bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 6058: Fibroin, a Silk-Based Biodegradable Protein, is a Promising Material to Engineer Small-Diameter Vascular Graft
Authors: Enomoto Soichiro , Sata Masataka , Sumi Makoto , Tanaka Kimie , Nakamura Kazuto , Sahara Makoto , Asakura Tetsuo , Nagai Ryozo
Published: July 2021

Background: Smaller vascular grafts made from synthetic biomaterials, particularly smaller than 5 mm in diameter, are associated with high incidence of thrombosis. Fibroin is a silk-derived biodegradable protein which provides anti-thrombotic surface and serves as a scaffold for various cell types in tissue-engineering. We evaluate the potential of fibroin to generate artificial vascular prosthesis for small arteries.

Methods and Results: A small artificial vessel with three layers was woven from fibroin thread. Fibroin-based grafts (1.5 mm in diameter, 10 mm in length) were implanted into the abdominal aorta of male 10 to 14-week-old Sprague Dawley rats by end-to-end anastomosis. Polytetrafluoroethylene (PTFE)-based grafts were used as control. Patency of fibroin grafts at 1 year after implantation was significantly higher than that of PTFE grafts (85.1% vs. 30%, p<0.01). Endothelial cells and smooth muscle cells (SMCs) migrated into the fibroin graft early after implantation and organized endothelial and medial layers, as determined by anti-CD31 or anti-α-smooth muscle actin immunostain-ing, respectively. Total number of SMCs increased 1.6-fold from 1 month to 3 months after implantation. Vasa vasorum was formed in adventitia. Sirius-red staining revealed that the content of collagen in fibroin grafts significantly increased at 1 year after implantation (520.9±0.2%, p<0.05) with decrease in fibroin fiber content (32.9±1.9%, p<0.05). To investigate the origin of the cells of neointima and media, bone marrow (BM) transplantation was performed from GFP rats to wild-type rats. GFP-positive cells substantially contributed to organization of endothelium and smooth muscle layers in the fibroin grafts implanted into the BM chimeric rats. The rate of BM-derived SMCs was 70% at 1 month and 55% at 3 months after implantation.

Conclusion: A small-diameter fibroin-based vascular graft has significantly higher patency than a PTFE-based graft. BM-derived cells substantially contribute to the initial formation of SMCs layer after graft implantation. The number of non-BM-derived SMCs increases at chronic phase. Fibroin might be a promising material to engineer vascular prosthesis for small arteries.
Abstract 6083: Sex Differences in 1-Year Mortality Following Acute Coronary Syndromes
Authors: Berger Jeffrey S , Elliott Laine E , Newby L. Kristin , Roe Matthew , Granger Christopher B , Armstrong Paul W , Simes R. John , White Harvey D , Van de Werf Frans , Hochman Judith S , Topol Eric J , Harrington Robert A , Califf Robert M , Douglas Pamela S
Published: July 2021

Background
: There is conflicting information whether sex modulates mortality following acute coronary syndromes (ACS). We investigated the relationships between sex, other clinical characteristics and 1-year mortality across the spectrum of ACS using a large database.

Methods
: Data from 6 ACS trials encompassing 1993 to 2006 were pooled. Of 81,010 patients, 21,409 (26%) were women. The ACS spectrum included 57,113 (24% women) STEMI, 13,376 (29% women) NSTEMI and 10,523 (39% women) unstable angina (UA). We compared 1-year mortality of women versus men in those surviving at least 30 days post ACS after multivariable adjustment using previously validated STEMI and NSTEMI/UA mortality models and coronary anatomy,

Results
: In the combined ACS population, women had higher unadjusted risk (HR 1.26, 95% CI 1.16 –1.36) compared with men. A significant interaction between sex and type of ACS was detected (P<0.001). Women had an increased unadjusted 1-year mortality risk in STEMI (HR 1.43, 95% CI 1.30 –1.58) and NSTEMI (HR 1.17, 95% CI 0.98 –1.39) but a decreased risk in UA (HR 0.84, 95% CI 0.69 –1.02) compared with men. After adjustment for baseline characteristics (age, heart rate, systolic blood pressure, weight, race, Killip class, smoking status, and history of diabetes, heart failure, myocardial infarction or bypass surgery) women had a lower risk of 1-year mortality for each type of ACS (STEMI, HR 0.86, 95% CI 0.77– 0.96; NSTEMI, HR 0.81, 95% CI 0.67– 0.97; and UA, HR 0.65, 95% CI 0.53– 0.79). After further adjustment for in-hospital procedures and coronary anatomy, hazard ratios were unchanged and mortality at 1-year remained lower for women in all ACS types.

Conclusions
: Sex-based differences exist in unadjusted 1-year mortality following ACS and vary by type of clinical syndrome. Adjustment for baseline differences, in-hospital procedures and coronary anatomy reveal that women are actually at lower risk for 1-year mortality compared with men across the spectrum of ACS.
Abstract 5803: Optimal Threshold for Multi Detector Computer Tomography to Detect Physiologically Significant Stenosis in Patients with Ischemic Heart Disease
Authors: Yamano Takashi , Tanaka Atsushi , Tanimoto Takashi , Takarada Shigeho , Kitabata Hiroki , Kuroi Akio , Imanishi Toshio , Akasaka Takashi
Published: July 2021

PURPOSE:
Sixty-four multi detector computed tomography angiography (64-MDCT) has emerged as a rapidly developing method for the noninvasive detection of coronary artery disease with high negative predictive value and relatively low positive predictive value, especially in patients with intermediate-severity coronary artery disease (ISCAD). There are, however, few studies regarding with optimal threshold for detection of physiologically significant stenosis in 64-MDCT. The purpose of this study was to investigate the optimal threshold for 64-MDCT to detect physiologically significant stenosis using fractional flow reserve of the myocardium (FFRmyo) in patients with ISCAD.

