bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 12011: Vascular Function in Leukemia Survivors After Hematopoietic Cell Transplantation
Authors: Dengel Donald R , Kelly Aaron S , Zhang Lei , Hodges James S , Steinberger Julia , Baker K S
Published: April 2024

Introduction:
Previously, we have documented the effects of radiation and/or chemotherapy on vascular structure and function in childhood cancer survivors. To date, little is known about the effects on vascular health of the hematopoietic cell transplantation (HCT) preparative regimen (total body irradiation [TBI] and high dose chemotherapy) that often accompanies this treatment.

Hypothesis:
HCT preparative regimens utilizing TBI would result in a decrement in arterial function in HCT survivors than those that did not utilize TBI.

Methods:
Measures of carotid artery stiffness (compliance, distensibility) and intima-media thickness (cIMT) were obtained from ultrasound imaging in patients who had survived >2 years after HCT for hematologic malignancy and were diagnosed at age <21 yrs. Siblings (n=122) were invited to participate as controls. A total of 87 HCT survivors were examined; 50 received TBI only, 17 received TBI plus central nervous system irradiation (TBI+CNS); another 20 received a chemotherapy only preparative regimen ([CHEMO], most busulfan + cyclophosphamide).

Results:
Although cIMT did not differ between siblings and HCT survivors, both carotid cross-sectional compliance (CSD) and carotid diameter distensibility (DD) were greater in siblings than HCT survivors (Table). Comparing the different HCT preparative regimens, cIMT did not differ significantly between siblings and the three preparative regimen groups. However, both CSD and DD were significantly lower in TBI+CNS and TBI subjects compared to siblings. Also, carotid incremental elastic modulus (IEM) was significant higher in TBI+CNS than in the TBI only, CHEMO, and sibling groups.

Conclusion:
These results demonstrate that HCT preparative regimens containing TBI result in greater arterial decrements indicating increased risk for premature atherosclerosis and cardiovascular disease. The addition of CNS radiation to TBI results in further decrements in arterial function.
Abstract 12114: Safety and Efficacy of Sitagliptin plus Granulocyte-colony Stimulating Factor in Patients Suffering From Acute Myocardial Infarction (Sitagrami Trial) - Primary and Secondary Analyses
Authors: Brenner Christoph , Theiss Hans D , Adrion Christine , Grabmaier Ulrich , Theisen Daniel , von Ziegler Franz , Leber Alexander , Becker Alexander , Sohn Hae-Young , Hoffmann Ellen , Mansmann Ulrich , Steinbeck Gerhard , Franz Wolfgang-Michael
Published: April 2024

Introduction:
In animal models, we have previously shown that a combined progenitor cell therapy comprising G-CSF treatment and a pharmacological inhibition of DPP4 can enhance the recruitment of circulating progenitor cells (ciPCs) into the ischemic cardiac tissue via the SDF1/CXCR4 signaling. Within the myocardium, these bone marrow-derived cells can mediate local regenerative effects. Mainly via a paracarine action ciPCs thus reduce adverse cardiac remodeling, inhibit apoptosis and enhance heart function and survival.

Due to these promising preclinical results, we transferred our therapeutic concept into the phase III, multi-center, randomized, double blind and placebo-controlled SITAGRAMI trial. The purpose of the study was to assess the therapeutic impact of a combined pharmacological progenitor cell therapy using G-CSF and the DPP4 inhibitor Sitagliptin (G+S) after severe acute myocardial infarction (EudraCT Number: 2007-003941-34; www.clinicaltrials.gov; registration number: NCT00650143).

Methods and Results:
The enrolled 174 patients suffered from large myocardial infarction and underwent successful percutaneous coronary intervention within 24 hours after initiation of symptoms. We randomized patients in a 1:1 ratio to a treatment with either placebo or a combination of G-CSF for 5 days and Sitagliptin for 4 weeks. We executed Cardiac MRI in all patients at screening visit and after 6 months and planned additional clinical follow-up visits 6 and 52 weeks after the index event. In our final analysis, placebo treated patients showed a mean change in left ventricular EF after 6 months of 4.6%. This exactly corresponds to the changes reported 6 months after acute myocardial infarction by previously published clinical trials.

Conclusions:
Besides the primary endpoint data (change of left and right ventricular ejection fraction (EF) from screening to 6 months of follow-up) and general safety analyses, we will report about various secondary endpoints including cardiac volumes and myocardial perfusion. Furthermore, we will present additional analyses on the occurrence of major adverse cardiac events, in stent restenosis as well as de novo stenosis, gender specific-differences and various subgroup analyses.
Abstract 12139: Calpain Inhibition Attenuates Contractile Dysfunction Induced by Cardiac Dyssynchrony
Authors: Greyson Clifford R , Ye Shuyu , Lu Li , Schwartz Gregory G , Walker John S
Published: April 2024

Introduction:
Cardiac dyssynchrony confers poor prognosis in heart failure, but whether dyssynchrony is merely a marker for contractile dysfunction, or actively contributes to it, is uncertain. In vivo, dyssynchrony causes local muscle lengthening during electrical activation. In skeletal muscle,
forced lengthening during contraction
(LEN-CON) activates the calcium sensitive protease calpain and causes contractile dysfunction and sarcomere disorganization.

Hypothesis:
Calpain inhibition attenuates contractile dysfunction and sarcomere disorganization in cardiac muscle subjected to LEN-CON.

Methods:
Rat right ventricular trabeculae (cross sectional area 0.06±.04 mm
2
) at fixed diastolic length L
0
were paced at 1 Hz for 1 hr and allowed to shorten against normal load (50% initial isometric force F
0
,

CONTROL n=4), or forced to lengthen to 110% L
0
during each contraction without (UNTREATED n=12) or with (TREATED n=14) calpain inhibitor (calpeptin 1 μM). After 1 hr, isometric force was remeasured (F
1Hr
), and sarcomere length, length dispersion and organization in trabeculae fixed in diastole at L
0
and stained for α-actinin were quantified by Fourier power spectrum analysis of digitally deconvolved photomicrographs.

