bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 3226: The “Single-Big-Cryo-Balloon” Technique for Pulmonary Vein Isolation - A New Ice Age?
Authors: Chun Julian , Antz Matthias , Ouyang Feifan , Satomi Kazuhiro , Bansch Dietnar , Tilz Roland , Zerm Thomas , Kuck Karl-Heinz
Published: July 2021

Background: Cryothermal-energy (CTE) applied via a balloon catheter (Arctic Front, Cryocath) represents a novel technology which may facilitate accomplishing the challenging endpoint of complete electrial pulmonary vein isolation (PVI). However, as in all balloon based PVI approaches, phrenic nerve (PN) injury remains a concern. Therefore, we pursued the ,,single big cryo-balloon technique“ deploying proximal (antral) CTE to

achieve complete electrical PVI and

avoid PN palsy in patients (pts) with paroxysmal atrial fibrillation (PAF).

Methods: After double transseptal punctures one lasso catheter and the big 28 mm Cryo-balloon catheter (10.5 F) using a steerable sheath (15F) were inserted into the left atrium (LA). PV angiographies and ostial lasso recordings from all PVs were obtained. Selective PV occlusion angiographies were used to evaluate balloon to LA-PV junction contact. One CTE freezing cycle lasted 300 seconds. To early identify PN injury, the PN was constantly paced (10 V, 2.9 ms) from the superior caval vein while applying energy at the right superior PV (RSPV). Follow up included weekly telephonic interviews, holter ECGs, office visits after 1, 3 and 6 months and additional daily tele ECGs.

Results: Twenty-six pts (18 males, mean age: 56 ± 9, LA size: 41.5 ± 5.2) with highly symptomatic paroxysmal atrial fibrillation (mean duration: 6.7 ± 5.8 years) despite antiarrhythmic drug therapy (3 ± 1) were included in this study. Complete electrical PV isolation was achieved in 93/95 PVs (98%) using exclusively the big balloon technique. Mean procedural-, balloon- and fluoroscopy-time were 239 ± 99, 135 ± 66, and 56 ± 22 min, respectively. One persistent PN palsy occurred due to an unanticipated ablation inside the RSPV (inner balloon defect). A total of 17 pts (62 %) remained in sinusrhythm during a mean follow up of 142 ± 114 days.

Conclusion: Using exclusively the “single big cryo-balloon” technique, the vast majority of all PVs (98%) can be electrically isolated resulting in an acceptable clinical success rate after one procedure. PN palsy is avoided as long ablation is performed at the proximal LA-PV junction.
Abstract 441: Cerebral Vasospasm Depends On Rac-1 Mediated Oxidative Stress
Authors: Vecchione Carmine , Landolfi Alessandro , Di Pardo Alba , Bettarini Umberto , Lembo Giuseppe
Published: July 2021

Subarachnoid hemorrhage is one of the most common events related to hypertensive crisis. The cerebral vasospasm is the complication of subarachnoid hemorrhage that causes more frequently death. Experimental evidences describe a direct relationship between hemolysed blood and vasospasm. Understand the molecular basis of vasospasm could help to reduce the mortality in patients with cerebrovascular damage. To clarify this aim, carotid and basilary arteries of rats were mounted on pressure myography and perfused at 100 mmHg. The vessels were placed in intracerebral fluid and entire (eb) or hemolysed blood (hb) was added. Our results showed that the eb did not modify the diameter of the vessel. Meanwhile, hb caused a clear vasoconstriction (max vasoconstriction: 10±1 vs 430±15, p<0.01). Previous studies have hypothesized that oxidative stress could be involved in the cerebral vasospasm. So, the vessels were incubated with Tyron, an antioxidant agent. Our data demonstrated that the administration of Tyron reduced the vasoconstriction induced by hb (max vasoconstriction: 205±7 vs 410±12, p<0.01) without influencing the effect of eb, suggesting an involvement of oxidative stress in the vascular response. Moreover, using lucigenin assay we found an increase in oxidative stress directly in the vessel treated with hb. One of the most important source of oxidative stress is the NADPH oxidase which needs Rac-1 to be activated. Our results demonstrated that the hb, and not the eb, was able to activate Rac-1 in the vessel, evaluated by Rac-1/PAK complex. To clearly define the role of Rac-1 in the vasoconstriction induced by hb, the vessels were transfected with an adenoviral vector containing Rac-1 dominant negative or an empty adenoviral vector. In this experimental condition, the vascular response induced by the hb was significantly blunted as compared to vessels treated with the empty adenovirus (max vasoconstriction: 180±7 vs 390±17, p<0.01). Our results demonstrate that the vasoconstriction induced by the hb is induced by Rac-1-mediated oxidative stress. Thus, Rac-1 could represent the target of novel therapeutic strategies to reduce the cerebral vasospasm and so the mortality in patients with subarachnoid hemorrhage.
Abstract 442: Flow-Dependent Regulation of Angiopoietin-2
Authors: Goettsch Winfried , Gryczka Corina , Korff Thomas , Ernst Evelyn , Goettsch Claudia , Seebach Jochen , Schnittler Hans J , Augustin Hellmut G , Morawietz Henning
Published: July 2021

Background:
Endothelial cells are constantly exposed to high or low shear stress in arteries and veins by the flowing blood. Angiopoietin-2 (Ang-2) is acting as a critical regulator of vessel maturation and endothelial cell quiescence. In this study, we determined the effect of low and high laminar shear stress on the expression and release of angiopoietin (Ang-)2 in human endothelial cells, studied the role of nitric oxide and protein kinases in this context, determined the impact of VEGF on Ang-2, studied the expression, activity and translocation of the forkhead box O transcription factor FOXO1 by low and high shear stress, and analyzed the vessel- and flow-dependent expression of Ang-2
in vivo
.

