bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 645: Effect of Stun Gun Discharges on Pacemaker Function
Authors: Khaja Azamuddin , Govindarajan Gurushankar , McDaniel Wayne , Flaker Greg
Published: July 2021

Introduction: Tasers are electronic controlled devices used by law enforcement to temporarily incapacitate individuals. They generate high voltage, low current repetitive pulsed waveforms which may adversely affect implanted pacemakers.

Methods: A single chamber Medtronic bipolar lead was placed under fluoroscopic guidance in the RV apex of 4 pigs and connected to an Adapta generator placed in pre-pectoral pocket. After anesthesia, multiple stun gun shocks were fired every 3 minutes with Taser X-26, Taser M-26 and Stinger S-200. Intracardiac electrograms were continuously recorded during the taser discharges by placing the wand over the pacemaker pocket.

Results: The taser did not produce any effects on the native rhythm which is easily seen underlying the distinctive noise signature from the taser shock (Fig-1A

). The Adapta device used for this testing has atrial tachycardia detection capability, explaining the atrial sense markers appearing with the taser noise. Figure 1B

was recorded when the pig was 100% paced and the stun gun fired. The reversion pacing, observed in this strip, is functionally asynchronous from the native rhythm the entire time that the taser noise is present and goes away as soon as the taser noise is removed.

Conclusions: Stun Gun discharges,

were recognized by the pulse generator and sensed as either high rate atrial or ventricular activity depending on which vector is more in line with the electric field created by the two taser electrodes,

did not affect the native rhythm,

did not conduct down the lead systems to cause any extra systoles,

and had no effect on paced rhythm. The use of these devices appears safe in victims with this type of pulse generator.
Abstract 653: SCN5A Mutation is Associated with Early and Frequent Recurrence of Ventricular Fibrillation in Patients with Brugada Syndrome
Authors: Nishii Nobuhiro , Morita Hiroshi , Hiramatsu Shigeki , Tada Takeshi , Murakami Masato , Nagase Satoshi , Nakamura Kazufumi , Oka Takefumi , Ohe Tohru , Kusano Kengo F
Published: July 2021

Mutation in SCN5A has been reported to be causally linked to Brugada syndrome (BrS), but recent observation revealed that this mutation is not necessarily associated with ventricular fibrillation (VF) or syncope episode in a case of BrS. We therefore examined the clinical importance of SCN5A mutation in BrS patients. Total 121 patients were examined. The existence of SCN5A mutation (n=14) was not associated with VF/syncope episode [SCN5A (+) vs SCN5A (−), 28.6% (4/14) vs 10.9% (10/92); P=NS]. ICD was implanted for secondary prevention (SP group) in 28 patients (54.9%) and for primary prevention n (PP group) in 23 of 51 patients (45.1%). During a mean follow-up period of 49.3 ± 33.7 months, 13 patients (46.4%) in SP group and 1 patient (4.3%) in PP group had received appropriate shocks. The shock free survival was significantly shorter in SP group than PP group (52.4% vs 88.9% at 5 years, p = 0.0016). Next, we examined SCN5A mutation on the recurrence of VF episode in SP group. The shock free survival was significantly shorter in BrS patients with SCN5A mutation than the patients without SCN5A mutation (0% vs. 76.4% at 1 years, p = 0.002, figure

). Moreover, the number of ICD shocks was significantly larger in BrS patients with SCN5A mutation than in BrS patients without SCN5A mutation (9.3 ± 6.4 vs. 1.7 ± 3.2, p = 0.001). VF inducibility by programmed electrical stimulation was not associated with shock free survival. SCN5A mutation is strongly associated with early and frequent VF recurrence. Additional medical management should be required in symptomatic BrS patients with SCN5A mutation.
Abstract 656: Impact of Percutaneous Coronary Intervention on Ventricular Function in Potential Candidates for Prophylactic Implantable Defibrillators
Authors: Ramana Ravi K , Dieter Robert S , Cytron Joseph , Quader Nishath , Homan David , Cohoon Kevin P , Steen Lowell , Lewis Bruce E , Leya Ferdinand , Wilber David J
Published: July 2021

While left ventricular ejection fraction (LVEF) may improve in some pts with ischemic cardiomyopathy (ICM) following percutaneous coronary intervention (PCI), there are limited data with respect to the frequency and clinical predictors of this finding in pts who are candidates for subsequent placement of an implantable defibrillator (ICD). We retrospectively identified 105 consecutive pts with an initial LVEF <35% who underwent PCI and had follow-up echocardiographic assessment at least one mo (median 5.2 mo) later. No pt had a history of syncope or sustained ventricular arrhythmias. The indication for PCI was ST-elevation myocardial infarction (STEMI) in 17 patients (16.2%), non-ST-elevation MI (NSTEMI) in 76 pts (72.4%), and angina in 12 pts (11.4%). Mean age was 65 ± 12 yrs and 76% of pts were male. Hypertension was present in 80% of pts, diabetes in 47%, renal insufficiency in 30%, prior MI in 58%, and prior PCI in 51%. Following PCI, 85% received beta blockers, and 78% received ACEI or ARBs. These variables were distributed equally between groups. Overall, mean LVEF improved significantly at follow-up (27.8 ± 6.8% vs 38.3% ± 14.7%, p<0.001). LVEF improved for all indications, though there was a trend toward greater improvement in pts with STEMI (table

). LVEF improved by > 5% in 76 pts (72%). In 60 pts (57%) LVEF improved to a value > 35%, including 14 pts with initial LVEF ≤ 25%. Multivariate analysis of variance with repeated measures demonstrated that the improvement in LVEF was independent of all other clinical variables (p< 0.001), none of which alone or jointly predicted improvement. These results suggest that significant improvement in LVEF can be expected in a majority of pts with ICM following PCI, irrespective of clinical indication, and cannot be predicted easily from standard clinical variables. Decisions regarding prophylactic ICD implantation should be deferred until after late reassessment of LVEF in most of these pts.
Abstract 657: Use of a Screening Tool Improves Appropriate Referral for Implantable Cardioverter Defibrillators for Primary Prevention
Authors: Gravelin Laura M , Remetz Michael , Radford Martha , Lampert Rachel
Published: July 2021

Background:
The AHA/ACC released guidelines in 2006 recommending the use of ICDs in patients with EF less than 35%, congestive heart failure and/or myocardial infarction. Several studies have suggested that ICDs for primary prevention are underutilized. We sought to determine if use of a screening tool would increase adherence to guidelines.

