bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 422: Transcoronary Delivery of a Novel Alginate-Based Biomaterial Improves Cardiac Remodeling and Function after Myocardial Infarction in Pig
Authors: Leor Jonathan , Guetta Victor , Horvath Ivan , Manzur Frenz , Simor Tamas , Petrasi Zsolt , Freeman Inbar , Feinberg Micha S , Tuvia Shmuel , Cohen Smadar
Published: July 2021

BACKGROUND:
Injection of a designer biomaterial scaffold to replace the injured extracellular matrix (ECM) can enhance mechanical strength of the scar and may have an instructive role for cell assembling during healing and repair of the infarct. The present study aimed to determine the feasibility and efficacy of transcoronary injection of a novel, resorbable, alginate-based biomaterial to repair the infarcted myocardium.

METHODS AND RESULTS
: We developed a novel calcium cross-linked alginate solution with the unique capacity to undergo phase transition into a hydrogel after injection into the infarct thereby acting as a mechanical tissue stabilizer. To test this new biomaterial solution in MI model, anterior MI was induced in domestic pigs (n = 9) by percutaneous, 90 min occlusion of mid LAD coronary artery. At 3– 4 days after MI, the biomaterial (2 ml) was injected selectively into the infarct through the infarct-related artery. To track the injected biomaterial, biotin-labeled cross-linked alginate was used. A few hours later, the hearts were harvested and histological examination showed that the alginate solution infiltrated into the infarct and transformed into hydrogel implant. Serial echocardiography and MRI studies were performed in another group of MI pigs (n = 21) treated with intracoronary injection of the alginate solution (1,2 and 4 ml) or saline (control), before and 2 months after injection. At 2 months, alginate biomaterial solution prevented LV diastolic dilatation, compared with control (0.3 ± 3.9 vs. 44.3 ± 8.1%; p<0.001). Furthermore, alginate injection reversed LV systolic dilatation, compared with control (−12.2 ± 6.3 vs. 48.1 ± 22.1; p<0.001), and improved global and regional LV function. Postmortem analysis showed that the alginate biomaterial injection increased scar thickness, compared with control (3 ± 0.2 vs. 1.9 ± 0.3 mm; p<0.01).

CONCLUSIONS:
The present study shows, for the first time that transcoronary injection of alginate biomaterial solution is safe and effective in preventing LV remodeling and dysfunction after MI. Our findings suggest a new catheter-based, acellular option to facilitate myocardial repair and prevent adverse remodeling and dysfunction.
Abstract 3088: Association between Coronary Plaque Burden as Measured by Multidetector Computed Tomography and Inflammatory Biomarkers in Patients with Acute Chest Pain
Authors: Bamberg Fabian , Koenig Wolfgang , Kurtz Emily G , Nichols John H , Trischler Gerlinde , Nagurney Tobias J , Seneviratne Sujith , Butler Javed , Hoffmann Udo
Published: July 2021

Objective:
Both the extent of coronary artery disease (CAD) and increased levels of inflammatory markers are associated with cardiovascular risk. However, the association of these markers with different types of atherosclerotic plaque as detected by multidetector computed tomography (MDCT) is unknown.

Methods:
In this cross-sectional study, we examined consecutive patients who were admitted ith acute chest pain to the ED but had no evidence of ACS during their index hospitalization and 6- month follow up. All patients underwent contrast enhanced 64-slice coronary MDCT. Commercially available assays were used to determine the levels of hs-CRP, matrix metalloproteinase 2 and 9, oxidized low-density lipoprotein (ox-LDL), tumor necrosis factor alpha, interleukin-6, soluble E-selectin, and lipoprotein-associated phospholipase A2 at the time of initial ED triage. Two independent observers determined the extent of CAD (number of coronary segments containing calcified and/or non-calcified plaque). Log-transformed biomarkers associated with the extent of CAD were determined in univariate and multivariable regression analysis (adjusted for age, gender, body mass index, diabetes mellitus, smoking, hypertension, and hyperlipidemia/ use of cholesterol lowering medication).

Results:
We analyzed inflammatory biomarkers and extent of CAD in 78 patients (mean age: 51.2 years, 42% female). In univariate analysis, hs-CRP (r=0.24, >p=0.02), and ox-LDL (r=0.33, p=0.008) were significantly correlated to the extent of any plaque, and non-calcified plaque, respectively. In multivariable analysis only ox- LDL remained an independent predictor of the extent of non-calcified plaque (beta coefficient: 1.81, p=0.005). The models including traditional risk factors and hs-CRP or ox-LDL explained 34.3%, and 24.5% of the variability of overall, and non-calcified plaque burden, respectively.

Conclusions
: In this exploratory analysis, we found that in patients with acute chest pain levels of ox-LDL were independent predictors of the extent of non-calcified plaque as detected by MDCT. Further studies are needed to confirm a complementary role of local (plaque) and systemic biomarkers of atherosclerosis to identify subjects at high probability of ACS.
Abstract 3093: Long Term Prognostic Value of Stress Perfusion CMR and Late Gadolinium Enhanced CMR for The Prediction of Major Adverse Cardiac Events.
Authors: Kurita Tairo , Sakuma Hajime , Onishi Katsuya , Nagata Motonori , Takamura Takeshi , Ishida Masaki , Fujimoto Naoki , Dohi Kaoru , Takeda Kan , Ito Masaaki
Published: July 2021

Background:
Combined stress myocardial perfusion (S-PERF) and late gadolinium enhanced (LGE) CMR allows for the detection of myocardial ischemia and infarction. However, prognostic values of S-PERF and LGE CMR have not been determined in a large number of patients. In this study we determined the prognostic significance of combined S-PERF and LGE CMR study.

Methods:
We studied 826 patients who underwent both stress-rest perfusion CMR and LGE CMR. Stress-induced ischemia on S-PERF CMR and myocardial infarction on LGE CMR were qualitatively determined. Major adverse cardiovascular event (MACE) was defined as cardiac death, non-fatal acute myocardial infarction, heart failure on admission. Patients who underwent revascularization within 2 month after CMR were excluded.