Results:
In CONTROL, isometric force was unchanged after 1 hr (F
1Hr
/F
0
94±18%, mean±SD). In UNTREATED, 1 hr LEN-CON caused dysfunction (F
1Hr
/F
0
50±9%, p<.001 vs CONTROL). In TREATED, dysfunction from LEN-CON was attenuated (F
1Hr
/F
0
63±16%, p=.02 vs UNTREATED). Sarcomere length after LEN-CON was similar in UNTREATED and TREATED (2.21±.20 vs 2.12±.09 μm, p=NS), but TREATED showed less length dispersion and better preserved sarcomere organization (FIG) by Fourier analysis (p<.05).

Conclusions:
Lengthening contraction causes dysfunction and sarcomere disorganization in cardiac muscle, at least in part through calpain activation. Calpain inhibition may have potential to ameliorate contractile dysfunction due to dyssynchrony in vivo.
Abstract 12233: Low Cardiovascular Risk in Midlife Predicts Active and Healthy Aging
Authors: Strandberg Timo , Rantanen Kirsi
Published: April 2024

Introduction and hypothesis:
Low cardiovascular disease (CVD) risk in midlife predicts survival and fewer CVD events up to old age. But do they also predict a broad concept of “active and healthy aging” (“successful aging”)? We studied this in our long-term cohort.

Methods:
The Helsinki Businessmen Study is a follow-up study of socioeconomically homogenous cohort of men born 1919-1934 (n=3293). Midlife (average age 42 years) risk factors included BMI, smoking, cholesterol, blood pressure, and one-hour glucose. Total CVD risk was also assessed with Keys’ risk score including age, BMI, smoking, cholesterol, and systolic blood pressure. Mortality follow-up was through 2010 whereupon mailed questionnaire data, including lifestyle, diseases, and quality of life was obtained from survivors. As there is no consensus criteria on active and healthy aging, our definition included the following 6 criteria which in general could be considered important: survival to an average age of 82 years, and 5 dimensions related to health, wellbeing, and physical, cognitive, and social functioning. In the analyses we divided the cohort into 3 age groups: men born 1919-1924 (n=969), 1925-1929 (n=1481), and 1930-1934 (n=843).

Results:
By 2010, 1788 of the midlife cohort had died and 894 (59% of survivors) responded to mailed questionnaire survey. According to our definition, only 154 men (4.8%) of the whole cohort experienced active and healthy aging fulfilling all 6 criteria. Of the individual midlife CVD risk factors only higher systolic blood pressure reduced odds of active and healthy aging (OR per SD 0.65. 95% CI 0.52 to 0.82, P<0.001) in adjusted analyses. Keys’ score was a powerful predictor of active and healthy aging overall (OR per SD of log value: 0.49, 95% CI 0.41-0.60, P<0.001), and in all age groups. ORs were: 0.52, 95% CI 0.29-0.95 (P=0.03); 0.52, 95% CI 0.38-0.72 (P<0.001), and 0.65, 95% CI 0.46-0.92 (P=0.01) in the oldest, middle and youngest age group, respectively.

Conclusions:
From a life-course viewpoint, active and healthy aging was relatively infrequent among men of higher social class. Lower systolic blood pressure and CVD risk overall in early midlife strongly predicted active and healthy aging giving impetus to controlling CVD risk in time in aging societies.
Abstract 12267: Clinical Significance of Very Late Ischemic and Bleeding Events After Percutaneous Coronary Intervention
Authors: Secemsky Eric , Yeh Robert W , Kereiakes Dean J , Steg P. Gabriel , Cutlip Donald E , Apruzzese Patricia K , Massaro Joseph M , Mauri Laura
Published: April 2024

Background:
Ischemic and bleeding events following percutaneous coronary intervention are associated with increased mortality, but the prognosis of events occurring beyond 1 year is unknown.

Methods:
The Dual Antiplatelet Therapy study randomized 11,648 subjects following percutaneous coronary intervention who completed 12 months of dual antiplatelet therapy to either continued thienopyridine plus aspirin treatment for another 18 months versus aspirin therapy alone. Subjects were followed for 21 months after randomization. Ischemic events were defined as Academic Research Consortium definite or probable stent thrombosis, myocardial infarction, ischemic stroke and other cardiovascular deaths. Bleeding events were defined by GUSTO classification (moderate or severe). Kaplan-Meier methods were used to estimate the cumulative incidence of death (regardless of cause) following ischemic and bleeding events over the full study follow-up.

Results:
At 21 months after randomization, 566 (4.9%) patients had ischemic events and 232 (2.0%) patients had bleeding events. Of the ischemic events, 58.8% were myocardial infarctions, 16.4% were stent thromboses and 12.8% were other cardiovascular deaths. Of all myocardial infarctions and stent thromboses, 8 (2.0%) were fatal on presentation. Among bleeding events, 66.0% were moderate and 34.0% were severe. Of all bleeding events, 3 (1.3%) were immediately fatal. In patients with ischemic events, 24.7% died, and the cumulative incidence of death preceded by an ischemic event was greater following myocardial infarction (0.39%) compared with stent thrombosis (0.13%) and ischemic stroke (0.11%). Among patients with a bleed, 17.7% died, and the cumulative incidence of death preceded by a bleed was 0.14% after a moderate bleed and 0.24% after a severe bleed (see Figure).

