characteristics and displayed more co-morbidities than patients with normal kidney function. In multivariate logistic regression analysis intra-aortic balloon pump use, congestive heart failure, age75 years and admission serum creatinine1.5mg/dl were independent predictors of contrast induced acute kidney injury development. contrast induced acute kidney injury RIFLE stage ⩾ II was an independent predictor of in-hospital mortality (odds ratio 33.16, confidence interval 1.426-770.79, p=0.029) and long-term mortality (hazard ratio 4.713, confidence interval 1.53-14.51, p=0.007) even after adjustment for confounders (variables of Global Risk of Acute Coronary Events score).Contrast induced acute kidney injury is a common complication of acute coronary syndrome patients treated by percutaneous coronary intervention. Advanced deterioration in renal function after percutaneous coronary intervention is an independent predictor for in-hospital and long-term mortality.

Published
2015

37. Platelet turnover predicts outcome after coronary intervention

Author

Florian Egger, Veronika Bruno, Wolfgang Hübl, Martin Willheim, Matthias K. Freynhofer, Kurt Huber, Miklos Rohla, Thomas W. Weiss, Johann Wojta, and Liana Iliev

Subjects
Male, Time Factors, Platelet Aggregation, medicine.medical_treatment, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, 0302 clinical medicine, Multiplate, Risk Factors, Odds Ratio, Medicine, Myocardial infarction, Prospective Studies, Phosphorylation, Reticulated platelets, Aged, 80 and over, Aspirin, Microfilament Proteins, Hematology, Middle Aged, Clopidogrel, Treatment Outcome, 030220 oncology & carcinogenesis, Cardiology, Drug Therapy, Combination, Female, Stents, medicine.drug, Coagulation and Fibrinolysis, Blood Platelets, medicine.medical_specialty, Ticlopidine, VASP-P, Hemorrhage, 03 medical and health sciences, Percutaneous Coronary Intervention, Internal medicine, Humans, cardiovascular diseases, Mean platelet volume, Aged, Chi-Square Distribution, mean platelet volume, business.industry, Percutaneous coronary intervention, Odds ratio, medicine.disease, Phosphoproteins, Platelet Activation, dual antiplatelet therapy, Surgery, Logistic Models, Conventional PCI, Multivariate Analysis, Linear Models, Purinergic P2Y Receptor Antagonists, business, Cell Adhesion Molecules, Mace, Biomarkers, Platelet Aggregation Inhibitors
Abstract

SummaryElevated platelet turnover contributes to high platelet reactivity. High platelet reactivity after percutaneous coronary intervention (PCI) is associated with major adverse cardiovascular events (MACE). The purpose of this study was to determine the prognostic value of platelet turnover and function with regard to MACE after PCI with stent implantation. In this prospective observational study, 486 consecutive patients after PCI on aspirin and clopidogrel were included to determine platelet turnover (mean platelet volume (MPV), reticulated platelet fraction (RPF)) and platelet function (multiple electrode aggregometry (MEA), vasodilator-stimulated phosphoprotein-phosphorylation (VASP-P) assay). At six-months follow-up, MACE occurred in 10.7 % of patients. RPF (odds ratio [OR]=1.173 (95% confidence interval [CI 95 %] 1.040–1.324), p=0.009) and MPV (OR=1.459 (CI 95 % 1.059–2.008), p=0.021) were univariable predictors of MACE, whereas VASP-P (OR=1.016 (CI 95 % 1.000–1.032), p=0.052) and MEA (OR=0.999 (CI 95 % 0.980–1.017), p=0.895) failed to predict MACE. RPF remained the only platelet variable independently associated with MACE. The best model to predict MACE included: troponin I (OR=1.007 (CI 95 % 1.002–1.012), p=0.009), RPF (OR=1.136 (CI 95 % 1.001–1.288), p=0.048), CRP (OR=1.008 (CI 95 % 1.001–1.014), p=0.023) and history of myocardial infarction (OR=2.039 (CI 95 % 1.093–3.806), p=0.025). RPF (OR=1.211 (CI 95 % 1.042–1.406), p=0.012) was also independently associated with in-hospital bleedings. In conclusion, RPF as index of platelet turnover is an independent predictor of MACE and bleeding events in PCI patients on dual antiplatelet therapy. Since RPF can reliably be quantified along with routine haemograms, RPF might easily be applied in the setting of cardiovascular risk prediction.

