bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9109: Incremental Prognostic Value of MDCT Findings for Predicting Symptomatic Deterioration and Major Adverse Cardiac Events in Patients with Aortic Stenosis
Authors: Utsunomiya Hiroto , Yamamoto Hideya , Kunita Eiji , Urabe Yoji , Tsushima Hiroshi , Ishibashi Ken , Hidaka Takayuki , Oda Noboru , Dohi Yoshihiro , Nishioka Kenji , Kurisu Satoshi , Nakano Yukiko , Ishida Takafumi , Kihara Yasuki
Published: April 2024

Background:
Currently, management of aortic stenosis (AS) is based on the presence of symptoms, disease severity (peak transaortic velocity; V
peak
) and left ventricular (LV) function determined by echocardiography, and the concomitant coronary artery disease detected by cardiac catheterization. Multidetector computed tomography (MDCT) can provide a simultaneous evaluation of valvular morphology, ventricular function, and coronary anatomy. We sought to determine the prognostic value of MDCT findings in patients with AS and, in particular, the incremental prognostic value as compared with clinical symptoms and V
peak
.

Methods:
A total of 46 patients (74 ± 7 years; 61% women)with AS underwent echocardiography and 64-MDCT to evaluate aortic valve area (AVA), LV ejection fraction, LV mass index (LVMI), the presence of obstructive coronary artery disease, and aortic valve calcification score (AVCS). Patients were followed up as to symptomatic deterioration and major adverse cardiac events (cardiac death, nonfatal myocardial infarction, aortic valve replacement (AVR), and heart failure requiring hospitalization).

Results:
V
peak
averaged 3.53 ± 1.16 m/sec (range, 1.97 to 6.21 m/sec). During a mean follow-up of 21.8 ± 13.2 months, 21 events occurred in 19 patients (6 symptomatic deterioration, 3 cardiac death, 3 unstable angina, 6 AVR, and 3 heart failure). V
peak
measured by echocardiography showed a statistically significant incremental prognostic value as compared to baseline clinical symptoms (p = 0.006), whereas MDCT provided an additional incremental prognostic value as compared with baseline clinical symptoms plus V
peak
if considering both MDCT-derived AVA (per 0.1cm
2
decrease, HR [95%CI] 1.14 [1.01-1.28], p = 0.031; incremental value, p = 0.027), or better, MDCT-derived LVMI (per 1-SD increase, 2.04 [1.27-3.27], p = 0.003; incremental value, p = 0.006). Among cardiac MDCT findings, AVCS measured by non-contrast enhanced CT had the strongest incremental prognostic value (per 100 Agatston Unit increase, 1.21 [1.11-1.32], p < 0.001; incremental value, p < 0.0001).

Conclusions:
MDCT provides independent and incremental prognostic information as compared to baseline clinical symptoms and echocardiographic V
peak
in patients with AS.
Abstract 9146: Antithrombotic Use and Outcomes in Patients with Atrial Fibrillation Complicating Acute Coronary Syndromes
Authors: Lopes Renato D , White Jennifer A , Atar Dan , Keltai Matyas , Kleiman Neal S , White Harvey D , Widimsky Petr , Zeymer Uwe , Jackson Kevin , Giugliano Robert P , Tricoci Pierluigi , Braunwald Eugene , Gibson C. M , Bode Christoph , Ohman E. M , Armstrong Paul W , Van de Werf Frans , Harrington Robert A , Newby L. K
Published: April 2024

Background:
Little is known about the use of oral anticoagulant and antiplatelet agents in patients with atrial fibrillation (AF) complicating non-ST-segment elevation (NSTE) ACS.

Methods:
We examined the occurrence and timing of AF and use of antithrombotic therapy in 9242 high-risk NSTE ACS patients randomized in EARLY ACS to early eptifibatide vs. delayed provisional use at PCI for whom AF information was available. Logistic regression with a landmark approach examined the association of AF within 7 days after ACS with death at 30 days. Adjusted models considered important clinical variables available prior to the 7-day landmark period.

Results:
Overall, 550 patients (6.0%) had AF as an in-hospital complication. AF events occurred at a median of 4 (2, 8) days after ACS, and 395 (72%) AF events occurred within 7 days. AF patients were older (median age 72 vs. 67 years), had worse renal function (median eCrCl 66 vs. 74 ml/min), more frequently had elevated troponin at baseline (90 vs. 83%), and more often had diabetes (34 vs. 30%), HTN (74 vs. 71%), or history of heart failure (15 vs. 12%) compared with patients without AF. The table shows rates of discharge antiplatelet and antithrombotic therapy. Among AF patients, 87% received aspirin at discharge, 48% received clopidogrel, and 19% received warfarin. Triple therapy (combination of aspirin, clopidogrel, and warfarin) was used in only 5.7%. After adjusting for clinical variables, in-hospital AF within 7 days post ACS was associated with nearly 5-fold higher risk for death between 7 and 30 days (HR 4.83, 95% CI 3.06-7.62).

Conclusions:
AF complicated 6% of post-ACS patients and was associated with substantially greater risk for death at 30 days. The majority of AF patients did not receive oral anticoagulation with antiplatelet agents at discharge, highlighting unmet needs to better optimize antithrombotic therapy at hospital discharge in these patients.
Abstract 9148: Inhibition of Endothelial Senescence Ameliorates Insulin Resistance of Obese Mice
Authors: Yokoyama Masataka , Minamino Tohru , Okada Sho , Tateno Kaoru , Moriya Junji , Shimizu Ippei , Nojima Aika , Ito Takashi , Ogasawara Yoko , Komuro Issei , Kobayashi Yoshio
Published: April 2024

