bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17330: Relation Between Coronary Plaque Characteristics in Culprit Lesions and C-Reactive Protein Elevation after Percutaneous Coronary Intervention in Patients with Effort Angina Pectoris
Authors: Miura Eisuke , Iwaya Syouji , sakamoto Keiji , ujiie Yuichi , Seino Yoshitane , Kijima Mikihiro , Maruyama Yukio
Published: April 2024

Background:
A significant increase in plasma C-reactive protein(CRP) after percutaneous coronary intervention(PCI) has been reported to be a predictor of long term cardiovascular events in patients with stable angina pectoris. The aim of this study was to investigate the relation between the plasma CRP before and after PCI and the coronary plaque characteristics in patients with effort angina pectoris.

Methods:
54 patients with effort angina pectoris who underwent intravascular ultrasound(IVUS) and optical coherence tomography(OCT) before PCI were included. Patients were divided into a high increment in CRP one day after PCI(high-delta CRP) group(n=14, ≥3mg/l: 14.4±10.6mg/l) and a low-delta CRP group(n=40, <3mg/l: 0.84±1.1mg/l). Arterial remodeling of culprit lesion was assessed by IVUS. OCT plaque characteristics for lipid content, thrombus and fibrous cap thickness were examined using previously validated criteria. In addition, the presence of lipid-laden intima with characterized a high signal band with attenuation and a diffuse border was evaluated.

Results:
Ruptured plaque was not observed. The thickness of the fibrous cap in the low-delta CRP group was significantly larger than that of high-delta CRP group(112.3±42.5μ m vs. 77.1±28.1μ m P<0.01). And, lipid-laden intima was more frequently observed in high-delta CRP group than in the low -delta CRP group(84% vs. 25%, respectively; P<0.05). Higher CRP values before PCI were observed in high-delta CRP group(2.9±2.9 mg/l vs. 1.1±1.4 mg/l, respectively; P<0.05). Remodeling index, calcified and lipid plaque frequency and lipid profile were comparable between two groups. An increment of Troponin-I level after PCI had a tendency to be higher in high-delta CRP group than low-delta CRP group(2.75±3.39 ng/ml vs. 0.97±2.57 ng/ml, respectively; p=0.067).

Conclusion:
This result suggests that existence of thin fibrous cap with non-ruptured lipid plaque accelerates to inflammatory process in coronary atherosclerotic lesion by mechanical stress due to PCI and that OCT is useful for detecting the appearance of coronary plaque instability in patients with effort angina pectoris.
Abstract 17393: Early Reperfusion Phase as the Critical Therapeutic Window for Flavonoids Baicalein's Cardioprotection via Oxidant Scavenging and Nitric Oxide Signaling
Authors: Chang Wei-Tien , Li Jing , Li Juan , Li Chang-Qing , Hsu Chin-Wan , Yuan Chun-Su , Chien Chiang-Ting , Chen Wen-Jone , Vanden Hoek Terry L , Shao Zuo-Hui
Published: April 2024

Background:
Baicalein is a natural flavonoid with antioxidant activities protecting against ischemia-reperfusion (IR) injury. Previous studies suggest that oxidative burst occurs early after reperfusion that leads to accelerated cell death thereafter. We therefore investigated the timing of baicalein treatment in relation to its oxidant modulating effects and IR protection in order to sort out the critical therapeutic window.

Methods:
Using an established cardiomyocyte model of IR, we administered baicalein (100 μ M) at 0, 15, 30, 60 and 120 min after reperfusion and compared the cell viability, reactive oxygen species (ROS) and nitric oxide (NO) profiles with those of IR control. The cell viability was assessed by propidium iodide. The intracellular ROS were monitored by 2’,7’-dichlorofluorescin diacetate (DCFH-DA), while NO was assessed by 4’,5’-diaminofluorescin diacetate (DAF-2 DA).

Results:
Baicalein administered at 0 min of reperfusion significantly reduced cell death (35.5 ± 2.6% vs. 57.4 ± 1.9% in IR control,
P
< 0.001). Delay of baicalein for 15 or 30 min led to time-dependent decrease of cytoprotection (cell death 40.6 ± 1.7% and 44.5 ± 3.0%,
P
< 0.001 and 0.05 vs. IR control). If baicalein was delayed for 60 or 120 min, the protective effect was lost. In IR control, a transient but significant ROS burst was seen within 15 min of reperfusion. Baicalein treated at 0 min significantly decreased the ROS burst (
P
< 0.01). If treatment was delayed for 15 min, the ROS burst became unaffected at all. In terms of NO, baicalein treatment at 0 min resulted in a significant increase of NO in the later phase (> 30 min) of reperfusion. Cotreatment of baicalein with NO synthase (NOS) inhibitor L-NAME (200 μ M) not only decreased NO at reperfusion but abrogated the protective effect. If baicalein was delayed for 15 min, not only the NO increase was delayed, the level of NO was also lower. These suggest that NOS activation in the early phase of reperfusion is critical for NO signaling and protection.

Conclusion:
Baicalein protects cardiomyocytes from IR injury via oxidant scavenging and NOS-mediated NO signaling. The critical therapeutic window is within the first 15 to 30 min of reperfusion, during which reperfusion ROS burst can be timely scavenged and NOS effectively activated.
Abstract 17396: Iron Deficiency as the Most Ominous Substrate for Anemia in Patients Undergoing Coronary Artery Bypass Surgery
Authors: Weissert Susanne , Flint Julia , Aggarwal Suneil , Connell Alistair , Papalia Francesco , Babu Girish , Ling Hua Zen , Aung Nay , Richards Toby , Okonko Darlington
Published: April 2024

Background:
Whilst pre-operative anemia escalates morbidity and mortality after coronary artery bypass grafting (CABG), it is unclear whether its different etiologies confer different magnitudes of risk. Because iron is quantitatively the most important biocatalyst in human physiology, we hypothesized that iron deficiency (ID) anemia (IDA) might confer the greatest hazard. Additionally, we supposed that ID even in the absence of anemia might be detrimental.