Methods and Results:
Primary cultures of human umbilical vein endothelial cells (HUVEC) were subjected to laminar shear stress at different physiological levels of laminar shear stress of 1, 5, 10, 15, and 30 dyne/cm
2
in a cone-and-plate viscometer. Ang-2 mRNA, protein expression and release was upregulated by 24 h of low (1 dyne/cm
2
), but downregulated by high flow (30 dyne/cm
2
) in human endothelial cells. Increased endothelial NO synthase expression and NO formation was not affecting regulation of Ang-2 by low or high flow. Tie2 protein expression, but not Tie2 phosphorylation was induced by high flow. Furthermore, low and high flow increased VEGF-A expression. Inhibition of VEGFR-2 prevented upregulation of Ang-2 by low flow, but not downregulation of Ang-2 by high flow. Upregulation of Ang-2 by VEGF was reduced by application of high flow. Forkhead box O (FOXO) transcription factor FOXO1 has been shown to regulate Ang-2 expression in endothelial cells. FOXO1 binding activity was reduced by high flow. Nuclear localization of transcription factor FOXO1 was not changed by low flow, but reduced by high flow.
In vivo
, Ang-2 was higher expressed in veins compared to arteries. Arterial ligation augmented Ang-2 expression in distal arterial low flow areas.

Conclusion:
Our results support a VEGF-dependent induction of Ang-2 in low flow areas, and FOXO1-dependent downregulation of Ang-2 in high flow areas. These data suggest a new mechanism of flow-dependent regulation of vessel stability and differentiation.
Abstract 3246: Skeletonization of Internal Thoracic Arteries: Is it Safe in Long-term?
Authors: Mommerot Arnaud , Cartier Raymond
Published: July 2021

Background:
Skeletonization of internal thoracic arteries (ITA) is a popular technique in OPCAB surgery to increase length of arterial conduit and feasibility of «No-touch» revascularization. Impact of skeletonized (SK) ITA on long-term survival and cardiac events is not clearly defined.

Methods:
We reviewed 1000 consecutive patients having undergone OPCAB surgery at the Montreal Heart Institute, between September 1996 and March 2004 that were prospectively recorded in an OPCAB database. Among them, 994 had at least one ITA bypass.

Results:
Skeletonized ITA was used in 558 patients (56.1%). SK patients were older (p=0.045), had significantly more risk factors [dyslipidemia (p<0.001), hypertension (p<0.001), obesity (p=0.002)]. Preoperative Parsonnet score was not different between SK and non-SK groups. Use of bilateral ITA (p<0.001) and sequential grafting (p<0.001) were more frequent in SK group (36.6% vs 25.7% and 29.9% vs 0.7%, respectively). Operative mortality was similar (SK: 1.8% vs non-SK: 1.6%; p=0.82). Sternal wound infection rate was similar, but dehiscence rate was higher in the PD group (p=0.03). Hospital (p=0.27) and ICU (p=0.09) length of stay were similar in both groups. Overall 7-year survival was 83±2% in SK group and 80±2% in non-SK group (p=0.84). Long-term freedom from major adverse cardiac events was also similar between SK and non-SK groups (83±2% and 82±2%, respectively, p=0.4). Late rate rehospitalization for heart failure or revascularization (CABG or PCI) was similar for both groups. However, 7-year freedom from myocardial infarction was significantly better for non-SK group (p=0.04). By Cox regression analysis, COPD, cardiac heart failure, peripheral vascular disease, emergency and completeness of revascularization were independent predictors of late mortality whereas diabetes, skeletonization and the number of grafts by territory of revascularization were independent predictors of late myocardial infarction.

Conclusion:
ITA has no influence in long-term survival or major cardiac events in an all comer OPCAB population. However, SK and diabetes were predictors of late incidence of myocardial infarction. Thus, a word of caution should be made about skeletonization of the ITA in diabetic population.
Abstract 3249: Late Endothelial Function of Bilateral Internal Thoracic Arteries Used as a Y-graft Configuration
Authors: Glineur David , Gurne Olivier , Djaoudi Sophia , Kefer Joelle , Debbas Nadia , Renkin Jean , Noihomme Philippe , El Khoury Gebrine , Hanet Claude
Published: July 2021

The manner in which a blood vessel is harvested for use as a coronary graft may be important in maintaining a viable and functional endothelial lining. Internal thoracic arteries (ITA), when used as a Y-graft configuration are characterized by the connection of a pedicled left ITA with preserved innervation and lymphatics and of a free skeletonized right ITA. To determine whether endothelial function differs between left and right ITA segments in a Y-graft configuration, 11 patients were studied 3 years after surgery. The endothelial-dependent vasodilator substance P was selectively infused (1.4 up to 22.4 pmol/min in doubling dose increments) in the ostium of ITA Y-grafts. A maximal endothelium-independent vasodilatory response was obtained by intragraft infusion of 2 mg isosorbide dinitrate (ISDN). Biplane angiograms obtained at 3 minutes intervals using an automated contrast injection system with fixed pre-set volume and pressure parameters were analyzed off-line using a quantitative analysis system (CAAS, Pie Medical). A similar dose-dependent vasodilatory response to substance P was observed in the left and in the right ITA (figure

). No difference in maximal endothelium-dependent response to substance P (7.4±4.3% in left ITA and 8.1 ± 5.3% in right ITA) or in maximal endothelium-independent response to ISDN (12.2 ± 4.4% in left ITA and 10.6 ± 8.1% in right ITA) was observed. In conclusion, the endothelial function and the vasodilator reserve of the two branches of a Y-graft ITA configuration appear similar 3 years after bypass surgery. This suggests that the preservation of the ITA pedicle does not significantly affect basal vasomotor tone or long-term endothelial function.
Abstract 3250: Low-does Of Amiodarone For The Prevention Of Atrial Fibrillation After Coronary Artery Bypass Grafting
Authors: Gu Song , Su Pi-xiong , Liu Yan
Published: July 2021

Aim:
to identify the risk factors associated with atrial fibrillation after CABG and to evaluate the necessity, anti-arrhythmic efficacy and safty of low-does of amiodarone for AF.