Various stimuli can induce irreversible cell growth arrest, termed cellular senescence. This response is controlled by negative regulators of the cell cycle such as p53. Accumulating evidence suggests a potential relationship between cellular senescence and age-associated diseases including type 2 diabetes. Here we show a crucial role for endothelial p53 in the regulation of insulin resistance. We found that treatment of endothelial cells with high glucose and palmitate synergistically increased p53 expression. Consistent with the in vitro results, endothelial expression of p53 was markedly up-regulated when the mice were fed a high-calorie diet, suggesting that excessive calorie intake promotes endothelial senescence. To investigate the role of endothelial p53 in type 2 diabetes, we analyzed metabolic parameters in endothelial cell-specific p53 conditional knockout (ECp53CKO) mice on a high-calorie diet. In spite of no difference in dietary intake, ECp53CKO mice had a significantly smaller weight and less fat accumulation than control mice. Moreover, ECp53CKO mice showed better insulin sensitivity and glucose tolerance than control littermates. ECp53CKO mice demonstrated a significant increase in oxygen consumption and had a higher core body temperature compared with control mice. Next we considered some assumed mechanisms of relationship between endothelial cell p53 expression and metabolic disorders. As a result, we found that ECp53CKO mice had higher glucose uptake in skeletal muscles than control. These results indicate that inhibition of endothelial senescence ameliorates insulin resistance by increasing energy consumption via glucose uptake and suggest that endothelial p53 will be a novel therapeutic target for type 2 diabetes.
Abstract 9155: Intravenous Adenosine Reveals Arrhythmogenic Foci in Patients with Atrial Fibrillation Undergoing Radiofrequency Catheter Ablation
Authors: Tsuboi Ippei , Miyauchi Yasushi , Hayashi Meiso , Takahashi Kenta , Uetake Shunsuke , Hayashi Hiroshi , Nakatsuji Ayano , Murata Hiroshige , Yamamoto Teppei , Horie Tsutomu , Katoh Takao , Mizuno Kyoichi
Published: April 2024

Background:
Intravenous adenosine often induces atrial fibrillation (AF). However, the role of adenosine in patients with AF undergoing radiofrequency ablation is not determined. We tested the hypothesis that intravenous adenosine reveals culprit site for AF.

Method:
We included 75 consecutive patients (57 male, 62±10 years) with symptomatic AF undergoing pulmonary vein (PV) isolation for either paroxysmal (N=63) or persistent (N=12) AF in whom PV venography was performed during sinus rhythm. For PV venography, intravenous adenosine triphosphate (ATP) at a dose of 40mg was administered to produce transient asystole. We determined the incidence and origin of ectopic beats emerged after intravenous ATP utilizing simultaneous recording of the left and right superior PVs, left inferior PV, coronary sinus, right atrial free wall, septum and superior vena cava (Figure). For each PV, a straight 10-pole catheter was used to determine the longitudinal activation sequence.

Results:
Repetitive beats initiating AF (RBAF) or single to triplet of premature beats (SPB) were induced within 1 minute after administration of ATP in 29 patients (39%) and 57 patients (76%), respectively. In 22 patients with RBAF from the PVs, the AF-free rate after 1.3±0.5 sessions of PVI was 86%, whereas that in 7 patients with extra-PV RBAF was 57% (P= 0.15). A total of 111 SPB origin was identified in 57 patients. The origin of 37 SPBs was in the PV, and that of the remaining 74 SPB was outside the PV. The AF-free rate in patients with SPB restricted in the PVs was 88%, and that with extra-PV SPB was 78% (P= 0.52) after PVI. In 9 patients in whom neither RBAF nor SPB was induced by ATP, AF-free rate was 67%.

Conclusion:
In most patients, RBAF or SPB could be induced by intravenous ATP within 1 minute from the injection, revealing culprit site for AF. Induction of extra-PV RBAF or non-inducibility of either RBAF or SPB correlates with higher incidence of recurrence. However, extra-PV SPB is less significant.
Abstract 9179: Free Oxidized Fatty Acids Contribute to Pro-Inflammatory HDL
Authors: Van Lenten Brian J , Wagner Alan C , Reddy Srinivasa T , Navab Mohamad , Fogelman Alan M
Published: April 2024

Background:
Based on previous studies we thought it likely that the content of oxidized phospholipids would be elevated in pro-inflammatory HDL. While total plasma levels of oxidized phospholipids were increased in mouse models of atherosclerosis and in humans with coronary heart disease (CHD), the content of these oxidized phospholipids in HDL was NOT increased. This led us to look for other lipid components of HDL that might contribute to pro-inflammatory HDL.

Methods &Results:
HDL was isolated from sucrose-cryopreserved plasma by ultracentrifugation in the presence of anti-oxidants. The content of free 5-HETE, 9-HETE, 12-HETE, 15-HETE, 9-HODE, and 13-HODE were determined by LC-MS/MS and found to be significantly (p<0.0001; p = 0.0008; p = 0.0289; p = 0.0028; p = 0.0052; and p = 0.0029, respectively) elevated in HDL of 10 patients with CHD (all of whom had pro-inflammatory HDL as determined by cell-based assay) compared to 10 healthy controls (all of whom had anti-inflammatory HDL as determined by cell-based assay). To determine if free oxidized fatty acids contributed to the formation of pro-inflammatory HDL these oxidized fatty acids were added to anti-inflammatory HDL in amounts similar to that found in the CHD patients. The addition of 5-HETE, 9-HETE, and 15-HETE significantly (p = 0.0199; p = 0.0249; p = 0.0382, respectively) reduced the ability of the anti-inflammatory HDL to inhibit cytokine production in cultures of human aortic endothelial cells exposed to oxidized phospholipids. In contrast, addition of saturated non-oxidized free fatty acids such as decanoic or stearic acid did not alter the anti-inflammatory properties of HDL.

