bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 3071: Reversible Transmural Electrical Dyssynchrony in Pacing-Induced Congestive Heart Failure
Authors: Mathuria Nilesh , Wang Jianwen , Gilbert April L , Schulz Daryl G , Naware Mihir , Siou Jeff , Panescu Dorin , Youker Keith A , Shih Hue-Teh , Nagueh Sherif F , Khoury Dirar S
Published: July 2021

Introduction:
Inter and Intra-ventricular dyssynchrony can develop during congestive heart failure (CHF). We investigated transmural electrical conduction properties within the LV wall during CHF and subsequent recovery.

Methods:
Biventricular pacemakers were implanted in 8 normal mongrel dogs (mean weight: 38 kg), and continuous RV pacing (230 –250 bpm) was initiated to induce CHF. Echocardiography, catheterization, and LV myocardial biopsy were performed biweekly while pacing was temporarily stopped. At each catheterization, an intracardiac electrode-catheter was placed at the LV endocardium against the pacemaker coronary sinus lead tip located at the LV epicardium. Intrinsic transmural electrical conduction delay was measured by recording endocardial electrograms via the electrode-catheter and epicardial electrograms via the pacemaker coronary sinus lead, both in posterolateral LV. The conduction delay was also assessed during LV pacing via the endocardial catheter and measuring the time to the coronary sinus lead tip. Pacing was stopped in 4 dogs with CHF to allow for recovery of function. All times were corrected for heart rate.

Results:
All dogs developed CHF within 2– 4 wks of pacing from baseline (EF: 27±8 vs. 49±4%; LVEDP: 20±9 vs. 6±3 mmHg; QRS: 98±8 vs. 70±14 msec with no LBBB). There was no change in LV wall thickness during CHF compared to baseline (0.9 cm), while LV myocyte size increased (21.7±6.6 vs. 16.2±1.5 μm). Transmural endocardial-to-epicardial intrinsic electrical conduction time lengthened during CHF compared to baseline (35±13 vs. 10±5msec, P<0.001). In dogs recovering from CHF 2– 4 wks after cessation of pacing, intrinsic transmural endocardial-to-epicardial conduction time shortened compared to CHF (10±9 vs. 39±1ms, n=4), which was consistent with LV endocardial pacing (recovery: 47.5±6 ms; CHF: 70.7±9 ms, n=3).

Conclusions:
Electrical transmural dyssynchrony develops as a consequence of pacing-induced CHF, and is reversible upon recovery of cardiac function. These changes are not associated with LV wall thickness. This novel finding suggests another aspect of ventricular dyssynchrony that may not be reflected by routine noninvasive modalities and warrants further investigation.
Abstract 3084: Accuracy of Multidetector CT in Assessing the Degree of Stenosis Caused by Calcified Coronary Artery Plaques
Authors: Zhang Shaoxiong , Levin David , Halpern Ethan , Fischman David , Savage Michael , Walinsky Paul
Published: July 2021

Purpose:

Because of beam hardening and blooming artifacts, it is difficult to determine the degree of stenosis caused by calcified CAPs at CCTA. Our goal was to determine how accurate CCTA is in evaluating these lesions.

Method & Materials:

Thirty-one patients who had 1 or more calcified CAPs at CCTA underwent cardiac catheterization (cath). CCTAs were reviewed by 2 experienced radiologists blinded as to cath results. CCTAs were performed on 40- and 64-detector row CTs (Philips Medical Systems, Cleveland, OH) and post-processed using Philips Brilliance workstations. The size of the calcified CAPs was graded subjectively as small, moderate, or large. Using post-processing techniques such as segmentation and tracking, we attempted to determine whether the calcified lesions were obstructive (>50% diameter narrowing) or nonobstructive (<50% diameter narrowing). Concordance with cath was then determined.

Results:

Calcified CAPS were graded as small at 61 locations, moderate at 22 locations, and large at 43 locations. With small calcified CAPs, CCTA and cath were concordant in 58/61 (95%). CCTA overestimated the degree of stenosis in 2 and underestimated it in 1. With moderate-sized calcified CAPs, CCTA and cath were concordant in 20/22 (91%). CCTA overestimated the degree of stenosis in the other 2. With large calcified CAPs, CCTA and cath were concordant in 29/43 (67%). In all the other 14, CCTA overestimated the degree of stenosis. In detecting obstructive lesions caused by the large calcified CAPs, CCTA sens=100%, spec=44%, PPV=56%, NPV=100%, accuracy=67%.

Conclusion:

CCTA accurately predicts the presence of obstructive disease in >90% of small and moderate-sized calcified CAPs. With large calcified CAPs, CTA correctly predicts presence of obstructive disease about 2/3 of the time. When errors occur, they are virtually always due to overestimation of the degree of stenosis.
Abstract 3103: A Cardiopulmonary Exercise Testing Score for Predicting Risk in Patients with Heart Failure
Authors: Myers Jonathan , Arena Ross , Bensimhon Daniel , Abella Joshua , Hsu Leon , Chase Paul , Guazzi Marco , Peberdy Mary Ann
Published: July 2021

Background.
Cardiopulmonary exercise test (CPX) responses, including markers of ventilatory inefficiency (eg. the VE/VCO
2
slope and oxygen uptake efficiency slope [OUES]), and hemodynamic responses, such as heart rate recovery (HRR) and chronotropic incompetence (CRI) predict outcomes in patients with heart failure (HF). However, multivariate risk models integrating the full range of CPX variables have not been fully explored.

Methods:
710 HF patients (568 male/142 female, mean age 56±13 years, EF 33±14%) underwent CPX and were followed for major cardiac events (death, transplant, LVAD implantation) for a mean of 29± 25 months. The age-adjusted prognostic power of peak VO
2
, VE/VCO
2
slope, OUES (VO
2
= a log
10
VE + b), resting end-tidal CO
2
pressure (PetCO
2
), HRR, and CRI were determined using Cox proportional hazards, optimal cutpoints were determined, the variables were weighted, and a multivariate score was derived.