Methods:
We analysed hospital outcomes in 1910 CABG patients (mean [±SD] age 67±10 years, EuroSCORE 4±3%, 79% male, 36% CCS class>2). The combination of a red cell distribution width≥15% and a mean cell volume ≤80fL was utilised to identify ID as it has a ≥90% sensitivity and specificity for this diagnosis. A hemoglobin <13g/dL in males and <12g/dl in females defined anemia.

Results:
On admission, 70%, 27%, and 3% of patients had no anemia, non-iron deficiency anemia (NIDA), and IDA, respectively. Patients with IDA were more likely to be female (38% vs 21%), diabetic (53% vs 25%), with poorer ejection fractions (51% vs 33% with EF<50%), more congestive symptoms (15% vs 5%), and higher CCS class (2.5±1.6 vs 2.1±1.2), EuroSCOREs (5±3 vs 4±3) and post-op renal (15% vs 8%) and neurological (16% vs 5%) complications (all P<0.05). Over a median (±IQR) hospital stay of 10±12 days, 46 (2.4%) patients died. IDA predicted inpatient mortality (HR 3.9, CI: 1.6-9.3, P=0.002) independently of all covariates including the EuroSCORE, and conferred a greater risk than NIDA (Fig
A
). Interestingly, ID
per se
also predicted an escalated risk of death (unadjusted HR 3.3, CI:1.4-7.8, P=0.007, Fig
B
) and did so independently of the presence of anemia (ID adjusted HR 2.6, CI:1.1-6.5, P=0.03).

Conclusions:
Pre-operative iron deficiency is the most ominous cause of anemia in CABG patients and confers adversity even in the absence of anemia. Optimizing iron status in anemic and non-anemic subjects might improve outcomes.
Abstract 17415: Speckle-Tracking Longitudinal Strain Assessment in the Presence of Myocardial Contrast Agents is Feasible After Microbubble Destruction
Authors: Cavalcante Joao , Plana Juan C , Negishi Kazuaki , Thomas James D , Marwick Thomas
Published: April 2024

BACKGROUND:
Speckle-tracking longitudinal strain (STLS) is an important tool for quantification of LV function. STLS assessment is challenging in the presence of echo contrast agents (CA). This is a problem because CA are increasingly used to improve endocardial definition for quantification of LV volumes in patients with poor endocardial border definition. We hypothesized that the use of different timing intervals and image settings could allow the measurement of STLS despite the presence of CA.

METHODS:
We studied 15 consecutive individuals who had a clinically indicated transthoracic echocardiogram requiring CA. STLS was measured from apical 4-, 2- and 3-chamber views before and after CA was given. Four different settings were tested: A) baseline STLS without contrast; B) STLS with low MI (0.3); C) STLS 1 minute post-contrast administration with high MI; D) STLS 1 minute post-contrast administration at high MI using three-dimensional imaging for microbubble destruction.

RESULTS:
Feasibility of STLS assessment was significantly reduced post CA with low MI (35% of uninterpretable segments vs 1.1% at baseline, p<0.0001), but not statistically different with high MI (3%, p=0.27) or high MI with microbubble destruction (1.1%, p=NS). When comparing the global longitudinal strain, significant underestimation biases were observed for post CA with low MI (-2.3; Figure 1, Panel A) and high MI settings (-1.8) but not for high MI with microbubble destruction (-0.4; Figure 1, Panel B), which had the best measurement agreement with baseline values.

CONCLUSION:
STLS cannot be performed after CA administration using the conventional contrast settings. The calculation of STLS is feasible, if three-dimensional imaging is used as a tool for microbubble destruction 1 minute after the administration of contrast.
Abstract 17449: PACT: Preventable Admission Care Team: A Unique Approach to Reducing 30 Day Readmissions
Authors: Basso Lipani Maria , Bernstein Susan R , Stulman James , Ricks Doran , Colgan Claudia , Nash Ira , Kalman Jill
Published: April 2024

Background/Significance:
There is a national mandate to prevent hospital readmissions. In 2009, CMS began publicly reporting 30-day readmission rates for patients hospitalized with pneumonia, acute myocardial infarction, and heart failure. Multiple factors contribute to avoidable readmissions, and can result from: poor quality care, premature discharges, poor coordination and communication between patient and providers.

Program:
Mount Sinai Hospital (MSH) has created The PACT Program, with the goal of reducing 30 day readmissions. PACT is internally funded and consists of 4 social workers (SW) in the hospital and 2 NP's and 1 SW in the internal medicine clinic. Patients at high risk of readmission are identified in the hospital based on their readmission history. The SW performs a 75 minute patient/caregiver psychosocial assessment. A five week post-discharge care coordination plan follows by the same enrolling SW. This includes intensive phone follow-up and home visits to appraise home safety, environmental hazards, family involvement, medication compliance, nutritional/dietary assessments. Patients with fragmented primary care are referred to the PACT clinic.

Patient Profile:
Age range from 19-99; 52% are 65+; 8% 85+; 52% women; 48% male; 38% are African-American; 32% Hispanic; 43% have congestive heart failure, 45% diabetes; 16% dialysis, 21% documented mental illness; 66% greater than 2 co-morbidities; 85% Medicare and/or Medicaid; 87% have a family caregiver.