Conclusions:
These results suggest that i) HDL from CHD patients contains elevated levels of free oxidized fatty acids; ii) Free oxidized fatty acids can convert anti-inflammatory HDL to pro-inflammatory HDL.
Abstract 9180: HMG-CoA Reductase Inhibitor Stabilizes Mast Cells and Attenuates Atrial Fibrillation in Stressed Hearts
Authors: Fujimoto Masanori , Akazawa Hiroshi , Nagai Toshio , Kobayashi Yoshio , Nakaya Haruaki , Komuro Issei
Published: April 2024

Atrial fibrillation (AF) is a common arrhythmia, which increases the risk of stroke and heart failure. We previously reported that mast cells play a pathogenic role in atrial fibrosis and AF inducibility in transverse aortic constriction (TAC)-operated mice. On the other hand, it has been reported that treatment with HMG-CoA reductase inhibitors significantly decreased the incidence of postoperative AF after cardiac surgery. To explore the potential use of HMG-CoA reductase inhibitors in the upstream therapy for AF, we investigated whether pitavastatin could stabilize mast cells and thereby prevent the occurrence of AF in TAC-operated mice. Pressure overload induced interstitial fibrosis in atrium, and electrical stimulation on atrium evoked AF under Langendorff perfusion. However, treatment with pitavastatin (3 mg/kg/day) remarkably attenuated both atrial fibrosis and AF inducibility in pressure-overloaded mice. In addition, pressure overload induced mast cell degranulation and macrophage infilatration in atrium, which was associated with increased mRNA levels of MCP-1, IL-6, IFN-γ, TNF-α and PDGF-A. Notably, activation of mast cells and macrophages, as well as up-regulations of these inflammatory cytokines and growth factors, in atrium of TAC-operated mice was almost completely inhibited by pitavastatin treatment. Endothelin-1, known as potent mast cell activator, is up-regulated in atrium after TAC operation, and ET-1-induced degranulation in mouse peritoneal cavity-derived mast cells was significantly inhibited by treatment with pitavastatin (5 μM). These results suggest that pitavastatin suppresses mast cell activation both in vitro and in vivo, and thereby alleviates atrial fibrosis and AF inducibility through inhibition of cytokine production and macrophage infiltration in atrium of pressure-overloaded mice.
Abstract 9191: MicroRNA-150 is Essential in the Regulation of Blood Pressure
Authors: Zuo Zhong , Lei Han , Sun Zhongjie
Published: April 2024

Background & Hypothesis.
Micro RNAs are small noncoding RNAs that regulate protein expression at the post-transcriptional level. The purpose of this study was to determine if microRNA-150 (miR-150) plays a role in the regulation of blood pressure (BP).

Methods & Results.
We found that knockout of miR-150 resulted in a significant increase in systolic, diastolic and mean BP in mice. Vascular relaxing responses to acetylcholine were decreased significantly in miR-150 knockout (miR150-KO) mice, suggesting impaired endothelial function. Therefore, miR-150 is essential in the maintenance of normal BP and endothelial function. MiR150-KO was accompanied by a significant increase in NADPH oxidase activity and superoxide production in aortas and kidneys. MiR150-KO mice demonstrated vascular and renal remodeling. Interestingly, miR150-KO significantly increased Cyp11β2 protein expression in adrenal cortex, suggesting that miR-150 is a negative regulator of Cyp11β2. Plasma level of aldosterone was elevated in the miR150-KO mice. It was noted that daily treatment with aldosterone receptor blockade eplerenone (EPL) effectively reversed hypertension, endothelial dysfunction, increases in NADPH oxidase activity and superoxide production, and vascular and renal damage in miR150-KO mice.

Conclusions.
These results suggest that miR150-KO-inudced hypertension may be mediated by the upregulation of Cyp11β2 expression which led to increased biosynthesis of aldosterone. It is concluded that miR-150 is a critical regulator of Cyp11β2 in the control of BP. MiR-150 may be a novel therapeutic target for hypertension. (Supported by NIH R01 HL105362).
Abstract 9207: Distinct Prognostic Factors in Patients with Chronic Heart Failure and Chronic Kidney Disease
Authors: Sato Takamasa , Misaka Tomofumi , Ohwada Takashi , Yamauchi Hiroyuki , Yoshihisa Akiomi , Suzuki Hitoshi , Saitoh Shu-ichi , Takeishi Yasuchika
Published: April 2024

Background:
In chronic heart failure (CHF), impaired renal function is a strong predictor of mortality. However, the impact of chronic kidney disease (CKD) on prognostic factors in CHF has not been rigorously examined.

Purpose:
The purpose of this study was to compare prognostic factors between CHF patients with and without CKD.

Methods:
Consecutive 505 patients with CHF (226 males, age 60±14 years) who performed cardiopulmonary exercise testing before discharge were enrolled. Patients were divided into two groups: CKD group (estimated GFR<60 mL/min/1.73m
2
, n=213) and non-CKD group (estimated GFR>60 mL/min/1.73m
2
, n=292). Patients were followed up to register cardiac events including cardiac deaths and re-hospitalization due to worsening heart failure.

Results:
Patients with CKD had lower hemoglobin concentration, higher uric acid concentration, higher plasma brain natriuretic peptide levels, lower left ventricular ejection fraction, larger left atrium volumes, higher E/E’ rario, lower peak heart rate, lower peak VO

2

, and higher VE/VCO
2
slope than those without CKD (P<0.01, for each). There were 115 events during follow-up period (746±238days), and cardiac event rate was higher in CKD group than in non-CKD group (34% vs. 14%, P<0.001). In non-CKD group, multivariate Cox hazard analysis demonstrated that body mass index (hazard ratio (HR): 0.532, 95% confidence interval (CI): 0.322-0.879, P<0.001), log BNP (HR: 3.300, CI: 1.634-6.661, P<0.001), left atrial dimension (HR: 1.318, CI: 1.105-1.573, P<0.05) and peak VO
2
(HR: 0.743, CI: 0.557-0.956, P<0.05) were independent parameters to predict cardiac events after discharge. In contrast, serum concentration of sodium (HR: 0.876, CI: 0.767-0.999, P<0.05), uric acid (HR: 1.345, CI: 1.062-1.705, P<0.05), log BNP (HR 2.364, CI: 1.404-3.980, P<0.001) and peak VO
2
(HR: 0.742, CI: 0.631-0.874, P<0.001) were independent prognostic factors in CKD group.

