bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 17315: Comparing Knowledge and Attitudes about CHD Prevention Among Older Women Prior to and After a Cardiac Event
Authors: Lefler Leanne L , McSweeney Jean C , Meaux Julie B , Garner Kiimberly K
Published: April 2024

Purpose:
Risk factors for coronary heart disease (CHD) are at epidemic proportions among older women but few recognize their actual risk. Our purpose was to compare and contrast knowledge and attitudes concerning CHD prevention among older women without a CHD diagnosis with those who had experienced a cardiac event.

Method:
Using a mixed-methods design, we measured standard cardiac risk factors to determine actual risk and obtained measures of self-perceived risk among 20 older women, 6-12 months post cardiac event, and 24 community-dwelling women (≥60 years) without a CHD diagnosis. Semi-structured individual qualitative interviews were conducted to query about knowledge and attitudes regarding CHD prevention and risk. Narratives were transcribed verbatim and analyzed using content analysis. Next, constant comparison was used to compare and contrast findings between the two groups with the quantitative risk measures for convergence/divergence of data.

Results:
Of the 44 women, 30% were African-American and 64% had some college education, with a mean age of 72 years. Despite a mean of 5.84 vs. 4.46 CHD risk factors (event vs. no CHD) indicating “high-risk” for both groups, personal risk perceptions were unrealistically low: 4.47 vs. 1.95 (0-10 scale). Narrative data indicated a general lack of understanding in both groups regarding risk factors and lifestyle behaviors that would reduce probability for experiencing a cardiac event. Few engaged in lifestyle risk factor modification and felt limited control of their health or did not think change was necessary. Most felt that taking daily medications and visiting their Provider were sufficient. They tended to rely on their Provider to recommend behavior changes and did not recall their Provider discussing risk factors or recommending lifestyle modifications.

Conclusions:
Results provide information that is critically important from which to derive interventions that facilitate primary and secondary prevention for older women with and without CHD. Tailored interventions that consider knowledge and attitudes about CHD risk and risk factors are needed to promote lifestyle behavior modification.
Abstract 17352: Incidence and Predictors of Stroke in Patients with Chronic Heart Failure: Does Left Ventricular Function Matter? Insights From the CHARM Program
Authors: Castagno Davide , Skali Hicham , Takeuchi Madoka , Swedberg Karl , Yusuf Salim , Granger Christopher B , Pfeffer Marc A , McMurray John J , Solomon Scott D
Published: April 2024

Objectives
Patients with heart failure and reduced ejection fraction (HF-REF) are at increased risk of stroke, with some studies suggesting an inverse association between ejection fraction (EF) and stroke risk. The rate of stroke in simultaneously enrolled patients with HF-REF and preserved EF (HF-PEF) has not been reported and the predictors of stroke in a contemporary population of patients with HF are unknown. The Candesartan in Heart Failure: Assessment of Reduction in Mortality and morbidity (CHARM) program, which included patients with a wide range of EF, provided a unique opportunity to examine these questions about stroke in HF.

Methods
We evaluated risk factors for stroke with multivariable Cox proportional hazard regression analysis using forward- and backward-stepwise selection of candidate variables, with gender, history of hypertension, EF and randomized treatment (i.e. candesartan) forced into the model.

Results
Of the 7599 participants in CHARM, 287 (3.8%) experienced a fatal or nonfatal stroke during a median follow-up of 37.7 months. The stroke rate was 1.3 (95% CI=1.1-1.5) and 1.4 (95% CI=1.2-1.7) per 100 pt yrs in subjects with reduced and preserved EF respectively. The 5 strongest predictors of stroke (ranked by chi-square value) were: older age, previous stroke, higher systolic blood pressure, diabetes and atrial fibrillation on baseline ECG; other independent predictors are shown in the figure. Univariate predictors not retained in the multivariable model were: history of hypertension, NYHA class III or IV, baseline oral anticoagulant use, previous coronary bypass surgery, current smoking, signs of HF, diuretic use and female sex; none of the other forced variables were predictive in either the univariate or multivariable models.

Conclusions
The rate of stroke is similar in patients with HF-REF and HF-PEF. Even in this relatively normotensive population, higher systolic BP was associated with greater stroke risk.
Abstract 17364: Abnormal Repolarizations in Electrocardiogram Correlate with Abnormal Diastolic Mechanics in Patients with Hypertrophic Cardiomyopathy
Authors: Lin Xiaoping , Liang Hsin-Yueh , Pinheiro Aurelio , Dimaano Lea , Sorensen Lars , Tereshchenko Larisa , Abraham Theodore , Abraham Roselle
Published: April 2024

Introduction:
HCM is often characterized by marked repolarization abnormalities. However the significance of repolarization changes in these patients has not been investigated.

Aim:
We investigated the prevalence and significance of ECG repolarization patterns on sensitive measures of systolic and diastolic function in a cohort of 110 patients (mean age 52± 17 yrs, male 65%, Caucasian 73%) with HCM.

Method:
We performed echocardiography and ECG evaluation in 110 HCM patients. ECG repolarization parameters including strain pattern, early repolarization pattern, ST elevation, ST depression and T wave inversion were measured. Conventional and longitudinal tissue Doppler- derived tissue velocity and strain were analyzed off-line.