Results:
6 month (see table)

Conclusions:
PACT is engaging the most challenging patients and is successful in reducing 30,60,90 day readmissions. PACT patients represent a diversity of age, gender and ethnicity, are medically complex, enriched in cardiovascular disease and diabetes. PACT includes non-english speaking patients with cognitive impairment, mental illness, which other transitional programs have excluded. The model is replicable, sustainable, and improving quality of care.
Abstract 17554: Mice with Endothelial-Targeted Inactivation of
Ppap2b
(Lipid Phosphate Phosphatase 3) Display Enhanced Vascular Inflammation
Authors: Panchatcharam Manikandan , Miriyala Sumitra , Wheeler Jessica , Salous Abdel K , Dong Anping , Sunkara Manjula , Morris Andrew J , Escalante-Alcalde Diana , Smyth. Susan S
Published: April 2024

Meta-analysis of data from a series of genome-wide association studies (GWAS) revealed a striking association between the
PPAP2B
locus and coronary artery disease. The
PPAP2B
gene encodes for lipid phosphate phosphatase 3 (LPP3), an integral membrane enzyme that dephosphorylates lysophosphatidic acid (LPA), sphingosine 1-phosphate (S1P) and related bioactive lipids. While emerging evidence suggests a role for both LPA and S1P in experimental models of atherosclerosis, essentially nothing is understood about the pathophysiologic role of LPP3, largely due to the fact that genetic deletion results embryonic lethality in mice. We report that constitutive inactivation of LPP3 in vascular endothelial cells accomplished by breeding mice with floxed
Ppap2b
to mice expressing Cre recombinase under control of the
Tie1
promoter results in embryonic lethality and a similar defect in vasculogenesis as is observed in mice with global inactivation of
Ppap2b
, indicating that dysregulation of LPP3-dependent vascular endothelial cell function likely underlies the developmental phenotype observed in
Ppap2b
-null embryos. Using an estrogen inducible Cre transgene under control of the
Tie1
promoter, we have inactivated
Ppap2b
expression in endothelial cells in adult mice and confirmed the lack of vascular endothelial LPP3 by immunologic and biochemical approaches. The absence of vascular endothelial LPP3 results in a 2.2 ± 0.5 fold increase in basal vascular permeability, as assessed by Evans blue dye extravasation in lung tissue. The permeability difference is exaggerated following an inflammatory challenge (LPS; 2 mg/kg), and LPS-induced expression of plasma inflammatory markers IL6 and KC are 3.3 ± 0.5 and 1.9 ± 0.6 fold higher in mice lacking endothelial LPP3. In addition, loss of endothelial LPP3 impairs angiogenesis in matrigel implanted in mice. These results demonstrate a fundamental role for LPP3 in maintaining the integrity of the vascular endothelium. Importantly, our findings suggest that polymorphisms associated with a reduction in LPP3 expression could promote vascular inflammation and thereby heighten risk of coronary artery disease and myocardial infarction.
Abstract 17680: A Comparison of Primary Care, Home-Based Telemonitoring, Telemonitoring with Video, or Specialist Directed Heart Failure Clinic Care for Patients with High Risk Heart Failure
Authors: Howlett Jonathan G , Marr David , Palmer Krisan , O'Neill Blair J , Rajda Miroslaw
Published: April 2024

Introduction:
Most studies of telephone-based care for heart failure (HF) patients have not integrated primary care providers at the initial point of care. Further, the addition of video assessment to telemonitoring has not been studied. We aimed to evaluate, in heart failure outpatients, the safety and feasibility of a telephone-based monitoring system with involvement of primary care providers compared to the gold-standard heart failure clinic model.

Methods:
Patients with a heart failure and at least one hospitalization within the previous six months were randomized in a 1:1:1 fashion to either usual care in a nurse-managed heart failure clinic with cardiologist backup (UC), or a daily telemonitoring system, with standard phone (TM) or video (TV) capability. The latter two groups additionally underwent biweekly scripted telephone (TM) or videophone (TV) calls. Protocol-based interventions with involvement of primary care provider were utilized. The primary outcome was the composite total mortality and hospitalization at 12 months follow up.

Results:
There were 122 patients (44 to UC, 38 to TM and 40 to TV), with 100% follow up. The median age was 67 years, 35% were female, mean EF was 46% and median NT-pro-BNP was 2211 pg/ml. The primary endpoint of occurred in 40 (or 33%) of patients and was not different between the three groups (UC 14, TM 12, and TV 14 events respectively, p= 0.81). Additionally, no difference in death (UC 4, TM 2, TV 4, p= 0.65) or total hospitalitzations were seen (UC 20, TM 17, TV 21, p= 0.75).

Conclusions:
A home telemonitoring strategy with primary care provider involvement appears to be a safe and feasible alternative to care in a specialist led heart failure clinic for patients with ambulatory heart failure. The addition of video capability is unlikely to provide a major impact. Further, properly powered studies are justified in order to establish the relative benefits of this strategy as a routine treatment modality for heart failure.
Abstract 17694: Angiographic and Clinical Outcomes in Infrapopliteal InterventioniIn Chronic Renal Impairment
Authors: Elnagar Amro , Rha Seung Woon , Choi Byoung Geol , Im Sung Il , Kim Sun Won , Na Jin Oh , Han Seong Woo , Choi Cheol Ung , Lim Hong Euy , Kim Jin Won , Kim Eung Ju , Park Chang Gyu , Seo Hong Seog , Oh Dong Joo
Published: April 2024

Background:
Chronic renal impairment (CRI) is well known risk factor in patients (pts) with coronary artery disease; however impact of CRI in pts with peripheral arterial disease (PAD) is not well defined. We evulate effect of CRI on procedural & clinical outcomes in below the knee (BTK) intervention.

Methods:
A total 82 consecutive patients with 147 BTK lesions. Study population were divided into 2 groups according to renal funtion.CRI was defined as serum creatinine more than 1.5 mg/dl.

Results:
Baseline characteristics were similar between 2 groups. Lesions data were also similar except that CRI group had more calcific lesions. Pre procedure diameter stenosis (DS) was more in normal group, while Post procedure (DS) was more in CRI .Post procedure diameter stenosis (DS) was more in CRI. Post procedural ischemic complications and one year clinical follow up were not different; except for wound debridement was more in CRI group. (Table 1)

Conclusions:
In our study, CRI was not associated with worse angiographic and clinical outcome than pts with normal renal function.
Abstract 17708: Hydrogel Loaded with Mesenchymal Stem Cells Preserves Cardiac Function and Ventricular Remodeling After Myocardial Infarction
Authors: Eva Mathieu , Guillaume Lamirault , Claire Toquet , Pierre Weiss , Jérôme Guicheux , Patricia Lemarchand
Published: April 2024

Purpose:
We hypothesized that the injection of mesenchymal stem cells (MSC) within an hydrogel would improve efficacy of cell therapy after myocardial infarction (MI). We have developed an hydrogel composed to Hydroxypropyl methylcellulose Silanyzed (Si-HPMC).