METHODS:
We enrolled single lesions detected by 64-MDCT of 64 ISCAD patients (age, 68.3 +/− 10.2 years; 78% male). FFRmyo </= 0.75 measured by a 0.014-inch pressure wire was used as the gold standard for presence of physiologically significant stenosis. The area stenosis (%AS) in 64-MDCT were compared with the results of FFRmyo and percent diameter stenosis (%DS) in quantitative coronary angiography (QCA) during elective coronary angiography. Using receiver operating characteristic (ROC) analysis, the optimum threshold for percent area stenosis (%AS) in 64-MDCT was determined in the prediction of FFRmyo </= 0.75.

RESULTS:
There was an inverse correlation between %AS in 64-MDCT and FFRmyo (65 +/− 20 % and 0.71 +/− 0.16, respectively; r = −0.67; p < 0.01). Furthermore, there was a positive correlation between %AS in 64-MDCT and %DS in QCA (65 +/− 20 % and 63 +/− 19 %, respectively; r = 0.69; p < 0.01). Using a cutoff of 62 %AS in 64-MDCT, ROC curve analysis shows 79 % sensitivity, 85 % specificity, 82% positive predictive value, 83% negative predictive value and 83% accuracy for detecting physiologically significant stenosis.

CONCLUSION: >
62 %AS in 64-MDCT could predict the physiologically significant coronary stenosis in patients with ISCAD. Applying an alternative threshold to detect physiologically significant stenosis might contribute to improve the diagnostic accuracy for 64-MDCT in patients with ISCAD.
Abstract 6116: Assessment of Global and Regional Left Ventricular Twist in Patients with Anterior Wall Myocardial Infarction Before and After Revascularization by 2-D Speckle Tracking Imaging
Authors: Xie Mingxing , Han Wei , Wang Xinfang , Zheng Minjuan , Ge Shuping
Published: July 2021

Background:
Torsion of the left ventricle is related to myocardial architecture and contractility and is being evaluated as a sensitive marker of cardiac performance. New 2-D speckle tracking imaging (STI) may provide a powerful means of assessing LV torsion noninvasively. This study sought to evaluate the global and regional left ventricular twist in patients with anterior wall myocardial infarction (AMI) before and after revascularization by STI.

Methods:
A total of 50 subjects, including

study group (n = 20) who underwent revascularization for AMI as well as 1 month after revascularization, and

control group (n = 30) of normal individuals were studied using STI.

LV twist was defined as apical rotation relative to the base. The peak LV twist, standard deviation of time to peak twist (Tw-SD) and maximal temporal difference of time to peak twist (Tw-diff) of 6 myocardial regions were measured.

Results:
Before revascularization, peak LV twist was significantly reduced while Tw-SD and Tw-diff significantly increased in patients with AMI as compared with normal control group (
P
<0.001). One month after revascularization, these changes improved compared with pre- revascularization but remained diminished compared with normal controls (Table 1

). There were significant correlations between LV peak twist and LVEF (
r
=0.78,
P
<0.05), and LVEDD (
r
=−0.63,
P
<0.05) in all subjects.

Conclusion:
LV twist measures significantly diminished and dys-synchronized in AMI patients prior to revascularization and improved after revascularization. STI measures correlate with EF and have the potential to quantify left ventricular global and segmental dysfunction in patients with AMI.

Left ventricular regional and global peak twist, torsion and synchrony measures
Abstract 6117: Significance of Flow Aliasing in the Proximal Left Coronary Artery on Transthoracic Color Doppler Echocardiography in Patients with Unstable Angina
Authors: Okayama Hideki , Nishimura Kazuhisa , Saito Makoto , Inoue Katsuji , Ogimoto Akiyoshi , Ohtsuka Tomoaki , Yoshii Toyofumi , Hiasa Go , Sumimoto Takumi , Funada Junichi , Higaki Jitsuo
Published: July 2021

Background:
Noninvasive coronary flow velocity reserve (CFVR) measurement by transthoracic Doppler echocardiography (TTDE) has been validated and utilized at the bedside. However, because this method requires pharmaceutical provocation, it has some risk especially for patients suspected of acute coronary syndrome. Color aliasing of coronary flow on TTDE in the short axis (SAX) view at the aortic root level suggests that flow acceleration produced by stenosis is occasionally observed during screening in patients with chest pain. The aim of this study was to investigate the clinical significance of flow aliasing on TTDE in the SAX view at the aortic root in patients with unstable angina.

Methods:
Patients (n=104) with unstable angina were evaluated. Proximal left coronary flow was sought in the SAX view at the aortic root level under color Doppler guidance at a color velocity range of ±19 cm/sec. When detected coronary flow showed color aliasing, the color velocity range was gradually raised until color aliasing nearly disappeared. Then, the color baseline was shifted until color flow showed isovelocity. AHA segment 6 on the coronary angiogram obtained within 24 hours was defined as the proximal left anterior descending artery (LAD).

Results:
Color aliasing was observed in 49 of 104 patients. In 14 of these 49 patients, there was significant stenosis (≥50% luminal reduction) in the left main coronary artery (LMCA) and 25 had significant stenosis in the proximal LAD. In patients with flow aliasing, a cut-off value of isovelocity ≥33.0 cm/sec predicted significant coronary stenosis with a sensitivity of 90%, specificity of 80%, positive predictive value of 95%, and negative predictive value of 67%. In all 104 patients, the cut-off value predicted significant coronary stenosis with a sensitivity of 60%, specificity of 96%, positive predictive value of 95%, and negative predictive value of 66%.

