bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 353: New Technique of Gas Adiabatic Expansion for Brain and General Hypothermia in Pig
Authors: Fontaine Guy , Lécuelle Benoit , Didon Jean Philippe , Schmid Johan Jacob , Chachques Juan Carlos
Published: April 2024

Objective:
The purpose of this work was to confirm on a pig model the previous work performed on a rabbit model (ReSS 2012) to demonstrate induction of both brain and general hypothermia on a beating heart.

Material and method:
8 Landrace pigs 39.4 ± 3.9 kg (mean ± SD) were studied under general anesthesia according to the WICCM protocol. Temperatures were measured by thermocouples every minute, after each injection: close to the injector inserted up to the nasopharynx without contact to the posterior wall, in the retrograde jugular vein, in the tympanic area, in the esophagus and in the rectum. After stabilization of temperatures, CO2 regulated at 580 psi (40 bar) was delivered for periods of 10 min. Valid data were obtained from 14 injections. We compared the drops in temperatures recorded until stabilization. In these pigs 2 ± 1.5 injections of CO2 were delivered.

Results:
The initial 90% drop in temperature was detected after 4.7 ± 1.4 min for tympanic and 9.4 ± 4 min p=0.02 for the core temperature. Temperatures recorded from the tympanic/jugular probes were identical p=1. Return to stable temperature was observed in 10-15 mn. Esophagus drop in temperature was 23 ± 10 °C n=6. The drop in temperature was significantly higher in the tympanic area 0.69 ± 0.4 °C than in the core temperature 0.36 ± 0.15 p = 0.02. The amount of extracted calories was 14.9 ± 6.7 kilocalories.

Discussion:
Core temperature drop was similar to that reported in pigs after nasopharynx PFC evaporation (Yu et al Crit Care Med. 2010). In our experiments the lowest temperature (-30°C) was recorded, as expected, at the exit point for the gas. Significant decrease in temperature of 26°C in the esophagus was always observed.

Conclusion:
This study confirms that CO2 expansion in the nasopharynx is effective for brain and body hypothermia in a pig model. This new technique which is simple, inexpensive and easy to use opens new vistas for the treatment of OHCA which, mixed with oxygen, can be started intra-arrest before CPR.
Abstract 9432: Superior Long-term Prognostic Impact of Angiotensin Converting Enzyme Inhibitors to Angiotensin II Receptor Blockers After ST-Elevation Myocardial Infarction
Authors: Hara Masahiko , Sakata Yasuhiko , Nakatani Daisaku , Suna Shinichiro , Usami Masaya , Matsumoto Sen , Sugitani Toshifumi , Nishino Masami , Sato Hiroshi , Kitamura Tetsuhisa , Nanto Shinsuke , Hamasaki Toshimitsu , Hori Masatsugu , Komuro Issei
Published: April 2024

Masahiko Hara, 2013 Finalist and Presenting Author
Abstract 12244: Repeat cardiovascular risk assessment after four years: Is there improvement in risk prediction?
Authors: Chamnan Parinya , Simmons Rebecca K. , Sharp Stephen J. , Khaw Kay-Tee , Wareham Nicholas J. , Griffin Simon J.
Published: April 2024

Parinya Chamnan, 2013 Finalist and Presenting Author
Abstract 16018: Genetic variation near HCRTR2 associates with dramatic improvement of heart function in patients with heart failure
Authors: Perez Marco V. , Pavlovic Aleksandra , Wheeler Matthew T. , Dewey Frederick E. , Pan Stephen , Absher Devin , Cretti Elizabeth , Southwick Audrey , Heidenreich Paul , Sedehi Daniel , Brandimarto Jeffrey , Kao David , Salisbury Heidi , Chan Khin , Rosenthal David , Bernstein Daniel , Fowler Michael B. , Robbins Robert C. , Myers Richard M. , Quertermous Thomas , Cappola Thomas , Ashley Euan
Published: April 2024

Marco V. Perez, 2013 Finalist and Presenting Author
Abstract 15492: ADAM12 Modifies Severity of Peripheral Arterial Disease; Evidence from Preclinical and Human studies
Authors: Dokun Ayotunde O. , Okutsu Mitsuharu , Jones W. Schuyler , Craig Damian , Shah Svati H. , Marchuk Douglas A. , Lye R. John , Annex Brian H.
Published: April 2024

Ayotunde Dokun, 2013 Finalist and Presenting Author
Abstract 16776: Persistent Fevers and Diffuse Rash in a 27 Year-Old Female with Heart Failure
Authors: Narla Venkata A. , Bolger Ann
Published: April 2024

Annie Narla, 2013 Finalist and Presenting Author
Abstract 16829: Myocardial Extracellular Volume Fraction and Survival in Systemic AL Amyloidosis
Authors: Banypersad Sanjay M. , Fontana Marianna , Sado Daniel M. , Pinney Jennifer H. , Mahmood Shameem , Sachchithanantham Sajitha , Dungu Jason , Whelan Carol J. , Wechalekar Ashutosh D. , Gillmore Julian D. , Lachmann Helen J. , Hawkins Philip N. , Moon James C.
Published: April 2024

Sanjay M. Banypersad, 2013 Finalist and Presenting Author
Abstract 14146: Systolic Anterior Motion of the Mitral Valve Alters Three Dimensional Hemodynamics in the Ascending Aorta in Hypertrophic Cardiomyopathy
Authors: Allen Bradley D. , Choudhury Lubna , Barker Alex J. , Ooij Pim von , Collins Jeremy D. , Carr James C. , Bonow Robert O. , Markl Michael
Published: April 2024

Bradley D. Allen, 2013 Finalist and Presenting Author
Abstract 17681: A Redox Dependent Mechanism for Regulation of AMPK Activation by Thioredoxin1 during Energy Starvation
Authors: Shao Dan , Oka Shin-ichi , Liu Tong , Zhai Peiyong , Ago Tetsuro , Sciarretta Sebastiano , Li Hong , Sadoshima Junichi
Published: April 2024

