Optimization of Preprocedural Full-cycle Computed Tomography in Patients Referred for Transcatheter Tricuspid Valve Repair: Test Bolus Versus Bolus Tracking.

PURPOSE/OBJECTIVES: Advancements in transcatheter mitral and tricuspid valve repair have resulted in growing demands in preprocedural computed tomography (CT) imaging. Due to the introduction of multidetector CT (MDCT), shorter acquisition times as well as high rates of heart failure and arrhythmias in this specific patient population, optimal synchronization between the passage of contrast agent and data acquisition is mandatory. There is no consensus on which acquisition technique should be used in this patient population. We aimed to optimize our preprocedural CT protocol comparing bolus tracking (BT) and test bolus (TB) techniques. MATERIALS AND METHODS: We performed a retrospective analysis on 151 patients referred for full-cycle MDCT evaluation for transcatheter tricuspid valve repair comparing BT with TB (BT n=75 TB n=75). Contrast-to-noise ratios (CNR) were obtained. Demographic data, laboratory, electrocardiographic, and transthoracic echocardiography/transoesophageal echocardiography parameters were collected from electronic health records. Also, the volume of contrast agent and saline chaser and radiation dose length product and milliampere seconds were collected. RESULTS: BT and TB resulted in comparable CNR (BT: 0.47 [0.34 to 0.98]; TB: 0.51 [0.41 to 1.40]; P =0.1). BT was associated with a shorter scan duration (BT: 8.3 min [4.1 to 24.4]; TB: 13.9 min [6.2 to 41.4]; P <0.001), less radiation in terms of dose length product (BT: 1186±585; TB: 1383±679, P =0.04), and lower total volume administration (BT: 101 mL [63 to 16]; TB: 114 mL [71 to 154]; P <0.001). In patients with severely impaired ejection fraction (left ventricular ejection fraction [LVEF] ≤35%; n=65 [TB n=31; BT n=34]) using the TB technique yielded significantly better image quality in terms of CNR (TB=0.57 [0.41 to 1.07); BT=0.41 [0.34 to 0.65]; P =0.02). CONCLUSION: In patients with impaired LVEF (LVEF≤35%), the TB technique yielded significantly superior image quality and may be the preferred approach in this specific patient population. BT showed advantages in terms of shorter duration, less radiation, and lower contrast agent volume.

Transcatheter Aortic Valve Replacement with the Self-Expandable Core Valve Evolut Prosthesis Using the Cusp-Overlap vs. Tricusp-View.

Despite the rapid increase in experience and technological improvement, the incidence of conduction disturbances in patients undergoing transcatheter aortic valve replacement (TAVR) with the self-expandable CoreValve Evolut valve remains high. Recently, a cusp-overlap view (COP) implantation technique has been proposed for TAVR with self-expandable valves offering an improved visualization during valve expansion compared to the three-cusp view (TCV). This study aims to systematically analyze procedural outcomes of TAVR patients treated with the CoreValve Evolut valve using a COP compared to TCV in a high-volume center. The primary endpoint was technical success according the 2021 VARC-3 criteria. A total of 122 consecutive patients (61 pts. TCV: April 2019 to November 2020; 61 pts. COP: December 2020 to October 2021) that underwent TAVR with the CoreValve Evolut prosthesis were included in this analysis. Although there was no difference in the primary endpoint technical success between TCV and COP patients (93.4% vs. 90.2%, OR 0.65, 95% CI 0.16, 2.4, p = 0.51), we observed a significantly lower risk for permanent pacemaker implantation (PPI) among COP patients (TCV: 27.9% vs. COP: 13.1%, OR 0.39, 95% CI 0.15, 0.97, p = 0.047). Implantation of the CoreValve Evolut prosthesis using the COP might help to reduce the rate of PPI following TAVR.

Heart failure from ATTRwt amyloid cardiomyopathy is associated with poor prognosis.