Methods:
Between April 2005 and April 2007, 480 adult patients underwent CABG were randomly divided into two groups. They were given 0.6 g of amiodarone (220 cases) or placebo (260 cases) daily in 7 days before surgery and 0.2 g of amiodarone or placebo daily for 30 days postoperatively. Electrocardiograms were monitored over 14-day postoperative period.

Results :
Of 480 patients, there were 85 patients(17.7%) occurred AF. The recurrent AF usually developed within 1–3 days after operation, and continued for 0.5–24 hours. The incidence of postoperative AF was significantly (p < 0.001) lower in patients on low-does of amiodarone (9.55%) as compared with placebo (24.62%). Heart rate at onset of atrial fibrillation were 131.4 ± 28.9 beats/min for amiodarone compared with 144.1 ± 30.7 for placebo (P < 0.05). Duration of AF were 12.8 ± 6.7 hours in amiodarone group compared with 18.2 ± 11.6 hours in placebo group(P < 0.05).

Conclusion:
The strongest independent preoperative predictors for AF after CABG were the patients’age(≥ 70 ys), heart failure(EF ≤ 40% and/or FS ≤ 24%) and hypokalemia; Postoperative administration of Low-does of amiodarone reduced the occurrence of AF by 27.97% and prevented sudden death by 17.02% after CABG surgery; Amiodarone is the safest in four groups of anti-arrhythmic drugs, Preventive trials of low does of amiodarone significantly reduces the incidence, ventricular rate, and duration of AF after CABG, and seems to be of similar efficacy with the trials of large does amiodarone. Furthermore, low-dose amiodarone is well tolerated and decreases the risks of severe side effects and proarrhythmic effects, especially for these patients with high risk factors at peroperative period.
Abstract 3262: Dynamic Left Ventricular Outflow Tract Obstruction In Patients Without Hypertrophic Cardiomyopathy
Authors: Lee Kyung Jin , Ommen Steve R. , Foley David A. , Oh Jae K.
Published: July 2021

Background:
Although dynamic left ventricular outflow tract (LVOT) obstruction is a hallmark for hypertrophic obstructive cardiomyopathy (HOCM), it can occur in other conditions. The aim of this study was to determine underlying conditions and clinical importance of LVOT obstruction in patients without HOCM.

Methods:
We reviewed the echocardiographic and clinical data of patients who underwent transthoracic echocardiography in Mayo Clinic Rochester from October 2001 to August 2006, and had LVOT peak pressure gradient (PG) > 25mmHg at rest.

Results:
Of 719 patients identified, 159 (22 %) patients had dynamic LVOT obstruction without HOCM (77 men; mean age, 66.6 ± 12.9 years). Main presenting symptoms were chest pains in 95 (59.7 %), and dyspnea in 46 (28.9 %). LVOT PG was 51 ± 24 mmHg at rest and 68 ± 27 mmHg after provocation. In 114 (71.7 %) patients, early diastolic transmitral inflow velocity (E) and early diastolic mitral annular tissue velocity (Ea) were obtained. Mean E, Ea, and E/Ea were 105 ± 47 cm/s, 6.4 ± 5.7 cm/s, and 18.3 ± 11.0, respectively. Systolic anterior motion of mitral apparatus was observed in 100 (62.9 %) patients. Concentric increase in LV wall thickness or LVH was most common condition present in 57 patients (36%). The cause of LVH was hypertension in 40 (70.1%), aortic stenosis in 8 (14.0%), and chronic renal failure in 4 (7.0%). In these patients, major precipitating factors were hyperdynamic LV systolic function in 54 (94.7%), use of vasodilator in 34 (59.6%) and small LV cavity in 30 (52.6%). Other prominent associated conditions were basal septal hypertrophy, mitral valve repair, cardiac amyloid, and apical ballooning. There were 28 (17.6%) all-cause mortalities during follow up (25 ± 17 months) including malignancy in 6 (21.4 %), sudden cardiac deaths in 4 (14.3 %), congestive heart failure in 3 (10.7 %).

Conclusions:
Dynamic LVOT obstruction can be found in patients without HOCM. The most common condition to develop dynamic LVOT obstruction without HOCM, is concentric increase in LV wall thickness in the setting of hyperdynamic motion, small LV cavity, and use of vasodilator. Other conditions which predispose patients for dynamic LVOT obstruction are hypovolemia, cardiac amyloidosis, apical ballooning syndrome, and mitral valve repair.
Abstract 3273: Timely Access to Care - Risk Stratification Utilizing the Seattle Heart Failure Model in patients with Advanced Heart Failure: Dying to be seen.
Authors: Billia Filio , Micevski Vaska , Carson Susan , Delgado Diego H , Ross Heather J
Published: July 2021

Introduction

Heart failure is an epidemic with age-adjusted mortality of 45%/5 years. Multidisciplinary heart function clinics (HFC) have been shown to improve outcomes in patients. Timely access to cardiac care remains one of Canada’s leading concerns. Risk stratification of patients upon referral to a HFC may identify patients that require urgent access to, and benefit from, multidisciplinary care.

Hypothesis

To determine if a priori assessment using the Seattle Heart Failure Survival Model (SHFM) at the time of referral to a multidisciplinary HFC would help risk stratify patients regarding urgency of consultation.

Methods

The referral packages of patients known to have died prior to or within 60 days of initial consultation were retrospectively reviewed (Group 1). Data were collected to determine the mortality risk based on the SHFM. Age and sex-matched controls were randomly selected from our HFC database (Group 2). Statistical analysis was performed using SPSS.

Results

A total of 107 patients were included in this study (Group 1, n=57; Group 2 n=50). There were no significant differences in baseline characteristics between the groups. In Group 1, 38% of patients died before being evaluated, while the remaining 62% died within 60 days of the initial HFC visit. The majority of patients in both groups had either ischemic or idiopathic dilated cardiomyopathy (52% and 22%, respectively). Patients in Group 1 reported NYHA class III/IV symptoms 40%/33%, respectively, versus Group 2 patients reporting NYHA class III/IV symptoms 46%/8%, respectively. There was a statistically significant difference in the mean SHFM mortality risk score, predicted at the time of initial receipt of referral, between the study groups with Group 1 patients having a much higher predicted mortality versus Group 2 at 1, 2 and 5 years (p<0.001).

