bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 4203: Diastolic Wall Strain Can Noninvasively Predict Hemodynamic Deterioration Unassociated with Systolic Dysfunction in Hypertensive Hearts
Authors: Omori Yosuke , Sakata Yasushi , Mano Toshiaki , Ohtani Tomohito , Takeda Yasuharu , Kamimura Daisuke , Tamaki Shunsuke , Yamamoto Kazuhiro
Published: July 2021

This study examined whether LV diastolic wall strain (DWS) could noninvasively predict the transition to decompensated diastolic heart failure (DHF) in hypertensive hearts. Dahl salt-sensitive rats fed 0.3 % NaCl diet served as control group (group N: n=8) and those fed 8 % NaCl diet as hypertensive group (group HT: n=15). Serial Doppler echocardiographic studies were performed at age 13, 17 and 19 weeks. At 19 weeks, LV pressure was measured following the echocardiographic study. DWS was calculated as [(end-systolic thickness of LV posterior wall) - (end-diastolic thickness of LV posterior wall)]/(end-systolic thickness of LV posterior wall). Mid-wall fractional shortening (MFS) was not different between two groups at any stage. At 13 weeks (compensatory hypertrophic stage), the transmitral flow velocity curves (TMFV) represented the abnormal relaxation pattern with low E/A ratio in group HT. At 19 weeks (heart failure stage), E/A increased with the elevation of LV end-diastolic pressure and lung weight in group HT. DWS was not different between two groups at 13 weeks, however, its decrease preceded the pseudonormalization of TMFV at 17 weeks in group HT and continued until 19 weeks. The difference between the endocardial and epicardial movements is equal to that between the wall thickness at end-systole and end-diastole (a numerator of DWS). Therefore, based on the linear elastic theory, DWS is considered to decrease with increase of LV wall stiffness. We previously demonstrated that myocardial stiffness constant was elevated at age 17 weeks but not at age 13 weeks in Dahl salt-sensitive rats fed high-salt diet. The current results indicate that DWS is helpful in noninvasively predicting hemodynamic deterioration without the changes in systolic function, which is explained partly by the theory that DWS reflects LV wall stiffness.

Echocardiographic Parameters and Hemodynamic Data in Control Group and Hypertensive Group
Abstract 4239: Speckle Tracking Imaging Detects Sub-Clinical Myocardial Dysfunction in Asymptomatic Patients with Type 2 Diabetes Mellitus
Authors: Ernande Laura , Bergerot Cyrille , Rietzschel Ernst R , De Buyzere Marc L , Van de Veire Nico , Ovize Michel , Decaudain Aurélie , Moulin Philippe , Gillebert Thierry C , Derumeaux Genevieve A
Published: July 2021

Diabetic cardiomyopathy, a major complication of diabetes mellitus (DM), is preceded by a silent phase of progressive left ventricular (LV) remodeling. Our aim was to evaluate whether speckle tracking imaging (STI) was able to detect early, sub-clinical myocardial dysfunction in a population of asymptomatic type II DM patients with no signs or history of heart disease and a normal conventional echo . 114 patients with type II DM (52 ± 4 years, 45 females, HbA1c 7.7 ± 1.4%) and 88 age-matched healthy volunteers (HV) without any cardiovascular risk factor (52 ± 3 years, 58 females) underwent a conventional and STI echocardiography (Vivid 7, GE). Mean longitudinal strain (S
L
) was assessed from the basal, mid and apical segments of the myocardial walls in apical 2- and 4-chamber views. Mean radial strain (S
R
) was calculated from the short-axis view at the midventricular level. Univariate and multivariate regression analyses were used to identify the parameters contributing to the difference in S
L
and S
R
between the 2 groups. Variables used for analysis were as follows: DM, gender, BMI, systolic (sBP) and diastolic blood pressure (dBP), heart rate, IVSd and PWd thickeness, LV end-diastolic (LVEDD) and end-systolic diameters (LVESD). Clinical, conventional echo and STI parameters in the 2 groups are summurized in the table

. On univariate analysis, factors associated with a significant lower strain in type II DM patients were: DM, male gender, BMI, sBP and dBP for S
L
and DM, sex and LVESD for S
R
(p<0.05 for all). On multiple regression analysis, the only factors accociated with a significant decrease in strain in the DM group were DM (p = 0.005) and male gender (p = 0.008) for S
L
and DM (p = 0.01) for S
R
. STI is able to early detect subclinical myocardial dysfunction in a population with Type II DM. This decrease in S
L
and S
R
might be considered as a preclinical marker of diabetic cardiomyopathy.
Abstract 4241: Left Atrial Minimum Volume Is The Most Powerful Predictor Of Adverse Cardiovascular Events.
Authors: Caselli Stefano , Canali Emanuele , Foschi Maria Laura , Lombardi Umberto , Centurion Carlos , Santini Daria , Pandian Natesa G , Fedele Francesco , De Castro Stefano
Published: July 2021

Objective:
we sought to identify, among all two-dimensional (2D), Doppler and three-dimensional (3D) echocardiography variables, the best predictor of adverse cardiovascular events in a 4 years follow-up study.

Methods:
A population of 151 consecutive sinus rhythm outpatients (mean age 57 ± 15 years) with cardiovascular risk factors, free from previous cardiovascular events or valvular heart disease, underwent 2D, Doppler and 3D echocardiography; data were indexed by body surface area. After a mean follow up of 54 ± 3 months, the study population was divided in two subgroups according to the subsequent development of cardiovascular events (death, myocardial infarction and stroke) or not.

Results:
combined endpoint was reached in 28 patients (18%). These patients showed significant differences for: e/e′ ratio (p<0.001), end systolic and end diastolic left ventricular (LV) diameters (p<0.05), 2D ejection fraction (p<0.01), 3D LV end diastolic (p<0.01) and end systolic volume (p<0.01), 3D LV mass (p<0.001) and ejection fraction (p<0.01), 3D left atrial maximum (p<0.001) and minimum volumes (p<0.001). By Cox Proportional Hazard analysis we were able to identify left atrial minimum volume as the best independent predictor of cumulative events (hazard ratio: 1.286, confidence interval 1.056 to 1.565; p=0.012). Kaplan-Meier analysis allowed to highlight statistically significant differences among tertiles of 3D left atrial minimum volume in terms of combined endpoint (p=0.002; Figure

).

