bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2563: Off Label Use Of Sirolimus Eluting Stent Increases The Rate Of Death And Stent Thrombosis Without Jeopardizing The Efficacy: Result Of The Evastent Matched Corhort Registry
Authors: Boignard Aude , Foote Alison , Quesada Jean Louis , Sahnoun Mohamed , Danchin Nicolas , Machecourt Jacques
Published: July 2021

In everyday practice the off label use of DES is widespread, but are SES as effective in reducing the need for revascularisation when used on-label and do certain types of off-label use raise greater safety concerns? The EVASTENT nationwide matched cohort registry was designed to assess the efficacy and safety of the SES in diabetic patients with single or multiple vessel disease (SVD and MVD) compared to non-diabetic patients. 1731 pts were included (844 diabetic and 730 MVD patients). Although on-label use of SES was required patients presenting with various categories of off-label lesions were included. 428 (24% ) patients included and 514/ 2730 lesions (19%) treated were off-label: bifurcation lesions (n=182), lesions with thrombus (n=139), highly calcified lesions (n=134), ostial lesions (n=102), very long (>30 mm) lesions (n=15), left-main stenosis n=11), EF<0.30 (n=7). In 73 cases the lesion was off-label for more than one reason. Complete interim one year follow-up data are available for 98% of the patients and in October 2007 most patients will have been followed for 3 years. All MACES (cardiac death, non-fatal myocardial infarction and Stent thrombosis ST) have been evaluated by an independent critical events committee and cases of ST have been classified according to the ARC criteria.

Results: off-label use was not more frequent in diabetic patients but occurred more often in MVD patients. Table 1

shows the one-year comparison between on and off-label use. Subgroup analysis suggests that highly calcified, bifurcation and ostial lesions are particularly at risk for ST. In multivariate analysis off-label use remained an independent predictor of death and the occurrence of MACEs.

Conclusion: Off-label use of SES does not reduce the efficacy of the SES, but increases the risk of death and ST. This safety concern must be taken into consideration when designing studies to evaluate new indications for these DES.

On and Off-Label comparison
Abstract 2566: Late and Very Late Stent Thrombosis following Elective Drug Eluting Stent Implantation in Unprotected Left Main Coronary Artery: a Multicentre Registry
Authors: Chieffo Alaide , Kim Young H , Meliga Emanuele , Park Seung J , Valgimigli Marco , Magni Valeria , Rogacka Renata , Park Seong W , Park Duk W , Airoldi Flavio , Montorfano Matteo , Serruys Patrick W , Colombo Antonio
Published: July 2021

The long-term safety of drug-eluting stent (DES) implantation in the treatment of unprotected left main coronary artery (LMCA) stenosis is still a matter of debate. Some concerns have been recently raised regarding the risk of late and very late stent thrombosis (ST).

Methods:
All consecutive patients (pts) who had sirolimus (SES, Cypher, Cordis, Johnson and Johnson Company, Warren, NJ) or paclitaxel-eluting stent (PES, Taxus, Boston Scientific, Natick, MA) electively implanted in de novo lesions on LMCA between March 2002 and June 2006 were included in this multicentre registry. Stent thromboses were defined according to Academic Research Consortium (ARC) definitions.

Results
Five-hundred and thirty-four consecutive patients were analyzed: 357 patients were treated with SES, 168 with PES and 9 with both of them. One-hundred and thirty-eight (25.8%) patients were diabetics, 171 (32.0%) unstable angina, mean age 62.4 ± 11.4 years, EF 54.1 ± 11.2 %. Distal location occurred in 417 (78.0%) of the patients. Fifty-seven (10.6%) patients had a peri-procedural myocardial infarction (defined as CK-MB elevation ≥3 ULN). At 1044 ± 361 day clinical follow-up, 32 (5.9%) patients died: 23 (4.3%) were adjudicated as cardiac according to ARC definition. One patient had an acute ST (with cardiogenic shock treated with CABG), 1 a sub-acute ST (occlusion of circumflex artery treated with PCI) and 1 a late definite ST (in the left anterior descending artery with MI at 3 months while on antiplatelet therapy). None of the patients had a very late definite ST. In the Table

are reported probable and possibile ST.

Conclusions
Treatment of LMCA stenosis with DES appears safe at long-term clinical follow-up with a 0.6% incidence of definite and probable ST at a median follow-up of almost 3 years.

Table.
Abstract 2578: Acceleration and Deceleration Slope of Longitudinal Early Mitral Annulus Velocity Distinguishes Primary from Secondary Constrictive Pericarditis
Authors: Dal-Bianco Jacob P , Ling Lieng H , Bellavia Diego , Barnes Marion E , Oh Jae K
Published: July 2021

Background: Assessment of coexisting pericardial and myocardial disease in constrictive pericarditis (CP) remains a diagnostic challenge and decision for pericardiectomy depends on the degree of pericardial versus myocardial restraint limiting left ventricular (LV) filling. Early diastolic longitudinal mitral annulus velocity (Ea) can help to differentiate CP from restrictive cardiomyopathy. Recently, acceleration rate of Ea has been shown to be an index of LV myocardial relaxation. We therefore assessed acceleration (Ea-AR) and deceleration (Ea-DR) rate of Ea in patients with CP before and after pericardiectomy.

Methods: We retrospectively studied patients (n=42) with surgically confirmed CP who underwent radical pericardiectomy between 2003–2006 at Mayo Clinic Rochester. Ea-AR and Ea-DR slopes were measured before (pre-Echo) and after (post-Echo) pericardiectomy. Patients were divided into primary CP (idiopathic & acute pericarditis with presumed normal myocardial function) and secondary CP (cardiac surgery & chest irradiation with presumed abnormal myocardial function).