Results:
During a median follow-up time of 34 months (range, 2 to 96 months), event-free survival rate was 89% in S-PERF(−)/LGE(−), 64% in S-PERF(−)/LGE(+), 49% in S-PERF(+)/LGE(−), and 38% in S-PERF(+)/LGE(+) group (P<0.001 between any combinations). Abnormality on S-PERT/LGE CMR was a significant negative prognostic factor of MACE with a high hazard ratio of 7.0 (95% CI 3.9–12.7, P<0.001). While LGE also predicted patients outcome, its hazard ratio (1.42, 95% CI 1.22–1.67, P<0.001) was lower than that by S-PERT/LGE CMR (FIgure 1

). Normal S-PERF/LGE CMR was associated with lower event rate per year (1.6%) as compared with that by normal LGE alone (4.3%, P<0.001).

Conclusions:
Combined S-PERF and LGE CMR can provide improved prognostic value when compared with LGE CMR alone in patients with known or suspected coronary artery disease. Patients with normal S-PERF and LGE CMR were at low risk of adverse outcome.

Figure 1:

Kaplan- Meler survival distributions based on presence of LGE alone (left) and any abnormality on S-PER/LGE CMR (right)
Abstract 3098: Left Ventricular Delayed Hyper-enhancement Further Risk Stratifies Patients with Severe Systolic Dysfunction Regardless of the Presence of Coronary Artery Disease: A Cardiac MRI Study
Authors: Kwon Deborah H , Halley Carmel , Carrigan Tom , Setser Randolph , Schoenhagen Paul , Starling Randall , Flamm Scott , Desai Milind
Published: July 2021

Background:
Patients with severe systolic left ventricular (LV) dysfunction have poor survival. Delayed hyperenhancement magnetic resonance imaging (DHE-MRI) accurately measures myocardial scar. In patients with severe systolic LV dysfunction, it is unclear if presence of scar further impacts survival. We sought to determine if presence of LV scar further risk-stratifies patients with severe LV dysfunction.

Methods:
We studied 199 consecutive patients with LV systolic dysfunction who underwent DHE-MRI (Siemens 1.5 T scanner, Erlangen, Germany) from 2005– 6. The percentage of myocardial scar was determined semi-quantitatively on DHE-MR images, in a standard 17-segment model using custom software (Siemens Research), and defined as intensity >2 standard deviation above viable myocardium. Transmurality score was recorded in all segments as follows: 0 = no scar, 1 = 1–25% scar, 2 = 26 –50 %, 3 = 51–75% and 4 = > 75%. Global LV scar burden was calculated as total transmurality score for all segments/17. LV ejection fraction (EF) and end-diastolic diameter (EDD) were recorded from echocardiography. Presence of coronary artery disease (CAD) and all-cause mortality were recorded.

Results:
In a median follow up of 1.6 years [1, 1.9], 26 (13 %) patients died. Characteristics of survivors vs. non-survivors are detailed in Table

. Survival in patients with any amount of LV scar had significantly worse 1-year survival compared to those without (log-rank p = 0.03). Median global LV scar burden was 1.8 [1, 2.5]. On receiver operating characteristic curve analysis, global scar burden > 1.8 was predictive of death (area under curve 0.61, p = 0.05). Patients with scar burden > 1.8 also had significantly worse 1-year survival compared to those with scar burden ≤ 1.8 (log rank p = 0.03).

Conclusions:
In patients with severe systolic LV dysfunction, higher LV myocardial scar burden, detected on DHE-MRI is associated with worse survival, despite similar LVEF, LVEDD, and prevalence of CAD.

Table
Abstract 3114: Antiplatelet Therapy Use and the Risk of Venous Thromboembolic Events in the Double-Blind Raloxifene Use in The Heart (RUTH) Trial
Authors: Duvernoy Claire S , Yeo Adeline A , Wong Mayme , Cox David A , Kim Hyungin M
Published: July 2021

Background: Raloxifene (RLX) use in postmenopausal women (PMW) with osteoporosis increases risk of venous thromboembolic events (VTE) 2-fold, compared to placebo (PL). Platelet activation is involved in the pathophysiology of arterial thromboses more than venous thromboses, but some data suggest that aspirin may reduce VTE risk associated with estrogen use. This analysis examines the effects of concomitant antiplatelet (AP) therapy on VTE risk in RLX-treated women.

Methods: In RUTH, 10,101 PMW with coronary heart disease (CHD) or increased risk of CHD were randomized to either PL or RLX 60 mg/d and followed for a median 5.6 yr. Reports of clinical symptoms of VTE were supported by relevant diagnostic data and adjudicated. Concomitant use of AP agents (aspirin, clopidogrel, ticlopidine, dipyridamole) was allowed. Cox proportional hazard models, with use of warfarin, presence of fracture, and/or hospitalization as covariates, were used to estimate hazard ratios (HR) with 95% confidence intervals (CI).

Results: Overall, RLX 60 mg/d use was associated with an increased VTE risk [HR 1.44 (95% CI 1.06 –1.95)] from PL. Most women (71%) reported using aspirin, and 14.2% reported using non-aspirin AP agents. VTE risk was similar (HR = 1.04, Table

) for women who used RLX alone versus those who used RLX with AP agents. The increase in VTE risk with RLX compared to PL was similar between women who used any AP prior to VTE and those who did not (interaction P=0.29). Women who used aspirin prior to VTE had a similar increased VTE risk with RLX from PL [HR 1.57(95% CI 1.00 –2.47)], compared to women who did not use aspirin [HR 1.34 (95% CI 0.89 –2.01)] (interaction P=0.62).

Conclusion: In RUTH, PMW with CHD or at high risk of CHD treated with RLX had an increased risk of VTE compared to PL. Concomitant use of aspirin or non-aspirin AP agents with RLX therapy did not lower VTE risk from RLX alone.
Abstract 3124: Impact of Age on Outcome of Pulmonary Valve Replacement for Pulmonary Regurgitation
Authors: Frigiola Alessandra , Tsang Victor , Nordmeyer Johannes , Lurz Philipp , Bull Kate , Coats Louise , Walker Fiona , Van Doorn Carin , Bohnoeffer Philipp , Taylor Andrew M
Published: July 2021

Objectives: Pulmonary valve replacement (PVR) for pulmonary regurgitation improves right ventricular function when performed relatively early. Effects on exercise performance are still controversial. Furthermore little attention has been given to the effects on left ventricular function.