Conclusion:
left atrial minimum volume obtained by 3D echocardiography, was in our selected population, the most powerful independent predictor of adverse cardiovascular events.
Abstract 4244: Longitudinal Cardiac Rotation Affects Systolic Myocardial Velocities and Velocity-Defined Measures Of Ventricular Dyssynchrony
Authors: Popovic Zoran , Phillips Karen , Lim Pascal , Meulet John E , Barrett Conor D , Di Biase Luigi , Agler Deborah , Thomas James D , Grimm Richard A
Published: July 2021

Background
: Left ventricle (LV) of cardiac resynchronization therapy (CRT) candidates often displays rotational motion in the horizontal plane, a phenomenon we named longitudinal rotation (LR). We assessed if magnitude and direction of LR affects myocardial velocity-based measures of LV dyssynchrony.

Methods
: In 100 CRT patients (age 64±13 yrs, 76 men) LR was assessed in the apical 4-chamber view by speckle-tracking while myocardial systolic velocities of basal septum and lateral LV wall were measured from 2-dimensional color tissue Doppler data. Patients were classified into quartiles based on their LR values. Intraventricular dyssynchrony was calculated as the absolute, while septo-lateral delay was calculated as the true difference between the time to peak systolic velocity of the septum and lateral wall.

Results
: LR in all quartiles except Quartile 4 had a clockwise (negative) direction when viewed in apical 4-chamber view. As quartiles increased, patients were more frequently ischemic, systolic septal velocity and septo-lateral delay decreased, while intraventricular dyssynchrony showed a U shaped relationship (Table

). While difference in peak amplitude of basal septal and lateral systolic velocities and LR correlated with end-systolic volume (ESV) decrease at follow-up in non-ischemic patients (r = 0.44 and r = 0.49, p < 0.01 for both), neither intraventrivcular dyssynchrony nor septal-lateral delay correlated with ESV decrease in either etiology.

Conclusions
: LR affects amplitudes and timing of myocardial velocities. While difference in peak amplitude of basal septal and lateral systolic velocities and LR predict LV reverse remodeling, time-based velocity measures do not. ICM:/DCM: ischemic/dilated cardiomyopathy; T(sep/lat): time to peak (septal/lateral) systolic velocity; S(sep/lat): peak systolic (septal/lateral) velocity; S-L delay: septo-lateral delay; Dys: intraventricular dyssynchrony; ΔESV: end-systolic volume decrease
Abstract 4270: Comprehensive Meta-Analysis on Oral Anticoagulants for the Secondary Prevention of Coronary Artery Disease Including more than 50,000 Patients
Authors: Zoccai Giuseppe Biondi , Abbate Antonio , Lotrionte Marzia , Castagno Davide , Moretti Claudio , Sciuto Filippo , Omedè Pierluigi , Trevi Gian Paolo , Sheiban Imad
Published: July 2021

Recurrent events remain frequent among patients with coronary artery disease (CAD). Several trials have appraised the role of oral anticoaugulants in the secondary prevention of CAD, but with inconclusive results. We thus aimed to assess the efficacy and safety of long-term oral anticoagulant treatment in patients with CAD. Potentially eligible studies were searched systematically. The primary end-point was the occurrence of death, myocardial infarction, or stroke. In addition, we appraised individual components of the primary end-point, as well as the risk of major and minor bleedings. Odds ratios (OR) with 95% confidence intervals were computed according to fixed/random effect methods. A total of 61 randomized controlled trials were retrieved, including 57,983 patients. After a median follow-up of 12 months, oral anticoagulants significantly reduced the risk of death, myocardial infarction or stroke in comparison to control therapy (OR=0.74 [0.65– 0.83], p<0.001), as well as death from all causes (p<0.001), myocardial infarction (p<0.001), and stroke (p<0.001), despite an increase in major (p<0.001) and minor bleedings (p<0.001). Stratification for control therapy showed that benefits were maintained when anticoagulants were compared to placebo or standard therapy without any antithrombotic medication (p0.05), despite significant increases in bleeding rates (p<0.001), whereas significant benefits in terms of reduction of stroke risk occurred when comparing oral anticoagulants versus oral antiplatelet agents alone (p<0.001). Specifically, an International Normalized Ratio (INR) between 2.0 and 3.0 appear critical to minimize bleeding risk and maximize antithrombotic effects. Oral anticoagulants significantly prevent adverse events in patients with established CAD in comparison to standard therapy without any antithrombotic medication. Comparisons of oral antiplatelet agents versus oral anticoagulants alone or oral anticoagulants plus oral antiplatelet agents showed conversely that oral anticoagulant therapy can achieve a favorable risk-benefit balance only in subjects without increased bleeding risk are selected and INR is maintained between 2.0 and 3.0.
Abstract 4281: Does Preoperative Aortic Insufficiency Affect Outcome Following Aortic Valve Sparing Surgery?
Authors: de Kerchove Laurent , Boodhwani Munir , Glineur David , Noirhomme Philippe , Khoury Gebrine El
Published: July 2021