Methods:
Data were collected prospectively at the Yale Cardiology Group office during September and October 2007 (screening period). All patients’ charts were flagged with a screening tool that asked if the EF was less than 35%; if they were referred to an electrophysiologist (EP) and if not, why not. Clinical and demographic data were collected by chart review to determine appropriateness of referral. Control data were obtained through retrospective review of charts corresponding to all patient visits during March and April 2007 (control period).

Results:
As shown in the table

, the screening tool increased appropriate referral, from 39% of appropriate patients in the control group, to 72% during the screening period (p=0.06). More patients had been evaluated by an EP prior to the visit in the screening period (71%) than in the control period (47%). Approximately 2/3 of patients offered referral declined in both time periods.

Conclusions:
In this study, the first to investigate if a screening tool in the outpatient setting would increase the rate of appropriate patient referral for ICD as recommended by current ACC/AHA guidelines, utilization of a screening tool showed a trend toward increased physician adherence to guidelines. Surprisingly, over half of patients offered EP referral for ICD declined. Patient education regarding the benefits of ICDs may also increase appropriate use of this life-saving device.
Abstract 683: Regression of Plaque Volume in One Arterial Bed is not Necessarily Associated with Similar Changes in Other Vessels
Authors: Suzuki Takayuki , Nozawa Takashi , Sobajima Mitsuo , Ohori Takashi , Matsuki Akira , Fujii Nozomu , Igawa Akihiko , Kameyama Tomoki , Inoue Hiroshi
Published: July 2021

Background:
Population-based studies have shown good correlation between severity of atherosclerotic disease in one arterial bed and involvement of other vessels. However, in patients with coronary artery disease (CAD), it remains unclear whether atherosclerotic plaque in an artery might regress or progress in parallel with other vessels. Accordingly, the present study was performed in patients with CAD to compare changes in plaque volume (PV) between the left main (LMT) and right coronary arteries (RCA), thoracic descending aorta (TDA) and common carotid artery (CCA), and to clarify clinical factors and biomarkers which might affect changes in PV in each artery.

Methods:
Using 64-multislice computed tomography, PVs in each artery were determined before and after 2.0-year follow-up period in 52 patients with CAD (67.4±9.9yo). Based on our previous study using ultrasound, CCA-PV was determined at windows of 90–240HU and TDA-PV determined manually. Coronary soft plaque was determined at windows of 0–75HU. Plasma levels of hsCRP, matrix metalloproteinase (MMP)-9 and urinary 8-iso-prostaglandin F2
α
(PGF) were determined at baseline.

Results:
At baseline, PVs of TDA were correlated with CCA-PV (r=0.38, p<0.02), but PVs of other arteries did not correlate to each other. Two-year later, PVs of LMT, RCA, TDA, and CCA were reduced in 41, 62, 27, and 39% of patients, respectively. Changes in LMT-PV were weakly related with those of TDA-PV (r=0.37, p=0.02) and RCA-PV (r=0.31, p=0.08), but there were no relation between other arteries. The multivariate analysis revealed that treatment with statin and low LDL-cholesterol (C, <100mg/dl) were independent variables regarding a reduction in DTA-PV, but, in LMT, only low LDL-C was independent variable. However, there were no independent variables in RCA or CCA. The ratio of soft PV to total PV was similar between LMT (45.2±7.1%) and RCA (45.7±4.9%) at baseline and was unchanged in the follow-up study. None of hsCRP, MMP-9 or PGF levels was related with PVs of any arteries at baseline and with changes in PVs.

Conclusions:
Regression of PV in one arterial bed dose not necessarily allow us to predict atherosclerotic changes in the other vessels. Major factors which affect changes in PV may not be homogeneous between arteries.
Abstract 687: Cardiac Imaging with Multi-Slice Computed Tomography and Echocardiography to Guide Left Ventricular Lead Placement in Resynchronization Therapy. The CAMERA Trial
Authors: Curtin Ronan , Grimm Richard A , Saracino Giuseppe , Hsing Jeff , Hu Tingfei , Kuzmiak Stacey , Mulligan Larry J , Wilkoff Bruce
Published: July 2021