Result:
The mean left ventricular mass index was 141± 48 g/m,
2
LVEF was 69± 10% and left ventricular outflow tract gradient was 27±29 mmHg. ECG analysis revealed mean QTc of 451± 34 ms; 45/110 had strain pattern, 17/110 had early repolarization pattern and 14/110 had deeply inverted T waves. Patients with strain pattern on ECG, demonstrated decreased
early diastolic velocity
(lateral: -3.7± 2.2 vs. -4.6± 2.3 cm/s, p= 0.044, anterior: -2.6± 1.5 vs. -3.4± 1.4 cm/s, p= 0.04 and inferior:-2.7± 1.4 vs. -3.9± 1.6 cm/s, p= 0.005 regions), and late diastolic velocity (lateral:-1.2+- 0.76 vs -2.3+- 1.6, p= 0.001, anterior: -1.6+- 0.7, -2.7+- 1.3, p= 0.0006 and inferior: -2.7+- 1.8 vs -4.1 +- 1.7, p= 0.0003) in the corresponding regional myocardium, when compared to HCM patients without strain pattern. Patients who exhibited deeply inverted T waves on ECG exhibited
decrease in late diastolic strain rate
in the corresponding regional myocardium (lateral: 0.44± 0.32 vs. 0.84±0.48 s
-1
, p= 0.001 and anterior: 0.56±0.19 vs. 1.0± 0.56 s
-1
, p= 0.005), when compared to HCM patients without this finding. In contrast, early diastolic strain rate was increased in the corresponding regional myocardium (lateral: 1.75± 0.6 vs. 1.1± 0.62 s
-1
, p= 0.015 and anterior: 1.17± 0.3 vs. 0.87± 0.5 s
-1
, p= 0.01) in patients with evidence of early repolarization on ECG, when compared to patients without this feature.

Conclusion:
Strain pattern and deeply inverted T waves are markers for abnormal diastolic mechanics in patients with hypertrophic cardiomyopathy.
Abstract 17366: Reduced Protein O-GlcNAcylation Exacerbates Pressure Overload Induced Ventricular Dysfunction
Authors: Brainard Robert E , Jones Steven P
Published: April 2024

Background:
Hypertension is a leading risk factor for heart disease. Because the beta-O-linkage of N-acetylglucosamine (O-GlcNAc) post-translational modification plays a significant, pro-adaptive role in the cardiovascular system's response to various stressors, we hypothesized that this stress response (protein O-GlcNAcylation) was important in mitigating pressure overload-induced cardiac dysfunction.

Methods and Results:
Wild-type mice were randomly assigned to drug or vehicle groups and followed for seven days after transverse aortic constriction (TAC, i.e., pressure overload). The drug group was given TT04 (10mg/kg, bid), a specific inhibitor of O-GlcNAc transferase (the enzyme that adds O-GlcNAc to proteins). TT04 treatment significantly exacerbated systolic dysfunction (Fig 1B) despite no change in diastolic diameter (Fig 1A). TT04 treatment also diminished ejection fraction (Fig 1C) and reduced levels of protein O-GlcNAcylation (Fig 1D) compared to vehicle (p<0.05).

Conclusions:
O-GlcNAc signaling plays an important, seemingly pro-adaptive role in the heart during pressure overload-induced cardiac dysfunction.
Abstract 17367: Echogenic Liposomes for Clot Imaging and Combined Delivery of Thrombolytic/neuroprotective Agents with Ultrasound-Facilitated Drug Release for Stroke Treatment
Authors: Britton George L , Peng Tao , Kim Hyunggun , Klegerman Melvin , Laing Susan , McPherson David , Huang Shaoling
Published: April 2024

Background:
Currently, the only FDA-approved therapy for acute ischemic stroke is the administration of recombinant tissue plasminogen activator (tPA). However, the therapeutic application of tPA requires optimization. Combining thrombolytic treatment with administration of neuroprotective agents is a promising strategy under development. We have previously developed tPA-loaded echogenic liposomes (tPA-ELIP) as an improved thrombolytic formulation. We hypothesized that tPA-ELIP can co-encapsulate another agent for combined treatment with the potential for ultrasound-controlled drug release.

MATERIALS AND METHODS:
Calcein, a small (MW < 1 kDa) molecular fluorophore, was used as a prototypic hydrophilic drug. Calcein-tPA-ELIP, comprising the fluorophore, protein thrombolytic, phospholipids and cholesterol, were prepared by a lipid drying-rehydration-lyophilization method. Clots were incubated with calcein-tPA-ELIP for 2 minutes in vitro. Transvascular ultrasound imaging was performed before and after the incubation to demonstrate tPA-fibrin binding. Color Doppler ultrasound was applied for 30 seconds to trigger the release of calcein from targeted calcein-tPA ELIP. The fluorescent intensity of calcein in solution was measured before and after ultrasound application.

RESULTS:
Fifteen percent of calcein was entrapped in tPA-ELIP with retention of ultrasound reflectivity. Transvascular B-mode ultrasound imaging demonstrated specific highlighting of clots by tPA-ELIP. The release of calcein from calcein-tPA-ELIP was triggered by application of Doppler ultrasound.

CONCLUSIONS:
We have demonstrated co-encapsulation of a hydrophilic drug surrogate and a protein thrombolytic agent into ELIP with targeted clot highlighting and in situ ultrasound-triggered drug release. Co-encapsulation of drugs in tPA-ELIP has potential for thrombus-targeted combination thrombolysis and neuroprotective treatment for stroke.
Abstract 17388: Applicability of a Western Model of Hypertension in a Yup'ik Eskimo Population
Authors: Roberts Eric T , Hopkins Scarlett , Boyer Bert , Boden-Albala Bernadette
Published: April 2024