Conclusion

The SHFM is a useful tool to risk stratify patients with HF at the time of referral/entry into a multidisciplinary clinic. It provides a reliable method to triage risk and ensure that those at greatest risk are seen soonest, hence facilitating timely access for care. Prospective validation regarding the triage applicability of the SHFSS is needed.
Abstract 3274: Application of Guidelines into Practice for Sudden Cardiac Arrest through Implementation of a Novel Protocol
Authors: Ramza Brian M , Kao Andrew C , Daniel William C
Published: July 2021

Introduction:
Specific guidelines exist for identification and treatment of patients at risk for sudden cardiac arrest (SCA); however, little data exist describing how often these patients are accurately identified and appropriately treated. The objectives of this prospective, single center study were to compare the effect of an electronic reminder and protocol on the ability to recognize patients at risk for SCA and the application of the guidelines for therapy.

Methods:
In this study an electronic reminder and protocol were used at one site, the main clinic (MC), compared to all other sites, regional clinics (RC). The protocol was based on current AHA/ACC and CMS guidelines with practice specific quality measures. The protocol included optimal medical treatment prior to ICD, temporary and absolute exclusions for ICD therapy. MC staff was trained to use a new process designed to better identify patients at risk for SCA. This included screening forms, a standardized patient education video, and a patented reminder tool for EMR systems to continue tracking patients that did not immediately qualify for ICD therapy. An independent review of medical charts for all patients visiting the MC and RC over a 2-month period was then conducted to evaluate the clinics ability to identify patients at risk for SCA and apply the current guidelines for appropriate care. Patients were followed for 6 months.

Results:
Table 1

. Recognition of patients at risk for SCA improved significantly from 70% at RC to 93% at MC. Application of the guidelines into practice as measured ultimately by optimal medical treatment combined with ICD implantation was significantly improved as well.

Conclusions:
Recognition rates of patients at risk for SCA and subsequent adoption of guideline-based therapy including optimal medical therapy and ICD implantation was significantly greater with the use of this novel protocol combining AHA/ACC and CMS guidelines with practice specific quality measures.

Table 1
Abstract 3276: Assessment of Predictive Accuracy of Centers for Medicare and Medicaid Services’ Method to Risk Adjust Patients for Interhospital Comparison of 30-day Mortality Rates
Authors: Koelling Todd M , Saberi Sara , DeFranco Anthony C , Skorcz Stephen , Montoye Cecelia K , Shultz Cameron , Smith Kirk D , Fotenakes Andrew , Levine Pete A , Aaronson Keith D
Published: July 2021

Introduction
: The Centers for Medicare and Medicaid Services (CMS) will initiate public reporting of 30 day death rates for hospitals caring for patients with heart failure (HF). While hospital specific rates will be adjusted for medical comorbidities, it is not known if this method is adequate to allow direct hospital comparisons.

Hypothesis
: More accurate risk adjustment of patients can be accomplished by including variables that have previously been described to be predictors of mortality in HF.

Methods
: We assessed the CMS HF risk adjustment model in a population of 3639 patients studied in the Guidelines Applied in Practice (GAP) - HF study. Probabilties for 30 day mortality were calculated for the CMS model. Multivariable logistic regression analysis was then performed with other models including variables (no mVO
2
) from the Heart Failure Survival Score (HFSS), ADHERE Registry model (ARM), body mass index categories (BMI), pre-admission origin of patient (PAO), and admission in the previous 6 months (AP6). Probabilities of mortality were tabulated. Backward selection was then used to derive the best model from all candidate variables from a derivation data subset, followed by testing of the model on a validation data subset. Area under the curve (AUC) was then compared for each model.

Results
: The AUCs and 95% CI are shown in the table

below. Calculated AUCs for the CMS model and separate models were similar. The best model was defined by the following variables: admission in the previous 6 months, BUN > 43, systolic blood pressure > 115, 35 ≤ BMI < 40, BMI ≥ 40, mean arterial pressure, serum sodium, and PAO as well as the CMS model variables. The AUCs for the derivation and validation sets were both significantly greater than that provided by the CMS model alone.

Conclusions
: Risk adjustment for the purpose of interhospital comparison of 30-day mortality rates is best performed with models that include clinical admission variables in addition to the medical comorbidites.

Comparison of AUCs for 30 day mortality prediction
Abstract 447: Sonic Hedgehog Carried By Microparticles Corrects Endothelial Injury Through Nitric Oxide Release
Authors: Agouni Abdelali , Mostefai Hadj A , Porro Chiarra , Carusio Nunzia , Favre Julie , Martinez Maria C , Andriantsitohaina Ramaroson
Published: July 2021