Results: Ea-AR and Ea-DR changed significantly after pericardiectomy in primary CP patients, however remained similar in secondary CP patients. Diagnostic accuracy of Ea-AR, Ea-DR and Ea to discriminate primary versus secondary CP by ROC analysis was 0.88, 0.80 and 0.81 respectively.

Conclusion: Assessment of Ea-AR and Ea-DR in patients with CP is useful to discriminate primary from secondary CP and may help to predict coexistence of myocardial disease: Prepericardiectomy Ea-AR and Ea-DR appear to reflect the interaction of intrinsic myocardial relaxation with enhanced early LV filling. The lack of decrease of Ea-AR and Ea-DR in patients with secondary CP seems to indicate a primarily restrictive component. The significant decrease of Ea-DR in patients with primary CP after pericardiectomy could reflect abolition of a predominant pericardial limitation to LV filling.

Early Diastolic Longitudinal Mitral Annulus Motion before and after Pericardiectomy
Abstract 2592: Clinical Events and MSCTA Anatomy in Anomalous Coronary Artery Arising from the Opposite Coronary Sinus (AOCOS): Relationship of the Pulmonary Valve, Slit-like Orifice, and Arterial Course
Authors: Knickelbine Thomas , Aggarwal Niti , Flygenring Bjorn , Longe Terrance F , Maron Barry J , Schwartz Robert S , Lesser John R
Published: July 2021

Background:
Anomalous Orgin of a Coronary from the Opposite Sinus (AOCOS) is associated with myocardial infarction and sudden death. Proximal vessel variations and course can be difficult to assess by conventional angiography but can be easily imaged noninvasively by Multislice CT facilitating appropriate clinical management.

Methods:
We evaluated proximal vessel variations by MSCT in patients with AOCOS including the presence of a slit-like orifice, interarterial course between the aorta and pulmonary artery, relationship to the pulmonic valve, and the presence of spontaneous cardiac events.

Results:
2500 cases were examined by MSCTA in pts referred for chest pain, abnormal stress testing, or acute coronary syndrome in a large volume clinical setting. There were 28 cases (1.1%) of AOCOS with 16/28 (58%) of RCA off the left cusp (2 single coronaries) and 12/28 (42%) of LCA off the right cusp (4 single coronaries).
RCA off the left sinus
: 14/16 with interarterial course, origin above the pulmonic valve with 2/16 interarterial but below the pulmonic valve. 9/16 had slit-like orifice, 2/16 highly angled ostium without slit-like orifice. 8/16 pts (50%) underwent CABG while 8/16 (50%) were treated medically.
LCA off the right sinus
: 1/12 (8%) was above the level of the pulmonic valve, none had a slit-like orifice. 5/12 (42%) had an intraseptal course below the pulmonic valve. Two pts underwent CABG.
Spontaneous events
: 3/28 (11%) pts initially presented with spontaneous clinical events (NSTEMI, sustained VT, acute inferior MI) attributed directly to the coronary anomaly. All three of these pts had a slit-like orifice, an origin at or above the level of the pulmonary valve, an interarterial course, and a RCA off the left sinus.

Conclusion:

Anomalous coronary arteries arising from the opposite sinus can be readily characterized by MSCT.

MSCT can now be used to help select patients for revascularization with high risk characteristics

All patients who presented with a spontaneous malignant event had a slit-like orifice, an interarterial course, and an origin at or above the pulmonic valve.
Abstract 2598: Radiation Exposure, Procedure Time And Contrast Load In Patients Referred For Coronary Angiography: Head-to-head Comparison Of Dual Source Ct With Conventional Coronary Angiography.
Authors: Van Mieghem Carlos A , Weustink Annick C , Kofflard Marcel , Schreve-Steensma A. , Matheijssen Niels A , Boer Ad den , de Feyter Pim J
Published: July 2021

Introduction and aim:
Dual Source CT (DSCT) scanners, with an increased temporal resolution (83 ms), are becoming widely available. To evaluate the current potential of this scanner in the clinical arena, we performed a head-to-head comparison with conventional coronary angiography (CCA) taking into account the following parameters: radiation exposure, procedure time and contrast load.

Methods:
During a one-year period (april 2006 to march 2007) we compared a consecutive patient group who underwent DSCT (318 patients, 222 male, mean age 68±11 years) and CCA (352 patients, 258 male, mean age 61±12) respectively. Patients with previous bypass surgery were excluded. In DSCT, the volume of iodinated contrast material was adapted to the scan time. A contrast bolus was injected in an antecubital vein at a flow rate of 5.0 ml/s followed by a saline chaser of 40 ml at 5.0 ml/s. Each tube provided 412 mAs/rot (maximum), and full X-ray tube current was given during 25–70% of the RR-interval. Exposure data were collected using the x-ray dosimetrical reports from DSCT and CCA.

Results:
The mean procedure time using DSCT and CCA was 16.1±4.7 min and 44.1±25.5 min (p<0.001), respectively. The mean contrast load in DSCT and CCA was 77.9±7.6 ml and 175.3±4.3ml (p<0.001), respectively. The overall radiation exposure for DSCT and CCA was calculated as 15.3±4.0 mSv and 5.7±4.3 mSv, respectively. Radiation exposure with DSCT was significantly lower (p<0.001) in patients with a heart rate of >70 bpm (12.9±3.1 mSv ) as compared with patients with heart rates <70 bpm (16.4±3.8 mSv).

