bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 1958: Age Related Changes in Left Atrial Hemodynamics in Normal Adults
Authors: Hees Paul S , Resar Jon R , Ringel Richard , Shapiro Edward P
Published: July 2021

INTRODUCTION
A marked shift in LV filling from early to late diastole occurs with normal aging and is often ascribed to changes in LV relaxation. Yet, left atrial properties also affect LV filling, and may also change with age, but have not been studied. We recorded atrial pressure-volume loops in patients with normal LV function over a wide age range undergoing percutaneous PFO closure after paradoxical embolism.

METHODS
We studied 35 adults undergoing cath for PFO closure (age range=24 – 81). Baseline LV diastolic function was measured by transmitral doppler echo and tissue doppler. Just before closure, a high-fidelity pressure sensor was placed across the PFO into the LA; in a subset of patients (n=18), a 2-sensor catheter was advanced transmitrally to record simultaneous LVP and LAP. In them, LV relaxation was estimated as τ by 3-parameter fit. Balloon inflation achieved IVC occlusion; LA area by transthoracic echo served as volume surrogate in P-V loops. Elastance at end-systole (Ees) and end-reservoir phase (Eer) are slopes from IVC occlusion loops (Figure

).

RESULTS
As expected, age was associated with rising peak A-wave velocity (p≤.001), and falling E/A (p≤.001) and tissue-doppler E/A (p≤.002). τ did not vary with age (r=.20, p=.43). At rest, age was associated with rising peak (p≤.05) and minimum (p≤.02) A-wave LAP, and a trend upward in mean LAP (p≤.07). Both Ees (p≤.01) and Eer (p≤.05) fell with age.

CONCLUSIONS
Atrial contractility declines with age, despite increasing late transmitral flow, suggesting increased preload. At the same time, reduced atrial elastance at onset of LV filling (end reservoir) may potentiate the shift to later filling with age.
Abstract 1965: Global Longitudinal Strain and Strain Rate Imaging for Assessment of Systemic Right Ventricular Function
Authors: Chow Pak-cheong , Liang Xue-cun , Lam Wendy W , Cheung Eddie W , Cheung Yiu-fai
Published: July 2021

Background -
We determined the usefulness of novel 2-dimensional strain indices, based on speckle tracking imaging, for assessment of systemic right ventricular (RV) function after atrial switch operation for transposition of the great arteries.

Methods -
Twenty-six patients, aged 21.0±3.6 years at 19.9±3.2 years after atrial switch operation, and 27 age-matched controls were studied. Two-dimensional imaging at the 4 chamber view was obtained with tracing of the entire RV endocardial border. The RV global longitudinal strain (GLS) and GLS rate were derived using an automated software (EchoPAC, GE Medical) (fig

), and correlated with tissue Doppler-derived RV isovolumic acceleration (IVA), and, in patient cohort, with cardiac magnetic resonance-derived RV ejection fraction.

Results
- Intraobserver and interobserver variability for measurement of GLS from 20 studies were 0.06±1.93% and 0.24±1.77% respectively. Compared with controls, patients had lower RV GLS (17.1±1.9%
vs
26.3 ±2.9%, p<0.001), reduced GLS rate (0.78 ±0.11/s
vs
1.33 ±0.23/s, p <0.001), lower RV IVA (1.10 ±0.36 m/s
2
vs
1.56 ±0.53 m/s
2
, p=0.001), and increased RV myocardial performance index (0.52±0.09
vs
0.38 ±0.09, p=0.001). Both RV GLS and GLS rate correlated positively with RV IVA (r=0.43, p<0.001 and r=0.46, p<0.001, respectively), and negatively with RV myocardial performance index (r=−0.65, p<0.001 and r=−0.57, p<0.001 respectively). In patients, GLS rate correlated positively with RV ejection fraction (r=0.62, p=0.001).

Conclusion
- Two-dimensional RV GLS and GLS rate are novel indices potentially useful for assessment of systemic RV function.
Abstract 1978: Patterns of Late Gadolinium Enhancement are Associated with Ventricular Stiffness in Patients with Advanced Non-Ischemic Dilated Cardiomyopathy
Authors: Choi Eui-Young , Kim Sung-Ai , Shim Chi-Young , Yoon Se-Jung , Lee Byoung Ho , Choi Byoung Wook , Ha Jong-Won , Rim Se-Joong , Chung Namsik
Published: July 2021

Background:
In patients with advanced systolic heart failure, restriction of left ventricular (LV) filling or mechanical dyssynchrony rather than lower ejection fraction (EF) is more associated with poor prognosis. However, structural determinants of these parameters have not been fully studied.

Objectives:
We investigated whether patterns of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) affect the ventricular mechanics and fillings in patients with non-ischemic dilated cardiomyopathy (DCM).

Methods:
Patients with markedly reduced systolic function (LVEF <35%) due to longstanding (> 6 months) non-ischemic DCM underwent CMR after comprehensive echo-Doppler evaluations. Intraventricular synchrony index was measured by standard deviation of time to peak longitudinal contractions (Ts-SD) in 12 LV segments. Patients with significant aortic regurgitation or atrial fibrillation were excluded.

Results:
Patients (n=49) could be divided into three groups according to LGE patterns as non-LGE group (n=18), non-midwall LGE group (n=13) and midwall LGE group (n=18). There were no differences in clinical characteristics, LV dimension, LVEF and Ts-SD among three groups. However, in terms of LV longitudinal mechanics, midwall LGE group was associated with higher E/Em and lower Am and Sm. Moreover, diastolic LV stiffness index (Ed), defined as E/Em/stroke volume (ml), was significantly higher in midwall LGE group compared with non-LGE group (0.85±0.51 vs. 0.41±0.21, p=0.002), and non-midwall LGE group (0.85±0.51 vs. 0.46±0.31, p=0.008).