Results.
There were 111 composite outcomes. Multivariately, only CRI was not a significant predictor of risk. The VE/VCO
2
slope (≥ 34) was the strongest predictor, and was attributed a relative weight of 7, with weighted scores for abnormal HRR (≤6 beats at 1 min), OUES (>1.4), PetCO2 (<33mmHg), and peak VO
2
(≤14 ml/kg/min) having scores of 5, 3, 3, and 2, respectively. A Kaplan-Meier curve illustrating the incremental scores is presented in the figure

; a score >15 was associated with an annual mortality rate of 26% and a relative risk of 15.

Conclusion
. A score using CPX responses provides a simple and integrated method that powerfully predicts outcomes in patients with HF.
Abstract 3108: Single Molecule Troponin Detection to Assess for Transient Myocardial Ischemia
Authors: Sabatine Marc S , Morrow David A , Lu Quynh Anh , de Lemos James A , Jarolim Petr , Todd John A , Braunwald Eugene
Published: July 2021

Background
: It has been proposed that small amounts of cardiac troponin (Tn) may be released from myocytes in the setting of reversible myocardial injury. We hypothesized that a more sensitive Tn assay could permit the quantification of transient myocardial ischemia.

Methods
: Blood samples were obtained before and 4 hrs after stress testing with perfusion imaging in 99 pts w/o recent angina. Tn was measured using the current generation TnT assay (Roche, limit of detection, LOD, 0.01 ng/ml) and the new Singulex TnI assay, which, using single molecule counting technology, has a LOD 50 fold lower (0.2 pg/ml). Pts were categorized by severity of ischemia on perfusion imaging; median changes in Tn levels were compared across ischemic groups.

Results
: Using the Singulex assay, TnI was detectable in all pts before stress testing (median 4.4 pg/ml). The median duration of angina during testing was 0, 0, and 3 mins in pts with none, mild, and mod/sev ischemia. By 4 hrs, TnI levels were unchanged in pts w/o ischemia, whereas circulating levels had significantly increased by 1.37 pg/ml (24%) in pts with mild ischemia (P=.002) and by 2.08 pg/ml (40%) in pts with mod/sev ischemia (P=.0006) (Fig

). In a multivariable model that included mins of exercise, angina, and ST changes, change in TnI was a significant predictor of ischemia (OR 3.36, P=.03). In contrast, using the existing TnT assay there were no detectable differences in Tn levels (median difference 0.00 ng/ml in all groups).

Conclusion
: A 50-fold more sensitive troponin assay can quantify rises in circulating troponin in patients experiencing brief, provoked myocardial ischemia. The clinical applications of such assays warrant further study.
Abstract 3109: Exaggerated Blood Pressure Response During Treadmill Test is Accompanied by a State of Pronounced Albuminuria, Hypoadiponectinemia and Increased Asymmetric Dimethylarginine Levels in Essential Hypertension
Authors: Dimitriadis Kyriakos , Tsioufis Costas , Tsiachris Dimitris , Thomopoulos Costas , Skiadas Ioannis , Michaelides Andreas , Stefanadis Christodoulos , Kallikazaros Ioannis
Published: July 2021

Introduction:
A hypertensive response to exercise (HRE) is associated with high cardiovascular risk, whereas the data regarding its relation to markers of atherosclerosis progression are currently scarce.

Hypothesis:
Urinary albumin excretion, expressed as the albumin to creatinine ratio (ACR), asymmetric dimethylarginine (ADMA) levels, and adiponectin may be correlated with HRE in essential hypertensives.

Methods:
Our population of 109 newly diagnosed untreated non-diabetics with stage I to II essential hypertension [76 men, mean age =52 years, office blood pressure (BP) = 146/94 mmHg] with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n=34) (peak exercise systolic BP ≥ 210mmHg in men and ≥190 mmHg in women) and to those without HRE (n=75). In all subjects ACR values were determined as the mean of two non-consecutive morning spot urine samples and venous blood samples were drawn for estimation of adiponectin and ADMA concentrations.

Results:
Patients with HRE compared to those without HRE were older (55 ± 9 vs 51 ± 9 years, p<0.05), had greater 24-h systolic BP (141 ± 13 vs 132 ± 12 mmHg, p<0.05), while did not differ regarding metabolic profile and left ventricular mass index (p = NS). Patients with HRE compared to those without HRE exhibited greater levels of ADMA (0.62 ± 0.05 vs 0.54 ± 0.04 μ mol/l, p<0.0001) and ACR (61.4 ± 12 vs 15.2 ± 2.2 mg/g, p<0.0001), whereas had lower adiponectin values (6.1 ± 1.4 vs 9.3 ± 2.1 μg/ml, p<0.0001), independently of confounders. In the total population, peak exercise systolic BP was related to 24-h systolic BP (r=0.239, p<0.05), ACR (r=0.432, p<0.0001), ADMA (r=0.260, p=0.007), and negatively associated with adiponectin (r = −0.216, p<0.05). Multiple regression analysis revealed that 24-h systolic BP (b=0.232, p=0.023), male sex (b=0.240, p=0.029) and ACR (b=0.450, p<0.0001) were independent predictors of peak exercise systolic BP.

Conclusions:
In essential hypertension, a HRE is associated with hypoadiponectinemia, augmented ADMA and ACR values, reflecting activation of diverse pro-atherosclerotic pathways. These findings suggest that treadmill exercise testing could be an additional tool to identify hypertensive patients with pronounced cardiorenal vascular dysfunction.
Abstract 428: Creating Biocompatible 3-D Scaffolds for Engineering Cardiovascular Tissues: Heart, Lung, and Kidney
Authors: Matthiesen Thomas , Ott Harald C , Goh Sak-Kia , Kren Stefan M , Taylor Doris A
Published: July 2021

Background
. Biocompatibility is an essential property of any extracellular matrix (ECM) used in tissue engineering. Perfusion decellularized whole cadaveric organs could provide novel scaffolds for organogenesis but their long term biocompatibility remains unknown. .

Hypothesis:
Perfusion decellularization of mammalian organs yields a biocompatible matrix that influences cell growth differentially in non-perfused 2-D tissue culture conditions.

