bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 829: High Plasma Levels of Stromal Cell-Derived Factor-1 Alpha Predict a Worse Prognosis in Patients with Chronic Heart Failure
Authors: Kodama Yasushi , Makino Aritaka , Sano Keita , Takishima Isao , Hirano Masamitsu , Nakamura Takamitsu , Saito Yukio , Nakamura Kazuto , Kitta Yoshinobu , Kawabata Ken-ichi , Obata Jyun-ei , Kugiyama Kiyotaka
Published: July 2021

Stromal cell-derived factor-1 alpha (SDF-1α) is expressed in injured myocardium and plays a key role in the repair of the injured myocardium. This study examined whether SDF-1α in the circulation may have a prognostic information in patients with heart failure (HF). SDF-1α levels in plasma from a peripheral vein (PV) were measured using ELISA in 297 patients with chronic HF defined by the Framingham criteria, who had LV functional abnormalities (102 patients in NYHA class II, 65 in NYHA III, 32 in NYHA IV), and in 50 age- and sex-matched controls. The levels were also measured in plasma from the aorta (AO) and the coronary sinus (CS) in a subgroup of 82 HF patients. Then, all patients with HF were prospectively followed for 60 months or until occurrence of cardiac death or hospitalization with worsening HF. PV levels of SDF-1α were higher in HF patients than controls (2661 ± 67 vs. 2320 ± 55 pg/mL, p < 0.01), and patients with higher NYHA class had higher SDF-1α levels (ρ = 0.41, p < 0.0001). The PV levels of SDF-1α were similar between patients with ischemic HF (n = 204) and non-ischemic HF (n = 93). During follow-up, 19 cardiac death and 69 hospitalization occurred. The PV levels of SDF-1α were higher in patients with an event than those without an event (2820 ± 78 vs. 2490 ± 38 pg/mL, p < 0.01). In a multivariate Cox hazards analysis, a higher level of SDF-1α (> 3040 pg/mL, defined by ROC analysis) was a predictor of events that was independent of age, LVEF, use of medications, and BNP levels (HR 2.1, 95% CI 1.2–4.2, p < 0.01). Moreover, the CS - AO difference in SDF-1α levels, reflecting release from the heart, was higher in patients with (n = 21) than without an event (n = 67) (80 ± 46 vs. −32 ± 33 pg/mL, p < 0.01). The CS - AO difference in SDF-1α levels was positively correlated with the PV levels (r = 0.22, p < 0.05). Both the CS - AO difference in SDF-1α levels and the PV levels had a significant positive correlation with PV levels of BNP and an inverse correlation with LVEF. Higher SDF-1α levels in the peripheral circulation independently predict a worse outcome in patients with chronic HF. SDF-1α is released from the heart in proportion to the severity of LV dysfunction via a compensatory mechanism and may partly contribute to increased circulating levels of SDF-1α in chronic HF.
Abstract 857: Systolic Blood Pressure of 115 mmHg and Above is Associated with Worsening Cardiac Risk Profile in Normotensive Individuals
Authors: Rafey Mohammed A , Butt Saud , Hila Sorana , Butler Robert , Pohl Marc A , Poggio Emilio , Schreiber Martin J
Published: July 2021

Aim: To explore whether a systolic blood pressure (SBP) cut-off of ≥115 mmHg is associated with worsening in the cardiac risk profile of healthy, normotensive individuals.

Background: Data from population based trials demonstrates an increase in cardiovascular events beginning with a SBP of 115mmHg. We sought to study the cardiac risk profile of healthy, normotensive individuals with SBP ≥115 mmHg.

Methods: A retrospective chart review was performed on all 391 consecutive live donors who were found healthy and eventually donated kidney between April 1997 and December 2005 at our institution. Pre-kidney donation profile collected included age, gender, race, body mass index [BMI], office blood pressure readings, fasting glucose (FBS), uric acid (UA), lipid profile and iothalamate GFR [iGFR]. We stratified patients into two groups based on systolic blood pressure cut-off value of ≥115mmHg. Continuous variables were compared between groups using independent samples t test, categorical variables were compared using chi square and Fisher’s exact tests utilizing a 2 sided p value < 0.05.

Results: The sample included 230 women (59%), 361 white patients (81%). Mean age was 41±9 years, SBP was 115.6 ± 15 mmHg, BMI 26.7 ± 4.24, UA 5.0 mg/dl ± 1, FBS of 87 ± 9 mg/dl and iGFR 106.47 ± 16.47 ml/min. Each of these risk factor variables was significantly elevated in the subgroup with SBP ≥115 mmHg when compared to those with lower SBP.

Conclusion: These data suggest that in otherwise healthy living donors a SBP of ≥115 mmHg is associated with a more adverse cardiac risk profile in comparison to those with a SBP less than 115 mmHg. Further studies are needed to see if instituting early interventions would improve cardiac profile and prevent cardiovascular events.
Abstract 893: Contrast Medium-Induced Renal Damage is Tightly Associated with Endothelial Injury in Patients
Authors: Tajiri Kazuko , Maruyama Hidekazu , Sakai Satoshi , Shimojo Noritake , Aihara Hideaki , Endo Masae , Saito Takumi , Kawano Satoru , Watanabe Shigeyuki , Aonuma Kazutaka
Published: July 2021

Background:
Contrast-induced nephropathy (CIN) remains a common complication of radiographic procedures. We hypothesized that endothelial dysfunction is the main cause of CIN. To clarify whether contrast medium-induced renal damage is associated with endothelial injury, we measured microparticles derived from endothelial cells as markers of endothelial injury. Circulating microparticles are shed from cell surface respond to cell activation and apoptotic stimuli, reflecting the condition of damaged cells.

Methods:
Renal function of 35 adult patients was analyzed before and after the use of contrast medium for coronary angiography. Parameters for renal function and urinary 15-isoprostane F2t, a specific marker of oxidative stress were measured before and after radiocontrast administration. Flow cytometry was used to count circulating CD34
+
microparticles, which is regarded as one of markers for endothelial damage.