Methods:
The cytocompatibility was evaluated by the MSC viability cultivated in 3D within the hydrogel using cytotoxicity assays. Immediately after coronary ligation, hydrogel, 3.106 MSCs alone or with the hydrogel (MSC+hydrogel) were injected into the myocardium of rats (PBS used as control). Cardiac function was assessed using echocardiography over 56 days and left ventricular (LV) remodeling was assessed using histopathology.

Results:
The hydrogel maintained the MSC viability during the whole culture period. In the PBS group, MI induced a reduction in left ventricular ejection fraction (LVEF) (87.4±1.5% at baseline vs 47.4±2.4% at 56 days; p<0.001) and an increase in LV diameters during the whole study. The injection of MSC+hydrogel in acute phase of MI induced an significant increased of LVEF at day 7 up to day 56 as compared to PBS group (at day 56: 47.4±2.4% in PBS group vs 68.5±2.0% in MSC+hydrogel group; p<0.001) and an increase as compared to day 1 after MI (61.2±2.9% at day 1 vs 76.4±1.5 % at day 28; p<0.001 as compared to day 1). The injection of hydrogel alone induced an increase in LVEF at 28 days as compared to PBS group but not at day 7 and 56 and the injection of MSC induced an increase at 28 and 56 days as compared to PBS group, but not at day 7. In the both groups the LV diameters and LVEF are not significantly altered during the whole study as compared to day 1. Interestingly when animals have been treated with MSC+hydrogel, their LVEF was higher at day 7 as compared to EF in MSC group and at day 56 in compared to hydrogel group.

Conclusion:
These results showed the major effects of Si-HPMC hydrogel are observed at the short-term. In acute phase of MI, the MSC delivery with hydrogel allowed a better preservation of cardiac function and LV remodeling as compared to injection of MSC alone.
Abstract 17769: Increased Blood Pressure Variability During Early Bereavement
Authors: Mihailidou Anastasia S , Buckley Tom , McKinley Sharon , Ward Christopher , Bartrop Roger , Morel-Kopp Marie-Christine , Spinaze Monica , Tofler Geoffrey
Published: April 2024

Background:
Bereavement is a unique stress with heightened cardiovascular disease (CVD) risk for the surviving spouse; the physiological
changes
underlying this increased risk have not been well defined.

Aims:
Since increased blood pressure variability (BPV) has been associated with higher CVD mortality, we tested the hypothesis that there is greater BPV during bereavement.

Methods:
Sixty-three bereaved (B) spouses and parents (41F/22M; aged 65 ± 2 yrs) were studied within 2 weeks of bereavement (acute) and at 6 months (6m), and compared to a non-bereaved (NB) reference group of 78 spouses of discharged patients (52F/26M; age 64 ± 1 yrs) underwent 24-hour ambulatory blood pressure (ABP) assessment using the validated TM-2430 device. Systolic BPV for the awake period (0800 - 2000 hours) was calculated as standard deviation (SD), coefficient of variability (CoV) and average real variability (ARV). SD identifies the spread of BP measurements around a single value (the mean) not accounting for order of measurement, whereas ARV averages absolute differences of consecutive measurements.

Results:
Acutely bereaved have significantly higher awake systolic blood pressure (SBP, 136 ± 2 vs 131 ± 1 mmHg, p<0.05) and systolic BPV measures (SD and ARV) compared with non-bereaved (see Table 1). By 6 months, there were no longer significant differences between B and NB in ARV or SBP. However, BPV measured by SD remained higher in bereaved at 6 months.

Conclusion:
This study, the first to focus on CVD risk in early bereavement, demonstrates increased blood pressure variability that may contribute to the increased CVD events. Table 1
Abstract 17780: Efficacy of Bag-Mask Ventilation for Ventricular Fibrillation Sudden Cardiac Arrest
Authors: Tahara Yoshio , Morimura Naoto , Kimura Kazuo , Oi Yasufumi , Yonemoto Naohiro , Nonogi Hiroshi , Kimura Takeshi , Nagao Ken ,   JCS-ReSS Investigators
Published: April 2024

Background:
If bag-mask ventilation is adequate, an advanced airway is not urgently required. Although rescuers may defer insertion of an advanced airway until the patient fails to respond to initial cardiopulmonary resuscitation (CPR) and defibrillation attempts or has return of spontaneous circulation (ROSC), its effects and optimal timing remain unclear.

Methods:
An observational study was performed in 547,218 patients who had out-of-hospital cardiac arrest (OHCA) in Japan and received CPR between January 1, 2005 and December 31, 2009. Of these patients, 15,675 in whom age was from 18 to 74 years, OHCA was cardiogenic, the scene of OHCA was witnessed, bystander CPR was performed, and initial rhythm was ventricular fibrillation (VF) were studied. The subjects were divided into two groups according to the method used for airway management by emergency medical service (EMS) personnel: 8,101 who used a bag-valve mask (bag-mask ventilation group: BMV group) and 7,574 who used an advanced airway including a supraglottic airway device and endotracheal tube (advanced airway group: AA group). The rates of ROSC from the initiation of EMS CPR to arrival at the hospital were compared. Next, subjects who did not have ROSC within 45 minutes before arrival at the hospital were divided into two groups, the pre-hospital non-ROSC BMV group (N=5,127) and the pre-hospital non-ROSC AA group (N=5,867), and neurologic outcomes at 30 days were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1 or 2.

