bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 10880: Impact of Post-Extrasystolic Potentiation on Takotsubo Cardiomyopathy
Authors: Aoi Shunsuke , Carabello Blase , Rachko Maurice
Published: April 2024

Introduction:
Takotsubo cardiomyopathy (TCM) is an increasingly recognized condition that presents with transient and reversible left ventricular (LV) dysfunction despite angiographically unobstructed coronary arteries. However the detailed pathophysiology of the stunned myocardium remains to be determined. Post-extrasystolic potentiation (PESP) is an increase in contractility after an extrasystole, thought at least in part due to a net increase in myocardial calcium. When PESP occurs in akinetic LV segments, it is a marker of myocardial viability. Obviously the myocardium in TCM is viable, thus we hypothesized that the affected myocardium in TCM would demonstrate PESP.

Methods:
We retrospectively reviewed 61 cases of TCM diagnosed by the Mayo criteria between the periods of October 2004 to May 2015. The 24 cases wherein left ventriculography fortuitously provoked extra systoles (PVCs) were evaluated.

Results:
In our study, the baseline characteristics of TCM were 93.4% female patients with mean age of 67. Mean ejection fraction was 38% and mean troponin I elevation was 5.5. Apical type was the predominant (72.1%) compared to the mid-ventricular type (23.0%). None of the 24 patients in whom ventriculographic PVCs occurred demonstrated PESP in the affected region of the LV, while all did in the unaffected portion.

Conclusions:
Extra-systoles in TCM fail to elicit PESP in affected LV segments despite proven viability in those segments while unaffected segments behave as predicted. Since increased calcium is thought to be the basis for PESP, it is possible in TCM that either there is failure of calcium release in the affected areas or that the presumed catecholamine excess of TCM has already caused maximum calcium release so PCVs cannot enhance contractility further.
Abstract 10919: Contemporary Life Expectancy and Standardized Mortality of Adult Survivors With Congenital Heart Lesions
Authors: Oliver Jose M , Gallego Pastora , Gonzalez Garcia Ana E , Garcia Hamilton Diego , Yotti Raquel , Ferreira Gonzalez Ignacio , Fernandez Aviles Francisco
Published: April 2024

Background:
Survival beyond the age of 18 years in patients born with congenital heart disease (CHD) is now near 90% but contemporary estimates of outcome in adult survivors are lacking.

Methods:
In a prospective cohort of 3,334 adults with CHD followed up to 24 years in a single tertiary centre median age of survival (MAS) was estimated by computing left-truncated and right-censored Kaplan-Meier curves with age as time scale. Standardized mortality ratio (SMR) was also determined using one-sample log-rank test from age at diagnosis-, sex- and time of follow-up-adjusted death rates of general population in Spain. Patients were classified into 3 groups according to CHD complexity: I, simple (1,647); II, moderate (1,283); and III, severe (404). For mortality analysis, data provided by the Spanish national death index were used.

Results:
There were 1,688 males and 1,646 females. Median age at first examination was 22 years (IQR 18-39) and median follow-up time 10.6 years (1-18). At the end of the study 336 patients had died (prevalence 10%; annual incidence 0.89%). Estimated MAS was 78.0 years (95% CI 76-82) for group I; 72,1 years (68-78) for group II; and 51.1 years (48-53) for group III (p<0.001). MAS was older than 75 years in all diagnostic categories in group I; between 60 and 75 years (moderate reduction) in subvalvular aortic stenosis, Ebstein anomaly, coarctation of the aorta, tetralogy of Fallot and complete transposition; and < 60 years (severe reduction) in Eisenmenger syndrome, single ventricle, AV discordance and pulmonary atresia The SMR was 1.66 (1.4-2.5) for the group I; 3.27 (2.6-4.1) for the group II; and 20.4 (10-26) for the group III (p<0.001 in all, compared to reference population). The SMRs for main individual diagnostic categories are shown in figure.

Conclusion:
Life expectancy for CHD adults is reduced proportionally to complexity of the heart defect. Data for individual diagnostic categories might be used as a prognostic index.
Abstract 10931: Serum Mac-2 Binding Protein May be a Potential Biomarker for Diagnosis of Silent Atherosclerosis in Subjects With Cardiovascular Risk Factors
Authors: Sugiura Tomonori , Dohi Yasuaki , Yamashita Sumiyo , Tanaka Yasuhito , Ohte Nobuyuki
Published: April 2024

Introduction:
Mac-2 binding protein (M2BP) is secreted from many cell types. Recently, serum M2BP levels were reported to be useful as a glycoprotein biomarker for liver fibrosis and several types of malignant tumors.

Hypothesis:
We hypothesized that expression of M2BP might change in the process of atherosclerosis. Hence, the present study was designed to investigate a possible association of the serum M2BP level with cardiovascular risk factors and whether M2BP is a candidate for a marker of progression of atherosclerosis.

Methods:
Outpatients with one or more cardiovascular risk factors (n=156) and healthy controls without cardiovascular risk factors (n=20) were enrolled. Subjects with liver dysfunction, a history of hepatic disease, malignant neoplasm, or cardiovascular events were excluded. Blood was sampled and serum levels of hyperglycosylated-M2BP were measured by glycan-based immunoassay. Vascular function was assessed by pulse wave velocity (PWV) and flow-mediated dilation (FMD).