Conclusion:
In today’s practice currently available DSCT scanners perform favorably as compared with CCA, considering procedure time and patient contrast load. Radiation exposure with DSCT remains higher but should not be considered a major disadvantage taking into account the relatively old age group that generally undergoes coronary angiography and the major benefit of not being exposed to the risks of an invasive procedure.
Abstract 2605: Hypoglycemia Does Not Increase Long-term Mortality Or Morbidity In Diabetic Patients With Myocardial Infarction. A Report From The Digami 2 Trial.
Authors: Mellbin Linda G , Malmberg Klas , Waldenstrom Anders , Wedel Hans , Ryden Lars
Published: July 2021

Aims
Tight, insulin-based glucose control is recommended to diabetic patients (DM pat) with acute myocardial infarction (AMI). A potential draw-back would be if insulin induced hypoglycaemia (HG) had a negative impact of future prognosis.

Methods
1253 pat (mean age 68 years; 67% males) with type 2 DM and suspect AMI were followed for a median of 2.1 years. 947 were randomised to insulin infusion during at least 24 hours while 306 were treated routinely. HG (blood glucose<3.0 mmol/L with or without symptoms) was recorded during hospitalisation. Unadjusted and adjusted (age, sex, smoking, previous MI and heart failure, renal function, duration of DM, coronary interventions, blood glucose at randomisation) Hazard Ratios (HR) and 95% Confidence Intervals (CI) for cardiovascular events (CVE = death, MI or stroke) during follow up were calculated.

Results
153 pat (12.2%) experienced HG. During the first 24 hours 111 (11.7%) insulin-treated pat experienced HG (symptomatic 23.4%) compared with 3 (1.0%) pat on routine treatment (symptomatic 33.3%). As outlined in the figure

HG was not an independent predictor of subsequent CVE.

Conclusion
Insulin induced HG was not a significant risk factor for subsequent CVE in AMI-pat with type 2 DM. Hypoglycaemic seem to identify patients at high risk for other reasons.
Abstract 2607: Impact Of Acute Myocardial Infarction On Perfusion In Non-infarct Related Territories. Study With Sestamibi G-spect Imaging
Authors: Pregowski Jerzy , Ciszewski Michal , Teresinska Anna , Kalinczuk Lukasz , Kruk Mariusz , Pracon Radoslaw , Witkowski Adam , Debski Artur , Ruzyllo Witold
Published: July 2021

In the setting of acute STEM blood flow may be slower also in non infarct related arteries. This may impact perfusion beyond infarct zone. The aim of our study was to assess viability and perfusion in non-infarcted myocardium using sestamibi G-SPECT. 36 pts with anterior STEMI within 12 hours from pain onset were enrolled. All pts were hemodynamically stable (Kilip≤3) on admission, without prior myocardial infarction and underwent primary angioplasty (pPCI). Two G-SPECTs at rest were performed: SPECT 1 - sestamibi injected immediately before pPCI (scintigrams registered within 6 hrs from pPCI) and SPECT 2, performed 5– 8 days later. Perfusion of the myocardium was visually assessed and standard grading (0 – 4) for 17 segments was used, where 0 indicates no, 1 - mild, 2 and 3 moderate perfusion abnormalities and 4 - total lack of perfusion. Sum of perfusion segmental defects grades for each territory and for the whole myocardium produces respective Summary Defect Score (SDS) indices. Higher SDS indicates more severe and wider perfusion defect. Left anterior descending artery (LAD) territory consists of 7, right coronary (RCA) and left circumflex artery (LCX) territories consist of 5 segments. Separate SDS for LAD (SDS LAD), for RCA (SDS RCA) and for LCX (SDS LCX) territories were calculated for SPECT 1 and SPECT 2. Also SDS for basal RCA segments (SDS RCA basal) and for basal LCX segments (SDS LCX basal) were calculated to avoid bias related to overlapping of blood supply. Results are presented in Table

. Both total SDS and SDS indices for separate vessel territories decreased while left ventricle ejection fraction increased between G-SPECT 1 and G-SPECT 2 procedures.

Conclusions
In pts with anterior STEMI and culprit lesion in LAD perfusion of inferior wall is significantly reduced in acute phase. This suggests that anterior STEMI may cause global myocardial ischemia even in patients without cardiogenic shock.

Table
Abstract 2618: Use of Myeloperoxidase in Chest Pain Evaluation in The Emergency Department
Authors: Möckel Martin , Müller Reinhold , Lueders Christian , Reiche Janett , Müller Christian , Danne Oliver , Shih Jessie
Published: July 2021

Background
Elevated levels of myeloperoxidase (MPO) have been reported to indicate adverse outcome in selected patients with chest pain and acute coronary syndrome (ACS) but no data exists on its value in the routine setting of an emergency department (ED).

Patients and methods
Initial MPO was assessed at admission in 432 consecutive patients presenting to the ED who were evaluated for an acute coronary syndrome. In a subset of 116 patients blood samples were also available after 6 and 12–36 hours. All patients were followed up for six weeks with respect to major adverse cardiac events (MACE) including death, re-admission for heart failure or ACS and unplanned repeat coronary revascularisation. MPO was measured using a fully automated immunoassay in development on the ARCHITECT® platform and its prognostic power was compared with serial cardiac troponin I using cut-offs of 198 pmol/L for MPO and 0.1 μg/L for troponin I.

Results
Incidence of MACE was 13% in this population. MPO was detectable in all samples with a median of 246.5 (range 18 – 4547) pmol/L at admission. MPO increased significantly after 6h and decreased again after 12–36h. In this low-risk population, initial MPO levels revealed a sensitivity (Sens) of 82.1% and a specificity (Spec) of 37.5% (p<0.0001) for MACE compared with 28.6% Sens and 81.1% Spec (p=0.09 n.s.) for initial troponin I. Sensitivity of both markers improved when available serial information was used (MPO: Sens 96.4, Spec 22.6, p<0.0001; troponin I: Sens 44.6%, Spec 76.1%, p<0.01). In serial troponin I negative patients (n=317), both, initial MPO (Sens 80.6%, Spec 42.7%, p<0.05) and serial MPO (Sens 93.5%, Spec 28.7%, p<0.01) still demonstrated significant discriminatory power.