Methods
. Adult F344 rats were euthanized after systemic heparinization. Heart, lung, liver, and kidney were removed, canulated, and perfused with SDS to remove cellular debris. Subsequent washing with 1% Triton-X-100 and PBS was performed to remove detergent. Biocompatibility was assessed by co-culture of ECM from each organ with either rat skeletal myoblasts (SKMBs) or mouse embryonic stem cells (mESCs). Decellularized tissue was cut into 0.5x1cm pieces and seeded with 40K cells each. Cells were fed daily and photographed on day 3, 9, 13, 17 (SKMB) or day 3, 5, 10, 12, 14, 20, 24 (mESC). Double-blinded high powered field (HPF) analysis was used to quantify cell growth over time. At day 17 or 24 tissues were harvested for histological analysis and TUNEL assays to assess cell number and viability.

Results
. Cell viability was >90% in all cases but showed no organ preference. heart + SKMB 90.2 ± 2.4 and mESC 98.3 ± 1.1; lung + SKMB 96.3 ± 1.9 and mESC 96.4 ± 1.0; liver + SKMB 90.3 ± 3.2 and mESC 97.7 ± 1.6; kidney + SKMB 89.5 ± 4.5 and mESC 98.1 ± 1.4 Cell number on the other hand increased in all ECM coculture conditions (Table 1

;) but with two distinct patterns depending on the organ. Maximal cell density was observed in Kidney followed by Liver, Lung and Heart (Table 1

). Conclusion. SDS-based perfusion decellularization of cadaveric heart, lung, liver, and kidney provides biocompatible scaffolds that are conducive to cell growth and viability. Kidney and liver scaffolds allowed for greatest cell proliferation over time.
Abstract 3123: Doppler Echocardiography Reliably Predicts Severe Pulmonary Regurgitation (PR) As Quantified by Cardiac Magnetic Resonance (CMR)
Authors: Renella Pierangelo , Aboulhosn Jamil , Lohan Derek G , Jonnala Praveen , Finn J. P , Child John S
Published: July 2021

Background:

Significant PR is a common sequel to repair of some forms of congenital heart disease (CHD). Grading the severity of PR by Doppler echocardiography (echo-Doppler) is not standardized and may be problematic. CMR is considered the gold standard method for quantifying PR, but is not universally available. We sought to determine the best echo-Doppler predictors of severe PR.

Methods & Results:

We retrospectively reviewed 36 CHD pts (median age 31 yrs, range 10 – 67 yrs; 33 with Tetralogy of Fallot, 3 with primary pulmonary stenosis) with prior pulmonary valvuloplasty and/or transannular patch placement who underwent both Doppler echo and velocity encoded CMR. Severe CMR PR was defined as ≥40% regurgitant fraction. Echo-Doppler measurements used to predict severe PR were: diastolic flow reversal (DFR) of color flow or spectral pulsed wave Doppler in the main pulmonary artery (MPA) or the branch pulmonary arteries (BPA), a PR jet that fills ≥50% of the pulmonary annular diameter (PAD), PR pressure half-time (PHT) <100 msec, & pulmonary regurgitation index (PRi) <0.77. MPA DFR had 100% sensitivity but low specificity (39%) for detecting severe PR (Table 1

). BPA DFR remained quite sensitive (87%), but much more specific (87%). Univariate analysis showed each variable (except PRi) was a good individual predictor of severe PR (Table 2

). Classification & regression tree analysis showed the 2 most useful variables were (first) DFR in the BPA & (second) the PRi <0.77.

Conclusions:

Readily obtained targeted echo-Doppler measurements reliably identify severe PR as quantified by CMR. BPA DFR is the most specific and MPA DFR is the most sensitive echo-Doppler finding for detecting severe PR.

Table 1.

Statistical Analysis of 5 Echo-Doppler Measures

Table 2.

Univariate Analysis of 5 Echo-Doppler Measures
Abstract 3126: Pulmonary Valve Replacement In Chronic Pulmonary Regurgitation In Adults With Congenital Heart Disease: Influence Of Preoperative QRS-duration On Postoperative Right Ventricular Function
Authors: Westhoff-Bleck Mechthild , Stefan Girke , Breymann Thomas , Lotz Joachim , Pertsch Stafanie , Tutarel Oktay , Röntgen Phillip , Bertram Harald , Wessel Armin , Drexler Helmut , Meyer Gerd Peter
Published: July 2021

Background:
Chronic pulmonary regurgitation (PR) causes progressive right ventricular (RV) dysfunction and heart failure. Parameters defining the optimal time point for surgery of chronic PR are lacking. The present study prospectively evaluated the impact of clinical parameters, cardiorespiratory function and neurohumoral activation on post operative RV function and volumes assessed with magnetic resonance imaging (MRI) after pulmonary valve replacement in patients with severe PR.

Methods and Results:
MRI was performed preoperatively and at follow-up 5.2±3.5months after surgery in 27 patients (23.6±2.9 years, 15 women) with severe PR. Underlying cardiac disease was repaired Tetralogy of Fallot (n=22), Double outlet right ventricle (n=3) and PR after pulmonary valvulotomy (n=2). Postoperatively, RV endsystolic (RVESVI) and enddiastolic volume indices (RVEDVI) decreased significantly (RVESVI pre 78,2±20,4 ml/m
2
BSA vs. RVESVI post 52,2±16,8 ml/m
2
BSA, p<0,001; RVEDVI pre 150,7±27,7 ml/m
2
BSA vs. RVEDVI post 105,7±26,7 ml/m
2
BSA; p<0,001). Mean RV ejection fraction (RVEF) remained unchanged in the study cohort (47.6 ± 8.7% vs. 49.7 ±7.0%, n.s.). Preoperative volumes did not correlate with postoperative ejection fraction. With increasing preoperative QRS-duration, postoperative RVEF decreased significantly (r=−0.57; p<0,005). A preoperative QRS-duration smaller than the median (156ms) predicted an improved RVEF as compared to a QRS-duration ≤ 156ms (54.9% vs. 46.8%, p<0.05). Neither elevated NT-proBNP levels nor reduced cardiorespiratory function were able to predict postoperative RVEF.