Results:
Serum M2BP levels were positively correlated with cardiovascular risk factors (age, BMI, systolic blood pressure, fasting blood sugar, and HbA1c) and inversely correlated with HDL-cholesterol and estimated-GFR. The M2BP levels were also correlated with CRP, urinary albumin to creatinine ratio, and PWV. The M2BP levels in subjects with hypertension, dyslipidemia, or abnormal glucose metabolism were higher than those in subjects without hypertension, dyslipidemia, or abnormal glucose metabolism (P<0.01, respectively). Moreover, the M2BP levels were associated with accumulation of cardiovascular risk factors. Multiple logistic regression analysis with endpoint of high M2BP (above mean value) revealed that hypertension and dyslipidemia were significantly associated with high M2BP. Subjects with high M2BP showed significantly decreased FMD than those with low M2BP (p<0.05).

Conclusions:
Serum M2BP levels were increased with age and accumulation of cardiovascular risks factors. Although the spectrum was narrow as compared to that in cases of hepatic fibrosis, significant correlations with cardiovascular risk markers suggest that serum M2BP reflects silent atherosclerosis in subjects with cardiovascular risk factors.
Abstract 11025: Insertable Cardiac Monitors Reveal Progression of 1
st
Degree AV-block to Higher Grade Block Requiring Pacemaker Implant
Authors: Lewalter Thorsten , Rieger Guido , Mangoni Lorenza
Published: April 2024

Introduction:
In the past, 1
st
degree AV-block has generally been considered a benign condition. A few recent studies have shown that 1
st
degree AV-block is associated with an increased risk for heart failure, pacemaker (IPG) implantation, and death. We investigated the outcomes of patients who received an insertable cardiac monitor (ICM) (Medtronic Reveal XT
®
) within the scope of the INSIGHT XT study and had 1
st
degree AV-block at baseline.

Methods:
The observational, international, multicenter INSIGHT XT study prospectively enrolled 1003 patients implanted with an ICM for arrhythmia diagnosis, irrespective of the clinical indication. This analysis includes 37 patients (3.7%) who had documented 1
st
degree AV-block at enrollment. Patients with known concurrent higher grade block at enrollment were excluded.

Results:
The indication for ICM implantation was syncope or pre-syncope in 54.1%, cryptogenic stroke in 18.9%, AF with rhythm control intervention in 21.6%, and unexplained palpitations or symptoms in 5.4%. The mean age was 68±14 years and 75.7% were male. Concurrent bundle branch block (BBB) was present in 8.1%. The median follow-up time was 12.2 months (IQR: 3.9-15.9). Fifteen patients (40.5%) received an IPG during the follow-up, and in 93.3% of the cases the implant was needed to treat a progression of the conduction disease. In addition, one patient died due to sinus arrest 86 days after enrollment; one patient developed transient 3
rd
degree AV block but did not receive an IPG.

Conclusions:
The ICM revealed progression of 1
st
degree AV-block to a higher grade block warranting an IPG in 40.5% patients. This finding supports the conclusion that 1
st
degree AV-block is not benign in all patients. Further studies may reveal patient subgroups which are at high risk for developing higher grade AV block and may warrant a preventive IPG implantation.
Abstract 11422: Aligned Nanofibrillar Collagen Scaffold Guide Therapeutic Lymphangiogenic Repair in Secondary Lymphedema
Authors: Rockson Stanley G
Published: April 2024

Background:
As a mechanical adjunct to therapeutic lymphatic repair in acquired lymphedema, we have investigated the applicability of guided lymphatic regeneration, through the introduction of a biological scaffold consisting of aligned collagen fibrils. These fibrils provide for cell attachment, alignment, and migration.

Methods:
We refined a large animal model using minipigs (n=16). We resected the inguinal and popliteal lymphatic system and irradiated the groin area to reproduce the conditions encountered in human cancer-related lymphedema. We assessed the status of lymphedema by detecting interstitial fluid accumulation through bioimpedance, the number of major lymphatic collectors by contrast-enhanced CT, and presence of lymphatic dermal backflow by contrast-enhanced MRI.

Results:
Three months after lymphatic resection and irradiation, animal subjects were randomized to: (1) scaffolds only, (2) scaffolds impregnated with VEGF-C, and (3) VEGF-C-scaffolds with additional transplantation of autologous lymph node fragments. The control group (4) did not receive any treatment. Seven animals out of 16 developed chronic lymphedema by the pre-defined bioimpedance threshold. The number of lymphatic collectors, as determined by CT, correlated with bioimpedance data. In group 1, there was slight improvement of bioimpedance ratios. In groups 2 and 4 (control), lymphedema persisted. In group 3 lymphedema was reversed in all subjects at post-Rx time-point 6 months. Macroscopic analysis of collectors in the implantation area after intradermal injection of blue dye showed newly developed lymphatic collectors aligned in the direction of the implanted collagen scaffolds.

Conclusions:
In this porcine acquired lymphedema model, implantation of aligned nanofibrillar collagen scaffolds facilitates the ingrowth of lymphatics across the treatment field. Moreover, simultaneous transplantation of autologous lymph node fragments improves lymphatic regeneration. The biocompatibility of these surgical approaches suggests their potential as an effective treatment option for the human disease.
Abstract 11501: An Assessment of Unmet Needs and Outcomes Important to Patients With Heart Failure
Authors: Richards Kristen M , Sasane Rahul , Turner Stuart , Thach Andrew V , Brown Carolyn M
Published: April 2024

Introduction:
Heart failure (HF) is a progressively debilitating disease resulting in functional disability and lower quality of life. Besides responses to quality of life (QoL) scales, the literature contains few studies regarding HF patient-reported outcomes. Given the advances in pharmacological management, as well as other advances in the delivery of health-related services and information impacting the HF patient, additional insight is needed to understand and respond to patients’ perspectives of HF.

Objectives:
To identify outcomes that are important to patients with HF and to assess their perceived unmet needs regarding the effective management of HF.