Conclusions:
Presence and patterns of LGE is associated with ventricular filling and stiffness in advanced non-ischemic dilated cardiomyopathy.
Abstract 2011: Basic Resuscitation with Chest Compression Only for Patients Who Had Out-Of-Hospital Cardiac Arrest Not Witnessed by Bystanders
Authors: Nagao Ken , Sakamoto Tetsuya , Igarashi Masaki , Ishimatsu Shinichi , Sato Akira , Hori Shingo , Kanesaka Shigeru , Hamabe Yuichi , Kitamura Nobuya , Kikushima Kimio
Published: July 2021

BACKGROUND SOS-KANTO study showed that bystander chest compression-only resuscitation was the preferable approach to resuscitation for adult patients with witnessed out-of-hospital cardiac arrest (

Lancet

2007
;
369

), but few clinical studies have focused on the efficacy of basic resuscitation with chest compression only for patients with unwitnessed out-of-hospital cardiac arrest.

METHODS SOS-KANTO study was conducted in 58 emergency hospitals and emergency medical service units. On arrival at the scene, paramedics assessed the technique of basic resuscitation and asked additional questions. The primary endpoint was favorable neurological outcome 30 days after cardiac arrest.

RESULTS Of the 9,592 patients with out-of-hospital cardiac arrest, 4,347 adult patients with unwitnessed arrest were included; 385 (8.9%) received chest compression-only resuscitation, 507 (11.7%) received chest compression plus mouth-to-mouth ventilation resuscitation, and 3,456 (79.5%) received no resuscitation. Any resuscitation attempt was associated with a higher proportion of the favorable neurological outcome than no resuscitation (1.1% vs. 0.4%, p=0.009). The chest compression-only resuscitation group had higher proportions of the favorable neurological outcome than the no resuscitation group in the whole cohort (1.3% vs. 0.4%, p=0.018) and in the subgroups of patients with cardiac causes (2.0% vs. 0.6%, p=0.018) and with time interval from EMS call to arrival at patient’s side for ≤ 8 min (2.0% vs. 0.6%, p=0.020). However, the chest compression-only resuscitation group had a similar proportion of the favorable neurological outcome than the chest compression plus ventilation resuscitation in the whole cohort (1.3% vs. 1.0%, p=0.662) and there was no evidence for any benefit from the addition of ventilation in any subgroups. The adjusted odds ratios for the favorable neurological outcome after chest compression-only resuscitation and after chest compression plus ventilation resuscitation were 3.4 (95% CI, 1.1 to 10.5, p=0.033) and 3.3 (95% CI, 1.1 to 10.1 p=0.035).

CONCLUSIONS Basic resuscitation with chest compression only is the preferable approach to resuscitation even though the adult patients with unwitnessed out-of-hospital cardiac arrest.
Abstract 2023: Effect Of Chronic Stretch Reversal On Atrial Remodeling In Humans: Implications For The Atrial Fibrillation Substrate
Authors: John Bobby , Stiles Martin K , Chandy Sunil T , Kuklik Pawel K , Young Glenn D , Kalman Jonathan M , Sanders Prashanthan
Published: July 2021

Background
: Chronic atrial stretch is an important determinant for atrial fibrillation (AF). Whether relief of stretch reverses the substrate predisposed to AF is unknown.

Methods:
Twenty one pts (31±9 years) with mitral stenosis (MS; MVA 0.89±0.1cm
2
) undergoing mitral commissurotomy (MC) were studied by electrophysiological or electroanatomical mapping of both atria before and after MC. Multipolar catheters were placed in the lateral RA, Crista (CT), coronary sinus (CS), septal RA and LA. We measured: effective refractory period (ERP) at the LA appendage, septal/lateral LA roof, posterior LA, inferior LA, proximal/distal CS, low/high LRA and SRA at 600 and 450ms; P wave duration (PWD); double potentials (DP) or fractionated signals (FS) along CT; and conduction time along CS, LRA, inferior LA and LA roof. Activation and voltage maps were created to evaluate changes in conduction and voltage. In 14 pts, RA studies were repeated ≥6 months after MC.

Results
: Following MC, there was significant increase in MVA (2.1±0.3 cm
2,
p<0.0001) with decrease in LA (23±8 to 10±4 mmHg, p<0.0001) and PA pressures (38±17 to 27±14mmHg, p<0.0001) and LA volume (75±12 to 52±13ml, p<0.0001). This was associated with no change in ERP and No. of DP/FS along the CT but with reduction in PWD (139±19 to 135±20ms, p=0.047), increase in conduction velocity (CV) in LA (1.3±0.3 to 1.7±0.2m/s, p=0.005) and RA (1.0±0.1 to 1.3±0.3 m/s, p=0.007) and increase in LA voltage (1.7±0.6 to 2.5±1.0 mV, p=0.05). Late after MC, there was a further decrease in PWD and RA ERP, with increase in RA CV (1.0±0.1 to 1.3±0.2 m/s, p=0.01) and voltage (1.7±0.7 to 2.8±0.6 mV, p=0.004) but with no change in other parameters. See table

for details of pts studied late after MC.

Conclusion:
The electrophysiologic and electroanatomic abnormalities within the atria that result from MS are reversed after MC. These observations suggest that the substrate predisposing to atrial arrhythmias may be reversed.

Results
Abstract 311: Osteogenic Transcription Factor Runx2 Represses Connective Tissue Growth Factor Gene Expression And TGFβ Signaling In Vascular Smooth Muscle Cells
Authors: Tanaka Toru , Shimizu Takehisa , Koitabashi Norimichi , Matsui Hiroki , Doi Hiroshi , Iso Tatsuya , Arai Masashi , Kurabayashi Masahiko
Published: July 2021

[Objective] Runx2, a key transcription factor in osteoblast differentiation, is expressed in calcified atherosclerotic plaques. We have recently shown that Runx2 represses vascular smooth muscle cells (VSMCs) differentiation and promotes their osteogenic differentiation. Connective tissue growth factor (CTGF) has been implicated in the progression to vulnerable plaque by inducing mononuclear cell chemotaxis and VSMCs apoptosis despite of its potent stimulatory effect on connective tissue cell the proliferation and extracellular matrix synthesis. To assess the role of Runx2 in the process of plaque development, we investigated the molecular mechanism of the CTGF gene expression by Runx2 in VSMCs.