Conclusions
MPO has independent prognostic value in unselected patients evaluated for ACS in the ED. However MPO levels vary widely over the first 24h hours and also lack specificity.
Abstract 2643: The Effects of Statin Therapy on Ventricular Tachyarrhythmias - A Meta Analysis
Authors: Shah Kunal , Wanahita Nikolas , Bangalore Sripal , Huang Yili , Rachko Maurice , Schweitzer Paul
Published: July 2021

Objectives
: To assess whether statin therapy is associated with a reduction in ventricular tachyarrhythmias.

Background:
Statins have been shown to be beneficial beyond their cholesterol-lowering effects. These pleiotropic effects have been implicated in the protection against atrial fibrillation and the reduction in appropriate implantable cardioverter-defibrillator (ICD) therapy in patients with coronary artery disease (CAD). This meta-analysis was conducted to evaluate whether statins were associated with a reduction in ventricular tachyarrhythmias in patients with CAD or non-ischemic cardiomyopathy.

Methods:
The Medline and Cochrane databases were searched from 1966 to April 2007 for English language, prospective, randomized studies looking into the association between the use of statins and the incidence of ventricular tachycardia/ventricular fibrillation (VT/VF). The occurrence of ventricular arrhythmias was defined as the VT/VF occurrence or appropriate ICD therapy for VT/VF.

Results:
Of the 133 identified articles, 10 prospective randomized studies with 34,794 patients enrolled met our inclusion criteria and were included in this analysis. Using a random effects model, statin therapy was associated with a 26% reduction in the risk of VT/VF when compared to the group not on statin therapy (Pooled RR=0.94; 95% CI, 0.59 – 0.91; P=0.005; Heterogeneity χ
2
=30.02; P<0.0001). There was no publication bias in this analysis (Egger’s test P=0.687).

Conclusion:
Statin use in patients with CAD or non-ischemic cardiomyopathy is associated with a 26% reduction in the development of ventricular tachyarrhythmias.
Abstract 2658: Does Aortic Valve Morphology Influence The Natural History Of Aortic Regurgitation?
Authors: Alguersuari Joan , Sambola Antonia , Tornos Pilar , Evangelista Arturo
Published: July 2021

BACKROUND: The influence of the morphology of aortic valve on the natural history of aortic regurgitation (AR) is uncertain.

OBJECTIVE: To assess the natural history of AR in patients with bicuspid aortic valve (BAV) comparing with tricuspid aortic valve (TAV).

METHODS AND RESULTS: Ninety-five patients with asymptomatic severe chronic AR were prospectively studied. Follow-up period was 7+/- 2 years. Forty-one patients (42%) had BAV and were significantly younger than patients with TAV (39 +/- 11 vs 47 +/- 14 years, p=0.001). Mean ascending aortic diameter (AAD) was significantly larger in BAV (42 +/- 7 vs 37 +/- 5 mm, p=0.0001). Differences in AAD persisted until the end of the follow-up (47 +/- 6 vs 40 +/-5 mm, p=0.0001). The percentatge of increase in AAD was 12 +/- 5% in BAV and 8 +/- 5% in TAV with yearly increase of 0.83 mm in BAV and 0.42 mm in TAV. The changes in left ventricle diameters, mass index, wall stress, regurgitant fraction and ejection fraction were similar in BAV and TAV. Patients with BAV did not need surgery earlier due to AR than patients with TAV (4.7 +/- 2 vs 4.8 +/- 3 years). At 5 years follow-up 11 patients with BAV (27%) and 10 patients with TAV (23%) needed surgery.

CONCLUSIONS: Patients with BAV are younger, had a larger AAD and a higher rate of AAD enlargement than patients with TAV. The morphology of the aortic valve (BAV vs TAV) had no infuence in the progression of AR and the impact on left ventricular function.
Abstract 2690: Should We Classify Impaired Relaxation Pattern With Elevated E/e’ As Grade 1 Diastolic Dysfunction?
Authors: Choi Un-jung , Lim Hong-Seok , Kang Soo-Jin , Hwang Jung-Won , Choi Byoung-Joo , Choi So-Yeon , Yoon Myeong-Ho , Hwang Gyo-Seung , Tahk Seung-Jea , Shin Joon-Han
Published: July 2021

Purpose :
Impaired relaxation pattern (grade 1 diastolic dysfunction) by Doppler echocardiography is known to reflect preserved left ventricular filling pressure (LVFP), while increased ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E’) indicated elevated LVFP. We evaluated the characteristics of impaired relaxation pattern with elevated E/E’ ratio.

Methods
: Eighty-eight patients (mean age 63 ± 11, 59 males) who had coronary artery disease with impaired relaxation pattern (E/A < 1) were enrolled. Echocardiography including tissue Doppler imaging (TDI) was performed. All patients underwent cardiac catheterization to investigate LV pre-A pressure (LVP
pre-A
) within 6 hours after echocardiographic measurement. Patients were divided into subjects with E/E’ < 10 (n = 71) and E/E’ ≥ 10 (n = 17).

Results
: LVP
pre-A
was well correlated with echocardiographic Doppler and hemodynamic parameters (E/E’, r = 0.536, p < 0.001; LA volume, r = 0.295, p = 0.008; EF, r = -0.234, p = 0.028). Forty (45% of total) patients had high LVFP, defined as LVP
pre-A
≥15 mmHg. Patients with E/E’ ≥10 had a significantly higher incidence of high LVFP, when compared to patients with E/E’ < 10 (88% vs 35%, p < 0.001). LA volume and LVP
pre-A
were significantly increased and EF was decreased in patients with E/E’ ≥ 10 (table 1

). However, there were no significant differences of parameters derived from transmitral inflow and transpulmonary venous flow between two groups.