Dan Shao, 2013 Finalist and Presenting Author
Abstract 14176: Preclinical Evaluation of the Engineered Stem Cell Chemokine Stromal Cell-Derived Factor 1- alpha in a Translational Ovine Myocardial Infarction Model.
Authors: MacArthur John W. , Cohen Jeffrey E. , McGarvey Jeremy R. , Shudo Yasuhiro , Patel Jay B. , Fairman Alexander S. , Trubelja Alen , Edwards Bryan B. , Hiesinger William , Goldstone Andrew B. , Atluri Pavan , Pilla James J. , Gorman Joseph H. , Gorman Robert C. , Woo Y. Joseph
Published: April 2024

John MacArthur, 2013 Finalist and Presenting Author
Abstract XXXXX : H2 Gas Improves Functional Outcome After Cardiac Arrest to an Extent Comparable to Therapeutic Hypothermia in a Rat Model
Authors: Hayashida Kei , Sano Motoaki , Kamimura Naomi , Yokota Takashi , Suzuki Masaru , Hori Shingo , Maekawa Yuichiro , Kawamura Akio , Abe Takayuki , Ohta Shigeo , Fukuda Keiichi
Published: April 2024

Kei Hayashida, 2013 Finalist and Presenting Author
The Importance of Non-Coronary Atherosclerosis
Authors: Criqui Michael
Published: April 2024

Coronary atherosclerosis leading to coronary heart disease (CHD) is now responsible for the largest burden of morbid and mortal disease in developed countries, and this is increasing so in developing countries around the world. It is now well recognized that computed tomography (CT) scans can quantitatively assess coronary artery calcium (CAC), a direct marker of coronary atherosclerosis, and CAC can substantially aid in risk prediction of both CHD and other cardiovascular disease (CVD) outcomes. Of course, this might be expected since CAC is actually a direct measure of coronary atherosclerosis, as opposed to a risk factor for CHD such as cigarette smoking or dyslipidemia.

Atherosclerosis is a generalized disease and as such also affects other arterial beds throughout the body. This observation raises the question as to whether measurement of atherosclerosis outside of the coronary arteries is of value in risk prediction or disease prognosis for CHD or CVD. Extensive research has shown that the answer is yes; that is, selected measurements of non-coronary atherosclerosis provide incremental and independent information beyond both standardized risk scores employing risk factors, as well as beyond measurement of CAC. Thus, measurements of non-coronary atherosclerosis, both subclinical and clinical, can aid in the prediction of, and determining prognosis for, CHD as well as other CVD events.

The epidemiologic and clinical value of non-coronary atherosclerosis will be illustrated with data from research into four selected non-coronary atherosclerosis measures. These measures are the ankle-brachial index (ABI), which is the ratio of the systolic blood pressure at the ankle to that in the arm; subclavian stenosis (SS), which is determined by a significant systolic blood pressure difference between the left and right arms; renal artery calcification (RAC) assessed by CT scan, and abdominal aortic calcification (AAC) assessed by CT scan. Data to be presented come from both US and international studies, and will address the significance of these four measure both in persons without known CVD and in persons with a clinical diagnosis of CVD.
Importance of Clinical Trials and International Cooperation
Authors: Pfeffer Marc A.
Published: April 2024

As physicians, we are fundamentally biologists with the objective of utilizing this knowledge to limit disease burden. As medical practitioners and investigators, we strive to meaningfully contribute to this growing body of knowledge to improve the understanding of physiology and pathophysiology in an attempt to develop better therapeutic approaches for patients. Preliminary data from multiple sources are used to develop mechanistic constructs which can be focused into a testable hypothesis. In clinical investigation, the randomized controlled clinical trial (RCT) has emerged as the most definitive method of determining whether or not a novel therapy alters the clinical course of a cohort of patients with a defined disease. Although the skillful practice of medicine remains an art of using, at best incomplete data, the RCT provides the most quantitative assessments of both the benefits as well as the risks of a therapeutic strategy. However, RCTs that can provide such data are massive undertakings that require long-term dedication from large numbers of patients, investigators, and staff. As such, these large international cooperative ventures demand huge financial and personal commitments. As a consequence, smaller studies with more intermediate so-called surrogate outcomes are often conducted providing less definitive data that can only be extrapolated to presumed clinical outcomes. This presentation will highlight the advances and challenges of designing and conducting international clinical outcome trials with examples from cardiovascular medicine looking backwards as well as forward.
Regulation of Plasma Lipoprotein Levels in Humans: New Insights Using Methods Pioneered by Bob Levy
Authors: Ginsberg Henry
Published: April 2024

In the early 1970s, Robert Levy and colleagues published a series of groundbreaking papers showing, in detail, the metabolic fates of the apolipoproteins on very low density lipoproteins after intravenous injection into normal and hyperlipidemic subjects. These studies were the foundation for the field of human lipoprotein kinetics that has provided very significant insights into the pathophysiology of lipid disorders as well as mechanisms of action of lipid altering diets and drugs. Early studies used mainly exogenously radiolabeled lipoproteins, but more recently, stable isotopes of amino acids have been used to endogenously label the apolipoproteins of interest. Our group has used both approaches for more than three decades and in this lecture, I will highlight the results of several of our studies including very recent unpublished work.
Abstract 76: Testing the Feasibility of Using Telemedicine for Post-Cardiac Arrest Management in the Emergency Department
Authors: Agarwal Anish K , Perman Sarah M , Gaieski David F , Delfin Gail , Leary MSN, RN Marion , Abella Benjamin S , Carr Brendan G
Published: April 2024

Objectives:
Dissemination and implementation of post-cardiac arrest care (i.e. targeted temperature management [TTM]) has lagged across the US, and access to centers capable of delivering TTM remains limited. Telemedicine has been utilized for time sensitive conditions (acute ischemic stroke) and may provide a means for expanding clinical expertise. We sought to test the practical and technological feasibility of using emergency department (ED) based telemedicine to manage return of spontaneous circulation (ROSC) after OHCA including induction of TTM.