Hypertension (HT) is a powerful contributor to cardiovascular disease. Importantly, HT is becoming increasingly common in non-western and rural contexts. While much literature has clarified the role of- and risk factors for HT in urban, western contexts little is known about the relevance of these results to other populations. This abstract explores the applicability of a western model of HT to a sample of Yup'ik Eskimo people. As part of the Center for Alaskan Native Health Research study we interviewed Yup'ik individuals residing in 7 rural villages located in Southwestern Alaska. Covariates of interest were age, sex, education, body composition, physical activity, tobacco use, household composition, and ethnic identification. We assessed the association between vascular risk factors and the odds of having either normal (systolic 120 to 129 mmHg) or borderline to hypertensive (systolic ≥ 130 mmHg) as compared to optimal (systolic < 120 mmHg) blood pressure with multinomial logistic regressions. Data comes from 1015 Yup'ik individuals: 54% female, mean age 37.6 (SD 17.4). Mean systolic BP was 120.07 mmHg, 20.7% had systolic BP ≥ 130 mmHg. In our final model age (one year increase; odds ratio = 1.06), male sex (1.46), waist circumference (one cm increase; 1.04), ever smoking tobacco (1.31), being single (compared to married; 1.44), and having 4 or more biological children (compared to none; 0.74) were associated with having borderline or definite hypertension. A similar pattern was observed for the presence of normal blood pressure as compared to optimal blood pressure - age (1.02), male sex (1.79), waist circumference (1.02), ever smoking tobacco (1.21), and being single (compared to married; 1.62). There were no direct effects of education, physical activity, or ethnic identification on the odds of HT. Interactions suggest individuals identifying highly with both Yup'ik and White culture have slower age related increases in HT, and that high levels of education negate differences in HT across all categories of ethnic identification. HT is emerging as an important risk factor among Yup'ik and other Alaskan Native people. Western models for HT may be applicable to Alaska Native populations; differences may elucidate causes and mechanisms across populations.
Abstract 17476: Transplantation of an Antigenically-Defined Subpopulation of Bone Marrow Mesenchymal Stem Cells Results in Superior Cardiac Repair After a Reperfused Myocardial Infarction
Authors: Cheng Guangming , Zuba-Surma Ewa K , Xuan Yu-Ting , Yang Yanjuan , Girgis Magdy , Wang Ou-Li , Zhu Yanqing , Sanganalmath Santosh , Lietzau-Mourer Shelley , Xu Dong , Dawn Buddhadeb
Published: April 2024

Although bone marrow mesenchymal stem cells (MSCs) have been used quite extensively for cardiac repair, the outcomes have been highly variable. We investigated whether antigenically-defined subpopulations of MSCs would promote superior repair after myocardial infarction (MI). Unfractionated MSCs were obtained from the adherent fraction of bone marrow cells from C57BL/6 mice using expansion culture, and subpopulations were obtained using two-step FACS isolation. Our in vitro studies identified a Sca-1+/CD45-/c-kit-/Thy1+/CD105- MSC population (CD105- MSCs) that exhibited greater mRNA expression of angiogenic molecules (VEGF, HGF), SDF-1, and reduced expression of deleterious molecules, including TNF-a (Figure). The CD105- MSCs also exhibited greater propensity toward cardiac differentiation. The efficacy of these cells for cardiac repair in vivo was tested in a mouse model of reperfused MI. Wild-type (C57BL/6) mice underwent a 30-min coronary occlusion followed by reperfusion, and 48 h later received intramyocardial injection of vehicle (Vehicle, n=8), unfractionated MSCs (MSCs, n=8), or CD105- MSCs (CD105- MSCs, n=6). Echocardiography was performed 4 d prior to coronary occlusion/reperfusion (BSL1) and at 48 h (BSL2) and 35 d after cell injection. Mice were sacrificed at 35 d. LV ejection fraction (EF) was significantly and similarly reduced in all groups at 48 h after MI (Figure). At 35 d after MI, mice injected with CD105- MSCs exhibited greater EF (Figure) and smaller LV end-diastolic volume compared with vehicle-treated and unfractionated MSC-treated mice. We conclude that compared with unfractionated MSCs, intramyocardial transplantation of CD105- MSCs after a reperfused MI results in improved cardiac repair. The use of this MSC subpopulation may potentially improve the outcomes of cell therapy in humans.
Abstract 17483: Healthy Heart Check®: A Large Scale Low-Cost Student Athlete Screening Model Using ECGs and Quick Look Echos Improve Specificity of ECG Screening of Student Athletes
Authors: Bonzheim Kim , deJong Adam , Almany Steven , Cutler Nancy , Trivax Justin , Brand Monique , Koyblarek Susan , Gentry Ralph , Berman Aaron , Franklin Barry , Haines David E
Published: April 2024

Introduction:
Exertion-related sudden cardiac death (SCD) in a student athlete is a catastrophic and potentially preventable event. Aggressive screening with ECGs may reduce SCD risk, but low specificity and perceived costs limit widespread utilization.

Purpose:
We developed a rapid, low-cost, scalable cardiovascular screening model using physician volunteers and paid technical staff to effectively screen large numbers of high school students for SCD risk.

Methods:
Physicians review a parent-completed cardiac risk questionnaire, perform a physical exam and analyze a 12-lead ECG. If higher risk is suspected, a quick-look 2D echo screens for structural disease. Students at increased risk are told to stop exercise and see their physician.

Results:
Since 2007, 4 hospitals performed 23 free screenings at 12 locations, and screened 5,861 students (age 15.5 ± 1.9 yrs). Average screening time was 10 ± 4 min/student. Abnormal ECGs were found in 740 students (13%), of whom 467 were referred on for a quick look echo. Of these, 418 (90%) were normal. Abnormal echoes were seen in 49 students resulting in a “stop exercise” advisory for 10, or physician follow-up for 35. Of those with normal ECGs, 701 had echoes - 42 (94%) were normal. In the total population, 40 students (0.7%) received “stop exercise” and 527 (9%) physician follow-up advice. Findings included: HCM (1); dilated CM (2); significant LVH (2) and RVH (2); long QT (2); abnormal valve function (4); exertional or frequent syncope (3); tachy- or bradycardias (7); WPW (5); bundle branch block (4); immediate family history SCD (3); possible Marfan's Syndrome (1) and, pericardial effusion (1). Cost analysis of the screening, including staffing and supplies, was $7.84/student. The screening was successfully franchised to three new hospital groups.

Conclusions:
In conclusion, our screening model provides a low-cost, accessible and sustainable physician-directed option for pre-participation cardiovascular examinations. Addition of a quick look echo reduces false positives generated by ECG screening by 90%. This volunteer-based screening is effective identifying high school students who may be at risk for SCD and other cardiovascular complications. The franchise kit is offered free of charge to other communities.
Abstract 17489: Regional Strain Shows Greater Interplatform Variability Than Global Strain
Authors: Anwar Shafkat , Gladding Patrick , Negishi Kazuaki , Popovic Zoran , Thomas James D
Published: April 2024

Introduction:
Strain (S) analysis is a useful adjunct to conventional echocardiography but is limited by vendor-specific restrictions. Analysis of DICOM (D) images enables extraction of S regardless of image source. Existing data show good agreement in Global (G) Longitudinal S values between native polar (P) and processed D images. To further evaluate agreement we compared Regional S (RS) values from the same images in P & D formats.