Results:
The rate of ROSC from the initiation of EMS CPR to arrival at the hospital was higher (35.5% vs. 19.8%, p<0.01) in the BMV group than in the AA group. The rate of favorable outcomes was higher (5.7% vs. 2.9%, p<0.01) in the pre-hospital non-ROSC BMV group than in the pre-hospital non-ROSC AA group. In particular, the rate of favorable outcomes was higher in the pre-hospital non-ROSC BMV group than in the pre-hospital non-ROSC AA group during the first 25 minutes after the initiation of EMS CPR.

Conclusions:
In patients with ventricular fibrillation sudden cardiac arrest, the use of a bag-valve mask for airway management increases the rates of ROSC and favorable outcomes, particularly during the initial period from EMS CPR to arrival at the hospital.
Abstract 17806: Progressive Myocardial Tissue Injury Immediately After Coronary Reperfusion Can be Assessed by Ultrasonic Integrated Backscatter
Authors: Katayama Minako , Jiamsripong Panupong , McMahon Eileen M , Boukatina Anna , Lombari Jacquelyn M , Lombari Theresa R , Belohlavek Marek
Published: April 2024

Background:
Myocardial reperfusion following prolonged ischemia may paradoxically cause additional injury, including edema and microvascular damage. These structural alterations augment tissue echogenicity measurable by integrated backscatter (IB). We sought to characterize alterations of myocardial IB in an ischemic and then reperfused region of the rat heart.

Methods:
Myocardial IB in 12 adult male Sprague-Dawley rats was studied at baseline, 60 minutes after left anterior descending coronary artery occlusion, and chronologically after coronary reopening. Short-axis scans of the mid left ventricle were acquired at a frequency of 8 MHz. Mean±SD values of IB were measured in the region of interest at baseline, ischemia, and reperfusion, and assessed by a paired t-test.

Results:
See figure and table. IB did not significantly change between baseline and ischemia. However, within 1 minute of reperfusion, IB significantly increased, as compared to both baseline and ischemia, and continued to increase until 10 minutes after reperfusion, when a plateau was reached.

Conclusions:
Myocardial reperfusion following acute prolonged ischemia in a rat heart significantly augments tissue echogenicity. A continuing increase of IB within minutes of the reperfusion onset and the subsequent plateau of elevated IB values suggest progression and completion, respectively, of reperfusion injury, detectable by a high-frequency transducer.
Abstract 17808: Perceived Health Predicts Risk of Hospitalizations and Death in Adults with Heart Failure
Authors: Masterson Creber Ruth M , Riegel Barbara
Published: April 2024

Background:
Hospitalization and death are common in adults with heart failure (HF). The purpose of this study is to determine whether overall perceived health can predict all-cause hospitalization or death in HF patients.

Methods:
A secondary analysis was conducted using data collected on 280 Stage C HF patients from three U.S. northeastern sites. Perceived health was measured at enrollment with the question, “In general would you say your health is, excellent, very good, good, fair, or poor?” Data on hospitalization and death were obtained from the medical record or US death records. We compared the rate of events among patients with poor or fair perceptions of health to those with good or excellent perceptions of health. A Cox proportional hazards model was used to examine the association between perceived health and event rates. Kaplan-Meier survival estimates were compared between groups.

Results:
The sample was older (mean=62 SD 12.5 years), 64.3% male, 76.4% NYHA class III/IV, 69% with systolic HF (ejection fraction 35.4% SD 17%), and 39% ischemic etiology. Few patients (13.2%) rated their health as being poor. During a 180-day follow-up period, 6 deaths and 91 hospitalizations occurred as first events. Among patients with events, 64.9% perceived their health as poor and 33.9% perceived their health as fair. Controlling for 8 confounders (site, age, race, gender, NYHA class, HF type, HF knowledge, Charlson Comorbidity Index), patients with poor perceived health had over double the rate of dying or being hospitalized (hazard ratio (HR): 2.5; 95% confidence interval (CI): 1.3 to 4.7; p=0.007).

CONCLUSION:
Perceived health is a powerful indicator of impending events. Asking HF patients how they perceive their health can be a simple and quick tool for prioritizing patients who are at highest risk of death and hospitalization.
Abstract 17809: The Cardiovascular Phenotype of D-Dimer: From the Dallas Heart Study
Authors: Grodin Justin L , Powell Tiffany M , Ayers Colby R , Rohatgi Anand , Khera Amit , McGuire Darren K , Drazner Mark H , de Lemos James A , Das Sandeep R
Published: April 2024

Background.
The D-dimer antigen is a circulating marker of fibrin degradation; increased levels have been associated with coronary artery disease, systolic heart failure and all-cause mortality in clinical cohorts. However, its associations with cardiovascular phenotypes in the general population have not been described.

Methods.
In the Dallas Heart Study, a multi-ethnic probability-based population sample of Dallas County residents ages 30-65, we assessed associations between plasma D-dimer antigen and mortality, cardiac and aortic MRI measures (n=2500), and coronary calcium by EBCT (n=2536). Multivariable linear and logistic regression methods using log transformed D-dimer levels as the exposure variable were used to assess associations, adjusted for age, diabetes, smoking, hypertension, cholesterol, fat mass, lean mass, sex, and race.

Results.
Mean age was 44; 56% women, 52% African American. Median circulating D-dimer antigen was 0.22 μg/ml, ranging 0.04 to 8.85 μg/ml. Increasing D-dimer levels independently predicted all-cause mortality with a similar estimate for CV mortality prediction, although the latter was not statistically significant (Table). Increasing D-dimer also independently associated with increasing LV end diastolic volume and mass, but not with aortic or coronary atherosclerosis (Table).

Conclusion.
In this large, ethnically diverse, population-based cohort with detailed cardiovascular phenotyping, increasing plasma levels of D-dimer were not associated with atherosclerosis, but were independently associated with higher LV mass, larger end diastolic volume, and all-cause mortality.
Abstract 17828: Preconditioning of Mice with a Prolyl Hydroxylase Inhibitor, Dimethyloxalylglycine, Prevents Skin Flap Necrosis
Authors: Takaku Mitsuru , Tomita Shuhei , Kurobe Hirotsugu , Ushiyama Akira , Hashimoto Ichiro , Nakanishi Hideki , Tamaki Toshiaki
Published: April 2024

Background-
Local skin flaps often present with flap necrosis caused by critical disturbance of blood supply. Because hypoxia-inducible factor 1 (HIF-1) has a pivotal role in ischemic vascular responses, we assessed the hypothesis that preoperative stabilization of HIFs using prolyl hydroxylases (PHD) inhibitor contributes to improvement of skin flap survival.