Conclusions:
Prognostic factors were different between CHF patients with and without CKD, and this should be considered to manage CHF patients with CKD.
Abstract 9242: Tight Regulation of Left Ventricular Transmural Filling Pressure in Healthy Individuals
Authors: Fujimoto Naoki , Hastings Jeffrey L , Bhella Paul S , Carrick-Ranson Graeme , Shibata Shigeki , Palmer Dean , Levine Benjamin D
Published: April 2024

Background:
Healthy aging impairs left ventricular (LV) compliance and relaxation, which results in a decreased stroke volume in elderly individuals. By contrast, lifelong exercise training can preserve LV compliance and increase stroke volume in the elderly. However, it is unclear whether LV transmural distending pressure (LVTMP), which is thought to be the true preload for the LV, is influenced by healthy aging or lifelong exercise training.

Methods:
Healthy subjects (n=159; 99 male, 60 female) with no cardiovascular diseases were enrolled. Sedentary subjects were recruited from Dallas Heart Study, a multiethnic probability-based sample of Dallas County residents. Lifelong exercisers were recruited from Aerobics Center Longitudinal Study, a cohort which has documented lifelong exercise training patterns for 25 years. Subjects were stratified into 3 ‘sedentary’ age groups and 3 ‘lifelong training’ groups: Sedentary Age < 40 (n=30), Age 40-64 (n=43), and Age 65+ (n=21); Lifelong Training Age 65+ 2-3sessions/wk (n=23), Age 65+ 4-5 sessions/wk (n=20), and Age 65+ 6-7sessions/wk and competitive (n=22). All subjects underwent invasive right heart catheterization to determine stroke volume by thermodilution, pulmonary capillary wedge pressure (PCWP), and right atrial pressure (RAP). To eliminate the effect of external constraint on the LV, LVTMP was defined as PCWP - RAP.

Results:
Stroke volume decreased with increasing age and this age-related decline of stroke volume was prevented by lifelong exercise training. No effects of lifelong training on PCWP or RAP were observed in subjects > 65 years (p ≥ 0.76). In sedentary subjects, PCWP and RAP appeared to be slightly higher in Age <40 and Age 40-64 than Age 65+. However, LVTMP was identical among 6 groups (3.1±1.4 ∼ 3.6±1.5 mmHg, p = 0.74) and tightly controlled within a remarkably narrow range.

Conclusion:
True LV preload was tightly regulated in healthy subjects irrespective of age or lifelong exercise training. Therefore, changes in stroke volume associated with healthy aging or lifelong exercise training are not related to changes in LVTMP, but rather to changes in LV compliance.
Abstract 9280: A Targeted Delivery of Adipocytokines into the Heart by Cell-Sheet Technique Induces Immune-Tolerance and Ameliorates Cardiac Performance in Autoimmune-Associated Fulminant Myocarditis in Rat
Authors: Kamata Sokichi , Miyagawa Shigeru , Fukushima Satsuki , Sakaguchi Taichi , Imanishi Yukiko , Saito Atsuhiro , Maeda Norikazu , Sawa Yoshiki
Published: April 2024

Background:
Clinical prognosis is critically poor in fulminant myocarditis, whose initiation and progression are regulated in partby autoimmune disorders. Adiponectin (APN) and associated cytokines, which have anti-inflammatory/fibrotic effects, were shown to be immune-tolerance inducers, though effective delivery methods into target pathologies have not been established. We hypothesized cell sheet-based delivery system of adipocytokines, which we recently developed, might induce immune-tolerance and functional recovery in fulminant myocarditis.

Methods and Results:
Lewis rats were immunized against myosin for 7 days to develop experimental autoimmune myocarditis (EAM), which is an established fulminant myocarditis model. Scaffold-free induced adipocyte cell-sheet (iACS) was generated by inducing differentiation of syngeneic cultured adipose tissue-derived stem cells into the adipocytes on the temperature responsive dishes. Supernatants of iACS contained a high level of APN and hepatocyte growth factor (HGF), and reduced proliferation of CD4-positive T cells that were sorted from splenocytes of the EAM rats,
in-vitro
. EAM rats underwent iACS implantation onto the anterior surface of the heart (n=24) or sham operation (n=24). Immunohistolabelling showed that CD4-positive T cells significantly less migrated in the anterior myocardium at 21 days after the iACS implantation (73±35 /mm
2
) than the sham (148±38 /mm
2
, P=0.03). This finding was consistent with reduced expression of
Tnfα
and
Il2
, assessed by real-time PCR, and elevated level of APN (48±5 ng/ml
vs.
5±2 ng/ml P=0.01) and HGF (37±4ng/ml
vs.
8±5ng/ml P=0.01), assessed by ELISA, in the myocardium after the iACS implantation compared to the sham. Consequently, left ventricular ejection fraction was significantly greater at 42 days after the iACS implantation (52±3.8%) than the sham (43±4.7%, P=0.03) in association with less myocardial collagen accumulation.

Conclusion:
This tissue-engineered iACS treatment suppressed intramyocardial T cell activity and inflammation by persistently supplying adipocytokines to the heart, consequently inducing functional recovery in the EAM rat model. The findings support possible translation of this strategy into the clinical arena.
Abstract 9312: Prediction of Plasma Brain Natriuretic Peptide Levels Using ECG Gated 320 Slice CT in Subjects with Pulmonary Hypertension in Multiple Regression Models
Authors: Kataoka Akihisa , Funabashi Nobusada , Uehara Masae , Sugiura Toshihiko , Tanabe Nobuhiro , Takaoka Hiroyuki , Tatsumi Koichiro , Kobayashi Yoshio
Published: April 2024

Purpose:
Plasma brain natriuretic peptide (BNP) levels integrates responses of cardiovascular and pulmonary systems. We tied to predict plasma BNP levels in subjects with pulmonary hypertension (PH) using 320 slice CT and right heart catheter (RHC) examinations.