Aortic valve (AV) sparing surgery is an attractive option for the treatment of aortic root pathology. However, presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been associated with poorer outcome. We analyze the influence of preoperative AI severity and the need for cusp repair on the early and mid-term outcomes of AV sparing surgery. From 1996 to 2007, 134 consecutive patients underwent elective AV sparing surgery. (mean age − 52±16 years; 84% male). Significant preoperative AI (3+ or 4+) was present in 83 patients (62%) and 46 (34%) had a bicuspid valve. Root repair was performed with either the reimplantation (67%) or remodeling technique (33%). A systematic approach was used for intraoperative valve assessment and cusp repair was performed in 74 patients (55%). Clinical and echocardiographic follow-up was complete in 100% and 96% respectively at a mean follow-up time of 57 months (range: 12–147 months). Kaplan-Meier curves, log rank test, and Cox regression analyses were used. Hospital mortality was 0.7%. AV cusp repair was required in 53% of patients without significant AI and in 57% with significant AI (p=0.9). Cusp repair was required more frequently in bicuspid versus tricuspid valves (89% vs. 38%, p = 0.005). Overall survival at 5 and 8 years was 94±5% and 86±10% respectively. Freedom from recurrent AI (>2+) was similar with or without significant preoperative AI (90±10% vs. 86±10% at 5 years, p=0.5) and with or without cusp repair (87±11% vs. 89±10%, p=0.6; Figure 1). Freedom from AV reoperation at 5 years was similar with or without significant preoperative AI (94±6% vs. 89±8%, p=0.5) and with and without cusp repair (90±9% vs. 91±8%, p=0.8). With a systematic approach to valve assessment and cusp repair, AV sparing surgery for aortic root pathology has an acceptable early and mid-term outcome, irrespective of preoperative AI or need for cusp repair. Cusp repair is not predicted by presence of preoperative AI but is more frequent in bicuspid valves. Preoperative AI should not be considered a contra-indication for valve sparing surgery.
Abstract 4283: Outcomes of Patients Undergoing Concomitant Aortic and Mitral Valve Surgery in Northern New England
Authors: Leavitt Bruce J , Baribeau Yvon R , DiScipio Anthony W , Quinn Reed D , Cochran Richard P , Sisto Donato , Boss Richard A , Clough Robert A , Olmstead Elaine M , Ross Cathy S , O’Connor Gerald T
Published: July 2021

Background
: During the past 20 years (yrs), there has been a steady increase in concomitant aortic(AV) and mitral valve(MV) surgery in northern New England (NNE). We examined the in-hospital and long-term mortality for these patients by procedure, patient age and sex.

Methods
: This is a prospective, regional, cohort study of 1057 patients undergoing concomitant AV and MV surgery in NNE from 1989 through 2007. Long-term survival was obtained by linking our registry data to the Social Security Administration Death Master File. Kaplan-Meier and log-rank tests were performed.

Results
: Patient characteristics: age <70 yrs (45.1%), 70–79 yrs (41.0%), and ≥ 80 yrs (13.9%); female sex (44.1%); associated CABG (46.9%); diabetes (19.5%); CHF (60.7%); PVD (17.7%); non dialysis renal failure (RF) (5.3%); dialysis dependant RF (2.4%). In-hospital mortality was 15.4% (11.0% for patients <70 yrs, 18.0% for 70–79 year olds, and 24% for those ≥80). The median period of follow-up was 3.5 yrs. Overall median survival was 7.3 yrs. Median survival for surgery without CABG was 9.5 yrs and 5.7 yrs with CABG (p<0.001). Survival among women was worse compared to men (7.3 v 9.3, yrs, p=0.033). Median survival by age group was 11.0 yrs for patients <70, 5.4 yrs for 70-79 year olds, and 4.8 for ≥ 80. Median survival was not significantly different for patients ≥ 80 compared to those 70–79 yrs old (p=0.245).

Conclusions
: Double valve open heart surgery has a high in-hospital mortality rate. Long-term survival was decreased by having a concomitant CABG, being female and being 70 yrs or older. Although short-term mortality was higher, median survival for patients ≥ 80 yrs was equivalent to that for patients 70–79 yrs.
Abstract 4296: Allogeneic Bone Marrow Mesenchymal Cells Improved Heart Function but Were Rejected after Myogenic Differentiation
Authors: Huang Xi-Ping , Sun Zhuo , Miyagi Yasuo , Fazel Shafie , Weisel Richard D , Li Ren-Ke
Published: July 2021

Rationale:
Allogeneic bone marrow mesenchymal stem cells (MSC) are currently undergoing clinical trials to test their potential to repair the heart after a myocardial infarction (MI). MSCs can improve function, but neither the host immune responses nor the fate of these cells has been extensively investigated. This study compared the outcomes of allogeneic and syngeneic MSC transplantation after an MI.

Methods:
Female Lewis rat underwent coronary ligation. Three weeks later, allogeneic or syngeneic MSCs (3×10
6
/rat) from male rats (Wister or Lewis, respectively) were implanted into the infracted region. We evaluated implanted cell survival (real-time PCR to quantify Y-chromosomes), cytokines (RT-PCR) and infiltrating cells (immunostaining) in the heart, and allogeneic antibodies in the blood. Cardiac function was assessed by echocardiography and pressure-volume catheters. Immune antigen expression (RT-PCR, immunostaining and flow cytometry) was characterized in the MSCs before and after myogenic differentiation.

Results:
At 1 week post implantation, cell survival was similar in the allogeneic and syngeneic groups. Gene expression of 11 cytokines and T-cell infiltration into the cell-implanted region were also similar, but more B-cells were observed in the allogeneic group (p<0.05 vs. syngeneic group). Allo-antibodies (IgG1) against Wistar MSCs were detected in the peripheral blood of animals that received allogeneic cells. At 5 weeks after delivery, implanted MSCs were detected only in the syngeneic group. Cardiac function was equally restored in both cell groups (ejection fraction: allogeneic=30.4±1.8%; syngeneic=29.5±2.8%; p<0.05 vs. media controls; control=24.8±3.2%); these data were supported by the pressure-volume analysis. Myogenic differentiation (expression of Nkx2.5, MyoD, MHCβ), CD86 expression and MHC class II molecules were observed in the MSCs after prolonged culture, which could explain why the cells were rejected.