Hypothesis:
RS values will have variability between P & D analysis. We will accept good agreement if there is no significant difference in mean RS values in P and D analysis, and if the correlation coefficient (r) is ≥ 0.85.

Methods:
20 patients (54 +/− 12 years) had echocardiograms with a General Electric (GE) Vivid 7 scanner: 7 normals, 13 cardiomyopathies. 4,3 & 2-chamber LV apical views yielding 60 datasets were analyzed using EchoPAC (GE, version 10.8.1) in P format and Velocity Vector Imaging (VVI, Siemens, version 3.5) in D format by 3 blinded observers. RS data was analyzed using an 18-segment LV model.

Results:
While agreement for GS was good (r=0.90, p<0.0001), there was low (though generally significant, p<0.05) correlation between P & D RS. 1 segment showed r ≥ 0.85, with 6 segments showing r ≥ 0.75 (Table 1). D images yielded lower S in magnitude in 13 of 18 segments (mean P-D -2.1, range -5.0 to 1.47). There was low inter-observer agreement for RS (Table 2).

Conclusion:
LV Longitudinal RS from DICOM images do not agree well with native Polar S for the majority of cardiac segments, with fairly high inter-observer variability. Higher agreement for GS is likely due to averaging of RS across LV segments. Standardization efforts are essential to address this issue.
Abstract 17634: Increase in Epicardial Fat Volume is Associated with Greater Coronary Artery Calcification Progression in Subjects at Intermediate Risk by Coronary Calcium Score: A Serial Study Using Non-Contrast Cardiac CT
Authors: Nakanishi Rine , Rajani Ronak , Cheng Victor Y , Gransar Heidi , Nakazato Ryo , Shmilovich Haim , Otaki Yuka , Hayes Sean W , Thomson Louise E , Friedman John D , Slomka Piotr J , Berman Daniel S , Dey Damini
Published: April 2024

Objective:
Epicardial fat volume (EFV) is related to calcified coronary plaques. However, it is unknown whether baseline EFV or changes in EFV affect the progression of coronary artery calcification over time.

Methods:
We identified 375 consecutive asymptomatic subjects with an intermediate risk of developing coronary heart disease [1) a man ≥55 years or woman ≥65 years or 2) a man 45-54 years or woman 55-64 years with at least 1 traditional CAD risk factor and baseline coronary calcium score (CCS) 50-399] who underwent serial non-contrast CT at least 3-5 years apart. Subjects were divided into tertiles of CCS progression (% increase) between the 2 scans. Subjects from the upper tertile (High Progressors) were matched by age and gender to 81 subjects from the lower tertile (Low Progressors). All subjects underwent serial measurements of CCS and EFV. The relationship between EFV and CCS progression, and changes in plaque number were compared between the two groups.

Results:
At baseline, there was no difference in EFV, and EFV indexed to body surface area (EFVi) between the two groups. At follow-up, EFV, EFVi and percent increase in EFVi-change were higher in the High Progressors than the Low Progressors (EFV, 102 ± 38 cm
3
vs. 90 ± 35 cm
3
, p=0.03; EFVi, 50 ± 16 cm
3
/m
2
vs. 45 ± 15 cm
3
/m
2
, p=0.03; EFVi-change, 15 ± 22% vs. 7 ± 20%, p=0.02). Based on our previously determined inter-scanner and inter-observer variability, a ≥ 15 % increase from baseline EFVi was set as the criterion for significant EFVi increase. On multivariate analysis, after adjusting for conventional cardiovascular risk factors, EFVi increase ≥ 15% and scan interval time were predictive of being a High Progressor [EFVi increase ≥ 15%, p<0.05, OR 2.3, 95% C.I 1.0-5.3, scan interval time p=0.003, OR 1.0, 95% CI 1.001-1.006]. By multivariable linear regression analysis, EFVi increase ≥ 15% (β= 3.0, 95% C.I. 0.4 - 5.6, p=0.02) and hypertension (β= 3.1, 95% C.I. 0.6 - 5.6, p=0.01) were independent predictors of the number of new calcified plaques on follow-up.

Conclusion:
Increase in EFV is associated with greater progression of coronary artery calcification in intermediate-risk subjects.
Abstract 177: Regional Cerebral Oxygen Saturation as a Novel Termination of Resuscitation Rule in Cases of Refractory Out-of-Hospital Cardiac Arrest
Authors: Ito Noritoshi , Nanto Shinsuke , Nagao Ken , Hatanaka Tetsuo , Nishiyama Kei , Doi Yasuji , Kurozumi Yuma , Natsukawa Tomoaki , Morita Masaya , Kawata Atsushi , Tsuruoka Ayumu , Sawano Hirotaka , Shibata Hiroyuki , Yamada Noriaki , Okada Ken-ichiro , Hayashi Yasuyuki , Kai Tatsuro , Hayashi Toru
Published: April 2024

Background:
To better utilize medical resources, basic life support (BLS) and advanced life support (ALS) pre-hospital termination-of-resuscitation (TOR) rules have been developed, validated, and implemented in North America. Recently, “regional cerebral oxygen saturation (rSO2) ≤15%”, as no detectable cortical oxygen value (N-value), has been considered to be a strong predictor of poor neurological outcome in patients with out-of-hospital cardiac arrest (OHCA).

Objective:
To assess the impact of the N-value as a novel TOR rule.

Method:
This study was a prospective cohort study. Of 418 OHCA patients, 186 consecutive non-traumatic, cardiac arrest on arrival (CAOA) patients were prospectively registered. The rSO2 were measured with sensors placed on either side of their forehead using a near-infrared spectroscopy (NIRS) device (INVOS, Covidien, US) immediately on hospital arrival. We monitored rSO2 values at least for more than one minute and used the lower of the 2 measured rSO2 values for analysis. Clinical staff performed ordinary post-cardiac-arrest interventions (PCAIs) regardless of rSO2 values. Primary outcome measure was good neurological outcome (CPC =<2) at hospital discharge according to the “Utstein-style”. We calculated the specificity and positive predictive value (PPV) of N-value TOR rule and BLS/ALS TOR rules for identifying CAOA patients without good neurological outcome.