[Methods and Results] RT-PCR analyses showed that adenovirally overexpressed Runx2 significantly repressed the basal expression of the CTGF gene in human aortic SMCs (HASMCs). Consistent with this, knockdown of the Runx2 expression in HASMCs by small interfering RNA (siRNA) increased CTGF mRNA levels. Luciferase assays showed that Runx2 reduced the transcriptional activity of the CTGF promoter. Transfection of a series of 5′-deletion constructs revealed that Runx2 inhibited CTGF expression through the sequence element located at 5′ untranslated region of CTGF mRNA. We next examined the effects of Runx2 on the TGFβ-induced CTGF expression. Runx2 overexpression significantly repressed CTGF expression in HASMCs stimulated with TGFβ, and knockdown of Runx2 by siRNA enhanced the induction of CTGF expression in response to TGFβ. Runx2 repressed TGFβ-induced CTGF promoter activity through the sequence including Smad binding element (SBE). Overexpression of Runx2 significantly reduced TGFβ- and Smad3-mediated luciferase activity of Smad-dependent promoter which contains four copies of SBE. Biotinylated DNA pulldown assay using SBE of CTGF promoter showed that Runx2 formed a complex with Smad3 and Smad4.

[Conclusion] Runx2 repressed basal and TGFβ-induced CTGF gene expression in VSMCs. Thus, in addition to the potential for inducing vascular calcification, Runx2 may affect plaque stability by modulating extracellular matrix synthesis through inhibiting CTGF gene expression and TGFβ signaling.
Abstract 2053: Biodegradable Small Calibre Polydioxanone-based Vascular Prostheses: Potential as Coronary Bypass Grafts
Authors: Walpoth Beat H , Cikirikcioglu Mustafa , Mugnai Damiano , Tille Jean-Christophe , Pektok Erman , Pfister Raymond , Palombo Domenico , Kalangos Afksendiyos , Bowlin Gary
Published: July 2021

Aims
: Shelf-ready synthetic small calibre prostheses are needed for coronary artery bypass grafting. Biodegradable scaffolds resistant to degradation-induced aneurysm formation in the systemic arterial circulation have been developed for
in vivo
vascular tissue engineering. We evaluated patency, biocompatibility and mechanical properties (remodelling) of 3 electrospun biodegradable random nano-fibre polymer prostheses: polydioxanone (PDO) alone; blended with: poly(lactic-acid) (PDO-PLA); with polycaprolactone (PDO-PCL).

Methods:
In 30 anaesthetised Sprague Dawley rats, 2mm ePTFE grafts controls(n=9), PDO(n=3), PDO-PLA(n=9), PDO-PCL(n=9), were interposed in the infrarenal abdominal aorta and followed for 3, 6 and 12 weeks. Digital substraction angiography was made for patency, stenosis and aneurysmal dilatation before euthanasia. Grafts were harvested for SEM, histology and computed morphometry for assessment of neo-endothelialisation and intimal hyperplasia.

Results:
Patency rates were excellent for all grafts (100%) and no relevant stenoses were found. Angiography follow-up showed aneurysmal formation for all PDO-alone grafts at 3 weeks (therefore no further implantations were made) and 1/3 for PDO-PLA at 6 and 12 weeks. No aneurysms were found for PDO-PCL grafts. All PDO-based grafts show slow degradation, a significantly better neoendothelialisation and insignificant neointimal formation compared to ePTFE.

Conclusion(s):
Patency of electrospun biodegradable PDO-based prostheses is excellent. Using slow, biodegrading polymer blends, e.g. PDO-PCL can avoid aneurysm formation and the neoendothelialisation (blood compatibility) of such prostheses is significantly better compared to ePTFE. Therefore, biodegradable, electrospun PDO-based vascular prostheses may be a promising alternative as shelf-ready cardiopulmonary bypass grafts.

RESULTS AFTER
12 WEEKS
IMPLANTATION:
Abstract 2063: Longitudinal Follow-up Of Cognitive Function After Cardiac Valve Replacement: A Three-Year Prospective Study
Authors: Knipp Stephan C , Uslar Sylvia , Thielmann Matthias , Matatko Nadine , Schlamann Marc , Forsting Michael , Diener Hans C , Jakob Heinz
Published: July 2021

Background:

Adverse neurocognitive outcome has been a continuing challenge to modern cardiac surgery. Cardiac valve replacement implies a high risk of neuronal injury. However, long-term studies of cognitive function do not exist until now. We aimed to assess the course of cognitive performance during 3 years after cardiac valve surgery and to identify factors that may predict long-term outcome.

Methods:

A total of 30 patients (64.9±9.8 yrs.) undergoing elective isolated heart valve replacement as the first time cardiac operation were prospectively investigated preoperatively, at discharge, 3 months and 3 years after surgery. Neuropsychological performance was evaluated with a battery of 11 standardized psychometric tests measuring seven cognitive domains (psychomotor speed, executive function, attention, verbal memory, visual memory, logical thinking, visuoconstruction). High-resolution multi-sequence magnetic resonance imaging (MRI) including diffusion-weighted technique was performed to detect cerebral ischemia.

Results:

Cognitive deficits (drop of ≥1 standard deviation in scores in ≥3 tests) were present in 15/30 patients (50%) at discharge, 2/30 patients (7%) at 3 months, and 4/25 patients (16%) at 3 years compared to baseline, respectively. Both patients with a deficit at 3 months behaved normal at discharge, and none of the patients had a persistent deficit. Postoperative MRI disclosed 41 new focal ischemic brain lesions in 47% of patients (1–7 lesions/patient; lesion volume 91–745 mm
3
). All lesions were neurologically silent. None of the variables tested by stepwise regression analyses including medical history data, operative factors, preexisting or new postoperative ischemic lesions on MRI, postoperative adverse events or type of prosthesis were found to predict late cognitive decline.