Results:
The decrease of estimated glomerular filtration rate positively correlated with the amount of contrast medium (r=0.427; P=0.013). Urinary N-acetyl-beta-D-glucosaminidase, a marker of renal tubular injury, was increased after angiography (from 7.6+/− 6.8 to 9.1 +/− 6.0 U/g-CRE, P=0.011). Furthermore, urinary 15-isoprostane F2t positively correlated with the volume of contrast medium (r=0.421; P=0.012). CD34+ microparticle was significantly increased after angiography (1.3-fold increased from basal level, P=0.0017). The increase of CD34+ microparticle was associated with the insult of contrast medium, but not of the amount.

Conclusion:
Radiocontrast impaired renal function in accordant with the increase of oxidative stress. The release of CD34+ microparticle was also increased by use of radiocontrast. These data suggest that CIN is tightly associated with endothelial injury mediated by radiocontrast-induced oxidative stress.
Abstract 903: Low Plasma Adiponectin Level and High Oxidative Stress are Associated with In Vivo Thin-Cap Fibroatheloma Prevalence in Patients with Stable Coronary Artery Disease
Authors: Sawada Takahiro , Shite Junya , Shinke Toshiro , Tanino Yusuke , Ogasawara Daisuke , Kawamori Hiroyuki , Kato Hiroki , Miyoshi Naoki , Yoshino Naoki , Hirata Ken-ichi
Published: July 2021

Background
; Few studies have investigated the association between biomarkers and in vivo plaque vulnerability in patients with stable coronary artery disease (CAD).

Methods
; We examined two or three vessels of 55 stable CAD patients with combined use of virtual histology intravascular ultrasound (VH-IVUS) and optical coherence tomography (OCT), and diagnosed thin-cap fibroatheroma (TCFA). The definition of TCFA was described as follow:

necrotic core rich lesion (%necrotic-core>10%) without evident overlying fibrous component and %plaque-volume>40% by VH-IVUS analysis, and

the thinnest fibrous-cap thickness <65μm by OCT measurement. The patients were divided into two groups, the patients with TCFA and without TCFA, and compared their clinical characteristics, laboratory data and new atherosclerotic biomarkers (adiponectin, oxidative stress marker) between these two groups.

Results
; In 55 patients, we could observe 126 vessels (2.29±0.46 vessel/patient) with both modality and we identified 37 TCFA in them. At least one TCFA was identified in 24 patients (43.6%) and not in 31 patients. There were no differences in the clinical characteristics between the two groups. However, a greater number of patients with TCFA had a past history of ACS than those without TCFA (P=0.04). As for laboratory data, there were no differences in lipid and sugar profiles and inflammatory markers, but patients with TCFA had lower plasma adiponectin levels and higher urine- 8-isoprostane/creatinine levels, which is considered as reliable in vivo oxidative stress marker, than patients without TCFA (p=0.0002, P=0.04, respectively). Multivariate logistic regression analysis revealed the most powerful indicative factor of TCFA prevalence in stable CAD was plasma adiponectin levels (P=0.001). The receiver-operating characteristic curve analysis identified plasma adiponectin <6.8μg/ml (Area under curve = 0.80, 95% confidence interval = 0.67 to 0.90, P=0.0001, sensitivity 70.8%, specificity 80.6%) as the optimal cut-off point for prediction of the TCFA prevalence in stable CAD.

Conclusion
; Plasma adiponectin levels and urine-8-isoprostane may be one of the tools that help to stratify vulnerable patients into risk categories in patients with stable CAD.
Abstract 906: Healing of Thin-Capped Fibroatheroma Assessed by Serial VH-IVUS Tissue Characterization
Authors: Kubo Takashi , Maehara Akiko , Mintz Gary S , Doi Hiroshi , Tsujita Kenichi , Yang Junqing , Liu Jian , Oviedo Carlos , Tam Anthony , Bharaj Harpreet , Abendroth Richard , Biro Sinan , Aaskar Rasha , Castellanos Celia , Dani Lokesh , Moses Jeffrey W , Vince Geoffrey , Margolis Pauliina , Margolis James R , Stone Gregg W , Leon Martin B
Published: July 2021

Thin-cap fibroatheromas (TCFA) are prone to plaque rupture and thrombosis. Intravascular ultrasound (IVUS) virtual histology (VH) assesses plaque composition and lesion morphology in vivo.

Methods & Results:
We used serial (baseline and follow-up @11 mos) VH-IVUS to study non-culprit plaque morphology in 221 lesions (plaque burden >40%) in 106 pts. Lesions were classified into 4 types based on plaque composition; pathological intimal thickening (PIT), thin-capped fibroatheroma (TCFA), thick-capped fibroatheroma (ThCFA), fibrotic/fibrocalcific. At baseline, 21 lesions were TCFAs (confluent necrotic core contacting to the lumen). Overall during follow-up (Figure

), 16/21 (76%) TCFAs healed: 13 became ThCFAs, 2 TCFAs became PIT, 1 TCFA became fibrotic, and 5 TCFAs (24%) remains unchanged although the location of the necrotic core in contact with the lumen shifted axially. Compared to TCFAs that healed, TCFAs that remained TCFAs

were more often proximal in location (distance from coronary ostium to the lesion of 19±6 vs. 41±22mm, respectively, p=0.037) and

had larger lumen area (9.9±3.1 vs. 6.9±1.8 mm2, p=0.013), vessel area (22.8±6.4 vs. 15.3±2.6 mm2, p=0.001), plaque area (12.9±4.9 vs. 8.4±1.7 mm2, p=0.005), calcium area (1.3±0.6 vs. 0.6±0.3 mm2, p=0.014), and necrotic core area (2.6±1.0 vs. 1.6±0.7 mm2, p=0.015). In addition, 6 new TCFAs developed; these 6 late-developing TCFAs had the appearance of PIT at baseline (Figure

).