Methods and Results-
Mice with ischemic skin flap on the dorsum were treated with PHD inhibitor dimethyloxalylglycine (DMOG) 48hr prior to operation by intraperitoneal administration. Immunoblot assay revealed sustained up-regulation of HIF-1α protein at pre- and postoperative states in the skin. Survival area of flap and the number of CD31 positive vessels at proximal part of flaps in DMOG-treated mice were significantly increased at day seven (20.6±4.9% vs. 55.5±13.2%; P<0.001 and 11.3±1.7 vs. 17.3±3.3; P<0.05). Serum vascular endothelial growth factor (VEGF) protein at the time of operation and its receptor Flk-1 protein at proximal part of flap on day one were significantly increased in DMOG-treated mice. Furthermore, flow cytometric analysis revealed a marked induction of circulating endothelial progenitor cells (EPCs) in DMOG-treated mice on day one (0.75±0.01% vs. 1.49±0.11% of CD45 gated CD34/CD133 positive cells; P<0.005). Of interest, flow cytometric bromodeoxyuridine (BrdU)/DNA analysis showed a marked induction of proliferative progenitor cells in bone marrow 48hr after DMOG treatment. In addition, TUNEL staining at distal part of flaps revealed significantly decreasing apoptotic cells accompanied by increasing protein level of hexokinase II and decreasing Bax protein expression in DMOG-treated mice. HIF-1α heterozygous-null mice showed the reduction of flap survival areas, decreasing the number of circulating EPCs, and increasing the number of apoptotic cells, but these mutant mice with DMOG pretreatment demonstrated complete recovery of these parameters.

Conclusion-
These findings indicate that prevention of flap necrosis by pretreatment of DMOG is due to enhancement of both anti-apoptotic effects and angiogenesis at the flap region via HIF-1 functions, and that pretreatment of DMOG could be a potential therapeutic strategy for prevention of flap necrosis.
Abstract 17835: Effect of Cardiopulmonary Resuscitation Training on Favorable Neurological Outcome for In-Hospital Cardiac Arrest
Authors: Yoshikawa Kei , Yokoyama Hiroyuki , Yonemoto Naohiro , Nonogi Hiroshi ,   the J-RCPR Investigators
Published: April 2024

Background:
Many training courses for CPR have been performed to medical personnel but few data have been reported those effect.

Method:
From 2008 to 2009, during 24 month, 491 patients were registered in the Japanese Registry of CPR for In-hospital Cardiac Arrest (J-RCPR). In this study, 445 patients treated by the first responder received the CPR training (Group T n=357) and non-trained first responder (group n-T n=88) were analyzed. We evaluated the ratio of return of spontaneous circulation (ROSC) and good neurological function at discharge (CPC1 or 2 in Glasgow-Pittsburgh cerebral performance category) in each groups. We also analyzed each indexes by initial rhythm was VF/VT arrest (n=122) and PEA/Asystole (n=316).

Result:
The ratio of ROSC, good neurological performance were 65.8%, 21.1% in group T, and 59.1,10.3% in group n-T (In good CPC p<0.05). In VF/VT, the ratio were 80.2%, 45.5% in group T, and 74.2%,15.4% in group n-T (In good CPC p<0.01). In PEA/Asystole, the ratio were 60.8%, 12.5% in group T, and 50.0%, 5.9% in group n-T.

Conclusion:
In-hospital cardiac arrest treated by the first responder with the CPR training is significantly associated with higher rate of favorable neurological outcome, especially in VF/VT
Abstract 17927: Transcatheter Implantation of Autologous in vivo Tissue-Engineered, Valved Stents (BIOVALVED STENTs) in the Pulmonary Position in a Beagle Model
Authors: Uechi Masami , Funayama Marina , Matsui Yuichi , Mizuno Takeshi , Fujiwara Megumi , Tajikawa Tsutomu , Ohba Kenkichi , Yamanami Masashi , Watanabe Taiji , Kanda Keiichi , Yaku Hitoshi , Nakayama Yasuhide
Published: April 2024

Objectives
We developed completely autologous valved conduits (BIOVALVEs) using simple, safe and economical in vivo tissue engineering, which is a practical concept of regenerative medicine. In this study, self-expandable BIOVALVEs impregnating stents (BIOVALVED STENTs) were successfully replaced to pulmonary valves by transcatheter method in a beagle model. The use of BIOVALVED STENTs might solve the problem of degeneration and limited durability of biological heart valves.

Methods and Results
As a mold for BIOVALVED STENTs preparation, a pair of the custom-designed acrylate rods (diameter, 14 mm; length, 40 mm), assembled with a small aperture in a trileaflet shape, were covered with NiTi stents, and then capped with another pair of acrylate covers at their both terminals. The molds were placed in the dorsal subcutaneous spaces of beagle dogs. After 4 weeks of implantation, autologous connective tissues, impregnating stents, completely covered the surface of the molds and migrated into the apertures for the leaflets. BIOVALVED STENTs with autologous three leaflets, strongly connected with stent strut, were obtained after removing the molds. They had appropriate compliance and robustness (> 3000 mmHg) as the conduit-valves for aortic full root replacement. They were subsequently deployed into the main pulmonary arteries through catheters after technical establishment using allogenic implantation. Postoperative UCG demonstrated smooth movement of the leaflets with little regurgitation for at least up to 3 months.

