bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2437: The Interaction between Left Ventricular Apical Rotation and the Arterial Blood Pressure in Elderly Females may Reveal Mechanisms Involved in the Syndrome of Diastolic Heart Failure a Follow-Up Study
Authors: Soma Johannes , Dahl Ketil , Widerøe Tor-Erik
Published: July 2021

LV apical short-axis loops were obtained with 2D echocardiography (80 – 110 frames/s) in 31 healthy females, age 69 to 84 years. Peak apical rotation (PAR) and peak rotation velocity (PAR-velocity) was assessed with speckle tracking (ST). Ambulatory systolic (SBP) and diastolic (DBP) blood pressures were averaged between 0600 and 2300. The difference (Δ) between measurements after four years follow-up was calculated by subtracting the first from the last assessment. Apical short-axis loops were eligible for ST in 27 subjects. SBP and DBP increased (126 ± 14 vs 133 ± 13 mm Hg, p = 0.007 and 70 ± 7 vs 73 ± 7 mm Hg, p = 0.049) and LV end-diastolic and end-systolic volumes decreased (84 ± 15 vs 74 ± 10 ml, p < 0.0001 and 33 ± 9 vs 25 ± 7 ml, p < 0.0001) during follow-up. ΔSBP and ΔDBP correlated inversely with the LV end-diastolic short-axis dimension (r = −0.38, p = 0.03 and r = −0.43, p = 0.02). ΔSBP, ΔDBP and DBP, correlated inversely with PAR (r = −0.51, p = 0.007; r = −0.59, p = 0.0001 and r = −0.47, p = 0.01). PAR correlated positively with LV stroke volume and with body weight (p < 0.05) and with systolic and diastolic PAR-velocity (r = 0.76, p < 0.0001 and r = 0.58, p = 0.001). Diastolic PAR-velocity correlated with mitral E peak velocity (r = 0.48, p = 0.01). In healthy elderly females LV peak apical rotation and peak diastolic rotation velocity correlate with indices of LV filling and ejection, indicating that suction, a key property for effective early LV filling, may be preserved in elderly subjects. Suction seems to deteriorate with BP elevations. An age- or blood pressure related reduction in LV end-diastolic volume may represent an additional impediment to LV filling. Both features may contribute to the development of LV diastolic dysfunction and to diastolic heart failure.
Abstract 2439: Invasive Right Ventricular Hemodynamics and Tricuspid Annular Plane Systolic Excursion to Predict Right Ventricular Dysfunction After Left Ventricular Assist Device Implantation
Authors: Ketner Elizabeth A , Forfia Paul R , Russell Stuart R , Wittstein Ilan S , Conte John V , Shah Ashish , Yuh David , Champion Hunter C
Published: July 2021

Introduction
: Right ventricular (RV) failure is a major cause of morbidity and mortality in heart failure patients undergoing destination left ventricular assist device (LVAD) implantation. Using tricuspid annular plane systolic excursion (TAPSE; an echo based measure of RV function linked to mortality in patients with pulmonary arterial hypertension) and invasive measurement of RV systolic function (dP/dtmax/IP; dP/dt max normalized to instantaneous pressure) we hypothesized that these parameters correlate with the incidence of RV failure post LVAD implantation.

Methods
: 65 consecutive patients with heart failure and clinical indication for LVAD implantation were prospectively evaluated. All patients underwent transthoracic echocardiography and right heart catheterization within 14 days prior to implantation. TAPSE was measured by M-mode echocardiography as the mean displacement (cm) of the tricuspid annular plane towards the RV apex from end-diastole to end-systole over 3 to 5 cycles. RVFAC was measured as the percent change in RV area from end diastole to end systole as measured in the apical four chamber view. Pressure-dependent measures of RV function were derived from PA catheterization based RV waveforms analyzed using pressure volume loop software (WinPVAN 3.5.8). RV failure post LVAD was defined as IV inotrope therapy requirement >14 days, inhaled NO use >48 hrs, death due to decompensated RV failure, or RVAD implantation. Clinical, hemodynamic and echo data were compared in patients with RV Failure (group I; n=14) vs. those without RV failure (group II; n=51).

Results
: Groups I and II had similar mean pulmonary arterial pressure, cardiac index, systolic blood pressure, baseline liver function test values, and renal function (P>0.05). Group I had higher right atrial pressure (14±5vs.11±4 mmHg; *p<0.05). TAPSE of less than 1.8 cm and dP/dt
max
/IP of less than 10 correlated strongly with RV failure post LVAD implantation (P<0.005 and P<0.001, respectively) while RVFAC showed no correlation.