Microparticles (MPs) are small fragments generated from the plasma membrane of cells upon stimulation. Among the candidate proteins harboured by MPs, we have recently shown that Sonic Hedgehog (Shh) is present in MPs generated from activated/apoptotic human T CEM lymphocytes. MPs were isolated following serial centrifugations. Eahy 926 endothelial cells were grown for 24h in the absence or presence of 10 μg/mL MPs pre-incubated (or not) either with inhibitors of PI3-kinase (LY294002, 20 μM), MEK 1/2 (U0126, 10 μM), cyclopamine (30 μM), a specific antagonist of the Sonic Hedgehog receptor (Patched), or siRNA of Patched. Cell lysates were analyzed by Western blot. Cells were used for direct measurement of nitric oxide (NO), and oxidative stress was determined by flow cytometry. In other experiments, after 24h of intravenous injection of MPs to mice, endothelium-dependent relaxation was determined in aortic rings. In addition, ischemia/reperfusion was induced in mice by ligating the left anterior descending coronary artery proximal to its origin and endothelial function of the distal coronary artery was assessed. We show that Shh carried by MPs: a) induces NO release from endothelial cells under basal (2.5 fold) and after a bradykinin-stimulation (20 μM) conditions (2.6 fold) b) increases both the expression and the phosphorylation of enzymes related to the NO pathway, and c) decreases the production of reactive oxygen species (38.6 ± 1.4 % of positive cells in treated
vs.
51.4 ± 0.2 % in control). Inhibition of PI3-kinase and ERK signalling reversed the effects of MPs. Injection of MPs to mice improved endothelial function in aorta (EC
50
; 8.5 x 10
−8
M of acetylcholine in control
vs.
7.05 x 10
−8
M in treated mice) and elevated NO release in blood, heart and lungs (1.4, 1.9 and 2.6-fold, respectively). Mice treated with Shh MPs had reduced coronary endothelial dysfunction after ischaemia/reperfusion. Silencing Shh with either cyclopamine or siRNA of Patched caused a 35 % reduction of NO release elicited by MPs. Based on our findings, we propose that the cardiovascular effects of MPs harbouring Shh may represent a new therapeutic approach against endothelial dysfunction caused by endothelial injury e.g. during cardiac ischemia.
Abstract 3286: Prediction for Long-term Effect Of Cardiac Resynchronization Therapy: Comparison Between Tissue Doppler Imaging And Speckle Tracking Imaging
Authors: Furugen Azusa , Matsuda Naoki , Ashihara Kyomi , Mochida Asako , Shoda Morio , Ishizuka Naoko , Hagiwara Nobuhisa , Kasanuki Hiroshi
Published: July 2021

Recent studies have demonstrated that the septal-to-posterior motion delay (SPWMD) assessed by M-mode echo and the longitudinal intra-LV dyssynchrony assessed by tissue Doppler imaging (TDI) can predict chronic effects of cardiac resynchronization therapy (CRT). A newly developed 2D speckle tracking imaging (STI) has enabled assessment of not only longitudinal but circumferential regional strain of LV. We investigated the usefulness of STI in selecting patients for CRT.

Methods:
Fifty-one patients with heart failure symptoms and QRS duration>120 ms underwent standard echocardiography, TDI and STI before CRT. Time to peak systolic velocity was measured in 12 basal and mid LV segments in apical views by TDI. The time difference between the basal septal and the basal lateral segments was calculated (TDI-SLPVD).The standard deviation of those among 12 segments was calculated (TDI-SD). Time to peak circumferential strain, radial strain and longitudinal strain were measured in basal segments in parasternal short axis and apical views by STI. The time difference between the septal and the lateral segments was calculated (CS-SL, RS-SL and LS-SL). A responder to CRT was defined as a patient whose NYHA class improved by >1 class and whose LVESV reduced by >10% at 6 months after CRT.

Results:
Thirty-six patients (71%) responded to CRT. CS-SL showed high sensitivity and specificity for predicting the responders at a cut-off point of 124 ms (Table

). The area under the ROC curve (AUC) of CS-SL was larger than that of QRS duration, SPWMD, TDI-SLPVD, TDI-SD, RS-SL and LS-SL.

Conclusion:
Assessment of circumferential dyssynchrony using STI seems useful in selecting patients for CRT.
Abstract 3295: De-induction of the Maladaptive Fetal Gene Program During Chronic Monotherapy with Metoprolol Succinate is Retained Following Withdrawal of Therapy in Dogs with Chronic Heart Failure
Authors: Bazari Rasha , Rastogi Sharad , Zaca Valerio , Goldstein Sidney , Sabbah Hani N
Published: July 2021

Background:
Chronic therapy with extended release metoprolol succinate (MET), a selective β1 adrenergic receptor blocker, improves left ventricular (LV) function and attenuates global LV remodeling in dogs with chronic heart failure (HF). We previously showed that chronic therapy with β-blockade results in de-induction of the fetal gene program (FGP) in LV myocardium of dogs with HF. In this study, we tested the hypothesis that in dogs with HF withdrawal of chronic MET does not lead to re-induction of FGP.

Methods:
Studies were performed in 17 intracoronary microembolization-induced HF dogs randomized to 3 months oral therapy with MET (100 mg, once daily, n=11) or no therapy at all (Controls, n=6). In dogs randomized to MET, 6 were sacrificed after 3 months of therapy and in the remaining 5, MET was withdrawn after 3 months of therapy and dogs were observed for 6 weeks after withdrawal of MET (MET-W) and then sacrificed. LV tissue was also obtained from 6 normal (NL) dogs for comparison. mRNA expression of the FGP genes namely, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), sarcoplasmic reticulum calcium ATPase (CAA), cardiac β-1 adren-ergic receptor (AR) and α-myosin heavy chain isoform (α-MHC) was measured using reverse transcriptase polymerase chain reaction (RT-PCR) and bands were quantified in densitometric units (du).

Results:
In Controls, mRNA expression of ANP and BNP increased and expression of CAA, β 1-AR and α-MHC decreased. Treatment with MET decreased expression of ANP and BNP and increased expression of CAA, β 1-AR and α-MHC. Except for α-MHC, the improvement in FGP seen during MET treatment was preserved in MET-W dogs.

Conclusions:
Withdrawal of MET is associated with sustained de-induction of the FGP in LV myocardium of dogs with HF. This observation supports the concept that chronic β-blockade therapy in HF confers lasting reversal of LV remodeling and molecular recovery of the failing myocardium.
Abstract 3305: FDG PET Imaging in the PRKAG2 Cardiac Syndrome Demonstrates Altered Myocardial Glucose Uptake
Authors: Ha Andrew C , Renaud Jennifer , Thorn Stephanie , deKemp Rob , Yoshinaga Keiichiro , Garrard Linda , DaSilva Jean N , Beanlands Robert S , Gollob Michael H
Published: July 2021

Background :
The PRKAG2 gene encodes for the gamma-2 subunit of AMP-activated protein kinase (AMPK), a protein implicated in the regulation of myocardial glucose metabolism. In humans, mutations of the PRKAG2 gene result in a cardiomyopathy characterized by ventricular pre-excitation, atrioventricular conduction disease, and cardiac hypertrophy. It is recognized that altered cardiac glucose metabolism and abnormal glycogen stores are responsible for the clinical manifestations of this syndrome. Since myocardial glucose uptake can be measured with 2-[
18
F]Fluoro-2-deoxyglucose dynamic positron emission tomography ([
18
F]FDG PET), we examined whether adult patients with an identified Arg302Gln PRKAG2 mutation have altered myocardial glucose uptake using this imaging modality.