Conclusion:
Detection of flow aliasing by TTDE in the SAX view is a promising method for noninvasive diagnosis of LMCA and proximal LAD stenosis. This method may be useful for expeditious risk stratification and decision making in patients with unstable angina.
Abstract 6131: Regadenoson Induces Perfusion Defects of Comparable Extent and Severity as Adenosine: A Quantitative Analysis from the ADVANCE 2 Trial
Authors: Mahmarian John J , Cerqueira Manuel D , Iskandrian Ami E , Bateman Timothy M , Thomas Gregory S , Hendel Robert C , Moye Lemuel A , Olmsted Ann W
Published: July 2021

The quantified total and ischemic left ventricular (LV) perfusion defect size (PDS) is an important determinant of subsequent patient outcome. Therefore it is important to determine whether a new stressor agent induces similar perfusion abnormalities as a standard stressor agent such as adenosine. The ADVANCE 2 was a double-blind randomized trial comparing image results in patients undergoing standard adenosine (Ad) SPECT who were then randomized to either a second Ad SPECT (N=260) or SPECT following pharmacologic stress with Regadenoson (Reg) (N=493). All raw data of gated SPECT images (2 sets/patient) were reconstructed and reoriented in a standard fashion. Quantitative SPECT was performed using a previously validated automated program which determined the extent and severity of left ventricular (LV) perfusion defect size (PDS) and the extent of scintigraphic ischemia. PDS severity was defined as mild, moderate or severe based on the relation to normal pixel count activity (>50%, 26–50%, and 0–25%, respectively). Quantification was performed blinded to randomization and image sequence. Baseline perfusion results were similar (p>.05) between patients randomized to Ad vs Reg with respect to total (10.2±14.8 vs 11.5±15.8), ischemic (4.2±7.8 vs 4.6±8.9) and scar (6.0±10.7 vs 6.9±11.3) LV PDS. Results are summarized in the table

below. Linear regression analysis showed a close correlation between Ad vs Reg for total (r=0.97, p<.0001) and ischemic (0.94, p<.0001) LV PDS. In this large database, quantitative SPECT analysis demonstrates that Regadenoson induces a comparable extent and severity of perfusion abnormality as induced with standard adenosine stress. This implies that similar prognostic information should be obtainable with Regadenoson stress as observed with adenosine.
Abstract 6139: Flow Acceleration Time: A Novel Diagnostic Parameter for Prosthetic Aortic Valve Stenosis
Authors: Ben Zekry Sagit , Saad Robert M , Little Stephen H , Zoghbi William A
Published: July 2021

Diagnosing prosthetic aortic valve (PAV) stenosis, especially in mechanical valves, is challenging. We postulated that ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET) can differentiate PAV stenosis from normals and those with patient-prosthesis mismatch. Doppler echocardiographic studies were reviewed and quantitated in 74 patients with PAV (38 mechanical and 36 bioprosthetic; age 61±23.6 years; valve size range). Three groups of patients were identified:

patients with normal prostheses (n=60) evaluated within 3 months of surgery

patients with patient-prosthesis mismatch (n=10) and

documented PAV stenosis (n=14) with surgical confirmation.

Quantitative Doppler parameters included ejection dynamics (AT, ET and AT/ET) and conventional PAV parameters of effective orifice area (EOA) and gradient. Summary of the Doppler parameters is presented in Table 1

. Patient with PAV stenosis had significantly lower EOA and higher gradients compared to normals and mismatch. Flow ejection parameters (ET, AT and AT/ET) were significantly longer in the stenotic valves. Patients with prosthetic mismatch, while having a normal absolute EOA, had gradients and ejection dynamics intermediate, between normal and stenotic valves. Receiver-Operating characteristic curve analysis showed that AT discriminated best PAV stenosis from normals and patients with mismatch (area under ROC=0.97). A cut off of AT = 100 msec had a sensitivity of 93% and specificity of 88% for PAV stenosis. In prosthetic aortic valves, ejection dynamics, particular acceleration time, are reliable, angle independent diagnostic parameters for identifying prosthetic valve stenosis.

Table 1:

Doppler Echocardiographic parameters in normal PAV, stenotic valves and patients with mismatch.
Abstract 5807: First Demonstration that Coronary CT Angiography Reveals Coronary Arterial Vessel Wall Thickening in Patients with Intermediate and High Framingham Risk Score
Authors: Rinehart Sarah , Marvasty Idean , Anderson Hunt , Voros Szilard
Published: July 2021

Introduction.
Early atherosclerosis is characterized by vessel-wall thickening with preserved lumen size. Contrast-enhanced coronary artery computed tomography (CTA) has been validated for stenosis detection and characterization of atherosclerotic plaques but vessel wall thickening in patients with high Framingham risk score (FRS) has not been shown. We hypothesized that increased mean percent vessel wall area (PVWA) and remodeling index (RI) reflect early vessel wall thickening in subjects with higher FRS, with preservation of luminal size.

Methods.
We assessed 25 patients with coronary CTA using a validated, highly standardized approach on a commercial post processing workstation (Vitrea; SurePlaque 4.0). FRS was calculated by standard criteria. We evaluated 153 segments in patients with low FRS (<10%) and 35 segments in patients with intermediate-high FRS (>10%). Mean minimal lumen diameter (MLD), minimal lumen area (MLA), remodeling index (RI), and PVWA were compared with unpaired t-test in patients with low versus >10% FRS. Mean PVWA was calculated as follows: (total vessel area-lumen area)/total vessel area. p-value <0.05 was considered significant.

Results.
In all patients, mean FRS was 7%; 20 patients had FRS<10% and 5 had FRS>10%. PVWA and RI were significantly higher in the intermediate-high FRS group compared to low FRS (0.46±0.07 vs 0.42±0.07; p=0.04 and 0.97±0.15 vs 0.92±0.13; p=0.004, respectively), while MLD/MLA were similar (Figure 1

).

Conclusions.
This is the first demonstration that coronary CTA can detect vessel wall thickening with preserved lumen size in patients with FRS>10%.

Figure 1.