Conclusions
: TAPSE and the load-independent index dP/dt max/IP correlate strongly with RV failure post-LVAD implantation. These data provide the basis for future study of these endpoints in patients with heart failure and RV dysfunction.
Abstract 2453: Exercise Capacity is Inversely Associated with Mortality Risk in Pre-Hypertensive Men
Authors: Pittaras Andreas E , Myers Jonathan , Narayan Puneet , Manolis Athanasios , Faselis Charles , Singh Steven , Kokkinos Peter
Published: July 2021

Introduction:
Epidemiologic evidence supports an inverse and strong association between fitness status, and mortality in healthy individuals. Pre-hypertensive individuals are at increased risk for cardiovascular events compared to those with normal blood pressure. However, there is no information on the association between exercise capacity and mortality in pre-hypertensive individuals.

Methods:
We assessed the association between peak exercise capacity (METs) and all-cause mortality in pre-hypertensive men (n=4,735; age=56±12). We established four fitness categories based on the MET level achieved. Those who achieved <5 METs (n=674); 5–7 METs (n=1,170); 7.1 to 10 METs (1,784); and > 10 METs (n= n=1,107). There were 943 deaths over 22 years of follow-up (mean=8.0±5.5).

Results
: After adjusting for age, BMI, diabetes and dyslipidemia, exercise capacity was the strongest predictor of risk for mortality. The adjusted risk was reduced by 14% for every 1-MET increase in exercise capacity (Hazard Ratio= 0.86; CI: 0.84 – 0.88; p<0.001). When compared to those who achieved ≥5 METs, the mortality risk in those who achieved 5.1–7 METs was 25% lower (hazard ratio= 0.75; CI: 0.64 – 0.87; p<0.001); 60% lower for those who achieved 7.1–10 METs (hazard ratio= 0.40; CI: 0.33– 0.48; p<0.001), and 75% lower for those achieving >10 METs (Hazard Ratio= 0.25; CI: 0.19 – 0.33; p<0.001).

Conclusions:
The association between exercise capacity and mortality in pre-hypertensive individuals was strong, inverse and graded. The mortality risk was lowered by 14% for each 1-MET increase in exercise capacity. The overall reduction in mortality was 25% to 75% for those with an exercise capacity of >7 METs compared to those who achieved <5 METs.
Abstract 2464: Severity of Obstructive Sleep Apnea Dependent upon Aldosterone Status in Subjects with Resistant Hypertension
Authors: Gonzaga Carolina C , Gaddam Krishna K , Pimenta Eduardo , Calhoun David A
Published: July 2021

Background:
Obstructive sleep apnea (OSA) and hyperaldosteronism are common in subjects with resistant hypertension. Prior results from our laboratory relate severity of OSA to aldosterone levels in patients with resistant hypertension suggesting that the 2 disease entities may be mechanistically linked.

Objective:
This study prospectively evaluated the relation between OSA severity and aldosterone status in subjects with resistant hypertension.

Methods:
One hundred nine consecutive subjects (age 55.9±9.3 years; 50% male) with resistant hypertension referred to a university clinic for resistant hypertension were prospectively evaluated with plasma renin activity (PRA), plasma aldosterone concentration, and 24-hr urinary aldosterone excretion. Hyperaldosteronism was defined as a PRA <1.0 ng/mL/hr and 24-h urinary aldosterone excretion ≥ 12 μg/24-hr. Remaining patients were considered as having normal-aldosterone status. All subjects were evaluated by full-night attended diagnostic polysomnography. OSA was defined as an apnea-hypopnea index (AHI) ≥ 5 events/hr.

Results
: Hyperaldosteronism was present in 28% of subjects. Overall, OSA was diagnosed in 77% of subjects; 81% of the high-aldosterone and 74% of the normal-aldosterone subjects. In subjects with hyperaldosteronism, plasma aldosterone and urinary aldosterone excretion correlated with AHI (r = 0.723, p <0.001 and r = 0.639, p <0.001, respectively) but not in the normal-aldosterone subjects (r = 0.008, p = 0.94 and r = 0.042, p = 0.71 respectively). Atrial natriuretic peptide (ANP) levels were significantly higher in the high-aldosterone compared to normal-aldosterone subjects (89±57 vs. 67±102 pg/ml; p = 0.03).