Cardiac resynchronization (CRT) is associated with reverse ventricular remodeling and improved clinical outcomes, but is not successful in all patients. We looked at the feasibility of combined non-invasive imaging of the coronary veins and assessment of left ventricular dyssynchrony prior to pacemaker implantation and whether this combination would improve procedural success and patient outcome. Heart failure patients with standard indications for CRT were randomized to cardiac Multi-Detector CT (MDCT) plus Doppler echocardiographic assessment of left ventricular dyssynchrony versus conventional management prior to CRT. Co-registration of MDCT and tissue synchronization imaging data using a novel software program was performed and the results were used to optimize left ventricular lead placement for patients in the non-invasive imaging arm. 21 patients were enrolled with 9 patients randomized to the contemporary non-invasive imaging strategy and 12 patients randomized to the control group. MDCT correctly identified 19 of 24 (79%) coronary venous branches ≥ 2 mm in diameter when compared to invasive coronary venography. Patients in the non-invasive imaging group had a significant improvement in the 6 minute walk time on 6 month follow up (76.1 ± 48.4 meters vs 20.0 ± 64.8 meters, p = 0.04). Improvements in NYHA functional class and LV remodeling at 6 months were not significantly different in the non-invasive imaging and control arms. Left ventricular lead placement was successful in all patients, however more patients in the non-invasive imaging arm demonstrated LV lead placement in the most delayed or adjacent myocardial segment (8 of 9 vs 6 of 12, p = 0.09). Those patients with “optimal” lead placement showed a trend towards improved 6 minute walk times and improvement in left ventricular function 6 months after biventricular pacing. An imaging-guided strategy with coregistration of MDCT coronary venous anatomy and delayed myocardial segments by tissue Doppler echocardiography prior to CRT is feasible and may improve patient outcomes by facilitating optimal LV lead placement.
Abstract 698: Late Enhancement in Isolated Noncompaction Left Ventricle is Related to Repetitive Ventricular Arrhythmias
Authors: Almeida Ana G , Marques João S , Guilherme Pereira , Dias Nuno C , varela Manuel G , Sargento Luis M , David Cláudio , Lopes Mário G
Published: July 2021

Isolated noncompaction left ventricle (INLV), an unclassified cardiomyopathy, is associated to an ominous prognosis due to arrhythmias, embolism and heart failure. We hypothesized that, in patients with INLV, the presence of late enhancement (LE), assessed by cardiovascular magnetic resonance (CMR) could be related to repetitive ventricular arrhythmias, which are determinants of sudden death.

Methods: 22 consecutive patients (pts), aged 35±11 years-old, 11 men) with INLV, were included. Diagnosis was established by echocardiography and CMR using accepted criteria. All underwent complete CMR LV assessment using a 17-segments model:

SSFP short-axis LV volumes and ejection fraction;

SSFP 2, 3, 4-chambers for noncompaction segmental distribution;

LV segmental LE (segmented inversion-recovery fast gradient-echo sequence, 10–15 mn after 0.2mmol/kg of Gd-DTP);

the number of segments with LE was assessed. A 24 hours-Holter monitoring was obtained in less than two-weeks interval and the number of repetitive ventricular arrhythmias was assessed (pairs, triplets, ventricular tachycardia).

Results: Non-compaction was present in 212 segments, involving mainly the inferior, posterior and lateral walls, but all walls were involved in different patients. LE was detected in 242 segments (8±2 per patient), present in all non-compaction segments and in 30 morphologically normal segments. Fibrosis was visible in the non-compacted layer (all segments) and in the more internal layer of the compacted myocardium (161 segments, 67%). LV end-diastolic volume was 128±22ml/m2) and there was LV dilatation and reduced ejection fraction in 14 patients. Repetitive ventricular arrhythmias were present in all patients, varying from 3 to 155 episodes in the Holter monitoring. There was a correlation between the number of ventricular arrhythmias the number of non-compaction segments (r=0.43, 0,04) and the number of LE present segments (r=0.65, p=0.001). No correlation was found with LV end-diastolic volumes or ejection fraction.

Conclusions: CMR late enhancement is a frequent finding in isolated non-compaction LV and is significantly associated to complex ventricular arrhythmias. Further study should address the prognostic meaning of LE in this condition
Abstract 708: Age and Gender Specific Changes in Tissue Doppler Derived Diastolic Index: A Doppler Echocardiographic Study in Healthy Individuals and Hypertensive Patients
Authors: Okura Hiroyuki , Takada Yuko , Yamabe Azusa , Toda Iku , Yoshiyama Minoru , Yoshikawa Junichi , Yoshida Kiyoshi
Published: July 2021

Although left ventricular diastolic function has been shown to deteriorate with advancing age, its gender specific change is unknown. The aim of this study was to investigate age and gender specific changes in tissue Doppler derived left ventrisular diastolic index. A total of 1,333 healthy individual without known heart disease (mean age 55 years, range 10–89) and 138 patients with hypertension (mean 65 years, range 50–89) were enrolled and studied. Using Doppler echocardiography, peak early mitral annular velocity (E′) was recorded and measured from apical 4 chamber view. E′ value was compared between male and female in each age group. (Figure

) Among those aged between 10–19, E′ was similar between male and female. E′ progressively decline with advancing age in both gender, but more so in male than in female until age 50. In subjects with age 50–59 years (mean 55 years), E′ become identical in male and female. After 50 years, E′ decline more so in female than in male. Similarly, E′ was significantly lower in elderly women among hypertensive population. Age-related changes in diastolic indices were gender specific. In the elderly population diastolic function deteliorate more significantly in female gender than in male. These results may explaine the relatively higher incidence in elderly female among patients with diastolic heart failure and higher cardiovascular mortality in female gender.
Abstract 721: Increased Fluorodeoxyglucose Uptake in the Abdominal Aortic Aneurysm (AAA) Wall Significantly Predicts the AAA Expansion Rate
Authors: Akram Kamran , Kolodny Gerald
Published: July 2021

