bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17965: Echocardiographic Assessment of Surgically Placed Melody Valves in the Mitral Position in Young Children
Authors: Freud Lindsay R , Emani Sitaram M , Marshall Audrey C , Marx Gerald R , Tworetzky Wayne
Published: July 2021

Introduction:
Mitral valve replacement (MVR) in young children is limited by lack of small prostheses, resulting in high re-intervention rates and mortality. Therefore, in 2010, we began performing MVR with modified, surgically placed, stented jugular vein grafts (Melody valve) to allow for tailoring to small annular dimensions as well as subsequent expansion in the catheterization lab. We aimed to analyze key pre- and post-operative (op) echo variables to refine surgical planning for this novel procedure.

Methods:
We included 17 patients who underwent surgically placed Melody MVR. The pre- and post-op echoes before discharge were retrospectively reviewed for anatomic and physiologic variables. On the pre-op echo, we performed “potential” mitral annular measurements in orthogonal planes to estimate the maximum intra-op balloon sizing. Given concern for left ventricular outflow tract obstruction (LVOTO), a ratio of the narrowest subaortic region in systole to the actual mitral annular dimension (SubA:MV) was assessed in the parasternal long axis view. Values are presented as median (range), where applicable.

Results:
Melody MVR was performed at 8 months of age (weight 5.2 kg) for stenosis (5), regurgitation (1), and mixed disease (11). On pre-op echo, the potential mitral measurement in the lateral dimension correlated well with the intra-op balloon size selected by the surgeon (ρ=0.58, p=0.01). The Melody valve was expanded to 1.0 times the potential lateral dimension (median 14 mm). The SubA:MV measured >0.5 in all patients. By post-op day 10 (5-35), the mean mitral gradient improved by 9 mm Hg (1-16), and right ventricular pressure was <½ systemic in 76% (vs. 12% pre-op, p<0.001). Only 2 patients had mild regurgitation and 1 had a mild perivalvar leak. The internal diameter of the Melody valve measured 3.4 mm (1-6) less than the intra-op balloon size. No patient had LVOTO >25 mm Hg or pulmonary vein obstruction.

Conclusion:
Intra-op balloon sizing of Melody MVR may be guided by pre-op echo indices to achieve adequate mitral valve function without significant LVOTO. The post-op Melody valve diameter was found to measure less than the intra-op balloon size, which should be considered as experience with the Melody in native, non-conduit positions evolves.
Abstract 17969: Cardiovascular Implantable Electronic Device Longevity Estimates at Autopsy - An Unrealized Resource?: a 5 Year Review of the Johns Hopkins Post-mortem CIED Registry
Authors: Sinha Sunil K , Crain Barbara , Flickinger Katie , Calkins Hugh , Rickard Jack , Cheng Alan , Berger Ronald , Tomaselli Gordon , Marine Joseph E
Published: July 2021

Introduction:
Feasibility of post-mortem CIED (pacemaker (PPM) or defibrillator (ICD)) retrieval for reuse has recently been shown but a model for systematic post-mortem CIED acquisition remains elusive. Prior studies of CIED longevity in retrospective autopsy and funeral home & crematory series have indicated a low yield of usable devices (21 - 30%). However, processes for timely interrogation and reprogramming were not in place. We undertook a registry analysis to
determine estimated longevities and reuse potential upon routine CIED retrieval at autopsy.

Methods:
From May 19, 2009 - May 18, 2014 adult & pediatric autopsy subjects at two academic institutions underwent concomitant CIED pulse generator explantation. The CIED was interrogated by an electrophysiologist, device longevity was cataloged and the device submitted to the applicable manufacturer for formal technical analysis.

Results:
Seventy (4.3%) of 1642 autopsies had CIEDs. All were retrieved and interrogated within a mean 18.4 ± 14.1 days. There were 30 PPMs and 40 ICDs (4 manufacturers). CIEDs had been implanted for a mean of 2.7 ± 2.4 years and 22/70 (31.4%) had been implanted < 1 year prior to death. Overall, 12/70 CIEDs (17.1%) had a longevity < 1 year (including 5 at elective replacement indication (ERI), 1 recalled PPM, and 1 ICD hard reset), 20/70 (28.6%) had a longevity 1 - < 4 years, and 38/70 (54.3%) had longevity ≥ 4 years. This last group demonstrated a mean longevity of 7.1 ± 2.3 years. Manufacturer technical analyses helped to confirm device longevity status and functionality, identify premature battery depletion, and confirm non-reprogrammable hard reset (due to cold exposure).

Conclusion:
In contrast to prior studies, our registry analysis demonstrated that the majority of CIEDs retain considerable device longevity and functionality when promptly evaluated post-mortem. Such a systematic approach represents a practical model for post-mortem CIED retrieval, evaluation and potential reuse.
Abstract 17973: Biomass Fuel Use is Associated With Elevated Blood Pressure and Hypertension Status in Puno, Peru
Authors: Burroughs Pena Melissa S , Romero Karina , Bernabe Ortiz Antonio , Velazquez Eric J , Miranda J. Jaime , Gilman Robert H , Checkley William ,   CRONICAS Study Group
Published: July 2021

Background:
Household air pollution from biomass fuel use affects 3 billion people worldwide. There are few studies that examine the relationship between biomass fuel use and blood pressure. We sought to determine if daily biomass fuel use was associated with higher blood pressure and increased hypertension in Peru.

Methods:
We analyzed baseline information from an age- and sex-matched, population-based study in Puno, Peru. Daily biomass fuel use was self-reported. Hypertension was defined as a systolic blood pressure (SBP) ≥140 mmHg; diastolic blood pressure (DBP) ≥90 mmHg; or self-report of diagnosis and anti-hypertensive medications. We used linear and logistic multivariable regressions, adjusting for age, sex, daily cigarette use and body mass index, to examine the relationship between daily biomass fuel use with blood pressure and hypertension, respectively.