Methods:
Focus groups (FGs) were conducted with HF patients in Austin, TX. A diverse sample of HF patients was recruited in terms of disease severity and history, HF treatments, gender, ethnicity and socioeconomic status. A FG guide with open-ended questions was used to explore three areas: disease burden, important outcomes of treatment and care, and strategies to address unmet need. A grounded theory approach was used to inductively analyze and identify the categories/themes that emerged from the data.

Results:
Four FGs were conducted with a total of 29 HF patients. Most patients were male (58.6%) and Caucasian (41.4%) or African American (37.9%) and aged 60.2±10.3 years. The mean number of years since being diagnosed with HF was 5.4±5.6. A total of eight major themes emerged from the data: 1) burden of daily living impacts of HF, 2) important elements of HF treatment, 3) indicators that care is being managed well, 4) negative aspects of medication, 5) dealing with other health issues, 6) different types of HF treatments, 7) unmet treatment and support needs, and 8) self-education.

Conclusions:
Several outcomes important to HF patients emerged, from physical limitations (e.g., limited recreational pastimes) to psychological issues (e.g., self-control in life). These outcomes were typically related to patients’ daily quality of living. Several unmet needs emerged, including financial assistance, reduced pill burden of prescribed therapies, and improved collaboration and communication among healthcare providers.
Abstract 11515: Does Prolonged Dual Antiplatelet Therapy Increase Mortality After Drug-Eluting Stent Implantation?
Authors: Bittl John A , Baber Usman , Bradley Steven M
Published: April 2024

Introduction:
The Dual Antiplatelet Therapy (DAPT) trial found a borderline increase in the rate of all-cause mortality in patients treated with 30 compared with 12 months of DAPT (2.0% vs. 1.5%, HR 1.36, 95% CI 1.00-1.85, P = 0.05).

Hypothesis:
A finding of borderline significance in a mega-trial may reflect the play of chance.

Methods:
We used a Bayesian conjugate-normal approach (Figure A) to update the mortality results from the DAPT trial with an empiric prior probability distribution based on results in 9 smaller randomized controlled trials (RCTs).

Results:
The empiric prior (blue), which suggests that the odds of mortality in the 9 smaller RCTs could be 6% lower or as much as 40% higher after prolonged than after short DAPT, overlaps with the likelihood (red) from the DAPT trial itself. Bayesian inference (black) affirms a significant increase in mortality with prolonged DAPT (posterior mean odds ratio [OR] 1.21, 95% Bayesian confidence interval [BCI] 1.02-1.44). Sensitivity analysis, which weighs the number of effective events by the proportion of patients with acute coronary syndromes, produces a nearly identical point estimate (OR 1.23, 95% BCI 0.96-1.58).

Conclusions:
Our analysis provides credible evidence that 30 months of DAPT is associated with higher mortality rates than is 12 months of therapy. The mortality increase in the DAPT trial is predictable from prior RCTs and not likely to be a chance finding.
Abstract 11703: Adipose Angiotensinogen Inactivation Reduces Adipose Tissue Inflammation and Increases Metabolic Activity in Adipose Stroma Vascular cells
Authors: LeMieux Monique J , Ramalingam Latha , Mynatt Randall , Kalupahana Nishan S , Kim Jung Han , Moustaid-Moussa Naima
Published: April 2024

The adipose renin-angiotensin system (RAS) is an important regulator of blood pressure and fluid balance and has been linked to obesity-induced inflammation, though mechanisms are not completely understood. Previously, we showed that overexpression of the RAS protein precursor, angiotensinogen (Agt) in adipose tissue increases adiposity, insulin resistance, adipose and systemic inflammation in mice fed a low-fat diet (LFD). Accordingly, we hypothesized that Agt inactivation in adipose tissue will protect against obesity-associated inflammation. To test this hypothesis, we generated adipose tissue Agt knockout (Agt-KO) mice using the aP2-Cre-LoxP system. Agt-KO and wild-type (WT) littermates were each fed a LFD or high-fat diet (HFD) to assess metabolic changes. Our results demonstrate that while no significant differences were observed in body weight or fat mass between the two genotypes on either diet, glucose tolerance was improved in the Agt-KO compared to the WT littermates. This was consistent with higher expression of genes involved in insulin signaling, glucose transport and fatty acid metabolism in white adipose tissue from Agt-KO mice. Moreover, Agt inactivation reduced total adipose macrophage infiltration,and gene/protein expression of MCP-1 and other proinflammatory adipokines in Agt-KO mice compared to WT. Lastly, extracellular flux analyses (using Seahorse Xfe) in both differentiated and non-differentiated stromal vascular cells revealed higher glycolytic activity and mitochondrial respiration in Agt-KO compared to WT mice. Overall, our findings indicate that adipose Agt inactivation reduced adipose inflammation and improved glucose tolerance in part via increased metabolic activity of adipose cells. The cellular and molecular changes observed are consistent with previously reported functions of RAS in insulin resistance, and inflammation.

Funded by a GIA from the American Heart Association Southwest Affiliate (NMM)
Abstract 11742: Moderate to Severe Acute Kidney Injury Provides the Additional Long-Term Prognostic Information to ADHERE Risk Level in Patients Admitted With Acute Decompensated Heart Failure
Authors: Yamada Takahisa , Morita Takashi , Furukawa Yoshio , Tamaki Shunsuke , Iwasaki Yusuke , Kawasaki Masato , Kikuchi Atsushi , Kondo Takumi , Ishimi Masashi , Hakui Hideyuki , Ozaki Tatsuhisa , Satoh Yoshihiro , Seo Masahiro , Fukunami Masatake
Published: April 2024

Backgrounds:
The Acute Decompensated Heart Failure National Registry (AHDERE) risk levels are a validated tool to assess the risk of in-hospital mortality in patients (pts) with acute decompensated heart failure (ADHF). Acute kidney injury (AKI) during heart failure treatment is also associated with poor outcome in ADHF pts. However, there is no information available on the long-term prognostic significance of AKI, relating to ADHERE risk levels in ADHF pts.