Methods: 60 patients (mean age 20.5 ± 10.4, 27 male, 77% tetralogy of Fallot) underwent pulmonary valve replacement (PVR). Indications for intervention were presence of severe PR (regurgitant fraction ≥ 35%) and RV/LV end-diastolic volume ≥1.5. Fifty-six patients had a pulmonary homograft (mean size 21.5±1.7 mm). Magnetic resonance imaging and cardiopulmonary exercise testing (CPEX) were performed prior to and 1 year after intervention. NYHA class was also recorded.

Results: On a retrospective analysis, we found that Ve/VCO2 exercise parameter was most likely to normalize when PVR was performed at a younger age (< than 16 years, p=0.027). We therefore compared the results between the younger patients (group 1: n=24, 6 male, mean age of PVR 12±2.4 years) and the older patients (group 2: n=37, 21 male, mean age of PVR 26±10 years). Before intervention there were no differences in MR parameters. NYHA class was ≤ 2 in 83% of patients in group 1 vs 51% in group 2, p=0.01. Following PVR, only group 1 had a significant improvement in RV effective strove volume (40.9±8.7 to 47.1±7.1 mL/beat, p=0.001 vs 40.3±9.9 to 43.8±10.2, ns); in both groups there was a significant increase in LV end-diastolic volume, reflecting a better filling, and LV effective stroke volume (effSV), although these changes were more pronounced in group 1 (EDV: 11±11 vs 4±12 mL, p=0.041; effSV: 26±7 vs 19±11 mL/beat, p=0.025). Ve/VCO
2
improved significantly only in group 1 (33±3 to 30±4, p=0.015, vs 36±6 to 35±7, ns).

Conclusions: PVR leads to a better RV and LV performance when performed at a younger age. This is mirrored by an improved Ve/VCO
2
exercise parameter which is more likely to normalize when surgery is performed prior to 16 year of age.
Abstract 3134: Aldosterone A Major Determinant Of Long Term Mortality in Elective PCI
Authors: Van Belle Eric , Susen Sophie , Mouquet Frederic , Collet Jean-Philippe , Salpétrière La Pitié , Beygui Farzin , Salpétrière La Pïtié , Ennezat Pierre Vladimir , Pigny Pascal , Bauters Christophe , Jude Brigitte , Montalescot Gilles , Salpétrière La Pité
Published: July 2021

Background:
Aldosterone, the final mediator of the renin-angiotensin-aldosterone pathway, exerts toxic effects on the vessel wall and the myocardium. We recently demonstrated that aldosterone levels predict long term mortality in patients treated by primary PCI for an acute myocardial infarction. Whether aldosterone levels predict long term clinical outcome in elective PCI remains currently unknown.

Methods and Results:
In 807 consecutive patients undergoing elective PCI, plasma aldosterone, hsCRP and troponin levels were measured before the procedure. During follow-up (median = 14.9 months), 52 patients died including 40 from a cardiovascular cause. Plasma aldosterone levels (median = 25 pg/mL, interquartile range = 13– 45 pg/mL) were higher in diabetics (p=0.01) or in patients with a higher NYHA class (p=0.0002), and were inversely related to age (p=0.0001). In univariate analysis, a plasma aldosterone > 25 pg/mL was associated with a higher mortality (9.0% vs 3.7%, p=0.01) and a higher cardiovascular mortality rate (8.2% vs 2.5%, p=0.0005, Figure

). Using a multivariable Cox model analysis, 6 variables were associated with cardiovascular mortality: plasma aldosterone [HR (log) = 3.48; p=0.004], hsCRP [HR (log) = 2.59; p=0.002], recent acute coronary syndrome [HR = 3.23, p=0.02], age [HR for a 10 year-increase = 1.42; p=0.04], diabetes [HR = 2.20; p=0.04] and LVEF [HR for a 10%-decrease = 1.58; p=0.001].

Conclusion:
A high plasma level of aldosterone in patients referred for an elective PCI is an independent predictor of cardiovascular mortality during follow-up. Whether such patients could benefit from aldosterone antagonist remains to be tested.
Abstract 3152: Hyperdynamic Circulatory State And Volume Overload Without Left Ventricular Intrinsic Myocardial Dysfunction Is Detected In Normotensive Non Diabetic Patients With Morbid Obesity
Authors: Kozakova Michaela , Malshi Emona , Morizzo Carmela , Muscelli Elza , Camastra Stefania , Nannipieri Monica , Ferrannini Eleuterio , Palombo Carlo
Published: July 2021

Background: increasing reports suggest that morbid obesity (BMI ≥ 40 kg/m2) is associated with an early impairment of intrinsic myocardial function, possibly contributing to an increased susceptibility to heart failure. However, the relative role of obesity and associated comorbidities such as HBP and diabetes in LV dysfunction is still unclear.

Aim of the study: to investigate subclinical cardiovascular involvement in patients with isolated morbid obesity as compared to age-matched lean subjects.

Methods: 38 lean healthy volunteers (BMI ≤ 25 kg/m2, 21 females, mean age 39 ± 11, BP 118 ± 9/69 ± 8 mmHg) and 29 non diabetic normotensive patients with morbid obesity (24 females, mean age 34 ± 10, BP 123 ± 10/78 ± 9 mmHg) were studied. LV geometry, pump function, midwall circumferential shortening, diastolic filling, myocardial longitudinal systolic and diastolic velocities, were evaluated by 2-D and M-mode echo, transmitral Doppler and Tissue Doppler Imaging of mitral annulus and interventricular septum and lateral wall (Aloka SSD-5500). Indices of aortic stiffness and arterial wave reflection were obtained by carotid-femoral pulse wave velocity (PWV) and carotid augmentation index (AIx). Ratio of stroke volume to pulse pressure (SV/PP) was used as an index of total arterial compliance

Results: Compared to lean subjects, obese patients had significantly (p < at least 0.05) higher HR (75 ± 10 vs 62 ± 9 bpm), LV diastolic diameter (5.5 ± 0.7 vs 5.0 ± 0.5 cm), LV mean wall thickness (0.85 ± 0.11 vs 0.73 ± 0.13), LVMI (51 ± 15 vs 34 ± 9 g/m2.7), cardiac output (6.9 ± 2.5 vs 4.9 ± 1.1 L), LV stroke work (160 ± 50 vs 135 ± 34 g-ml/beat), mitral A velocity (0.63 ± 0.14 vs 0.52 ± 0.12 m/s), E/Ea ratio (a Doppler index related to capillary pulmonary pressure: 6.6 ± 4.4 vs 4.5 ± 1.1) and SV/PP (2.0 ± 0.6 vs 1.6 ± 0.4 ml/mmHg). Total peripheral resistance was significantly lower (1199 ± 419 vs 1452 ± 360 dyn*s/cm5). No differences between groups were found for LV midwall systolic shortening, longitudinal myocardial velocities, PWV and AIx.