Cross sectional image demonstrating normal wall thickness (A). Cross sectional image demonstrating increased wall thickness (B). Bar graph demonstrating significant difference in PVWA between low and intermediate-high Framingham risk groups (C). Bar graph demonstrating significant difference in RI between low and intermediate-high Framingham risk groups (D).
Abstract 6165: Increased Circulating Cd62e+ Endothelial Microparticles Levels Predict Poor Outcome in Pulmonary Hypertension Patients
Authors: Amabile Nicolas J , Yeghiazarians Yerem , Chang Vivian , Damon Lauren , Heiss Christian , Angeli Franca S , Rame Eduardo J , McGlothlin Dana , Grossman William , DeMarco Teresa
Published: July 2021

Pulmonary hypertension (PH) is characterized by vascular remodeling and endothelial dysfunction. Levels of endothelial (EMPs) and leukocytes-derived (LMPs) microparticles, which are submicron membrane fragments shed from damaged or activated cells, have been shown to be significantly increased in PH patients compared to healthy controls. We hypothesized that the levels of circulating endothelial and leukocytes-MPs could predict outcome in these patients. Patients undergoing right heart catheterization for untreated pre-capillary PH, and without any conditions associated with increased circulating MPs levels, were eligible for the study. The following were measured at the time of enrollment: body mass index, mean pulmonary artery pressure (mPAP), C reactive protein (CRP)and BNP. CD62e+, CD144+, and CD31+/CD41− EMPs and CD45+ LMPs were measured using flow cytometry in platelet-free plasma from venous blood. After inclusion, patients were treated at the discretion of the physician and prospectively followed for 12 months. The primary endpoint assessed was the combined occurrence of death and readmission for right heart failure (RHF) or worsening of RHF symptoms. Seven of 21 patients (mean age=54.1±3.5y/62% female) experienced an adverse clinical event during this period. These patients had significantly higher baseline levels of CD62e+ EMPs (581±123 vs. 202±52 ev/μL, p=0.003), CD45+ LMPs (500±141 vs. 247±44 ev/μL, p=0.03) and CRP (9.9±2.2 vs. 3.8±0.7 IU/L, p=0.004) than patients without events, whereas no difference was observed for CD31+/CD41− and CD144+ EMPs, mPAP or baseline plasma BNP values. Moreover, CD62e+ levels correlated significantly with CD45+ LMPs (r=0.70, p=0.001). Multivariate analysis revealed that 4th quartile levels of CD62e+ EMPs was an independent predictor of adverse event after adjustment for CRP, CD45+ LMPs levels, body mass index and gender. These preliminary results show that high levels of circulating CD62e+ EMPs prior to treatment, but not other MPs subpopulations, are associated with clinical adverse events in PH subjects. These data suggest that this new biological parameter may be useful to predict outcome in patients with PH.
Abstract 6178: Trial of Routine ANgioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) - Six Month Outcomes
Authors: Cantor Warren J , Fitchett David , Borgundvaag Bjug , Heffernan Michael , Cohen Eric A , Morrison Laurie J , Ducas John , Langer Anatoly , Mehta Shamir , Lazzam Charles , Schwartz Brian , Dzavik Vladimir , Casanova Amparo , Singh Paramjit , Goodman Shaun G
Published: July 2021

Patients who present with ST-elevation myocardial infarction to hospitals without percutaneous coronary intervention (PCI) often cannot undergo primary PCI in a timely manner and therefore receive fibrinolysis. The role and optimal timing of routine PCI after fibrinolysis, using contemporary stents and pharmacotherapy, has not been studied in a large adequately powered randomized trial. To compare a pharmacoinvasive strategy of transfer for routine PCI within 6 hrs after fibrinolysis with standard treatment after fibrinolysis (including predefined criteria for rescue PCI). Pts presenting to non-PCI centres with STEMI within 12 hrs of symptom onset and with high-risk features were randomized to a pharmacoinvasive strategy (transfer for PCI within 6 hrs of fibrinolysis) or to standard treatment after fibrinolysis (which included rescue PCI as required for ongoing chest pain and < 50% resolution of ST-elevation at 60 –90 minutes). For standard treatment pts who did not require rescue PCI, cardiac catheterization was encouraged beyond 24 hrs. All pts received ASA and antithrombin therapy (unfractionated heparin or enoxaparin for age <75 yrs); use of upfront clopidogrel was strongly encouraged; all other therapies were left to the discretion of the treating physician. The primary endpoint was the 30-day composite of death, reinfarction, recurrent ischemia, heart failure or shock. All patients were contacted at 6-months and 1-year for death and reinfarction, and all events were independently adjudicated. 1,059 pts were enrolled as of December 31, 2007. The preliminary 30-day results were recently presented, showing a 45% reduction in the primary endpoint with the pharmacoinvasive strategy (10.6% vs. 16.6%, p=0.01), with no difference in major bleeding complications. This study is the largest randomized trial to date comparing a pharmacoinvasive strategy with standard care after fibrinolysis. The 6-month outcomes will demonstrate whether the significantly lower rates of ischemic complications seen with the pharmacoinvasive strategy at 30-days are sustained and translate into lower rates of death or reinfarction at 6 months.
Abstract 6191: Efficacy and Safety Assessment of Anticoagulation Strategies in Peripheral Percutaneous Intervention
Authors: Sheikh Imran , Ahmed S. Hinan , Ahmed Mubashir , Saeed Athar , Dochee Jennifer , Saeed Atif , Ansaarie Imraan , Khitha Jayant , Mewissen Mark W , Tumuluri Ramagopal , Gupta Anjan , Allaqaband Suhail , Bajwa Tanvir
Published: July 2021

Background:

Anticoagulation strategies used in peripheral percutaneous intervention (PPI) are based primarily on percutaneous coronary intervention. In these studies, relatively higher doses of heparin were used, usually in combination with a GP IIb/IIIa agent. There are no studies comparing PPIs done with low-dose heparin alone versus bivalirudin in PPI. We compared the efficacy and safety (i.e. bleeding complications) of low-dose heparin versus bivalirudin in PPI.