Results:
Data from 1004 individuals (mean age 55.3 years, 51.7% female) were included. There was evidence of an association between daily biomass fuel use and hypertension (adjusted OR = 2.1, 95%CI 1.2 to 3.5). Subjects who reported daily use of biomass fuels had 6.0 mmHg (95% CI 4.1 to 8.0) higher SBP and 4.8 mmHg (95%CI 3.5 to 6.0) higher DBP compared to those who did not use biomass fuels daily. In a secondary analysis, we used rural residence (vs. urban) as a proxy of biomass daily use and the relationship with hypertension and systolic blood pressure was similar: a higher odds of hypertension (adjusted OR = 2.1, 95%CI 1.3 to 3.6), and higher SBP (6.7mmHg, 95% CI 4.8 to 8.6) and DBP (5.5 mmHg, 95% CI 4.3 to 6.8) in rural vs. urban participants.

Conclusion:
Biomass fuel use is associated with increased odds of hypertension and higher blood pressure in Puno, Peru. Reducing exposure to air pollution from biomass fuel use represents a potential opportunity for cardiovascular prevention in rural communities worldwide. Longitudinal studies to evaluate the impact of reducing household air pollution are needed.
Abstract 17994: Echocardiographic parameters of Left Ventricular Size and Function as Predictors of Symptomatic Heart Failure in Patients with Low Normal Ejection Fraction Treated with Anthracyclines
Authors: Mousavi Negareh , Tan Timothy , Ali Mohammad , Halpern Elkan F. , Wang Lin , Scherrer-Crosbie Marielle
Published: July 2021

Objectives:
The aim of this study was to assess whether baseline echocardiographic measures of left ventricular (LV) size and function predict the development of symptomatic heart failure or cardiac death (major adverse cardiac events, MACE) in patients treated with anthracyclines who have a pre-chemotherapy left ventricular ejection fraction (LVEF) in the low normal range (between 50-59%).

Background:
Anthracycline-induced symptomatic heart failure and impaired LVEF are late and often irreversible manifestations of anthracycline-induced cardiotoxicity. The value of echocardiographic parameters of myocardial size and function before chemotherapy to identify patients at high-risk for development of symptomatic heart failure in patients with low normal LVEF was studied.

Methods:
Patients with a LVEF between 50 and 59% before anthracyclines were selected. In these patients, LV volumes, LVEF and peak longitudinal strain (GLS) were measured. Individuals were followed for MACE and all-cause mortality over a median of 659 days (range; 3-3704 days).

Results:
Of 2234 patients undergoing echocardiography for pre-anthracycline assessment, 158 (7%) had a resting ejection fraction of 50-59%. Their average LV end-diastolic volume (LVEDV) was 101±22ml, LVEF was 54 ±3% and global longitudinal strain (GLS) was -17.7±2.6%. Twelve patients experienced a MACE (congestive heart failure) at a median of 173 days (range; 15-530). Age, diabetes, previous coronary artery disease, LVEDV, LVESV and GLS were all-predictive of MACE (P= 0.015, 0.0043 and 0.0065 for LVEDV, LVESV, and GLS respectively). LVEDV and GLS remained predictive of MACE when adjusted for age. Age and GLS were also predictive of overall mortality (p<0.0001 and 0.0105 respectively).

Conclusions:
In patients treated with anthracyclines with an LVEF of 50-59%, both baseline EDV and GLS predict the occurrence of MACE. These parameters may help target patients who could bene[[Unable to Display Character: ﬁ]]t from closer cardiac surveillance and earlier initiation of cardioprotective medical therapy.
Abstract 17995: Inhibition of Myofibroblast Differentiation by FOXO3a - Implications for Acute Myocardial Infarction and Cardiac Remodeling
Authors: Holzhauser Luise , Jenke Alexander , Savvatis Kostas , Grueger Mathias , Schur Robert , Lindner Diana , Westermann Dirk , Poller Wolfgang , Schultheiss Heinz-Peter , Skurk Carsten
Published: July 2021

Introduction:
Transdifferentiation of cardiac fibroblasts into myofibroblasts regulated by TGFβ/SMAD3 signaling is a major mechanism of scar formation and adverse remodeling following myocardial infarction.

Hypothesis:
We hypothesized that the transcription factor FOXO3a, a key regulator of cell differentiation, cycle and size, might inhibit this process.

Methods:
Acute myocardial infarction was induced in FOXO3-/- and WT mice (FVB) by permanent LAD ligation and myofibroblast transdifferentiation markers were assessed. FOXO3a-/- and WT cardiac fibroblasts were investigated in transdifferentiation assays ex vivo. FOXO3a gene transfer was performed with gain of function adenoviral vectors. IP/IF and Western blotting were used to test for a direct interaction between FOXO3a and SMAD3.

Results:
FOXO3a-/- mice had significantly higher survival rates compared to WT mice due to reduced rates of ventricle perforation. Myocardial expression of alpha smooth muscle actin (ASMA) and Collagen1A1 (Col1A1) was significantly enhanced in FOXO3a-/- mice 3 and 14 days post infarction. Moreover, Foxo3a-/- mice showed larger fibrotic areas following MI. In line with these results, cardiac fibroblasts isolated from FOXO3a-/- mice showed significantly enhanced expression levels of Col1A1 and ASMA 24 hours following stretch or TGF-β stimulation when compared to WT cells in vitro. Furthermore supernatants of FOXO3a -/- fibroblasts showed significantly higher protein expression of Col1A1 in (p<0.01) while FOXO3a gene-transfer dose-dependently downregulated Col1A1. Immunfluorescence staining for ASMA protein was significantly attenuated following FOXO3a gene transfer in cardiac fibroblasts. Mechanistically, immunoprecipitation showed direct interaction of FOXO3a with SMAD3a that was enhanced following activation of the transcription factor leading to diminished SMAD3 downstream gene expression.