Conclusion:
Although most TCFAs seem to stabilize or heal during 12 mos follow-up,

proximal TCFAs in larger vessels with more plaque and calcium and a larger necrotic core appear to heal less often and

new TCFAs can develop.
Abstract 915: The Effect of Gender and Race on Outcomes in Patients Undergoing PCI for Proximal Coronary Artery Lesions: A Report from the NHLBI Dynamic Registry of PCI
Authors: Green Sandy M , Selzer Faith , Mulukutla Suresh , Lee Ashley , Joon Lee S , Kelsey Sherry F , Kip Kevin E , Marroquin Oscar C
Published: July 2021

Background:
Little is known about the effect of gender and race on outcomes in patients after revascularization of proximal coronary lesions (PCL). We investigated their effect on outcomes using the NHLBI Dynamic Registry.

Methods:
Of the 9962 patients receiving PCI, 3918 (39%) were treated for disease in a proximal coronary artery segment. Left main and PCI for graft lesions were excluded. Primary outcomes were death/MI or need for repeat revascularization at 1 year after the index procedure.

Results:
80% of the patients were white (n=3144), 11% black (n=469), 63% male (n=2461), and 37% female (n=1457). Patients with PCL had lower rates of HTN, prior MI, but where older and had more concomitant medical disease. Compared to non-proximal lesions, patients with PCL had higher rate of death (5.4% vs. 4%, p=0.001) and repeat revascularization (16.3% vs. 14.3%, p=0.01). The effect of gender and race were then included in the multivariate model for predicting risk in patients with PCL (Table 1

). Race did not modify the risk associated with PCL but females had a 32% greater relative risk (p=0.002) of repeat revascularization when compared to men.

Conclusions:
Treatment of proximal coronary lesions is associated with a more adverse outcomes compared to non-proximal coronary lesions. In this high-risk population, female gender is an independent predictor for the need for repeat revascularization.

Table 1:

Event rates, unadjusted and adjusted hazard ratios and 95% confidence intervals in patients undergoing proximal vessel PCI
Abstract 978: The Clinical Significance of Borderline Elevated Troponin-I Levels Across Different Assays
Authors: Zahid Maliha , Good Chester B , Sonel Ali F
Published: July 2021

Background
: Markedly elevated troponin I (TnI) is a strong predictor of adverse cardiac events. It is not clear if borderline elevations with different commercially available TnI assays provide similar prognostic information.

Methods
: From 1/01 to 2/04, three different TnI assays (Beckman Access TnI, Beckman Access AccuTnI and Vitros ECI Troponin) were used to evaluate the peak TnI value in1094 consecutive patients admitted with suspected ACS/NSTEMI. Recommended cut-offs were used to differentiate borderline from marked elevations reported as consistent with myocardial infarction (MI). Clinical data and 30-day death/new MI were determined by chart abstraction.

Results
: Demographics and cardiac risk factors were similar for the three groups. Frequency of borderline TnI ranged widely between the assays (18.7– 42.1%) but was significantly less with the Vitros ECI TnI assay (p<0.0001). Prognostic significance of borderline elevated TnI varied greatly by assay as well, with borderline Beckman Access AccuTnI elevations being predictive of adverse 30-day outcomes (OR=4.0, 95% CI=1.46 – 10.97, p-value=0.007), but not the other two assays. Borderline elevations were significantly associated with chronic renal insufficiency (CRI, serum Cr>1.5); the relationship to adverse 30-day outcomes and borderline elevations persisted after correcting for CRI in a multivariate logistic regression model.

Conclusions
: Although borderline elevated troponin-I levels are common and significantly associated with chronic renal insufficiency, they do not all portend the same clinical prognosis. This study highlights the need for standardization of TnI levels across different assays.

Combined Outcomes by Troponin-I Assay and Range.
Abstract 1104: Polymer Injection Therapy to Reverse Remodel the Papillary Muscles: Efficacy in Reducing Mitral Regurgitation in a Chronic Ischemic Model
Authors: Solis-Martin Jorge , Johnson Benjamin , Guerrero J. Luis , Handschumacher Mark , Sullivan Suzanne , Braithwaite G.J.C , Muratoglu O.k. , Vlahakes G.j , Levine Robert A , Hung Judy
Published: July 2021

Ischemic mitral regurgitation (IMR) relates to displacement of the papillary muscles from ischemic ventricular distortion. Recurrent IMR is frequent after annuloplasty, particularly when left ventricular remodeling continues to progress. Our hypothesis is that repositioning of the papillary muscles can be achieved by injection of polyvinyl-alcohol (PVA) polymer into the myocardium, in chronic MR with great left ventricle remodeling.

Methods
: we studied 8 sheep underwent ligation of circumflex branches to produce chronic ischemic MR over eight weeks. Once MR developed, PVA was injected into the myocardium underlying the infarcted PM. 2D and 3D echocardiograms were used pre infarct (baseline), pre PVA (Chronic MR) and post PVA. Hemodynamic data were obtained

Results: One animal died, in the remaining 7 moderate MR developed. With PVA, the MR decreased significantly from moderate to trace-mild (vena contracta: 5.3 ± 0.9 mm vs 2.3 ± 0.9 mm, post MR vs post PVA; p<0.001). This was associated with a decrease in infarcted papillary muscle-to-mitral annulus tethering distance (33.1 ± 4.6 to 27.4±4.1 mm, post MR vs post PVA, P<0.05), tenting volume (2.1±0.3 to 1.6±0.4 mm, post MR vs post PVA, P<0.05) and leaflet area (9.4 ± 0.8 to 8.2 ± 0.7 mm, post MR vs post PVA, P<0.04). PVA was not associated with significant decreases in LVEF (41±2 % vs 39±2 %, p=ns).