18-Fluorodeoxyglucose (FDG)-PET is capable to image active vascular inflammation. FDG uptake is seen frequently in the wall of abdominal aortic aneurysm (AAA) suggesting active areas of inflammation with unknown clinical significance. We hypothesized that focally increased FDG uptake in the AAA wall predicts accelerated AAA expansion. 20 patients who had a baseline oncologic PET/CT study and a follow-up PET/CT or CT study after 1 year were included. The AAA size in two dimensions and maximum standardized uptake value (maxSUV) in focally increased FDG uptake in the AAA wall on the baseline PET/CT and the AAA size on the follow-up study were recorded in similar position. A difference greater than 1 mm in size on repeated measurements in the largest dimension between the first and second study defined AAA progression. ROC curve analysis and t-test were used for statistical analysis. A p-value<0.05 defined statistical significance. 13/20 (65%) had an increase (G1), 7/20 (35%) had stable (G2) AAA size. Cardiovascular risk factors were similar between the groups (Male 53%, HTN 80%, Hypercholesterolemia 60%, DM 13%, Smoker 53%, CAD or CAD equivalent 100%, Statin use 53%). Mean AAA growth in G1 and G2 was 4.2 and 0.86 mm/year, respectively. Mean maxSUV in the AAA wall was significantly higher for G1 compared to G2 (2.88 vs. 2.03, p=0.0004). ROC analysis showed FDG uptake in the AAA wall to be an excellent test to predict AAA expansion as evidenced by an AUC=0.95. A maxSUV of 2.45 served as best cut-point to predict AAA expansion (sensitivity 92%, specificity 86%, p<0.001). The correlation between maxSUV and degree of AAA expansion was r=0.7 (p<0.001). After adjusting for all risk factors and statin use the maxSUV remained an independent predictor of AAA size progression (p=0.007). This is the first study to demonstrate that FDG uptake in the AAA wall significantly predicts the AAA size expansion. FDG-PET/CT may provide a mean to identify patients at high risk of AAA expansion and rupture.
Abstract 724: The Addition of Coronary Artery Calcium Scoring (CAC) to Myocardial Perfusion Imaging (MPI) Improves Diagnostic Accuracy in the Detection of Obstructive CAD: Results of a Prospective Multicenter Trial
Authors: Thomas Gregory S , Budoff Matthew J , Mieres Jennifer H , Kazerooni Ella A , Shaw Leslee J
Published: July 2021

Background: The PICTURE Trial evaluated the accuracy of 64-CT coronary angiography (CCTA) & MPI to invasive coronary angiography (ICA) for the detection of obstructive CAD. CCTA included an evaluation of Coronary Artery Calcium. The objective of this substudy was to evaluate the combination of measures of ischemia & atherosclerosis, with MPI & CAC respectively.

Methods: 230 patients [52% male, 56.9 yrs] referred for MPI for chest pain were prospectively enrolled at 12 sites. 22% of patients underwent ICA for either abnormal MPI or coronary CCTA. The efficacy was assessed on a per-patient basis.

Results: Of the 47 patients prospectively enrolled that underwent ICA, the prevalence of a >50% stenosis by ICA was 47% (22/47). Mean CAC for all patients was 434 +/−926. The frequency of obstructive CAD based on MPI & CAC are shown in the Figure

. The odds (95% CI) for obstructive CAD is elevated 12.73-fold (2.43– 66.55) for ≥5% myocardium with stress defects (p<0.0001). Adding stress EF to perfusion results in a diagnostic sensitivity & specificity of 76.0% & 90.9% (p<0.0001). For CAC ≥100 alone, the diagnostic sensitivity & specificity is 76% & 72.7% (p=0.001). Adding a CAC score >100 to perfusion + EF increases the odds of obstructive CAD by 2.5-fold (1.31– 4.77, p=0.006). In patients with <5% defects, the addition of a CAC score of >100 increased the odds by 4.8-fold (0.95–24.14, p=0.057). ROC analysis revealed the % myocardium with stress defects categorized obstructive CAD with an area of 0.76 (95% CI=0.62– 0.90, p=0.002). Adding CAC improved the area to 0.85 (95% CI=0.74–0.96, p<0.0001).

Conclusion: The addition of CAC to MPI improves diagnostic accuracy in the detection of obstructive CAD.

Prevalence of ≥50% Obstructive CAD by MPI & CAC
Abstract 726: Cardiac Sympathetic Nerve System Abnormality Predicts Long-Term Outcome in Patients with Paroxysmal Atrial Fibrillation who did not have Conventional Risk Factors
Authors: Akutsu Yasushi , Kaneko Kyouichi , Kodama Yusuke , Li Hui-Ling , Suyama Jumpei , Shinozuka Akira , Gokan Takehiko , Kobayashi Youichi
Published: July 2021

Backgrounds:
A history of structural heart disease, heart failure, or stroke increases mortality in patients with atrial fibrillation (AF). However, a useful marker for predicting mortality is not clarified in AF patients without those conventional risks. We recently reported cardiac sympathetic nerve system (SNS) abnormality as a predictor of arrhythmogenic mortality. We hypothesized that SNS abnormality would be associated with increased mortality in patients with paroxysmal AF who didn’t have conventional risk factors.

Methods and Results:
Iodine-123 metaiodobenzylguanidine scintigraphy was performed to measure Heart/Mediastinum (H/M) ratio as SNS activity in 48 patients (mean ± standard deviation, age: 65 ± 14 years, 65% males) with paroxysmal AF who didn’t have structural heart disease, heart failure, or stroke. P wave dispersion on 12-lead ECG and left atrial dimension on echocardiography were also measured to evaluate structural and electrical properties. Over 11 years follow up, 15 patients (31.3%) transited to permanent AF, and 12 (25%) had cardio/cerebrovascular events. SNS abnormality (defines as H/M ratio <2.7) was a powerful predictor of vascular events (50% in 9 of 18 patients with SNS abnormality vs 10% in 3 of 30 patients without those, p=0.0008). After adjustment for potential confounding variables such as age, gender, P wave dispersion, left atrial dimension, transit to permanent AF, and medications, SNS abnormality remained predictive of vascular events with hazard ratio of 6.9 [95% confidence interval, 1.9 to 25.7 (p=0.004)].