Conclusion:
Valve replacement in severe pulmonary regurgitation causes significant reduction of RV volumes. Prolonged preoperative QRS-duration was associated with a worse outcome with respect to postoperative RVEF. During follow-up an increase in QRS-duration in patients with chronic PR might indicate deterioration in RV function reflecting a risk of impaired RV function postoperatively.
Abstract 3148: Atrial Fibrillation Is Associated With Increased Risk Of Fatal And Non-fatal Cardiovascular Events In Patients With Heart Failure And Preserved Ejection Fraction - Findings From The Irbesartan In Heart Failure With Preserved Systolic Function Trial (I-PRESERVE)
Authors: Zile Michael R , Komajda Michel , McKelvie Robert , McMurray John , Donovan Mark , Ptaszynska Agata , Carson Peter , Massie Barry M
Published: July 2021

Background:
Atrial fibrillation (AF, documented by ECG) is present in 15% of patients with heart failure and a reduced LV ejection fraction (HF-REF) and is an independent predictor of cardiovascular (CV) events. The prevalence of AF in patients with HF and preserved EF (HF-PEF) and whether AF is an independent predictor of CV outcomes in HF-PEF have not been defined.

Methods:
The Irbesartan in Heart Failure with Preserved Systolic Function Trial (I-PRESERVE) randomized 4128 patients with an EF ≥ 45% to receive Irbesartan or placebo. The prevalence of AF was established by ECG at randomization. The “
primary”
outcome (475 events/3796 patients) of all-cause mortality or CV hospitalization (myocardial infarction, stroke, worsening heart failure, atrial or ventricular arrhythmia, unstable angina) and a “
secondary”
outcome (294 events/3796 patients) of HF mortality and HF hospitalizations were compared over one year of follow-up between patients with and without AF. The independent predictive role of AF was examined in a multivariable model (including symptoms, clinical history, CV examination, biochemistry, hematology).

Results:
In I-PRESERVE, 16% of patients had AF by ECG at randomization. Patients with AF, compared to patients without AF, were older (74 ± 0.3 vs 71 ± 0.1 yrs, mean ± SEM), less often female (54% vs 62%), had lower EF (58 ± 0.4% vs 60 ± 0.2%), lower eGFR (68 ± 0.8 vs 73 ± 0.4), higher incidence of previous HF hospitalization (61% vs 41%), less frequent history of hypertension and MI (84 & 17% vs 89 & 25%), lower systolic BP (134 ± 0.6 vs 137 ± 0.3 mmHg), higher heart rate (76 ± 0.5 vs 71 ± 0.2 BPM), all p < 0.05. The primary and secondary outcomes occurred in 19 & 15% of patients with AF and 12 & 6% of patients without AF at 1 year. In a multivariate analysis AF remained a significant predictor of increased risk of the primary (Hazard Ratio, HR 1.33 [95% CI 1.07, 1.65]) and secondary (HR 1.81 [95% CI 1.40, 2.33]) outcomes.

Conclusions:
At randomization to I-PRESERVE, the prevalence of AF by ECG in HF-PEF patients was similar to patients with HF-REF in previous studies. HF-PEF patients with AF had a significantly worse outcome than those without AF and this increased risk of fatal and non-fatal CV events was independent of other factors associated with a worse prognosis.
Abstract 3158: Changes In Exracellular Matrix Regulation During Episodes Of Clinical Decompensation In Patients With Systolic Heart Failure
Authors: Biolo Andreia , Fisch Mark , Balog Joshua , Chao Tania , Denmark David , Sam Flora , Ooi Henry , Siwik Deborah , Colucci Wilson S
Published: July 2021

Introduction:
The extracellular matrix (ECM) plays an active role in myocardial remodeling in heart failure (HF). Episodes of decompensation are associated with increased levels of neurohormones, inflammation and oxidative stress that are known to affect ECM regulation, and may contribute to progression of HF. We hypothesized that HF decompensation is associated with dysregulation of ECM turnover, as reflected by markers of degradation (matrix metalloproteinases [MMPs] and their tissue inhibitors [TIMPs]) and synthesis (pro-collagen N-terminal types I [PINP] and III [PIIINP]).

Methods:
Blood levels of MMP-2 and -9, TIMP-1, -2 and -4, and PI- and PIIINP were measured in 80 patients in 3 groups: 20 controls without HF, 21 patients with chronic stable systolic HF (no recent admission and no congestion by clinical examination), and 39 patients with acute HF decompensation, in whom measures were done on admission, at discharge, and chronically at least 2 months later.

Results:
In chronic stable HF, ECM markers were not increased vs. controls. In contrast, in patients with decompensated HF, MMP-2, TIMP-1 and PIIINP levels were increased (vs. stable HF or controls; Table

), while MMP-9, TIMP-2 and -4 or PINP were unchanged. Likewise, following effective therapy and return to clinical compensation (chronically but not at discharge) MMP-2, TIMP-1 and PIIINP levels returned to chronic stable HF levels, whereas MMP-9, TIMP-2 and -4 or PINP remained unchanged.

Conclusion:
A transient ECM dysregulation occurs during acute episodes of HF decompensation and may contribute to adverse ventricular remodeling. While HF decompensation is associated with certain markers of degradation and synthesis (MMP-2, TIMP-1 and PIIINP), other markers (MMP-9, TIMP-2 and -4 or PINP) are unchanged, suggesting selective pattern of ECM activation. The observation that matrix turnover is increased in decompensated but not stable HF may have implication for the timing of anti-remodeling therapy.