Conclusions
: PVA polymer injections improve coaptation and reduce remodeling chronic MR without impairing LV systolic function. This new approach offers a potential alternative for relieving ischemic mitral regurgitation by correcting papillary muscle position, thus relieving tethering that causes ischemic mitral regurgitation.
Abstract 1173: Risk of Recurrent Cerebrovascular Events in Patients with Cryptogenic Cerebral Ischemia and Patent Foramen Ovale: A Meta-Analysis of Observational Studies
Authors: Wilton Stephen B , Almekhlafi Mohammed A , Rabi Doreen M , Ghali William A , Lorenzetti Diane L , Hill Michael D
Published: July 2021

In patients with a patent foramen ovale (PFO) and a prior cryptogenic ischemic stroke or transient ischemic attack (TIA), the risk of recurrent events is unclear. To conduct a systematic review and meta-analysis of studies assessing the risk of recurrent cerebrovascular events in patients with cryptogenic cerebral ischemia and PFO. MEDLINE (1950 to February 2008) and EMBASE (1980 to February 2008) databases were searched to identify studies in any language. Searches were supplemented by scanning bibliographies of key articles. Studies reporting original data on recurrent cerebrovascular events in patients with prior cryptogenic stroke or TIA and PFO, with or without a non-PFO comparison group, were included. Uncontrolled case series evaluating device or surgical closure of PFO were excluded. Two authors independently extracted the data from included studies and evaluated study quality. For studies with a non-PFO comparison group, relative risks were pooled using a fixed effects model after confirming homogeneity of results. For all studies, the pooled absolute rate of recurrent events was calculated using a random effects model due to heterogeneity of results. Fifteen studies published between 1994 and 2007, following 2377 patients over a mean of 37 months were included. In the four studies with a non-PFO comparison group, the pooled relative risk of recurrent stroke or TIA associated with the presence of a PFO was 1.1 (95% CI 0.8 to 1.5), while for recurrent ischemic stroke the pooled relative risk associated with the presence of a PFO was 0.8 (95% CI 0.5 to 1.3). The pooled absolute rate of recurrent ischemic stroke or TIA in patients with PFO was 4.0 events per 100 person-years (95% CI 3.0 to 5.1) while the rate of recurrent ischemic stroke was 1.6 events per 100 person years (95% CI 1.1 to 2.1). No clinical or imaging features are reliably associated with increased risk of recurrent events. In medically treated patients with prior cryptogenic stroke, available evidence does not support an increased risk of recurrent ischemic events in those with vs. without a PFO. Routine PFO closure in these patients may not be warranted, outside of ongoing clinical trials.
Abstract 2000: Incomplete ST-Segment Deviation Resolution after Primary Percutaneous Coronary Intervention in Patients with Multivessel Disease is Mainly Due to the Presence of a Non-Infarct-Related Chronic Total Occlusion
Authors: Verouden Niels J , Claessen Bimmer E , van der Schaaf René J , Koch Karel T , Baan Jan , Vis Marije M , Tijssen Jan G , Piek Jan J , Henriques José P , de Winter Robbert J
Published: July 2021

Background
Incomplete ST-segment deviation resolution (STR) after epicardial flow restoration may represent microvascular dysfunction and predicts an unfavorable outcome in patients with ST-segment elevation myocardial infarction (STEMI). From recently published data concerning STEMI patients that underwent primary percutaneous coronary intervention (PCI), increased mortality in patients with multivessel disease (MVD) was attributed to the presence of a chronic total occlusion (CTO) in a non-infarct-related artery (IRA). We evaluated whether the presence of MVD with or without a CTO in a non-IRA significantly contributes to incomplete STR in a large cohort of patients undergoing primary PCI for STEMI.

Methods
In this single-center study, 2127 STEMI patients underwent primary PCI between 2000 and 2006. The IRA and presence of MVD was determined during diagnostic angiography preceding primary PCI. MVD was assessed if ≥ 1 non-IRA showed ≥ 1 coronary stenosis of ≥ 70% and a CTO was defined as a 100% luminal narrowing in a non-IRA. STR was defined as the relative difference (in %) of the summed ST deviation between the pre-PCI and the immediately post-PCI 12-lead ECG. A post-PCI STR of ≥ 70% was considered complete.

Results
During emergency coronary angiography, singlevessel disease (SVD) was observed in 1474 (69.3 %) patients, MVD without a CTO in 433 (20.4 %) patients, and MVD with a CTO in a non-IRA in 220 (10.3 %) patients. MVD patients less frequently showed complete STR compared to patients with SVD (OR 1.2 95% CI, 1.0 – 1.5 p = 0.046). However, the occurrence of complete STR in SVD patients and MVD patients without a CTO was comparable (OR 1.1, 95% CI, 0.9 – 1.4 p = 0.43). In MVD patients with a CTO, STR was significantly less often complete compared to patients with SVD or with MVD without a CTO (OR 1.6 95% CI, 1.1 – 2.6 p = 0.01).

Conclusion
STEMI patients with MVD undergoing primary PCI showed complete STR less often compared to SVD patients. This effect is mainly due to a subgroup of MVD patients with a CTO in a non-IRA and not due to mere MVD.
Abstract 2001: Clinical and Angiographic Predictors of 30-Day and One-Year Ischemic Cardiac Events in Patients with Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: An ACUITY Substudy
Authors: Goto Kenji , Lansky Alexandra , Cristea Ecatarina , Bertrand Michel E , Lincoff A. Michael , Moses Jeffrey W , Fahy Martin , Mehran Roxana , Stone Gregg W
Published: July 2021

Background:
Clinical predictors of short and long-term ischemic outcomes following PCI in acute coronary syndromes (ACS) have been well studied. However, the angiographic predictors of adverse events have not been defined.