AIMS: Amyloid cardiomyopathy is an underappreciated cause of morbidity and mortality. Recent evidence suggests that ATTR wild-type cardiomyopathy (ATTRwt-CM) is probably much more common than widely appreciated. So far, no data are available on comparison of mortality from ATTRwt-CM and other heart failure aetiologies. METHODS AND RESULTS: This was a retrospective, observational, cohort study of 2251 patients and their data collected prospectively from May 2000 to June 2018. Long-term mortality was the main outcome measure. Underlying cardiomyopathies were classified as amyloid CM (6.1%) [ATTRwt 3.0%; light-chain amyloidosis (AL) 3.1%], dilated CM (dCMP) (46.4%), ischaemic heart disease (IHD) (24.4%), hypertensive heart disease (HHD) (14.6%), hypertrophic CM (HCM) (5.1%), and valvular heart disease (VHD) (3.4%). Median duration of follow-up was 7.1 years (interquartile range 3.4-11.3). Five-year overall survival in the whole cohort was 80.1%. In multivariate analysis, individuals with amyloid CM were 3.74 times [95% confidence interval (CI) 2.72-5.14; P < 0.001] more likely to die of any reason than were individuals with dCMP. Mortality was higher in AL-CM compared with ATTRwt-CM [hazard ratio (HR) 2.88; 95% CI 1.48-5.58; P = 0.002]. Mortality rates in patients with ATTRwt-CM were higher than in patients with dCMP (HR 1.96; 95% CI 1.24-3.22; P = 0.007), HCM (HR 2.94; 95% CI 1.28-6.67; P = 0.011), HHD (HR 2.08; 95% CI 1.27-3.45; P = 0.004), VHD (HR 2.38; 95% CI 1.30-4.35; P = 0.005), or left ventricular ejection fraction ≥ 40% (HR 1.99; 95% CI 1.12-3.52; P = 0.018). CONCLUSIONS: Our study demonstrates that amyloid CM is independently associated with poor survival among patients with various causes of heart failure. ATTRwt-CM had a better long-term prognosis than did AL-CM, but was associated with higher mortality than were dCMP, HCM, HHD, VHD, and heart failure with preserved or mid-range ejection fraction.

Characterization and quantification of odor-active compounds in unsaturated fatty acid/conjugated linoleic acid (UFA/CLA)-enriched butter and in conventional butter during storage and induced oxidation.

Dairy products enriched in unsaturated fatty acids (UFA) and conjugated linoleic acids (CLA) have a higher nutritional value and are suggested to have beneficial health effects. However, such acids are susceptible to oxidation, and off-flavors may be formed during storage. This study was aimed to compare the most important odorants in UFA/CLA-enriched butter to that of conventional butter during storage and induced oxidation. Volatiles were isolated by solvent-assisted flavor evaporation and identified by gas chromatography-olfactometry and mass spectrometry. Aroma extract dilution analysis revealed 18 odorants that were quantified by stable isotope dilution analysis. Another important odorant, 3-methyl-1H-indole (mothball-like odor), was quantified by high-performance liquid chromatography. After storage, UFA/CLA-enriched butter showed higher concentrations of pentanal (fatty), heptanal (green), butanoic acid (cheesy), and delta-decalactone (peach-like). Photo-oxidation of butter samples induced increases in heptanal, (E)-2-octenal, and trans-4,5-epoxy-(E)-2-decenal, especially in conventional butter. The higher vitamin content in UFA/CLA samples may protect this butter from oxidation.

Roasting and aroma formation: effect of initial moisture content and steam treatment.

Initial moisture of green coffee may vary as a function of green coffee processing and storage conditions. The impact of initial moisture and steam treatment on roasting behavior and aroma formation was investigated. Steam treated coffees as well as coffees with initial moisture content of 5.10, 10.04, and 14.70 g water per 100 g wb were roasted. Light and dark roasting trials were carried out using a fluidizing-bed roaster with a batch size of 100 g of green beans. Differences in roast coffee attributes, that is, color, density, and organic roast loss, and odorant concentrations were more marked in light roasted than in dark roasted coffees. The results of roasting steam treated coffee suggest that this step affects roasting behavior primarily by extracting some aroma precursor compounds.

Coffee roasting and aroma formation: application of different time-temperature conditions.