Conclusion: young to middle age patients with morbid obesity still free of comorbidities show an hyperdynamic circulatory state associated to volume overload, without detectable subclinical abnormalities of intrinsic myocardial function and arterial function.
Abstract 3157: Coupling of Left Ventricular Relaxation to Systolic Contraction in Normal, Hypertrophied, and Dilated Myocardium Quantified by Speckle-Tracking Global Strain and Strain Rate Imaging
Authors: Takamura Takeshi , Dohi Kaoru , Onishi Katsuya , Fujimoto Naoki , Kurita Tairo , Kato Shinya , Tanigawa Takashi , Yamada Norikazu , Isaka Naoki , Ito Masaaki
Published: July 2021

Background:
It has not been fully investigated whether impairments of left ventricular (LV) relaxation precede or couple to systolic dysfunction during the disease process ranged from latent myocardial dysfunction to failing myocardium in patients with either left ventricular hypertrophy (LVH) or dilated cardiomyopathy (DCM).

Methods:
To quantify global LV longitudinal (L) and circumferential (C) function, fifty-seven patients with hypertensive LVH (ejection fraction 58 ± 10 %), twenty-one patients with DCM (ejection fraction 33 ± 13 %), and fifty-seven normal controls (Controls: ejection fraction 65 ± 6 %) had echo-study with speckle-tracking strain and strain rate imaging (Vivid 7 and EchoPAC, GE Electronic) from apical 4-, 2-, long axis, and mid-ventricular short axis views. Global peak systolic strain (PSS) and peak relaxation rate (PRR) were used as indices of global LV contraction and relaxation, respectively.

Results:
PRR was significantly correlated to PSS from both (L) and (C) in LVH, DCM, and Controls with linear regressions, respectively (DCM (L); r = 0.81
*
, (C); r = 0.81
*
, LVH (L); r = 0.78
*
, (C); r = 0.74
*
, Control (L); r = 0.64
*
, (C); r = 0.70
*
,
*
p < 0.05). Furthermore, correlations between PSS and PRR were best fit with exponential regression from (L) and linear regression from (C) all through the subjects ((L); y = 0.18e
-0.099x
, r = 0.84
*
, (C); y = −0.070x - 0.017, r = 0.79
*
,
*
p < 0.05).

Conclusion:
Speckle-tracking strain and strain rate imaging exhibited the strong coupling of LV relaxation to systolic contraction ranged from the normal to failing myocardium regardless of their initiating disease process.
Abstract 3162: Dynamic mortality modeling in PCI-treated ST-elevation Myocardial Infarction: Implications for Clinical Decision Making
Authors: Westerhout Cynthia M , Lee Kerry L , James Stefan K , Van de Werf Frans , O’Neill William W , Nielsen Torsten Toftegaard , Weaver W D , Granger Christopher B , Armstrong Paul W
Published: July 2021

Background:
Baseline factors predict adverse events after acute myocardial infarction (AMI), whereas dynamic risk modeling captures its evolving nature using continuous temporal profile updating. This refinement may guide medical decisions.

Methods:
APEX AMI trial tested pexelizumab efficacy in 5745 STEMI pts undergoing primary PCI; no treatment effect was observed. Four multivariable Cox models predicted 90-day mortality from key time points: baseline, 30-min post-PCI, 24 hrs, 96 hrs. % ST-resolution 30-min post-PCI, TIMI Flow pre-and post-PCI were measured. Complications included shock, CHF, re-MI, recurrent ischemia, stroke, renal failure, severe bleeding and major cardiac rhythm disturbances. The relative covariate contribution was quantified as the % of the ∑individual X
2
’s.

Results:
Ninety-day mortality was 4.7%; 22% and 40% of deaths occurred < 24 hrs and 4 days, respectively. The figure

(left ) shows decreasing relative contributions of age, systolic BP/heart rate and other factors over time to 90d mortality, and incremental influence of in-hospital complications, TIMI flow and post-PCI ST-resolution. As time elapsed, the % of “low risk” pts increased. (Right panel) At 96 hrs, a possible early discharge point for low risk pts, 44.0% of survivors had been discharged. This discharge rate decreased with increasing risk: Low: 53.3%; Moderate: 35.3%; High: 20.4% (p < 0.001). If early discharge depended on risk, the remaining 46.7% of low risk pts might have been discharged early.

Conclusions:
This novel approach demonstrates the dynamic nature of STEMI risk over time and may be used to guide early clinical decision-making.
Abstract 3166: Blood Transfusion and Clinical Outcomes in Patients with Acute Myocardial Infarction
Authors: Aronson Doron , Kapeliovich Michael , Markiewicz Walter , Hammerman Haim
Published: July 2021

Introduction:
The safety of red blood cells transfusion (RBC-T) in patients (pts) with acute coronary syndromes is controversial, with some studies suggesting that RBC-T may adversely affect outcome.

Methods:
We studied the relationship between RBC-T during hospitalization and 6-months mortality in 2325 pts with acute myocardial infarction (AMI).Propensity score for RBC-T was calculated based on a logistic regression model incorporating age, sex, baseline hemoglobin (Hb), creatinine, diabetes, smoking, blood pressure and heart rate, Killip class, thrombolytic therapy and coronary interventions. The association between RBC-T and mortality was assessed using Cox mode with RBC-T as a time-dependent covariate, adjusting for the propensity to receive RBC-T and nadir Hb prior to RBC-T.