Conclusions
: In patients with impaired relaxation pattern, elevated E/E’ has related to elevation of LVFP, regardless of transmitral inflow and transpulmonary indices. Therefore, impaired relaxation pattern with elevated ratio of early diastolic transmitral flow velocity to mitral annular velocity (E/E’) may have been considered as another grade of diastolic dysfunction.

Table 1
Abstract 382: Kidney-Heart Connection: One Kidney Nephrectomy Results in Cardiac Fibrosis and Differential Ventricular Gene Profiles in the Absence of Heart Failure
Authors: Martin Fernando L , Huntley Brenda K , Harders Gerald E , Burnett John C
Published: July 2021

Background:
Decreased renal function is associated with increased cardiovascular morbidity and mortality by mechanisms that remain unclear. We hypothesized that even mild renal insufficiency produced by unilateral nephrectomy results in changes in ventricular structure and gene expression in the absence of hypertension or volume overload underscoring a kidney-heart connection in the control of myocardial structure.

Methods:
Cardiorenal function and structure were assessed in Wistar rats [sham (S; n=10) and unilateral nephrectomized (UNX; n=9)] 4 weeks after UNX. GFR was determined by inulin clearance and renal blood flow (RBF) by PAH. Blood was obtained for BNP, PRA, and aldosterone. Hearts and kidneys were harvested for histological analysis. Cardiac function was assessed by echo. Genome-wide microarray analysis was performed on left ventricular myocardium (Affymetrix GeneChip® Rat Genome 230 2.0).

Results:
Glomerular hypertrophy was observed in UNX (S:1±0.04, Nx:1.6±0.1 u3x106, p<0.001). GFR tended to decrease with a reduction in RBF (S:8±1, Nx:5±1 ml/min, p<0.005). Sodium and water excretions were not different between groups with no activation of PRA, aldosterone or BNP. LVEF and LV end-systolic and end-diastolic diameters were normal. Blood pressure (BP) was not different between groups. Importantly, Picrosirius Red staining in the ventricular myocardium of UNX compared to S revealed greater fibrosis (S:2.4±0.1, Nx:4.2±0.4 %, p<0.001). Further, microarray analysis of ventricular myocardium revealed that 278 genes significantly changed with UNX (1.5 fold, P<0.05) compared to S in genes related to cell growth, bone remodeling and muscle contraction (Z value>2).

Conclusion:
We conclude that even mild renal insufficiency produced by unilateral nephrectomy initiates myocardial gene responses and fibrosis independent of alterations in the circulating RAAS, BNP, BP, volume overload or systolic dysfunction.

These studies support a kidney - heart connection in early renal dysfunction resulting in molecular ventricular remodeling and fibrosis. These studies in experimental mild renal dysfunction produced by removal of one kidney reveal a renal mediated mechanism for myocardial remodeling.
Abstract 2714: Heart Failure Device Therapy: Effect of Age and Gender on Patient Survival
Authors: Rasmusson Kismet D , Kfoury Abdallah G , French Thomas K , Connolly Jennifer J , Hanson Douglas M , Roberts Colleen A , Ensign Richard , Crandall Brian G , Evans R. S , Horne Benjamin D , Renlund Dale G
Published: July 2021

Background
: Indications for heart failure (HF) device therapy are well-established. Cardiac resynchronization therapy (CRT) and internal cardiovertor defibrillator (ICD) use, alone or in combination, reduce morbidity and mortality. However, the frequency of device implantation in situations with limited survival is unknown. This study assessed, in an unselected population, what proportion of patients had a < 1 year survival and whether such survival was affected by age or gender after HF device therapy.

Methods
: All patients admitted from 2000 –2006 to a referral center for
de novo
HF device therapy were identified using ICD-9 codes: 0050 (CRT), 0051 (CRT & ICD), and 3794 (ICD). Mortality rates were estimated using Kaplan Meier product limit estimation and between group comparisons for gender and age were made using logistic regression.

Results
: From 2000 to 2006, 1,735 patients received CRT, ICD, or CRT & ICD. Of these, 1,331 (77%) were men and averaged 66.7 years of age while the women averaged 64.7 years (p = 0.347). One-year survival for all patients was 91%. One-year mortality by age and gender (see Table

), demonstrates that the proportion deriving a less than one year survival benefit after device implantation increases with age, but is not affected by gender.

Conclusions
: One-year survival after HF device implantation is high, suggestive of appropriate patient selection. However, advanced age increases the likelihood of deriving a shorter term benefit of device therapy, suggesting that careful patient selection is particularly important in older adults to avoid the futile use of expensive technologies. While no apparent gender differences were found related to survival, the overwhelming majority of devices were implanted in men, suggesting gender bias, gender-based co-morbidities affecting care, or gender-based differences in care preferences.

Table
Abstract 2723: Large Genomic Deletions in Plakophilin-2 are a Rare Cause of ARVD/C and ARVD/C-like Disease.
Authors: van der Smagt Jasper J , Cox Moniek G , Nelen Marcel R , van Tintelen J P , Entius Marc M , Wiesfeld A C , van Gelder I C , de Jong Gert J , Doevendans Pieter , Hauer Richard N
Published: July 2021

Introduction: Plakophilin-2 (PKP2) is the major genetic determinant of ARVD/C in the Netherlands. Mutations have been found in 43 out of 82 index cases (52%), diagnosed in accordance with the 1994 Task Force criteria (TFC). A total of 15 different mutations were detected, most of them nonsense (7), frameshift (2) and splice mutations (3), suggesting haploinsufficiency (loss of function) of PKP2 as the predominant mechanism in the etiology of ARVD/C. Since many of these mutations are probably functional null alleles, it was hypothesized that large deletions within - or encompassing - the PKP2 gene can also predispose to ARVD/C.