Results:
Among 186 CAOA patients in the PCAIs era, 18 patients (9.7%) had good neurological outcome at hospital discharge, and the specificity and PPV of N-value, BLS and ALS TOR rules were high. However, N-value TOR rule had relatively high specificity and PPV compared with BLS TOR rule and relatively high sensitivity compared with ALS TOR rule. In addition, NIRS provides non-invasive and objective rSO2 values immediately.

Conclusion:
The N-value TOR rule may be of considerable help to make decisions to cease futile resuscitative efforts in CAOA patients after OHCA.
Abstract 17805: Efficacy of Collateral Circulation in Patients with Acute Coronary Syndrome Treated with Primary Percutaneous Coronary Intervention
Authors: Sugiyama Tomoyo , Kimura Shigeki , Inagaki Hiroshi , Yoshikawa Shunji , Haraguchi Go , Hikita Hiroyuki , Takahashi Atsushi , Isobe Mitsuaki
Published: April 2024

Background:
Collateral circulation has been reported to be related to a better outcome in patients with coronary artery disease. However, the efficacy of collateral circulation remains unclear in patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI).

Method:
We investigated 139 patients with ACS (acute myocardial infarction; n=108, unstable angina; n=31) who underwent primary PCI. We divided the patients into two groups according to the formation of collateral circulation; patients with rich collateral (Rentrop grade 2-3) (rich-coll) and with poor collateral (Rentrop grade 0-1) (poor-coll). Baseline characteristics, intravascular ultrasound (IVUS) and angiographical findings including TIMI flow, corrected TIMI frame counts (CTFCs) and myocardial blush grades (MBG) were examined. The efficacy of collateral circulation was evaluated according to the antegrade coronary flow grade of each lesion.

Result:
Thirty-four patients (24.5%) had rich collateral circulation. In patients with occluded culprit arteries (initial TIMI flow 0-1, n=74), rich-coll patients (n=26, 35.1%) had a significantly higher CK levels on admission (969±1249 IU/l vs. 225±421 IU/l, p=0.0003), greater plaque volume of necrotic-core (NC) by IVUS (60.6±32.2 mm
3
vs. 42.7±32.8 mm
3
, p=0.05) and a higher frequency of transient slow-flow phenomenon during PCI than poor-coll patients (38.5% vs. 16.7%, p=0.049). However, outcomes after PCI were similar among the groups (final CTFC>27; 44.0% vs. 42.6%, p=1.00, MBG 0-1; 57.7% vs. 56.3%, p=1.00 and max CK levels; 3337±2864 IU/l vs. 4147±3337 IU/l, p=0.30). On the other hand, in patients with non-occluded culprit arteries (TIMI flow 2-3, n=65), rich-coll patients (n=8, 12.3%) showed a tendency of better outcome after PCI including coronary flow (final CTFC>27; 0.0% vs. 29.8%, p=0.099) and myocardial perfusion (MBG 0-1; 0.0% vs. 24.6%, p=0.18), although CK levels on admission (187±122 IU/l vs. 258±289 IU/l, p=0.50) and NC volume by IVUS (41.4±42.6 mm
3
vs. 36.6±28.5 mm
3
, p=0.69) were similar.

Conclusion:
In ACS patients, the existence of rich collateral circulation might reduce the influences of several risk factors including IVUS findings on worse outcomes after PCI.
Abstract 17812: Race is Not Associated with Contrast-Induced Nephropathy but is Associated with Long-Term Initiation of Dialysis After Cardiac Catheterization and Coronary Intervention
Authors: Turlington Jeremy , Danyi Peter , Patel Kalpesh , Patel Manishkumar , Jovin Ion S
Published: April 2024

Background:
Contrast-induced nephropathy (CIN) is a complication of diagnostic angiography and percutaneous coronary and endovascular intervention. It is associated with diabetes and chronic kidney disease, both diseases which are associated with poorer outcomes in non-Caucasians. We investigated the effect of race in the development of CIN .

Methods and Results:
We studied 2201 predominantly (98%) male patients undergoing peripheral and coronary angiography and percutaneous coronary and endovascular intervention at a veterans’ administration medical center. We analyzed the incidence of CIN at 72 hours, of renal dysfunction at 3 months as well as the incidence of hemodialysis. CIN was defined as either a rise in creatinine of 25% or an absolute rise in creatinine of 0.5 mg/dl. The mean age was 68.2 years. The Caucasian patients (n=1446) were significantly older, had a lower baseline creatinine, lower rates of hypertension and diabetes compared to the non-Caucasian patients. Information on creatinine at 3 days was available on 1062 patients and on creatinine at 3 months on 1937 patients. CIN occurred in 56 (7.9%) Caucasian patients (n=711 patients) and in 31 (8.8%) non-Caucasians at 72 hours after the procedure (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.42 - 1.37; P=0.36). At 3 months, renal dysfunction was seen in 77 (15.04%) Caucasian patients (n=512) versus 49 (16.72%) of the non-Caucasian group (OR 0.88, CI 0.60 - 1.30; P=0.53). On multivariate analysis, after adjustment for age, comorbidities and baseline creatinine, Caucasian race was not significantly associated with CIN at 72 hours (OR=0.94, 95% CI 0.40 - 2.33, P=0.89) or with renal dysfunction at 3 months (OR= 1.2, 95% CI 0.78 - 2.0, P=0.35). After a median follow up of 67 months, of the 2201 patients 12 patients (0.8 %) of the Caucasian group were placed on dialysis versus 26 (3.4 %) of the non-Caucasian group (HR 0.20, CI 0.08 - 0.47; P<0.0001).