Results:
One hundred and ninety one pts (8.2%) received RBC-T. Median nadir Hb was markedly lower in pts receiving RBC-T (8.8 gr/dL [interquartile range 8.2–9.3]) compared with pts not receiving RBC-T (12.8 gr/dL [interquartile range 11.6 –13.9];
P
< 0.0001). Mortality increased progressively in pts receiving RBC-T over the 6-months follow-up (Figure

). The unadjusted hazard ratio (HR) for mortality in pts receiving RBC-T was 4.1 (95% CI 3.0 –5.7,
P
< 0.0001). The effect of RBC-T was attenuated but remained significant after adjustments for the propensity to receive RBC-T (HR 2.1; 95% CI 1.4 –3.2,
P
< 0.0001). However, after adjusting for nadir Hb, the association between RBC-T and mortality was not significant (HR 1.4; 95% 0.9 –2.1,
P
= 0.09).

Conclusion:
The transfusion-associated risk in patients with AMI reflects the severity of the anemia at the time of transfusion and associated comorbidities.
Abstract 3176: Percutaneous Pulmonary Valve Implantation Is A Successful Treatment Option For RVOT Conduit Failure After Ross Procedure
Authors: Nordmeyer Johannes , Lurz Philipp , Coats Louise , Walker Fiona , Taylor Andrew M , Khambadkone Sachin , Bonhoeffer Philipp
Published: July 2021

Background-
The Ross operation offers good autograft function and low re-operation rates for the left ventricular outflow tract, however, the rate of conduit dysfunction in the right ventricular outflow tract (RVOT) remains a significant concern. Percutaneous pulmonary valve implantation (PPVI) is a novel trans-catheter treatment option for RVOT conduit dysfunction.

Methods and Results-
Of the 156 patients who underwent PPVI at our institutions with the current device, we retrospectively analyzed the outcomes of 11 patients (mean age: 26±5 years) who had RVOT conduit failure, 11.3±3.2 years following the Ross operation. PPVI could be performed in all patients (procedure time: 100±15 min; fluoroscopy time: 20±6 min). The RVOT gradient during catheterization and pulmonary regurgitant fraction (PRF) measured on magnetic resonance imaging (MRI) fell after PPVI (RVOT gradient: 35±6.5 mmHg to 14±2.8 mmHg, P<0.01; PRF: 18±6% to 3±2%, P<0.05). During mean follow-up of 17.4±5.2 months, there was 1 explantation (re-stenosis). The probability for freedom from RVOT re-operation was 100% at 1 year and 85.7% at 3 years.

Conclusions-
Failure of the conduit in the RVOT following Ross procedure can be successfully treated with PPVI to decrease the cumulative surgical burden in the lifetime management of congenital or acquired lesions of ventricular outflow tracts.
Abstract 3182: Real-Time 3D Transesophageal Echocardiographic Mitral Valve Measurements: Comparison with Transthoracic Imaging
Authors: Chandra Sonal , Weinert Lynn , Hyca Martin , Klas Berthold , Lang Roberto M , Sugeng Lissa
Published: July 2021

Although mitral annular (MA) geometry has been assessed using transthoracic real-time 3D echocardiography (TT RT3DE), it is unknown whether these images are of sufficient quality to provide similar data to that obtained from the transesophageal (TEE) approach. We compared MV annular measurements derived from images obtained using the new matrix array RT3DE TEE (mTEE) transducer with those obtained from TT RT3DE images.

Method
: Ten patients undergoing TEE evaluation were studied (iE33, Philips). ECG-gated, wide-angled acquisitions of the LV including the mitral valve were obtained using the mTEE probe and the TT RT3DE transducer (X3). Both TT and mTEE images were analyzed off-line using a semi-automated MA assessment software (TomTec), that yielded: anterior-posterior (AP), anterolateral-posteromedial (AL-PM) and commissural (CC) diameters, sphericity index (SI), and annular circumference (AC). For each mTEE and TT RT3DE images, inter- and intra-observer variability were calculated.

Results
: All 10 patients had adequate mTEE and TT RT3DE image quality for analysis. Although there were no significant differences between TT RT3DE and mTEE measurements, the latter had lower inter- and intra-observer variability (Table).

Conclusion:
MA measurements obtained with the mTEE are similar to TT RT3DE data, but more reproducible. Accordingly, studies involving quantitative 3D evaluation of the mitral valve from mTEE images are likely to reach statistical significance with a smaller number of subjects.
Abstract 3193: First Preclinical Study of a New F-18 Labeled PET Tracer for Myocardial Perfusion Imaging
Authors: Huisman Marc , Higuchi Takahiro , Reder Sybille , Nekolla Stephan , Poethko Thorsten , Casebier David , Schwaiger Markus
Published: July 2021

Introduction: An F-18 based myocardial perfusion imaging (MPI) tracer would increase the availability of tracers for cardiac PET/CT exams at stand-alone PET facilities.

Hypothesis: F-18 labeled BMS-747158 – 02 is a promising tracer for MPI.

Methods: All studies were carried out in healthy male Wistar rats (275 ± 25 g). The biodistribution of F-18 BMS-747158 – 02 was obtained 10 and 60 minutes post injection (p.i.). The first pass extraction fraction of the tracer was determined according to the Langendorff method. ECG gated microPET imaging (FOCUS F-120, Siemens Medical Imaging, USA) was performed, and the listmode data were sorted into dynamic sinograms corresponding to the diastolic phase of the heart cycle. After reorientation of the data time activity curves (TACs) were derived for the left ventricular cavity and myocardium, as well as tracer uptake polar maps two minutes p.i.. Rats were measured under MMF anesthesia, either during rest (n = 6) or during adenosine induced stress conditions (n = 6). Tracer retention two minutes p.i. was defined as tracer uptake divided through the integral under the input function.