Aim: to determine whether large deletions in PKP2 underlie apparently PKP2 negative ARVD/C cases.

Methods: a multiple ligation-dependent probe amplification kit was developed to determine copy number of all 14 exons of the PKP2 gene. In total 120 patients were included that had been referred for PKP2 testing, and that had tested negative with direct sequencing or denaturing gradient gel electrophoresis. Twenty-six patients had definite ARVD/C (TFC: ≥ 4 pts), 11 patients scored 3 pts and 83 patients scored less than 3 pts or had insufficient clinical data.

Results: a single deletion was detected encompassing the first 4 exons and promoter region of the PKP2 gene. The patient, a 35 year old male, had experienced near-syncope during exercise. Mild dilation of the right ventricle (1 pt), negative T-waves in V1-V5 (1 pt) and short VT’s with LBBB morphology during exercise testing were found (1 pt). There were frequent PVC’s. The father also carried the deletion. A third degree paternal relative died suddenly at age 28 during exercise.

Conclusion: large genomic deletions of PKP2, that go unnoticed with sequencing, can cause ARVD/C-like disease. Comprehensive testing of PKP2 should include assessment of copy number. However, the frequency of large deletions seems to be low. Since the detected deletion includes the promoter and the transcription initiation site, no protein can be derived from the affected allele. This patient demonstrates that complete loss of one PKP2 allele does not necessarily lead to more severe ARVD/C. This is in keeping with the concept of haploinsufficiency and the assumption that many PKP2 mutations cause functional null alleles.
Abstract 2726: Haplotype Sharing Test as a Tool to Map Genes for Familial Cardiomyopathy
Authors: Gerbens Frans , van Tintelen Peter , van der Zwaag Paul A , Boven Ludolf G , van der Smagt Jasper J , Hauer Richard N , Hofstra Robert M , Meerman Gerard J te
Published: July 2021

Background:
In Mendelian diseases, such as arrhythmogenic right ventricular and dilated cardiomyopathies (ARVC and DCM), chromosomal regions identical-by-descent (IBD) from a common founder can be ascertained both by pedigree analysis and by haplotype-sharing methods. Finding shared haplotypes is greatly facilitated with the currently available high-density SNP arrays. However, determining which of the shared haplotypes is IBD and contains the disease-associated mutation, and which are identical-by-state (IBS) and are shared by chance, is difficult. An additional criterion is needed to indicate the region containing the disease mutation. The probability for shared haplotypes to be IBD rather than IBS increases with an increasing number of SNPs. We hypothesized that the largest shared haplotype is the most likely region to hold the causative disease mutation.

Methods:
The Haplotype-Sharing Test (HST) was designed, using SNP genotyping data from isolated patients and parent-offspring pairs and trios to identify the largest possibly shared haplotypes between patients that are members of a (large but unobserved) pedigree. We applied the HST to:

three distantly related families each with at least one ARVC patient using 10K SNP genotyping arrays, and

a large family with 5 DCM patients using 250K SNP arrays.

Results:
In pedigree A a haplotype run of 118 SNPs spanning 32 MB on chromosome 12p12.3-q13.13 was identified. This haplotype is substantially larger than any other area that is shared due to random effects. Screening of the PKP2 gene, located in this region, revealed a pathogenic splice-site mutation that was segregating with the disease. In family B (DCM) the largest shared haplotype was 178 SNPs, spanning 3.5 MB on chromosome 15. Sequencing of potential candidate genes (including alpha Tropomyosin and Integrin alpha 1) is pending.

Conclusions:
Our identification of the causative founder mutation in pedigree A in the largest shared region shows that our hypothesis, though heuristic in character, was correct. More importantly, haplotype sharing is a powerful tool for identifying disease-causing genes in single and extended families when an insufficient number of meioses are present to perform classic linkage analysis.
Abstract 2742: The Comparison Of Direct Measurement Of Central Blood Pressure And Noninvasive Evaluation By Radial Artery Tonometry.
Authors: Takazawa Kenji , kobayashi hiroshi , kino mineko , aizawa akira
Published: July 2021

Background and objectives: New devices including radial applanation tonometer have been developed for central blood pressure measurement. The devices can noninvasively calculate the central blood pressure. To investigate the accuracy of estimated central blood pressure, this study demonstrates the comparison of catheter based central blood pressure and radial applatnation tonometer based central blood pressure.

Materials and Methods: Seventy two patients (64 ± 10 years old) underwent cardiac catheterization were recruited for this study. Ascending aortic pressure was measured using a pressure guide wire (RADI Medical Systems), and recorded on a laptop personal computer through a SEIREG polygraph (Siemens). Radial arterial pulse waves were simultaneously measured noninvasively using applanation tonometry technique by HEM-9000AI (Omron Healthcare Co.,Ltd.) and SphygmoCor (AtCor Medical Pty Ltd.). The measurements were performed before and after administration of vasodilator (nicorandil or glycerol trinitrate) or antihypertensive (nicardipine hydrochloride) drugs. The central blood pressure calculated by HEM-9000AI (cSBP) and SphygmoCor (aSBP Sphy) was compared respectively with that by catheter (aSBP).

Results: cSBP and aSBP Sphy indicated significant correlation with aSBP (r=0.94, 0.93, respectively, p=0.001). The regression line slope of cSBP to aSBP was 0.92 and that of aSBP Sphy to aSBP was 0.76. A significant difference was observed between aSBP and aSBP Sphy, but was not observed between aSBP and cSBP. Bland-Altman test showed that the difference of cSBP to aSBP was - 0.4 ± 9.6 mmHg and that of aSBP Sphy to aSBP was -9.0 ± 10.3 mmHg. It shows significant difference between cSBP to aSBP error and aSBP Sphy to aSBP error (p<0.05).