Conclusion:
OSA is extraordinarily common in patients with resistant hypertension. A significant correlation between both plasma and urinary aldosterone levels and severity of OSA is observed in high-aldosterone but not normal-aldosterone subjects. The higher level of ANP in high-compared to normal-aldosterone subjects suggests greater intravascular fluid retention in the former subjects. These results suggest worsening of OSA in patients with hyperaldosteronism secondary to chronic aldosterone-induced intravascular fluid retention.
Abstract 2466: Increased Plasma Concentrations of N-Terminal Pro Brain Natriuretic Peptide is a More Sensitive Marker of Subclinical Diastolic Dysfunction and Arterial Remodeling in Hypertension: Analytical Performance Comparison with BNP
Authors: Furumoto Tomoo , Fujii Satoshi , Tsutsui Hiroyuki
Published: July 2021

Concentrations of plasma N-terminal pro brain natriuretic peptide (NT-proBNP) is inversely related to metabolic cardiovascular risk factors and is a valuable prognostic marker of cardiovascular events in arterial hypertension. Whether NT-proBNP levels are connected with diastolic function and arterial function was determined in hypertension. NT-proBNP was measured in 40 untreated patients with hypertension (mean BP 166/96 mmHg) without heart failure and 20 age and gender matched healthy, controls. Hypertensive patients were studied by pulsed Doppler and color M-mode Doppler echocardiography to evaluate LV diastolic function. Plasma NT-proBNP was significantly elevated in patients with hypertension (75.1 ± 75.2 [SD] pg/ml compared with 37.9 ± 38.5 in controls p < 0.05). In hypertensive patients, NT-proBNP values were negatively correlated with the ratio of color M-mode flow propagation velocity to transmitral E velocity (r=−0.33, p<0.05) while those of BNP had no correlation, suggesting that higher plasma NT-proBNP is indicative of subclinical diastolic dysfunction. Moreover, hypertensive patients with higher NT-proBNP values above the mean value in the control group (NT-proBNP > 38 pg/ml) had significantly increased brachial intimal-medial thickness (0.36 ± 0.08 mm vs. 0.32 ± 0.05, p < 0.05) and reduced wall stress (112.4 ± 29.5 kPa vs. 142.2 ± 30.8, p < 0.05) compared with those with lower NT-proBNP, suggesting that the reference value of NT-proBNP plasma concentrations in uncomplicated hypertensives is 38pg/ml and higher NT-proBNP levels were associated with favorable remodeling of the peripheral arteries. Elevation of plasma NT-proBNP can be useful to identify subclinical LV diastolic dysfunction and peripheral arterial remodeling in asymptomatic patients with hypertension.
Abstract 2470: Augmented Tonic Activation Of Chemoreceptors May Contribute To Sympathetic Overactivity In Patients With Essential Hypertension
Authors: Sinski Maciej , Lewandowski Jacek , Bidiuk Joanna , Abramczyk Piotr , Dobosiewicz Anna , Gaciong Zbigniew
Published: July 2021

Rationale
: Peripheral chemoreflex contributes to regulation of arterial blood pressure and chemoreceptors respond not only to hypoxia but they are also continuously activated by normal ambient oxygen concentration. Stimulation of chemoreceptors activates sympathetic traffic and this response may be altered in subjects with essential hypertension..

Objective:
The aim of our study was to investigate the effect of deactivation of carotid body chemoreceptors on sympathetic activity directly measured as MSNA (muscle sympathetic nerve activity) in young subjects with mild to moderate untreated hypertension.

Methods:
Twelve patients with essential hypertension (36±9 years, all men, BMI 29±4 kg/m
2
,) and 8 controls (37±7, men BMI 27±5kg/m
2
) participated in the study. None of the patients or controls received any medications. MSNA (burst/minute and mean burst amplitude - au), systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), ECG, hemoglobin saturation with oxygen (Sat%), end tidal CO
2
and respiratory movements were monitored and measured after 10 minute of respiration by non-rebreathing mask with 100% 0
2
or 21% O
2
applied in blinded fashion.

Results:
Hypertensives had higher resting MSNA (38.6 ±8.6 burst/min vs. 30.3±.7 burst/min, p<0.05), SBP (149.1± 9.9 vs. 124.1 ±11.6, p < 0.05) and DBP (92.1 ±8.6 vs. 78.1 ± 8.9, p< 0.05) than controls. Breathing with 100% oxygen caused significant decrease in MSNA in hypertensives (from 38.6 ± 8.6 burst/min to 26.3 burst/min ± 6.8 and from 100 ± 0 au to 86 ± 18 au, p< 0.05) and no change in MSNA in controls (30.3 ± 5.7 burst/min initially and 27.3 burst/min ± 6.2 after 100% 0
2
, 100 ± 0 au vs. 98 ± 11 au). Blood pressure, end tidal CO
2
, respiration frequency did not change significantly after hyperoxia while HR decreased (from 69.6 ± 9 to 64.1 ± 7 in hypertensives p<0.05 and from 67± 8 to 62.5 ± 7 in controls, p< 0.05). Sat% increased significantly in both groups to 99%.