Results: The biodistribution of F-18 BMS-747158 – 02 is favorable for cardiac imaging: high myocardial uptake (3.1 %ID/g) combines with low uptake in lung and liver (0.3 %ID/g and 1.0 %ID/g, respectively, 10 minutes p.i. (n = 3)). The myocardial uptake is homogeneous (the average means equal 77.4 ± 6.0 % and 77.8 ± 7.8 % of the maximum uptake for the rest and stress groups, respectively). The tracer shows a high and flow independent myocardial first pass extraction fraction, averaging 0.94 ± 0.04 (3 flow velocities, n >= 3 per group). Adenosine infusion (140 μg/kg/min) leads to a significant increase in myocardial tracer retention (1.68 ± 0.23 sec
−1
to 3.21 ± 0.92 sec
−1
; P = 0.03).

Conclusions: F-18 labeled BMS-747158 – 02 shows high extraction combined with excellent imaging characteristics in this first preclinical study of its applicability as a PET MPI agent.
Abstract 3198: RAGE-directed Imaging of Atherosclerotic Plaque in a Murine Model of Spontaneous Atherosclerosis
Authors: Tekabe Yared , Li Qing , Sedlar Marija , Majeweski Stan , Schmidt Ann Marie , Johnson Lynne L
Published: July 2021

Introduction:
The receptor for advanced glycation end products (RAGE) interacts with distinct molecules implicated in the development and progression of atherosclerosis. We assessed the hypothesis that
99m
Tc-labeled anti-RAGE F(ab’)2 fragments can be used as a noninvasive tool to access atherosclerotic lesion in apolipoprotein E deficient (apoE
−/−
) mice.

Methods:
We developed a novel antibody in rabbits against the V-type Ig extracellular domain of RAGE. Five 20 wk apoE
−/−
mice fed a high-cholesterol diet plus 2 C57BL/6 mice were injected with 21.6 MBq (0.5 mCi)
99m
Tc-labeled anti-RAGE F(ab’)2 fragments and two 20 wk apoE
−/−
were injected with non-immune rabbit IgG. All mice were imaged on a high resolution parallel hole gamma camera 4 hr after injection (time based on blood pool clearance). Animals were sacrificed and the aortic tree dissected and photographed, and the root and proximal aorta sectioned for immunohistochemical staining after gamma scintillation counting.

Results:
All five apoE
−/−
mice injected with
99m
Tc-labeled anti-RAGE F(ab’)2 fragments were scan positive. Both disease and antibody controls were scan negative. The mean percentage injected dose per gram (%ID/g) for scan positive was 3.35 and for scan negative <1.0. In vivo image and histology are shown below.

Conclusion:
RAGE imaging identifies atherosclerotic lesions with vulnerable features..
Abstract 3220: Bivalirudin Monotherapy Provides Similar One-Year Survival Compared to Heparin plus GP IIb/IIIa Inhibitors in Diabetic Patients with Acute Coronary Syndromes: Results from the Randomized ACUITY Trial
Authors: Feit Frederick , Manoukian Stuart V , Dangas George D , Lincoff A. M , Ohman E. M , Attubato Michael J , Mehran Roxana , Stone Gregg W
Published: July 2021

Background:
Among diabetic patients with acute coronary syndromes (ACS) in the ACUITY trial, bivalirudin (Biv) monotherapy (Mono) provided similar survival and protection from ischemic events with significantly less major bleeding compared to heparin (unfractionated or enoxaparin) plus GP IIb/IIIa inhibitors (Hep+GPI) at 30 days. Whether this protection from ischemic events persists to one year is unknown.

Methods:
In the ACUITY trial, patients with moderate and high risk (ACS) were randomized to Hep+GPI, Biv+gPI, or Biv Mono. We evaluated the impact of treatment group on composite ischemia (death, MI, or unplanned revascularization) and mortality at one year in diabetic patients using Kaplan Meier survival analysis and log rank tests.

Results:
Of patients enrolled in the ACUITY trial, 3852 were diabetic (28.1%) and 9857 (71.9%) were non-diabetic. Compared with non-diabetics, diabetics had higher rates of mortality at one year (6.1% vs 3.4%, p<0.001). There was no significant difference in the rate of composite ischemia at one year for diabetic patients who received Biv Mono vs Hep+GPI (19.7% vs 18.9%, p=0.39) or Biv+GPI vs Hep+GPI (20.9% vs 18.9%, p=0.16). Mortality rates for diabetic patients by treatment group are shown below.

Conclusions:
In the ACUITY Trial, diabetic patients had lower survival rates at one year than non-diabetics. Among diabetic patients, treatment with Biv Mono resulted in similar rates of composite ischemia and survival at one year compared to those treated with Hep+GPI. Combined with the early reduction in major bleeding, these findings indicate that Biv Mono is a suitable alternative to Hep + GPI for diabetic patients with moderate and high risk ACS.
Abstract 3223: Feasibility and Safety of the Integrated 3D Image and Contact Force-Guided Ablation for Atrial Fibrillation with the Hansen Robotic Catheter Sheath System
Authors: Okumura Yasuo , Henz Benhur D , Johnson Susa B , Packer Douglas L
Published: July 2021

Background:
Current technologies to fully “register” surrogate maps onto 3D CT (CartoMerge, NavxMerge) or 3D ICE images (CartoSound) have emerged to guide ablation. The feasibility of navigation with the Hansen Robotic Catheter Sheath System (HRCS) has also been reported. Integrated 3D Image and contact force sensor with this robotic system may allow for feasibility and safety for guiding complex anatomic-based ablation.

Methods:
Circumferential pulmonary vein (PV) ablation with the robotic system guided by integrated 3D images (CartoMerge, NavxMerge or CartoSound) (n=3), were done and compared to manual manipulation guided by the integrated 3D images (CartoSound) (n=8). Each ablation was performed using contact force ranges of 10 –20 grams (20W, 17 ml/min flow, 30 seconds). Accuracy of PV ablation was assessed by comparing distance from the PV ostia (specific 4 sites) to the ablative points on the 3D image structures, and the corresponding distances of the actual ablative lesions at pathologic exam.

Results:
Using three integrated 3D image systems, circumferential PV ablation was successfully guided in 6 PVs (3 RSPVs and 3 LSPVs) with the robotic system. During all ablations with contact forces of 10 –20 grams, no impedance rises, pops or type 2 microbubbles were seen. Accuracy of the PV ablation was 0.22±0.84 mm (range 0 –2). The PV rings were 100% circumferential by electroanatomic mapping, yielding an 86±7% (range 80 –98%) uninterrupted circumferential ablative ring around each PV with 1.1 ± 0.4 gaps (3.0 ± 0.9 mm). These resulting parameters were equal to those in the integrated 3D image-based manual navigation (Accuracy: 0.5±0.9 (range 0 –2.5) mm, Gaps:1.3 ± 0.9 ( 2.6 ± 0.9 mm), circumferential lesions 88 ± 10% (range 70 –100).