The impact of time-temperature combinations of roasting processes on the kinetics of aroma formation in coffee was investigated. The development of 16 aroma compounds and the physical properties of coffee beans was followed in a commercial horizontal drum roasting process and in laboratory scale fluidizing-bed roasting processes at high temperature-short time and low temperature-long time conditions. All trials were run to an equal roast end point as defined by the lightness of coffee beans. In addition, the effect of excessive roasting on aroma composition was studied. Compared to low temperature-long time roasting, high temperature-short time roasting resulted in considerable differences in the physical properties and kinetics of aroma formation. Excessive roasting generally led to decreasing or stable amounts of volatile substances, except for hexanal, pyridine, and dimethyl trisulfide, whose concentrations continued to increase during over-roasting. When the drum roaster and the fluidizing bed roaster were operated in the so-called temperature profile mode, that is, along the identical development of coffee bean temperature over roasting time, the kinetics of aroma generation were similar in both processes.

Influence of roasting conditions on the acrylamide content and the color of roasted almonds.

The influence of roasting conditions on the acrylamide content and on the color of roasted almonds of 3 cultivars was investigated. The temperature inside the almond kernel, the water content, the color, and the acrylamide content were determined at different roasting temperatures and times. The formation of acrylamide started only when the kernel temperature had exceeded approximately 130 degrees C. The activation energy for the acrylamide formation during the roasting of almonds was 123 kJ x mol(-1). The color as measured by the degree of brightness correlated well with the acrylamide content as acrylamide content increased with increasing darkness. Therefore, control of roasting temperature presents the critical factor for limiting the acrylamide concentration in the final product. At constant roasting conditions, almonds with higher initial moisture content contained less acrylamide after roasting, which is probably due to the influence of moisture on the development product temperature during roasting.

Occurrence of acrylamide in selected foods and mitigation options.

Acrylamide reduction in certain food products is an important issue for both the food industry and academic research institutions. The present paper summarises past and current research on the occurrence and reduction of acrylamide in potatoes, bakery products, almonds, olives and dried fruit. In potatoes, the control of reducing sugars, process temperature and moisture is imperative to limit acrylamide formation. In bakery products, free asparagine and the type of baking agent largely determine acrylamide formation and present the starting points for reduction. The application of asparaginase is promising in this respect because it acts only on the key precursor, asparagine, whereby the product character remains unchanged. The baking agent NH4HCO3 promotes acrylamide formation in sweet bakery but its replacement by NaHCO3 effectively decreases acrylamide concentrations. Temperature and free asparagine are the key factors for acrylamide formation in roasted almonds. Olives and dried fruit may contain acrylamide and large amounts of acrylamide can be formed upon heating these products, a phenomenon which needs further investigation.

Influence of water quench cooling on degassing and aroma stability of roasted coffee.

Coffee roasting experiments with air cooling versus water quench cooling were carried out on laboratory scale with a fluidized-bed hot air roasting system (200 g batch size) and on production scale with a rotating bowl roaster (320 kg batch size). Two series of coffees with different water contents resulted, which were stored at 25 degrees C under normal atmospheric conditions. Carbon dioxide desorption was followed and stability of selected aroma compounds was tested with headspace solid-phase microextraction-gas chromatography-mass spectrometry (SPME-GC-MS) and stable isotope labeled compounds as internal standards. Degassing is faster in water-quenched coffees with higher moisture content, but pore size distribution in the different coffee samples did not correlate with degassing behavior. Bean firmness, which increases with increasing moisture content, might have an influence on degassing. Air- and water-quenched coffees exhibit similar stability of most aroma compounds despite different degassing behavior. However, evolution of dimethyl trisulfide was different in coffees with increased water content. This suggests higher thiol oxidation rates, a factor that is cited to be related to a faster loss of freshness attributes.

Influence of thermal processing conditions on acrylamide generation and browning in a potato model system.