Conclusions:
Increased sympathetic activity in young, untreated hypertensives may be caused by the elevated tonic chemoreflex activation.
Abstract 2473: Dipping Status Definition Does not Differentiate the Estimated Magnitude of Subclinical Inflammation in non Dipper Hypertensives
Authors: Syrseloudis Dimitris , Tsioufis Costas , Thomopoulos Costas , Tzamou Vanessa , Kasiakogias Alexandros , Vlasseros Ioannis , Kallikazaros Ioannis , Stefanadis Christodoulos
Published: July 2021

Objective:
Different dipping definitions in literature constitute a source of confusion regarding the significance of circadian blood pressure (BP) variation. We aimed to investigate the impact of three different dipping definitions on the assessed relation between inflammation and disrupted circadian blood pressure rhythm.

Methods:
We studied 269 consecutive untreated subjects with stage I–II essential hypertension who underwent ambulatory blood pressure (BP) monitoring, echocardiographic examination and hs-CRP levels determination. According to their ambulatory BP data three different classifications into dippers and non-dippers were used, as presented in Table 1

.

Results:
Non- dippers compared to dippers in all classifications had higher log hs- CRP values by 0.11, p=0.02; 0.13, p=0.03 and 0.14 mg/l, p=0.02 and 24h Pulse Pressure (PP) by 3.4 (p=0.006), 5.07 (p=0.003) and 5.4 mmHg (p<0.0001) respectively. Only in SND definition non-dippers had higher by 4.7 mmHg (p=0.003) 24h SBP. Multiple regression analysis identified body mass index (BMI), 24h Pulse Pressure (PP), nocturnal SBP fall and triglyceride levels as independent predictors of log hs-CRP in (p<0.05 in all cases).

Conclusions:
Irrespectively of the definition, non- dippers compared to dippers are characterized by more intense inflammatory processes which along with the increased ambulatory PP classify them in a higher cardiovascular risk class.

Table 1
Abstract 2475: Excess Cardiovascular Mortality among Lean Hypertensive Nonsmoking Japanese
Authors: Tsuji Hisako , Sato Tadashi , Morisaki Kentaro
Published: July 2021

BACKGROUND:
Although several reports demonstrated that underweight was associated with higher cardiovascular (CVD) mortality, smoking was considered to be a major confounding factor. In Japan, prevalence of underweight is higher.

METHODS:
We studied 13,089 subjects (mean age 55±13 years, men 18%) who had the annual health examination offered to adult citizens of Moriguchi city, Osaka, Japan in 1997 and were not current smoker at the examination. Underweight was defined as a body mass index (BMI) <18.0 kg/m
2
. Proportional hazards regression analysis was used to assess the association of BMI categories with CVD mortality.

RESULTS:
During a mean follow-up of 9.4±2.4 years, there were 136 CVD deaths. Of those, 78 CVD deaths, including 32 stroke deaths and 22 coronary deaths occurred in the hypertensives (n=3,925). Incidence of CVD deaths according to BMI categories and hypertension status was presented in the figure. Age and sex-adjusted proportional hazards regression analysis in the hypertensives showed CVD mortality was significantly higher in the underweight group (HR=3.2, 95%CI=1.3 to 7.7; p=0.0105), compared with the normal weight group (BMI 18.0 –24.9 kg/m
2
). After adjustment for age, sex, diabetes mellitus, hypercholesterolemia, and drinking habit in the hypertensives, the result was unchanged (HR=3.1, 95%CI=1.3 to 7.4; p=0.0130). In the analyses restricted to never smokers (n=3,506) of the hypertensives, the result remained unchanged (HR=2.9, 95%CI=1.1 to 7.8; p=0.0296) after adjustment for all clinical variables.

CONCLUSIONS:
In the general Japanese hypertensive population, underweight was associated with higher CVD mortality unrelated to smoking.
Abstract 2477: Repetitive Apneic Events Augment Arterial Blood Pressure Fluctuation in Patients with Central and Obstructive Sleep Apnea Syndrome
Authors: Takamura Takeshi , Dohi Kaoru , Onishi Katsuya , Ogawa Emiyo , Nakajima Hiroshi , Tanabe Masaki , Tamada Hiroya , Miyahara Masatoshi , Nakamura Mashio , Ito Masaaki
Published: July 2021

Background:
Sleep apnea-hypopneas induce transient increases in arterial blood pressure (BP). We test the hypothesis that periodic nocturnal apneic events augment those hemodynamic responses in patients both with central and obstructive sleep apnea syndrome (SAS).