Methods and Results:
We studied 305 consecutive ADHF pts discharged with survival. ADHERE risk levels were assigned, as previously described, baseline BUN(≥43 vs <43 mg/dl), systolic BP (<115 vs ≥115 mmHg), and creatinine(Cr≥2.75 vs <2.75 mg/dl). AKI during ADHF treatment was defined according to AKI Network criteria (stage 1, ≥0.3mg/dl absolute or 1.5- to 2.0-fold relative increase in Cr; stage 2, >2- to 3-fold increase in Cr; stage 3, >3-fold increase in Cr or Cr≥4.0mg/dl with an acute rise of ≥0.5mg/dl). During a follow-up period of 4.1±3.2 yrs, 81 pts had cardiovascular-renal poor outcome, defined as cardiovascular death and the development of end-stage renal disease requiring renal replacement therapy. At multivariate Cox analysis, ADHERE risk levels (p<0.0001) and AKI (p<0.0001) were significantly associated with cardiovascular-renal poor outcome, independently of age, serum sodium and hemoglobin levels. Irrespective of high/intermediate or low ADHERE risk levels, pts with stage 2 or 3 AKI (adjusted HR: 5.9[1.8-19.2] in high/intermediate riskgroup, 4.9[2.1-11.3] in low risk group) had a significant increased risk of cardiovascular-renal poor outcome, compared to pts with no AKI. On the other hand, there were no significant differences in the risk between pts with stage 1 AKI and no AKI in both groups.

Conclusion:
Moderate to severe AKI during heart failure treatment would provide the additional long-term prognostic information to ADHERE risk levels in ADHF pts.
Abstract 11770: Egg Consumption and Risk of Cardiovascular Disease: A Systematic Review and Meta-Analysis
Authors: Krittanawong Chayakrit , Tunhasiriwet Anusith , Tweet Marysia S , Bisanz Kimberly J , Chirapongsathorn Sakkarin , Hoy Matthew B , Wang Zhen , Hayes Sharonne N
Published: April 2024

Introduction:
Current dietary guidelines no longer recommend against egg consumption despite the high cholesterol content. However, considerable controversy remains on the relationship between high egg consumption and cardiovascular disease (CVD) risk. The objective of this systematic review and meta-analysis was to explore the association between egg consumption and CVD events.

Methods:
We systematically searched PubMed, Scopus, and the Cochrane Database of Systematic Reviews from database inception through April 2015 for observational studies with hazard ratio (HRs) or relative risks (RRs) and 95% confidence intervals (95% CI) that reported the association between egg consumption and CVD events which included coronary heart disease (CHD) and stroke. Data were extracted by one reviewer followed by independent screening and extraction of study characteristics and outcome data by two other reviewers. Conflicts were resolved through consensus. Random-effects meta-analyses were used to pool the hazard ratios or relative risks from the included studies. Subgroup analyses were performed to explore the potential sources of heterogeneity. The quality of the included studies and publication bias were assessed.

Results:
We identified 5 cross-sectional and 6 prospective studies with median follow-up of 13.1 years. A total of 301,339 individuals and 10,262 total CVD events were included with 7,225 CHD and 3,037 stroke cases. Compared to consumption of less than 1 egg/day, higher egg consumption was associated with an increased risk of CVD events (pooled HR, 1.43; 95% CI, 1.01-2.03; p=0.012; I
2
= 65.7% and pooled RR, 1.09; 95% CI, 0.89-1.34; p=0.145; I
2
= 41.4%).

Conclusions:
Our analysis suggests that higher consumption of eggs (more than 1 egg/day) may be associated with increased risk of cardiovascular disease. Large and diverse prospective community-based cohorts will be necessary to establish optimal dietary recommendations for public health.
Abstract 11807: Impact of Abdominal Aortic Calcification on Long Term Cardiovascular Outcomes in Patients With Chronic Kidney Disease
Authors: Tatami Yosuke , Suzuki Susumu , Ishii Hideki , Harada Kazuhiro , Hirayama Kenshi , Shibata Yohei , Ota Tomoyuki , Yasuda Yoshinari , Murohara Toyoaki
Published: April 2024

Introduction:
Abdominal aortic calcification (AAC) was related to cardiovascular (CV) events in hemodialysis patients. However, little is known about predictive value of the AAC for CV events in chronic kidney disease (CKD) patients.

Hypothesis:
The purpose of this study was to investigate the prevalence and the predictive value of AAC in asymptomatic CKD patients.

Methods:
We prospectively evaluated 347 asymptomatic CKD patients (mean estimated glomerular filtration rate: 46.6 ± 22.9 mL/min/1.73 m2). A non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI) as a semi-quantitative measure of aortic calcification. Major adverse cardiovascular events (MACE) were defined as the composite endpoint of cardiovascular death, myocardial infarction, stroke, heart failure, and any coronary revascularization.

Results:
Among the subjects, AAC was present in 296 patients (86.3%), as defined by ACI > 0, and the median ACI was 11.4% (interquartile ranges; 1.38 - 30.7%). During the median follow-up of 41.5 months, a total of 33 MACEs were observed. Event-free survival rate was significantly associated with ACI tertiles, patients with the high tertile of ACI had the highest risk of MACE compared to the other two groups (high, middle and low tertile; 74.3%, 93.0%, and 96.5%, respectively, p< 0.001). The Cox proportional hazard models adjusted for conventional risk factors showed that the ACI was independently associated with MACE (hazard ratio 1.032, 95% confidence interval, 1.009- 1.055, p= 0.006).