Methods:
[
18
F]FDG PET was performed in 5 adult patients with the Arg302Gln PRKAG2 mutation (PRKAG2) and in 6 healthy volunteers (Control) with a hyperinsulinemic euglycemic clamp protocol. The fractional rate of radiotracer uptake (K) is derived from PATLAK analysis. The rate of myocardial glucose uptake (rMGU) of the left ventricle (LV) is calculated as (K / LC) x P
glucose
, where P
glucose
represents the mean plasma glucose level during imaging. LC (lump constant) corrects for the differences in the transport and phosphorylation of [
18
F]FDG and glucose. Results are expressed as mean ± standard deviation and are analyzed with the student t-test.

Results:
The mean rMGU in the PRKAG2 group was significantly lower than the control group. There was no difference in the mean plasma glucose levels between the 2 groups.

(Table

)

Conclusion:
Myocardial glucose uptake is reduced in adult patients with mutation of the PRKAG2 gene when compared to normal controls. Measurement of rMGU using [
18
F]FDG PET imaging appears to be a useful tool to investigate the pathophysiology of the PRKAG2 cardiac syndrome and to potentially distinguish this metabolic cardiomyopathy from other etiolgies.

Mean rate of myocardial glucose uptake between patients with the PRKAG2 mutation and normal controls
Abstract 3311: Relationships Among Renal Function Loss Within the Normal to Mildly Impaired Range, Arterial Stiffness, Inflammation and Oxidative Stress
Authors: yoshida masanobu , Tomiyama Hirofumi , Matsumoto Chisa , Yamada Jiko , Shiina Kazuki , Yamashina Akira
Published: July 2021

Objective:
This study was conducted to clarify whether subjects with mildly impaired renal function {glomerular filtration rate (GFR) = 60 – 89 mL/min per 1.73 m
2
body surface area} show increased arterial stiffness, microinflammation and oxidative stress as compared to those with normal renal function, and also to examine the association of these parameters with GFR loss in middle-aged Japanese men with a low cardiovascular risk.

Methods and Results:
The brachial-ankle pulse wave velocity (baPWV) and plasma levels of C-reactive protein (CRP) and lipid peroxides (LipOX) were measured in 1873 male subjects (42±9 years old). The baPWV, but not the CRP or LipOX, was increased in subjects with mildly impaired renal function (Figure

). Multiple linear regression analysis demonstrated a significant relationship between the GFR and the baPWV independent of the conventional atherosclerotic risk factors (beta = −0.08, t-value = −2.19, p<0.05). This relationship was significant even in subjects with renal function within the normal range.

Conclusions
: Increased arterial stiffness, rather than microinflammation and/ or oxidative stress, may underlie the elevated cardiovascular risk in subjects with mildly impaired renal function. The association between GFR loss and arterial stiffness seems to precede the occurrence of microinflammation and/or oxidative stress associated with GFR loss.
Abstract 3312: Cilostazol Improves Long-term Patency after Percutaneous Transluminal Angioplasty in Hemodialysis Patients with Peripheral Artery Disease
Authors: Kumada Yoshitaka , Ishii Hideki , Aoyama Toru , Tanaka Miho , Toriyama Takanobu , Takahashi Hiroshi , Morishita Tetsuji , Amano Tetsuya , Izawa Hideo , Murakami Ryuichiro , Matsubara Tatsuaki , Murohara Toyoaki
Published: July 2021

Background:
Percutaneous transluminal angioplasty (PTA) has become common therapeutic standard for peripheral artery disease (PAD). Although initial success rate of PTA is high, higher restenosis rate is a limitation in hemidialysis (HD) patients. Cilostazol is a PDE3 inhibitor with anti-platelet and vasodilatory effects, and also inhibits the proliferation of the smooth muscle cells, and has been reported to reduce target lesion revascularization (TLR) in PAD patients. The aim of this study was to clarify the effects of cilostazol administration for long-term patency after PTA in HD patients.

Methods:
Consecutive 372 lesions of 193 HD patients undergoing successfully PTA were enrolled. They were divided into two groups; patients administered cilostazol (130 lesions of 71 patients) and those without cilostazol as a control (242 lesions of 122 patients). They were followed-up using Doppler ultrasound and/or angiography for 5 years. To minimize the selection bias for cilostazol administration, a propensity-matched analysis using the model including male, age, diabetes, critical limb ischemia (CLI), TASC C+D type, femoropopoliteal (FPA) lesion and stenting was performed. The propensity score was matched 1:1 with two-digit (AUC=0.69 using ROC analysis).

Results:
Mean follow-up period was 28±24months. Primary patency rate for 5 years was significantly higher in the cilostazol group than in the control group (53% vs 33%, p = 0.0003). Also, rates for freedom from TLR and for limb salvage were higher in cilostazol group than in control group (67% vs. 50%, p=0.011 and 88% vs. 72%, p =0.031, respectively). In 102 lesions matched after propensity score analysis, the primary patency for 5-year was significantly higher in the cilostazol group (58%) than in the control group (35%) (HR 0.48, 95%CI 0.30 – 0.76, p = 0.0017). Upon multivariate Cox analysis, Cilostazol (HR 0.50, 95%CI 0.26 – 0.87, p = 0.014), age (HR 1.03, 95%CI 1.01–1.07, p = 0.041), FPA lesion (HR 2.62, 95%CI 1.22–5.62, p = 0.013), TASC C+D type (HR 2.85, 95%CI 1.56 –5.20, p = 0.0006) and CLI (HR 4.09, 95%CI 2.10 –7.94, p <0.0001) were independent predictors of restenosis after PTA.