Methods:
We created a hub-spoke telemedical network between an academic level I trauma center and two affiliated EDs - each with a telemedical cart equipped with a HD-video camera, speaker, and microphone. Text- alerts notified the on-call telemedical team of OHCA in the ED. The on-call physician connected via an Internet ready laptop with the ability to: control the ED cart camera, access the EMR, lab values, and radiology images. Consults were monitored to assess connection time and clarity.

Results:
Over 12-weeks there were 31 OHCA alerts; 13 achieved ROSC (41.9%), 84.6% of ROSC cases utilized telemedicine; 81.8% were TTM-eligible and 100% of these cases utilized telemedicine. Mean connection time was 3.7 min (3.6 SD); mean duration was 71.7 min (SD 62.7). Mean number of connection attempts was 1.2, with no complete disconnections. Consultants ranked ability to see and hear staff/patients on a Likert scale (5, 4.7 respectively: 5= great). Staff ranked ability to see and hear the telemedical consultant similarly (4.9, 4.8).

Conclusions:
This ED-based telemedical pilot demonstrates the practical and technological feasibility of expanding the use of telemedicine to manage and direct protocolized post-cardiac arrest care. This pilot begins to reveal the capability of using telemedicine within the ED for improving the adherence to evidence based protocols for the management of unplanned critical illnesses.
Abstract 89: Nitrite After Cardiac Arrest Has Mitochondrial Antioxidant Effects Reducing Reperfusion Cerebral Hyperemia
Authors: Dezfulian Cameron , Misse Amalea , Stezoski Jason P , Kenny Elizabeth , Kochanek Patrick M , Bayir Hulya , Clark Robert S
Published: April 2024

Background:
Nitrite confers neuroprotection after asphyxial cardiac arrest (ACA) through uncertain mechanisms though others have demonstrated antioxidant effects and improved blood flow after ischemia. We hypothesized that nitrite would modulate reperfusion blood flow and reduce reactive oxygen species (ROS).

Methods:
Adult male SD rats were intubated and catheterized. Cardiac output (CO) was measured using an ultrasonic flow probe (ascending aorta), cortical blood flow (CBF) was measured using laser speckle imaging (5mm craniotomy). 5m post-ROSC from 8m ACA, animals were randomized to a 500 ul 10m infusion of 8 uM nitrite or plasmalyte placebo. Physiology was measured for 1h and normalized to pre-arrest baseline. Brains were removed at 1h and homogenized for ascorbate measurement (ac-TEMPO). Separately, brains removed 15m post-ROSC had mitochondria isolated by Percoll gradient. Respiration was measured using a Clark electrode and ROS generation quantified by Amplex Red fluorescence +/- UV pretreatment to lyse S-nitrosothiols. Pyruvate/malate or succinate +/- ADP were the substrates.

Results:
Animals had similar baseline physiology. In placebo animals, post-RSOC hypertension resulted in significant increases in CBF (187%) compared to nitrite treated animals (136%; p<0.01;
Figure):
This difference persisted until 20 min after ROSC at which point groups converged. Nitrite treated animals had significantly higher levels of ascorbate (33.09 nmol/mg protein) compared to placebo treated animals (26.17; p=0.027). ROS generation with pyruvate substrate was reduced with nitrite therapy with minimal effects on respiration (
Figure
). This difference was reversed with UV pretreatment and not present with succinate.

Conclusion:
Nitrite is antioxidant after ROSC, preserving ascorbate, reducing mitochondrial ROS generation at complex I presumably via S-nitrosation and blunting loss of autoregulation and hyperemia.
Abstract 90: Pyruvate Dehydrogenase is Inhibited in Post Cardiac Arrest Patients
Authors: Donnino Michael W , Giberson Tyler , Cocchi Michael , Berg Katherine , Anderson Lars , Liu Xiaowen
Published: April 2024

Introduction:
Pyruvate Dehydrogenase (PDH) activity has been shown to be inhibited in animal models of post-cardiac arrest. This depressed activity has been postulated to be directly related to neurologic injury secondary to aerobic metabolic dysfunction and accumulation of toxic metabolites. The objective of this study was to determine if PDH inhibition occurs after cardiac arrest (CA) in humans.

Methods:
Patients were enrolled as part of a prospective observational trial of CA at a single urban academic medical center from 1/13 to 4/13. A blood sample was collected as early after ROSC as informed consent could be obtained (<24 hours). Our control group consisted of volunteers with no significant medical history. We used a novel method to measure PDH activity from peripheral blood mononuclear cells isolated from fresh blood. We quantified total PDH in 15mg / ml of isolated protein and determined overall PDH activity (PDH activity / total protein) and specific PDH activity (PDH activity / PDH protein). Wilcoxon rank sum test was used to compare median quantity and activity between the two groups. A p-value < 0.05 was considered statistically significant. All tests of the data were performed in SAS v. 9.3 (SAS Institute Inc., Cary, NC, USA).

Results:
We enrolled 10 post-arrest patients; average age was 48 and 50% were female. Mortality was 50%. Overall PDH activity was significantly lower in the CA group (2.20 IQR 1.70 - 3.49) compared to controls (8.40 IQR 5.51 - 8.67) (p = .007). PDH quantity was also significantly lower in the CA group (1.26 IQR 0.90 - 2.02) compared to controls (4.88 IQR 3.08 - 6.09) (p = .009). There was no difference in specific PDH activity between the groups (p = 0.84).