Conclusions:
Allogeneic BMSC transplantation produced a robust cardiac functional improvement, but following myogenic differentiation the cells were no longer immunoprivileged. Rejection of the allogeneic cells could limit their long term benefit on cardiac remodeling after an MI.
Abstract 4329: Myocardial Protein Kinase G Activity Differs in Heart Failure with Normal and Reduced Ejection Fraction
Authors: van Heerebeek Loek , Hamdani Nazha , Handoko Martin L , van der Velden Jolanda , Stienen Ger J , Niessen Hans W , Laarman Gerrit Jan , Somsen Aernout , Gasthuis Onze Lieve Vrouwe , Paulus Walter J
Published: July 2021

Concentric left ventricular (LV) remodeling and cardiomyocyte (CM) hypertrophy characterize heart failure with normal ejection fraction (HFNEF) whereas eccentric LV remodeling and low myofilamentary density characterize heart failure with reduced ejection fraction (HFREF). In rodents, low myocardial protein kinase G (PKG) activity has been implicated in the development of pathological CM hypertrophy induced by LV pressure-overload. The present study therefore compared LV remodeling, CM hypertrophy and myocardial PKG activity in patients (pts) with HFNEF (n=36) and HFREF (n=43). All pts had been admitted to hospital for worsening heart failure (NYHA 3–4) and were free of coronary artery disease. HFNEF pts had a LVEF > 50% and a LV end-diastolic pressure > 16 mmHg. HFREF pts had a LVEF <45%. LV remodeling was measured by LV mass/volume ratio derived from biplane LV angiograms and 2D-echocardiograms. CM hypertrophy and myocardial PKG activity were assessed in LV endomyocardial biopsies by histomorphometry of CM diameter and by immunohistochemistry using antibodies against the specific PKG substrate vasodilator stimulated phosphoprotein (VASP) and against phosphorylated VASP ((P)-VASP). Myocardial PKG activity corresponded to the ratio of (P)-VASP/VASP. LV mass/volume ratio and CM diameter were significantly larger in HFNEF than in HFREF (Table

). As evident from (P)-VASP/VASP ratio, PKG activity was lower in HFNEF than in HFREF (Table

).

Conclusion: HFNEF patients have lower myocardial PKG activity than HFREF patients. This low myocardial PKG activity could contribute to CM hypertrophy and concentric LV remodeling observed in HFNEF. Raising myocardial PKG activity by phosphodiesterase 5A inhibition could be useful to limit CM hypertrophy and concentric LV remodeling in HFNEF.
Abstract 4351: Albuminuria is a Risk Factor for Adverse Events in Heart Failure Independent of the Presence of Chronic Kidney Disease
Authors: Agnihotri Adheesh , Bishu Kalkidan , Arnold James , Gustafson Gary , Anand Inder S
Published: July 2021

Background
: Chronic kidney disease (CKD) is a known risk factor for adverse events in patients with heart failure (HF). Whether albuminuria defined as urine albumin creatinine ratio ≥30 mg/g with or without CKD is also a risk factor for adverse events, is unclear.

Methods
: Data was abstracted from the electronic medical records of 442 patients admitted to the Minneapolis VA Medical Center with a primary diagnosis of HF, and an outpatient measurement of albumin creatinine ratio between September 2002 and March 2006. Multivariable Cox regression analysis was used to determine the impact of albuminuria on mortality and hospitalizations for HF at 1-year.

Results
: Albuminuria was seen in 54% (238/442) patients at baseline. Patients with albuminuria were more likely to have edema, higher systolic blood pressure, left ventricular hypertrophy, lower eGFR and use of beta-blockers (all p<0.05). Albuminuria correlated (p<0.05) with serum creatinine (rho=0.23), systolic blood pressure (0.37), and LVEF (0.13). The presence of albuminuria did not increase the risk of death (HR 0.65, 95% CI 0.38 –1.11), but was strongly associated with the risk of hospitalization for HF at 1-year (HR 1.77, 95% CI 1.11–2.82, p=0.017) independent of age, gender, h/o HTN, DM, CAD, PVD, COPD, CKD, atrial fibrillation, EF, use of ACE-I, spironolactone and beta-blocker.

Conclusion
: The presence of albuminuria is an independent prognostic marker for hospitalizations for heart failure.
Abstract 4355: Functional Status Is More Strongly Associated with Mortality in Cardiac Amyloid Compared to Echocardiographic Parameters
Authors: Austin Bethany A , Duffy Brendan , Rodriguez Rene , Tan Carmela , Starling Randall C , Desai Milind Y
Published: July 2021

Cardiac amyloidosis (CA) is generally associated with a poor prognosis and significantly increased mortality. We sought to identify predictors of longer-term survival in patients with EMB documented CA. Forty-five consecutive EMB documented CA patients were studied from 1/98 –12/03. Age, gender, NYHA class, medications, presence of light chain amyloid and ECG voltage were recorded. Baseline left ventricular ejection fraction (LVEF), deceleration time (DT), diastology, LV mass, interventricular septal (IVS) thickness and myocardial performance index (MPI) [(isovolumic contraction time + isovolumic relaxation time)/ejection time] were recorded. Length of follow-up and all-cause mortality were recorded. Mean age was 66 ±10 years with 34 (76 %) men. NYHA class > 2 and low voltage on ECG [S (V1) + R (V5) ≤12] were noted in 26 (58 %) and 12 (27 %) patients, respectively. Mean LVEF, IVS thickness and LV mass were 46 % ±13, 1.7 cm ±0.42 and 303 grams ±114, respectively. DT <150 msec and MPI > 0.6 were found in 19 (42 %) and 15 (33 %) patients, respectively. At median follow-up of 1.7 years, there were 25 (56%) deaths. On univariate Kaplan-Meier survival analysis, NYHA class > 2, DT <150 msec and lack of beta-blocker use were associated with increased mortality (log-rank statistic p-values <0.001, <0.05 and 0.01, respectively). Cox Proportional Hazard Survival Analysis is shown in the table

. In patients with EMB-documented CA,
s
urvival is more strongly associated with NYHA functional class compared to ECG and echocardiographic variables, including DT and MPI. Evaluation of advanced imaging techniques such as cardiac magnetic resonance in predicting prognosis in these patients is warranted.