Conclusion:
SNS abnormality is predictive of mortality in patients with paroxysmal AF who did not have conventional risk.
Abstract 754: Ascending Aortic vs. Femoral Cannulation for Acute Aortic Dissection Type A
Authors: Kamiya Hiroyuki , Halmer Dominique , Oezsoez Merve , Ilg Kathrin , Lichtenberg Artur , Karck Matthias , Kallenbach Klaus
Published: July 2021

Objectives:
The site of cannulation for repair of ascending aortic dissection remains controversial. Here we present our experience with ascending aortic cannulation for acute aortic dissection type A (AADA).

Methods:
From 01/1988 to 09/2007, we operated on 242 patients for AADA. Medical records of 235 patients who received ascending aortic cannulation or femoral cannulation were retrospectively reviewed. Long term follow-up was complete in 97% of patients. Cannulation was accomplished in 82 patients through the ascending aorta and in 153 patients through the femoral artery.

Results:
There were no significant differences in preoperative characteristics between groups. Similarly, there were no differences in preoperative patient characteristics and intraoperative parameters including operation time (ascending 357±139 vs. peripheral 342±125 min.; p=0.40), bypass time (ascending 219±105 vs peripheral 206±96 min.; p=0.32), cross-clamp time (ascending 106±43 vs peripheral 106±51 min.; p=0.69), hypothermic circulatory arrest time (ascending 28±19 vs peripheral 27±23 min.; p=0.73), and percentage of total arch replacement (ascending 54.9% vs peripheral 55.7%; p=0.44). Hospital mortality was 12.2% in each group (p=0.98), and incidence of stroke was 4.9% in ascending group and 4.5% in peripheral group (p=0.86). During follow-up (mean 5.5 years), survival at 5 years and 10 years was 65% and 41% in ascending group and 64% and 46% in peripheral group, respectively (p=0.97). No persistent malperfusion by ECC was observed after aortic cannulation.

Conclusions:
Direct cannulation of the dissected aorta in patients with AADA was safe with acceptable results in our study cohort. The conventional femoral cannulation had no advantage on the direct cannulation strategy, and the avoidance of additional incision and possible peripheral vascular injury may favor the direct cannulation strategy.
Abstract 810: Impact of Elevated Plasma Matrix Metalloproteinase-2 on Prognosis in Hypertrophic Cardiomyopathy: Evidence from Long-Term Follow-Up of Genotyped Patients
Authors: Masuta Eiichi , Ino Hidekazu , Fujino Noboru , Uchiyama Katsuharu , Hayashi Kenshi , Sakata Kenji , Tsubokawa Toshinari , Sakamoto Yuichiro , Funada Akira , Muramoto Akihiko , Yamagishi Masakazu
Published: July 2021

Background: Previous studies suggest that production of matrix metalloproteinase-2 (MMP-2) which is responsible for cardiac remodeling could determine prognosis of hypertrophic cardiomyopahty (HCM). However, few data exist regarding the importance of MMP-2 production in clinical settings. Therefore, we determined MMP-2 levels correlated to prognosis in HCM with sarcomere gene mutations.

Methods and Results: Echocardiography and determination of plasma MMP-2 levels by enzyme-linked immunoassay were simultaneously performed in 31 HCM patients (22 women, mean age 56±12 years) with sarcomere protein gene mutation including 22 for cardiac troponin I, 5 for cardiac myosin binding-protein C, 3 for cardiac troponin T and 1 for beta-myosin heavy chain. Major cardiac events such as hospitalization due to congestive heart failure or ventricular fibrillation and mortality were prospectively examined for follow-up period of 48.4±29.1 months. When patients were divided into two groups (Group A: MMP-2 ≥800 ng/ml n=16 and Group B: MMP-2<800ng/ml n=15), there was no differences in mean age (59.4±11.7 year vs 53.1±11.3 year, p=0.13). On echocardiograms, interventricular septal thickness in group A (11.7±4.2 mm) was smaller than that in group B (15.9±4.8 mm, p<0.05) and percent fractional shortening (FS) was significantly impaired in group A (24.8±12.5%) in comparison with that in group B (37.7±8.1%, p=0.002). There was negative correlation between the MMP-2 levels and FS (p<0.001, r=0.76). The frequency of cardiac events was significantly higher in group A (10 patients of 16 patients) than in group B (1 patient of 15 patients, p=0.0012). Importantly, 5 patients of group A died, although none of groupB patients did (p=0.018).

Conclusion: These results demonstrate that the high plasma concentration of MMP-2 (≥800 ng/ml) could be a predictor of prognosis in HCM with sarcomere mutations probably through reflecting impaired left ventricular function.
Abstract 855: White-Coat Effect among Older Patients with Suspected Cognitive Impairment: Prevalence and Clinical Implications
Authors: Bo Mario , Massaia Massimiliano , Merlo Chiara , Brescianini Alessia , Sona Alessandro , Canadè Antonella , Fonte Gianfranco
Published: July 2021

OBJECTIVES
To evaluate prevalence of the white-coat effect (WCE), and its association with individual anxiety and insight of disease, among older patients attending for a first visit for suspected cognitive impairment (CI).

DESIGN
Prospective cohort study

SETTING
An Alzheimer Evaluation Unit.