Conclusion:
These data suggest that cilostazol administration improves long-term patency after PTA in HD Patients with PAD.
Abstract 3314: Visualization of the Left Atrial Appendage in 3-Dimensions: Complex Anatomy and Structure in Multidetector CTA as an aid to Percutaneous Obliteration Strategies
Authors: Hara Hidehiko , Lesser John R , Holmes David R , Erickson Steve , Van Tassel Robert A , Schwartz Robert S
Published: July 2021

Backgrounds:
The left atrial appendage (LAA) is a structure with unique anatomic and functional features. Unfortunately it is the source of ≥ 90% of all cardiac emboli. Recently, percutaneous LAA obliteration was developed to limit cardioembolic events in patients with atrial fibrillation. The feasibility of this treatment is under study to eliminate anticoagulation and simultaneously eliminate cardioembolic events. We examined the LAA from the standpoint of its structure, function compared with the RAA, as well as analyzing its complexity with Multidetector CT (MDCT).

Methods and Results:
64-slice MDCT was used to visualize the LAA and RAA in 25 patients. All patients were scanned and a 3D volume rendered technique. Visual comparison between LAA and RAA was performed and LAA orifice diameter, circumference, total and usable length were measured in 2D and 3D. MDCT images revealed complicated LAA structure including small septation, features often not completely appreciated by 2D images (Figure

). 3D images demonstrated 32% single and 28% multiple septae in LAA. There was an excellent correlation of minimum orifice diameter (95%CI 0.46 – 0.94, p<.0001), circumference (CI 0.25– 0.77, p=.0005), and total depth (CI 0.22–1.21, p=.0064) between 2 groups. No relationship was found between maximum diameter and usable LAA length in the 2 groups.

Conclusions:
LAA imaging in 3D by MDCT is an excellent method to visualize complex anatomy and morphology. The usable LAA length for device implant bears no relation to 2D and 3D analysis, an important consideration for obliteration technologies.
Abstract 3316: Revascularization for Chronic Critical Lower Limb Ischemia in Octogenarians
Authors: Dick Florian , Brosi Philippe , Do Dai-Do , Schmidli Juerg , Baumgartner Iris , Diehm Nicolas
Published: July 2021

Objective:
Advanced age is considered a relative contraindication for surgical revascularization in patients with peripheral arterial occlusive disease (PAD). Aim was to analyze usefulness of endovascular and surgical revascularization for chronic critical limb ischemia (CLI) in patients older than 80 years.

Materials:
Prospective cohort study of a consecutive series (01/1999 to 06/2004) of patients presenting with CLI. Revascularization cohorts were either surgical or endovascular with conservatively treated patients used as reference. Prospective follow-up after 30 days, 2, 6, and 12 months.

Methods:
Primary endpoint was
sustained clinical success
defined as categorical upward shift in clinical symptoms according to Rutherford without major amputation or need for repeated target extremity revascularization (TER).
Secondary clinical success
was defined accordingly including repeated TER. Mortality, major amputation and TER were secondary endpoints. Results were stratified for age (non-octogenarians [<80 years] vs octogenarians [≥80 years]). Cumulative outcome was determined by Kaplan-Meier method and differences assessed by log-rank tests. Multivariate analysis was performed by Cox proportional regression.

Results:
376 patients (158 women, mean age 75.8 ± 10.7 years) with 416 critically ischemic limbs were analysed. Overall, 150 patients were octogenarians (39.9%). 85 limbs were treated surgically (31% octogenarians), and 207 limbs by endovascular means (46% octogenarians). Both sustained and secondary clinical success rates as well as limb salvage were higher in revascularization cohorts as compared to conservatively treated patients regardless of age category (
P
=.013,
P
=.006, and
P
=.041, respectively). Mortality was significantly higher in octogenarians (
P
=.006), and particularly high within 30-days after surgical revascularization (HR 5.35, 95%CI 1.15–24.9). Patient age category did not affect major amputation and TER rate in multivariate analysis.

Conclusions:
Individually tailored revascularization improves outcome of CLI in octogenarians comparably to non-octogenarians, even so endovascular revascularization should be preferred in octogenarians due to high 30-day mortality associated with surgery.
Abstract 3332: Fractional Flow Reserve (FFR) And MIBI SPECT: A comparison In Patients With Multi-vessel Coronary Disease
Authors: Melikian Narbeh , De Bondt Pieter , Cuisset Thomas , Wyffels Eric , Bartunek Jozef , Heyndrickx Guy , Wijns William , De Bruyne Bernard
Published: July 2021

INTRODUCTION
In patients with angiographic 3 vessel disease only 29% have been reported to have perfusion defects. However the association between physiological evidence for ischemia per vessel derived from fractional flow reserve (FFR) and MIBI SPECT (SPECT) in multivessel disease (MVD) is unknown. We comapred this association in patients with MVD.

METHOD
In 84 vascular territories in 28 patients (mean age 63.9±9.8 years, LV ejection fraction 69±12%) with angiographic MVD (>50% stenosis in at least 2 vessels) results of SPECT (rest / stress adenosine) were compared to FFR measurements in each coronary vessel. AHA semi-quantitative 5 point scorning system using a 17-segment model was used to report SPECT scans. A FFR <0.80 was taken as evidence for ischemia.

RESULTS
MIBI was positive in at least 1 territory in 19 (67%) and FFR <0.80 in at least 1 territory in 23 (82%) of patients. 7 (25%) patients with no perfusion defect on SPECT had FFR <0.80 in at least 2 territories. The association between MIBI and FFR in each patient and per vascular territory are summarised below. Per patient there was no concordance between SPECT and FFR (Kappa −0.11) and per vascular territory there was poor concordance between SPECT and FFR (Kappa 0.23). In 8 (29%) patients both SPECT and FFR detected identical ischemic territories [mean number of ischemic territories: 1.5±0.9 for both; P=1.00]. In the remaining 20 patients in comparison to FFR, SPECT either underestimated [9 (32%) patients − mean number of ischemic territories, SPECT: 0.3±0.7, FFR: 1.9±0.6; P=0.001] or overestimated [11 (39%) patients -mean number of ischemic territories, MIBI: 2.0±1.0, FFR: 1.0±0.9; P=0.02] the number of ischemic territories. There was a weak correlation between severity of ischemia as assessed by SPECT in each vascular territory and the actual FFR value (r=0.34; P=0.001).