Conclusions:

Cognitive decline after cardiac valve replacement is benign and frequently resolves within weeks. The few cognitive deficits that were found years later are most likely related to factors other than the operation itself.
Abstract 319: Cardiomyocyte-specific Overexpression of Type 5 Phosphodiesterase Impairs Postinfarction Myocardial Function and Left Ventricular Remodeling.
Authors: Pokreisz Peter , Pellens Marijke , Van Den Bergh An , Gillijns Hilde , Bito Virginie , Lenaerts Ilse , Biesmans Liesbeth , Marsboom Glenn , Vermeersch Pieter , D’hooge Jan , Sipido Karin , Herijgers Paul , Schoonjans Luc , Bloch Kenneth D , Janssens Stefan
Published: July 2021

Background
: Cyclic guanosine monophosphate (cGMP), a second-messenger regulator of cardiovascular function, modulates acute and chronic stress responses in the heart. Myocardial cGMP levels are determined by the balance between production via guanylate cyclases and hydrolysis via phosphodiesterases (PDEs). To better understand the role of cGMP hydrolysis in the myocardial response to hemodynamic challenge, we generated transgenic mice with cardiomyocyte-specific overexpression of a cGMP-specific PDE (PDE5TG) and compared the LV remodeling response to myocardial infarction (MI) with wild-type littermates (WT).

Methods
: PDE5 expression was examined in hearts of WT and PDE5TG using qRT-PCR, immunoblot analysis, confocal microscopy, and measurement of cGMP hydrolysis. Cell shortening and calcium (Ca) handling were determined in paced cardiomyocytes from adult PDE5TG (n = 7) and WT (n = 5). LV function and dimensions, as well as hemodynamic parameters, were compared in anesthetized PDE5TG and WT using echocardiography and pressure-volume catheter techniques at baseline (n = 20) and 10 weeks after proximal LAD ligation (n = 16).

Results
: The PDE5 transgene was selectively but homogeneously expressed in cardiomyocytes of PDE5TG and resulted in a 10-fold increase in cGMP hydrolysis. Ca transients, Ca currents and cell shortening did not differ between PDE5TG and WT cardiomyocytes and baseline echocardiographic and hemodynamic parameters were comparable. After MI, cardiac dimensions were larger in PDE5TG than in WT and for a similar infarct size, LV end-diastolic volumes and pressures were larger in PDE5TG than in WT (81 ± 15 vs 50 ± 20 μL, P < 0.01 and 9 ± 5 vs 4 ± 4 mmHg, P < 0.05 respectively), and isovolumic relaxation was more prolonged (11 ± 2 vs 8 ± 3 ms, P = 0.01). Preload-recruitable stroke work and maximal elastance tended to be lower in PDE5TG than in WT (P = 0.07 and 0.05, respectively). After MI, extravascular lung water weight was greater in PDE5TG than in WT (P < 0.05).

Conclusions
: Cardiomyocyte-specific overexpression of PDE5 does not alter baseline cardiac structure or function, but significantly impairs systolic and diastolic function and LV remodeling after MI. Myocardial PDE signaling is an important novel target in post-infarction heart failure.
Abstract 2097: Acute Ventricular Unloading in Dogs with Chronic Heart Failure: Comparison Between Intra-Aortic Balloon Counterpulsation and Continuous Aortic Flow Augmentation
Authors: Wang Mengjun , Brewer Robert , Ilsar Itamar , Jiang Alice , Viole Tony , Konstam Marvin A , Sabbah Hani N
Published: July 2021

Background:
Continuous aortic flow augmentation (CAFA) therapy provided by the
Cancion
®
system
(Orqis Medical, Inc.)
for decompensated heart failure (HF)has been shown to effectively unload the left ventricle (LV) in dogs with chronic HF. In the present study, we compared the extent of acute LV unloading elicited by CAFA to that elicited by intra-aortic balloon counterpulsation (IABP) in normotensive dogs with HF produced by multiple sequential intracoronary microembolizations.

Methods:
Studies were performed in 6 dogs with HF. Each dog was studied with CAFA and with IABP. Studies were performed one week apart. For each study, therapy with CAFA or IABP was maintained for 4 hours. The Cancion system was positioned using a dual femoral approach configuration with constant pump flow of 250 ml/min thus superimposing an element of continuous flow on existing pulsatile aortic flow. In all dogs and with both devices, LV end-diastolic pressure (LVEDP), LV end-diastolic volume (EDV), LV end-systolic volume (ESV) and LV ejection fraction (EF) were measured at baseline prior to initiating therapy and were repeated at 2 hours and 4 hours after insituting CAFA or IABP.

Results:
Data (mean SEM) are shown in the table

. Up to 4 hours of IABP had no significant effects on LVEDP, EDV, ESV or EF. In contrast, institution of CAFA for 4 hours significantly decreased LVEDP, EDV and ESV and significantly increased EF.

Conclusions:
In normotensive dogs with chronic HF and no epicardial coronary artery disease, acute therapy with IABP for up to 4 hours had no effect on LV unloading defined as a reduction in LV filling pressure and LV size. In the same cohort of dogs, CAFA therapy elicited marked LV unloading. These data indicate that CAFA is superior to IABP in achieving acute LV unloading in the setting of chronic HF not complicated by ongoing myocardial ischemia and/or cardiogenic shock.
Abstract 2114: Antihypertensive Efficacy And Cerebral Hemodynamic Advantage Of Olmesartan Medoxomil Compared With Amlodipine In Post-stroke Patients
Authors: Matsumoto Shuji , Shimodozono Megumi , Miyata Ryuji , Kawahira Kazumi
Published: July 2021

In patients with severe hypertension, chronic heart failure or a history of stroke, the lower limit of autoregulation of cerebral blood flow (CBF) is shifted to higher levels of blood pressure (BP) than those observed in healthy subjects. The effects of anigiotensin II receptor blocker (ARB) on cerebral hemodynamics in humans have not been well elucidated. The antihypertensive efficacy of ARB olmesartan medoxomil (olmesartan) has been shown to compare favourably with that of other antihypertensive agents. We objected:

To compare the effects of olmesartan and amlodipine on 24-h ambulatory blood pressure monitoring (ABPM);

To compare the advantage of CBF of olmesartan and amlodipine on xenon-computed tomography (Xe-CT) after administration of either drug for 8 weeks.