Conclusions:
In this cohort of patients, race was not associated with the development of CIN at 72 hours, or the development of renal dysfunction at 3 months post procedure. In the long-term, the rate of initiation of dialysis after was significantly higher in the non-Caucasian patients.
Abstract 17839: Attenuated Plaque: Novel IVUS Predictors of No-reflow in the Percutaneous Coronary Intervention of Thrombus-Containing Lesions
Authors: Lee Sung-Yun , Doh Jun Huyng , Kim Sang-Wook , Hong Young Joon
Published: April 2024

We investigated the relationship between no-reflow and pre-intervention intravascular ultrasound (IVUS) findings in 87 patients with angiographic evidence of target lesion thrombus (defined as presence of generalized haziness or filling defect) within native arteries undergoing percutaneous coronary intervention (PCI) without a distal protection device. Angiographic no-reflow was defined as post-PCI TIMI flow grade 0∼2. IVUS assessment included (1) morphological characteristics of thrombus (scintillating appearance, lobulated mass, distinct interface between the suspect thrombi and plaque, or microchannels within a lobulated mass), (2) thrombus mobility, and (3) presence of attenuated plaque (plaque with deep echo attenuation, but without calcification).

Results:
There were no serious IVUS-imaging related procedural complications. IVUS identified thrombus in 59 lesions (67.8%): scintillation in 39.1%, lobulated mass in 56.3%, distinct interface in 10.3%, microchannels in 9.2%, mobility in 24.1%, and attenuated plaque in 41.4%. Most attenuated plaques (88.9%) were detected at the minimal lumen area site. No-reflow was observed in 21 lesions post-PCI (24.1%). In general, IVUS features of thrombus were significantly more common in lesions that developed no-reflow; however, multivariate logistic regression analysis showed that attenuated plaque (p=0.012; OR, 6.04; 95% CI, 2.33∼15.70) and thrombus mobility (p<0.0001; OR, 31.33; 95% CI, 6.54∼149.93) were independent predictors of post-PCI no-reflow in angiographic thrombus-containing lesion.

Conclusions:
IVUS imaging of angiographic thrombus-containing target lesions is safe. In thrombus-containing native coronary artery lesions IVUS findings of mobility and attenuated plaque predict no-reflow; and the use of distal protection should be considered.
Abstract 17874: Effect of Therapeutic Hypothermia with Less Invasive Cardiopulmonary Bypass Hypothermia for Out-of-Hospital Cardiac Arrest
Authors: Arimoto Hideki , Ikehara Teruyuki , Rinka Hiroshi , Miyaichi Toshinori , Fuke Akihiro , Morooka Takaya , Ishikawa Junichi
Published: April 2024

Background:
Mild therapeutic hypothermia has been integrated into management strategies for improving the neurological outcome of cardiac arrest with ventricular fibrillation. We introduce our rapid and safe hypothermia procedure with Modified Invasive Cardiopulmonary bypass Hypothermia (LICH) for Return of Spontaneous Circulation (ROSC) patients. This study aimed to evaluate the effects of these new procedures on the outcomes of cardiac arrest patients.

Methods:
From January 2007 to May 2011, 47 patients were treated with mild hypothermia. These patients were divided into LICH procedure (Group L, N=23) and traditional cold blanket procedure (Group C, N=24) groups. The LICH procedure was indicated for unconscious ROSC patients under 75 years of age with a witness OHCA, and excluded with brain hemorrhage, traumatic cardiac arrest, and any risk of bleeding. Our LICH procedure quickly induced hypothermia via narrow pediatric cannulas on low-perfusion (1 l/min) artery-venous cardiopulmonary bypass (CPB) with minimal anticoagulation. Activated coagulation time (ACT) was set at 150 seconds for the Group L. Any complications, time to target temperature, temperature stability, cytokines and neurological outcomes were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2.

Results:
There were no significant characteristic differences between groups L and C. As compared with Group L, Group C had higher rates of temperature instability (9% vs. 50%, p=0.021), temperature over-shoot (0% vs. 54%, p=0.001), and quick induction (11 min vs. 307 min, p=0.003). Mortality and serum cytokines level (ΔIL-6, ΔTNF-A) were not seen significant differences in both groups. Addition, a favorable neurological outcome (91% vs. 58%, p=0.017) were seen in Group L.

Conclusions:
These results indicate that our LICH procedure has the advantages of not only rapid induction for the target temperature, but also less invasive therapy for ROSC patient instead of CPB. In addition, quick induction of mild hypothermia is a great benefit for favorable outcomes.
Abstract 17938: Evidence of Vicious Cycle in Mitral Regurgitation with Prolapse: Secondary Tethering Due to Primary Prolapse Demonstrated by 3-Dimensional Echocardiography Exacerbates Regurgitation
Authors: Otani Kyoko , Takeuchi Masaaki , Kaku Kyoko , Haruki Nobuhiko , Yoshitani Hidetoshi , Levine Robert A , Otsuji Yutaka
Published: April 2024

Background:
In patients with mitral valve prolapse (MVP), we often observe that non-prolapsed leaflets are tented (apically displaced) (Figure). We hypothesized 1) that secondary left ventricular (LV) dilatation due to primary mitral regurgitation (MR) causes this leaflet tethering and 2) that secondary tethering along with primary prolapse exacerbates malcoaptation and contributes to the severity of MR.

Methods:
3DTEE was performed in 20 patients with posterior leaflet (PML) prolapse and intact anterior leaflet (AML) by TEE and surgical observation. 20 patients with cerebral infarction but without cardiac disease served as controls. From mid-systolic 3D zoom datasets, 10 parallel antero-posterior planes of the MV were obtained using i-slice mode (Q-LAB). In each view, area between leaflets and annular line was measured to obtain prolapse and tenting area, respectively. Prolapse/tenting volume of the whole leaflets was obtained as the product of inter-slice distance and the prolapse/tenting area in each plane. LV volume was also measured. MR volume was calculated as LV ejection volume minus aortic stroke volume by pulsed Doppler method.

Results:
1) The AML tenting volume was significantly larger in patients with PML prolapse compared to controls (1.04±0.54 vs 0.58±0.14 ml/m2, p<0.001). 2) The AML tenting volume was significantly correlated with mid-systolic LV volume (r=0.61, p<0.001). 3) Sum of prolapse and tenting volume of the whole leaflets strongly correlated with MR volume (r=0.66, p<0.01) (r=0.38 and 0.48 for isolated prolapse and tenting volume, respectively).