Conclusion: The central blood pressure measured by HEM-9000AI is very close to that by catheter. These findings indicate that noninvasive central blood pressure measurement by radial applanation tonometry is accurate enough for clinical applications.
Abstract 2745: Diagnostic Algorithm Using Office and Home Blood Pressures to Exclude White Coat Hypertension
Authors: Kuruvilla Sujith , Nallella Kiran , Mani Anne , Pinto Geetha , Shimbo Daichi , Schwartz Joseph , Gerin William , Pickering Thomas
Published: July 2021

Background:

It has been suggested that the diagnosis of sustained hypertension (SHTN), defined as clinic blood pressure (CBP) ≥140 or ≥90 mmHg plus a daytime ambulatory BP (ABP) ≥135 or ≥85 mmHg can be optimized by taking home BP (HBP) in those with high CBP, and obtaining ABP only if HBP is normal (<135/85). This study tested whether a higher cutoff value for CBP using Receiver Operator Curves (ROC) based on systolic and diastolic CBP for the diagnosis of SHT (95% specificity) would improve the efficiency of the algorithm for diagnosing SHT and reduce the number of subjects requiring HBP and ABP to establish the diagnosis.

Methods and Results:

We assessed CBP, ABP and HBP in 229 normotensive and untreated hypertensive subjects. CBP was high in 84 subjects. Of these, 74 (88%) had SHTN, and 10 (12%) white coat HTN (WCH- high CBP but normal ABP). With HBP, 69 (82%) had high HBP, and of these 63 (91%) had SHT. Based on traditional algorithm, 15 subjects require ABP monitoring to diagnose SHT, which would be confirmed in 11. Using the ROC algorithm, 55 of 84 subjects (50 SHT; 5 WCH) would be classified as ``hypertensive” (at or above the CBP cut-off); 29 subjects would fall below the cut-off and require HBP (with 24 having SHT); 5 subjects would require ABP. The sensitivity and specificity for diagnosing SHT were 100% and 40% for the traditional algorithm, and 100% and 20% for the ROC algorithm.

Conclusions:

The ROC algorithm is as effective as the traditional algorithm for diagnosing SHT, and requires fewer HBPs (29 vs. 84) and ABPs (5 vs. 15). Therefore, this algorithm may have widespread indications for the screening of ambulatory hypertension.
Abstract 2751: Preoperative Cardiothoracic Computed Tomographic Angiography is Associated with Increased Adoption of Preventive Surgical Techniques in Patients Undergoing Redo Open Heart Surgery after Prior Coronary Artery Bypass Grafting
Authors: Kamdar Apur R , Meadows Telly A , Gorodeski Eiran Z , Curtin Ronan J , Roselli Eric E , Sabik Joseph , Schoenhagen Paul , Lytle Bruce W , Flamm Scott D , Desai Milind Y
Published: July 2021

Introduction:
Redo cardiothoracic surgery (CTS) is associated with increased morbidity and mortality, compared to first-time CTS. Multi-detector computed tomography angiography (MDCTA) reliably delineates the course of previous coronary artery bypass grafts (CABG) and proximity of mediastinal structures to chest wall. We sought to determine if high risk preoperative MDCTA findings impacted use of preventive surgical strategies in patients with prior CABG undergoing re-CTS.

Methods:
We studied 167 patients (mean age 69 ± 9 years, 79% men) with prior CABG referred for re-CTS who underwent contrast-enhanced MDCTA (16 – 64 MDCT, 2 mm slice thickness) to assess CABG location and relationship of aorta/right ventricle (RV) to chest wall. Demographic, laboratory, and clinical data were used to determine the Higgins preoperative risk score. Prevalence of high risk MDCTA findings, use of preventive surgical strategies, frequency of severe intraoperative bleeding and postoperative mortality were recorded.

Results:
Mean preoperative risk score was high (7.5 ± 3) and 49% patients underwent combined redo CABG plus valve surgery. Incidences of 2
nd
, 3
rd
and 4
th
operations were 78%, 19% and 3%, respectively. High-risk CT findings were as follows: adherence/ proximity (≤ 1 cm) of RV/aorta to chest wall (24%) or bypass graft crossing midline (≤ 1 cm antero-posteriorly) (38%). Preventive surgical strategies included: surgery cancelled (4%), non-midline incision (8%), deep hypothermic circulatory arrest (5%), initiation of peripheral cardiopulmonary bypass (11%), and extrathoracic vascular exposure prior to incision (53%). These surgical strategies were used at a significantly higher frequency in patients with high risk MDCTA findings compared to those without (88% vs. 28%, p<0.0001). After adjustment for multiple clinical variables, only high risk MDCTA finding was significantly associated with operative changes (OR=16 [95% CI 7–36], p<0.001). Frequency of severe bleeding, graft injuries, and 1 month mortality were 3%, 5% and 3 %, respectively.

Conclusions:
In high risk re-CTS patients with prior CABG, use of preoperative MDCTA plays a significant role in planning and performance. Impact of preoperative MDCTA on outcomes requires further evaluation.
Abstract 2759: Elevated Coronary Calcium Scores Measured by Multi-Slice Computed Tomography are Associated with Low Response to Clopidogrel in Patients with Stable Angina pectoris
Authors: Burgstahler Christof , Geisler Tobias , Lindemann Stephan , Reimann Anja , Brodoefel Harald , Tsiflikas Ilias , Kopp Andreas F , Gawaz Meinrad , Schroeder Stephen
Published: July 2021

Cardiac multi-detector computed tomography (MDCT) with retrospective ECG-gating permits the determination and quantification of coronary calcifications. High calcium scores are known to be associated with elevated all-cause mortality. Moreover, low response to clopidogrel influences cardiovascular outcome after coronary stent placement. We sought to evaluate whether elevated calcium scores are associated with a low response to clopidogrel.