24 hypertensive patients who had an episode of stroke more than 4 weeks previously were recruited for this randomized double-blind study. Olmesartan 10 –20mg (12 patients) or amlodipine 2.5–5mg (12 patients) was administered once daily for 8 weeks. During 24-h monitoring, both drugs caused a decrease in systolic BP of 14 mmHg, and caused a decrease in diastolic BP of 8 mmHg. The Xe-CT results indicated that the increase of CBF of olmesartan was 3.3 ± 1.1 ml/min/100g and that of amlodipine was 0.2 ± 1.3 ml/min/100g. Thus, despite the reduction in BP, CBF was significantly increased in olmesartan group compared with amlodipine group. We consider the use of olmesartan is advantageous for hypertensive patients with a history of stroke in whom autoregulation of CBF is potentially impaired.
Abstract 2122: Head-to-head Comparison Between Tissue Doppler Imaging And Velocity Encoded Magnetic Resonance Imaging For The Measurement Of Myocardial Velocities And The Assessment Of Left Ventricular Dyssynchrony And Diastolic Function.
Authors: Marsan Nina Ajmone , Westenberg Jos , Ypenburg Claudia , Holman Eduard R , van der Wall Ernst E , Schalij Martin J , Roelandt Jos , Bax Jeroen J
Published: July 2021

Aim of the study.
To compare echocardiographic tissue Doppler imaging (TDI) and velocity encoded (VE) magnetic resonance imaging (MRI) for the measurement of myocardial velocities and the assessment of left ventricular (LV) dyssynchrony and diastolic function.

Methods.
Ten healthy volounteers (5 men, 31±5 yrs) and 25 heart failure (HF) pts (17 men, 58±11 yrs) underwent both cardiac MRI and TDI. Longitudinal myocardial peak systolic (PSV) and diastolic (PDV) velocities and time to PSV (Ts) and to PDV (Td) were measured at basal and mid level of LV septum and lateral wall. To quantify LV dyssynchrony, delay in Ts between basal septum and lateral wall was calculated (SLD) and pts were categorized in 3 groups according to the extent of LV dyssynchrony by TDI: minimal (SLD<30 ms), intermediate (30 – 60 ms) and extensive (>60 ms) LV dyssynchrony. As a measure of LV diastolic function, the ratio of transmitral E wave velocity and mitral annulus septal early velocity (E/E′) was also calculated and pts were classified in 3 groups: normal LV diastolic function (E/E′ <8), abnormal LV diastolic function (E/E′= 8 –15) and severe LV diastolic dysfunction (E/E′>15).

Results.
PSV measured with VE-MRI showed excellent correlation with PSV measured with TDI (r=0.94, P<0.001) in both normals and HF pts and Bland-Altman analysis revealed a small bias (MRI-TDI) of 1±1 cm/s (P< 0.001) between both techniques. A strong correlation was also observed between Ts measured with TDI and VE-MRI (r=0.97, P<0.001) without significant bias. Excellent agreement between TDI and VE-MRI was found for LV dyssynchrony classification with a weighted κ=0.96. e′ and A′ PDV measured with VE-MRI correlated very well with PDV measured with TDI (r=0.95, P<0.001) with a small bias of 0.4±1 cm/s (P<0.001) between the 2 techniques. Excellent agreement between TDI and VE-MRI was also observed in classifying LV diastolic function with a weighted k=0.91. A very good correlation has been observed also for Td of E′(r=0.96, P<0.001) and Td of A′ (r=0.88, P<0.001) measured with both techniques.

Conclusions.
TDI and VE-MRI can be used interchangeably to measure LV myocardial systolic and diastolic velocities and excellent agreement exists between the 2 techniques for LV dyssynchrony and diastolic function classification.
Abstract 2124: Accuracy of T2-weighted Cardiac Magnetic Resonance in Detecting Myocardial Edema in Acute Myocardial Infarction is Strongly Influenced by Microvascular Obstruction.
Authors: Mikami Yoko , Sakuma Hajime , Nagata Motonori , Ishida Nanaka , Kurita Tairo , Tanigawa Takashi , Onishi Katsuya , Komuro Issei , Takeda Kan , Ito Masaaki
Published: July 2021

Background:
High signal intensity (SI) on T2-weighted Cardiac Magnetic Resonance (CMR) indicates infarct-associated myocardial edema in patients with acute myocardial infarction (MI). However, erythrocytes leaking from capillaries in infarct tissue may result in reduced signal on T2W CMR due to T2 shortening. The purpose of this study was to determine if detection of myocardial edema with T2-weighted CMR is influenced by microvascular obstruction (MO- ).

Methods:
Thirty-seven patients underwent black blood T2 weighted MRI with a spectral presaturation with inversion recovery fat saturation method, rest perfusion MRI and late gadolinium enhanced (LGE) MRI 5.4±3.1 days after onsets. The presence and transmural extent of LGE and MO were analyzed based on a 16-segment model. The relative SI compared with remote normal myocardium was determined in the infarction and peri-infarction zones on T2 weighted MRI, by using the mean + 2SD of the SI in normal segments as a threshold.