Conclusions:
PDH activity is inhibited in the post-arrest period compared to healthy controls. The main driver of inhibition may be loss of PDH protein as opposed to changes in intrinsic activity. These findings are pertinent as animal models suggest PDH inhibition may drive neurologic injury after CA.
Abstract 9258: LDL Phenotype-B is Strongly Associated With CHD Risk Among Individuals With CKD. The Multi-ethnic Study of Atherosclerosis (MESA)
Authors: Lamprea-Montealegre Julio A , Astor Brad C , McClelland Robyn , Grams Morgan , Sibley Cristopher T , Ouyang Pamela , de Boer Ian , Szklo Moyses
Published: April 2024

Introduction:
LDL phenotype B, characterized by high triglyceride (TG), small dense LDL (sd-LDL), and very low-density lipoprotein (VLDL) levels, and low high-density lipoprotein (HDL) levels, is the hallmark lipid phenotype of chronic kidney disease (CKD). Whether this phenotype is associated with clinical coronary heart disease (CHD) in individuals with CKD is not known.

Methods:
CKD was defined as an eGFR of 15-59 ml/min/1.63m2 (stage 3-4). Principal component analyses were used to account for the correlations among lipoproteins defining lipid phenotype B. Nuclear magnetic resonance spectroscopy was used to measure lipoprotein sub-fractions. CHD was defined as a new MI, angina followed by revascularization, resuscitated cardiac arrest or CHD death.

Results:
A total of 6,814 individuals free of CHD at baseline were followed for a median time of 8.5 years. CHD developed in 303 individuals (5%) with eGFR≥60 and in 72 individuals (12%) with CKD (p for difference<0.001). Principal component 1 captured the lipoprotein abnormalities defining lipid phenotype B: high TG levels (r for correlation with PC1=0.78), VLDL (r=0.73), sd-LDL(r=0.82) and low levels of HDL (r=-0.80). Compared to those without CKD, this phenotype (and its components) was more common (p for difference<0.001), and was more strongly associated with CHD in those with CKD (figure): adjusted hazard ratios and 95% confidence intervals 1.13 (1.00-1.28; p=0.05) and 1.51 (1.17-1.94; p=0.001) in eGFR≥60 and CKD respectively (p for interaction=0.04).

Conclusion:
LDL phenotype-B is strongly associated with CHD risk in individuals with CKD. Whether a modification of the components of this phenotype leads to a reduction in the cardiovascular disease burden of individuals with CKD should be established in future studies.
Abstract 9262: Clinical Implication of ST-Segment Elevation in Lead aVR in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome
Authors: Kosuge Masami , Ebina Toshiaki , Hibi Kiyoshi , Tsukahara Kengo , Maejima Nobuhiko , Iwahashi Noriaki , Tahara Yoshio , Konishi Masaaki , Umemura Satoshi , Kimura Kazuo
Published: April 2024

Background:
In patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), ST-segment depression (STD) has been shown to be associated with poor outcomes; however, lead aVR is not considered. Lead aVR is referred to as a “cavity lead,” and ST-segment elevation in this lead (STE-aVR) might reflect global subendocardial ischemia.

Methods:
We studied 818 patients with NSTE-ACS who underwent coronary angiography during hospitalization. ST-segment deviation was measured on admission ECG, and it was considered present if ≥ 0.5 mm. Troponin T (TnT), hemoglobin (Hb), estimated glomerular filtration rate (eGFR), high-sensitivity C-reactive protein (hsCRP), brain natriuretic peptide (BNP), and TIMI risk score were also measured on admission.

Results:
STD in 11 leads except aVR was observed in 568 patients. Among these patients, 225 patients had STE-aVR. In patients with no STD (n=250), isolated STD (n=343), and STD plus STE-aVR (n=225), age was 63±10, 67±11, and 70±11 years; the rates of diabetes mellitus were 25%, 32%, and 50%; Killip class ≥2 was 2%, 6%, and 27%; positive TnT was 22%, 34%, and 49%; the levels of Hb were 13.8±1.7, 13.9±1.9, and 12.7±2.2 g/dl; eGFR was 69.1±22.8, 65.8±24.7, and 56.8±27.5 ml/min/1.73m
2
; hsCRP was 0.310±1.480, 0.499±1.249, and 0.899±1.820 mg/dl; BNP was 90±203, 200±359, and 431±575 pg/ml; TIMI risk core was 1.9±1.2, 3.1±1.3, and 3.6±1.2; the frequencies of left main/3-vessel disease were 4.0%, 8.5%, and 56.9%; and in-hospital adverse events (death, [re]infarction, or urgent revascularization) were 5.2%, 8.7%, and 31.6%, respectively (all p<0.01). Multivariate analysis showed that STD plus STE-aVR (OR 3.56, 95%CI 1.13-7.99, p<0.01) was the strongest predictor of in-hospital adverse events, followed by positive TnT (OR 1.33, 95%CI 1.03-2.99, p=0.048), but isolated STD was not.

Conclusions:
In patients with NSTE-ACS, STE-aVR in addition to STD on admission ECG was strongly associated with left main/3-vessel disease and in-hospital adverse outcomes, but isolated STD was not. Our findings suggest the importance of evaluation of ST-segment deviation in 12 leads including aVR in early risk stratification.
Abstract 9268: NT-proBNP and Myocardial Perfusion in Asymptomatic Adults: The Multi-Ethnic Study of Atherosclerosis (MESA)
Authors: Mitchell Adam , Misialek Jeffery R , Folsom Aaron R , Alonso Alvaro , Duprez Daniel , Jerosch-Herold Michael , Watson Karol E , Sallam Tamer , Konety Suma H
Published: April 2024

Introduction:
B-type natriuretic peptide (BNP) is a cardiac neurohormone secreted from membrane granules in the cardiac ventricles as a response to ventricular volume expansion and pressure overload. While it is a sensitive marker of heart failure, it may also be elevated in the setting of reduced myocardial perfusion. We hypothesized that reduced myocardial blood flow (MBF) would be associated with elevated NT-proBNP in the MESA study.