Conclusions:
Very late ischemic and bleeding events were infrequent, but patients who suffered these events are subject to high mortality risk.
Abstract 12282: A Nationwide Study on the Predictors of In-hospital Mortality Among Patient With Heart Failure Receiving an Intra-aortic Balloon Pump
Authors: Mahmoud Ahmed M , Abbas Ali , Draganov Peter , Aranda Juan
Published: April 2024

Background:
Intra-aortic balloon pump (IABP) is an important treatment modality for patients with cardiogenic shock. However, little information is known about the actual incidence and predictors of in-hospital mortality following IABP placement.

Methods:
Using the National Inpatient Sample database 2009-2011, all adult patients with admission diagnosis codes of congestive heart failure and procedure codes for IABP were identified. Patients who underwent LVAD or OHT placement off IABP were excluded from the analysis. Information about demographics, insurance, year of admission, hospital characteristics, comorbidities and acute in hospital complications were abstracted from the database. Using in-hospital death as our outcome, variables that achieved statistical significance (p <0.05) using Chi square testing were included in a multivariable analysis.

Results:
A total of 75,744 patients were diagnosed with congestive heart failure and had IABP placement from 2009 till 2011. The mean age was 66 years. The patient’s demographics revealed a higher incidence of IABP placement in Caucasian patients (64.3%) compared to other racial minorities. The majority of IABP placement occurred in urban hospitals (94.9%) with higher number of IABP placement in teaching (56.7%) compared to non-teaching hospitals (43.3%). The overall mortality rate following IABP placement was 20%. By multivariate analysis, the presence of acute kidney injury (AKI) requiring hemodialysis was associated with the highest risk of in-hospital death; other predictors of mortality are shown in Table 1. In a subgroup analysis, predictors of mortality did not differ for patients with or without myocardial infaction.

Conclusion:
In this nationwide analysis, overall in-hospital mortality was high occurring in 20% of the patients following IABP placement. The presence of older age, AKI, DIC, GIB and DIC are associated with worse outcome following IABP placement.
Abstract 12308: Aortic Aneurysm Associated With Bicuspid Aortic Valve: Relation to Gender, Hemodynamics, and Valve Morphology: The NHLBI GenTAC Registry
Authors: Roman Mary J , Pugh Norma L , Bavaria Joseph E , Devereux Richard B , Eagle Kim A , Holmes Kathryn , LeMaire Scott A , Morris Shaine A , Pyeritz Reed , Ravekes William J , Asch Federico M
Published: April 2024

Background:
Aortic aneurysm phenotype in bicuspid aortic valve (BAV) may vary according to gender, hemodynamic alterations, and valve morphology (type of cusp fusion). To better understand these potential associations, BAV participants in the GenTAC Registry were analyzed.

Methods:
973 patients with BAV were enrolled (76.3% male; mean age 44.5 years). At time of enrollment, 549 (56.4%; 76.9% male) had undergone valvular and/or aortic surgery. Imaging data were available on 424 unoperated or pre-operative participants.

Results:
Sinuses of Valsalva (SOV) diameter was larger in men than women (3.90 vs. 3.36 cm, p<0.0001); Z score: 2.2±2.3 vs. 1.4±1.9, p=0.002), whereas ascending aortic (AscAo) diameters were comparable (4.01 vs. 3.89, p=0.22; Z score: 3.2±2.0 vs. 3.5±2.2, p=0.124). BAV function was normal in 15.0%, predominantly regurgitant (AR) in 38.9%, predominantly stenotic (AS) in 21.6%, and mixed AS/AR in 16.0%. AR was more common in men (43.8 vs. 25.0%, p=0.003) whereas AS was more common in women (30.0 vs. 18.6%, p=0.033). Moderate-severe AR was associated with larger SOV diameters than mild AS (p=0.01) or moderate-severe AS (p=0.0006) or normal function (p<0.001). SOV diameters in mild AR were larger than those with normal function (p=0.012). Moderate-severe AS was associated with significantly larger AscAo diameter compared to normal function (p=0.002) but not compared to BAV with AR. AscAo diameters were larger in AR compared to normal function (both p<0.001).

Diameters of the SOV (3.70±0.67 vs. 3.36±0.56 cm, p=0.001) were larger in right-left fusion than in right-non fusion pattern whereas AscAo diameter was comparable.

Conclusions:
In the GenTAC Registry, SOV diameters were larger in males, even after adjustment for body size. AR was associated with both SOV and AscAo enlargement whereas moderate-severe AS was only associated with AscAo enlargement. Aortic diameters were larger in those with right-left cusp fusion independent of valve function.
Abstract 12369: Synchrotron Radiation Coronary Microangiography Could Confirm Induction of Coronary Vasoconstriction by Cold Exposure in the Diabetic Rat
Authors: Sakamoto Hiroaki , Matsushita Shonosuke , Hyodo Kazuyuki , Tokunaga Chiho , Sato Fujio , Hiramatsu Yuji
Published: April 2024

Background:
Previous reports have suggested that sympathetic nerve stimulation by cold exposure induces coronary vasoconstriction in diabetes, but this has not been directly confirmed. The purpose of this study was to confirm, in the in vivo diabetic rat, that coronary vasoconstriction is induced by cold exposure. Conventional coronary angiography cannot visualize small arteries of less than 300 μm in diameter, such as the rat coronary artery. We have developed a system of synchrotron radiation coronary microangiography (SRCA) in the in vivo rat. SRCA can visualize vessels as small as 50 μm in diameter, thus enabling us to evaluate the coronary artery reaction in the in vivo rat.

Method:
The advantages of synchrotron radiation-derived X-rays are their high spatial resolution (9 μm/pixel) obtained as a result of the increased photon density and straightness of the beam. Diabetes was induced in rats by administration of 65 mg/kg streptozotocin. A polyethylene tube for angiography was inserted into the carotid artery of anesthetized rat. SRCA was performed before and after cold exposure. We compared the changes in the caliber of the coronary arteries of normal rats (n = 6) with those of the diabetic rats (n = 6).