Results:
LGE was observed in 37 (100%) of 37 patients and MO in 19 (51%) of 37 patients. The SI in LGE segments without MO and the SI in periinfarct zones were significantly higher than those in normal segments (relative SI 1.84±0.5, p<0.001 and 1.69±0.18, p<0.001, respectively). However, no significant difference was found between the SI in MO segments and the SI in normal segments (relative SI 1.12±0.24, p=N.S.). The sensitivity of T2 weighted MRI for detecting edema in acute MI was 95% (73/77) in the LGE segments without MO, but was reduced to 30% (22/73) in the segments with MO. Myocardial edema was completely missed on T2 weighted MRI in 2 patients with severe MO.

Conclusions:
Although T2-weighted CMR is highly sensitive in detecting myocardial edema in the segments without MO, reduced T2 signal intensity in MO segments can be an important pitfall in characterizing the area of the acute event.
Abstract 2132: Late Functional Outcomes after Operation for Ebstein’s Anomaly
Authors: Brown Morgan , Dearani Joseph A , Danielson Gordon K , Cetta Frank , Connolly Heidi M , Warnes Carole A , Li Zhuo , Hodge David O , Driscoll David J
Published: July 2021

Objective
To review the long-term functional outcomes of patients with Ebstein anomaly who had cardiac surgery at our institution.

Methods
From April 1, 1972 to January 1, 2006, 539 patients with Ebstein anomaly had 604 cardiac operations at Mayo Clinic Rochester. The 506 late survivors form the basis of this report. Patient records were reviewed and all patients were mailed a medical questionnaire or contacted by telephone. Patients who had associated complex congenital heart disease were excluded (pulmonary atresia, conotruncal abnormalities, and atrioventricular discordance and ventriculoarterial discordance).

Results
At the initial operation at our institution, the mean age was 24 years (range 8 days to 79 years) and 53% were female. Survival at 5, 10, 15, and 20 years was 94%, 90%, 86%, and 76%. Survival free of late reoperation was 86%, 74%, 62%, and 46% at 5, 10, 15, and 20 years respectively. Surveys were returned by 285 patients. Two hundred and thirty-seven (83%) of patients were in NYHA class I or II and 34% were taking no cardiac medication. Five patients (2%) reported having endocarditis, 1 patient (<1%) reported a stroke, and 103 patients (36%) had atrial fibrillation or flutter. There were a total of 202 pregnancies among 82 women. Recurrence of congenital heart disease was low. Only 9/232 (0.04%) of liveborn children had congenital heart disease.

Conclusions
Patients have good long term survival and functional outcomes, after operation for Ebstein anomaly. Atrial arrhythmias are relatively common both before and after operation. Pregnancy appears to be well tolerated with low recurrence risk of congenital heart disease.
Abstract 2156: In-Stent Restenosis after Sirolimus-Eluting Stent Implantation is Related to Coronary Stent Fracture
Authors: Lee SY , Kim MH , Ahn CM , Kim JS , Choi DH , Jang YS , Chung NS , Min PK , Yoon YW , Hong BK
Published: July 2021

Background and objectives

: It has been reported in few studies about relationship between sirolimus-eluting stent (SES) fracture and in-stent restenosis (ISR). Therefore, authors investigated clinical characteristics of the SES fracture and the association with ISR.

Subjects and Methods

: From December 2003 to February 2006, implantation and follow-up coronary angiography(CAG) for 796 sirolimus-eluting stents were carried out in
Severance hospital.
We reviewed clinical, procedural and structural factors which might affect SES fracture and ISR.

Results

: Twenty four fractures after 796 SES implantation were identified by follow-up coronary angiography, sixteen cases in the left anterior descending artery and eight in the right coronary artery. The median time interval from stent implantation to follow up CAG was 9.0 months [range: 2 ~ 30 months]. No statistical difference was found in stent diameter (fracture group 3.06 ± 0.32 mm vs non-fracture group 3.08 ± 0.31 mm, P=0.778). Length of fractured stents was longer than non-fractured stents (30.29 ± 4.16 mm vs 24.51 ± 6.18 mm, P<0.001). The binary ISR rate in the stent fracture group was higher compared to non-fracture group (50% vs 4.4%, p < 0.001). Predictors for ISR estimated by multivariate analysis were stent fracture (OR=33.6, p < 0.001), stent diameter less than 3.0 mm (OR=2.84, p =0.015) and stent length over 28 mm (OR = 3.10, p = 0.023). Among twelve cases which had both binary restenosis and stent fracture, eight cases were treated by balloon angioplasty or additional stent implantation considering the condition of patients.

Conclusion

: Stent fracture may be one of the crucial mechanisms of ISR after implantation of SES. However, further studies in larger scale are required to define the incidence, predisposing factors, and clinical outcomes of SES fracture.
Abstract 2180: Relationship of Left Ventricular Systolic Function to Persistence or Development of Electrocardiographic Left Ventricular Hypertrophy in Hypertensive Patients: Implications for the Development of New Heart Failure
Authors: Okin Peter M , Wachtell Kristian , Gerdts Eva , Boman Kurt , Nieminen Markku S , Dahlöf Björn , Devereux Richard B
Published: July 2021

Background
: We have previously demonstrated that persistence or development of ECG left ventricular hypertrophy (LVH) by Cornell product criteria are associated with an increased risk of developing heart failure (HF) compared with regression or continued absence of LVH. We postulated that this relationship might be in part mediated via worse LV systolic function in patients with new and persistent LVH.

Methods
: Baseline and year-3 ECG LVH and LV midwall shortening (MWS) were examined in 725 patients in the LIFE echocardiographic substudy. MWS was measured and considered abnormal if <14.2%; stress-corrected MWS (scMWS) was considered abnormal if 2440 mm-msec.