Conclusions:
Our results identify FOXO3a as a direct inhibitor of TGF- β regulated matrix remodeling via FOXO3a-SMAD3 interaction. FOXO3a regulates fibrosis and scar formation following myocardial infarction and thus targeting the FOXO3a-SMAD3 axis might be of therapeutic interest.
Abstract 18019: Successful Surgical Management of Severely Symptomatic Hypertrophic Cardiomyopathy Patients With Minimal Septal Hypertrophy
Authors: Ahmad Raabia N , Maron Barry J , Rowin Ethan J , Haas Tammy S , Dearani Joseph A , Maron Martin S
Published: July 2021

Background:
Marked septal hypertrophy is considered a requirement for effective myectomy in obstructive hypertrophic cardiomyopathy (HCM), with mitral valve replacement recommended as the alternative strategy in patients with minimal hypertrophy. However, it remains uncertain whether relief of obstruction can be effectively abolished without mitral valve replacement in patients with minimal septal wall thickening.

Methods:
Of 500 patients who underwent surgical myectomy from 2004 to January 2014, 21 (4.2%) were identified with a maximum LV wall thickness ≤ 15mm and constitute the study cohort.

Results:
All 21 patients (56 ± 10 years old; 62% male) were followed for advanced heart failure symptoms refractory to drug therapy with a maximal septal wall thickness of 13.6 ± 1.7 mm (range: 10-15 mm; ≤ 12 mm in 5 patients). Outflow obstruction ≥ 30 mmHg due to mitral valve-septal contact was present after exercise in 17 of 21 patients (range: 50-150 mmHg), and under resting conditions in 4 patients (range: 30-65 mmHg). In all patients, surgical relief of obstruction consisted of muscular resection of the basal septum with revision of abnormal and apically displaced papillary muscles, which were judged intraoperatively to be contributing to obstruction. In addition, in 10 patients (47%) myectomy alone was not sufficient to relieve obstruction due to the limited opportunity for septal reduction and adjunctive mitral valve repair was performed to shorten an elongated anterior leaflet. No patient required mitral valve replacement or incurred a ventricular septal defect. Post-operatively, 4 patients developed complete heart block requiring permanent pacemaker (1 patient with pre-operative right bundle branch block) and 1 had a cerebrovascular event. At most recent follow up 18 ± 19 months post-myectomy, septal thickness was reduced to 10 ± 2 mm, no patient had an outflow gradient at rest or with provocation, and all patients were alive with the majority asymptomatic (class I: n=13; 62% and class II n=8; 38%).

Conclusion:
In patients with minimal septal hypertrophy, outflow obstruction can be effectively abolished with surgical myectomy and adjunctive mitral valve repair with a small increased risk of heart block, but without the need for mitral valve replacement.
Abstract 18048: Short and Long Term Mortality in Women and Men Undergoing Primary Angioplasty: a Comprehensive Meta-analysis
Authors: Bavishi Chirag , Patel Dipen , Chatterjee Saurav , Trivedi Vrinda , Sawant Ashwin , Tamis-Holland Jacqueline E
Published: July 2021

Introduction:
Women with acute myocardial infarction are treated less aggressively than men and have a higher mortality. It is possible that the reported differences in outcome by sex are a result of differences in baseline risk and hospital management. We hypothesized that mortality would be similar among a cohort of women and men receiving guideline recommended reperfusion therapy for STEMI with primary PCI.

Methods:
We performed a meta-analysis of studies of patients with STEMI referred for primary PCI. PubMed, EMBASE and Scopus databases were searched. Studies reporting 30-day and long-term gender specific crude mortality rates and or adjusted effect estimates in STEMI patients undergoing PCI were identified. Pooled effect estimates were calculated with random effects models.

Results:
A total of 33 studies, involving 67,875 patients, (17,093 women and 50,782 men) were included in the analysis. As compared to men, women were older, had higher prevalence of hypertension, diabetes, hyperlipidemia, Killip >1/heart failure and had lower use of aspirin, plavix and statins on discharge (p<0.001 for all).Using crude rates from individual studies, women had significantly higher 30-day mortality [pooled relative risk (RR): 1.79 (1.51 -2.11), p<0.001; 20 studies (n=42,749)] and long-term mortality [RR: 1.58 (1.44 -1.74), p<0.001; 25 studies (n=50,552)]. When meta-analysis using multi-variable adjusted RR from individual studies was performed, 30-day mortality [RR: 1.15 (0.97 - 1.37), p =0.11; 11 studies (n=23,805)] and long-term mortality [RR: 1.02 (0.95 -1.10), p =0.58; 19 studies (n=51,124)] were no longer significantly different between women and men.

Conclusions:
Among STEMI patients undergoing primary PCI, short and long term mortality risk is similar in women and men after adjusting for other confounding variables. This reinforces the importance of providing evidence based reperfusion therapy to eligible women and men with acute STEMI.
Abstract 18093: Bleeding Events in Clopidogrel-Treated Patients with STEMI is Associated with a Genetic Risk Score Based on High-Risk Genetic Polymorphisms
Authors: Zhang Jia-Hui , Yuan Jin-Qing , Meng Xian-Min , Tang Xiao-Fang , Wang Jing , Yao Yi
Published: July 2021

Introduction:
Gene polymorphisms of ABCB1, CYP2C19, PON1 and P2Y12 may influence pharmacodynamics and clinical events of clopidogrel treatment.

Hypothesis:
We assessed the hypothesis that a genetic risk score based on identified high-risk single nucleotide polymorphisms (SNPs) would be associated with bleedings in clopidogrel-treated Chinese STEMI patients after percutaneous coronary intervention (PCI).