Published
2016

38. Implementation of a Dynamic Mining Strategy Following Changing Conditions in a Multipit, Multielement Blending Iron Ore Mining Operation

Author

Florian Egger

Subjects
Flexibility (engineering), business.industry, media_common.quotation_subject, General Medicine, General Chemistry, engineering.material, Crusher, Term (time), Lead (geology), Mining engineering, Iron ore, Range (aeronautics), engineering, Production (economics), Quality (business), business, media_common
Abstract

The Greater Paraburdoo operation is part of the Pilbara Iron Ore operations comprising of a network of 11 mines, three shipping terminals and a heavy freight railway. The Paraburdoo, Channar and Eastern Range mines are located in close proximity to one another, and are operated as the Greater Paraburdoo operation. Ore is sourced from close to 20 pits and other material is dumped and stockpiled at more than 50 waste dumps and low grade stockpiles. During 2008 to 2009, changing geological conditions, increased quality targets, geotechnical challenges, delays in approvals and assumptions in the mine plan, lead to a delay in developing new mining areas in Eastern Range posing a high risk to achieve future production targets. A new strategy was developed during 2009 to increase the number of independent mining areas in Eastern Range mine and to increase the number of pit accesses. Major changes have been applied to the Section-A development strategy to achieve short to long term production targets and during 2010 five milestones of the development strategy have been implemented. The key benefits were a 9 % increase of forecasted crusher feed from Eastern Range mine, a decrease of batter works and bench turnover delays of 46 % in Section-A and an average increase of 1.5 years of additional time per mining area to utilize independent accesses, enabling multi bench mining and increasing blending options. Although the implementation of the new development strategy for Section-A started in Q4-2009, it will take two years to decrease the production time per mining area by 20 %. In order to avoid high risk production periods it is critical to understand reasons and consequences of nonconformances to the mine plan. Appropriate actions can only be taken when considering impacts from a total system point of view in order to provide sufficient flexibility and buffer to absorb delays and changing conditions without posing a risk to achieve production targets.

Published
2011

39. Effects of Sodium Bicarbonate on High-Intensity Endurance Performance in Cyclists: A Double-Blind, Randomized Cross-Over Trial

Author

Tim Meyer, Anne Hecksteden, Ulf Such, and Florian Egger

Subjects
Male, medicine.medical_specialty, Veterinary medicine, Physiology, Science, Athletic Performance, law.invention, Material fatigue, Double blind, chemistry.chemical_compound, Young Adult, Oxygen Consumption, Randomized controlled trial, Double-Blind Method, law, Heart rate, medicine, Medicine and Health Sciences, Humans, Lactic Acid, Sports and Exercise Medicine, Exercise, Acid-Base Equilibrium, Multidisciplinary, Sodium bicarbonate, Cross-Over Studies, biology, Athletes, business.industry, High intensity, Biology and Life Sciences, biology.organism_classification, Crossover study, Bicycling, Sodium Bicarbonate, chemistry, Physical therapy, Physical Endurance, Medicine, Female, business, Research Article
Abstract

BackgroundWhile the ergogenic effect of sodium bicarbonate (BICA) on short-term, sprint-type performance has been repeatedly demonstrated, little is known about its effectiveness during prolonged high-intensity exercise in well-trained athletes. Therefore, this study aims to examine the influence of BICA on performance during exhaustive, high-intensity endurance cycling.MethodsThis was a single-center, double-blind, randomized, placebo-controlled cross-over study. Twenty-one well-trained cyclists (mean ± SD: age 24±8 y, BMI 21.3±1.7, VO2peak 67.3±9.8 ml·kg-1·min-1) were randomly allocated to sequences of following interventions: oral ingestion of 0.3 g·kg-1 BICA or 4 g of sodium chloride (placebo), respectively. One h after ingestion subjects exercised for 30 min at 95% of the individual anaerobic threshold (IAT) followed by 110% IAT until exhaustion. Prior to these constant load tests stepwise incremental exercise tests were conducted under both conditions to determine IAT and VO2peak. Analysis of blood gas parameters, blood lactate (BLa) and gas exchange measurements were conducted before, during and after the tests. The main outcome measure was the time to exhaustion in the constant load test.ResultsCycling time to exhaustion was improved (pConclusionThe results suggest that ingestion of BICA may improve prolonged, high-intensity cycling performance.Trial registrationGerman Clinical Trials Register (DRKS) DRKS00006198.