Results
: Between baseline and 3 years follow-up, there was continued absence (n=260) or regression (n=167) of LVH in 427 patients and persistence (n=259) or development (n=39) of ECG LVH in 298 patients. Although there was no difference in baseline prevalence of abnormal MWS (23.4 vs 26.5%, p=0.389) or abnormal scMWS (24.6 vs 26.4%, p=0.663) between groups, after 3 years follow-up persistence or development of new LVH was associated with significantly lower mean MWS and scMWS and with higher prevalence and odds of abnormal MWS and scMWS than continued absence or regression of LVH (Table

). After controlling for differences in age, gender, race, treatment group, baseline and change from baseline to year-3 of heart rate, Sokolow-Lyon voltage, systolic and diastolic pressure and baseline severity of LVH by Cornell product, persistent or new ECG LVH remained associated with a >2-fold increased risk of abnormal MWS or scMWS at year 3.

Conclusions
: Persistence or development of new ECG LVH during antihypertensive therapy is associated with an increased risk of LV systolic dysfunction after 3 years of follow-up. These findings provide insight into a possible mechanism by which changes in ECG LVH are associated with changing risk of developing HF. <

Midwall LV Function in Relation to Persistence or Development of ECG LVH Between Baseline and Year-3
Abstract 2185: Ventilatory Efficiency Correlates with Exercise Pulmonary Hemodynamics in Chronic Heart Failure due to LV Systolic Dysfunction
Authors: Shah Ravi V , Lewis Gregory D , Semigran Marc J
Published: July 2021

Introduction
: Ventilatory efficiency (V
E
/V
CO2
) is a prognostic marker in heart failure (HF). The relationship between V
E
/V
CO2
and cardiovascular function in systolic HF remains unclear. We used cardiopulmonary exercise testing with continuous hemodynamic monitoring to clarify the relationship between V
E
/V
CO2
and rest and exercise hemodynamics in patients with HF due to LV systolic dysfunction.

Methods
: Breath-by-breath ventilation, pulmonary gas exchange, and right heart hemodynamics were measured during incremental cycle ergometry in 15 subjects (62±11 years old, 14 male, 53% ischemic HF, LVEF 0.28±0.05) with NYHA class II-IV HF at baseline and after 12 weeks. Ventilatory efficiency was determined by linear regression of V
E
versus V
CO2
throughout exercise with R
2
>0.95 in all cases. Pearson correlation and paired Student’s
t
-test (for baseline versus 12 week testing) were used for analysis.

Results
: Baseline V
E
/V
CO2
was 40.6±10.5. Higher V
E
/V
CO2
(reduced ventilatory efficiency) trended with higher resting mean pulmonary arterial (PA) pressure (r=0.49, p=0.06) and had a positive correlation with exercise PA pressure (r=0.57, p=0.03). Although pulmonary vascular resistance (PVR) at rest was not significantly related to V
E
/V
CO2
(r=0.30, p=0.28), exercise PVR correlated with V
E
/V
CO2
(r=0.62, p=0.01). There was no significant correlation between V
E
/V
CO2
and rest (r=0.29) or exercise (r=0.27) pulmonary capillary wedge pressure; rest (r=−0.15) or exercise (r=−0.27) cardiac index; and rest (r=−0.17) or exercise (r=0.05) right atrial pressure. At 12 weeks, repeat exercise testing revealed no significant change in V
E
/V
CO2
relative to baseline (41.4±15.4, p=0.70) or in any other measured hemodynamic parameters at rest or exercise.

Conclusions
: V
E
/V
CO2
can be measured reproducibly in HF patients with LV systolic dysfunction. Impaired ventilatory efficiency is associated with higher exercise PA pressure and PVR, and is not related to rest or exercise ventricular filling pressures in this small patient cohort. In systolic HF, ventilatory efficiency may be intrinsically related to dynamic changes in pulmonary vasomotor tone occurring with exercise.
Abstract 2186: Loss Of Sfrp-1 Increases Nuclear Translocation of Beta-Catenin and Thioredoxin in the Heart Leading to Dilated Cardiomyopathy
Authors: Kwon Susan H , Foronjy Robert , Sun Jie , Bodine Peter , D’Armiento Jeanine M
Published: July 2021

Secreted frizzled related proteins (sFRPs) inhibit the Wnt pathway which is critical for wound healing post myocardial infarction, cardiac hypertrophy and vascular angiogenesis. To understand the role of sFRP-1 in the heart, mice lacking the sFRP-1 gene were followed over a course of one year and compared to age-matched littermate wild-type mice (WT). As previously reported, the hearts of the sFRP-1 knockout (KO) mice were normal at three months of age; however, at 6 months of age, the KO mice developed hypertrophic changes with an increase in the heart/body weight and LV posterior wall thickness compared to age-matched WT mice. Furthermore, at one year of age, the KO mice developed LV chamber dilation when compared to WT mice with worsened LV systolic function and decreased diastolic function. There was increased interstitial and perivascular fibrosis in the KO mice at one year of age without change in proliferation. To determine how sFRP-1 impacted on signaling pathways linked to cardiac hypertrophy and failure, heart tissue of three month and one year old KO and WT mice was compartmentalized into cytosolic and nuclear fractions and analyzed for changes in MAPK activation, Wnt and thioredoxin signaling. Loss of sFRP-1 in the heart had no effect on MAPK proteins (p38, ERK, JNK); however, it significantly increased nuclear translocation of β-catenin and thioredoxin both at 3 months and 1 year of age. Coincident with the development of cardiac failure, increased levels of reactive nitrogen species (RNS) were observed at 1 year in the KO compared to WT mice (KO/n=6, 3.2 ±0.34 vs. WT/n=8, 2.2 ±0.30, p=0.0136). This study demonstrates for the first time that sFRP-1 regulates nuclear translocation of beta-catenin and thioredoxin in the heart, two key transcriptional regulators that have been linked to heart failure. These altered signaling events predate the development of cardiac decompensation and increased oxidative stress. Future studies will examine the downstream targets of beta-catenin and thioredoxin that mediate these physiologic changes. Further understanding the role of sFRP-1 in the heart and how it regulates the Wnt signaling and antioxidants may elucidate new insights into novel therapeutic targets in the management of heart failure patients.
Abstract 2192: Fcgamma Receptor II On Cardiomyocytes
Authors: Trimpert Christiane , Felix Stephan B , Greinacher Andreas , Birkenmeier Katrin , Staudt Alexander
Published: July 2021

Introduction
: Recently we detected the FcγII receptor on rat and human cardiomyocytes. Binding of cardiac antibodies obtained from DCM-patients to this receptor induced negative inotropic effects. The mechanism of these effects remains to be elucidated.