Methods:
A total of 503 consecutive patients with STEMI who received an uneventful PCI and were exposed to clopidogrel treatment for 12 months, were enrolled in the single-center registry. There were 38 tag SNPs selected from ABCB1, CYP2C19, PON1 and P2Y12 genes, which were detected by the ligase detection reaction. The primary clinical safety endpoint was the incidence of major bleeding events. Major bleeding was quantified according to bleeding academic research consortium definition (BARC) criteria, including type 3 and 5 in the analysis. The follow-up period was 12 months.

Results:
Overall, 46 BARC≥3 bleeding events (9.1%) occurred, which included 11 (2.1%) cases of BARC 3b bleedings and 35 (7.0%) cases of BARC 3a bleedings. After adjustment for traditional clinical risk factors, multivariate logistic regression analysis identified SNPs significantly associated with bleedings were ABCB1 (rs1045642, rs2235047, rs7779562), P2Y12 (rs6809699) and CYP2C19*17. A genetic risk score was constructed by summing the number of risk alleles. Bleedings were significantly associated with increased genetic risk score tertile. Patients in the top tertile of the genetic score were estimated to have a 3.268-fold (95%CI=1.198-8.929, p=0.021) increased risk of bleedings compared with those in the bottom tertile. As a continuous variable, the risk score resulted in an OR of 1.326 per unit increase in score (95%CI=1.098-1.601, p=0.003).

Conclusions:
This genetic score was significantly associated with bleedings after PCI in our study population.
Abstract 18099: Renal Sympathetic Denervation Increases Renal Artery Blood Flow: a Serial MRI Study in Resistant Hypertension
Authors: Delacroix Sinny , Chokka Ramesh G , Sahay Shweta , Nelson Adam J , Nimmo Joanne , Wong Dennis T , Rajwani Adil , Carbone Angelo , Lau Elizabeth O , Hata Cary , Chen Peter , Teo Karen S , Worthley Stephen G
Published: July 2021

Background:
Pre-clinical studies to date have demonstrated potential improvements in renal blood flow after renal sympathetic denervation, however such effects are yet to be confirmed in patients with resistant hypertension. We assessed the effects of renal sympathetic denervation in these patients on renal artery blood flow and diameter at multiple time points.

Methods and results:
Patients (n = 15) with systolic blood pressures ≤ 160mmHg despite taking ≥ 3 antihypertensive medications concurrently at maximum tolerated dose were recruited into this single centre, prospective, non-blinded study. MRI indices included renal blood flow and renal artery diameters at baseline, 1 month and 6 months. In addition to significant decreases in blood pressures (p
<
0.05) renal blood flow (total volume per cardiac cycle) increased 20% from (6.9 ± 2 mls) at baseline to (8.7 ± 2 mls; p=0.001) at one month and (8.0 ± 2mls; p=0.01) six months post procedure. There was a significant decrease in renal artery diameters from (6.8 ± 2 mm) at baseline to (6.2 ± 1 mm; p<0.03) at 1 month post procedure and this decrease was associated with increases of maximum velocity of blood flow from (73 ± 19 cm/sec) at baseline to (78 ± 19 cm/sec) at one month post procedure and notably, both parameters revert to 6.9 ± 2 mm and 72 ± 18 cm/sec respectively. Thus, this study is the first to provide evidence of an early reduction in renal artery diameters (potentially due to oedema and inflammation) post intervention that has resolved by 6 months.

Conclusion:
Renal sympathetic denervation improves renal physiology as evidenced by significant improvements in renal blood flow. Additionally, this study for the first time identifies a transient decrease in renal artery diameters immediately after procedure and further demonstrates that these changes revert to baseline values six months post procedure.
Abstract 18104: Chagas Disease is not Independently Associated with Atrial Fibrillation in Patients with Cardiomyopathy
Authors: Cardoso Rhanderson N , Garcia Daniel , Fernandes Gilson , Macedo Francisco , Ansari Mohammad , Mitrani Raul D
Published: July 2021

Introduction:
Chagas Disease (CD) has been associated with an increased incidence of stroke, which may ultimately be due to an increased prevalence of atrial fibrillation (AF). Observational studies support this possibility, but data is conflicting. Furthermore, it is unknown if CD represents an independent risk factor for AF when compared to other cardiomyopathies.

Hypothesis:
CD is significantly associated with an increased prevalence of AF when compared to other cardiomyopathies.

Methods:
PubMed, EMBASE, Cochrane Central and Latin American databases were searched for studies that directly compared the prevalence of AF in CD patients to a non-CD group. Odds-ratios were computed using a random-effects model due to anticipated heterogeneity. Subanalyses were performed on studies in which both the control group and CD patients had (1) cardiomyopathy and (2) heart failure.

Results:
A total of 18 studies and 10,724 patients were included, of whom 4,216 (39.3%) had a positive serology for CD. In the pooled data, AF was significantly more prevalent among the CD group (OR 1.69; 95% CI 1.24-2.30; p<0.001; Figure 1). However, no significant difference was observed between groups when the analysis included only patients with cardiomyopathy (11 studies; OR 1.33; 95% CI 0.94-1.89; p=0.11; Figure 2A) and heart failure (6 studies; OR 1.03; 95% CI 0.75-1.43; p=0.85; Figure 2B).

Conclusions:
Our meta-analysis suggests that in patients with cardiomyopathy or heart failure, Chagas Disease etiology is not independently associated with atrial fibrillation.
Abstract 18105: Comparison of Efficacy and Safety of Two Dosages Dabigatran versus Warfarin in Patients with Persistent and Long-standing Atrial Fibrillation Undergoing Electrical Cardioversion
Authors: Kalejs Oskars , Litunenko Olga , Sakne Sandis , Strelnieks Aldis , Kovalova Marina , Dormidontova Galina , Sime Iveta , Vikmane Maija , Zabunova Milana , Saripo Vita , Lejnieks Aivars , Erglis Andrejs
Published: July 2021

Introduction:
The most important factor for efficacy and safety for patients with atrial fibrillation (AF) undergoing electrical cardioversion (ECV) is appropriate use of oral anticoagulant (OAC) therapy. Dabigatran is a possible alternative OAC therapy before and after ECV versus therapy with warfarin.