Conclusions:
Evaluation of the AAC may provide useful information for predicting adverse clinical outcomes among asymptomatic CKD patients.
Abstract 11839: Hepatitis C sero-positivity Adversely Affects Long-term survival After Orthotropic Heart Transplant: Fifteen Year Analysis of a National Registry
Authors: Kumar Sachin , Deo Salil V , Altarabsheh Salah E , Dunlay Shannon M , Sarreyyupoglu Basar , Elgudin Yakov , Medalion Benjamin , ElAmm Chantal , Ginwalla Mahazarin , Oliveira Guilherme H , Fonarow Greg , Park Soon J
Published: April 2024

Background:
Concerns exist regarding orthotropic heart transplantation (OHT) in hepatitis C (HCV) seropositive recipients. The UNOS national registry was accessed to evaluate HCV recipient sero-positivity and outcomes.

Method:
Retrospective analysis of the UNOS registry (2000-2014) to evaluate recipient profile and clinical outcome of HCV sero-positive (HCV+ve) and sero-negative (HCV -ve) pts. Early and late adjusted survival and adverse events at follow-up were compared.

Results:
From 23,507 patients (mean age 52 yrs; 75% male), 481 (2%) were HCV +ve (mean age 52 yrs; 77% male). Annual proportion of HCV +ve recipients was comparable over the study period (range 1.3-2.7%; p=0.2). The HCV +ve cohort had more African American (22% vs 17%; p=0.01), pts with a prior LVAD (21 vs 14%; p<0.01 and more hepatitis B core Ag+ve recipients (17% vs 5%; p<0.01). However, ECMO (p=0.7), inotropic (p=0.2), and intra-aortic balloon pump (p=0.7) support, serum creatinine (p=0.7) and serum bilirubin (p=0.7) were similar. Proportion of Status 1A pts was similar (24% HCV+ vs 21% HCV -); however wait-time for HCV + recipients was longer (mean 23 vs 19 days; p<0.01). Among donor variables, age (p=0.8), hepatitis B status (p=0.4) and CDC high risk status (p=0.9) were comparable. At a median follow up of 4 years, 67.1% patients were alive, 28.4% died and 1.1% were re-transplanted (3.4% missing). Overall survival was worse in the HCV+ cohort (64.3 vs 72.9 % and 43.2 vs 55% at five and ten years; p<0.01). Late renal [OR 1.2(1-1.6); p = 0.02] and liver dysfunction [OR 4.5 (1.2-15.7); p=0.01] occur in HCV +ve recipients. On adjusted analysis, HCV sero-positivity is associated with poorer survival [HR0.6 (0.5-0.8); p<0.01].

Conclusion:
A small proportion of patients receiving a heart transplant in the United States have hepatitis C. In spite of comparable pre-operative hepatic function, hepatitis C sero-positive recipients develop late liver dysfunction and have poorer long-term survival.
Abstract 11922: Impact of Income Status on Prognosis of Acute Coronary Syndrome Patients During a Period of Financial Crisis - Insights From a Greek Prospective Multicenter Observational Study
Authors: Andrikopoulos George , Tzeis Stylianos , Terentes-Printzios Dimitrios , Varounis Christos , Vlachopoulos Charalampos , Mantas Ioannis , Patsilinakos Sotirios , Lampropoulos Stylianos , Olympios Christoforos , Kartalis Athanasios , Manolis Athanasios , Gotsis Alexandros , Triposkiadis Filippos , Tsaknakis Themistoklis , Goudevenos Ioannis , Kaprinis Ioannis , Pras Athanasios , Vasiliou Fotios , Skoumpourdis Emmanouil , Sakka Gerasimoula , Draganigos Antonios , Vardas Panos
Published: April 2024

Introduction:
The effect of income status on patient outcome merits investigation during periods of financial crisis.

Hypothesis:
We evaluated the impact of income status on out-of-hospital prognosis in a cohort of acute coronary syndrome (ACS) patients, included in a countrywide study during a period of financial crisis.

Methods:
The study is a secondary analysis of a prospective, multicenter, observational study - the PHAETHON study - enrolling consecutive ACS patients in 37 hospitals in Greece. Patients were classified as low- or high-income based on the reported net annual household income using as a cut-off point the relative poverty threshold for Greece of 12000 Euros. The outcome measure was survival free of the primary composite endpoint (cardiovascular death, myocardial infarction, stroke/transient ischemic attack, urgent revascularization and urgent hospitalization due to cardiovascular causes).

Results:
The study population included 794 patients. The administration rate of evidence-based medications was similar in the low- (n=455) and high-income (n=339) groups during hospitalization and upon discharge. In a median follow-up of 189 days (interquartile range: 180-212 days), low-income patients had 92% higher risk of the combined endpoint as compared to high-income patients [Hazard ratio (HR):1.92, 95%CI:1.25-2.94, p=0.003]. The effect of low-income status on the combined outcome remained significant after adjustment for age, gender and depression (HR:1.59, 95% CI:1.02-2.49; p=0.043).

Conclusions:
In a period of financial crisis, low income is a significant and independent predictor of poor out-of-hospital outcome in ACS patients. This association has profound implications and should be taken into consideration by public health policy makers.
Abstract 12008: Increased Circulating Endothelial Microparticles in the Acute Phase of Kawasaki Disease
Authors: Nakaoka Hideyuki , Hirono Keiichi , Takasaki Asami , Miyao Nariaki , Ibuki Keijiro , Saito Kazuyoshi , Ozawa Sayaka , Ichida Fukiko
Published: April 2024

Introduction:
Kawasaki disease(KD) is a typically acute inflammatory syndrome that takes the form of systemic vasculitis. The acute inflammation and subsequent reparative process may lead to lasting changes in arterial structure even in the convalescence of KD including increased endothelial dysfunction. Endothelial microparticles(EMPs) are vesicles formed by the cell membrane after endothelial activation. EMPs typically contain microRNAs(miRs). MiRs can affect mRNA degradation and translation. EMPs may transfer information from the parent cell to various target cells by direct cell-to-cell contact or alternatively through secretion of soluble mediators and effectors.