Table:

Cox Proportional Hazard Analysis of Various Clinical, Electrocardiographic and Echocardiographic Predictors of Mortality in Patients with Biopsy Proven Cardiac Amyloidosis
Abstract 4357: Soluble ST-2 Concentrations to Predict Sudden Cardiac Death in Stable Heart Failure Patients
Authors: Bayes-Genis Antoni , Pascual-Figal Domingo , Vazquez-Garcia Rafael , Bonet-Marques Rosa , Puig-Domingo Teresa , Cinca-Coscollola Joan , de Luna Antoni Bayes , Snider James V , Ordonez-Llanos Jordi
Published: July 2021

Background & Aim: The soluble form of the ST2 receptor (sST2) is released, like B-natriopeptides, by cardiomyocytes in response to mechanical overload. sST2 has been shown useful for predicting short- and long-term risk in heart failure (HF). Sudden cardiac death (SCD) is a poorly predictable HF-complication; we previously showed that NT-proBNP and left atrial size (LA) were prognostic of SCD in a cohort of stable HF patients. Since NT-proBNP and sST2 share some common features, we evaluated the role of sST2 to predict SCD in HF.

Patients & Methods: A 1:2 case:control design was used. Ninety-nine stable HF patients were included and followed during 3 years (942±323 days); 36 suffered SCD (Cases) and 63 survived (Controls). Cases and Controls were matched by age (66±11 years), sex (83% male) and LVEF (mean: 29%). NT-proBNP and sST2 were measured by immunoassays in serum/ plasma samples collected at inclusion; clinical information was recorded at inclusion and during follow-up.

Results: Cases had more often prior history of ischemic disease (72 vs 44%) and AMI (64 vs 41%), lower eGFR (54 vs 64 mL/min) and higher NYHA class (50 vs 22% in class III), LA (27 vs 23 mm/m
2
) and NT-proBNP (2873 vs 966 ng/L) than Controls (all variables, p<0.05). sST2 was higher in Cases (0.232 vs 0.121 ng/L, p=0.002) and unrelated to eGFR. ROC analysis of sST2 and NT-proBNP showed optimal cut-points to predict SCD of 0.152 and 2005 ng/L, respectively. sST2 values > 0.152 ng/L were found in 78% of Cases and 44% of Controls (p<0.001). In multivariable analysis sST2, NT-proBNP, eGFR and LA were independent predictors of SCD. When sST2 and NT-proBNP concentrations (dichotomized by the set cut-points) were analyzed combined as a single variable the OR to predict SCD raised to 21.857 (95% CI: 2.655–179.909, p=0.004). eGFR and indexed LA size were weaker predictors of SCD (OR: 1.665 and 1.157, respectively). The area under ROC of the combined variable to predict SCD was 0.869 (95% CI: 0.798 – 0.940).

Conclusions: sST2 is a novel biomarker for SCD prediction in stable HF patients. A multimarker approach using sST2 and NT-proBNP improves the identification of HF patients at high risk of SCD.
Abstract 4366: Relation of Functional and Morphological Changes in Mitochondria to Myocardial Contractile and Relaxation Reserves in Asymptomatic to Mildly Symptomatic Patients with Hypertrophic Cardiomyopathy
Authors: Unno Kazumasa , Isobe Satoshi , Izawa Hideo , Cheng Xian W , Kobayashi Masakazu , Hirashiki Akihiro , Murase Yosuke , Asano Hiroyuki , Yamada Takashi , Ohshima Satoru , Nishizawa Takao , Noda Akiko , Nagata Kohzo , Murohara Toyoaki , Yokota Mitsuhiro
Published: July 2021

Impairment of myocardial relaxation reserve and subsequent impairment of contractile reserve constitute a primary manifestation of hypertrophic cardiomyopathy (HCM). Although these reserves reflect energy-consuming processes, the relation between their impairment and mitochondrial function in HCM has remained unclear. Thirty HCM patients underwent biventricular cardiac catheterization analysis both at rest and during atrial pacing as well as myocardial
99m
Tc-sestamibi (MIBI) scintigraphy at rest. MIBI washout rate (WR) was calculated from initial and delayed left ventricular (LV) planar images. Endomyocardial biopsy specimens were obtained for quantitative mRNA analysis and electron microscopic observation. The HCM patients were divided into two groups: Group A consisted of 15 patients showing a normal force-frequency relation (FFR) and pressure half-time (
T
1/2
) of <30 ms, whereas group B consisted of 15 patients showing an abnormal FFR or
T
1/2
of ≥30 ms. The MIBI WR was significantly correlated with
T
1/2
at the peak pacing rate for all patients (
r
= 0.74,
P
<0.01). It was also significantly greater in group B (29.2 ± 6.3%) than in group A (19.3 ± 3.1%). The abundance of mRNAs for mitochondrial electron transport-related enzymes was significantly higher in group A than in group B. Mitochondria showed a greater variation in size and were more disorganized in group B than in group A. Mitochondria showed functional impairment and morphological disorganization in the left ventricle of HCM patients without baseline systolic dysfunction. These mitochondrial changes were associated with impaired myocardial contractile and relaxation reserves.
Abstract 4373: Effects of Darbepoetin-Alpha on Plasma Markers of Oxidative and Nitrosative Stress in Anemic Patients with Chronic Heart Failure
Authors: Parissis John , Kourea Kallirhoe , Andreadou Ioanna , Ikonomidis Ignatios , Ioannidis Konstadinos , kiroudis Sophia , Filippatos Gerasimos , Kremastinos Dimitrios
Published: July 2021