PARTICIPANTS
Outpatients aged 55 years or older with suspected CI

MEASUREMENTS
WCE was defined as a difference of at least 20 mmHg in systolic or 10 mmHg in diastolic blood pressure (BP) measured either by a physician during the visit or by a nurse (before and after the visit), compared with home self blood pressure measurement (SBPM). Severity of CI was evaluated through the Mini-Mental State Examination (MMSE); the Clinical Insight Rating Scale (CIR) and the Guidelines for the Rating for Awareness Deficits (GRAD) were used to evaluate the subject’s insight; anxiety disorder was evaluated using the 7-question Generalized Anxiety Disorder scale (GAD-7)

RESULTS
Among 273 subjects, prevalence of WCE was 52%, 32.6% and 30.4%, according to physician’s and nurse’s BP measurements, respectively (p=.000). Prevalence of WCE did not differ between patients diagnosed with and without dementia, but was higher among patients with than in those without anxiety disorder (70.7% vs 38.2%, p=.000). Positive relations were observed between severity of anxiety and insight of disease, which were both inversely related with severity of CI

CONCLUSIONS
WCE is extremely common and is roughly correlated to individual anxiety and insight of disease among older outpatients with suspected CI; overestimation of hypertension severity might lead to unnecessary drug treatment and greater health costs in this setting.
Abstract 908: Efficacy of Statin Treatment in Normocholesterolemic Patients with Coronary Artery Disease: Evaluation by Integrated Backscatter Intravascular Ultrasound: 6-month Prospective Study
Authors: Iida Kiyoshi , Tani Shigemasa , Matsumoto Michiaki , Kawamata Hirofumi , Kumabe Narimichi , Anazawa Takeo , Nagao Ken , Hirayama Atsushi
Published: July 2021

Few data exist regarding the effect of statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, on tissue characterization on coronary plaques in normocholesterolemic patients with coronary artery disease (CAD). The aim of this study was to clarify statin-induced the change in tissue characteristics on coronary atherogenesis in normocholesterolemic patients using an integrated backscatter intravascular ultrasound (IB-IVUS). We compared plaque characteristics on IB-IVUS and serum lipid markers in normocholesterolemic patients with CAD (n = 26) at baseline and after 6-month statin treatment. Totally, 1,288 (each of 644 lesions at baseline and after 6-month) non-target coronary lesions with mild to moderate stenosis were measured. After 6-month treatment, significant decrease in percentage lipid pool area (from 49 ± 10 to 46 ± 10%, p < 0.05) and increase in percentage dense fibrous plaque area (from 50 ± 9% to 53 ± 9%, p < 0.05) were found. Compared to the baseline values, there were significant reduction in serum low-density lipoprotein (LDL) cholesterol (111 ± 34 vs. 97 ± 28 mg/dL, p < 0.005) and significant increase in serum high-density lipoprotein (HDL) cholesterol (46 ± 13 vs. 49 ± 12 mg/dL, p < 0.05). Percent changes in HDL-cholesterol levels were inversely correlated with changes in %lipid pool (r = 0.40, p < 0.05) and positively correlated with changes in %fibrous plaque (r = 0.44, p < 0.05). We demonstrated that six months statin treatment changed in tissue characteristics towards coronary plaque stabilization, accompanying the changes in HDL-cholesterol levels. These results provide further support for the beneficial effect of statin on tissue characteristics on coronary artery in CAD patients with not only hypercholesterolemia but also normocholesterolemia.
Abstract 911: Usefulness of Coronary Fractional Flow Reserve Measurements to Guide Clinical Decisions in Intermediate Left Main Coronary Stenoses. Results of a Study Including 142 Consecutive Patients
Authors: Rodès-Cabau Josep , Courtis Javier , Potvin Jean-Michel , Côté Melanie , Dery Jean-Pierre , Larose Eric , Nguyen Can M , Gleeton Onil , Roy Louis , DeLarochellière Robert , Bertrand Olivier F
Published: July 2021

Background:
Limited data exist on the use of fractional flow reserve (FFR) measurements to guide clinical decisions in patients with intermediate left main coronary artery (LMCA) stenosis.

Objectives:
To evaluate the usefulness of FFR measurements to guide the clinical decision in patients with intermediate LMCA stenosis and to determine the predictors of major adverse cardiac events [MACE] (cardiac death, myocardial infarction, coronary revascularization) in such cases.
Methods:
A total of 142 consecutive patients (mean age 62 ± 10 yrs) with intermediate LMCA stenosis (mean percent diameter stenosis 42 ± 13%) were included. All patients underwent FFR measurement after intracoronary (ic) administration of adenosine at a dose ≥30 μg. Special care was taken in cases with ostial lesions to pull the catheter out of the LMCA after adenosine administration. The clinical decisions were based on FFR as follows: coronary revascularization was recommended if FFR was <0.75, medical treatment if FFR was >0.80, and individualized decision based on additional clinical data if FFR was between 0.75 and 0.80. The occurrence of MACE was evaluated at 14 ± 11 months follow-up.

Results:
Mean FFR was 0.81 ± 0.09 after the administration of a mean dose of 176 ± 99 μg of ic adenosine. Based on FFR results, sixty patients (42%) underwent coronary revascularization and 82 patients (58%) received medical treatment. At follow-up, the incidence of MACE related to the LMCA stenosis was 13% in the medical treatment group and 7% in the coronary revascularization group (p=0.27). The incidence of cardiac death and myocardial infarction was 7% in both groups (p=1.0). In the medical treatment group, patients with MACE had received a lower dose of ic adenosine (86 ± 57 μg vs. 167 ± 102 μg, OR: 1.39 for each decrease of 30 μg of ic adenosine, 95% CI 1.02–1.89, p=0.04) and were more frequently diabetics (55% vs. 21%, OR: 4.40, 95% CI 1.17–16.42, p=0.02).