Results:
High spatial and density resolution images were obtained (Figure). Several points along the left coronary artery were measured in each rat. The coronary diameter after cold exposure was increased by 8.6% in the normal rats and decreased by 10% in the diabetic rats; the difference between the 2 groups was significant (p < 0.05). The measured points were divided into 3 categories according to diameter: small (< 150 μm), medium (150-250 μm), and large (> 250 μm). In each category of the normal rats, the coronary arteries were dilated. On the other hand, in each category of the diabetic rats, they were constricted.

Conclusion:
The SRCA system could confirm that sympathetic nerve stimulation by cold exposure induced coronary vasoconstriction in the in vivo diabetic rat.
Abstract 12486: An Early Survey of the Incidence and Distribution of LVAD Thrombus Using a High-avidity Tc-99m Fibrin Probe
Authors: Nassif Michael , Cui Grace , Akers Walter J , Scott Michael J , Itoh Akinobu , Paranandi Krishna , Achilefu Samuel , Ewald Gregory A , Lanza Gregory M
Published: April 2024

Background:
99mTc-F4A is a tetrameric, fibrin-specific probe characterized in vitro, in mice and in left ventricular assist devices (LVAD) explanted from patients.

Objective:
To survey the incidence and spatial distribution of thrombus by 99mTc-F4A signal intensity in LVADs removed for pump exchange (n=9) or heart transplant (n=11) in an early cohort of patients.

Methods:
LVADs excised from patients were rewired and operated (~9,400 RPM) in a mock circulatory loop (1/2 tygon, 200ml, 50:50, PBS: plasma; heparin). 99mTc-F4A (500μCi) was injected into the loop, circulated for 30 min. Activity was localized within LVADs by NanoSPECT/CT.

Results:
The median time of LVAD support prior to explant was 7.6 ± 7.2 months. Thrombus was detected in 19/20 LVADs by high 99mTc-F4A signal and corroborated by gross pathology in 4 LVADs by the manufacturer. 99mTc-F4A signal was scored as strong, weak, or none, and was assessed for the inlet cannula (metallic and Gor-Tex tubing segments), the inlet stator/bearing, turbine, outlet bearing, and outlet cannula regions. Inlet cannulas were available for 8/20 LVADs with 7/8 having thrombus. Strong signal was noted in 4/7 of the metallic segment and in 5/7 of the Gor-Tex segments. 99mTc-F4A signal occurred around the inlet bearing in 8/20 LVADs and the outlet bearing region in 5/20 LVADs, but the incidence of thrombus within the axial turbine was negligible. Thrombus was observed in the outlet cannula in 10/20 pumps. (Fig) Strong 99mTc-F4A signal was noted most often at the inlet bearing 75% (6/8) and in outlet cannulas 50% (5/10). Strong signal was noted in 13/20 LVADs in at least one location. Of 5/20 LVADs with multiple deposits, 4/5 of these pumps had a strong 99mTc-F4A signal.

Conclusion:
These initial ex vivo survey data reveal a high incidence of LVAD thrombus in exchanged and routinely transplanted LVADs. 99mTc-F4A imaging may offer a sensitive and specific diagnostic tool to noninvasively assess and better manage LVAD thrombus.
Abstract 12493: Comparison of Prehospital Stroke Scales
Authors: Sequeira Denisse , Martin-Gill Christian , Guyette Francis X , Jadhav Ashutosh P
Published: April 2024

Introduction:
Stroke is a major cause of death and disability. The availability of time dependent therapies for stroke makes accurate triage critical. Recent data demonstrates superior outcomes in large vessel occlusion (LVO) after the adjunctive use of endovascular therapy. A sufficiently accurate pre-hospital scale is needed to appropriate LVO patients to the closest endovascular-capable center. Various prehospital stroke scales have been described in an attempt to help identify strokes. The objective of this study was to compare the sensitivity and specificity of the four most commonly used stroke scales, CPSS, LAPSS, LAMS and RACE in terms of their accuracy in identifying strokes and stroke severity. The National Institute of Health Stroke Scale serves as the gold standard for comparison.

Methods:
Retrospective cohort study of a total of 1,293 patients transported from 2010 to 2013 by STAT MedEvac. Subjects had a suspected stroke, a prehospital NIHSS and a discharge diagnosis of stroke. The prehospital data were recorded in EMS charts by the EMS provider and used to establish scores for each of the four stroke scales analyzed. The hospital record was used to identify ischemic stroke (final discharge diagnosis) and the presence of LVO. Stroke identification and severity was determined by using the best cut off points for each of the scales. Using STATA12 the receiver operating characteristics were calculated for each scale.

Conclusions:
Prehospital stroke scales differ significantly in sensitivity and specificity for stroke and LVO identification with most scores having low sensitivity for both stroke and LVO detection. Although the commonly used CPSS has a fairly high sensitivity its specificity is low which could lead to a potential over-triage of patients. The results of the study show that none of these scales has sufficient accuracy to identify strokes and eliminate stroke mimics. A new tool is needed to improve prehospital stroke and LVO.
Abstract 12557: INTERMACS Profiles and Clinical Outcomes Among Ambulatory Patients With Systolic Heart Failure
Authors: Tahhan Ayman S , Morris Alanna A , Hedley Jeffrey S , McCue Andrew A , Yazdani Mariyah , Al-Anbari Raghda , Butler Javed , Georgiopoulou Vasiliki V , Kalogeropoulos Andreas
Published: April 2024

Introduction:
The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles are used to classify patients with heart failure (HF) considered for mechanical circulatory support (MCS). Limited data exist on the prognostic value of INTERMACS profiles in the general ambulatory HF population.

Hypothesis:
INTERMACS profiles identify systolic HF outpatients with distinct disease trajectories.