Published
2014

40. High-degree atrioventricular block in patients with preexisting bundle branch block or bundle branch block occurring during transcatheter aortic valve implantation

Author

Alexander Geppert, Ferdinand R. Waldenberger, Anton Bambazek, Jürgen Falkensammer, Kurt Huber, Susanne C. Gruber, Michael Nürnberg, Florian Egger, Matthias K. Freynhofer, Thomas W. Weiss, Miklos Rohla, Peter Smetana, and Gerhard Unger

Subjects
Male, medicine.medical_specialty, Pacemaker, Artificial, Bundle-Branch Block, Severity of Illness Index, Statistics, Nonparametric, Cohort Studies, Transcatheter Aortic Valve Replacement, Electrocardiography, Age Distribution, Physiology (medical), Internal medicine, Medicine, Animals, Humans, Prospective Studies, Sex Distribution, Atrioventricular Block, Intraoperative Complications, Aged, Ultrasonography, Aged, 80 and over, Transcatheter aortic valve implantation, Bundle branch block, Preexisting Condition Coverage, business.industry, Left bundle branch block, Incidence, EuroSCORE, Aortic Valve Stenosis, Right bundle branch block, medicine.disease, Survival Analysis, Surgery, Pacemaker, Stenosis, Treatment Outcome, Cardiology, cardiovascular system, Female, Left anterior fascicular block, Cardiology and Cardiovascular Medicine, business, Complication, Atrioventricular block, Follow-Up Studies
Abstract

Background Transcatheter aortic valve implantation (TAVI) has become the standard therapy for high-risk and non-operable patients with severe aortic stenosis. However, the procedure involves several adverse effects, such as rhythm and conduction disturbances. Patients with postprocedural left bundle branch block may have an increased mortality risk, whereas patients with preprocedural right bundle branch block display a higher rate of postinterventional bradyarrhythmias. Objective The purpose of this study was to investigate the occurrence of high-degree atrioventricular block (AVB) in patients with preexisting bundle branch block (BBB) or BBB occurring during TAVI. Methods In this prospective single-center study, 50 consecutive patients undergoing TAVI with the Medtronic CoreValve Revalving System were included. Of these patients, 17 with preexisting BBB or BBB occurring during TAVI received a primary prophylactic permanent DDD pacemaker, programmed to the SafeR-mode and featuring dual-channel event counters as well as stored intracardiac electrograms. Pacemaker readouts and intracardiac electrograms were analyzed for the occurrence of high-degree AVB. Results Ten of 17 patients (58.8%) with preexisting BBB or BBB occurring during TAVI developed episodes of high-degree AVB that were immediately terminated due to switch into DDD backup pacing. In 5 of the cases (29.4%), the first documented episode of high-degree AVB occurred after hospital discharge. Mean follow-up period was 578.1 ± 294.9 days. Conclusion Development of high-degree AVB is a common complication in patients with preexisting BBB or BBB occurring during TAVI. Accordingly, intensified monitoring might be reasonable, especially in patients treated with the self-expandable Medtronic CoreValve Revalving System.

Published
2014

42. Interindividual Variation in the Relationship of Different Intensity Markers—A Challenge for Targeted Training Prescriptions

Author

Anne Hecksteden, Florian Egger, and Tim Meyer

Subjects
Male, Physiology, Individuality, Social Sciences, lcsh:Medicine, Polynomials, Training (Education), 0302 clinical medicine, Sociology, Heart Rate, Reference Values, Adaptive Training, Statistics, Medicine and Health Sciences, Homeostasis, Public and Occupational Health, lcsh:Science, Mathematics, Multidisciplinary, VO2 max, Regression analysis, Hematology, Sports Science, Body Fluids, Chemistry, Blood, Physical Sciences, Constant load, Performance curves, Anatomy, Research Article, Chemical Elements, Physical Conditioning, Human, Adult, Cardiology, Education, 03 medical and health sciences, Oxygen Consumption, Humans, Sports and Exercise Medicine, Exercise, Relative intensity, lcsh:R, Univariate, Biology and Life Sciences, Physical Activity, 030229 sport sciences, Bicycling, Intensity (physics), Oxygen, Algebra, Physical Fitness, lcsh:Q, Physiological Processes, Biomarkers, 030217 neurology & neurosurgery
Abstract

Purpose Training intensities are frequently prescribed as relative workloads based on a single reference value (e.g. maximum oxygen uptake). However, exercise-induced physical strain is multifaceted and large interindividual variability in intensity markers has been reported for constant load exercise with standardized relative intensity. This questions the accuracy of (univariate) relative intensities in targeting specific training stimuli. The present trial aims to investigate interindividual variability in the relationship of strain indicators using interpolated performance curves derived from constant load tests at different workloads. This approach enables the prediction of other indicators based on a chosen reference and subsequent comparison of predictive accuracy between group-based and individualized regression models. Methods 15 competitive cyclists completed a stepwise incremental cycling test followed by 5 constant load tests with the same absolute workloads as in the stepwise incremental test. The highest of theses workloads which yielded a lactate (BLa) steady state was repeated enabling estimation of intraindividual variability. From constant load tests, the courses of BLa relative to the respective reference value (e.g. %VO2peak) were interpolated by polynomial regression. Variability between individual regression curves was analyzed by mixed modeling. Predictive accuracy was estimated as the sum of squared differences between predicted and observed values. Results The proportion of total variation in the course of BLa relative to the respective reference parameter accounted for by subject identity ranged between 36 and 51%. A significant increase in predictive accuracy was observed for VO2peak and HRmax, respectively, as predicting parameters. Conclusion These results are in support of a multivariable, individualized approach to intensity prescriptions when aiming at accurately targeted perturbations of homeostasis.