Conclusion
Good functioning as the pulmonary valve was observed after implantation of firstly developed BIOVALVED STENTs with completely autologous tissues, which will become a valid future option in adolescents.
Abstract 17944: The Impact of Baseline PR Interval on Response to CRT in Heart Failure with Narrow QRS Complexes: A Sub-Study of the ReThinQ Trial
Authors: Stopper Matthew M , Li Jianqing , Beshai John F , Pavri Behzad B
Published: April 2024

Background:
In heart failure (HF) patients (pts) who are treated with cardiac resynchronization therapy (CRT), the programmed AV delay must be shorter than the native PR interval in order to preempt intrinsic, dyssynchronous conduction. When the native PR interval is short, such programming results in truncation of transmitral flow, especially in the presence of dilated atria and marked intraatrial (R–>L) conduction delays. Pts with longer baseline PR intervals can have longer (more physiologic) AV delay programming, thereby allowing complete left atrial emptying. Such pts may show improved response to CRT. We analyzed the impact of baseline PR interval in the ReThinQ Trial, which assessed response to CRT in pts with NYHA class III HF, QRS complex duration <130 ms, and echo-detected dyssynchrony.

Methods:
Pts randomized to CRT in the ReThinQ trial were divided onto 2 groups depending on baseline PR interval: PR≥180ms and PR<180ms. Outcomes at 6 months were compared in the 2 groups.

Results:
A total of 87 pts were randomized to CRT; 45 pts had PR≥180ms and 42 pts had PR<180ms. At baseline, age, gender, type of cardiomyopathy, LVEF and QRS duration were similar in the 2 groups. Compared to baseline, peak VO
2
at 6 months (which was the primary endpoint in the ReThinQ Trial) was significantly improved only in pts with PR≥180ms (12.1–>13.5 ml/kg/min,
P
=0.045) but not in pts with PR<180 ms (12.1–>12.3 ml/kg/min,
P
=NS). Although both groups had significant improvements in NYHA class, pts with PR≥180ms showed greater improvement at 6 months as compared to pts with PR<180 ms (2.3 vs. 2.6,
P
=0.017). Finally, improvement in exercise duration showed a trend toward significance in pts with PR≥180ms (9.1–>9.9 min,
P
=0.12), but there was no difference in pts with PR<180 ms (8.6–>8.7 min,
P
=0.42). There were no significant changes in LVEF.

Conclusions:
In the ReThinQ Trial, only pts with PR≥180ms showed significant improvements in peak VO
2
after 6 months of CRT. Similarly, NYHA class improved to a greater degree in pts with PR≥180ms as compared to pts with PR<180 ms. This suggests that some of the benefit of CRT may be negated by truncation of transmitral flow in pts with PR<180 ms. A short baseline PR may be a contributor to CRT non-response.
Abstract 17972: Low Levels of High-Density Lipoprotein Cholesterol (HDL-C) at Presentation in Acute Coronary Syndromes (ACS) and its Relation to Angiographically-Observed Atherosclerotic Burden: Results from the NCDR®
Authors: Acharjee Subroto , Roe Matthew T , Amsterdam Ezra A , Holmes DaJuanicia , Boden William E
Published: April 2024

Background:
Although low levels of HDL-C are a known independent risk predictor in stable cardiovascular disease, limited data exist regarding its association with atherosclerotic burden as observed by coronary angiography in patients admitted with ACS.

Methods:
We evaluated HDL-C levels among 83,110 non-ST-elevation MI patients from the NCDR ACTION-GWTG registry who underwent diagnostic angiography at 461 U.S. hospitals from January 2007 through December 2010. Clinical and angiographic characteristics were analyzed by quartiles of HDL-C measured during hospitalization. Multivariable models were created to determine the risk of severe CAD (left main or 3 vessel disease) vs 1-2 vessel CAD in each quartile, using the highest quartile as referent.

Results:
Over half of the patients in the examined cohort had presentation HDL-C levels lower than or equal to median (36.9 mg/dL). Patients in lower HDL-C quartiles were younger, more often male, white, smokers, obese, diabetic, hypertensive and had greater rates of prior MI, PCI, CABG and revascularization (P = 0.04 for hypertension, <0.0001 for others) compared to those in higher HDL-C quartiles. Use of medical therapy (aspirin, clopidogrel, beta-blocker, ACE inhibitor or ARB, statin and other lipid-lowering agents) at home was greater among patients with lower HDL-C (P = 0.02 for statin, <0.0001 for others). Individuals in lower HDL-C quartiles had a greater extent of angiographic stenoses and higher risk of severe CAD. This association persisted despite multivariable adjustment, with patients in the lowest HDL-C quartile demonstrating a 28% greater risk of severe CAD compared with their counterparts in the highest HDL-C quartile (Table 1).

Conclusion:
Among patients undergoing diagnostic angiography for non-ST-elevation ACS, low level of HDL-C at presentation was common and was independently associated with greater angiographically-observed atherosclerotic burden, including more left main or 3 vessel CAD.
Abstract 18022: High On-Treatment Platelet Reactivity Measured by Various Platelet Function Tests: Is the Current VASP-PRI Cutoff Too Low?
Authors: Jeong Young-Hoon , P. Bliden Kevin , S. Tantry Udaya , Park Yongwhi , Hwang Seok-Jae , A. Gurbel Paul
Published: April 2024

Background:
High on-treatment platelet reactivity (HPR) to ADP measured by multiple methods has been linked to adverse post-PCI clinical event occurrence. The correlation of HPR cutoffs is still a matter of debate, since the predictive value and HPR group size are different depending on platelet function assays. To determine the comparable cutpoint, we correlated cutpoints for HPR determined by various assays in the same patient cohort.

Methods:
Platelet measures [5µM ADP-induced light transmission aggregation (LTA5μ MADP); P2Y12 reaction units by VerifyNow (PRU), and platelet reactivity index by VASP assay (PRI)] were evaluated (n=936 pairs, cohort I) in stable CAD patients during P2Y12 receptor inhibitor treatment. These assays also performed in PCI-treated patients receiving standard aspirin and clopidogrel therapy (n=584, cohort II). The HPR cutpoints were defined as LTA
5μ MADP
>46%, PRU >235, and PRI >50%.