Methods:

We assessed prospectively 160 consecutive patients who underwent PPI from January through April 2008 during their index hospitalization for bleeding and thrombotic complications. Inclusion criteria included patients age >18 undergoing PPI for subclavian, renal or lower extremity arterial stenosis. Exclusion criteria included acute limb ischemia, use of fibrinolytic agents or GP IIb/IIIa antagonists, recent MI or CVA, and contraindication to heparin or bivalirudin. Out of 160 patients, 79 patients were dosed with heparin at 50 u/kg (goal ACT of 180 –225) and 81 patients were dosed with bivalirudin at 0.75 mcg/kg bolus followed by 1.75-mcg/kg infusion. Bivalirudin infusions were discontinued at the end of the procedure. Procedural success was defined as less than 30% post procedure residual stenosis. Major bleeding was defined as intracranial or retroperitoneal hemorrhage, or fall in Hgb ≥3 g/dl. All other bleeding was considered a minor bleed. In addition, anticoagulation cost analysis was conducted.

Results:

Procedural success in 100% and 96.2% patients (p=NS) (no patient suffered acute vessel occlusion or any intraprocedural thrombotic complications), major bleeding occurred in 0% and 3.7% patients (p=NS), minor bleeding occurred in 5.1% and 11% patients (p=NS), who received heparin and bivalirudin, respectively. There was no statistical difference in time to sheath removal, time-to-ambulation, and length of hospital stay. The average charge to patients for heparin was $66, whereas the charge for bivalirudin was $2727.

Conclusion:

Low-dose heparin is equally as safe and effective as bivalirudin in PPI. PPI with heparin is considerably more cost-effective than PPI with bivalirudin. Larger randomized studies are required to further evaluate this issue.
Abstract 6192: Endovascular Stent-Graft Repair of Type B Aortic Dissection: Intermediate to Long-Term Results
Authors: Kim Ung , Hong Seong-Jin , Kim Jung-Sun , Ko Young-Guk , Choi Dong-hoon , Jang Yang-Soo , Shim Won-Heum , Cho Seung-Yun
Published: July 2021

The aim of this study is to assess mid- to long-term clinical results of the endovascular stent-graft repair in patients with type B aortic dissection. Retrospective analysis was done on 73 patients (average age: 55.6 ± 12.4) who underwent stent-graft repair at our center from June 1994 to December 2007. The indications of case selection were progression of dissection despite adequate medical treatment, dynamic obstruction, intractable pain, aortic diameter of 6cm or more, or continuous false lumen leakage in either acute or chronic presentation. Median follow-up duration was 43 months (5 ~ 97 months, 64.4 ± 38.8 months). There was an absence of immediate postprocedural mortality or paraplegia. Angiographic success, defined as immediate closure of entry site without any significant endoleak, was obtained in 67/73 (91.7%) patients. Clinical success, defined as the complete obliteration or complete thrombosis of the false lumen at follow-up, was achieved in 53/73 (72.6%) patients. 22/73 (30.1%) patients demonstrated complications such as persistent type I endoleak, false lumen flow patency at distal portion of stent-graft, and 5/73 (6.8%) patients such as type II endoleak. Among these endoleaks, 5 cases were progressed and 17 cases were remained unchanged. There were unintended left subclavian artery occlusion (1 case), transient acute renal failure (1 case), saccular aneurysm (5 cases) and stent-graft migration or torsion (2 cases) as complications. During medial follow-up 43 months, 4 patients (5.5%) were died. In conclusion, cIinical outcomes of stent-graft repair of type B aortic dissection were favorable and should be considered as a safe and effective treatment option of type B aortic dissection, particularly in patients with a high risk surgical mortality or mobility.
Abstract 1186: Asymmetric Dimethylarginine and HDL-cholesterol Independently Affect Arterial Wall Thickness in the First Decade of Life
Authors: Ayer Julian G , Marks Guy , Harmer Jason A , Raitakari Olli T , Celermajer David S
Published: July 2021

Introduction The pathological changes of early atherosclerosis (fatty streaks and fibrous plaques) may be observed in the young and can be reflected
in vivo
by the carotid intima-media thickness (CIMT), measured by ultrasound. CIMT is a reliable marker of subclincal atherosclerosis in adults and traditional cardiovascular risk factors present in childhood predict CIMT in adulthood. However, the determinants of CIMT in childhood are largely unknown. We assessed the influence of traditional cardiovascular risk factors and also asymmetric dimethylarginine (ADMA, an endogenous inhibitor of nitric oxide synthesis) on CIMT, in healthy 8-year old children.

Methods 406 community-based children (age 8.0±0.1, 49% girls) had anthropometry, systolic and diastolic blood pressure (SBP, DBP) and mean left and right CIMT measured. A non-fasting blood sample was collected for HDL, non-HDL cholesterol, apolipoprotein B (apo B), high sensitivity CRP (hs-CRP) and ADMA (measured by ELISA). Correlates of CIMT were evaluated.

Results Mean (± sd) values were CIMT 0.59±0.06 mm, HDL 1.46±0.37 mmol/L, non-HDL cholesterol 2.96±0.70 mmol/L, apo B 0.64±0.15 mmol/L, and ADMA 0.91±0.22 μmol/L; median hs-CRP was 0.3 mg/L (interquartile range 0.21 to 1.09 mg/L). On univariate analysis, CIMT was associated significantly with SBP (r=0.164, p<0.001), DBP (r=0.105, p<0.017), HDL (r= −0.142, p<0.006) and ADMA (r=0.182, p<0.001). Measures of body size, apo B and hs-CRP were not significantly related to CIMT. On multivariable analysis, HDL (β coefficient = −0.118, p<0.035) and ADMA (β coefficient = 0.175, p<0.002) were significant independent determinants of CIMT in a model adjusted for all measured risk factors and sex.