Methods:
MBF was measured by cardiac MRI in 184 MESA participants without overt coronary heart disease, before and after adenosine infusion, for whom serum NT-proBNP levels were available (mean age 60 ± 10.4, 58% white, 42% Hispanic, 44% female). Hyperemic MBF was modeled with adjustment for resting MBF. A linear regression analysis, adjusted for demographics, established cardiovascular risk factors, left ventricular mass, body mass index and medications, was used to determine the association between hyperemic MBF and NT-proBNP.

Results:
Individuals with low hyperemic MBF were more likely to be older, male, diabetic, have higher blood pressure and higher coronary artery calcium (CAC) score. Hyperemic MBF was 3.04 ± 0.829 ml/min/g and was inversely associated with NT-proBNP levels. In the fully adjusted model, every one standard deviation decrement in hyperemic MBF was associated with a 21% increment in NT-proBNP (p=0.04) (TABLE).

Conclusions:
Hyperemic MBF is inversely associated with NT-proBNP level in this cross sectional study of asymptomatic individuals free of overt coronary artery disease. These results suggest that higher NT-proBNP levels may signify subclinical myocardial microvascular dysfunction.
Abstract 9351: Are “All-Comer” Clinical Trials Representative of Contemporary Clinical Practice: A Linked Analysis of the Dual Antiplatelet Therapy (DAPT) Study and the National Cardiovascular Data Registry®
Authors: Yeh Robert W , Czarny Matthew J , Kim Sunghee , Roe Matthew T , Holmes David R , Brindis Ralph G , Weaver W D , Normand Sharon-Lise T , Kereiakes Dean , Mauri Laura
Published: April 2024

Background:
Randomized clinical trials are often criticized for not reflecting real-world practice. To understand the effect of site and patient selection on trial generalizability, we examined US patient and hospital participation within the Dual Antiplatelet Therapy (DAPT) Study, a broadly inclusive trial of PCI patients, using a linked analysis with the CathPCI Registry®.

Methods:
Within the CathPCI Registry, we identified patients undergoing PCI between September 1, 2009 and July 1, 2011 - the period of DAPT Study enrollment. We compared US patients enrolled in DAPT to CathPCI Registry patients meeting DAPT inclusion criteria. Characteristics of US DAPT sites were also compared to those of hospitals not participating in DAPT. Standardized differences (%) for all variables were estimated, with those greater than 10% considered significant.

Results:
Among 1,139,932 NCDR patients undergoing PCI, 748374 (65.7%) met the enrollment criteria for DAPT, and 23495 (2.1%) were enrolled. Enrolled patients were younger and had lower rates of prior stroke, CHF and peripheral vascular disease, but were similar with respect to race and gender compared with eligible patients (Table). Of the 1276 hospitals within the NCDR, 309 (24.2%) participated in DAPT. Hospital characteristics differed markedly, with DAPT-participating hospitals being larger (mean beds 468 vs. 311), more often located in urban settings (61.2% vs. 42.6%), more often affiliated with training programs (53.7% vs. 34.1%), and with higher annual PCI volumes (mean annual hospital volume 858 vs. 378 PCIs) compared with non-DAPT hospitals.

Conclusions:
While liberal inclusion criteria may allow randomized trials to better simulate “real-world” clinical practice, the process of site selection may encourage participation of higher volume, urban hospital settings. These findings are relevant to clinical trial interpretation and implementation of evidence-based practice throughout the healthcare system.
Abstract 9436: Impact of Aortic Valve Calcification Severity and Impaired Left Ventricular Function on Long-Term Outcome After Transcatheter Aortic Valve Replacement: 24 Months Results From the Aachen Registry
Authors: Koos Ralf , Reinartz Sebastian , Lotfi Shahram , Autschbach Rüdiger , Marx Nikolaus , Hoffmann Rainer
Published: April 2024

Introduction:
Transcatheter aortic valve replacement (TAVI) has been established in high-risk patients with severe aortic valve stenosis. We aimed to evaluate pre-interventional clinical predictors of two-year outcome and mortality in a real-world population treated with TAVI.

Methods:
Consecutive patients with symptomatic aortic valve stenosis (aortic valve area ≤ 1cm
2
) undergoing TAVI were prospectively included into the Aachen TAVI registry. Among 346 patients, 105 patients (34 men, mean age 81 ± 6 years, logistic EuroSCORE of 21 ± 12) with a baseline dual-source computed tomography (DSCT) and a two-year follow-up were identified. Prior to TAVI, all patients received an echocardiography and underwent a non-enhanced and contrast-enhanced DSCT (Definition, Siemens, Forchheim, Germany with scan parameters as follows: 2x64x0,6mm collimation, tube voltage 120KV, 380mAs tube current) for quantification of aortic valve calcification (AVC) severity using the Agatston AVC score. Mortality tracking was achieved in 100% of patients.

Results:
Survival at 30 days was 90 %, and it was 63% at 2 years. NYHA class showed a marked improvement from 3.2 ± 0.6 at baseline to 1.4 ± 0.6 at 2 years. Non-survivors at 2 years showed a significantly higher Agatston AVC score (2722 ± 1485) than survivors (1809 ± 997, p=0.001). Multivariate analysis including age, logistic EuroScore, glomerular filtration rate, Agatston AVC score, ejection fraction < 40% and NYHA class revealed that only the Agatston AVC score (p<0.001) and impaired left ventricular function (p=0.021) was significantly associated with mortality. Patients with Agatston AVC scores > 1900 (above the median of the total cohort) had a significantly lower 2-year survival rate compared to patients with scores < 1900 (47% vs. 78%, p=0.001).

Conclusions:
In patients referred for TAVI, aortic valve calcification severity and impaired left ventricular function may serve as a predictor of long-term mortality. Therefore, aortic valve calcification scores easily to be determined from preprocedural CT-datasets may be used for patient risk stratification.
Abstract 9460: Increased Aortic and Main Pulmonary Arterial Diameters Are Independent Predictors of Incident Cardiovascular Disease Events
Authors: Chuang Michael L , Gona Philimon , Salton Carol J , Tsao Connie W , Yeon Susan B , Manning Warren J , O’Donnell Christopher J
Published: April 2024

Introduction:
Aortic dilation is associated with multiple cardiovascular disease (CVD) risk factors. We sought to determine whether enlargement of the aorta or main pulmonary artery (MPA) is an independent predictor of future adverse CVD events.