Conclusions:
FFR measurement is helpful in guiding the decision as to whether to revascularize patients with intermediate LMCA stenosis. However, diabetic patients remain at higher risk, and higher doses than previously recommended of ic adenosine should be used in the evaluation of LMCA to avoid cardiac events due to underestimation of stenosis severity.
Abstract 957: Elevated Levels of Neopterin are Associated with Carotid Complex Plaques in Patients with Stable Angina Pectoris
Authors: Sugioka Kenichi , Naruko Takahiko , Hozumi Takeshi , Ehara Shoichi , Okuyama Takuhiro , Oe Hiroki , Shirai Nobuyuki , Nakagawa Masashi , Kitabayashi Chizuko , Furukawa Atsuko , Itoh Akira , Yoshiyama Minoru , Ueda Makiko
Published: July 2021

Background:
Neopterin is produced by activated macrophages and serves as an activation marker for monocytes/macrophages. Serum levels of neopterin have been shown to be associated with the presence of complex coronary lesions in unstable angina pectoris. However, the relationship between neopterin levels and complex carotid lesions is still unknown. We investigated the association between plasma neopterin levels and the characteristics of carotid plaques in patients with stable angina pectoris (SAP). Moreover, we immunohistochemically studied the presence of neopterin in carotid endarterectomy specimens.

Methods:
We studied 65 SAP patients who were scheduled coronary angiography. In all patients, plasma neopterin levels were measured and carotid ultrasound was performed for evaluation of carotid artery plaque score (PS) defined by the sum of plaque thickness, plaque number (PN) and plaque surface irregularity. Frozen tissue of 40 endarterectomy specimens for extracranial high-grade carotid stenosis were immunohistochemically examed with antibodies against macrophages and neopterin.

Results:
There was no significant correlation between plasma neopterin levels and PS (P=0.38) or PN (P=0.49). On the other hand, plasma neopterin levels were significantly higher in patients with carotid plaque surface irregularity compared with patients without it (25.4 ± 13.5 nmol/L vs.16.9 ± 6.5 nmol/L, P=0.0015). Carotid plaque irregularity was detected more frequently in patients with higher neopterin levels (>=18.5 nmol/L median) compared with those with lower neopterin levels (41.9% vs. 16.1%, P=0.025). Using multivariate analyses, nepopterin levels (OR, 1.11; 95%CI, 1.01 to 1.21; P=0.023) and the number of diseased coronary vessels (OR, 2.51; 95%CI, 1.01 to 6.22; P=0.047) are independently associated with carotid plaque irregularity. Immunohistochemical staining showed abundant neopterin-positive macrophages in the unstable carotid plaques.

Conclusions:
Neopterin levels are associated with carotid complex plaques rather than the severity of carotid atherosclerotic change. Neopterin can be considered as one of the significant markers of plaque destabilization in not only coronary artery but carotid artery atherosclerotic lesions.
Abstract 1013: Depression and Heart Failure: A Recipe for Inflammation?
Authors: Cross Rebecca L , Evangelista Lorraine , Bower Julienne , Irwin Michael , Doering Lynn V
Published: July 2021

Background:
Depression is common among HF patients, and is independently associated with morbidity and mortality. Proinflammatory markers, which are elevated in each condition, may adversely affect clinical outcomes in HF patients. Initial studies show that tumor necrosis factor (TNF)-α is related to depression in this population. To date, the relationship of other proinflammatory markers to depression in HF is unclear. Thus, we investigated differences in soluble intracellular adhesion molecule (sICAM)-1, interleukin (IL)-6, and TNF-α between HF patients, with and without depressive symptoms, and controls, with and without depressive symptoms.

Methods:
Individuals with HF (n = 29, aged 55 ± 8 years, 76% male) and without HF (n = 43, aged 50 ± 7 years, 51% male) were recruited from HF clinics and from the community. Subjects completed the Beck Depression Inventory-II (BDI), were classified as depressed (BDI ≥ 10) or non-depressed (BDI < 10), and underwent phlebotomy. Proinflammatory markers were measured by ELISA. Data were analyzed with linear regression and ANCOVA, using age, gender, BMI, and medications as covariates.

Results:
Seventeen HF (58%) and 7 controls (16%) were coded as depressed. The depressed HF subgroup differed from the non-depressed controls for each of the inflammatory markers (see Table

, p < .05). Additionally, the presence of both HF and depression were independently associated with an increase in sICAM-1 (β = 3.05, p = .003) and IL-6 (β = 2.3, p= .03), but not TNF- α (β = 1.8, p = .07).

Conclusion:
Increased inflammation in HF results from multiple biomarkers, including sICAM-1 and IL-6. The combination of HF and depression is an independent predictor of increased inflammation. This relationship may partly explain increases in morbidity and mortality associated with comorbid depression and HF. Careful assessment and treatment of depression in HF patients is warranted.

Results of ANCOVA for HF and Controls
Abstract 1014: Geographical Analysis of Cardiac Interventional Services in Alabama
Authors: Graves Barbara A , Weber Joseph
Published: July 2021