Methods:
We enrolled 35 patients (aged 3 months to 14 years, 21 male, 14 female), 35 controls. KD patients were divided into two subgroups; coronary artery lesion (CAL, Zsocre>2.5, n=5) and no coronary lesion (NCAL, Zscore≦2.5, n=30). Blood samples were collected at the time of diagnosis before the initiation of IVIG treatment, then immediately after the first IVIG infusion and at 2-4 weeks after disease onset. EMPs were measured by using flow cytometry, and we performed miR expression profiling by using microarrays(Affymetrix® GeneChip® miRNA 4.0).

Results:
The percentage counts of EMPs were 2.90±1.26% in KD children before initial treatment, which were significantly higher (P<0.005) than those of controls (0.09±0.08%). The highest percentage count of EMPs (5.47%) was observed in the patient with CAL before initial treatment. In the patients with acute phase of KD with CAL, miR-320a (Fold change 22.66), miR-320b (Fold change 17.52) and miR-320c (Fold change 11.78) which were extracted from EMPs were up-regulated, while miR-550a (Fold change -4.81) and miR-3613-3p (Fold change -5.51) were down-regulated in comparison with those in convalescent phase. These 5 miRs were normalized after treatment.

Conclusions:
These results suggested that EMPs could serve as a sensitive marker of the severity of endothelial dysfunction and vasculitis in patients with KD. Moreover, miR-320 may have a pivotal role of vasculitis and the development of CAL during acute phase of KD.
Abstract 12095: Altered Brain Functional Connectivity During Valsalva Maneuver in Heart Failure
Authors: Woo Mary A , Park Bumhee , Fonarow Gregg C , Kumar Rajesh
Published: April 2024

Introduction:
Heart failure (HF) patients have abnormal autonomic (ANS) activity, which is linked to damage in specific gray matter brain regions (such as the insulae). Abnormal ANS activity in HF may be due to changes in both structural injury and functional connectivity (FC; temporal correlations between neural structures which indicate connection status and sequence of activation). While insular/brain structural injury has been reported in HF, FC has not been explored.

Hypothesis:
FC between brain regions during an autonomic challenge will be less in HF in comparison to controls.

Methods:
We collected functional MRI data with Valsalva maneuver block design task in 12 HF (age 55.6±8.1 years; Females 3; BMI 25.2±3.8 kg/m2; LVEF, 26.7±11.5%) and 33 controls (51.6±5.5 years; Females 13; BMI 25.7±3.2 kg/m2), using a 3.0 Tesla MRI scanner. Group independent component analysis was applied to identify individual task-related FC maps, which were compared between HF and controls (ANCOVA; covariates, age and gender; P<0.005)

Results:
No significant differences in age, gender, or BMI emerged between the two groups (P>0.05). Decreased FC in HF (Figure 1; p<0.005) were found in the left supramarginal gyrus/inferior parietal lobule, left middle temporal gyrus, bilateral thalamus, left fusiform gyrus, left ligual gyrus, right precuneus, left hippocampus, and left insula. However, increased FC in HF compared to controls were found in the left inferior frontal gyrus, right superior temporal gyrus, left cerebellar cortex, and right insula (P<0.005).

Conclusions:
These findings suggest that autonomic, cognitive, and affective deficits in HF may be related to altered FC. The outcomes likely result from the prominent structural changes in both axons and nuclear structures reported earlier in HF. Future interventions may need to address structural and functional deficits in both gray and white matter regions in HF.
Abstract 12116: Exercise Parameters and Risk of Coronary Heart Disease and Mortality Among Obstructive Lung Disease Patients: The Henry Ford Exercise Testing Project [FIT]
Authors: Adesiyun Tolulope , Zhao Di , Korada Sai , Blaha Michael J , Brawner Clinton A , Keteyian Steven J , Al-Mallah Mouaz H , Michos Erin D
Published: April 2024

Background:
In the general population, the exercise treadmill testing (ETT) variables of lower resting heart rate (HR) and higher peak HR, maximal age predicted HR (MPHR), and exercise capacity (METS) have favorable prognosis for mortality. Patients with obstructive lung disease have increased mortality risk. Furthermore, some pulmonary medications (i.e. beta agonists) can influence HR. We determined whether ETT parameters carry the same prognostic value in patients with lung disease on treatment compared to those without lung disease.

Methods:
We analyzed data on 69,855 patients (mean age 55 yrs) who completed a clinically indicated ETT. Patients were defined as “lung disease” if taking medications routinely used to treat obstructive lung disease (n=6145, 8.8%). ICD9 codes regarding type of lung disease were not available. Cox hazard models were used to determine risk of all-cause mortality, major adverse cardiac events (MACE) and myocardial infarction (MI) over a mean of 11 yrs follow-up.

Results:
Higher resting HR was associated with increased risk of all-cause mortality, while peak HR, achieving ≥85% MPHR, and higher METS were associated with decreased risk (
Table
). No significant interaction for lung disease status was seen for the HR variables, but slightly stronger protective effect for higher METS among lung patients (p-interaction 0.032). Similar results between lung and non-lung disease patients were observed for MACE and MI. Among lung patients stratified by the presence/absence of coronary artery disease (CAD), the prognostic significance for peak HR, MPHR, and METS was stronger among those without CAD (p-interaction <0.05).