Materials and Methods:
19 consecutive PH subjects (13 female, mean 53 yrs, 13 chronic pulmonary arterial thromboembolism and 6 primary PH) underwent retrospective ECG gated 320 slice CT (Aquilion one), and RHC. CT images were reconstructed every 5% from 0-95% of the R-R interval. We quantified right ventricular (RV) end-diastole (ED) (RVEDV) and end-systole (ES) volumes (RVESV), and RV ejection fraction (EF) (RVEF) and left ventricular (LV) end-diastole (ED) (LVEDV) and end-systole (ES) volumes (LVESV), and LV EF (LVEF) by CT, and mean pulmonary artery (PA) pressure (MPAP) and pulmonary vascular resistance (PVR) by RHC.

Results:
Plasma BNP was 100.9±100.0pg/ml. RVEDV, RVESV, RVEF, LVEDV LVESV and LVEF by CT were 155.9±47.8ml, 88.3±49.7ml, 46.1±14.1%, 101.1±26.8ml, 31.7±9.6ml and 68.4±6.5%, respectively. MPAP and PAR on RHC were 37.9±10.7mmHg, and 570.3±263.4 dyne.sec.cm-5, respectively. Significant positive correlations were seen between plasma BNP levels and RVEDV (0.536, P<0.05), RVESV (0.645, P<0.01) on CT, MPAP (0.582, P<0.01), PVR (0.661, P<0.01) on RHC. Significant negative correlations were seen between plasma BNP levels and RVEF (-0.578, P=0.01), and LVEF (-0.674, P<0.01) on CT. All predictor variables using CT and RHC were analyzed and plasma BNP levels was predicted by multiple regression formula Y=-6.3X1+0.1X2+1.9X3-1.1X4+0.2X5+384 (Y, plasma BNP levels, X1=LVEF on CT, X2= PAR on RHC, X3=age (yrs), X4=RVEF on CT, X5= RVEDV on CT) (R2=0.646, p<0.05).

Conclusion:
Plasma BNP levels can be predicted by 320 slice CT and RHC. LVEF and RVEF on CT might be negative predictors and PAR, MPAP on RHC and RVEDV and RVESV on CT might be positive predictors for estimating plasma BNP levels in subjects with PH.
Abstract 9345: Effects of Telmisartan on Inflammatory Cytokines and Coronary Plaque Component Assessed by Integrated Backscatter Intravascular Ultrasound in Hypertensive Patients
Authors: Yamaguchi Koji , Wakatsuki Tetsuzo , Soeki Takeshi , Niki Toshiyuki , Taketani Yoshio , Oezuka Hiroyasu , Bando Sachiko , Tomita Noriko , Kusunose Kenya , Iwase Takashi , Yamada Hirotsugu , Sata Masataka
Published: April 2024

Backgrounds:
Recently, assessment of the plaque composition has become possible using an integrated backscatter intravascular ultrasound (IB-IVUS). The pleiotropic effect of telmisartan has been focused, however, effects of telmisartan on coronary plaque component and inflammatory cytokines are not known.

Methods:
A total of 31 patients with hypertension were randomized to two groups: telmisartan group (treatment with telmisartan [80mg/day, n=16]) or control group (other antihypertensive drugs except renin-angiotensin system blocker, n=15) for six months. The tissue characteristics of target coronary plaque in each patient were analyzed using IB-IVUS before and after treatment. We also measured plasma levels of inflammatory cytokines sampled in coronary sinus (CS) and peripheral vein (PV).

Results:
Mean lumen area significantly increased (7.9±2.2 to 8.5±2.6 mm2, p<0.05) and plaque volume significantly decreased (21.1±6.0 to 19.4±6.2 mm3, p<0.01) after treatment with telmisartan. Additionally, significant increases of fibrous volume (47.3±9.3 to 63.1±4.1%, p<0.05) and reduction of lipid volume (37.5±15.4 to 24.8±8.6%, p<0.05) were observed on IB image analyses in the telmisartan group, while there were no significant changes in plaque component in the control group. The CS-levels of MMP3 and hsCRP were smaller after than before treatment with telmisartan (7.6±6.1 to 5.5±4.9 ng/ml, 5.6±6.0 to 2.2±2.4 mg/l, p<0.05, respectively), however, there were no significant differences in cytokine levels between pre- and post-treatment with other antihypertensive drugs. In the PV-levels of those cytokines, there were no significant differences between pre- and post-treatment in the two groups.

Conclusions:
Decreased local inflammatory response and plaque stabilization on IB image analyses were observed after six months of telmisartan treatment. These findings might be associated with local anti-inflammatory and antiarteriosclerotic effects of telmisartan.
Abstract 9379: Biomarkers of Aortic Stenosis Severity
Authors: Blackshear Joseph L , Safford Robert E , Ung Steven , Misiri Juna , Johns Gretchen S , Mufuka Gabriel B , Parikh Pragnesh P , Al-Omari Malik A , Chen Dong
Published: April 2024

Aortic stenosis (AS) requires repeat assessments to optimally time intervention. The utility of laboratory tests to complement clinical and hemodynamic assessments has not been established. We assessed clinical, echocardiographic, and laboratory data in 76 patients with AS or heart valve replacement (HVR), age 77 years, 37% women. Laboratory assessments included von Willebrand factor (VWF) antigen, activity, (Act/Ag, normal > 0.8), VWF multimer distribution (abnormal=loss of highest molecular weight multimers=Mult+), brain natriuretic peptide (BNP, abnormal > 155 pg/ml=BNP+), and platelet function analyzer 100 collagen-ADP closure time (PFA, normal < 121 seconds). Table: Coefficients of correlation, r, and F statistic. Chi-square, and probability. Correlation of BNP to mean gradient in patients with GFR>60 remained poor, r=0.29, while for PFA r = 0.65. Median (IQR) for PFA and BNP for mild, moderate, and severe AS and HVR are shown below. VWF multimers were abnormal in 3/14 mild AS, 6/14 moderate AS, 22/25 severe AS and 4/23 HVR patients. The severity of AS was most strongly associated with VWF multimer abnormality and prolonged PFA closure time, weakly with BNP, and not with VWF Act/Ag.