Methods:
The ACUITY trial randomized 13,819 pts with moderate and high risk ACS to unfractionated heparin or enoxaparin + GP IIb/Iii inhibitors (GPI), versus bivalirudin + GPI, vs. bivalirudin alone. The angiographic substudy of ACUITY included the first 7000 consecutive randomized US patients, of which 3664 underwent PCI. All angiograms were reviewed by an independent core laboratory for complete 3 vessel assessment of extent and CAD burden (total mm length of lesions with >30%DS), as well as baseline and final lesion and flow characteristics. Clinical and angiographic predictors of composite ischemia (death, non-fatal MI, or ischemic target vessel revascularization) at 30 days and 1 year were identified by univariate and multivariable analysis using logistic regression analysis.

Results:
Coronary stents were used in 3429 (93.6%) pts, (84.4% DES). Composite ischemia occurred in 366 pts (10.0%) at 30 days and in 735 pts (21.0%) at one year. The independent predictors of 30 day and 1 year composite ischemic events by multivariable analysis are shown in the table

.

Conclusions:
Beyond the clinical predictors of renal insufficiency and diabetes, CAD burden assessed by the number of diseased coronary vessels and the burden of CAD are independent predictor of 30 day and 1 year ischemic events in patients with ACS undergoing PCI. Baseline lesion specific characteristics including eccentric and calcified lesions, as well as angiographic PCI complications resulting in sustained no reflow, abrupt closure or thrombus were also independently predictive of adverse events.

Table 7:

Multivariate Predictors of Composite Ischemia
Abstract 2008: Impact of Hyperglycemia on Myocardial Damage and its Prognostic Implications in Patients with Acute ST-Segment Elevation Myocardial Infarction (STEMI) Assessed by Contrast-Enhanced Cardiac Magnetic Resonance Imaging (CMR)
Authors: Jensen Christoph J , Jochims Markus , Nassenstein Kai , Bell Michael , Schlosser Thomas , Sabin Georg V , Bruder Oliver
Published: July 2021

To investigate the impact of admission glucose levels on myocardial damage and long term outcome in patients with acute STEMI using contrast-enhanced CMR. 130 consecutive patients (104 males; mean age 59.4±11.8 years) with first reperfused STEMI were included. Hyperglycemia was defined as glucose levels above 7.8mmol/l. CMR was performed within 3.9±2.2 days after admission on a 1.5 Tesla MR System. The imaging protocol included SSFP cine sequences for the calculation of LV function, volumes and mass. Total no reflow volumes (NRV) and delayed enhancement volumes (DEV) were calculated from planimetry of the IR-SSFP stacks of short axis images by disc-summation performed early / late following administration of 0.2mmol/kg/BW of gadodiamid. NRV and DEV were expressed as percent of LV Mass (NR%, DE%). Continuous variables were compared by Mann-Whitney test. Correlation of admission hyperglycemia and NR% was tested by spearman rank test. Patients were prospectively followed for 30±9 months. A stepwise logistic regression model was used to analyze the impact of hyperglycemia and CMR parameters on NR% and outcome. 55 of 130 (42%) patients had hyperglycemia on admission. Patients with admission hyperglycemia had lower LV ejection fraction (38.6±12.9% vs. 47.7±11.9%, p=0.001), greater ESV (89.2±39.2ml vs. 71.7±34.1ml, p=0.002), greater LV Mass (156.7±40.4g vs. 136.3±36.7g, p=0.003), larger DE% (19.3±13.8% vs. 9.7±8.5%, p<0.001) and larger NR% (8.1± 9.2% vs. 2.3± 4.2%, p<0.001). Admission hyperglycemia correlated moderate but significant to DE% (r=0.386, p<0.001) and NR% (r=0.421, p<0.001). In a multivariable logistic regression model admission hyperglycemia was an independent predictor (OR 6.8; CI 2.8 −16.6) of extensive (> median) microvascular obstruction, extensive delayed enhancement (OR 3.2; CI 1.5–7.1) and was associated with an increased risk for death and reinfarction (OR 4.7; CI 1.2–18.3) during follow up. Admission hyperglycemia in acute, reperfused STEMI is independently related to the extent of microvascular obstruction on early contrast-enhanced CMR and is associated with worse long-term outcome. Thus, CMR may play a major role in monitoring effects of glucose control on myocardial damage in AMI.
Abstract 2025: TIMI Major Bleeding Independently Predicts Mortality in an Unselected STEMI Population: Results from the AMI-Quebec Study
Authors: L’Allier Philippe , Huynh Thao , Schampaert Erick , Kouz Simon , Eisenberg Mark , Lauzon Claude , Afilalo Marc , de Larocheliere Robert , Nguyen Michel , Levesque Claude , Dery Jean Pierre , Rinfret Stephane , Tardif Jean Claude
Published: July 2021

Major bleeding was recently identified as an independent predictor of adverse clinical outcomes in patients with acute coronary syndromes. We sought to determine the impact of major bleeding on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) and the clinical characteristics associated with major bleeding. AMI-QUEBEC was a retrospective cohort study of consecutive STEMI patients admitted to 17 selected acute-care hospitals in the Province of Quebec (Canada) in 2003. Research coordinators identified major bleeding complications according to the Thrombolysis In Myocardial Infarction (TIMI) classification. The cohort included 1,655 patients. Thirty-eight percent (38%) of patients were treated with fibrinolysis, 51% with primary percutaneous coronary intervention (PCI) (65% femoral approach) and 12% received no reperfusion therapy. Twenty-eight percent (28%) of patients were females, mean age was 62.3 years, mean weight was 77.5 kg, 5.1% had prior stroke, and baseline serum creatinine was 104 μmol/L. Concomitant medications included clopidogrel loading in 32%, glycoprotein IIb/IIIa inhibitor 24%, unfractionated heparin 82% and low molecular weight heparin 9%. TIMI major bleeding occurred in 7.3% of patients. Overall in-hospital mortality was 11.6%. Independent predictors of mortality were

major bleeding (OR 4.36 [2.48 –7.68]) and

age (OR 1.06 [1.03–1.08] per year increase).