Conclusions Lower HDL-cholesterol and higher levels of ADMA, an endogenous inhibitor of nitric oxide synthesis, are significantly associated with CIMT in childhood. These data may permit earlier cardiovascular risk stratification and suggest novel mechanisms whereby HDL and ADMA might be modulating atherogenesis at an earlier stage than previously envisaged.
Abstract 1198: The Relation Between Age and Serum Markers of Collagen Turnover in Healthy Elderly Individuals; The Cardiovascular Health Study
Authors: Barasch Eddy , Gottdiener John S , Han Jing , Aurigemma Gerard P , Kitzman Dalane W , Tracy Russell
Published: July 2021

Background:
Significant changes in the cardiac anatomy, morphology and function occur with aging. Increased collagen deposition in the myocardial matrix has been associated with prevalent heart failure (HF) in the elderly. The relation between age with serum level of procollagen type III aminoterminal peptide-PIIINP-, carboxyl-terminal propeptide type I -PIP-, reflecting collagen synthesis, and carboxyl-terminal telopeptide of collagen type I -CITP-marker of collagen type I degradation, is largely unknown in healthy free-living elderly individuals.

Aim:
To determine the relation between age with serum biomarkers of fibrosis (SBF) in a large group of community-dwelling elderly individuals.

Methods:
In 880 participants (ppts), mean age 77 ± 6 yrs, 52 % males, 79 % white, enrolled in the Cardiovascular Health Study, serum levels of PIIINP, PIP and CITP were measured; 179 had HF with normal LVEF (DHF), 131 had HF with LVEF < 55% (SHF), 287 controls (no HF), and 283 healthy ppts. Kruskal-Wallis test, one-way ANOVA, chi-square test and Spearman correlation were performed as appropriate.

Results:
SFB values and the main demographic variables are displayed in the table

. The association between age with the 3 SBF for the entire study population were: PIP: r = 0.13 (p <0.0001), CITP: r = 0.13, p < 0.0001, PIIINP: r = 0.04, p = 0.20. For the individuals groups, the associations were: PIP with DHF (r = 0.25, p=0.001), CITP with DHF (r = 0.15, p =0.05), controls (r= 0.27, p < 0.0001) and healthy control groups (r = 0.19, p = 0.001). PIIINP was associated with age only in the control group (r = 0.12, p = 0.04). No association was found between age and SBF in the SHF group.
Abstract 1205: Patients without obstructive coronary artery disease and stress test results: An analysis from the National Cardiovascular Data Registry
Authors: Patel Manesh R , Anstrom Kevin J , Eisenstein Eric L , Brindis Ralph G , Peterson Eric D , Douglas Pamela S
Published: July 2021

Background:
In stable patients without known coronary artery disease (CAD), clinical practice guidelines recommend documentation of ischemia prior to evaluation by invasive angiography. We sought to determine how often non-invasive stress testing is performed in this population and the association between stress test results and obstructive CAD.

Methods:
Patients undergoing cardiac catheterization for exclusion of CAD who were without prior history of myocardial infarction, PCI, or CABG were identified from 601 hospitals using the American College of Cardiology National Cardiovascular Data Registry between 2005 – 2007. Significant obstructive CAD was defined as the presence of any stenosis ≥ 50% left main or ≥ 70% major epicardial vessel. Patient demographics, risk factors, symptoms, stress test status and CAD presence were determined.

Results:
A total of 376,430 patients without known CAD were identified. The median age was 61 years, 53% were male, 26% had diabetes, and 69% had hypertension. At angiography, 142,912 (38%) of patients were found to have significant obstructive CAD. Symptom status was associated with the presence of CAD (stable angina 50%, atypical 25%, asymptomatic 40%; p<0.001). Stress testing was performed in 316,248 (84%) of patients prior to angiography, and results were associated with the presence of CAD (p<0.001) see

Table

. Although a positive stress test was noted in 255,617 (68% of patients undergoing cath), obstructive CAD was noted in only 105,435, yielding a positive predictive value of 41%.

Conclusions:
In a large national registry of stable patients without known CAD undergoing invasive angiography, only 38% were found to have significant obstructive disease. Although performed in 84% of patients prior to cath, the low positive predictive value of current stress tests may have contributed to the high rate of patients without obstructive CAD.

Table

p value for stress test results and presence of obstructive CAD p<0.001
Abstract 1253: Increased Red Blood Cell Distribution Width is Associated with Greater Risk of All-Cause, Cardiovascular and Non-Cardiovascular Mortality in a Large Community-Based Cohort
Authors: Perlstein Todd S , Weuve Jennifer , Pfeffer Marc A , Beckman Joshua A
Published: July 2021

Background:
The red cell distribution width (RDW), a measure of red cell size heterogeneity (anisocytosis), is a newly recognized risk marker in patients with CVD. It is unknown whether RDW is associated with mortality in the general population.

Methods and results:
We examined the association of RDW with mortality risk among 14,953 adult participants in the Third National Health and Nutrition Examination Survey (1988 –1994), a representative sample of the United States population. Over a geometric mean of 8.3 years, 2,372 deaths occurred. Age-standardized mortality rates, excepting external-cause (i.e. accidental) deaths, increased across RDW quintiles (figure

). A one standard deviation increment in RDW (0.98) was associated with a 21% greater risk of all-cause (HR 1.21, 95% CI 1.15–1.26) and cardiovascular mortality (HR 1.21, 95% CI 1.13–1.29) after multivariable adjustment including hemoglobin level. RDW was also independently associated with risk of death due to cancer (HR 1.21, 95% CI 1.12–1.30) and chronic lower respiratory disease (HR 1.31, 95% CI 1.14 –1.52). Only age exceeded the statistical strength of RDW’s association with all-cause and cardiovascular mortality; only age and smoking were more strongly associated with cancer and chronic lower respiratory disease mortality.