Conclusion:
Among various laboratory measures, PFA and VWF multimers are strongly associated with AS severity, and may merit assessment as complementary diagnostic and prognostic biomarkers in AS.
Abstract 9420: Detection Of No-Reflow Phenomenon by Three-Dimensional (3D) Myocardial Contrast Echocardiography in Patients with Acute Myocardial Infarction
Authors: Iwakura Katsuomi , Okamura Atsunori , Koyama Yasushi , Date Motoo , Higuchi Yoshiharu , Inoue Koichi , Kimura Ryusuke , Nagai Hiroyuki , Toyoshima Yuko , Ozawa Makito , Omiya Shigemiki , Morisawa Daisuke , Takagi Takashi , Masuda Masaharu , Nakatani Shimpei , Sotomi Yohei , Fujii Kenshi
Published: April 2024

Backgrounds:
No-reflow phenomenon observed after percutaneous coronary intervention (PCI) determines clinical and functional outcomes in patients with acute myocardial infarction (AMI). Myocardial contrast echocardiography (MCE) is one of the established methods to detect no-reflow after AMI. However, MCE using 2D echocardiography has only limited view of left ventricle, and it might evaluate myocardial perfusion inappropriately. We investigated the feasibility of MCE using three-dimensional echocardiography (3D-MCE) to assess myocardial perfusion after AMI.

Methods and Results:
We performed MCE study in 50 patients with AMI 15 minutes after successful primary PCI, using iE33 (Philips Medical Systems). We injected 3 mL of sonicated contrast agent containing microbubbles into a culprit coronary artery, and recorded an apical 2D-MCE image. Then, we recorded a full-volume 3D-MCE image with another injection of contrast agent. We obtained 7 short axis (SAX) images from one 3D data set, as shown in Figure. Myocardial perfusion in each segment was scored as good=0, poor=1, no-reflow=2, and sum of the score was calculated as a perfusion defect (PD) score. We determined ejection fraction (EF) and wall motion score index (WMSI), as an average of segmental score (0=normokinesis to 4=dyskinesis), on echocardiography recorded at 7.4±4.6 month later.

Myocardial perfusion was successfully evaluated in 673/767 (87.7%) segments within risk area in SAX images on 3D-MCE. PD score in 2D-MCE showed no correlation with CK-MB (R
2
=0.08, p=0.06), EF (R
2
=0.03, p=0.26) and WMSI (R
2
=0.04, p=0.19) on follow-up echocardiography. On the other hand, PD score on 3D-MCE was significantly correlated with CK-MB (R
2
=0.56, p<0.0001), WMSI (R
2
=0.40, p<0.0001). It was also weakly but significantly correlated with EF (R
2
=0.10, p=0.02).

Conclusions:
3D-MCE detected no-reflow after PCI and predicted functional recovery in patients with AMI more precisely than 2D-MCE.
Abstract 9422: T-Type Calcium Channel Inhibitor Attenuates Cardiac Dysfunction, Improves Cardiac Sympathovagal Imbalance and Decreases Mortality in Iron-Overloaded Mice
Authors: Kumfu Sirinart , Chattipakorn Siriporn , Fucharoen Suthat , Chattipakorn Nipon
Published: April 2024

Excess plasma iron can lead to iron deposition in many organs including the heart. In thalassemia, excess cardiac iron deposition can cause cardiac dysfunction and depressed heart rate variability (HRV). Recently, T-type calcium channel (TTCC) has been shown as a possible gateway for iron entry in thalassemic cardiomyocytes. However, the role of TTCC in “in vivo” with iron overload has never been investigated. We tested the hypothesis that TTCC blocker can improve impaired cardiac function and attenuate the depressed HRV, leading to decreased mortality in iron-overloaded mice.

Methods:
C57/BL6 adult mice were fed with either normal diet (control group) or diet supplemented with dicyclopentadienyl iron (FE group) for 90 days to induce iron overload condition. Then, mice in each group were divided into subgroups being treated with L-type calcium channel (LTCC) blocker, verapamil and nifedipine; TTCC blocker, efonidipine; or iron chelator deferoxamine (DFO) for 30 days. Pressure-volume (P-V) conductance catheter system was used for cardiac function assessment. HRV was determined at baseline and at the end of treatment in all mice.

Results:
Iron-overloaded mice demonstrated impaired cardiac function as shown by decreased stroke volume (SV), cardiac output (CO), ejection fraction (EF), impaired HRV as indicated by increased LF/HF ratio, with high mortality rate (Figure). Efonidipine effectively improved cardiac function impairment, whereas LTCC blockers and DFO did not. Efonidipine and DFO also significantly improved HRV parameter, whereas LTCC blockers could improve it at a lower extent. Both efonidipine and DFO markedly decreased mortality, while LTCC blocker did not, in these mice with iron overload.

Conclusion:
Impaired cardiac function and depressed HRV caused by iron overload were improved by efonidipine, but not by verapamil and nifedipine, suggesting that TTCC but not LTCC, plays an important role for iron uptake in the heart of iron-overloaded mice.
Abstract 9521: Obesity Increases the Prevalence of Cardiovascular Target Organ Damage in Hypertension
Authors: Gerdts Eva , de Simone Giovanni , Izzo Rafaelle , De Marco Marina , Casalnuovo Giusy , Giudice Renata , Trimarco Bruno , De Luca Nicola
Published: April 2024

Background:
Whether concomitant obesity in hypertension is associated with increased prevalence of vascular as well as cardiac target organ damage needs further clarification.

Methods:
Data from carotid ultrasound and echocardiography in 10800 hypertensive patients free of prevalent CV disease, participating in the Campania Salute Network were used. The population was grouped into body mass index (BMI) classes: normal BMI 20-24.9 kg/m
2
, overweight BMI 25-29.9 kg/m
2
and obese BMI>30 kg/m
2
. Vascular and cardiac target organ damage was defined as plaque in >1 of the common or internal carotid arteries and left ventricular hypertrophy (LVH), respectively. LVH was defined as LV mass/height
2.7
>46.7 g/m
2.7
in women and >49.2 g/m
2.7
in men, respectively.