Conclusions:
This feasibility study demonstrated successful integrated 3D image and contact force-guided robotic ablation. Contact sensor guided 3D volume construction and real time 3D images accurately replicated atrial and venous anatomy, resulting in successful circumferential ablation.
Abstract 3231: Esophageal Capsule Endoscopy: Different Findings Based On The Anesthesia Protocol
Authors: Di Biase Luigi , Poe Stacy , Saenz Luis Carlos , Vacca Miguel , Cabrales Mauricio , Patel Dimpi , Armaganijan Luciana , Wu Chia-Tung , Kai Sonnie , Riedlbauchova Lucie , El hallage Moataz , Elayi Claude S. , Ching Chi Keong , Barrett Conor , Meulet John , Phillips Karen , Duggal Sandeep , Wazni Oussama M. , Kanj Mohamed , Schweikert Robert A. , Cummings Jennifer E. , Burkhardt J. David , Saliba Walid I. , Arruda Mauricio , Natale Andrea
Published: July 2021

Introduction:
Left atrioesophageal fistula is a rare but devastating complication that can occur following catheter ablation of atrial fibrillation.

Methods
: Fifty patients undergoing AF ablation for paroxysmal and persistent/permanent symptomatic atrial fibrillation refractory to AAD have been enrolled and randomized into 2 groups: those undergoing the procedure under conscious sedation with fentanil or midazolam (25 patients, group

and those receiving general anesthesia (25 patients, group

All patients underwent esophageal temperature monitoring during the procedure.

Radiofrequency energy was discontinued when the luminal temperature reached 39 C. After ablation all patients had capsule endoscopy to assess the presence for endoluminal tissue damage of the esophagus.

Results
: The results are shown in the table

below

Conclusion
: The use of general anesthesia increases the risk of positive esophageal findings by capsule endoscopy
Abstract 3238: Synergy Between Severe LV Systolic Dysfunction and LVH for Risk of Sudden Cardiac Death
Authors: Chugh Sumeet S , Dervan Celia , Reinier Kyndaron , Socoteanu Carmen , Uy Audrey , Mariani Ronald , Gunson Karen , Jui Jonathan
Published: July 2021

Background
: The Framingham Heart Study reported an association between increased LV mass/hypertrophy (LVH) and sudden death that was independent of coronary risk factors. Severely decreased LV systolic dysfunction (LVEF ≤ 35%) is an established predictor of SCD risk, but the potential for enhancement of SCD risk in combination with LVH has not been evaluated.

Methods
: In an ongoing population-based study, adult residents of a metro area (population 1,000,000) who suffered SCD in association with coronary artery disease (CAD) were identified prospectively (2002–2005). The subgroup of consecutive SCDs that had a cardiac echo performed prior to, and remote from cardiac arrest was identified. Echocardio-graphic findings were evaluated and LV mass normalized for body surface area calculated (American Society of Echocardiography modified equation). Comparisons were conducted with a geographically matched control group of subjects with known CAD, but no history of SCD.

Results
: LV mass was available for 99 SCD cases with established CAD (mean age 71, 29% female), as well as 100 controls (mean age 68, 32% female). Patients with severe aortic stenosis or hypertrophic cardiomyopathy were excluded (6 SCDs, 2 controls). LV mass was significantly greater in cases vs controls and this was consistent for unadjusted LV mass (247 vs. 215 g, p=0.02) as well as LV mass adjusted for body surface area (124 g/m
2
vs. 108 g/m
2
, p=0.008). Among SCD cases, 40% had LVH vs. 22% in controls (p=0.01). In a logistic regression model controlling for age, LVH was independently associated with SCD (OR 2.3, 95% CI 1.2 – 4.4, p=0.009). In a logistic regression model including both age and LV dysfunction, there was an interaction between LVH and severe LV dysfunction (p =0.05). In the presence of severe LV dysfunction, LVH increased the odds of SCD by 8-fold (OR 8.1, 95% CI 2.4 –28.2).

Conclusions
: LVH and severe LV systolic dysfunction combined appear to substantially increase risk for SCD (8-fold). These findings have implications for refinement of SCD risk stratification.
Abstract 3242: Transient Post-Operative Atrial Fibrillation is Associated with an Increased Rate of All-Cause Mortality
Authors: Becker Matthew C , Galla John M , Daly Ryan P , Philip Femi , Chen Stephen O , Chow Chen H , Zimbwa Peter , Hu Tingfei , Askari Arman T , Krasuski Richard A
Published: July 2021

Background
: Atrial fibrillation (AF) is the most common arrhythmia observed following coronary artery bypass grafting surgery (CABG) and is associated with increased morbidity and mortality. While the majority of affected patients are discharged in sinus rhythm, little is known about their ultimate outcome. We evaluated the effect of
transient
post-operative AF (TPAF) on long-term outcome in this population.

Methods
: The Cleveland Clinic Cardiothoracic Database was used to identify 5,205 consecutive patients who underwent first time, isolated CABG from January 1993 to December 2005. Patients diagnosed with post-operative AF (n=1560, 30%) were separated into two groups:
transient
AF (confirmed AF with discharge rhythm of sinus; n=1490, 28.6%) and
persistent
AF (confirmed AF with discharge rhythm of AF; n=70, 1.3%). These groups were compared to those patients that did not develop post-operative AF (n=3645). Endpoints of death, myocardial infarction (MI), and stroke were evaluated using the Chi squared and Fischer Exact tests. Long-term survival was evaluated with multivariate Cox proportional hazards methods to account for baseline differences.