Conclusion:
HR-related parameters achieved on ETT are equally prognostic among patients with and without lung disease. Higher fitness (METS) was associated with improved clinical outcomes in both groups. However, the relative benefit of fitness on survival was even greater in patients with (versus without) lung disease.
Abstract 12118: Risk of Thrombotic Events After Discontinuation of Aspirin in Perioperative Period in Patients With Established or at Risk of Coronary Artery Disease: A Systematic Review and Meta-analysis
Authors: Luni Faraz Khan , Riaz Haris , Khan Abdur R , Khuder Sadik , Kanjwal Yusuf
Published: April 2024

Introduction:
Aspirin for prolonged duration is commonly prescribed to patients with a history of cardiovascular events who are at continued risk for occlusive vascular events (secondary prevention). Patients in the peri-operative period are not only at an increased risk of bleeding but also for thrombotic vascular events because of the pro-thrombotic milieu.

Hypothesis:
The objective of our study was to do a systematic review and meta-analysis to compare the risk of thrombotic events and the risk of bleeding in patients with early (3-5 days) versus late discontinuation/no discontinuation of aspirin.

Methods:
PubMed and Embase were searched to identify the studies that report discontinuation or non-adherence of aspirin in patients undergoing surgery. The studies were included if they reported thrombotic events (stroke, all-cause mortality, MI, stent thrombosis & restenosis, stroke, heart failure, VTE, acute limb ischemia, perioperative cardiovascular complications) and perioperative bleeding. Odds ratio was calculated for the measured outcomes. The outcomes were pooled by generic inverse variance method in a random effects model and corresponding forest plots were made. Quality assessment was done as per Newcastle-Ottawa scale.

Results:
Our search strategy revealed 1018 studies out of which 6 observational studies (3 evaluating cardiac and 3 non-cardiac surgeries) met the inclusion criteria. There was no difference in the risk of thrombotic events both in early or late discontinuation of aspirin (OR 1.17, 95% CI= 0.74-1.84, p =0.50; I2 = 56%) (Figure 1). Early discontinuation of aspirin showed a decreased risk of peri-operative bleeding (OR 0.82, 95% CI= 0.67-0.99; p =0.04; I2 = 42%) (Figure 2).

Conclusion:
Planned discontinuation of aspirin is acceptable with no increased risk of thrombotic events and with a decreased risk of bleeding. Moreover the decreased risk of peri-operative complications may help reduce the length of stay and associated co-morbidities.
Abstract 12191: The Posterior Circulation and Right Hemisphere are Particularly Vulnerable to Neurological Insult During Transcatheter Aortic Valve Replacement (TAVR)
Authors: Fanning Jonathon P , Wesley Allan J , Walters Darren L , Platts David G , Fraser John F
Published: April 2024

Introduction:
Stroke is among the most feared complication for patients undergoing TAVR. Despite maturation of the procedure, cerebrovascular events (CVEs) remain poorly defined, with clinically apparent CVEs representing only the ‘tip-of-the-iceberg’. MRI detection of cerebral infarction provides a useful surrogate marker for characterizing the full extent of cerebrovascular injury in this setting.

Hypothesis:
Anatomical distribution of MRI-defined brain infarction is heterogeneous involving multiple vascular territories in a classical embolic pattern.

Methods:
Thirty-six patients undergoing TAVR with the Edwards SAPIEN-XT
TM
at The Prince Charles Hospital, Australia, were prospectively enrolled. Participants underwent brain MRI, including diffusion weighted imaging (DWI) sequences, pre-procedure and 3 days post-procedure. Clinical assessment for CVEs included serial National Institute of Health stroke scale assessments at baseline, daily for 3 days post-procedure and again at 6 weeks.

Results:
The mean (±SEM) participant age was 82.17 (±1.1) years. Patients were of a moderate-to-high risk with Society of Thoracic score 6.29 (±0.09) and EuroSCORE II 6.75 (±1.1). There were no clinically apparent CVEs. MRI assessments identified 81 new DWI lesions in 16 of 27 participants (59.26%), mean 2.54 (±0.77) lesions/patient and 0.14 (±0.08) cm
3
/lesion. Anatomical characterization of these lesions can be found in the Table.

Conclusions:
Subclinical neurological injury is common with TAVI. Injury is predominantly right-sided, cortical and involving the posterior cerebral circulation. These results reveal unique considerations for neuroprotective strategies in TAVI.
Abstract 12235: A Randomized Control Hands-on Defibrillation Study - Barrier Use Evaluation
Authors: Wampler David , Kharod Chetan , Bolleter Scotty , Burkett Alison , Gabehart Caitlin , Manifold Craig
Published: April 2024

Introduction:
Chest compressions and defibrillation are the only therapies proven to increase survival in cardiac arrest. Historically, rescuers must remove hands to shock, thereby interrupting chest compressions. This hands-off time (pre-shock pause) results in a zero blood flow state. Pre-shock pause has been associated with poorer neurological recovery from cardiac arrest.

Methods:
This was a blinded randomized control cadaver study evaluating a rescuer’s ability to detect defibrillation during manual chest compressions. We used two defibrillators, with identical auditory signals during charging, and shock delivery. The active defibrillator was connected to the cadaver in the sternum-apex configuration with self-adhesive defibrillation pads. The sham defibrillator was connected to a device designed to safely and silently receive current. After informed consent, paramedic subjects performed chest compressions on the cadaver using 6 types of hand barriers: no-barrier, single and double layer nitrile gloves, firefighter gloves, neoprene pad, and a manual chest compression/decompression device. Randomized defibrillations (10 per barrier type) were delivered at 30 joules (J) for bare hand and 360J for all other barriers. After each shock, the subject indicated degree of sensation on a Likert scale.