Independent predictors of TIMI major bleeding were

femoral approach (OR 11.2 [3.9 –32.1])

female gender (OR 2.8 [1.5–5.1]) and

peak creatinine (OR1.02 [1.01–1.03] per 1μmol/L increase).

Age, weight, blood pressure, mode of reperfusion, clopidogrel, aspirin, anticoagulant, clopidogrel load, glycoprotein IIb/IIIa inhibitors, PCI within 24 hours post-fibrinolysis were not independent predictors of major bleeding. TIMI major bleeding conferred a greater than four-fold increase in risk of short-term mortality in an unselected STEMI population. The use of the femoral approach for vascular access was the most powerful predictor of major bleeding in this patient population, highlighting the impact of vascular access site selection.
Abstract 2044: Selective Head Cooling Initiated during Cpr Induces Post-Resuscitation Carotid Artery Dilation and Increases in Carotid Artery Flow and Cerebral Cortical Microcirculation
Authors: Ristagno Giuseppe , Cho Jun H , Yu Tao , Sun Shijie , Weil Max H , Tang Wanchun
Published: July 2021

Introduction.
We have previously reported that selective head cooling initiated during CPR prevented increases in brain temperature and improved neurological outcome. In the present study, we explored the relationship between head cooling during CPR and cerebral blood flows. We hypothesized that head cooling during CPR would yield carotid artery dilation with consequent increases in carotid flows and cerebral cortical microcirculation.

Methods.
Eight pigs weighing 37 ± 1 kg were intubated and mechanically ventilated. The common carotid artery was isolated and a parietal craniotomy was created. Ventricular fibrillation was electrically induced and untreated for 4 min. Animals were then randomized to head cooling or control. Head cooling was initiated with the aid of the RinoChill device (BeneChill Inc) at the beginning of CPR. CPR was performed for 4 min prior to defibrillation. Common carotid artery diameter and flow were assessed with a Doppler transducer. Cerebral cortical capillary density, representing the number of perfused capillaries, was assessed with Sidestream Dark Field imaging (MicroVisionMedical Inc). Brain temperature was measured with a needle sensor inserted in the cerebral cortex.

Results.
All the animals were resuscitated. After resuscitation, the brain temperature was significantly decreased in animals subjected to head cooling. Significantly greater carotid artery diameters and flows were observed in animals subjected to selective head cooling compared to the control animals. These increases in carotid blood flows were accompanied by significantly greater numbers of perfused capillaries in the cerebral cortices. No differences in cardiac output were observed between the two groups (Table

).

Conclusion.
Early selective head cooling induces carotid artery dilation and increases in carotid flows and cerebral cortical microcirculation after resuscitation.
Abstract 2061: High Velocity Penetrating Thoracic Trauma with Suspected Cardiac Involvement in Combat During Operation Iraqi Freedom
Authors: Dominguez Francisco , Beekley Alec C , Huffer Linda L , Gentlesk Philip J , Eckart Robert E
Published: July 2021

Introduction:

The most common cardiac injuries in the U.S. are either blunt trauma from motor vehicle accidents, or low-velocity injuries from stabbings. High-velocity injury is less common, and survival to presentation is rare. During military conflict, high-velocity injury, including gunshot wounds (GSW) and fragment injury from improvised explosive devices (IED) are relatively more common.

Methods:

Retrospective review of cases with high-velocity penetrating injury and suspected myocardial involvement. We sought to describe the role of varying diagnostic modalities during a 6 month period in Baghdad, Iraq at a U.S. Army hospital during Operation Iraqi Freedom.

Results:

There were 11 cases who survived to admission (GSW in 5, IED in 6). The mean age of the all male cohort was 27 years (range 3 to 54). Eight of the eleven patients (73%) were victims of polytrauma. The entrance involved the right ventricle (n=3), right atrium (n=2), left ventricle (n=1) or mediastinum and pericardial reflections (n=5). Echocardiography was performed in all eleven patients. All patients had preserved or hyperdynamic myocardial contractility. In seven patients, no foreign body was identifiable, in two patients the foreign body was identified as being within the pericardial fat pad. Three patients were identified as having a suspected ventricular septal defect, ranging in size from 2 to 8 mm. The most common ECG abnormality was conduction delay, both atrioventricular block and right bundle branch block. Plain film radiography and CT scanning were routinely performed, but definitive localization was frequently limited by metallic streak artifact. In four patients, the management of the chest injury was non-surgical, and in one patient the treatment was a chest tube only. Four of the patients underwent median sternotomy, one underwent emergent lateral thoracotomy, and one underwent an infra-diaphragmatic approach.

Conclusions:

While this case series is too small to draw definitive conclusions, it does demonstrate that a multidisciplinary approach to high-velocity injuries with potential for cardiac involvement augments pre-operative assessment for myocardial injury and may allow selective non-operative management.
Abstract 2083: Five-Year Follow-Up of Quality of Life in Randomized Patients to Receive Coronary Bypass Surgery, Percutaneous Coronary Intervention or Medical Treatment: The Medicine Angioplasty or Surgery Study (MASS-II) Trial
Authors: Takiuti Myrthes E , Girardi Priscyla , Nogueira Celia R , Nakano Teryo , Paulitsch Felipe S , Garzillo Cibele L , Lopes Neuza , Stolf Noedir A , Hueb Whady
Published: July 2021

Background: Although coronary bypass surgery (CABG), percutaneous coronary intervention (PCI) are used for the relief of symptoms and for a better tolerance to exercises, there is no conclusive evidence showing that these methods offer more benefits than the medical treatment (MT) to the quality of life (QoL) in patients with symptomatic coronary artery disease (CAD). This study sought to compare the QoL scores during 5-year in patients with stable multivessel CAD, who underwent one of the 3 therapeutic approaches.