Published
2016

43. Fieldwork

Author

Frédéric Gaillard, Natalia Kirillova, Sylvia Barnard, Florian Egger, and Korey Johnson

Subjects
business.industry, media_common.quotation_subject, Plan (drawing), Public relations, Moderation, computer.software_genre, User Research, Presentation, Consistency (negotiation), Cultural diversity, Sociology, business, computer, Regional differences, Interpreter, media_common
Abstract

Publisher Summary This chapter discusses methods and guidelines for the planning and execution of common fieldwork activities. It provides examples of cultural differences between countries when sessions are run with a local moderator and translated material. It also addresses the need for sensitive localization of the moderation guide and the impact this has on the way questions are structured and presented, as well as how a skilled moderator asks these questions. Moderation is an important part of fieldwork activities in general and of global fieldwork in particular. To ensure standard moderation procedures, certain rules should be followed, and all involved members should know the objectives of the project. The project leader who is responsible for planning a global user research study should localize the research material to get consistent answers when asking questions in different languages and countries, adjust the presentation of certain types of questions between countries, evaluate the effects of localization on moderation in each country, maintain overall consistency in global moderation while being open to regional differences during moderation, pilot with skilled interpreters or translators, and plan for sessions that require an interpreter or a translator. Finally, this chapter illustrates some examples of templates for collecting data and highlights some tips to organize and share results with local teams.

Published
2010

44. Determinants and consequences of applying value-based performance measures: the German evidence

Author

Florian Egger, Matthias Giebelstein, and Jürgen Ernstberger

Subjects
Research design, Organizational Behavior and Human Resource Management, Exploit, business.industry, Accounting, Economic Value Added, Annual report, Business value, Management accounting, Economics, Performance measurement, business, Finance, Valuation (finance)
Abstract

This paper examines the determinants of applying value-based performance measures like economic value added (EVA) and the impact of applying these measures on firms' returns. Our research design exploits a unique situation in Germany, where a regulatory change requires firms to describe their performance measurement system in their annual report since 2006. Analysing these disclosures, we find that firm size and firm age have a positive impact on the propensity of applying value-based performance measures. In a second analysis, we are not able to document a positive influence of the application of value-based performance measures on firms' performance. However, we find a significant positive association with firm valuation when controlling for self-selection. The paper contributes to the literature, as it is the first to comprehensively investigate the determinants and consequences of applying value-based performance measures.

Published
2010

45. Seasonal dynamics of Atlantic herring (Clupea harengus L.) populations spawning in the vicinity of marginal habitats.

Author

Florian Eggers, Aril Slotte, Lísa Anne Libungan, Arne Johannessen, Cecilie Kvamme, Even Moland, Esben M Olsen, and Richard D M Nash

Subjects
Medicine, Science
Abstract

Gillnet sampling and analyses of otolith shape, vertebral count and growth indicated the presence of three putative Atlantic herring (Clupea harengus L.) populations mixing together over the spawning season February-June inside and outside an inland brackish water lake (Landvikvannet) in southern Norway. Peak spawning of oceanic Norwegian spring spawners and coastal Skagerrak spring spawners occurred in March-April with small proportions of spawners entering the lake. In comparison, spawning of Landvik herring peaked in May-June with high proportions found inside the lake, which could be explained by local adaptations to the environmental conditions and seasonal changes of this marginal habitat. The 1.85 km(2) lake was characterized by oxygen depletion occurring between 2.5 and 5 m depth between March and June. This was followed by changes in salinity from 1-7‰ in the 0-1 m surface layer to levels of 20-25‰ deeper than 10 m. In comparison, outside the 3 km long narrow channel connecting the lake with the neighboring fjord, no anoxic conditions were found. Here salinity in the surface layer increased over the season from 10 to 25‰, whereas deeper than 5 m it was stable at around 35‰. Temperature at 0-5 m depth increased significantly over the season in both habitats, from 7 to 14 °C outside and 5 to 17 °C inside the lake. Despite differences in peak spawning and utilization of the lake habitat between the three putative populations, there was an apparent temporal and spatial overlap in spawning stages suggesting potential interbreeding in accordance with the metapopulation concept.

Published
2014
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