Methods:
1715 Framingham Offspring cohort members without prevalent CVD (69±9 y, 47% men) underwent cardiovascular magnetic resonance (CMR) of the aorta and MPA during 2002-2005. CMR at 1.5T used a free-breathing, ECG gated, black blood, fat suppressed T2-W turbo spin-echo sequence with 1.03x0.64-mm2 spatial resolution and 5-mm slice thickness. Luminal diameters of the ascending (ASC) and descending thoracic (DTA) aorta and MPA were measured at the level of MPA bifurcation, the abdominal aorta (ABD) was measured just below the renal arteries. Incident hard CVD events included CV death, myocardial infarction, coronary insufficiency, stroke and hospitalized congestive heart failure. For each vessel segment Cox proportional hazards regression models (adjusted for age, sex, body mass index, systolic blood pressure, pack years smoked; treatment for hypertension, diabetes or dyslipidemia; current smoking; emphysema) were used to assess hazard of a hard CVD event per 5mm of vessel diameter.

Results:
Over a mean 6.5-year follow up there were 60 (3.3%) incident hard CVD events. The Table shows mean±SD diameters by sex and sex-pooled hazard ratios (HR) and 95% confidence intervals (CI) for hard CVD events per 5 mm increase in vessel diameter. Men had greater mean diameters than women. Increasing diameter of each vessel segment, except ASC, was associated with greater multi-variable adjusted hazard of adverse CVD events. Results were qualitatively similar after indexation of diameters to height.

Conclusion:
In a community-dwelling cohort of adults initially free of clinical CVD, greater luminal diameter of the descending aorta or the MPA, measured by noncontrast CMR, is an independent predictor of future adverse CVD events.
Abstract 9464: International Incidence of Complications After Catheter Ablation of Persistent Atrial Fibrillation (AF): Insights From the Multicenter, Prospective, Randomized STAR AF II Trial
Authors: Verma Atul , Chen-yang Jiang , Betts Tim , Chen Jian , Deisenhofer Isabel , Mantovan Roberto , Macle Laurent , Morillo Carlos , Sanders Prashanthan
Published: April 2024

Background:
Complication rates after AF ablation are mostly reported in single center experiences or surveys. Little international, multicenter, prospective data on the contemporary incidence of complications is available. We report the incidence of complications from the large STAR AF II randomized trial.

Methods:
The STAR AF II trial is an international, randomized trial comparing 3 different strategies for ablation of persistent AF: pulmonary vein isolation (PVI) alone, PVI + linear ablation, and PVI + ablation of complex fractionated electrograms. 48 centers were involved across Canada, Australia, Korea, China, & 8 countries in Europe. Post-ablation, patients were all followed for 18 months. All adverse events were reported by protocol and were classified as “serious” if it was fatal, life-threatening, disabling, or required/prolonged hospitalization. Adverse events were also reviewed by an independent data safety monitoring board and classified as either being related or unrelated to the ablation procedure. Adverse events related to the ablation procedure were included in this analysis.

Results:
Patients (n=589) were enrolled in the STAR AF II trial (age 60±10 years, 79% male, EF 56±10%, LA diameter 44±9 mm). The most common post-procedural complications were access site hematoma (n=16, 2.7%), fluid overload/pulmonary edema (n=16, 2.7%), and transient pericarditis (n=15, 2.5%). Access site arterio-venous fistulas or pseudoaneurysms occurred in 7 patients (1.2%). Complications related to sedation occurred in 5 patients (0.8%). Cardiac tamponade (n=3, 0.5%), stroke or transient ischemic attack (n=3, 0.5%), and symptomatic PV stenosis (n=1, 0.2%) were uncommon. None of the neurological events resulted in permanent deficit. There was one atrio-esophageal fistula complicated by stroke which was successfully stented, but the patient died of aspiration pneumonia three months later.

Conclusions:
The most common complications were access site hematoma, fluid overload, and transient pericarditis. The rates of serious adverse events such as tamponade, stroke and symptomatic PV stenosis were quite low. There was one atrio-esophageal fistula that caused late death despite successful repair.
Abstract 9519: Knockdown of TRPC1 Expression Markedly Attenuates Hypoxia-Induced Pulmonary Arterial Hypertension in a Murine Model: Advantage of Liposome-Mediated siRNA Delivery System
Authors: Tsai Tzu -Hsien , Chua Sarah , Sheu Jiunn-Jye , Yip Hon-Kan
Published: April 2024

Background:
We tested the hypothesis that Lipofectamine siRNA delivery to deplete transient receptor potential cation channel (TRPC)1 protein expression can suppresses hypoxia-induced pulmonary arterial hypertension (PAH) in mice.

Methods and Results:
Adult male C57BL/6 mice (n=30) were equally divided into group 1 (normal controls), group 2 (hypoxia for 28 days), group 3 [hypoxia + Lipofetamine-delivered siRNA to knockdown TRPC1 (intra-tracheally administered on day 14 after hypoxia)]. By day 28, right ventricular blood pressure (RVSBP), number of muscularized arteries, RV and the lung weight were increased in group 2 than in group 1, and reduced in group 3 compared with group 2 (all p<0.001). Pulmonary crowded score showed similar pattern, whereas number of alveolar sacs exhibited an opposite pattern compared to that of RVSBP in the three groups (all p<0.0001). Protein expressions of TRPCs (1, 4, 6), HIF-1α, Ku-70, apoptosis (Bax, cleaved caspase 3, and PARP) and fibrosis (Smad3, TGF-β) and pulmonary mRNA expressions of inflammatory markers (MMP-9, TNF-α) was similar to, whereas protein expressions of anti-fibrosis (Smad1/5, BMP-2) and VEGF was opposite to the pattern of RVSBP (all p<0.01). Cellular markers of pulmonary DNA damage (γHA2X), repair (Ku-70), and smooth-muscle proliferation (Ki67) exhibited a pattern similar to that of RVSBP (all p<0.001). Pro-apoptotic mRNA expressions of (Bax, caspase 3) and hypertrophy (β-MHC) displayed a similar pattern, whereas sacromere length showed an opposite pattern compared to that of RVSBP in all groups (all p<0.001).