Methods:
We evaluated INTERMACS profiles, mortality, and healthcare resources utilization in 474 HF outpatients with left ventricular ejection fraction ≤40% who received care during a 3-month period in 2012 and were not on advanced therapies (MCS, heart transplant, or palliative inotropes). Patients whose HF severity did not meet any INTERMACS profile were classified as stage C.

Results: Table 1
presents the distribution of patient characteristics across INTERMACS profiles. After a median follow-up of 3.1 years (interquartile range 1.6, 3.3), 95 patients died (3-year mortality 21.4%); 24 patients received MCS; and 11 received heart transplant (combined 3-year mortality, MCS, and transplant: 29.3%). Compared to stage C patients, mortality and hospitalization rates were higher in all INTERMACS profiles,
Table 2
. Patients with profiles 4-5 demonstrated mortality and hospitalization rates similar to those with profiles 2-3, despite a higher use of advanced therapies in the latter.

Conclusions:
In ambulatory HF patients, all INTERMACS profiles are associated with significantly higher mortality and hospitalization rates compared to stage C patients. Outcomes in patients with profiles 2-3 are similar to those with the theoretically more benign profiles 4-5.
Abstract 12595: Variation in the Timing of Myocardial Infarctions After Hurricane Katrina: Eight Years After the Storm
Authors: Gonzales Holly , Singh Kanwar , Peters Matthew , Deandrade Kevin , Quevedo Henry , Baydoun Hassan , Raja Muhammad , Srivastav Sudesh , Irimpen Anand
Published: April 2024

Introduction:
The onset of acute myocardial infarction (AMI) has historically occurred with peaks on weekdays (especially Monday) and mornings, thought to be associated with stressful times of the day and week. AMI incidence increased in New Orleans following Hurricane Katrina with alterations in this chronobiology. The objective of this study is to determine the lasting impact of natural disasters on AMI chronobiology, which is currently unknown.

Hypothesis:
We hypothesized that the timing of AMI onset would return to pre-Katrina patterns given the amount of time lapsed since the storm.

Methods:
Single-center, retrospective, observational cohort analysis conducted at Tulane University Health Sciences Center (TUHSC) including symptomatic patients admitted for AMI with elevated troponin I. Exclusions were age < 18 years, hospital transfers, in-hospital AMIs, and inadequate documentation of day and time of symptom onset. There were two cohorts: pre-Katrina, including patients admitted in the 6 years prior to storm landfall (8/29/99 - 8/28/05, n=299), and post-Katrina, including patients admitted in the 8 years after TUHSC re-opened after the storm (2/14/06 - 2/14/14, n=1479). Medical records were reviewed for symptom onset and various demographic, clinical and laboratory data. AMI incidence was defined as the number of AMI admissions divided by total hospital admissions.

Results:
Post-Katrina AMI incidence decreased on Mondays, weekdays, and mornings, and increased on nights and weekends (p<0.0001, see table). The post-Katrina cohort had a significantly higher prevalence of smoking (53% vs 34%, p<0.01), unemployment (39% vs 7%, p<0.01) and lack of health insurance (25% vs 8%, p<0.01) without significant differences in age or sex.

Conclusions:
After Hurricane Katrina, the expected morning, weekday, and Monday peaks of AMI onset were eliminated. Traditional patterns of AMI onset may be altered for prolonged periods of time following natural disasters.
Abstract 12649: Long-Term Results of Early Surgery Versus Conventional Treatment for Infective Endocarditis Trial
Authors: Kang Duk-Hyun , Lee Sahmin , Kim Yong-Jin , Kim Dae-Hee , Song Jong-Min , Choi Kee-Joon , Song Jae-Kwan , Lee Jae-Won , Zo Joo-Hee
Published: April 2024

Introduction:
Although event-free survival in patients with infective endocarditis (IE) and large vegetations has been shown to be significantly higher at 6 months in those receiving early surgery vs. conventional treatment, long-term data are lacking.

Hypothesis:
We tried to compare the long-term outcomes of early surgery with those of a conventional treatment strategy.

Methods:
The Early Surgery versus Conventional Treatment in Infective Endocarditis (EASE) trial randomly enrolled 76 patients (51 men, 47±16 years) from 2006 through 2011 with left-sided native valve IE accompanied by severe valve disease and a diameter of vegetation > 10 mm. The end points were all-cause death and the composite of death, embolic events and recurrence of IE that occurred within 4 years after enrollment.

Results:
All patients in the early surgery group (n=37) underwent valve surgery within 48 hours, and 30 (77%) patients in the conventional treatment group (n=39) underwent surgery during the initial hospitalization. During median follow-up of 5.8 years (IQR, 4.8 to 7.1), 4 deaths occurred in the early surgery group and 5 deaths, 10 embolic events and 1 recurrence of IE in the conventional treatment group. There were no significant differences between the early surgery and the conventional treatment group in all-cause mortality (8.1% and 7.7% at 4 years, respectively; HR 1.04; 95% CI, 0.21 to 5.15; P=0.96). At 4 years, the rate of the composite of death from any cause, embolic events or recurrence of IE was 3.7% in the early surgery group as compared with 30.8% in the conventional treatment group (HR, 0.22; 95% CI, 0.06-0.79; P=0.02). The estimated actuarial rate of end points was significantly lower in the early surgery group than in the conventional treatment group (Figure).