Methods 62 patients were enrolled in this trial (52 male, mean age 64.8 ± 8.9 years). Coronary calcium scoring (expressed as Agatston score equivalent, ASE) was measured with multi-slice computed tomography (Sensation 64™ [n=19] and Somatom Definition
™
[n=43], Siemens, Forchheim, Germany) prior to stent implantation. Responsiveness to clopidogrel was assessed by ADP (20 micromol/L)-induced aggregometry at least 6 h after administration of a loading dose of 600 mg clopidogrel.

Results Median calcium score was 736 ASE [range 0 –3126] and mean platelet inhibition was 35±19% [range 0 –70]. There was a significant negative correlation between ASE and response to clopidogrel (r
2
=0.135, p=0.0033, slope 7.809 ± 2.549). Patients within the first quartile of ASE had significantly better response to clopidogrel than other patients (p<0.05). Establishing a threshold of 200 ASE responsiveness to clopidogrel could be predicted with a positive predictive value of 80% and a specificity of 91%.

Conclusions We could demonstrate that elevated ASE is associated with a low response to clopidogrel. Patients with a low coronary plaque burden are more likely to have a good response to clopidogrel. Coronary calcium scoring might help to identify low responders to clopidogrel prior to stent placement and aggregometry.
Abstract 2767: Congenital Heart Disease And Hypertrophic Cardiomyopathy In Noonans Syndrome: Determinants Of Outcome.
Authors: Hickey Edward J , Elmi Maryam , Asoh Kentaro , Mehta rohit , Williams William G , Holm-Larsen signe , McCrindle Brian W , Manlhiot Cedric , Benson Lee
Published: July 2021

To further understand the implications of hypertrophic cardiomyopathy (HCM) in Noonans syndrome (NS), we characterized our cardiovascular experience of NS over 40 years. All 141 children referred to our cardiovascular service since 1966 NS were reviewed. Time-related outcomes were modeled using multiphase parametric techniques and subjected to risk-hazard analysis with bootstrapping. Survival outcomes in NS HCM were then compared with a contemporaneous series of children with non-NS HCM (N=120) from our institution. The incidences of cardiac anomalies were: PV dysplasia, 56%; ASD, 24%; HCM, 23%; VSD, 11%; MV dysplasia, 6%; left SVC, 5%; tetralogy of Fallot and coarctation 3%. HCM in excess of what would be expected based on type and severity of cardiovascular anomaly was diagnosed in 30/141 (23%). In 18 of these (57%), HCM co-existed with an associated anomaly (PV dysplasia=14, VSD=2, ASD=4, MV dysplasia=4 and coarctation=1). In contrast, all 120 non-NS pediatric HCM at our institution had no associated cardiovascular anomaly. Cardiac surgery was necessary in 45 (32%) and was predicted by septal defects, RVOT gradient and LVOT gradient >30mmHg. Surgery was directed to the RVOT or septum in >75% cases. Left myectomy was necessary in only 5 (11%). Overall survival was 92% +/-3 at 10 years and death was independently predicted by HCM and LVOT obstruction. Risk-adjusted late-phase hazard for death was significantly higher for NS HCM than non-NS HCM (p=.008).

Conclusions
HCM in NS usually occurs in asociation with other lesions. HCM in NS carries a worse late prognosis than non-NS HCM. Survival outcomes are good, although the presence of HCM is an independent predictor of death.
Abstract 2771: Comparison of Everolimus-Eluting Stents with Paclitaxel-Eluting Stents in De Novo Native Coronary Artery Lesions: Intravascular Ultrasound Results From the SPIRIT III Trial
Authors: Yamasaki Masao , Tsujino Ichizo , Sakurai Ryota , Waseda Katsuhisa , Hasegawa Takao , Shimohama Takao , Ako Junya , Honda Yasuhiro , Sood Poornima , Lansky Alexandra J , Sudhir Krishnankutty , Stone Gregg W , Fitzgerald Peter J
Published: July 2021

Background
: SPIRIT III is a pivotal, multicenter, 2:1 randomized, controlled trial comparing Everolimus-eluting cobalt-chromium alloy XIENCE™ V stents (EES) to Paclitaxel-eluting Taxus
™
stents (PES) in de novo native coronary artery lesions. Intravascular ultrasound (IVUS) was performed in a subset of Spirit III to further investigate the safety and efficacy profiles of EES.

Methods
: The SPIRIT III IVUS study enrolled 305 patients who received 359 stents (244 EES in 205 patients; 115 PES in 100 patients). Serial IVUS imaging was performed post-intervention and at 8 months follow-up. Late lumen area loss was calculated as minimum lumen area (MLA) at post-intervention minus MLA at follow-up. Volume index, defined as volume data divided by stent length, was obtained for vessel (VVI), stent (SVI), lumen (LVI), plaque (PVI), and neointima (NVI).

Results
: At baseline, the incidence of tissue prolapse, edge dissections, and incomplete stent apposition (ISA) were not significantly different between EES and PES (15.6 vs 19.7%, 1.3 vs 2.8%, and 31.8 vs 28.2%, respectively). At follow-up, edge dissections and late-acquired ISA were not significantly different between EES and PES (1.4 vs 3.1%, 1.7 vs 4.1%, respectively). EES showed significantly less neointimal hyperplasia and a trend toward larger follow-up lumen than PES (Table

), whereas no statistical interactions were observed between EES and serial changes for VVI and PVI. PES showed a significant increase in VVI and PVI between post-intervention and follow-up. Reference segment analysis showed no unfavorable edge effect adjacent to either EES or PES.

Conclusion
: Detailed IVUS analysis confirmed significantly greater neointimal suppression with EES, with no apparent adverse vessel response, as compared to PES. Additional drug-eluting stent trials in more complex lesions are warranted to further validate the clinical utility of these new technologies.