Increased oxidative and nitrosative stress may be important pathophysiologic mechanisms that mediate cardiac and vascular dysfunction in chronic heart failure (CHF). This study investigate the effects of recombinant human erythropoietin analogue darbepoetin-alpha(α) on plasma markers of oxidative and nitrosative stress along with cardiac function and exercise capacity in patients with CHF and anemia. Thirty CHF patients [Hew York Heart Association class, II-III; LV ejection fraction (EF) <40%; hemoglobin <12.5 g/dl; serum creatinine <2.5 mg/dl] were randomized (1:1) to receive either a 3-month darbepoetin-α regimen at 1.5 μg/Kg every 20 days plus oral iron or placebo plus oral iron. Echocardiographic indices of LV function, plasma B-type natriuretic peptide (BNP) and plasma markers of oxidative [oxidative: malondyaldheyde (MDA), carbonyl proteins; anti-oxidative: glutathione) and nitrosative (nitrotyrosine) stress, and 6-min walked distance were assessed at baseline and post-treatment. A significant improvement of LV ejection fraction (p<0.01) and six min walked distance (p<0.001) was observed only in darbepoetin-treated patients. Moreover, plasma BNP (661±858 from 1102±1200 pg/ml, p<0.001), MDA (2.1±0.9 from 2.5±0.8 ng/ml, p<0.01), protein carbonyl (1.7±0.6 from 2.1±0.7 ng/ml, p<0.01) were significantly reduced, while plasma anti-oxidative enzyme glutathione (124±11 from 116±10 ng/ml, p<0.05) was increased after darbepoetin treatment. These factors remained unaffected in placebo-treated patients. Darbepoetin-induced percent changes in carbonyl protein was significantly correlated with respective changes in BNP (r=0.55, p<0.05) and LV ejection fraction (r=−0.46, p<0.05). Finally, a drug-induced percent reduction in nitrotyrosine was significantly correlated with the respective improvement in 6 min walked distance (r=−0.63 p<0.05). Darbepoetin seems to attenuate deleterious effects of oxidative and nitrosative stress into cardiovascular system of anemic patients with CHF. This beneficial action may be related with the drug-induced improvement of cardiac function and exercise capacity of these patients.
Abstract 4383: Incidence of Pulmonary Arterial Hypertension in Patients with Systemic Sclerosis: A 3-Year Longitudinal Study
Authors: de Groote Pascal , Hachulla Eric , Gressin Virginie , Sibilia Jean , Diot Elisabeth , Carpentier Patrick , Mouthon Luc , Hatron Pierre-Yves , Clerson Pierre , Humbert Marc
Published: July 2021

We have previously determined a prevalence of 7.85% [95%CI: 5.70–10.00] of pulmonary arterial hypertension (PAH) in a large multicentre systemic sclerosis (SSc) population (the ItinerAIR Scleroderma registry). We used a screening algorithm based on dyspnea, Doppler echocardiographic evaluation of the peak velocity of tricuspid regurgitation (VTR) and right heart catheterisation (RHC). No study has determined the incidence of PAH in a large population at risk. To determine the incidence of PAH over 3 years of follow-up in the ItinerAIR SSc registry. Patients underwent regular screening for PAH with Doppler echocardiography confirmed by RHC in patients with VTR of 2.8–3 m/s and unexplained dyspnea, or VTR >3 m/s. 384 patients were followed for a mean of 41±5.6 months (median 41 months). The baseline characteristics of this population were: 87% female, mean age 53±12 years, mean duration of SSc at study entry 8.7±7.6 years, and 24.0% with diffuse SSc. Doppler echocardiography detected PAH in 18 patients (incidence: 1.37 per 100 patient-years). Among these, RHC identified 8 patients with pre-capillary PAH (incidence: 0.61 per 100 patient-years [95%CI: 0.26–1.20]), 8 with post-capillary pulmonary hypertension (PH) and 2 with PH due to severe interstitial lung disease. The 8 patients with pre-capillary PAH had moderate PAH (mean pulmonary pressure: 36±14.6 mmHg). Among the 8 patients with post-capillary PH, echocardiography was always considered normal by the expert cardiologist, except in 2 cases (moderate left atrial dilatation in one and mild aortic sclerosis in the other). These 8 patients had mild post-capillary PH, 5 of them having normal mean pulmonary pressure at rest but a significant increase during exercise with a pulmonary wedge pressure > 15 mmHg. In this large multicentre SSc cohort we prospectively found an incidence of PAH of 0.61 per 100 patient-years. We also demonstrated that RHC is still mandatory to precisely define the type of pulmonary hypertension since mild post-capillary PH without echocardiographic abnormalities are frequent.
Abstract 4389: Right Ventricular Diastolic Function in Pulmonary Hypertension
Authors: Lopez-Candales Angel , Eleswarapu Ananth , Edelman Kathy
Published: July 2021

Background
: Left ventricular diastolic dysfunction is associated with worse outcomes in patients with severe chronic elevation in pulmonary artery systolic pressures (PASP); however, little is known if right ventricular diastolic dysfunction (RVDD) is also present in these patients.

Methods
: Color M-mode to measure RV propagation velocity (Vp) and tissue Doppler imaging (TDI) of the tricuspid valve annulus (TVa) were done in 21 patients (Group I: mean age 54 ± 15, mean PASP 80 ± 31 mmHg) and in 19 healthy individuals (Group II: mean age 51 ± 14 years, PASP 30 ± 7 mmHg). All subjects were in normal sinus rhythm and normal left ventricular systolic function.

Results
: Despite elevation in PASP, Group I RV systolic function measured by both TVa excursion (2.01 ± 0.7 cm) and TVa systolic velocity (0.10 ± 0.04 cm/s) were no different than Group II (2.5 ± 0.5 cm and 0.12 ± 0.03 cm/s, respectively). Even though there was no difference in either early (0.11 ± 0.04 versus 0.13 ± 0.04 cm/s) versus late (0.15 ± 0.05 versus 0.13 ± 0.04 cm/s) diastolic velocities by TDI; a lower Vp was seen in Group I (28 ± 12 cm/s) than Group II (41 ± 15 cm/s, p < 0.01) with a significantly shorter diastolic interval (259 ± 90 versus 390 ± 80 ms, p < 0.0001). Representative color M-mode images are shown in the Figure

.