Conclusions:
In the EASE trial, the beneficial effect of early surgery in IE patients with large vegetations persisted during long-term follow-up, and late clinical outcome after surgery was excellent in survivors of IE.
Abstract 12682: The Effect of Systolic Variation of Mitral Regurgitant Severity on Discordance Between Non-Invasive Imaging Modalities
Authors: Uretsky Seth , Koulogiannis Konstantinos , Marcoff Leo , Brown John , Argulian Edgar , Jagarlamudi Ashadevi , Awan Hira , Rosenthal Mark , Chaudhry Farooq , Gillam Linda , Wolff Steven D
Published: April 2024

Introduction:
Studies have shown a significant degree of discordance between echocardiography (Echo) and MRI in the quantification of mitral regurgitation (MR). A contributing factor to this discordance may be the systolic variation of MR severity. The ASE recommended quantitative parameters such as PISA and vena contracta rely on a single measurement during systole. These measurements can overestimate MR when MR severity varies during systole. We have previously developed a method to quantify the variation of MR during systole.

Hypothesis:
Greater systolic variation of MR severity is associated with discordance between MRI and Echo.

Methods:
This study included 94 pts (60 ± 14 yrs, male 60%) with MR. Echo was read per the ASE integrated method as mild, moderate or severe. Each MRI was read as mild, moderate, or severe based on calculated MR volume. Discordance was defined as the difference between the grades of MR (mild, moderate, or severe) by MRI and Echo. On MRI, systole was divided into thirds and the regurgitant rate was calculated for each third of systole as the difference between LV stroke volume and aortic outflow per unit time. The degree of systolic variation of MR severity was quantified by dividing the lowest regurgitant rate by the peak regurgitant rate, with higher numbers representing lower variation of MR severity during systole.

Results:
There was absolute agreement between echo and MRI in 38 pts, 1 grade difference in 41 pts, and a 2 grade difference in 15 pts. There was a trend of greater systolic variation of MR rate in pts with greater discordance between MRI and echo (figure). Pts with no discordance between echo and MRI had a significantly lower systolic variation of MR severity than those with 1 or 2 grades difference.

Conclusions:
Discordance between Echo and MRI in assessing MR severity was associated with greater systolic variation in MR severity. Thus, caution should be taken not to overestimate MR severity in patients with systolic variation of their MR.
Abstract 12775: Sixty is the New Ninety: Ten Year Experience of the In-Hospital 24X7 Interventional Cardiology Team
Authors: Jan M. Fuad , Basraon Jaswant , Allaqaband Suhail , Singh Maharaj , Walczak Sara , Bajwa Tanvir
Published: April 2024

Introduction:
Expeditious reperfusion in acute ST-elevation myocardial infarction (STEMI) with goal door-to-balloon time (DBT) < 90 minutes (ACC/AHA guidelines) is of utmost importance. The innovative 7-day 24-hour (24x7) in-hospital cardiac catheterization laboratory (CCL) program (24-hour in-hospital availability of an interventional cardiologist and dedicated lab staff) has been previously described by our institution. Here we present our 10-year experience on sustained gains of the program.

Hypothesis:
From a systems point, there is room for improvement in DBT as an integral process metric for measuring cardiovascular quality.

Methods:
A cohort of 1233 consecutive non-transfer STEMI patients [69.9% males (n=863), median age 61 years] presenting within 12 hours of symptom onset, formed the study population. Patients were studied for DBT, survival benefit and major adverse cardiovascular events (MACE, i.e., reinfarction, stroke, and cardiogenic shock) after primary percutaneous coronary intervention (PPCI). Using a precise protocol to allow quick entry into the CCL (door-to-CCL time) PPCI was used as the choice reperfusion strategy.

Results:
Median DBT was 50 minutes (interquartile range 39-67) with 91.65% of patients reperfused within the 90-minute goal. Of note, majority of the patients (66.59% n= 821) were reperfused within 60 minutes and approximately 10% of patients within 30 minutes. DBT < 60 minutes compared with DBT > 60 minutes was associated with statistically significant less in-hospital mortality (3.87 % vs. 7.66 %, p= 0.004), 1-year mortality (7.23 % vs. 12.99%, p= 0.0009) and MACE (10.7% vs. 16.01%, p= 0.0076) {(Figure 1).}

Conclusions:
A committed in-hospital 24x7 interventional cardiology team continues to succeed in breaking time inertia in achieving a new standard of 60 minutes. It decreases MACE and mortality in STEMI (in-hospital and 1-year) and thus justifies continued efforts to improve reperfusion times.
Abstract 13071: Computational Simulation of Virtual Ross Operation
Authors: Xuan Yue , El-Hamamsy Ismail , Mongeon Francois-Pierre , Leask Richard , Tseng Elaine E , Ge Liang
Published: April 2024

Background:
Unlike other bioprosthetic and mechanical valve replacement strategies, the Ross procedure has been shown to normalize patient survival comparable to an age-matched general population. However, one of the main limitations of the Ross procedure is the need for reoperation due to autograft dilatation or aortic insufficiency. The objective of this study was to develop a patient-specific virtual Ross operation with full root-replacement technique using computational simulation to investigate pulmonary autograft biomechanics early after surgery.

Methods:
A patient scheduled for Ross procedure underwent preoperative cine-cardiac magnetic resonance imaging (MRI). MRI lumen geometry was used to create surface contour meshes of aortic sinuses and pulmonary autograft. Using reverse engineering approach, zero-pressure geometries of aortic root and pulmonary autograft were created; unloaded wall thickness and autograft material properties were included. Using LS-DYNA software, simulations were performed of surgical suturing aortic root replacement with a pulmonary autograft. Sutured autograft and remaining aorta were then loaded to systemic pressure.

Results:
Average von Mises stress increased from 62kPa preoperatively in the native pulmonary root in situ at pulmonary pressure to 373.8kPa in the autograft as root replacement at systemic pressure, while postoperative von Mises stress in remaining aortic wall was 107.1kPa (fig 1).