ECM markers in controls, stable and decompensated HF
Abstract 3186: Right Ventricular Apical Pacing Impairs Left Ventricular Apical and Basal Rotation and Induces Apical-Basal Rotation Dyssynchrony
Authors: Matsuoka Ken , Nishino Masami , Hara Masahiko , Nakatani Shinpei , Hashimoto Akihito , Yamagami Kiyoshi , Kato Hiroyasu , Egami Yasuyuki , Shutta Ryu , Yamaguchi Hitoshi , Tanaka Kenjiro , Tanouchi Jun , Yamada Yoshio
Published: July 2021

Backgrounds:
Although right ventricular apical (RVA) pacing has been reported to result in asynchronous patterns of left ventricular (LV) contraction reducing the LV ejection fraction (EF), LV torsion in RVA pacing has been unknown. We hypothesized that RVA pacing impairs rotation of LV apex and base and synchrony between LV apical and basal rotation, leading to the reduction of LV torsion.

Methods:
We studied 30 adult patients with sick sinus syndrome who had undergone DDD pacemaker implantation. Right ventricular pacing leads were positioned at the right ventricular apex. Changing from the intrinsic AV conduction to RVA pacing, we assessed the acute effect on echocardiac parameters; LV EF, tissue Doppler imaging (TDI) derived intraventricular delay, LV rotation and torsion, and LV apical-basal rotation dyssynchrony.

Results:
Results were shown in a table

. Changing from the intrinsic AV conduction to RVA pacing, LV EF reduced (P=0.0003) and TDI derived intraventricular delay prolonged (P<0.0001). During RVA pacing, values of peak rotation in LV apex and LV base were significantly lower than those during intrinsic AV conduction (P=0.007 and 0.003, respectively). Correspondingly, LV torsion decreased significantly (P<0.0001). During the intrinsic AV conduction, LV apex and base rotated at the almost same time, while, during RVA pacing, LV basal rotation was delayed as compared to LV apical rotation. Consequently, apical-basal rotation dyssynchrony during RVA pacing was significantly longer than that during the intrinsic AV conduction (P=0.02).

Conclusion:
RVA pacing decreases LV rotation and torsion and induces LV apical-basal rotation dyssynchrony, resulting in partially LV systolic dysfunction.

Comparison between Intrinsic AV Conduction and RVA Pacing
Abstract 3229: First Time Validation of Point to Point NavX Map Registration to 3D Subject-Specific Computed Tomography (CT)
Authors: Kolasa Mark W , Okumura Yasuo , Johnson Susan B , Olson Eric , Schweitzer Jeffrey , Packer Douglas L
Published: July 2021

Background:
Current mapping systems use simultaneous displays of overlapping 3D maps and pre-acquired CT images of the LA to “pseudo-register” data sets rather than specifically “register” each point of one mapping data set to the other. The appropriateness of the 2 data set match has not been validated. Since significant surface to surface mismatch errors may occur, this study was undertaken to quanititatively validate NavX map to CT registration and determine its suitability for guiding AF ablation.

Methods:
Sixty-four slice, multidetector CT scans were acquired in 8 dogs and segmented to establish subject-specific LA/PV volumes for importation into the EnSite mapping system. A detailed multi-surface geometry (NavX map) was collected by navigating a mapping catheter in target LA and PVs. Using a novel developmental registration algorithm the map was registered to LA/PV CT volume. Validation was performed using the registered 3D CT model for the guidance of ablation at the location of multiple implanted radio-opaque markers.

Results:
A total of 39 radio-opaque markers were implanted before CT including 9 LSPV, 8 RSPV, 7 RIPV, 9 LIPV, 3 roof, and 3 LAA locations. Subsequent registration of individual NavX maps to acquired 3D CT volume was successfully completed in all animals. RF ablations were performed at the predicted 3D registered model locations of the radio-opaque markers using 5 mm tip RF ablation catheter. Resulting mean lesion size was 5.3 x 6.5 mm. The lesions enveloped the point of marker attachment to the myocardium in 31/36 (86%) ablations. The average distance from the center of the RF lesion to the targeted site was 2.5 ± 1.5mm. 47 points were successfully navigated under fluorscopic and ICE guidance. All points were accurately portrayed on the 3D registered model. 3 points in the region of the RSPV floor did have minor offsets on the model due to technically difficult segmentation of the RSPV from the right pulmonary artery.

Conclusion:
These data demonstrate the feasibility of registering NavX derived geometries to CT data sets accommodating sources of cardiac, respiratory, and translational cycle dependent error. Catheter navigation precisely conducted using the registered model demonstrates accuracy within the range required for RF ablation.
Abstract 3232: Risk Factor of the Thrombogenicity Related to Left Atrial Catheter Ablation for Atrial Fibrillation
Authors: Date Taro , Yamane Teiichi , Inada Keiichi , Kanzaki Yasuko , Shibayama Kenri , Taniguchi Ikuo , Matsuo Seiichiro , Sugimoto Ken-ichi , Yoshimura Michihiro
Published: July 2021

Introduction:
Although electrical pulmonary veins antral isolation (PVAI) has been shown to be beneficial in patients with drug-refractory atrial fibrillation (AF), cerebral embolism and stroke are still serious complications of AF ablation. We examined the risk factor of cerebral embolism caused by left atrial and PV catheter ablation, as detected by sensitive cerebral diffusion-weighted magnetic resonance imaging (DW-MRI).

Methods:
The subjects of this study were 52 patients (mean age 58 years, 44 males) with AF undergoing only PVAI (n =34), or PVAI+CFEA (continuous fragmented electrogram ablation, n =18). DW-MRI was performed 2 days after the procedures. Adequate heparin was given during the procedure to keep the activated clotting time 200 –250s, with following warfarin administration. Radiofrequency energy was delivered with a power limit of 30 or 35 W.

Results:
Postprocedural DW-MRI revealed new small embolic cerebral lesions (bright DW lesions) in 9 of 52 patients in cerebellum (5), frontal lobe (2), white matter (2), and parietal lobe (1). However, clinical neurological exam before and after the procedure was normal in all 9 patients. There was no statistical significance in age, history of AF, echocardiographic parameters, and procedure time between the patients with and without embolic cerebral lesions. The applied direct-current cardioversion during ablation procedure was only significantly associated with the occurrence of silent cerebral thromboembolism (p<0.05). Additional CFEA to the PVAI did not increase the incidence of thrombogenicity. However, in the patients who underwent CFEA, radiofrequency application with a power limit of 35 W (not 30W) was associated with higher prevalence of positive DW-MRI findings (4/7 (max. 35W) vs. 0/11 (max 30W), p<0.05).