Methods:
We have analysed the data collected before, during and after ECV in 1046 patients (pts) undergoing ECV. All pts had AF, 885 defined as persistent and 161 defined as long-acting, mean CHA2DS2 VASc score was 3.1 ± 1.8, 735 had one or two ECV in anamnesis. 628 (60%) pts started the use of dabigatran, (405 pts 150 mg twice or 223 pts 110 mg twice) before ECV for at least 21 day, 418 (40%) started warfarin therapy, 21 day start after INR was in range 2.0 - 3.0. Transesophageal echocardiography (TEE) was encouraged before ECV in all groups for pts with CHA2DS2VASc score ≥ 3, markedly left atrial dilatation and AF duration ≥ 6 months. ECG and Echo-kg data were analysed 30 and 90 days after ECV.

Results:
ECV was successful after first shock in 962 (91.7%) pts, in total successful ECV - in 1029 (98.37%) pts. Left atrial thrombi were detected on TEE before ECV in 7 pts in dabigatran group and 12 pts in warfarin group, so, pts continued OAC therapy for one month, and TEE had been performed again. 3 pts in dabigatran (150 mg twice) group and 2 pts in warfarin group were free of thrombus and have been referred to ECV. Average time for treatment before ECV was significantly lower for dabigatran (25 days) vs warfarin (44 days, p<0.01). Stroke and systemic embolism rates at 90 days were lower in both dabigatran group (0.1%) vs warfarin group (1.4%). There was no difference in analysis of events between TEE and non-TEE pts. Dabigatran pts had significantly lower clinical relevant bleeding rate vs warfarin (D 110 mg 0, D 150 mg 0.47% vs W 2.87%, p<0.04).

Conclusions:
Dabigatran 150 mg and 110 mg twice is a safe, effective and reasonable alternative to warfarin for patients undergoing ECV despite CHA2DS2VASc risk score and AF duration. The frequencies of stroke and embolic events were lower in dabigatran 150 mg and 110 mg versus warfarin with lower bleeding rates within 30 and 90 days after ECV. Patients undergoing dabigatran therapy have shorter time before procedures and can save time for INR test in normal range.
Abstract 18117: Trends in the Utilization and Outcomes of Medicare Beneficiaries Undergoing Catheter Ablation for Ventricular Tachycardia
Authors: Yousuf Omair , Zusterzeel Robbert , Sanders WIlliam , Dekmezian Carmen , Silverman Henry , MaCurdy Thomas , Nazarian Saman , Berger Ronald , Marinac-Dabic Danica , Caños Daniel , Strauss David
Published: July 2021

Background:
Sustained ventricular tachycardia (VT) is a significant cause of sudden death, progressive ventricular dysfunction, and heart failure hospitalizations. Radiofrequency catheter ablation is used to control incessant VT and prevent or reduce the frequency of VT episodes. However, data regarding mortality and complication rates with VT ablation are limited.

Objective:
To measure the incidence of procedural complications, repeat ablations, hospitalization for heart failure and ventricular tachycardia, and short and long term mortality in patients undergoing VT ablation.

Methods:
We conducted a population-based, retrospective cohort study of all fee-for-service Medicare beneficiaries who underwent catheter ablation for VT between 2000 and 2012. The main outcome measures were major complications within 30 days and 1-year rates of death, repeat ablation and heart failure and VT hospitalization.

Results:
There were 21,073 patients that received a VT ablation during the study period (mean age 70 years; 77% were men; 90% were white). The ablation frequency increased from 647 in 2000 to 2,760 in 2012. The 30-day incidence of pericardial complications was 2.3%, vascular complications 6.8%, stroke or transient ischemic attack 1.5%, need for mechanical circulatory support 2.3%, and death 4.2%. The 1-year incidence per 1,000 person-years for repeat ablation was 81, death 176, and hospitalization for heart failure and VT 156 and 272, respectively (Figure).

Conclusions:
Utilization of catheter ablation for VT has increased over the past 12 years. Major complications after VT ablation are relatively infrequent, but not trivial. These findings should inform discussion of potential procedural complications and long term prognosis and may have considerable implications when discussing treatment options for patients with VT.
Abstract 18150: Prediction of Imminent Deterioration of Children after Stage I Palliation Using Real-Time Processing of Physiological Data
Authors: Rusin Craig G , Acosta Sebastian I , Vu Eric L , Myers Risa B , Brady Kenneth M , Penny Daniel J
Published: July 2021

Patients after stage 1 palliation (S1P) for hypoplastic left heart syndrome (HLHS) and related lesions are at risk of life threatening deterioration resulting in shock, cardiac arrest, & hypoxemia. We hypothesize that these sudden deteriorations may be forecast by subtle, previously unidentified changes in cardiorespiratory dynamics. Identification of these precursors may provide an opportunity for early, life-saving intervention.

We created complete high-resolution physiological recordings for all patients who had a primary admission of S1P after Jan. 1, 2013. We used the SickbayTM system (Medical Informatics Corp, Houston, TX) to collect high frequency physiological waveforms including EKG, ABP, LAP, SpO2 and Chest Impedance (60Hz - 240Hz), as well as HR, RR, Temp. and ST segment vital signs (0.5 Hz) during the patient’s interstage hospitalization. A logistic regression model was constructed to discriminate between physiological characteristics observed in the hours prior to deterioration from the characteristics observed >24 hours prior to or >96 hours after a clinical deterioration. Model validation was done using a standard bagging approach with a REPtree classifier and 10 fold cross validation.