Conclusions:
We found that higher RDW was strongly predictive of increased risk of all-cause, cardiovascular, and non-cardiovascular mortality in this large, community-based sample. Study of anisocytosis may therefore yield broad pathophysiological insights, and measurement of RDW may contribute to patient risk assessment.
Abstract 1269 Physician Diagnosis of Overweight Predicts Weight Loss Attempts in Patients with Cardiovascular Disease and Central Obesity
Authors: Singh Siddharth , Somers Virend K , Clark Matthew M , Hensrud Donald D , Douglas Kristin Vickers , Romero Abel , Lopez-Jimenez Francisco
Published: July 2021

Central obesity has been associated with adverse events in patients with cardiovascular disease (CVD). We undertook this study to evaluate predictors of overweight awareness, desire to lose weight and weight loss attempts in patients with CVD and central obesity. Association of physician-rendered diagnosis of overweight with weight loss attempts was also evaluated. Data from National Health and Nutrition Examination Survey (NHANES) 1999 –2004 were used. CVD was defined as self-referred history of coronary artery disease or stroke. Central obesity was determined based on a waist circumference > 102 cm in men and > 88 cm in women. Motivational factors considered as determinant for behavioral change that were evaluated included: participants’ awareness of their overweight status; desire to lose weight; any weight loss attempts in last year. We examined demographic, anthropometric and clinical determinants of each stage of change using multivariate models. Of the 1484 participants with CVD that were identified in NHANES, 824 had central obesity (56%). 76% of centrally obese participants were aware of their overweight status and 79% were desirous of losing weight. Despite this awareness and desire, only 41% of centrally obese had attempted weight loss in the last year. Only 61% reported that they had been informed that they were overweight by physicians. On multivariate analysis, after adjusting for sociodemographic factors and body mass index, physician rendered diagnosis of overweight was a significant predictor of weight loss attempts (OR=2.5, 95% CI 1.3– 4.9, p= 0.006). Awareness of one’s overweight status strongly predicted desire to lose weight in multivariate models (OR=107.6, 95 % CI 42.9 –270.0, p<.0001) and desire to lose weight was linked to recent attempts to lose weight (OR 10.4, 95 % CI 2.8– 39.2, p= 0.0005), confirming that the Transtheoretical Model of behavioral change applies to the study population. In a nationally representative sample of participants with CVD and central obesity, physician-rendered diagnosis of overweight emerged as an important predictor of weight loss attempts. Efforts to promote weight loss should focus on interventions based on Transtheoretical Model of behavioral change.
Abstract 3110: Adherence to Beta-blockers and ACE Inhibitors/Angiotensin Receptor Blockers in the First Year after Diagnosis of Heart Failure: 10 Year Observational Trends
Authors: Lamb Darcy A , Eurich Dean T , McAlister Finlay A , Tsuyuki Ross , Semchuk William M , Wilson Thomas W , Blackburn David F
Published: July 2021

Introduction:
As prescriptions for evidence based medications in patients with heart failure (HF) have increased over the past 10 years, we aimed to determine if adherence to HF medications has also increased over this time.

Methods:
A retrospective cohort was created using administrative databases from the province of Saskatchewan, Canada. Subjects discharged alive from their first hospitalization for HF between 1994 and 2003 were eligible for study. Those filling a prescription for a beta blocker (BB), ACE inhibitor (ACEI), or angiotensin receptor blocker (ARB) within six months after discharge were selected. The proportion of subjects with optimal 1-year adherence (≥ 80%) was determined and divided according to the year of entry into the study.

Results:
Of 8,805 eligible patients, 67% of BB users (941/1414) and 74% of ACEI/ARB users (4441/5991) exhibited 1-year adherence ≥ 80%. When grouped by year of initial HF hospitalization, the proportion of patients with optimal 1-year adherence improved from 54% to 75% with BB and from 67% to 80% with ACEI/ARBs between 1994/95 and 2002/03 [Figure

]. Mean 1-year adherence improved from 71% to 83% and 80% to 88% for BB and ACEI/ARBs, respectively. After covariate adjustment using multivariate logistic regression, year of initial HF hospitalization remained independently associated with optimal 1-year adherence. Subjects discharged in 2003 were significantly more likely to exhibit optimal adherence to a BB (OR 2.04; 95% CI 1.21–3.44) or an ACEI/ARB (OR 1.65; 95% CI 1.30–2.08) than those prescribed therapy in 1994/95.

Conclusion:
One year adherence to BB and ACEI/ARB is improving over time in patients newly diagnosed with HF.
Abstract 3179: The Association Between Patient Cardiac Risk Factors and Referral Practices to Cardiac Rehabilitation
Authors: Habib Ammar , Buchanan Donna M , Reid Kimberly J , Spertus John A
Published: July 2021

Despite the overwhelming evidence showing the benefits of cardiac rehabilitation (CR) after Myocardial Infarction (MI), it remains highly underutilized. Limited information is available describing patient characteristics and treatments associated with CR referral practices. The study included 2294 patients from 17 US sites in the PREMIER registry that were discharged home after MI. Predictors of CR referral were determined using a multivariable hierarchical modified Poisson regression model with site-centered variables, which accounted for both clustering of patients within a hospital and confounding due to the hospital. Clinically pertinent variables were chosen
a priori
for inclusion in the multivariable model. Of patients discharged home, only 49.5% received referral to CR programs. Multivariable-adjusted results revealed patients with a history of chronic heart failure or coronary artery disease and those that arrived at the hospital with an acute non-cardiac condition were less likely to be referred to CR (Table

). Moreover other characteristics identifying patients with a strong indication for CR (e.g. smoking, less education and the presence of other comorbid diseases) were not more likely to be referred to CR. Despite existing evidence of the significant benefits of CR after MI, less than half of patients discharged home were referred to CR programs. Importantly, those with the greatest potential to benefit from CR programs were not more likely to be referred. Since CR remains underutilized by healthcare professionals, it is important to further explore barriers to CR referral and educate physicians about CR benefits to improve the implementation of the new AACVPR/ACC/AHA 2007 performance measure on CR referral.