Conclusions
: Routine use of TVA TDI appears to be less useful than color M-mode to appreciate RV diastole as it shows a slower Vp with flows shifted later in diastole. In addition, these patients also demonstrate a shorter diastolic interval. Further studies are now required to prospectively assess the effects of pulmonary hypertension in clinical outcomes in patients manifesting RVDD.

Figure.

(A) Color M-mode image of a patient artery systolic pressures demonstrating predominantly early diastolic flow.

(B) Color M-mode image from a patient with pulmonary hypertension showing predominantly late diastolic flow.
Abstract 4455: The Impact of Platelet Count Decline on Clinical Outcome of Patients Undergoing Percutaneous Coronary Intervention
Authors: de Labriolle Axel , Bonello Laurent , Lemesle Gilles , Roy Probal , Steinberg Daniel H , Xue Zhenyi , Torguson Rebecca , Suddath William O , Satler Lowell F , Kent Kenneth M , Pichard Augusto D , Lindsay Joseph , Waksman Ron
Published: July 2021

BACKGROUND:
Severe decline in platelet count (DPC) ≥ 50% has been shown to be predictor of outcome after PCI. The prognosis of mild or moderate DPC is unknown. This study aimed to examine the impact of various degrees of DPC on clinical outcome.

METHODS:
The study included 10,146 consecutive patients who were subjected to PCI. The population was divided in four groups according to the magnitude of the decline in platelet post PCI: no DPC (DPC ≤ 10 %), minor DPC (10 –25 %), mild DPC (26 –50 %) and severe DPC (≥50%). The primary endpoint for this analysis was the composite criteria of death-MI at 30 days.

RESULTS:
Among the 10,146 patients, 36 % had a DPC ≤10 %, 47.7% had a DPC 10 –25%, 14% had a DPC 26 –50% and 2.3% had a DPC ≥50%. At 30 days, there was a worsening of clinical outcome with the severity of DPC (table 1

). In univariate analysis, numerous variables were detected associated with the risk of death-MI at 30 days including both mild and severe DPC. After adjustment in multivariate analysis, DPC (25–50 %) and DPC (≥50%) were independently associated with the composite criteria death-MI at 30 days. All independent predictors in multivariate analysis are listed in table 2

.

CONCLUSIONS:
DPC after PCI is an independent predictor of death-MI at 30 days. The clinical significance of DPC is not limited to major DPC (≥50%) but also seen with moderate DPC (26 –50 %). Careful attention to platelet count is required in patients subjected to PCI who experienced more than 25% decline in their platelet count following the intervention.

Relation between Decline in platelet count and Death - MI

Independent predictors of death-MI at 30 days
Abstract 4470: Long Term Follow Up After Fractional Flow Reserve-guided Treatment Of ‘Moderate’ Left Main Coronary Artery Stenosis
Authors: Hamilos Michalis , Cuisset Thomas , Sarma Jaydeep , Barbato Emanuele , Bartunek Jozef , Vanderheyden Marc , Heyndrickx Guy , Wijns William , Pijls Nico , De Bruyne Bernard
Published: July 2021

Introduction:
We assesed the value, in terms of long-term clinical outcome, of a fractional flow reserve (FFR)-guided treatment strategy in patients with angiographically ‘intermediate’ left main coronary artery (LMCA) stenoses.

Methods:
In 215 consecutive patients with an angiographically ‘intermediate’ unprotected LMCA stenosis (between 30–70%, by visual estimate), FFR measurements and off line quantitative coronary angiography (QCA) were obtained. When FFR was ≥0.80, patients were treated medically (medical group); When FFR was <0.80 coronary artery bypass grafting (CABG) was advocated (surgical group). Incidence of death, myocardial infarction and any coronary revascularisation procedure were recorded.

Results:
140 patients had an FFR≥0.80 and 75 patients had an FFR<0.80. Percent diameter stenosis at QCA correlated significantly with FFR (r = −0.38, p<0.001), but a very large scatter was observed (Figure 1B

). Mean follow up duration was 35 ± 25 months. The incidence of death was 7.9 % in the medical group and 9.3 % in the surgical group. (Figure 1A

, p=0.73).

Conclusions
: Angiography alone does not allow appropriate decision making in patients with angiographically ‘intermediate’ stenosis of the LMCA. Given the favorable outcome of an FFR-guided strategy such patients deserve FFR assessment before blindly proceeding to revascularisation.

Figure 1:

A
Kaplan-Meier mortality curves for the 2 study groups.
B
Scatterplots showing the distribution of % diameter stenosis and the corresponding FFR values (filled dots indicate FFR≥0.80 and circles indicate FFR<0.80).
Abstract 4471: Long-Term Follow-Up After Deferral of Percutaneous Coronary Intervention (PCI) in Patients With Moderate Coronary Lesions and Borderline Fractional Flow Reserve Measurements
Authors: Yamane Takafumi , Tamita Koichi , Kimura Noriomi , Funakoshi Shunsuke , Kim Kite , An Yoshimori , Kitai Takeshi , Katayama Minako , Ehara Natuhiko , Kinoshita Makoto , Kobori Atushi , Kaji Shuichiro , Yamamuro Atushi , Tani Tomoko , Furukawa Yutaka
Published: July 2021

Background:
Many studies have demonstrated that deferral of percutaneous coronary intervention (PCI) on the basis of a myocardial fractional flow reserve (FFR) ≥0.75 is associated with a very low coronary event rate. However, some groups have empirically chosen the cut-off value of 0.80 rather than 0.75 for decision to defer PCI and the FFR measurement between 0.75 and 0.80 has been established as a grey zone. The aim of this study was to evaluate the long-term clinical outcomes of patients with moderate coronary lesions and FFR measurements between 0.75 and 0.80.