Twenty five patients were included in the study. Of these, 15 (60%) were found to have one or more deterioration events (arrest, CPR, unplanned intubation), with 24 total events observed during the interstage period. Characteristics associated with imminent deterioration were low SpO2 and depressed ST segment. Changes in physiological dynamics could be detected 1-2 hours before overt deterioration occurs (ROC area = 0.89) (Figure 1). This altered physiological state remains for ~96 hours after deterioration.

In conclusion, it is possible to identify clinical deterioration in HLHS patients during their interstage period ~1-2 hours before overt deterioration occurs, providing an opportunity for early, life-saving intervention to be administered.
Abstract 18191: Atrial Fibrillation: Possible Risk Factor of Senile Pulmonary Fibrosis?
Authors: Wu Caie , Guo Yifang
Published: July 2021

Introduction:
Idiopathic Pulmonary Fibrosis (IPF), usually occurred in the aged. Some possible risk factors are associated with IPF, like gastroesophageal reflux. However, there is hardly a complete explanation of the pathophysiological mechanisms of IPF, presenting some unrecognized risk factors could help studying the pathogenesis of IPF.

Hypothesis:
Chronic thromboembolic pulmonary hypertension patients share the same Image features and clinical manifestations of advanced secondary pulmonary changes with those of IPF patients. Chronic thromboembolic pulmonary hypertension patients with similar secondary pulmonary changes and without clear thrombus are easily misdiagnosed as IPF . Studies have shown that right ventricular thrombosis resulted from atrial fibrillation is one of the causes of chronic recurrent pulmonary embolism, We assessed the hypothesis that atrial fibrillation be associated with Senile IPF.

Methods:
Selected IPF patients aged ≥65 years old . 43 of them are without related risk factors. Other 43 IPFpatients are with the related risk factors,43 patients (Control group), without pulmonary fibrosis or related risk factors. We recorded the time of atrial fibrillation’s first happening, seizure frequency, and D-dimer levels when atrial fibrillation occurring,and the use of anticoagulant medication, the range of pulmonary fibrosis by high-resolution CT, and analysized the correlation between those and the range of pulmonary fibrosis .

Results:
Comparing the incidence and duration of first diagnosed of atrial fibrillation, there was a significant statistical difference between the IPFpatients without known risk factors and those with known related risk factors, or the control group (all P<0.0001). the range of pulmonary fibrosis of IPF patients was correlated with happening of atrial fibrillation, frequency of increased D-dimer levels positively, and used of anticoagulant medication negatively.

Conclusion:
In conclusion, atrial fibrillation can be considered one possible risk factor for senile IPF, and chronic pulmonary embolism may be atrial fibrillation’s pathological pathway leading towards IPF. Antithrombotic therapy should be used among the aged patients who suffer atrial fibrillation and pulmonary fibrosis.
Abstract 18210: Impact of AHA/ACC Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention Guidelines on Real-world Treatment Strategies for Complex Coronary Artery Disease
Authors: Rao Chenfei , Hu Shengshou , Zheng Zhe , Yuan Xin , Hua Kun , Zhang Heng
Published: July 2021

Introduction:
2011 ACCF/AHA coronary artery bypass grafting (CABG) guideline and percutaneous coronary intervention (PCI) guideline were published on December 2011.The aim of this study is to explore the impact of guidelines’ publication on real-world treatment for three-vessel or left-main coronary artery disease (CAD).

Hypothesis:
The release of revascularization guidelines has a positive impact on real-world practice and 1-year outcomes of patients with complex CAD.

Methods:
Between July 2011 and September 2012, patients diagnosed as three-vessel or left-main CAD at Fuwai hospital were consecutively enrolled. We reviewed medical records to abstract detailed in-hospital information. The Corelab calculated SYNTAX Scores according to coronary angiograms. We conducted follow-up at 12 months after the index hospitalization. The end point was major adverse cerebral and cardic event (MACCE) including death, myocardial infarction, stroke and additional revascularization. Patients were then divided into pre-guideline group and post-guideline group according to the conary angiography date. Binary viariables logistic model and Cox model were uesd for baseline and 1-year outcomes comparison respectively

Results:
1746 patients were consecutively enrolled. 37.9% (662) were in pre-guideline group, 62.1% (1084) in post-guideline group. There were no significant differences in demographic factors, cardiac surgery risks and SYNTAX Scores between pre- and post-guideline groups. After the publication of 2011 ACCF/AHA guidelines, doctors recommended more patients to choose CABG (pre: 49.0%, post: 55.6%, p<0.05), the surgeons’ consultation rate increased (pre: 41.9%, post: 49.9%, p<0.05), the rate of ad hoc PCI (PCI immediately after coronary angiography) decreased (pre: 47.5%, post: 40.9%, p<0.05). After adjustment for coronary anatomy complexity and cardiac surgery risks using Cox model, pre-guideline group was associated with significantly higher rates of MACCE (HR=1.62, 95% confidential interval: 1.15-2.27).

Conclusions:
The publication of 2011 ACCF/AHA CABG and PCI guidelines significantly changed real-world treatment for complex CAD in Fuwai hospital, and further improved outcomes.
Abstract 18238: Markedly Elevated Pericardial Fluid Levels of N-terminal Probrain Natriuretic Peptide are Involved in Left Ventricular Systolic Dysfunction with Aortic Stenosis and Ischemic Heart Disease
Authors: Miyamoto Shoichi , Izumi Toshiaki , Nakane Eisaku , Katoh Takao , Funasako Moritoshi , Kimura Masahiro , Su Kanae , Okano Mitsumasa , Kimura Yuki , Sekihara Takayuki , Hayashi Hideyuki , Iida Jun , Morishima Manabu , Ueyama Koji , Haruna Tetsuya , Fujita Masatoshi , Inoko Moriaki
Published: July 2021

Background:
Increasing evidence suggests that N-terminal probrain natriuretic peptide (NT-proBNP) may be a more discerning marker for the detection and evluation of heart failure than BNP. However, fundamental mechanisms that contribute to the heart failure in aortic stenosis (AS) and ischemic heart disease (IHD) via NT-proBNP remain unclear.