Results:
Ten subjects participated and utilized six barrier methods. Half of the shocks were randomized to sham. All subjects detected 30j shocks during barehand compressions, with only 1 undetected real shock, and no reports of feeling a bare-handed sham shock. All barriers combined totaled 500 shocks delivered. Five (1%) active shocks were detected with any barrier, 1 (0.2%) with single layer of Nitrile gloves, 3 (0.6%) with double layer nitrile-gloves and 1 (0.2%) with the neoprene barrier. One sham shock was reported detected with the single layer nitrile glove. No shocks were detected with fire gloves or compression decompression device. Subjects reported all shocks detected as barely perceptible (0.25 (±.05) cm on 10 cm Likert scale).

Conclusions:
Nitrile gloves or a neoprene pad essentially prevent (99%) responder’s detection of a 360J defibrillation on a cadaver. Fire gloves and compression decompression device prevented detection.
Abstract 12244: The Impact of Anti-angiogenic Isoform of Vascular Endothelial Growth Factor A in Patients With Pulmonary Hypertension
Authors: Suzuki Satoshi , Nakakzato Kazuhiko , Sugimoto Koichi , Yoshihisa Akiomi , Yamaki Takayoshi , Kunii Hiroyuki , Suzuki Hitoshi , Saitoh Shu-ichi , Takeishi Yasuchika
Published: April 2024

Background:
The primary form of pulmonary hypertension (PH) is classified as idiopathic pulmonary artery hypertension (IPAH), while the secondary disease state, including collagen disease, thromboembolism and congenital heart disease with systemic-to-pulmonary shunts. Vascular endothelial growth factor (VEGF) is a key contributor for angiogenesis and vasculogenesis, and production of VEGF is urged in PH patients due to hypoxia. Alternative splicing and proteolytic processing of VEGF-A, which is the most important member of VEGF family, produces various isoforms, including VEGF165b, which has anti-angiogenic effect. The purpose of this study was to examine the clinical significance of circulating levels of VEGF165b in patients with PH.

Methods and Results:
Plasma levels of VEGF165b were measured in 39 patients with PH (9 in IPAH, 7 in PH related to collagen disease, 13 in chronic thromboembolic PH (CTEPH), 10 in others including congenital heart disease) and 27 normal subjects as control. In baseline clinical characteristics, female was more frequent and body mass index was smaller in PH patients than in control. Plasma VEGF165b level in PH patients was higher than in control subjects (97.1±56.2 vs. 53.3±13.4 pg/ml, P<0.001). Especially, plasma VEGF165b level was higher in IPAH (137.1±108.1 pg/ml, P<0.001), but not in PH related to collagen disease (80.1±16.1 pg/ml), CTEPH (86.4±16.7 pg/ml), and others (88.4±9.7 pg/ml). Tricuspid regurgitation pressure gradient (TR-PG) was higher in PH patients than in control (71.9 ± 25.8 vs. 11.2 ± 11.6 mmHg, P<0.001), and TR-PG had significant positive correlation with plasma VEGF165b level (R=0.281, P=0.373). Right ventricular dimension, right ventricular fractional area change and SpO2 level were not correlated with plasma VEGF165b level.

Conclusions:
VAGF165b, anti-angiogenic isoform, might contribute to the pathophysiology in PH, especially in idiopathic pulmonary artery hypertension.
Abstract 12262: Clinical and Echocardiographic Predictors of Bioprosthetic Valve Thrombosis
Authors: Egbe Alexander , Pislaru Sorin V , Pellikka Patricia A , Poterucha Joeseph T , Maleszewski Joeseph , Schaff Hartzell V , Connolly Heidi
Published: April 2024

Background:
Bioprosthetic valve thrombosis (BPVT) is considered uncommon; this may be related to the fact that it is often unrecognized. Our objectives were to determine the clinical characteristics of BPVT, and formulate a diagnostic model for BPVT.

Methods:
Patients requiring redo surgery after initial bioprosthetic valve (BPV) implantation were identified from the Mayo Clinic pathology database. Cases of BPVT were matched 2:1 with degenerated, non-thrombosed BPV. Multivariate linear logistic regression and receiver operating characteristic were used to formulate a diagnostic model for BPVT.

Results:
There were 46 BPVT cases identified between 1997-2013 (age=63 ±15, male=68%; aortic=29, mitral=9, tricuspid=7, pulmonary=1) and 92 controls matched by age, gender and prosthesis position. BPVT was present in 11.6% of 397 explants, and led to surgery significantly earlier than degeneration (median of 24 vs108 months, respectively, p<0.001). Thirty (65%) of all BPVT occurred beyond 12 months post implantation. Predictors of BPVT were 50% increase in mean echo-Doppler gradient from baseline within 5 years (odds ratio [OR] 12.7), paroxysmal atrial fibrillation (OR 5.19), subtherapeutic INR (OR 7.37), increased cusp thickness (OR 12.2), and abnormal cusp mobility (OR: 6.94). Presence of all 5 diagnostic features was predictive of BPVT with 76% sensitivity, 93% specificity, 85% positive predictive value, and 89% negative predictive value, AUC=0.91, P<0.0001.

Conclusion:
BPVT requiring reoperation occur in over 10% of patients receiving BPV and can occur several years after surgery. A combination of clinical and echocardiographic features can reliably diagnose BPVT. It is crucial to consider the diagnosis of BPVT prior to referring for reoperation since therapy with VKA may reverse the BPV dysfunction and prevent reoperation.

Figure Legend: (A) Incidence of BPVT thrombosis (B) Freedom from BPV dysfunction (C) ROC curve for prediction of BPVT