Conclusion:
Lipofectamine siRNA delivery effectively knockdown PRTC1 expression, thereby attenuating PAH-associated RV and pulmonary arteriolar remodeling.
Abstract 9555: Ventricular Geometric Characteristics and Functional Benefit of Mild Right Ventricular Outflow Tract Obstruction in Patients With Significant Pulmonary Regurgitation After Repair of Tetralogy of Fallot
Authors: Chen Chun-An , Chen Ssu-Yuan , Wang Jou-Kou , Tseng Wen-Yih I , Chiu Hsin-Hui , Yang Ming-Chun , Chang Chung-I , Chiu Ing-Sh , Chen Yih-Sharng , Lu Chun-Wei , Lin Ming-Tai , Wu Mei-Hwan
Published: April 2024

Aims:
Right ventricular (RV) outflow tract obstruction (RVOTO) might protect the RV from adverse remodeling caused by pulmonary regurgitation (PR) in patients with repaired tetralogy of Fallot (rTOF), but the underlying mechanisms and influences on exercise tolerance remain unclear. This study sought to investigate the impacts from mild RVOTO on ventricular remodeling and exercise capacity in rTOF.

Methods and results:
85 rTOF patients with a PR fraction ≥ 20% were assessed with cardiac magnetic resonance, cardiopulmonary exercise test, and echocardiography. Comparing to patients with isolated PR (a peak RVOT pressure gradient < 20 mmHg, n = 56), patients with combined PR and mild RVOTO (a peak RVOT pressure gradient 20-50 mmHg, n = 29) had smaller RV and RVOT dimension, better RV and left ventricular (LV) ejection fraction (EF), and superior exercise capacity. PR severity and RV mass/volume ratio were similar between these 2 groups. LVEF was influenced by RVEF only in patients with isolated PR. Smaller RVOT dimension was an independent geometric factor related to smaller RV dimension (P < 0.001) and better RVEF (P = 0.005) in multivariate analysis. Furthermore, mild RVOTO was independently associated with higher percentage of predicted peak oxygen consumption (P = 0.014) and predicted oxygen uptake efficiency slope (P = 0.005).

Conclusion:
Patients with combined PR and mild RVOTO had better RV remodeling and superior exercise capacity compared to those with isolated PR. Our findings confirm the benefits from mild residual RVOTO support a policy of conservative RVOTO relief at repair.
Abstract 9559: Serum Uric Acid and the Vulnerability of Carotid Atherosclerotic Plaque Measured by Magnetic Resonance Imaging
Authors: Kagaya Hiroki , Watanabe Hirohumi , Yoshikawa Yuichiro , Kageyama Takahiro , Imamura Shigeki , Hirai Aizan
Published: April 2024

Carotid-wall intima-media thickness (IMT) is a surrogate marker of atherosclerosis associated with cardiovascular risk factors and with cardiovascular outcomes. MR imaging of carotid plaque has been shown to be superior to the diagnostic assessment of plaque vulnerability at high risk of rupture, and to provide information useful to the choice of treatment. Regression of plaque has been reported by intensive statin therapy (IST). The effect of IST on the characteristics of carotid plaques, especially on the instability of plaques was determined using a combination of ultrasonography and MR imaging. In the present investigation, 572 patients having max IMT over 1.5mm were included. Among them, 445 patients (234 males and 211 females, average age was 70 ± 9.9 and 70 ± 10.1, respectively ) had been treated on IST for more than 1 year before the study(IST group). On the other hand, 117 patients (49 males and 68 females) had not been treated on IST before the study(non-IST group). Serum levels of LDL-C, HDL-C, LDL-C/HDL-C and uric acid of IST group and non-IST group are 68 ± 15 vs 133 ± 29, 52 ± 13 vs 53 ± 12, 1.39 ± 0.4 vs 2.6 ± 0.5 and 5.4 ± 1.4 vs 5.1 ± 1.2, respectively. The black-blood method was used, and a horizontal cross-sectional image of plaque was taken with T1- and T2-weighted mode. Finally, the ratio of the lesion and the submandibular gland was determined. Plaques having the ratio of T1 evaluation more than 1.25 were defined as intraplaque hemorrhage (IPH), while those below 1.25 were defined as stable. Plaques having the ratio of T2 evaluation more than 1.25 were defined as lipid core (LC), while those below 1.25 were defined as stable. In IST group, 58% of the patients have stable plaque, 6% have IPH, 24% have LC and 11% have IPH+LC. On the other hand, 50% of the patients of non-IST group have stable plaque, 4% have IPH, 33% have LC and 12% have IPH+LC. In IST group, among various parameters, only serum uric acid has strong and significant correlation with the presence of LC in carotid plaque in male (p=0.0030). Odds ratio of uric acid in the presence of LC in carotid plaque is 1.530. No such correlation was observed in female patients. Thus the present investigation provides a new insight into the role of uric acid in the vulnerability of carotid atherosclerotic plaque.
Abstract 9803: Optimization and Comparison of Myocardial T1 Techniques at 3T in Patients With Aortic Stenosis
Authors: Chin Calvin W , Semple Scott , Malley Tamir , White Audrey , Mirsadraee Saeed , Weale Peter , Prasad Sanjay , Newby David E , Dweck Marc R
Published: April 2024

BACKGROUND:
T1 mapping is an emerging cardiac magnetic resonance imaging technique to assess diffuse myocardial fibrosis. However, the optimal approach remains uncertain, especially at 3T. We sought to optimize and compare the most widely-used techniques.