Conclusion:
The results suggest that LV dilatation by primary MVP with MR causes secondary mitral leaflet tethering, which worsens valve leakage and constitutes a vicious cycle.
Abstract 17950: Prediction of Sudden Cardiac Death in Chronic Heart Failure Patients with Mild to Moderate Systolic Dysfunction a Prospective Comparative Study of Cardiac I-123 Metaiodobenzylguanidine Imaging and Heart Rate Turbulence
Authors: Fujimoto Tadao , Yamada Takahisa , Okuyama Yuji , Morita Takashi , Furukawa Yoshio , Tanaka Koji , Iwasaki Yusuke , Masatake Kawasaki , Kuramoto Yuki , Naito Takashi , Ozu Kentaro , Kondou Takumi , Sengoku Kaoruko , Yamamoto Hironori
Published: April 2024

Background:
Although it is shown that ICD therapy could prevent sudden cardiac death (SCD) in chronic heart failure (CHF) patients with severely reduced LV systolic function (LV ejection fraction <35%), it remains unclear which CHF patients with LVEF>35% would have the risk of SCD. Therefore, we sought to prospectively compare the prognostic values for SCD of cardiac metaiodobenzylguanidine (MIBG) imaging and heart rate turbulence (HRT) analysis ,which are expected to provide prognostic information , in CHF patients with LVEF>35% in the gray zone for the ICD therapy.

Methods and Results:
We enrolled 55 CHF outpatients (NYHA 2±0.2) with radionuclide LV ejection fraction from 35% to 50% (38.5±0.8%). We performed the cardiac MIBG imaging and 24-hour Holter monitoring at the entry. The cardiac MIBG wash out rate (WR) was calculated from the chest anterior view images obtained at 20 and 200 min after isotope injection. Abnormal WR was defined as WR >27%. Furthermore, we also performed HRT analysis from Holter monitoring. Turbulance onset (TO) and turbulence slope (TS) were calculated as HRT parameters. Abnormal values of HRT analysis were defined as TO≥0% and TS≤2.5ms/beat.

Result:
During the follow up period of 6.0±0.8 years, 7 of 55 patients had SCD. At multivariate Cox analysis, WR was significantly (p=0.015) and independently associated with SCD, while TO and TS had no association with SCD. SCD was significantly more frequently observed in patients with than without abnormal WR (30% vs 3%, p=0.002), although there was no significant difference in the incidence of SCD between patients with and without abnormal HRT results. The hazard ratio of abnormal WR for SCD was 13 .7( 95%CI 1.6 to 114.7).

Conclusion:
Cardiac MIBG imaging, but not HRT analysis, would be useful to predict the risk of sudden cardiac death in CHF patients with mildly to moderately reduced LV systolic function.
Abstract 17951: Low Total Testosterone is Associated with Inflammation and Dyslipidemia in a Large Population of Asymptomatic Middle Aged Men
Authors: Iyengar Rupa L , Sawit Simonette T , Messeh Hany A , Escolin Narayan , Maceda Cynara , Moline Jacqueline , McLaughlin Mary Ann
Published: April 2024

Background:
Low testosterone levels are associated with an increased risk of dyslipidemia and the development of atherosclerosis in older men. This study aims to investigate whether a similar relationship exists between total testosterone (TT), triglyceride (TG), high density lipoprotein (HDL) cholesterol levels, and C-reactive protein (CRP) in a large population of asymptomatic middle aged men, between 40 to 60 years of age. In addition, we explore the effect of statin use on dyslipidemia in men with low TT.

Methods:
We evaluated 2,116 male participants in the Law Enforcement Cardiac Screening Program (LECS), a subset of the World Trade Center Medical Monitoring and Treatment Program. Low Total Testosterone (TT) is defined as TT of < 300 ng/dL. We measured fasting lipids, Apolipoprotein B/A1, glucose and CRP. In a subcohort of 354 (27%) men on statin therapy (HMG CoA reductase inhibitor), we performed independent t-test to see the effect of low TT on TG and HDL.

Results:
Men with low TT had significantly higher TG, CRP and glucose levels, and lower HDL levels (p < 0.0001) compared to men with normal TT. In the subcohort of men on statin therapy, subjects with low TT had significantly higher TG (p < 0.0001) and CRP (p < 0.001), and lower HDL levels (
p
= 0.025) compared to those with normal TT. See Table 1.

Conclusions:
We detected higher TG and CRP, and lower HDL levels in asymptomatic middle aged men with low TT. Further evaluation of men on statin therapy with low TT, revealed persistent dyslipidemia (elevated TG and reduced HDL) and inflammation (elevated CRP). Clinicians should be encouraged to measure TT in middle-aged men during assessment of cardiovascular disease risk.

Source of funding: NY Fraternal Order of Police, through the Office of the NY Attorney General Charity Fund.
Abstract 17956: Serpin Treatment Reduces Inflammation in Transplanted Temporal Artery Biopsy Specimens from Patients with Suspected Giant Cell Arteritis in Immunodeficient Mice
Authors: Chen Hao , Zheng Donghang , Dai Erbin , Liu Liying , Samy Hazem , Staples Nancy , Beaver Thomas , Hess Phil , Martin Thomas , Klodel Charles , Ryden Sally , Weyand Cornelia M , Reeves Westley , Thoburn Robert , Sobel Eric , Lucas Alexandra R
Published: April 2024

Background
- Giant cell / temporal arteritis (GCTA) is a severe inflammatory vasculitic syndrome (IVS), which causes arterial occlusion and sudden loss of vision. Treatment for IVS remains limited. Intra-aortic full thickness implants of human TA biopsy and left internal mammary artery (LIMA) specimens were surgically engrafted into the abdominal aorta of immunodeficient SCID mice as a new model for analyzing development of vascular inflammation, as well as response to new treatments. Serp-1 is a myxomaviral-derived serine protease inhibitor (serpin) that blocks thrombotic and thrombolytic protease pathways, arterial inflammation, and plaque growth. Serp-1 was recently tested in acute coronary syndromes (ACS), where reduced markers of myocardial damage were detected after stent implant.