Conclusions:
We performed patient-specific virtual Ross operation using computational simulation. Increased stress in pulmonary autograft indicated areas prone to possible structural failure. Reinforcement in these regions to support autograft wall may reduce future reoperation. Such patient-specific simulations to analyze stress concentrations may be an effective tool to optimize surgical techniques and determine patient-specific risk of aneurysm formation.
Abstract 13090: Beneficial Effects of Left Ventricular Assist Device Compared to Medical Therapy in Ambulatory Non-inotropic Dependent Heart Failure Patients in INTERMACS Profiles 4 vs 5-7: Results From the ROADMAP Study
Authors: Horstmanshof Douglas A , Shah Keyur B , Rogers Joseph G , Long James W , Starling Randall C , Moazami Nader , Bruckner Brian , Kasirajan Vigneshwar , Haas Donald C , Morris Rohinton , Milano Carmelo A , Stehlik Josef , Selzman Craig H , Thomas Jerome M , Drucker David W , Lanfear David E , Brewer Robert J , Aranda Juan M , Klodell Charles T , Chuang Joyce , Farrar David J , Estep Jerry D ,   For the ROADMAP Investigators
Published: April 2024

Introduction:
The role of left ventricular assist devices (LVAD) in advanced heart failure (HF) patients (pts) not dependent on intravenous inotropes is unclear. We hypothesize that the benefits of LVAD vs optimal medical management (OMM) are more pronounced in INTERMACS profile 4 (IM4) than profiles 5-7 (IM5-7).

Methods:
ROADMAP is a prospective, 41-center, non-randomized study of 200 pts. The objective was to evaluate the effectiveness and relative risks of HeartMate II LVAD support vs OMM in ambulatory NYHA Class IIIB/IV pts who met FDA indications for LVAD destination therapy but were non-inotrope dependent. The primary composite endpoint was survival with improvement in 6MWD ≥ 75m at 1 yr.

Results:
There were more LVAD pts in IM4 than IM5-7 (Table). Among IM4 pts, LVAD was 4.6X more likely than OMM to meet the primary endpoint, and 1 yr event-free survival as treated on original therapy was significantly greater for LVAD pts (Figure). The most frequent adverse event (AE) was bleeding for LVAD pts and worsening HF for OMM. For IM4 and IM5-7, LVAD pts had a higher composite of AEs compared to OMM, but freedom from rehospitalizations was similar for IM4. In OMM pts, 33% of IM4 and 15% of IM5-7 received delayed LVADs within 1 yr. Health related quality of life (HRQoL), severity of depression (PHQ-9), and NYHA class improved more at 1 yr with LVADs than OMM.

Conclusions:
Survival with improved functional status was better with LVADs compared to OMM in IM4 pts. HRQoL and depression improved more in all IM profiles with LVADs in spite of AEs being more frequent with LVADs. Results support the use of the HMII LVAD in functionally limited non-inotrope dependent HF patients, particularly those in IM4 profile.
Abstract 13093: Predictors for the Favorable Change of Fibrous-cap in Non-culprit Lipid Plaques in Response to Statin Therapy: A Serial Optical Coherence Tomography Study
Authors: Minami Yoshiyasu , Ong Daniel S. , Uemura Shiro , Wang Zhao , Aguirre Aaron D. , Mukhopadhyay Shankha , Soeda Tsunenari , Vergallo Rocco , Gao Lei , Xing Lei , Lee Hang , Yu Bo , Jang Ik-Kyung
Published: April 2024

Introduction:
Previous studies demonstrated that statins improved fibrous cap thickness (FCT) in patients with coronary artery disease. However, factors affecting the favorable FCT change in response to statin therapy remain unknown.

Aim:
To identify the clinical factors for favorable FCT change of non-culprit coronary plaques with statin therapy in patients with coronary artery disease.

Methods:
A total of 152 non-culprit plaques from 90 patients who were treated with statin and had serial optical coherence tomography (OCT) imaging at baseline and follow-up were included. FCT was assessed at the thinnest portion within the entire plaque.

Results:
The mean FCT was improved from 105.7 ± 52.3 μm to 128.4 ± 60.7 μm (P<0.001) from baseline to follow-up (median 6.38 [6.07-12.5] months). Multivariate liner regression analysis demonstrated that the percent change of FCT was significantly correlated to the eGFR at baseline (B=1.043, 95% confidential interval (CI) [0.321, 1.765], P=0.005) (Table). The percent change of FCT in patients with CKD Stage 1 (eGFR≥90) was significantly greater (42.3% [6.45, 100.0]) than in those with Stage 2 (eGFR: 60-89) (0.0% [-21.6, 58.5], P=0.007) or with Stage≥3 (eGFR<60) (0.0% [-14.3, 54.5], P=0.033) (Figure).

Conclusions:
Higher eGFR value at baseline was significantly correlated to the greater FCT improvement of non-culprit coronary plaques with statin therapy. Patients with eGFR≥90, in particular, had best response to statin therapy.
Abstract 13212: The Role of Macrophage STAT3 Signaling in Pathogenesis of Aortic Dissection
Authors: Ohno Satoko , Aoki Hiroki , Nishihara Michihide , Furusho Aya , Hirakata Saki , Nishida Norifumi , Ito Sohei , Hayashi Makiko , Fukumoto Yoshihiro
Published: April 2024