Methods:
Isolated adult rat cardiomyocytes stained with Fura-2-AM were field-stimulated (1 Hz, 12 V). The relative change of the calcium transients and systolic cell shortening due to superfusion with a polyclonal goat-antibody against the FcγII receptor (10 μg/ml) were recorded with a dual-excitation fluorescence microscope. For inhibition of possible involved tyrosine kinases we used PP2 (1μM) and specific syk-Kinase inhibitors.

Results:
Superfusion of rat cardiomyocytes with anti-FcγII-receptor antibody induces a negative inotropic effect. The tested concentrations (6 μg/ml, 8 μg/ml, 10 μg/ml and 16 μg/ml) show a clear dose-response-relationship. The contractility of the cells decreases after 2 min by −5,3%, −11,5%, −14,2% and −18,3% from baseline as well as the Ca
2+
-Ratio (−9,5%, −11,2%, −12,2%, −15,6%). The negative inotropic reaction could be blocked by preincubation of the cells with the tyrosine kinase inhibitor PP2 (change of contractility/Ca2+-Ratio from baseline: −1, 3%/−2,4%, p<0,001). Cells preincu-bated with specific inhibitors for syk-Kinases did not show a negative inotropic reaction after superfusion with the antibody (change of contractility/Ca
2+
-ratio from baseline +0,7%/−5,5%, p<0,05). A polyclonal goat control antibody (anti-CD45, c = 10 μg/ml)) did not trigger a reaction (change from baseline for contractility/Ca2+-Ratio: −3%/−2,4%, p<0,001).

Conclusion:
The inhibition of the negative inotropic effect of antibodies against FcγII receptor shows an involvement of Kinases in the signalling pathway like described for other cell types.
Abstract 2200: Variability in Post-pacing Intervals Predicts Global Atrial Activation Pattern During Tachycardia
Authors: Colombowala Ilyas K , Massumi Ali G , Rasekh Abdi , Saeed Mohammad , Cheng Jie , Fakhri Bita , Shuraih Mossaab , Razavi Mehdi
Published: July 2021

Background:
Knowledge of the global atrial activation pattern is critical to ablation of an atrial arrhythmia. We hypothesized that the variability in post-pacing intervals (PPI) with pacing at different cycle lengths (CL) from the same pacing site, regardless of distance to the circuit, can be used to identify atrial activation patterns during tachycardia.

Methods and Results:
Patients referred for ablation of SVT were included (n=28, 31 total tachycardias). During tachycardia, overdrive atrial pacing was performed. The variability in PPIs (PPIV) was calculated by comparing the difference in PPIs after overdrive pacing at trains 10, 20, and 30 ms shorter than the tachycardia cycle length (TCL). The global activation pattern was defined as circuitous (grossly visible circuit) or centrifugal (focal origin with centrifugal radiation) by electroanatomic mapping. Except for one case, all pacing was performed from the proximal CS bipole. Circuitous tachycardias exhibited minimal variability with pacing at 10 ms and 30 ms shorter than TCL (6.0±2.5 ms), whereas centrifugal tachycardias displayed a high degree of variability (56.5±20.6 ms, 8 of 14 were micro-reentrant). Rank sum analysis of PPIV suggests that the two groups are indeed distinct (P<0.001). Using PPIV cutoffs of ≤10 ms and ≥30 ms, circuitous and centrifugal activation patterns were classified with a high degree of sensitivity (94% circuitous, 92.8% centrifugal) and 100% specificity.

Conclusion:
Our data supports the use of PPIV to rapidly and accurately predict global activation pattern during atrial arrhythmia.
Abstract 2232: Survival Is Decreased If Ambulance Dispatchers Do Not Recognize Out-of-Hospital Cardiac Arrest
Authors: Berdowski Jocelyn , Beekhuis Fred , Koster Rudolph W
Published: July 2021

Introduction Exact content of 112 emergency calls for suspected cardiac arrest (CA) are rarely analyzed. The purpose of this study was to investigate if not recognizing a CA by emergency medical dispatchers influences survival rates.

Methods This was a prospective, observational study. During 8 months, all digitalized voice recordings of consecutive 112 high priority emergency calls were collected from the Amsterdam dispatch center and audited for CA recognition, time to recognition of CA and telephone CPR. Also, description of breathing and consciousness that the caller uses to describe a CA were scored. Actual presence of CA during call was assessed from the ambulance crew report. Calls were placed by laypersons on site, not involving trauma. Exclusion criteria were calls by a professional, by the victim or when victim was known to be conscious. Time recordings of call, dispatching and arrival were generated automatically. Survival after 3 months was taken as the primary endpoint.

Results Results are shown in table 1

. In 8 months, out of 11.329 calls, 285 involved patients in CA. Of these, 203 were recognized during the call; the remaining 82 cases (29%) were only diagnosed on site. Recognizing CA resulted in faster dispatch and earlier arrival on scene. When not recognizing CA, the dispatchers did not ask the caller about respiration in over 50% of the calls. Not recognizing the CA was associated with no telephone CPR, and significantly lower three-month survival.

Conclusion If the dispatcher did not recognize the CA, no CPR instruction is given. The ambulance is dispatched less rapidly and arrives a median of 2 minutes later at the scene. Both factors may contribute to the lower survival rates. Consequent interrogating the caller about the patientâ™s consciousness and respiration could improve CA recognition. In conclusion, not only early call, but also early recognition of a CA by dispatcher contributes to the survival after CA.

Table 1:

A comparison between calls where the dispatcher did and did not recognize CA