Objectives:
The purpose of this study was to investigate whether NT-proBNP represents autocrine/paracrine factors and are accumulated in pericardial fluid (PF) in patients with AS and IHD.

Methods:
With an electrochemiluminescent immunoassay, we measured the concentrations of NT-proBNP in serum and pericardial fluid simultaneously in 48 patients undergoing aortic valve replacement and 101 patients undergoing coronary artery bypass grafting. We investigated the correlation of NT-proBNP levels in serum or PF with hemodynamic variables.

Results:
In patients with AS, the PF levels of NT-proBNP were markedly elevated compared with serum levels (10747±17619 pg/ml vs. 2828±7787 pg/ml, p=0.0054). In patients with IHD, the PF levels of NT-proBNP were markedly elevated compared with serum levels (7224±16345 pg/ml vs. 764±1199 pg/ml, p=0.0001). In AS, NT-proBNP levels in PF but not in serum had closer relations with left ventricular (LV) end-diastolic (r=0.338, p=0.0463) and systolic volume indexes (r=0.551, p=0.0005). In AS, NT-proBNP levels in PF but not in serum inversely correlated with LV ejection fraction (EF) (r=-0.510, p=0.0002). In IHD, NT-proBNP levels in PF but not in serum had closer relations with left ventricular (LV) end-diastolic (r=0.493, p<0.0001) and systolic volume indexes (r=0.582, p<0.0001). NT-proBNP levels in PF but not in serum inversely correlated with LV ejection fraction (EF) (r=-0.406, p<0.0001). NT-proBNP levels in serum and PF is higher in AS due to pressure overload than in IHD due to volume overload.

Conclusion:
Increased PF concentrations of NT-proBNP reflects the direct actions as a local mediator against cardiac pressure overload in AS patients and cardiac voume overload in IHD patients with left ventricular systolic dysfunction.
Abstract 18301: Neurohormonal Activation Status Influences Prognostic Implication of Diuretics in Acute Decompensated Heart Failure
Authors: Hoshino Masahiro , Matsue Yuya , Kagiyama Nobuyuki , Kume Teruyoshi , Okura Hiroyuki , Suzuki Makoto , Matsumura Akihiko , Yoshida Kiyoshi , Hashimoto Yuji
Published: July 2021

Introduction:
The high serum levels of blood urea nitrogen (BUN) reflects neurohormonal activation including sympathetic nervous system and rennin-angiotensin-aldosterone system in hear failure patients. Although furosemide is a mainstay for acute decompensated heart failure (ADHF) treatment, there is possibility of worsening prognosis by adversely affecting the pathophysiology of ADHF including neurhormonal activation.

Hypothesis:
We hypothesize that the prognostic implication of furosemide dose is influenced by the degree of neurohormonal activation in ADHF patients.

Methods:
A total of 1044 patients with ADHF (78.2±12.7 years, 50.8% males) were included retrospectively from 3 hospitals in Japan, and 85 patients (8.1%) died during hospitalization. Patients were divided into 4 groups according to quartiles of total furosemide equivalent dose which was used within 2 days from admission (median 70.0mg, IQR 40-120mg). Patients were also divided to 2 groups according to median serum BUN value of 23 mg/dl (high-BUN group, n=515 and low-BUN group, n=529).

Results:
In-hospital mortality was increased as furosemide dose was increased (Q1: 8.4%, Q2: 6.0%, Q3: 11.9%, Q4: 18.0%, P=0.009) in high BUN group, but not in the low BUN group (Q1: 2.3%, Q2: 5.6%, Q3: 2.4%, Q4: 6.0%, P=0.28). Moreover, when Q1 group was used as a reference, odds ratio for in-hospital mortality was increased as the dose was increased even after multivariate analysis in high-BUN group (Q2: OR, 0.83; 95% CI, 0.29-2.73; P=0.82, Q3: OR, 1.99; 95% CI, 0.71-5.58; P=0.19, and Q4: OR, 2.84; 95% CI, 1.15-6.99; P=0.02, respectively) but not in low-BUN group (Q2: OR, 1.93; 95% CI, 0.45-8.22; P=0.37, Q3: OR, 1.14; 95% CI, 0.22-6.02; P=0.88, and Q4: OR, 1.85; 95% CI, 0.42-8.20; P=0.42, respectively).

Conclusions:
High dose furosemide use in ADHF patients increased in-hospital mortality in high-BUN group but not in low-BUN group. This indicates the influence of neurohormonal state on prognostic implication of furosemide dose used in acute phase of ADHF.
Abstract 18363: ApoA-I Suppresses Neointimal Hyperplasia Following Stent Deployment and Modulates Neointimal Cellular Phenotype
Authors: Vanags Laura , Tan Joanne , Wise Steven , Ali Ziad , Bursill Christina
Published: July 2021

Background:
Increases in smooth muscle cell (SMC) cholesterol content reduce the expression of SMC phenotypic markers and increase macrophage related markers. The balance of neointimal SMCs to macrophage-like cells may influence neointimal hyperplasia following stent deployment. Apolipoprotein (apo) A-I, the main protein component of high-density lipoproteins (HDL), mediates the efflux of cholesterol from cells via the cholesterol transporter ABCA1. In a murine model of balloon angioplasty and stenting, we aimed to investigate the effect of apoA-I on neointimal hyperplasia and neointimal cellular phenotype.