Conclusions:
Our results demonstrate unexpectedly higher incidence of asymptomatic cerebral embolism related to the left catheter ablation procedures. Radiofrequency application to the LA with higher power limit (35 W) during CFEA and the applied direct-current cardioversion during the ablation procedures were associated with the thrombogenicity of left atrial catheter ablation.
Abstract 3255: Left ventricular stroke volume reduction after Surgical Ventricular Restoration: a diastolic dysfunction?
Authors: Di Donato Marisa , Fantini Fabio , Castelvecchio Serenella , Bussadori Claudio , Giacomazzi Francesca , Menicanti Lorenzo
Published: July 2021

Background. Experimental studies and theoretical considerations suggest that reduction of left ventricle (LV) stroke volume (SV) following Surgical Ventricular Restoration (SVR) is a consequence of diastolic dysfunction. Aim. To analyze changes in SV following SVR and assess if SV reduction is related to diastolic dysfunction. Patients. 134 consecutive patients submitted to SVR for symptoms of HF and/or angina. Patients with mitral regurgitation were excluded.

Results. SV improved in 43 patients (54 ± 13 to 60 ± 15 ml; p 0.0001)-G1- and decreased in 91 patients (69 ± 19 to 48 ± 13 ml, p 0.0001)-G2-. The greater EDV reduction, the greater SV reduction (r = 0.609) and the greater EF improvement (r = 0.402)(Graph). Preoperatively, EF and SV were lower in G1 (31 ± 8 vs 35 ± 8%, p 0.002 and 54 ± 13 vs 69 ± 19 ml, respectively); no differences in LV volumes and Diastolic Filling Pattern (DP). Post surgery G2 shows smaller EDV and ESV and lower SV. DP significantly increased in G1 (from 1.42 ± 0.8 to 1.7 ± 0.7, p 0.01) and was higher than in G2, after surgery (p 0.008). NYHA class at FUP improved (2.4 ± 0.6 to 1.6 ± 0.6 in G1 and 2.4 ± 0.7 to 1.7 ± 0.6 in G2, p 0.001)
Post-operative data

Conclusions. Post-SVR stroke volume reduction is not related to diastolic dysfunction; paradoxically, diastolic function is more impaired in patients with SV improvement and larger residual volumes.
Abstract 3263: Right Heart Findings on Supine Bicycle Stress Echocardiography are Highly Predictive of Severe Sleep Apnea in Women Presenting with Chest Pain and Shortness of Breath
Authors: Smart Steven C , McHugh Vicki , Mathiason Michelle A
Published: July 2021

Background:
Chest pain and shortness of breath may be multifactorial, especially in women, and not always indicative of ischemic heart disease. Sleep apnea may contribute to mortality and morbidity in ischemic heart and cerebral vascular patients. Supine bicycle echocardiography is an effective tool to evaluate right heart function at rest and with stress.

Objective:
To determine if right heart abnormalities driving supine bicycle stress echocardiography are predictive of hemodynamic significant sleep apnea.

Methods:
638 consecutive women presenting with chest pain and/or shortness of breath underwent multistage supine bicycle stress echocardiography/Doppler imaging for left ventricular wall motion, ejection fraction (EF), right ventricular (RV) size and function, tricuspid (TR) and mitral (MR) regurgitation, and systolic pressure. Data was also collected on those who underwent sleep studies. ROC analysis was used to evaluate predictive value for severe sleep apnea (RDI ≥ 30).

Results:
Mean age was 63 ± 13 years, mean BMI 30 ± 7, and 80% post-menopausal. Mean EF was 62 ± 12%. Supine bicycle stress echocardiography/Doppler at peak exercise revealed moderate/severe RV enlargement 26%, RV hypokinesis 26%, and moderate/severe TR 40%. Mean values for exercise tolerance, peak heart rate, and peak systolic blood pressure were 4.3 ± 1.7 METs, 131 ± 23 bpm, and 183 ± 26 mmHg, respectively. Sleep study data was available for 88 women, of whom 45% had an RDI ≥ 30. 83% of sleep study subjects exhibited a combination of moderate/severe TR, moderate/severe RV dilatation, or moderate/severe hypokinetic RV function. The best predictor of severe sleep apnea was RV size (
C
= 0.705) at peak exercise. RV function (
C
= 0.640) and TR volume (
C
= 0.603) at peak exercise were moderate predictors. Epworth score (10.4 ± 4.0;
C
= NA) or pulmonary pressure (77.5 ± 14.7 mmHg;
C
= 0.525) alone were only fair predictors. A model containing RV function, RV size, TR, and EF at peak exercise (
C
= 0.730) further improved prediction of identification of those with severe sleep apnea.

Conclusion:
Sleep apnea can present with cardiopulmonary symptoms in advanced stages. Right heart abnormalities during supine bicycle stress echocardiography warrant screening for moderate/severe sleep apnea.
Abstract 3280: Heart Failure Quality of Care in the Outpatient Cardiology Practice Setting: A Report from IMPROVE HF
Authors: Fonarow Gregg C , Yancy Clyde W , Albert Nancy M , Curtis Anne , Stough Wendy Gattis , Gheorghiade Mihai , Heywood J Thomas , McBride Mark L , Mehra Mandeep , O’Connor Christopher , Reynolds Dwight , Walsh Mary N
Published: July 2021

Introduction:
Few data exist regarding adherence to evidence-based HF guidelines in the outpatient setting. IMPROVE HF is a prospective cohort study designed to characterize the current management of chronic systolic HF (EF<35%) in a national registry of outpatient cardiology practices and to evaluate the effect of practice-specific performance improvement interventions.

Methods:
Baseline performance data were collected by chart abstraction. To quantify care, IMPROVE HF performance measures were constructed for use of: ACEI/ARB, beta-blocker, aldosterone antagonist, anticoagulation for atrial fibrillation, ICD, CRT and HF education. Conformity with guideline indicated care includes only patients documented to be eligible without contraindications or intolerance.