Fried potato products such as French fries and chips may contain substantial amounts of acrylamide. Numerous efforts are undertaken to minimize the acrylamide content of these products while sensory properties such as color and flavor have to be respected as well. An optimization of the frying process can be achieved if the basic kinetic data of the browning and acrylamide formation are known. Therefore, heating experiments with potato powder were performed under controlled conditions (moisture, temperature, and time). Browning and acrylamide content both increased with heating time at all temperatures and moisture contents tested. The moisture content had a strong influence on the activation energy of browning and acrylamide formation. The activation energy strongly increased at moisture contents below 20%. At higher moisture contents, it was very similar for both parameters. At low moisture contents, the activation energy of acrylamide formation was larger as compared to the one for browning. This explains why the end of the frying process is very critical. Therefore, a lower temperature toward the end of frying reduces the acrylamide content of the product while color development is still good.

Acrylamide in roasted almonds and hazelnuts.

The influences of composition and roasting conditions on acrylamide formation in almonds and hazelnuts were investigated. Eighteen samples of almonds originating from the U.S. and Europe were analyzed for sugars and free amino acids, and acrylamide formed during roasting was determined. Asparagine was the main free amino acid in raw almonds and correlated with the acrylamide content of dark roasted almonds. Roasting temperature was another key factor and had a very strong influence on acrylamide formation. Almonds of European origin contained significantly less free asparagine and formed significantly less acrylamide during roasting as compared to the almonds from the U.S. Roasted hazelnuts contained very little acrylamide because of the low content of free asparagine in the raw nut. Reducing sugars, although being consumed much faster than free amino acids in both types of nuts, were not decisive for the extent of acrylamide formation during roasting.

Factors influencing acrylamide formation in gingerbread.

The influence of ingredients, additives, and process conditions on the acrylamide formation in gingerbread was investigated. The sources for reducing sugars and free asparagine were identified and the effect of different baking agents on the acrylamide formation was evaluated. Ammonium hydrogencarbonate strongly enhanced the acrylamide formation, but its N-atom was not incorporated into acrylamide, nor did acrylic acid form acrylamide in gingerbread. Acrylamide concentration and browning intensity increased both with baking time and correlated with each other. The use of sodium hydrogencarbonate as baking agent reduced the acrylamide concentration by more than 60%. Free asparagine was a limiting factor for acrylamide formation, but the acrylamide content could also be lowered by replacing reducing sugars with sucrose or by adding moderate amounts of organic acids. A significant reduction of the acrylamide content in gingerbread can be achieved by using sodium hydrogencarbonate as baking agent, minimizing free asparagine, and avoiding prolonged baking.

Acrylamide in gingerbread: critical factors for formation and possible ways for reduction.

The influence of ingredients, additives, and process conditions on acrylamide formation in gingerbread was investigated. The sources for reducing sugars and free asparagine were identified, and the effect of different baking agents on acrylamide formation was evaluated. Ammonium hydrogencarbonate strongly enhanced acrylamide formation, but its N atom was not incorporated into acrylamide, nor did acrylic acid form acrylamide in gingerbread. Acrylamide concentration and browning intensity both increased with baking time and correlated with each other. The use of sodium hydrogencarbonate as baking agent reduced the acrylamide concentration by >60%. Free asparagine was a limiting factor for acrylamide formation, but the acrylamide content could also be lowered by replacing reducing sugars with sucrose or by adding organic acids. It is concluded that a significant reduction of acrylamide in gingerbread can be achieved by using sodium hydrogencarbonate as baking agent, minimizing free asparagine, and avoiding prolonged baking.

Potential of acrylamide formation, sugars, and free asparagine in potatoes: a comparison of cultivars and farming systems.

Glucose, fructose, sucrose, free asparagine, and free glutamine were analyzed in 74 potato samples from 17 potato cultivars grown in 2002 at various locations in Switzerland and different farming systems. The potential of these potatoes for acrylamide formation was measured with a standardized heat treatment. These potentials correlated well with the product of the concentrations of reducing sugars and asparagine. Glucose and fructose were found to determine acrylamide formation. The cultivars showed large differences in their potential of acrylamide formation which was primarily related to their sugar contents. Agricultural practice neither influenced sugars and free asparagine nor the potential of acrylamide formation. It is concluded that acrylamide contents in potato products can be substantially reduced primarily by selecting cultivars with low concentrations of reducing sugars.