Table:

Relative Risk of Referral to Cardiac Rehab after MI
Abstract 3199: Diastolic Dysfunction in Chronic Heart Failure and Aging - Effects of Exercise Training
Authors: Sandri Marcus , Gielen Stephan , Mangner Norman , Höllriegel Robert , Erbs Sandra , Linke Axel , Möbius-Winkler Sven , Hambrecht Rainer , Schuler Gerhard
Published: July 2021

BACKGROUND: Diastolic left ventricular dysfunction may occur in both physiologic aging and chronic heart failure (CHF). It has, however, never been assessed, whether the degree of diastolic impairment in CHF is influenced by age and if the previously observed beneficial effects of exercise (ET) on left ventricular filling are diminished in old age.

METHODS: In this study we randomised 53 pts. with stable CHF(LVEF 27.3±2.1%) and 51 healthy subjects (HS) (LVEF 61.5±2.7%) to a training (T) or a control group (C). To detect possible aging effects we included subjects <55 (young) and >65 years (old). Subjects in the T-group exercised 4 times daily at 60 to 70% of VO
2
max for 4 weeks under supervision. At baseline and after the intervention E/A ratio and lateral E/E′ ratio were determined by echocardiography and with tissue Doppler imaging.

RESULTS: As compared to young HS, old HS showed at baseline a reduced E/A ratio and an increased E/È ratio (young: E/A 1.2±0.2; E/È 7.3±0.1 old: E/A 0.7±0.1; E/È 13.5±0.3; p<0.05). In CHF pts., diastolic function was impaired (young E/A 0.8±0.2; E/È 12.9±0.5 old: E/A 0.8±0.1; E/È 13.7±0.4). No difference of these baseline parameters between the age groups was observed (p=0.72). As a result of ET, E/A ratio improved from 0.7±0.1 to 1.2±0.2 and E/È ratio improved from 13.7±0.3 to 9.3±0.4 in old HS (p<0.05), while it remained unchanged in young training HS and C. In young and old pts. with CHF four weeks of ET resulted in a significant change in E/A ratio (young: from 0.8±0.1 to 1.2±0.1; p<0.05; old: from 0.7±0.1 to 1.1±0.2 p<0.05) and E/È ratio (young: from 13.1±0.3 to 10.1±0.2; p<0,05; old: from 14.1±0.3 to 11.2±0.3; p<0.05). In C no effect was detectable.

CONCLUSIONS: The present trial provides new insight into chronobiology of cardiovascular training effects: Among HS aging is associated with the development of significant left ventricular diastolic dysfunction. In CHF both young and old pts. exhibit a similar degree of LV-dysfunction. Four weeks of ET are effective in improving diastolic function in old HS and in young and old CHF pts. The lusitropic training effects were not significantly diminished among older pts. underlining the potentials of rehabilitation interventions in this patient group.
Abstract 3212: Dietary-Induced Insulin Resistance Associated with Dyslipidemia Induces Progressive Cardiac Dysfunction in Rats as Evidenced by Echocardiography
Authors: Toufektsian Marie-Claire , Grauzam Stéphane , Ormezzano Olivier , Vollaire Julien , Jouan Marie-Gabrielle , Boucher François , Sulpice Thierry
Published: July 2021

Background:
A major complication of diabetes is the development of cardiac dysfunction in absence of vascular disease. Metabolic disorders such as insulin resistance (IR) and dyslipidemia (DL) might contribute to the induction of diabetic cardiomyopathy (DCM). However, few relevant animal models are currently available for studying the time-course of DCM and evaluating experimental therapeutics. We developed a rodent model of dietary-induced IR combined or not with DL in order to investigate the impact of chronic IR and DL on
in vivo
myocardial function.

Methods & Results:
Male Sprague-Dawley rats were fed a western-type diet (65% fat; 15% fructose; WD: n=12). DL was induced by combining the western diet with
i.p
. injections of a nonionic surface-active agent (P-407; 0.2 mg/kg, 3 times/wk; WD-P407 n=9). A chow diet was used as control (Chow: n=9). At 6, 11 and 14 wks, cardiac function was assessed by echocardiography. After 6 wks, plasma insulin was significantly increased in both WD and WD-P407 groups (
P<
0.05
vs.
Chow). Fasting blood glucose increased in WD group while plasma lipids markedly accumulated in WD-P407-treated rats (
P<
0.05 and
P<
0.01
vs.
Chow, respectively). Pulse-wave Doppler indicated impaired diastolic function at 14 wks (E/A wave ratio: WD-P407: 1.42±0.06
vs.
Chow: 1.65±0.11). M-mode imaging showed no significant differences in cardiac function and geometry under basal conditions. However, fractional shortening (FS) was significantly depressed under dobutamine stress in WD group at 14 wks (FS in % of baseline: 151±9%
vs
196±7%;
P<
0.05) whereas systolic dysfunction appeared as early as 11 wks and worsened at 14 wks in WD-P407 animals (
P<
0.05 and
P<
0.01
vs.
Chow, respectively). Finally, compared to Chow, myocardial lipid tissue content and pro-inflammatory cytokine TNF-α were significantly higher in WD and WD-P407 groups, the cardiac lipid accumulation being more pronounced in the later.

Conclusions:
DL exacerbated cardiac lipotoxicity and functional complications associated with IR. This experimental model of combined IR and DL closely mimics the main clinical manifestations of DCM and might therefore constitute a useful tool for the evaluation of pharmacological treatments.