METHODS:
T1 mapping was performed at 3T using the modified-look-locker-inversion sequence in 20 healthy volunteers and 20 patients with aortic stenosis (AS). Pre- and post-contrast myocardial T1, the partition coefficient (λ) and interstitial contrast volume of distribution (Vd) were assessed. After establishing the optimal time-point and myocardial region for analysis, we compared the reproducibility of these T1 measures and their ability to differentiate asymptomatic patients with AS from healthy volunteers.

RESULTS:
There was no segmental variation across the ventricle in any of the T1 measures evaluated. λ and Vd did not vary with time, while post-contrast T1 was relatively constant between 15-30min. Thus, mid-cavity myocardium at 20min was used for subsequent analyses. Vd displayed excellent intra-, inter-observer, and scan-rescan reproducibility (intra-class correlation coefficients (ICC) 1.00, 0.97 and 0.96 respectively), as did λ (ICC 0.99, 0.94, 0.93 respectively). Moreover, Vd and λ were both higher in patients with AS compared to controls (Vd 28.3±1.7
versus
26.0±1.6%,
p
<0.001; λ 0.46±0.03
versus
0.44±0.03,
p
=0.02) (Figure 1A). By comparison, scan-rescan reproducibilities for pre- and post-contrast myocardial T1 values were only modest (ICC 0.72 and 0.56) with no differences observed between cases and controls (both p>0.05) (Figure 1B).

CONCLUSIONS:
We recommend Vd and λ to assess diffuse myocardial fibrosis at 3T based upon their superior reproducibility and ability to identify disease states.
Abstract 9817: Unlocking the Mystery of Symptom Severity in Patients With Heart Failure: Depressive Symptoms and Excess Sodium Intake are Associated With Severe Physical Symptoms
Authors: Heo Seongkum , Moser Debra K , Lennie Terry A , Fischer Mary , Smith Eugene , Walsh Mary N
Published: April 2024

Background:
The majority of patients with heart failure (HF) suffer from physical symptoms. In order to improve physical symptoms, the first step is to determine the modifiable factors associated with them.

Purpose:
To examine the modifiable psychosocial and behavioral factors associated with physical symptoms in patients with HF.

Methods:
Data on physical symptoms (Symptom Status Questionnaire-HF), psychosocial variables (depressive symptoms [Patient Health Questionnaire], perceived control [Control Attitudes Scale-Revised], and social support [Multidimensional Scale of Perceived Social Support]), and behavioral variables (medication adherence [Micro-Electro-Mechanical Systems], sodium intake [24-hour urine], and self-care management [Self-care management subscale of the Self-Care of Heart Failure Index]) were collected from 109 patients with HF (mean age 58 ± 14 years, 46% male, 59% New York Heart Association class [NYHA] II/III). Age and comorbidities were selected as covariates based on the literature. Hierarchical multiple regression analyses were used to analyze the data.

Results:
Among psychosocial variables (depressive symptoms, perceived control, and social support), only depressive symptoms were associated with physical symptoms. Among behavioral variables (medication adherence, sodium intake, and self-care management), only sodium intake was associated with physical symptoms. Those who had more severe depressive symptoms and higher sodium intake experienced more severe physical symptoms controlling for covariates (F = 11.633, R
2
= 48%, p < .001).

Conclusion:
The findings of this study showed that improvement in depressive symptoms and reduction of dietary sodium intake are primary of HF intervention targets to improve physical symptoms.
Abstract 9861: Caveolin 1-Regulated Src-dependent Cardiac Connexin 43 Degradation Mediates Renin-Angiotensin System Activation-Induced Arrhythmias
Authors: Yang Kai-Chien , Rutledge Cody A , Mao Mao , Bakhshi Farnaz R , Xie An , Liu Hong , Bonini Marcelo G , Patel Hemal H , Minshall Richard D , Dudley Samuel C
Published: April 2024

Background:
Activation of the cardiac renin-angiotensin system (RAS) is associated with increased risk of ventricular arrhythmia and sudden cardiac death. Increased cardiac RAS activity leads to conduction block and spontaneous ventricular arrhythmias as a result of connexin 43 (Cx43) degradation mediated by the activation of redox-sensitive tyrosine kinase c-Src signaling. The molecular mechanism of c-Src activation downstream of RAS signaling remains elusive.

Results:
Using a transgenic mouse model of cardiac-specific overexpression of angiotensin converting enzyme (ACE8/8) and a heterologous expression system, we uncovered a ~50% reduction in the binding of c-Src to caveolin 1 (Cav1) and subsequent c-Src activation as a result of S-nitrosylation of Cav-1 at Cys156 (Cav1-SNO) upon enhanced RAS signaling. RAS-induced Cav1-SNO and Src activation was mediated by eNOS-derived NO in response to increased mitochondrial oxidative stress. Knockout of Cav1 (but not caveolin 3) resulted in activation of c-Src, degradation of Cx43 (42% reduction from WT level), reduced cardiac conduction velocity (by 30%), and increased arrhythmic risk (75% Cav1-/- vs. 0% WT mice showed induced ventricular arrhythmia). Arrhythmic risk in Cav1-/- mice was mitigated by pharmacological inhibition of c-Src.

Conclusions:
Cav1 S-nitrosylation plays a critical role in mediating RAS-induced arrhythmias by increasing c-Src activity. Oxidative stress-induced Cav1 S-nitrosylation in response to cardiac RAS signaling promotes Src-dependent disruption of Cx43 hemichannels and ventricular arrhythmia. These findings may explain the genetic association of Cav1 with arrhythmias and suggests that targeted regulation of Cav1 or antioxidant therapy may reduce arrhythmic risk during RAS activation.