Results
: Overall rates of 1 year mortality, MI and stroke were 12.5, 2.2, and 3.3 % respectively. TPAF was associated with an increased risk of death at 1 year as compared to patients with persistent AF (6.4 vs 2.9%; p<0.001) or without post-operative AF (6.4 vs 2.7%; p<0.001) but was not associated with increased risk of stroke or MI. Multivariate analysis identified TPAF as an independent predictor of both death (HR 1.93 95% CI [1.45, 2.56]; p<0.001) and the combination of death, MI, or stroke (1.8 [1.37, 2.36]; p<0.001). Use of beta-blockers (0.52 [0.34, 0.80]; p<0.003) and statins (0.26 [0.11, 0.64]; p<0.003), but not antiplatlet agents or warfarin, were associated with a reduced risk of death.

Conclusion
: In those undergoing first-time, isolated CABG, the presence of TPAF identifies patients at increased risk for all-cause mortality. In addition, the use of post-operative statins and beta-blockers appear to reduce this risk. These data suggest that morbidity unrelated to stroke or MI are responsible for the poor outcome in this population and warrant prospective investigation.
Abstract 3254: Effectiveness of Surgical Ventricular Restoration in Patients With Different Shape Abnormalities following Myocardial Infarction
Authors: Di Donato Marisa , Castelvecchio Serenella , Bussadori Claudio , Giacomazzi Francesca , Quarenghi Matteo , Menicanti Lorenzo
Published: July 2021

Myocardial infarction leaves a spectrum of LV shape abnormalities. Surgical Ventricular Restoration(SVR) can be applied to any but there are no data that relates its effectiveness to pre-op LV shape. Aim. To assess cardiac function and survival following SVR in patients with different post-MI shape abnormalities. Methods. Ninety-eight patients (69 ± 9yrs) submitted to SVR for heart failure and/or angina. LV shape was classified by Echo 2CH: Type 1 (
true aneurysm):
LV shape is geometrically delimited by two “borders” identified by an abrupt change in curvature; Type 2 (
Intermediate
): shape is delimited by one “border” most often at the inferior region; Type 3 (
dilated cardiomyopathy
): LV shape is without borders ( i.e. the curvature is flattened along the overall LV perimeter). Results. Average FUP was 23 ± 13 months. Table 1

and Graph show that all types benefit from SVR and survival is not significantly different. Conclusions. This study relates the effectiveness of SVR to shape abnormalities and demonstrate that results are good not only in the true aneurysm but also in dilated cardiomyopathy (type 2 and 3).
Abstract 3260: Left Atrial Volume Assessment by 3D Echocardiography is Accurate When Compared to MRI in Patients with Acquired Heart Disease and Congenital Heart Disease
Authors: Niemann Petra S , Pinho Luiz , Broberg Craig S , Jerosch-Herold Michael , Sahn David J
Published: July 2021

Background:
We studied the role of 3D/4D ultrasound (US) for left atrial (LA) volume/function evaluation in patients with coronary artery disease (CAD) and congenital heart disease (CHD).

Methods:
22 patients with CAD/CHD were studied with live 3D US and MRI. US images and MRI were obtained at the same visit. US images were acquired with a real time 3D US system (Philips 7500) and X3 matrix-array transducer with full volume sweeps in apical, 4 and 2 chamber views. MR images were acquired with a 1.5/3 T magnet with gradient cine-loop sequencing of the left atrium (LA). US images were analyzed with 4D view software (TomTec) using sagittal/4-chamber/coronal views. LA end diastolic and end systolic volumes (EDV, ESV) and stroke volume (SV) could be measured in all images. MR data were measured offline with Philips MRI software.

Results:
Regardless of LA shape and size, assessment with 3D US provided images of both the atrial body and appendage in all patients. 3D US results agreed closely with MRI. 3D US measured LA EDV 22.6 ml to 69.8ml, mean = 43.3 ml ± 16.3, while MRI measured LA EDV 20.3 ml to 64 ml, mean = 39.2ml ± 14.4 (r = 0.93). 3D US LA ESV was 14.2ml to 40.7ml, mean = 24.6 ml ± 8.6, while MRI LA ESV was 16.5ml to 41.3 ml, mean = 22.8 ml ± 9.4 (r = 0.95; p < 0.01).

Conclusions:
Despite the distance from the matrix array in 3D US, it can accurately quantify LA cavity and appendage volume and function.
Abstract 3266: Detection Of Patent Foramen Ovale By Transesophageal Echocardiography and Contrast-Enhanced Cardiac Magnetic Resonance In Patients With Cryptogenic Stroke.
Authors: Sestito Alfonso , Santangeli Pasquale , Lamendola Priscilla , Pilato Fabio , Colizzi Christian , Natale Luigi , Di Lazzaro Vincenzo , Lanza Gaetano A , Crea Filippo
Published: July 2021

Background.

In ≈ 40% of patients with acute ischemic stroke, the cause remains undefined (cryptogenic stroke). Previous studies, using contrast echocardiography, showed a significant prevalence of a patent foramen ovale (PFO) in patients with cryptogenic stroke < 55 years of age, suggesting a causal role through paradoxical embolism. Contrast transesophageal echocardiography (TEE) is considered the gold standard for PFO detection. Recently, however, cardiac magnetic resonance (CMR) was also shown to reliably detect PFO. In this study we compared the accuracy of CMR and TEE in detecting PFO in a group of patients with cryptogenic stroke.

Methods and Results

. Sixteen patients (age 50 ± 13 years, 9 males) with cryptogenic ischemic stroke underwent contrast-enhanced TEE and contrast CMR for detection of possible PFO. Both imaging studies were performed during Valsalva maneuver. PFO grading results were assessed visually both for TEE and CMR, according to the entity of contrast passage in the left atrium (grade 0 = no PFO; grades 1, 2 and 3 = mild, medium and wide PFO, respectively). Nine patients (56%) were identified to have a PFO by contrast TEE. Contrast-enhanced CMR identified a PFO in only 5 (56%) of these patients. None of the 7 patients without PFO at TEE was shown to have a PFO at CMR. TEE showed a grade 1 PFO in 4 patients, a grade 2 PFO in 3 and a grade 3 PFO in 2 patients. Of these patients, CMR failed to identify PFO in all patients with a grade 1 PFO at TEE and underestimated the degree of the shunt in the other patients.

Conclusions.

Our data suggest that TEE should be considered the non-invasive diagnostic reference test to detect and characterize PFO in patients with ischemic cryptogenic stroke.