Methods and Results:
Thoracic aortic segments from apoE knockout mice underwent balloon angioplasty alone or balloon angioplasty with stenting then were carotid-interposition grafted into recipient mice. Mice received PBS or apoA-I (40mg/kg) injections on alternate days in the week prior to surgery and then until sacrifice (28 days). There were no changes in total cholesterol, LDL and HDL between groups at sacrifice and thrombosis rates were 16.7% lower in apoA-I injected mice. Histological analysis revealed that stented aortic sections from mice injected with apoA-I had significantly smaller neointimal areas (18%±6.9), compared to PBS control mice p<0.05. The percentage of SMC alpha-actin positive staining was strikingly higher in the neointimas of apoA-I stented arteries (76%±34.3, p<0.05), while RT-PCR analysis of balloon angioplasty injured aortas found mRNA levels of macrophage marker CD68 were lower in apoA-I infused mice (30%±8.9, p<0.01). Furthermore, mRNA levels of ABCA1 and the cholesterol efflux regulator PPAR-gamma were significantly higher in apoA-I balloon-injured aortic segments (30%±13.8 and 48%±20.7, respectively), p<0.05.

Conclusion:
ApoA-I infusions reduce neointimal area following stent deployment. In apoA-I infused mice, the cells of the neointima had significantly higher SMC alpha-actin expression and lower macrophage CD68 expression. Mechanistically, this may be due to increased SMC cholesterol efflux as apoA-I increased the expression of ABCA1 and PPAR-gamma. These findings have significant implications for therapeutic modulation of neointimal hyperplasia following stent deployment.
Abstract 18368: Evidence for Activation of Cerebral Autonomic Center in Response to Cardiac Electrical Stimulation in Humans -A New Finding of Cardio-Cerebral Connection
Authors: Suzuki Hideaki , Satoh Kimio , Tatebe Shunsuke , Matsumoto Yasuharu , Kondo Masateru , Nakano Makoto , Fukuda Koji , Watanuki Shoichi , Hiraoka Kotaro , Tashiro Manabu , Shimokawa Hiroaki
Published: July 2021

Introduction:
Anterior cingulate cortex (ACC) is one of the cortical receptive fields of afferent nerves innervating the visceral organs and modulates autonomic nervous system in collaboration with hypothalamus and brainstem. Cardiac afferent nerves are associated with not only chest pain but also sympathetic arousal in heart failure, in which ACC could be involved. However, the cortical receptive fields of cardiac afferent nerves still remain to be elucidated.

Hypothesis:
We thus investigated whether ACC is activated in response to cardiac electrical stimulation in humans.

Methods:
We studied 10 patients (74.7±1.9 yrs, M/F 9/1) with cardiac pacemaker implantation. Before the measurement, mode of cardiac pacemaker was changed to VVI 80-90 bpm with 1.5V intensity. Cerebral blood flow (CBF) was measured using [15O]H2O positron emission tomography (PET) during sham stimulation (1.5V) and intense stimulation (7.5-8V). The CBF images of intense stimulation were compared with those of sham stimulation using SPM8, a common analysis tool for neuroimages. Cardiac sensation was evaluated with an ordinate scale after CBF measurements. Blood samples were obtained from the cubital vein before and after CBF measurements for plasma catecholamine levels (one patient was excluded for the analysis due to urination before the last blood sampling).

Results:
Intense stimulation did not induce cardiac sensation but significantly increased plasma adrenaline levels as compared with sham stimulation (intense, 6.1±1.8 vs. sham, 0.1±3.0 pg/ml, P=0.031, n=9 each). CBF in ACC was significantly increased in response to intense stimulation as compared with sham stimulation (intense, 64.6±0.7 vs. sham, 61.0±1.3 ml/100g/min, P=0.008, n=10 each) (
Figure, yellow arrowhead
).

Conclusions:
This study demonstrates for the first time that ACC could be the cortical receptive field of cardiac afferent nerves associated with sympathetic arousal in humans.
Abstract 18382: Rna Splicing Regulated by A2bp1 is Essential for Cardiac Function in Zebrafish
Authors: Frese Karen S , Meder Benjamin , Keller Andreas , Haas Jan , Just Steffen , Katus Hugo A , Rottbauer Wolfgang
Published: July 2021

Objective:
Alternative splicing (AS) is one of the key mechanisms for the proteomic and functional diversity of eukaryotes. However, the complex nature of AS, its associated regulators and their targets are only partially understood. In the present study we investigated the transcriptomic diversity in the zebrafish heart using RNA-Sequencing and elucidated the functional role of the splicing regulator A2BP1 in vivo.

Results:
Using RNA-Sequencing we characterized the cardiac transcriptome of 48 hours post fertilization (hpf) old zebrafish embryos and compared the expression of genes and their isoforms to whole fish tissue. Besides the known cardiac genes, we found several previously described genes, highly expressed in cardiac tissue. The analysis of RNA-Seq data indicates that 14% of all genes expressed in the heart undergo AS by single exon-skipping/inclusion. To determine the effect of splicing factors on mRNA splicing we investigated the functional role of splicing regulator a2bp1 in vivo by using the zebrafish as a model organism. Morpholino-mediated a2bp1 knockdown in zebrafish embryos led to progressive cardiac contractile dysfunction, suggesting an important role of a2bp1 in maintenance of cardiac function. Splicing analysis revealed that loss of a2bp1 does not result in a completely splicing failure, but rather alters the splicing pattern of specific target genes. Here we identified novel spliceforms and potentialy novel targets of splicing factor a2bp1. Splice-junction blockage experiments showed that a balanced isoform expression of the targets actn3a, hug, ktn1, ptpla and camk2g is necessary for maintaining cardiac function in zebrafish. We assume, that the a2bp1-knockdown phenotype is not caused by missplicing of specific targets rather by the cumulative effect of many splicing abnormalities.

Conclusion:
Our study reveal a novel splicing regulator that is necessary for normal heart function. We showed that dysfunction of a2bp1 not only leads to heart failure, but show that a2bp1 mediates the splicing of different transcripts which might mediate the observed phenotype. Our results highlight the importance of balanced mRNA splicing in the heart and represents intriguing opportunities for novel therapeutic approaches.