Access to Cardiac Interventional Services in Alabama: A Geographical Information System Analysis Cardiovascular disease is the leading cause of death in Alabama. The purpose of this study was to explore the geographical accessibility of persons in Alabama to cardiac interventional services (CIS) for the treatment of acute myocardial infarction (MI). A retrospective cohort and descriptive ecological study DESIGN was used. A geographical information system (GIS) was used to visually identify and empirically measure spatial relationships among the variables of myocardial infarction. The unit of analysis was by county for the 149 total counties in Alabama. The sample consisted of all deaths due to MI recorded in the state of Alabama from 1996 through 2001 as reported to the National Center for Health Statistics. County age-adjusted MI mortality rates were the outcome variable. A total of 20 hospitals with CIS were identified within Alabama. GIS analysis revealed that 58.2%, 85.9%, and 96.0% of the total Alabama population were within 30, 60, or 90 minutes travel time, respectively, of a hospital with CIS. Maps were generated to provide visualization of CIS coverage areas. One distinct area was noted at greater than 90 minutes from a hospital with CIS. This area is within the Black Belt Region and is well known for a mostly black, impoverished population who are subject to health disparities. The American College of Cardiology and the American Heart Association recommend early reperfusion treatment for patients with MI (within 2 hours). Research supports percutaneous transluminal coronary angioplasty (PTCA) as beneficial, useful, and effective in the treatment of MI. Timely transport of MI victims to a hospital with CIS within 90 minutes and a “door-to-needle” time of 30 minutes are goals that can promote prompt and effective treatment in reducing MI mortality. Use of these standards allows for a maximum travel time of 90 minutes. GIS analysis demonstrated that 96% of Alabama’s population is within 90 minutes travel time of a hospital with CIS. But for the best outcomes to occur, only 58.2% of Alabamians have access.
Abstract 1034: Complex Fractionated Atrial Electrograms Are Often Due to Wavefront Collision or Functional Block Rather than Focal Triggers in a Canine Model of Atrial Fibrillation
Authors: Gerstenfeld Edward P , Gojraty Sattar , Valles Hermengol , Roux Jean-Francois , Lavi Nimrod , Michele John
Published: July 2021

Complex fractionated atrial electrograms (CFEs) have been described as a target during atrial fibrillation (AF) ablation, however, the mechanism leading to CFEs is poorly understood. We used noncontact mapping in a canine model of AF to determine the activation patterns in areas characterized by CFEs. Sustained AF was induced in 5 canines with 12 weeks of atrial tachy-pacing. A noncontact Multielctrode Array (MEA) was deployed in the left atrium (LA) and a contact bipolar CFE map was constructed. Areas of CFE were outlined on the map, and the MEA was then used to reconstruct wavefront propagation through CFE areas during 3 separate recording segments for each CFE site. There were 18 CFE regions identified (3.8/dog) and 54 noncontact CFE activation sequences studied. Activation patterns during the three recoding segments over time were consistent in 11/18 CFE regions (61%). The CFE regions were stereotypically located at the PV/LA junctions and the LA roof. Thirty-five CFE regions were characterized by wavefront collision, usually between circulating LA wavefronts and entry/exit from the PVs. Thirteen CFE regions were noted to be the central functional barrier of a rotor (Figure

) or partial rotor. Five regions were characterized by repeated conduction through a central isthmus with wavebreak. In this pacing-induced AF model, common causes of CFEs include

collision between circulating LA wavefronts

conduction through channels of functional block,

the central vortex of a circulating rotor. The vast majority of these CFE regions were caused by heterogeneous anatomy and areas of functional block rather than true “drivers” of AF.
Abstract 1036: Impact Of Emotions On Triggering Of Atrial Fibrillation
Authors: Lampert Rachel , Burg Matthew , Brandt Cynthia , Dziura James , Liu Haibei , Donovan Theresa , Soufer Robert , Jamner Larry
Published: July 2021

Small case-series suggest the possibility of “adrenergically-mediated” atrial fibrillation (AF) in humans, and pharmacological autonomic manipulations can alter atrial electrophysiology. Whether AF can be triggered by emotional arousal is unknown. In this prospective, controlled, electronic-diary-based study of emotions preceding AF, patients with a history of paroxysmal or persistent AF, (N=75, mean age 58 years, 60% male, 60% taking beta-blocking medications) recorded their rhythm on event-monitor at the time of AF symptoms, and completed a diary entry querying mood states for the preceding 30 minutes (pre-AF “case period”) over a one-year follow-up. Also, patients underwent monthly 24-hour holter-monitoring, and were prompted by the diary to complete an entry twice per hour. Diaries recorded during sinus comprise the controls. Further, patients completed a diary each night. Patients’ exposure to each emotion was compared between the pre-AF case period and control periods using GEE modeling. Similarly, emotion on a nightly diary preceding AF on the following day was compared to that emotion on other nightly diaries. 119 AF episodes, (in 23 subjects), and 5796 holter-confirmed sinus rhythm control-periods had associated diary data. 95 pre-AF nightly diaries and 9306 control nightly diaries were completed. The likelihood of an AF episode was increased by negative emotions and decreased by happiness whether reported immediately preceding an AF episode, or the night before (table

). Impact of emotion was gender-specific: anger increased the odds of subsequent AF for men, worry for women. In stratified analysis, emotion triggered AF only in those not taking beta-blockers (data not shown). Negative emotions can trigger AF, while happiness is protective. Whether interventions aimed at reducing the physiological effects of emotional stress may lessen AF burden requires further study.
Abstract 1058: The Athlete’s Heart - Gender Aspects
Authors: Steding Katarina , Engblom Henrik , Carlsson Marcus , Mosén Henrik , Buhre Torsten , Wohlfart Björn , Arheden Håkan
Published: July 2021

Training induced morphological changes to the heart in male subjects has previously been well described. Only a few studies include females. The aim of this study was to investigate if the morphological response to training differs between male and female athletes. Eighteen triathletes (6 female) and 59 controls (19 female) underwent cardiac magnetic resonance imaging (CMR). Total heart volume (THV), left ventricular mass (LVM) and end diastolic volume (EDV) was calculated using planimetry derived from steady state free precession cine images. Mann-Whitney non-parametric t-test was used to compare THV/body surface area (BSA), LVM/THV and EDV/THV in the four groups. THV/BSA was significantly higher in athletes, both for males and females (p<0.0001, p<0.001 respectively). Male controls had a significantly higher THV/BSA when compared to female controls (p=0.004) and also LVM/THV (p=0.001). However, there were no significant differences between male and female athletes for any of the variables studied. Long term endurance training increases THV in the same order of magnitude in both male and female athletes. The differences seen between male and female control subjects are not found in male and female athletes.