CONCLUSION
In patients with multivessel disease, the concordance between SPECT and FFR to localise hemodynamically significant stenosis is poor.

Per Patient and per vascular territory comparison of MIBI SPECT and FFR
Abstract 3336: Fractional and Coronary Flow Reserve in Prediction of Functional Recovery of Myocardium in Patients with Previous Myocardial Infarction
Authors: Beleslin Branko , Ostojic Miodrag , Djordjevic-Dikic Ana , Vukcevic Vladan , Stojkovic Sinisa , Nedeljkovic Milan , Stankovic Goran , Orlic Dejan , Stepanovic Jelena , Giga Vojislav , Arandjelovic Aleksandra
Published: July 2021

Background: Fractional flow reserve (FFR) may provide clinically useful diagnostic information both in patients (pts) with normal left ventricular (LV) function as well as in pts with previous myocardial infarction (MI). However, the question remains to the relation between improvement of FFR and improvement of LV function in pts with previous MI undergoing percutaneous coronary intervention (PCI).

Aim: The aim of the study was to evaluate the relation between FFR and simultaneously evaluated coronary flow reserve by thermodilution (CFRthermo), with functional improvement of LV function in pts with previous MI undergoing PCI.

Methods: Study population consisted of 50 pts (mean age 53±8 years; 40 male) with previous MI and significant coronary stenosis in one-vessel CAD (33 LAD, 4 Cx, 13 RCA) undergoing PCI of infarct-related coronary artery. In all pts we have evaluated by single pressure/thermo wire FFR and CFRthermo before and immediately after PCI. In all pts, we have evaluated LV ejection fraction by echo and wall motion score index (WMSI) before and 3 months after PCI.

Results: Coronary lesions were successfully treated in all pts with decrease of diameter stenosis from 63±7% to 18±9% (p<0.001). FFR increased significantly (p<0.001) from 0.62±0.15 to 0.91±0.06 after PCI, whereas CFRthermo increased significantly (p<0.01) from 1.5±0.3 to 2.5±0.7. LV ejection fraction increased from 49±6% to 55±8% (p<0.0001), and WMSI decreased from 1.44±0.24 to 1.29±0.29 (p<0.0001). LV functional improvement was observed in 33/50 (66%) of pts. In pts with LV functional recovery in comparison to pts with no recovery there was significant difference in FFR before PCI (0.57±0.15 vs. 0.71±0.11, p=0.001), improvement of FFR during PCI (0.34±0.15 vs. 0.21±0.13, p=0.004), improvement of CFRthermo during PCI (1.2±0.6 vs. 0.6±0.5, p=0.001) and CFRthermo after PCI (2.7±0.7 vs. 2.1±0.6, p=0.008), respectively.

Conclusion: Evaluation of FFR and CFRthermo provide significant prognostic information on LV functional recovery in pts with previous MI undergoing PCI. Lower FFR before PCI, higher CFRthermo after PCI, as well as higher improvement of FFR and CFRthermo during PCI are indicative of left ventricular functional improvement in pts with previous MI.
Abstract 3343: Incidence and Predictor of Late Stent Thrombosis After Implantation of Sirolimus-eluting Stent: From Two-year Clinical Follow-up of The j-Cypher Registry
Authors: Nakagawa Yoshihisa , Mitsudo Kazuaki , Kimura Takeshi , Morimoto Takeshi , Muramatsu Toshiya , Shiode Nobuo , Kazuya Kawai , Yokoi Yoshiaki , Isshiki Takaaki , Saku Keijiro , Doi Osamu
Published: July 2021

Background:
Unsolved issue about Sirolimus-eluting stent is thrombosis, especially, the potential for late stent thrombosis (ST).

Methods:
To clarify the incidence and predictors of ST, two-year data of the j-Cypher Registry were examined using ARC definition. Design of this registry was multi-center prospective enrollment of 15,216 consecutive patients (pts) with anti-platelet regimen of aspirin and ticlopidine in Japan.

Results:
Pts’ characteristics of this cohort were as follows, age 68+/−10 years, male in 75%, diabetes in 42%, emergency procedure in 6.6%, hemodialysis in 5%, CKD ( CCr<60, non-Hemodialysis ) in 51% and off-label use in 77%. Bifurcation lesion was observed in 19%. The other characteristics of lesions were as follows, in-stent restenosis in 12%, CTO in 9%, STEMI culprit in 6.3%. Cumulative ST (ARC definite/probable) rates within two-year were 0.62% at six-month, 0.71% at one-year and 0.93% at two-year as shown in the table

. Annual increase slope of late ST (ARC definite) was 0.25% per year. During follow-up, 439 Surgical operations excluding endovascular and CABG were needed. Within 30 days of operation, clinical event rates were death in 2.2%, MI in 0.65% and ST in 0.44%. Multivariate analysis identified 3 independent predictors of early ST (within three-month); Hemodialysis: Odds Ratio (OR) = 1.75 (95%CI 1.02–2.69) p=0.042, Male gender: OR = 2.00 (1.20–4.08) p=0.0051, and Emergency procedure: OR = 2.15 (1.36–3.22) p= 0.0017. Also, multivariate analysis identified one independent predictor of late ST (beyond three-month); Hemodialysis: OR = 2.44 (1.29–4.14) p=0.042.

Conclusions
: Stent thrombosis rate up to two years under Ticlopidine anti-platelet regimen in Japan seemed to be lower as compared with those reported from other registries in the real world, despite the fact that high risk pts were more prevalent in the j-Cypher registry. Hemodialysis was identified to be independent predictor of early and late stent thrombosis through two years.

Cumulative stent thrombosis rates in j-Cypher registry