Results:
131 practices are enrolled with baseline data abstracted for 12331 patients. 71.7% of practices are non-teaching. Patients are 71% male, with a median age of 70.5 years and a median EF of 25%. Baseline conformity with indicated HF therapies is shown in Fig 1

. While ACEI/ARB and beta-blocker use were relatively high in eligible patients in the outpatient cardiology setting, other measures showed large treatment gaps.

Conclusions:
These data are among the first to assess conformity to the latest national HF guidelines in the outpatient setting and demonstrate an opportunity to improve the quality of HF care delivered. IMPROVE HF will explore the impact of practice-specific performance improvement tools on closing the outpatient HF treatment gap.
Abstract 3306: Impact of Renal Dysfunction on Uptake of F-18 Fluorodeoxylucose on Positron Emission Tomography in Arterial Plaques
Authors: Ishii Hideki , Toriyama Takanobu , Aoyama Toru , Tanaka Miho , Takahashi Horoshi , Kumada Yoshitake , Amano Tstsuya , Izawa Hideo , Nishio Masami , Tamaki Tsuneo , Matsubara Tatsuaki , Murohara Toyoaki
Published: July 2021

Background:
Chronic kidney disease (CKD) is an independent risk factor for atherosclerosis. Recently, it has been reported that F-18 fluorodeoxyglucose (FDG) on positron emission tomography (PET) can detect inflammation at arterial plaques. In the present study, we evaluated the relationship between renal functions and uptake of FDG in various arterial plaques.

Methods
: In the present study, 365 subjects who underwent FDG-PET whole body imaging for cancer screening, but without cancer, were enrolled. Subjects were divided into 3 groups; Group 1 consisted of subjects with glomerular filtration rate (GFR) ≥90ml/min/1.73m
2
(n=259), Group 2; subjects with GFR≥60 and <90ml/min/1.73m
2
(n=77), Group3; subjects with GFR <60ml/min/1.73m
2
(n=29). Inflammations at various vascular sites including bilateral common carotid arteries, ascending aorta, and bilateral femoral arteries were quantified by using the standard uptake value (SUV) of FDG accumulation.

Results:
Mean SUV was significantly different among the 3 groups at every arterial site (see Table

). Univariate logistic analysis showed that GFR was significantly and well correlated with mean SUVs (common carotid arteries: r =−0.417, P<0.0001, ascending aorta: r =−0.450, P<0.0001, femoral arteries: r =−0.404, P <0.0001). In multivariable regression analysis including atherosclerotic risk factors (age, sex, diabetes, hypertension, smoking, body mass index, urea acid, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, and GFR), GFR was associated significantly and negatively with mean SUVs at various arteries (common carotid arteries: β =−0.170, P =0.0086, ascending aorta: β= −0.263, P<0.0001, femoral arteries: β =−0.148, P =0.0060).

Conclusions:
GFR is independently associated with SUVs of FDG. Inflammation in systemic atherosclerosis increases in subjects with CKD.

FDG Uptake Value According to CKD Progression
Abstract 3307: Early Use of Beta-blockers Attenuates Systemic Inflammatory Response and Lung Oxygenation Impairment after Distal Type Acute Aortic Dissection
Authors: Jo Yusuke , Anzai Toshihisa , Sugano Yasuo , Kaneko Hidehiro , Naito Kotaro , Ueno Koji , Kohno Takashi , Takahashi Toshiyuki , Yoshikawa Tsutomu , Ogawa Satoshi
Published: July 2021

BACKGROUND:
Systemic activation of the inflammatory system after aortic injury may play a role in the development of lung oxygenation impairment (LOI) in patients with acute aortic dissection (AAD). We have reported that serum C-reactive protein (CRP) elevation is an independent predictor of this complication. We evaluated the effect of beta-blocker on systemic inflammation and the development of LOI after distal type AAD.

METHODS:
A total of 49 patients, who were admitted with distal type AAD and treated conservatively, were examined. Patients were divided into 2 groups according to the presence or absence of beta-blocker treatment, started within 24 hours of the onset. White blood cell (WBC) count, serum CRP level and arterial blood gases were measured serially. Clinical outcome, maximum WBC count, maximum CRP level, and lowest PaO
2
/FiO
2
(P/F) ratio were compared between the two groups.

RESULTS:
There was no difference between the groups in patients’ backgrounds, blood pressure, serum level of CRP, WBC count and P/F ratio on admission. Beta-blocker treatment was associated with lower maximum WBC count (14,856 ± 3201 vs. 11,687 ± 2610 /mm
3
, p =0.0028) and lower maximum serum CRP level (28.2 ± 20.5 vs. 14.2 ± 5.6 mg/dl, p =0.0004). The minimum P/F ratio was higher in patients with beta-blocker than in those without (140 ± 41 vs. 226 ± 90 mmHg, p =0.0076). Multivariate analysis revealed that administration of a beta-blocker was an independent negative determinant of LOI (P/F ratio ≤ 200 mmHg).

CONCLUSIONS:
Early use of beta-blockers prevented excessive inflammation and LOI after distal type AAD, suggesting a pleiotropic effect of beta-blockers on the inflammatory response after AAD.
Abstract 3319: Autologous Transplantation of Peripheral Blood Mononuclear Cells for Patients with Peripheral Artery Diseases; Long Term Outcomes
Authors: Tateno Kaoru , Moriya Junji , Minamino Tohru , Miura Kentaro , Shimizu Naomi , Kobayashi Yoshio , Komuro Issei
Published: July 2021