Methods: From May 2000 and May 2005 a total of 611 patients were randomly assigned to a CABG (n=203), PCI (n=205) or MT (n=203). Of these patients, 546 (89%) were followed for assessments of QoL and demographic profile questionnaire for a 5-year period. 187 (34%) underwent CABG, 181 (33 %) PCI and 178 (33%) underwent MT. The Short Form Health-Related QoL Questionnaire (SF-36) was used to assess the patients, before randomization, six months, and 12months and annually until the end of study. The SF-36 comprises 36 items that can be combined into the following eight multi-item summary scores: physical functioning, vitality, bodily pain, mental heath, social functioning, and role limitation due to physical health, emotional problems and general health perceptions.

Results: At baseline, we found no difference relating to overall mortality between three groups. The eight domains of QoL showed improvement in all groups at 6-month follow-up visit compared with the baseline evaluation (p<0.001). Surgical therapy, PCI and MT showed improvements over baseline in most domains of quality of life (p<0.001). The improvements was observed mainly in surgical group and especially in physical role functioning. On the other hand medical therapy group showed fewer changed in their rating of general health. PCI group showed significant superiority over medical group in terms of physical functioning, vitality and general health after randomization.

Conclusion: All patients had improvement in QoL detected at 6 months persisting until 60 months. Moreover, CABG patients had better improvement of QoL compared with other groups. Furthermore, the QoL of PCI patients was better than MT patients at the end of follow-up.
Abstract 2128: Predictive Value of Short-term Deceleration Capacity
Authors: Schmidt Georg , Bauer Axel , Barthel Petra , Müller Alexander
Published: July 2021

Background: Deceleration Capacity (DC) derived from 24-hour Holter recordings is a strong predictor of mortality in patients after acute myocardial infarction (MI). This prospective cohort study investigates the predictive power of DC derived from short-term recordings.

Methods: 938 survivors of acute MI (age ≤80 years, sinus rhythm) were included. Within one week after index infarction, 30-min high resolution ECGs (1600Hz, supine position and resting conditions) as well as 24h-Holter recordings were performed. Short-term DC (DCs) and long-term DC (DCl) were calculated according to the previously published technology. Primary endpoint was death from any cause at two years. Multivariate Cox-regression analyses were adjusted for LVEF ≤30% and clinical covariates.

Results: During the 2-year follow-up, 36 patients (3.8%) died. Both, DCs and DCl were strong predictors of death with areas under the receiver-operator characteristics curves of 76.3% and 77.8%, respectively (p<0.0001). DCs was significantly correlated with DCl (r=0.7, p<0.0001). After adjustment for LVEF, presence of diabetes mellitus, advanced age and history of a previous MI, DCs (≤2.5ms) remained a highly significant predictor of death (Table

).

Conclusion: DC derived from high-resolution short-term ECGs is a strong and significant predictor of death in post-infarction patients.

Multivariate Cox regression analysis for Prediction of 2y-Mortality
Abstract 2132: Beta-Blocker Therapy and Effectiveness of Antitachycardia Pacing among ICD Patients: A Dose-Dependent Effect
Authors: Jimenez-Candil Javier , Morinigo Jose , Olgado Maria Ruiz , Ledesma Claudio , Martín-Luengo Cándido
Published: July 2021

Beta-blockers (BB) increase the efficacy of antitachycardia pacing (ATP) in terminating slow and monomorphic ventricular tachycardias (MVT) in ICD patients. Whether this effect occurs in fast MVT and whether it is dose-dependent it is unknown. Our aim is to determine the relationship between the indexed dose equivalents (IDE) of beta-blockers (BB-IDE) with the effectiveness of ATP in terminating MVT. In this prospective study we included 200 ICD patients (LVEF: 31±11). Detection and ATP therapies for VT were programmed as follows: Fast-VT zone (Cycle Length [CL]: 250 –320 ms; 1 burst of 5 pulses at 84% of CL); slow-VT zone (CL: 321–390 ms; 3 bursts of 15 pulses at 91%). In each patient we determined the BB-IDE at MVT presentation. Dose equivalents (DE) were defined with atenolol used as reference. IDE were calculated by dividing DE by body surface area (mg*m2/day). During a follow-up of 602±368 days, 546 MVT (CL: 329±35 ms; 41% fast-VT; 22 % no BB treatment; median of BB-IDE: 26 mg*m2/day) were recorded. Success rate of APT was 87%. BB-IDE was higher in the cases of successful ATP (S-ATP): 22±18 vs. 15±16 (p=0.001). Classifying the events into three groups according to the BB-IDE: no BB, low IDE (BB-IDE<median) and high IDE (BB-IDE≥median), the frequency of S-ATP increased with the BB-IDE: 78 vs. 84 vs. 94% (all MVTs; p<0.001 for the trend) and 47 vs. 84 vs. 97% (fast-MVTs; p<0.001, for the trend). In a multivariate analysis (logistic regression), BB-IDE (mg*m2/day) remained as a significant predictor of S-ATP: OR: 1.03 (95% CI: 1.01–1.05; p=0.001). The incidences of MVT-related symptoms and appropriate discharges were lower in higher values of BB-IDE. Table

. Among ICD patients, BB therapy increases the likelihood of ATP terminating MVTs, especially in fast MVTs. This effect is dose-dependent: the higher the IDE, the more probable the S-ATP. Thus, BB improves MVT clinical tolerance.

Frequencies of tachycardia-related symptoms and appropriate discharges with respect to BB-IDE
Abstract 2154: Paroxysmal Atrial Tachyarrhythmia (AT) as a Trigger for Heart Failure Exacerbations: Assessment by Implanted Trans-pulmonary Impedance Sensor
Authors: Jhanjee Rajat , Templeton Grant , Nguyen John , Sakaguchi Scott , Lu Fei , Lurie Keith G , Milstein Simon , Van Heel Laura , Benditt David G
Published: July 2021

Introduction: From clinical experience, it is known that worsening of heart failure (HF) is often associated with a seemingly greater susceptibility to atrial tachyarrhythmias (AT), particularly atrial fibrillation. However, it is not clear whether it is the HF or the AT that is the sentinel event, and triggers the other. recently, certain contemporary implantable pulse generators (IPGs) are able to estimate intra-thoracic fluid status by means of detecting alterations of trans-pulmonary electrical impedance (OptiVol® [OV], Medtronic Inc). This capability permits long-term assessment of HF in pts. Employing this tool (i.e., OV) this study examined the temporal relationship between HF as assessed by OV method and AT events.