Objective
- We assessed the effects of Serp-1 or saline treatment on inflammatory cell invasion and plaque growth after TA and LIMA engraftment in NOD-SCID mice.

Results
- Normal arterial (LIMA) specimens were harvested during bypass surgery and implanted into 24 SCID mice. Half the mice had saline (N=12) and half had Serp-1 treatment (N=12). In each group 6 mice had 5x106 peripheral blood mononuclear cells (PBMCs) infusions from the same patient as the donor LIMA graft, given immediately postop by tail vein and 6 had no cell infusion. TA grafts from patients with suspected GCA were implanted into a separate group of 24 SCID mice - 12 mice had saline (100µl) and 12 Serp-1 (100ng/g/100µl) treatment (one i.v. injection followed by daily i.p. injection for 10 days). in each treatment group 4 mice had infusion of non-matched PBMCs. At 4 weeks LIMA (P < 0.034) or TA (P < 0.0001) grafts, had significantly reduced plaque growth with Serp-1 treatment when human PBMC were also infused (p<0.05). In the absence of PBMC, Serp-1 had minimal effect. Mononuclear cell invasion was reduced in Serp-1 treated mice with PBMCs. Flow cytometry did not detect significant changes in splenocytes.

Conclusions
- Aortic implant of human LIMA or TA xenografts in SCID mice provides a physiological model for investigating inflammatory vasculitis. With PBMC infusion, treatment with the myxomaviral Serp-1, reduced inflammatory cell invasion and plaque growth in arterial xenografts.
Abstract 17967: Association of 3D Echocardiographic Principal and Planar Strains with Left Ventricular Remodeling Parameters and Abnormal Ejection Fraction by Cardiac Magnetic Resonance Imaging
Authors: Gopal Aasha S , Toole Rena S , Reichek Nathaniel , Cao Jie J
Published: April 2024

Background:
3D principal (P), circumferential (C), longitudinal (L) and radial (R) strains by speckle tracking echocardiography (ECHO) have been reported to be sensitive markers of left ventricular (LV) mechanical dysfunction. We explored the association of these parameters with markers of adverse LV remodeling as well as abnormal ejection fraction (EF) by cardiac magnetic resonance imaging (CMR).

Methods:
Subjects were prospectively recruited and underwent CMR and 3DECHO within 2 hours. 3D principal strain (P) was the 3D vector from which C, L, and R strain components were derived. CMR LV volumes (EDV, ESV), LV mass indexed to BSA (LVMi), LVM/EDV, LVM/ESV ratios and EF were also obtained. A Trend test was used to compare the variables across subgroups and ROC analysis was used to compare the sensitivity and specificity of each strain variable for association with CMREF<50%. .

Results:
120 subjects (62% male, 68 normal (Gp1), 15 with heart failure and preserved LVEF (Gp2) and 37 with heart failure and LV dysfunction (Gp3)) were evaluated. There were significant differences in LVMi (49, 64, and 63 g/m2, p<0.001), in LVM/EDV (0.4, 0.9, 0.6 g/ml, p<0.001) in LVM/ESV (1.6, 2.3, 1.1 g/ml, p<0.001) and in LVEF (59%, 60%, 39%, p<0.001). Larger LVMi and larger LVM/EDV and LVM/ESV ratios were associated with lower 3D strain indices (all p values <0.001). Of the strain indices (table), the highest area under the curve for CMREF<50% was obtained for 3D L strain. However, 3D P strain had the best sensitivity (86.5%) and specificity (79.5%) at a cutoff value of -31.2%.

Conclusions:
1) Higher indexed values of LV mass and abnormal LV mass/volume ratios, parameters of adverse LV remodeling are associated with lower 3D strain indices. 2) Cutoff values of -15.7% and -31.2% for 3D L strain and 3D P strain, respectively are sensitive and specific markers of reduced EF as measured by CMR in a mixed population of normals, heart failure patients with preserved LVEF and those with systolic dysfunction.
Abstract 17977: Mir-133 Transfection in Mscs Downregulates Critical Pro-Apoptotic Genes in the Infarct Heart and Improves Cardiac Function
Authors: Khan Mahmood , Meduru Sarath , Bryant Angela , Martin Mickey , Kuppusamy Periannan , Elton Terry S
Published: April 2024

Cell-based therapy (cardiomyoplasty) is one of the most promising techniques for repair and regeneration of the infarcted myocardium. Mesenchymal stem cells (MSCs) are pluripotent, adult stem cells that are easily expanded in culture, and can differentiate into numerous lineages, including vascular endothelial cells and cardiomyocytes. Unfortunately, a major impediment to the improvement of cardiac function following stem cell transplantation has been survival of the cells in the infarct myocardium due to the severely hypoxic nature of this tissue. The lack of oxygen and nutrients ultimately leads to apoptosis of the majority of the transplanted stem cells, thereby limiting engraftment and the chance of favorable outcome. microRNAs (miRNAs) are major post-transcriptional regulatory molecules that mainly suppress protein translation through binding their 3’UTR. microRNA-133a (miR-133a) is highly downregulated in hypertrophy and congestive heart failure in patients and in our animal model of myocardial infarction (MI). We found that transfecting MSCs with miR-133a decreases hypoxia-reoxygenation (6h of hypoxia, 12h reoxygenation) induced cell death and improves survival of MSCs. Similarly, transplantation of miR-133a transfected MSCs in rat (Fisher-344) hearts subjected to myocardial infarction (MI) by temporarily ligating the left coronary artery (LAD) and release, there was a significant improvement in cardiac function and decreased fibrosis when compared with MSC or MI groups. In addition, we performed a 96-well PCR array for apoptosis-related genes. The results from PCR array showed a 3-fold downregulation of ABL1 (c-abl oncogene 1, non-receptor tyrosine kinase) and BFAR (Bifunctional apoptosis regulator genes) in miR-133+MSCs as compared with the untreated MI group. This study demonstrated for the first time that the combination of miR-133a mimics along with MSCs improves cardiac function, decreases fibrosis and pro-apoptotic ABL1 and BFAR genes in the infarcted heart.