Results:
In the stable CAD patients, LTA
5μ MADP
showed significant correlations with PRU and PRI (r ≥0.688). In ROC curve analysis using the cutpoint of LTA
5μ MADP
(>46%), the matched values of PRU and PRI were >234 (AUC 0.943, p<0.001, sensitivity 87.3% and specificity 87.8%) and >60% (Figure A). Among PCI-treated patients, the prevalence of HPR was highest based on PRI >50% (69%) compared with other criteria (≤55%). The comparable values for LTA
5μ MADP
>46% were PRU >235 (AUC 0.850, p<0.001, sensitivity 85.3% and specificity 70.4%) and PRI >59% (Figure B).

Conclusion:
The published cutoff values for HPR by LTA
5μ MADP
and PRU were well correlated, whereas published PRI >50% cutoff value may overestimate the risk of HPR. Updated cutoff of PRI > 60% may better stratify the risk for HPR and can be used in future trials.
Abstract 18100: Usfulness of B-Type Natriuretic Peptide Plasma Levels to Predict Long-Term Mortality After Transcatheter Aortic Valve Implantation
Authors: Lopez Otero Diego , Trilo Nouche Ramiro , Cid Alvarez Belen , Ocaranza Sanchez Raymundo , Santas Alvarez Melisa , Alvarez Barredo Maria , Dominguez Tourino Maria Elena , Gonzalez Juantey Jose Ramon
Published: April 2024

Introduction and hypothesis:
B-type Natriuretic Peptide (BNP) has been shown to be useful for predicting long-term mortality after conventional aortic valve replacement. We assessed the hypothesis that the BNP levels also predicts long-term mortality after transcatheter aortic valve implantation (TAVI).

Methods:
A total of 74 patients who underwent TAVI were included. Indications for TAVI were nonoperable or surgical high-risk patients (Logistic EuroSCORE > 20%). The mean age was 82.3 years and (46) 62% were female. The usual baseline clinical characteristics were registered, and pro-BNP was measured 24 hours before the procedure. The Cox proportional hazards model were used to evaluate these clinical factors and the BNP variable was converted into its logarithm for the multifactorial Cox analysis (Log-proBNP).

Results:
The baseline clinical characteristics were similar among the survivors and nonsurvivors. BNP values were significantly lower in survivors [median (p25, p75)], [2245 pg/mL (1361 pg/mL, 4030 pg/mL)] than in nonsurvivors [6269 pg/mL (2937 pg/mL, 11028 pg/mL)], (p < 0.001). The multivariate analysis revealed that increased Log-proBNP levels were associated with a higher mortality rate [HR = 6.0 (IC 95%: 1.5-25), p = 0.012] after adjusting for gender, age, body mass index, glomerular filtration rate (calculated using the MDRD-4 formula) and left ventricular ejection fraction. Pairwise comparison of the ROC curves (Figure 1) showed a significantly better performance of Log-proBNP combined to the EuroSCORE compared with EuroSCORE alone for predicting mortality (area under the ROC EoroSCORE curve = 0.9295 and area under the ROC Log-proBNP + EuroSCORE curve = 0.9444).

Conclusions:
Preprocedure plasma proBNP level is an independent predictor of long-term mortality in patients with aortic stenosis after TAVI. Besides, this value combined with the EuroSCORE value is stronger than EuroSCORE alone in risk stratification of these patients.
Abstract 18175: Interaction of Platelets, Leukocytes and Released Neutrophil Extracellular Traps (NETs) Promote Deep Vein Thrombosis in vivo
Authors: von Bruehl Marie-Luise , Konstantin Stark , Steinhart Alexander , Chandraratne Sue , Koellnberger Maria , Lorenz Michael , Pfeiler Susanne , Manukyan Davit , Riegger Julia , Bergmeier Wolfgang , Mackmann Nigel , Preissner Klaus , Wagner Denisa , Engelmann Bernd , Massberg Steffen
Published: April 2024

Objective:
Venous thromboembolism has a major medical impact and is the third leading cause of cardiovascular associated death. While the critical contribution of platelets to arterial thrombosis has been recognized, the mechanisms that trigger the development of deep vein thrombosis (DVT) are not yet fully understood and are believed to be mainly dependent on coagulation. Current in vivo models associated with endothelial disruption or complete stasis only incompletely reflect the pathophysiology of DVT in humans and hinder further understanding of this process. Here, we established a novel mouse model of DVT formation and assessed the dynamics of leukocyte (lc) and platelet (pt) recruitment in vivo.

Methods:
In our new model DVT was induced by reduction of blood flow in the inferior vena cava (IVC) (to 23.8% of baseline) in the absence of endothelial injury. Layered thrombi develop slowly over a prolonged period of time (>6-12hrs) and occlude the entire IVC 24-48hrs later mimicking human venous thrombi. We observed the dynamics of pt (GPIb-/-, GPIIb-/-), lc (CX3CR1-EGFP, LysM-EGFP), and microparticle recruitment in the IVC in vivo by intravital microscopy.

Results:
Using corresponding transgenic mice we show here that lc accumulation required endothelial P-selectin, and, besides monocytes, consisted mainly of neutrophils which contribute to DVT development by NET release. In addition to innate immune cells, pts are indispensable for the initiation of venous thrombosis. Further, using low-TF and hTF mice we demonstrate that blood derived tissue factor (TF), exposed on NETs and microparticles, creates a procoagulatory environment that is supported by pt adhesion and activation. The intrinsic pathway of coagulation is also involved in DVT formation, since a factor XIIa inhibitor markedly impaired DVT development.

Conclusion:
Together, venous thrombosis in our model is driven by a concerted interaction of pts, lcs, and the coagulation cascade. Pts bind to endothelial cells mediated by GPIbα and GPIIb-IIIa, recruited lcs, and triggered NET release thereby initiating DVT. A modulation can be attained in three different ways: by aiming on the coagulation cascade (heparins, factor inhibitors), by impairing pt function and/or by inhibiting lc activation.