Results:
A majority of the patients were either overweight or obese (Table 1). In spite of more use of combination therapy, the obese group had slightly higher blood pressure (BP) and included more patients with carotid plaques and LVH (Table 1). In multivariate logistic analyses, concomitant obesity was associated with a 21% (95% confidence interval [CI] 7-36%) increased prevalence of carotid plaques, a 3.7 times higher prevalence of LVH (95% CI 3.32-4.18) and a 2.4 times higher prevalence of combined vascular and cardiac target organ damage (95% CI 2.12-2.78, all p<0.01) independent of significant associations with gender, age, diabetes mellitus, clinic systolic BP and antihypertensive treatment.

Conclusion:
In hypertensive patients participating in the Campania Salute Network, concomitant obesity is associated with a highly increased prevalence of LVH, and a modest increased prevalence of carotid plaques.
Abstract 9550: Regional Variation in Emergency Department Visits for Acute Myocardial Infarction - Nationwide Emergency Department Sample, 2008
Authors: Valderrama Amy L , Will Julie C , Yoon Paula W
Published: April 2024

Background:
For the majority of patients with acute myocardial infarction (AMI), the emergency department (ED) is the entry point into the healthcare system. Although previous studies have described regional differences in treatment for AMI, few studies have examined regional variations in ED visits for AMI.

Objective:
This study sought to describe variations in AMI visits to EDs by Census Bureau-designated regions of the U.S. in 2008 and to examine characteristics of those visits.

Methods:
ED data from the 2008 Nationwide Emergency Department Sample (NEDS) were analyzed. The NEDS is a stratified random probability sample of hospital-based EDs from community, non-rehabilitation hospitals in the U.S. SUDAAN was used to account for the complex sampling scheme. Only adults (aged ≥ 18 years) were included in the analysis. Visits for AMI were defined as the primary diagnosis listed as International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 410.xx, excluding cases for which the fifth digit was 2 which indicates further evaluation of a recent MI. Rates of AMI ED visits per population were calculated by region using U.S. Census estimates for 2008.

Results:
In 2008, adults made an estimated 98,515,683 ED visits. Of those, 537,167 (0.6%) had a primary diagnosis of AMI; 84% were admitted to the presenting hospital and 11% were transferred to another short-term hospital. Approximately 1% died in the ED. Men accounted for 59.6% of AMI ED visits. Persons aged ≥ 75 years accounted for 37.4% of AMI visits. More than half of visits (57.2%) were made by Medicare beneficiaries. The majority of visits were made to EDs in urban areas (79.4%). ED visit rates per 10,000 population for each region were: Northeast, 23.9 (95% confidence interval [CI]: 20.6-27.1); Midwest, 24.8 (95% CI: 22.1-27.4); South, 25.7 (95% CI: 23.1-28.2); West 17.9 (15.8-20.0). Women in the West had the lowest rate of AMI visits (13.8 per 10,000) compared to women and men in the other regions. Rates increased by age group for all regions.

Conclusions:
ED visits for AMI vary significantly by geographic region. The lowest rate of AMI visits per population was noted in the West. Further study is needed to identify the factors that cause these regional variations in ED visits.
Abstract 9569: Circulating Plasma Brain Natriuretic Peptide Predicts Longitudinal Change in Blood Pressure: The Jackson Heart Study
Authors: Musani Solomon K , Vasan Ramachandran S , Singh Preeti , Bidulescu Aurelian , Samdarshi Tandaw E , Steffes Michael , Taylor Herman A , Fox Ervin R
Published: April 2024

INTRODUCTION:
Elevation in circulating brain natriuretic peptide (BNP) concentrations has been associated with hypertension in studies of non-Hispanic whites. However, the relation of plasma BNP concentration to progression in blood pressure (BP) category and to incident hypertension in African Americans is unknown.

HYPOTHESIS:
We assessed the hypothesis that higher circulating BNP concentrations in non-hypertensive African Americans will be associated with change in BP category and incident hypertension.

METHODS:
Our study population consisted of non-hypertensive participants of the Jackson Heart Study with BP, anthropometry and phlebotomy measures in both exam 1 (2000-04) and exam 2 (2005-08), and plasma measures of BNP in exam 1 only. We examined the relation of circulating BNP concentrations (categorical measures by quartile) to BP progression and to incident hypertension using multivariable logistic regression. The model adjusted for age, sex, BP categories (optimal; normal and high normal), systolic and diastolic BP, smoking, diabetes, body mass index, echo LV mass (all measured at baseline) and change in age between the two exam cycles.

RESULTS:
The study population consisted of 1,158 participants (mean age 49±12 years, 59% women). The median follow-up period was 5.0± 0.8 years. We observed 38.1% of the participants progressed to a higher BP stage and 20.1% of the participants developed incident hypertension. In the multivariable regression model, elevated plasma BNP concentrations (based on highest quartile) were significantly and positively associated with BP progression [p=0.006; OR, 1.8; 95% CI (1.2, 2.6)] and marginally and positively associated with incident hypertension [p=0.06; OR, 1.3; 95% CI (0.8, 2.1)]. Categorical BNP was significantly and positively associated with both BP progression (p=0.006) and incident hypertension (p = 0.04).

CONCLUSION:
In our community-based sample of middle-aged and elderly African Americans, higher plasma BNP concentrations were associated with increased risk of BP progression and incident hypertension in all participants.
Abstract 9590: Early Blood Lowering Effects of Renal Sympathetic Denervation
Authors: Plehn Alexander , Holzapfel Daniel , Raaz Uwe , Schlitt Axel , Dietz Sebastian , Buerke Michael , Hofmann Britt , Markau Silke , Girndt Matthias , Werdan Karl
Published: April 2024

Introduction and Hypothesis
Hypertension is a major global health problem. Renal sympathetic hyperactivity has been identified as a major contributor to the complex pathophysiology of hypertension. Catheter-based renal sympathetic denervation (RDN) has been shown to significantly reduce blood pressure (BP) in patients with severe hypertension. According to Symplicity HTN-1 and -2 trials it is known that the BP lowering effect will take about 1 to 6 month to develop. However, there is little information available on the immediate BP lowering effects of RDN. Our study carefully investigated early BP response to RDN in a cohort of patients with resistant hypertension (systolic BP >150 mm Hg on >3 antihypertensive drugs).