Mononuclear cell (MNC) transplantation for peripheral artery diseases (PAD) has become prevalent. However, long-term outcomes of this novel therapeutic strategy have not been documented in details. We had extended the observation period following peripheral blood (PB) MNC transplantation for severe PAD, and obtained clinical data suggesting beneficial yet caution requiring effect of therapeutic neovascularization. Indications for intervention were severe rest pain (36/42, 86%), ischemic ulcer of lower limbs (30/42, 71%), or severe intermittent claudication compromising their ADL (6/42, 14%). Altogether, 42 patients (34 men, 8 women; average age 61 +/− 14 years) underwent 94 transplantations. Sixty seven percents (28/42) of the patients were diagnosed as arteriosclerosis obliterans (ASO), and the remainders were thromboangiitis obliterans (TAO). Co-morbidities included diabetes (21/42 50%) and chronic renal insufficiency treated by dialysis (19/42 45%). Early phase (~6 months) success, defined by improvement in either rest pain, ischemic ulcer, or walking distance, was achieved in 76% (32/42) of the patients. During the long-term follow up (average 30+/− 10 months range 6 –50 months), 85% (17/20) of the responding patients were safe from the relapse of ischemic ulcers, and 89% (23/26) were maintained rest pain free. Limb salvage was 91 % (4/42) at early phase, and 97 % (33/34) during the late follow up period. While there were no major adverse events seen in the TAO patients, 32% (9/28) of the ASO patients had suffered the progression of atherosclerosis in their long term follow-up. There were 11 deaths among 28 ASO patients (39%) in the same period, which were notably associated with the presence of renal insufficiency. In the group of patients undergoing hemo-dialyses, responses to the treatment seemed to correlate with their prognosis, suggesting that improved QOL by the cell therapy may have some good contribution on their survival. In conclusion, PBMNC transplantation for severe PAD is a safe and durable intervention for non-ASO patients without renal failure. However, careful and discrete case selection, in company with stringent follow up of atherosclerosis, is critically advisable for ASO patients with severe renal insufficiency.
Abstract 3340: Coronary Flow Velocity Pattern Immediately After Percutaneous Coronary Intervention Predicts Left Ventricular Remodeling in Patients with Acute Myocardial Infarction
Authors: Yamamuro Atsushi , Akasaka Takashi , Kaji Shuichiro , Tamita Koichi , Katayama Minako , Kinoshita Makoto , Ehara Natsuhiko , Oda Tomoyuki , Kitai Takeshi , Yamane Takafumi , An Yasumori , Kim Kite , Tani Tomoko , Tanabe Kazuaki , Morioka Shigefumi , Kihara Yasuki
Published: July 2021

Background: Studies using the Doppler guidewire have shown that coronary flow velocity (CFV) pattern in recanalized infracted arteries predicts recovery of regional left ventricular (LV) function, in-hospital complications, and long-term cardiac events. However, the relationship between the CFV pattern after reperfusion and serial changes in LV volumes is not clear. We postulated that the quantitative CFV measurement immediately after successful percutaneous coronary intervention (PCI) might be associated with the LV remodeling. To test this hypothesis, we prospectively analyzed the LV remodeling according to CFV parameters measured by the Doppler guidewire in patients with acute myocardial infarction (AMI).

Methods: Consecutive 211 patients with first-time anterior AMI underwent successful PCI (<50% residual stenosis with TIMI flow grade 2–3) and coronary flow measurement with the Doppler guidewire. The CFV spectrum provided the following parameters: time-averaged peak velocity (cm/s), systolic peak velocity (cm/s), and diastolic deceleration time (ms). Left ventriculograms obtained immediately after PCI and 6 months after the infarction were analyzed to measure the end-diastolic volume index and end-systolic volume index. The LV remodeling was defined as an increase in end-diastolic volume index ≥20%.

Result: The optimal cutoff values to predict LV remodeling (defined as 6-month LV dilation ≥20%) were 20 cm/s for time-averaged peak velocity, 0 cm/s for systolic peak velocity and 550 ms for diastolic deceleration time (sensitivity=0.63, specificity=0.56; sensitivity=0.76, specificity=0.85; and sensitivity=0.85, specificity=0.85, respectively). Systolic peak velocity and diastolic deceleration time correlated to the LV end-diastolic volume index obtained 6 months after AMI(r= −0.67; p<0.001 and r= −0.78; p<0.001, respectively).

Conclusions: The CFV pattern appears to be an accurate predictor of LV remodeling even in patients who received successful PCI in the left anterior descending coronary artery immediately after AMI. This index, therefore, identifies a subset of patients at-risk.
Abstract 3355: Relationship Between Electrocardiographic Remodeling, Mechanical Remodeling and the Occurrence of Appropriate Therapy in Biventricular Implantable Cardioverter Defibrillator Patients
Authors: Lellouche Nicolas , De Diego Carlos , Akopyan Gina , Cesario David A , Fujimura Osamu , Wiener Isaac , Boyle Noel G , Child John , Shivkumar Kalyanam
Published: July 2021

Background:
Cardiac Resynchronization Therapy (CRT) is associated with reverse left ventricular (LV) remodeling. However, the effect of CRT on electrical remodeling, reverse mechanical remodeling, occurrence of ventricular arrhythmias is not well established.

Methods: D
ata from 45 patients who underwent implantable cardioverter defibrillator(ICD)-CRT implantation was retrospectively analyzed. Patients had New York Heart Association (NYHA) functional class III or IV heart failure symptoms, left ventricular ejection fraction (LVEF) <35%, and QRS duration >130 ms or QRS ≤130ms with left intraventricular dyssynchrony. Significant LV reverse remodeling was defined by a decrease of left ventricular end diastolic diameter (LVEDd) by at least 10% after 1 year of follow up. Electrocardiographic indices of dispersion of repolarization (DR) (QTc, T peak-Tend (Tp-e) and their dispersion) were measured immediately and 1 year after implantation. The occurrence of appropriate ICD therapy was noted for each patient.

Results:
Patients with significant LV reverse remodeling (n=21) and without LV reverse remodeling (n=24) had similar baseline characteristics. After one year of follow up, patients with LV reverse remodeling exhibited a significant decrease in DR parameters (Tp-e, QT dispersion and Tp-e dispersion), and lower rate of appropriate ICD therapy (log rank p=0.002), compared to those without reverse remodeling who experienced an increase in DR parameters (QT dispersion and Tp-e dispersion), figure 1

.

Conclusion:
Mechanical LV reverse remodeling is associated with an electrical reverse remodelling and a lower rate of appropriate ICD therapy.

Figure 1:

Occurence of appropriate CD therapy according to LV reverse remodelling