Methods:
The study included 125 anigiographically moderate coronary lesions (>50% diameter stenosis by visual assessment) in 125 patients but in whom the PCI was deferred on the basis of an FFR ≥ 0.75. The FFR was calculated as the ratio of mean distal pressure divided by the proximal pressure during hyperemia. Patients were divided into two groups according to the result of FFR: ≥ 0.80 (n=99, group 1) and between 0.75 and 0.79 (n=26, group 2). We evaluated the long-term major adverse cardiovascular events (MACE) related and unrelated to the FFR-evaluated lesion.

Results:
During a follow-up period of 82 ± 29 months (mean ± SD), The Kaplan-Meier event-free survival curves showed that group 2 was poorer than group 1 in prognosis (p=0.0148). The incidence of MACE unrelated FFR-evaluated lesion in group 1 was equivalent to that in group 2 (p=0.96).

Conclusions:
In patients with moderate coronary lesions and borderline FFR measurements, deferral of PCI was associated with a higher rate of MACE related to the FFR-evaluated lesion. FFR cut-off point of 0.80 instead of 0.75 may be more appropriate for deferring PCI.
Abstract 4478: Local Determinants and Clinical Significance of Thrombus Formation Following Sirolimus-Eluting Stent Implantation: Insights from Optical Coherence Tomography Analysis
Authors: Otake Hiromasa , Shite Junya , Ako Junya , Shinke Toshiro , Sawada Takahiro , Bon-Kwon Koo , Yock Paul G , Honda Yasuhiro , Fitzgerald Peter J , Hirata Ken-ichi
Published: July 2021

Angioscopic analyses have shown the presence of subclinical thrombus in sirolimus-eluting stents (SES) is more common than the clinical incidence of stent thrombosis. However, the determinants and long term significance of subclinical thrombus remain unknown. Thirty five patients (44 stents) who received SES underwent 6 months follow-up optical coherence tomography (OCT). Patients were divided into 2 groups according to the presence of thrombus by OCT. Cross-sectional images were analyzed every 1mm. Stent eccentricity index (SEI; minimum stent diameter divided by maximum stent diameter) was determined in each cross section (CS). To assess the unevenness of neointimal thickness (NIT), a neointimal unevenness score (NUS) was calculated for each CS as maximum NIT in the CS divided by the average NIT of the same CS. Average SEI and NUS were also calculated for each stent. Major adverse cardiac event (MACE) was defined as a composite of death, myocardial infarction, and target vessel revascularization. Eight cases of thrombus were detected by OCT (18%). The thrombus cases were associated with longer stent length, larger numbers of uncovered struts, smaller average SEI, and greater average NUS (Table

). A significant relationship existed between the average SEI and average NUS (
P
<0.0001, R=0.66), as well as between average SEI and the number of uncovered struts (
P
=0.005, R=0.47). There was no significant difference in MACE during follow-up (median: 655days) (Thrombus: 0%, Non-thrombus: 7.4%, P=0.43). Based on OCT, longer stents, a larger number of uncovered stent struts, asymmetric stent expansion, and unevenness of NIT may be important determinants of thrombus formation in patients treated with SES. Asymmetric stent expansion may interfere with even neointimal coverage after SES deployment, perhaps a key mechanism for thrombus formation. In this small cohort, the presence of thrombus did not seem to increase the risk of MACE.
Abstract 4484: Predictors of Early vs. Late Stent Thrombosis after Drug Eluting vs. Bare Metal Stent Implantation: A Protective Effect of High Dose Statin Therapy?
Authors: Jeger Raban , Rocca Hanspeter Brunner-La , Leibundgut Gregor , Nietlispach Fabian , Handke Michael , Kaiser Christoph , Pfisterer Matthias
Published: July 2021

Background: Several predictors of stent thrombosis (ST) after implantation of drug-eluting stents (DES) have been identified. However, no data is available on the differences between early vs. late ST despite their different pathophysiology. In addition, a direct comparison of predictors of ST after DES vs. bare metal stent (BMS) implantation is lacking.

Methods: Baseline clinical and angiographic parameters and 3-year follow-up data of the Basel Kosten Effektivitäts Trial (BASKET; 826 patients randomized 2:1 to DES vs. BMS) were analyzed in univariate and multivariate models regarding early ST, i.e., ST on dual antiplatelet therapy with aspirin and clopidogrel in the first 6 months, and late ST, i.e., ST on aspirin only after the first 6 months (definite, probable, and possible). Separate analyses were done for DES and BMS.

Results: Overall, there were 51 (9.0%) vs. 21 (7.5%) ST in DES vs. BMS treated patients (p=0.51). Multivariate predictors of early ST in DES (n=16) were the use of glycoprotein IIb/IIIa inhibitors (OR 6.65, 95% CI 1.80 –24.57; p=0.005), type C lesions (OR 5.46, 95% CI 1.73–17.23; p=0.004), 3-vessel disease (OR 4.77, 95% CI 1.49 –15.26; p=0.009), statin dose (OR 0.37 per quintile increase, 95% CI 0.19 – 0.74; p=0.005), and intervention in the right coronary artery (OR 0.14, 95% CI 0.03– 0.69; p=0.016), whereas the only multivariate predictor of early ST in BMS (n=11) was age (OR 1.05 per year increase, 95% CI 1.005–1.092; p=0.029). The only multivariate predictor of late ST in DES (n=35) was saphenous vein graft intervention (OR 6.74, 95% CI 2.85–15.85; p<0.0001), whereas multivariate predictors of late ST in BMS (n=10) were saphenous vein graft intervention (OR 5.23, 95% CI 0.92–29.75; p=0.062) and age (OR 1.098 per year increase, 95% CI 1.021–1.18; p=0.011).

Conclusion: Early ST after DES implantation mainly depends on the complexity of the disease and the intervention, with the use of a higher statin dose possibly having a protective effect against early ST. The observation of a strong dose-dependent protective effect of statins to prevent early ST after DES is new, hypothesis-generating, and should be evaluated in an adequately powered prospective randomized trial.