Methods and Results
Our study enrolled 28 consecutive patients (mean age 65 years, 48% women, 47% diabetic). Baseline values included a mean of 5.7 antihypertensive medications. A 24h Holter BP monitoring was recorded in every patient 24h before and after RDN. BP readings were then averaged according to daytime (7:00am-22:00pm), night (22:00pm-7:00am) and 24 hours intervals (figure 1). In treated patients mean averaged systolic BP was reduced by 15.3±3.34 mmHg (p<0.001) during the first 24 hours. Systolic BP reduction appeared to be much higher at daytime (17.5±3.59 mmHG; p<0.001) compared to night (9.6±3.88 mmHg; p<0.021) which might indicate the role of sympathetic activity at daytime. A concordant effect on diastolic BP was observed: 6.9±1.72 mmHg (p<0.001). Heart rate was not affected at the early time points (1.64±1.62; p=0.319). The missing changes in heart rate may indicate the absence of inpatient stress factors that could have influenced BP.

Conclusion
In patients with resistant hypertension, catheter-based renal sympathetic denervation results in an immediate substantial reduction of systolic and diastolic BP. The relationship between the immediate and long-term BP lowering effect of RDN-therapy remains to be investigated.
Abstract 9616: Does “Men Are from Mars and Women are from Venus” hold true for Tako-Stubo Cardiomyopathy - A Nationwide Analysis?
Authors: Deshmukh Abhishek , Kumar Gagan , Singla Sandeep , Gobal Freij , Rihal Chiranjit , Jawahar Mehta L
Published: April 2024

Background:
Recent case series and smaller registries from around the world have reported higher frequency of Takotsubo Cardiomyopathy (TTC) in females.The aim of this study was to look for gender difference and age - gender interactions for TTC across the nation.

Methods:
This was a cross sectional study using the Nationwide Inpatient Sample (NIS) 2007 database. TTC or Broken heart syndrome or Reversible left ventricular dysfunction following sudden emotional stress or Stress induced Cardiomyopathy or Transient left ventricular apical ballooning syndrome was defined as patients discharged with any ICD code of 429.83 (
http://www.cdc.gov/nchs/data/icd9/agendasept05.pdf
). Multivariate logistic regression with interaction variable between age and sex was performed.

Results:
There were 6229 estimated discharges in 2007 NIS. Of these, 5558 (89.2 %) were females and 671 (10.8%) were males. 11.1 % were between 18-50 years, 32% between 50-65 years,58% were more than 65 years. Overall females had significantly higher odds of developing TTC (OR, 7.5; 95% CI, 6.31-9.13). In age group > 55yrs, the odds of developing TTC was 9.5 times higher in females than in males, while in age 55yrs had 2.9 times higher odds of developing TTC while there was no such age difference in males.

Conclusions:
We conclude that women have 7.5 times higher odds of developing TTC than males. Females with age > 55 years have 2.9 times higher odds of developing TTC than females with age < 55 years. Further research needs to be done on hormonal influence and its effect on TTC.
Abstract 9619: Identification of Response to Cardiac Resynchronization Therapy by Radial Strain: Influence of Cardiomyopathy Type
Authors: Park Mi Young , Altman Robert K , Orencole Mary , Kumar Prabhat , Singh Jagmeet P , Picard Michael H
Published: April 2024

Background:
The use of speckle tracking derived radial strain by echocardiography (echo) to predict response to cardiac resynchronization therapy (CRT) has yielded variable results. We aimed to examine factors influencing the usefulness of radial dyssynchrony after CRT to evaluate CRT response.

Method:
Serial assessments of radial dyssynchrony by speckle tracking strain were performed after CRT in 98 patients (49 non-ischemic and 49 ischemic etiology) who were followed in our multidisciplinary clinic. Radial dyssynchrony (RD) was defined as a difference in time to peak strain of ≥130ms between anteroseptum and posterior wall (AS-P delay) at the mid LV level. Response to CRT was defined as a decrease in LV end systolic volume (ESV) of ≥15% or absolute increase in LVEF of >5% on 6 month echo compared to baseline.

Results:
There was no difference in baseline EF between 66 responders and 32 nonresponders (25 ± 6 vs 24 ± 6 %; p=0.540). LV ESV index differed at baseline between groups (75 ± 24 vs 90± 31 ml/m
2
; p=0.017). For the total population, AS-P delay was not different on 1
st
follow up echo (echo 1, 54 ± 23 days) and 2
nd
follow up echo (echo 2, 215 ± 42 days) after CRT (132 ± 90 vs 126 ± 104 ms; p=NS). The prevalence of RD decreased over time (echo 1 vs echo 2, 49% vs 41%; p=0.000). In responders, the AS-P delay was reduced at echo 2 compared to echo 1 (123 ± 85 vs 93 ± 73 ms; p= 0.011). For the nonresponders, the AS-P delay showed a trend to increase (147 ± 96 vs 191 ± 128 ms; p=0.091). The improvement in AS-P delay in responders was due to non-ischemic cardiomyopathy responders (117 ± 83 to 74 ± 51 ms; p=0.003) as no change was noted in ischemic etiology responders (134 ± 90 vs 123 ± 88 ms; p=NS). The prevalence of RD also decreased in responders over time (44% vs 25%; p=0.001) due to non-ischemic etiology responders (40% vs 14%; p = 0.005). Nonresponders showed increased prevalence of RD over time (59% vs 72%, p=0.000).

Conclusion:
Serial RD assessment by speckle tracking after CRT is feasible and correlates well with other measures of CRT response in non-ischemic cardomyopathy patients while it appear to be of limited value in ischemic cardiomyopathy. Thus, when examining the value of AS-P delay in CRT populations, the prevalence of cardiomyopathy type is critical.