Aortic dissection (AD) is a fatal disease caused by the disruption of the intimomedial layer. Recent studies showed that IL-6, a STAT3-activating cytokine, and macrophages play important roles in AD. However, it is unknown whether or how activation of macrophage STAT3 is involved in AD pathogenesis. To answer this question, we examined both mouse AD model and human AD tissue. We used macrophage-specific knockout of SOCS3 (mSOCS3-KO), a negative regulator of STAT3, to specifically sensitize macrophages to STAT3 activation, and compared them with wild type (WT) mice. We created a mouse model of aortic stiffening by periaortic CaCl2 treatment of abdominal aorta, and infused them with angiotensin II (Ca+AngII), which augmented hemodynamic stress to aortic walls. Both WT and mSOCS3-KO showed microscopic injuries in aorta with equal frequencies (40%) 1 week after Ca+AngII. Whereas WT showed fibrotic repair of the injury, mSOCS3-KO failed to show such reparative response and developed large AD in 6 weeks. We analyzed the aorta 1 week after the Ca+AngII stimulation, focusing on the changes in aorta preceding AD development. Transcriptome analysis showed higher activation of cell cycle followed by higher proinflammatory response in mSOCS3-KO than in WT aorta before AD development. Ki67 staining and BrdU uptake study confirmed the proliferative response of inflammatory cells in aorta. Flowcytometric analysis showed preferential differentiation of mSOCS3-KO macrophages to proinflammatory M1 with reduction in reparative M2 population (M1:M2 = 2:1), while WT macrophages differentiated equally to M1 and M2. Immunofluorescence study of human AD tissue showed the infiltration of CD68-positive macrophages in adventitia and outer media at the site of dissection and surrounding intact aortic walls. The infiltrating cells showed high phospho- (active) STAT3 and Ki67. Interestingly, STAT3 was less active in tissue with fibrotic changes, suggesting the negative association of STAT3 activation and tissue repair. Therefore, macrophage STAT3 activation resulted in higher proliferation and M1 differentiation, which is likely to promote AD development. Over activation of STAT3 in macrophages may be a therapeutic target to mitigate the destructive process in AD.
Abstract 13391: Characteristics of Patients Undergoing Diagnostic Cardiac Catheterization Before Noncardiac Surgery; The National Cardiovascular Data Registry (NCDR)
Authors: Schulman-Marcus Joshua , Feldman Dmitriy N , Rao Sunil V , Prasad Abhiram , McCoy Lisa A , Garratt Kirk N , Kim Luke K , Minutello Robert M , Wong Shing-Chiu , Vora Amit N , Singh Harsimran , Wojdyla Daniel , Mohsen Amr , Bergman Geoffrey W , Swaminathan Rajesh V
Published: April 2024

Background:
While cardiac catheterization and/or revascularization before noncardiac surgery is not routinely indicated, many patients undergo these procedures as part of a preoperative evaluation. The angiographic findings and treatment patterns of these patients are unknown.

Methods:
Using the NCDR CathPCI registry, we performed a descriptive analysis of 194,444 patients at 1,046 sites reporting both diagnostic catheterization and PCI data who had a coronary angiogram prior to site-reported noncardiac surgery between 2009-2014. Patients with ACS, cardiogenic shock, cardiac arrest, or emergency catheterization were excluded. Demographics, pre-procedure noninvasive testing, angiographic findings, and treatment recommendations were summarized.

Results:
Of the included patients, 58.2% were male, the median age was 65 (IQR 57-73), and 83.6% were white. Most were overweight or obese (78.6%) and 40.6% had diabetes. A minority had prior MI (17.7%), PCI (18.9%), or CABG (12.1%). Most patients were asymptomatic (60.6%), although 57.8% had been on anti-anginal medications within 2 weeks of the procedure. Prior stress testing was reported in 65.2% and was positive in 86.4% of these patients; stress MPI was most commonly used (85.9% of noninvasive tests). Obstructive CAD (≥50% LM; ≥70% other) was present in 48.1%. After diagnostic angiography, revascularization with PCI or CABG was recommended in 23.8% of the overall cohort, 23.1% of asymptomatic patients, and in 48.3% of patients with obstructive CAD. Treatment recommendations varied by findings (Table).

Conclusions:
In this large contemporary US registry, a majority (60%) of patients undergoing diagnostic catheterization prior to noncardiac surgery are asymptomatic. Obstructive CAD by angiography is common, and revascularization is recommended in ~50% of these patients. These data highlight the complexity in decision making regarding the role of angiography and revascularization in this setting.
Abstract 13647: Comparison of the HEART and TIMI Risk Scores for Suspected Acute Coronary Syndrome in the Emergency Department
Authors: Sun Benjamin , Laurie Amber ,   i*trACS Investigators
Published: April 2024

Introduction:
The emergency department (ED) evaluation for suspected acute coronary syndrome (ACS) is common, costly, and challenging. Risk scores may facilitate clinical care and screening for research studies. The Thrombolysis in Myocardial Infarction (TIMI) score is perhaps the best known example, but the HEART score demonstrates promise specifically in ED settings.

Hypothesis:
We tested the null hypothesis that the TIMI and HEART risk scores have equivalent test characteristics in the ED evaluation of suspected ACS.

Methods:
We analyzed data from the Internet Tracking Registry of Acute Coronary Syndromes (i*trACS) from 9 EDs on patients with suspected ACS, 1999-2001. We excluded patients with an ED diagnosis of ACS, or without sufficient data to calculate TIMI and HEART scores. The primary outcome was 30-day major adverse cardiovascular events (MACE), including all-cause death, acute myocardial infarction, and urgent revascularization. We describe test characteristics of the TIMI and HEART risk scores.

Results:
The study cohort included 8,255 patients with 508 (6.2%) 30-day MACE. Receiver operating curve analysis favored HEART (c-statistic: 0.75, 95%CI 0.73-0.77) over TIMI (c-statistic: 0.68, 95%CI 0.66-0.70). A HEART score >3 (negative predictive value[NPV] 0.98, 95%CI 0.98-0.99; positive predictive value [PPV] 0.10, 95%CI 0.09-0.11) demonstrates equivalent or superior NPV/PPV compared to TIMI>0 (NPV 0.98, 95%CI;0.97-0.98; PPV 0.08, 95%CI 0.07-0.08) and TIMI>1 (NPV 0.96, 95%CI 0.96-0.97; PPV 0.1, 95%CI 0.09-0.11).

Conclusions:
The HEART score is more accurate than TIMI and specifically outperforms TIMI at “low-risk” thresholds.