Methods: Fourteen patients (pts: males, 71%, mean age 70±6.7 years) with OV-capable IPGs were enrolled. At each patient visit, OV index values since last follow-up, and AT duration (hours) were collected. OV Index >60 based on Medtronic Impedance Diagnostics in Heart Failure Trial (MID-HeFT) data was used as a cutoff to signify HF. Devices were interrogated to ascertain the temporal relationship of OV Index >60 and incidence of AT. Results are presented as mean ± SD.

Results: Eighty-five pt visits were analyzed (mean=6.1 visits per pt, average follow-up, 21.7±5.7 months). Left-ventricular ejection fraction was 40±10%, with ischemic cardiomyopathy accounting for 57% pts. In 23 of 85 visits the OV index exceeded threshold and episodes of AT were detected by the device. Of these 23 instances in which there was AT-HF concordance, AT onset preceded the increase of OV index above threshold in 21/23 cases (91% of the time), comprising 9 of 14 pts (64%).

Conclusions: In patients with both systolic HF and paroxysmal AT, our findings suggest that AT tends to precede worsening of heart failure and may act as the trigger event.
Abstract 2219: High Dose Modified-release Nicotinic Acid Reduces Carotid Atherosclerosis: a Randomized, Placebo-controlled Magnetic Resonance Study
Authors: Lee Justin M , Robson Matthew D , Yu Ly-Mee , Shirodaria Cheerag C , Cunnington Colin , Kylintireas Ilias , Bannister Tom , Wiesmann Frank , Handa Ashok , Channon Keith M , Neubauer Stefan E , Choudhury Robin P
Published: July 2021

Background:

Large clinical outcome studies (AIM-HIGH and HPS-2THRIVE) are underway testing the strategy of adding high dose nicotinic acid (NA) to statin treatment. However, the effect of this on atherosclerosis progression is unknown.

Hypothesis:

Nicotinic acid 2g daily would reduce change in carotid wall area, assessed by MRI, compared to placebo.

Methods:

We performed a double-blind randomized placebo-controlled study of 2g once daily modified release NA added to background statin therapy in 71 patients with low HDL-C <40 mg/dL and either

known coronary heart disease with type 2 diabetes mellitus or

carotid / peripheral atherosclerosis

The pre-specified primary end point was the change in carotid artery wall area, assessed by MRI, after 1 year. We compared the treatment effect using a mixed effect model adjusting for baseline covariates.

Results:

22/35 NA and 29/36 placebo patients completed MRI at all time points. Baseline characteristics were similar. In the NA treated group, HDL-C increased 23% (39±6 to 48±7 mg/dL), and LDL-C decreased 19% (85±23 to 69±21 mg/dL). At 12 months, the NA group had a significantly higher reduction in carotid wall area compared to placebo (adjusted treatment difference [95% CI] = −1.64 mm
2
[−3.12, −0.16]; P=0.03). Median (IQR) change in carotid wall area was −1.42 mm
2
(−2.65, 0.79) for NA and 0.47 mm
2
(−0.97, 2.59) for placebo. At 12 months the change in carotid plaque index (calculated by the recognised method of normalising wall area to total vessel area) was also reduced compared to placebo (treatment difference −0.016 [−0.03, −0.0022]; P = 0.02). Even as early as six months, although there was no treatment difference for change in absolute carotid wall area (−0.98 mm
2
[−2.45, 0.49]; P = 0.2), change in carotid plaque index was already significantly lower in the NA treated group (−0.016 [−0.03, 0.0019]; P = 0.03).

Conclusions:

This is the first demonstration that addition of high dose modified-release nicotinic acid, to statin-treated patients with low HDL-C, reduces carotid atherosclerosis at 12 months compared to placebo.
Abstract 2238: New Pharmacokinetic Models for Quantitative Molecular Imaging of Plaque Angiogenesis with Intergrin-targeted Nanoparticles
Authors: Sim Hoon , Neubauer Anne , Caruthers Shelton , Lanza Gregory , Wickline Samuel , Sept David
Published: July 2021

Cardiovascular molecular imaging with targeted nanoparticles has emerged as a promising method for early detection of atherosclerosis and vulnerable plaque. However, traditional pharmacokinetic models for diffusible drugs are inadequate to describe the efficacy of nanoparticle carriers of diagnostic and therapeutic cargos. To quantify blood and MRI tissue signals from gadolinium-loaded nanoparticles (Gd-NP) targeted to avb3 integrins expressed on angiogenic capillaries in the aortas of cholesterol-fed rabbit, a novel 4 compartment open PK model was developed that utilized a unique simultaneous fitting scheme. In 10 rabbits fed 0.25% cholesterol for 3 months, the concentration of nanoparticles was measured serially from blood samples after injection of 1 ml/kg of targeted or nontargeted Gd-NP. The MRI proton signatures emanating from nanoparticles bound to the expanded vasa vasorum of the descending thoracic aorta was computed for all aortic cross sections in 1.5T T1w fa-suppressed spin-echo images. Based on the PK analysis, the concentration of
targeted
nanoparticles in the aortic wall is double that of non-targeted nanoparticles. Notably, this signal enhancement is achieved with 20x less gadolinium (4.6x10
−3
mmol Gd/kg BW) as compared with the dose of conventional gadolinium agents (0.1 mmol/kg). Further, the PK analysis shows that the targeted nanoparticles are more than three times more effective at reaching the aortic wall. These results should facilitate development and use of nanotechnologies intended for early detection of atherosclerosis and provide enhanced understanding of the kinetics and mechanisms of active targeting of plaque angiogenesis.