Methods:
Eleven patients with central SAS (CSAS: mean age 70 ± 10 years), 11 patients with obstructive SAS (OSAS: mean age 64 ± 12 years), and 8 normal controls (Control) were studied. Polysomnography was performed and BP was measured on a beat-by-beat basis by finger plethysmography all through the sleep. Severity of SAS was assessed by apnea-hypopnea index (AHI). The degree of BP fluctuation associated with periodic nocturnal apnea-hypopnea was assessed by spectral analysis of mean BP variability. Spectral plots of mean BP were calculated in 2-min segments using a maximum entropy method. Power spectrum of mean BP variability was quantified by measuring the area in the very-low-frequency band which coincides with frequency of apnea-hypopneas (sleep apnea band: 0.01– 0.03 Hz), and was normalized by dividing by the total power in the spectrum up to 0.4 Hz.

Results:
AHI was similar in CSAS and OSAS (38.3 ± 9.5* and 39.8 ± 11.3*, *p<0.05 vs. Control: 2.5±1.6*). Repetitive fluctuations in BP coincided with periodic apnea-hypopneas were clearly observed in patients with SAS, and were more prominent in CSAS (Normalized spectral power of mean BP in sleep apnea band: 0.72 ± 0.10*† in CSAS, 0.62 ±0.13* in OSAS, and 0.46±0.07 in Control, * p<0.05 vs. Control, and †p<0.05 vs. OSAS).

Conclusion:
Periodic nocturnal apneic events augment blood pressure fluctuation in patients both with central and obstructive SAS.smoking.
Abstract 2509: Do Systemic Risk factors Impact the Composition of Coronary Plaques as Measured by IVUS-RF analysis? Results from the Global VH Registry on Whole Vessel Analysis
Authors: Philipp Sebastian , Böse Dirk , Wijns William , Marso Steven P , Schwartz Robert S , König Andreas , Lerman Amir , Carlier Stephane G , Serruys Patrick W , Erbel Raimund
Published: July 2021

Background: Cardiovascular risk factors have an impact on coronary atherosclerosis evolution. However, there is only limited information about the relationship between risk and atherosclerotic plaque as measured invasively by Intravascular Ultrasound Radiofrequency (IVUS-RF) analysis. The Aim of this study was to assess the impact of cardiovascular risk factors not only on overall coronary plaque volume but on coronary plaque composition.

Methods: 990 patients from 42 centers were enrolled in the prospective, multicenter, non randomized, global VH-IVUS registry. Coronary lesions were measured by conventional and IVUS-VH parameters using 20MHz Intravascular Ultrasound catheter. The four IVUS-VH plaque components (Dense Calcium-DC, Necrotic Core-NC, Fibrous tissue-F, Fibro Fatty-FF) were analyzed in every recorded frame. The results were expressed as mean cross-sectional areas, and percentage of total plaque volume. Risk factor assessment included correlation with family history of myocardial infarction, past or current smoking, diabetes mellitus, hypertension, and laboratory measurements.

Results: Patients with diabetes have an increased relative amount of NC (6.47±0.28% vs. 5.86±0.14%, p=0.037) and DC (4.58±0.27% vs. 3.90±0.14%, p=0.017), Patients with hypertension have an increased relative amount of FF, DC (4.35±0.16% vs. 3.57±0.17%, p=0.02) and NC (6.24±0.17% vs. 5.60±0.19%, p=0.01). Compared with patients with LDL cholesterol 160 mg/dl had higher plaque volume (342.1±26.2mm
3
vs. 318.6±10.7mm
3
). Linear Regression Analysis showed a correlation between the level of HDL and F (r=−0.149, p<0.01), FF (r=−0 –106, p< 0.01), and NC (r=−0.90, p<0.05). The level of LDL correlated with F (r = 0.110, p < 0.01). Patients with prior MI have an increased percentage of F (30.03±0.59 % vs. 28.20±0.37 %, p<0.009). Smoking had no relevant effect on plaque composition.

Conclusion: IVUS-RF analysis detects marked differences in coronary plaque depending on the risk factor profile with particular focus on lipid levels. Patients with greater amounts of necrotic core were associated with hypertension, myocardial infarction, and low HDL. This may have implications for prognosis and systemic treatment of patients with coronary artery disease.
Abstract 2534: Long-term (up To 6 Years) Results Of Drug-eluting Stents For The Treatment Of Diabetic Patients - Insights From The Drug Eluting Stents In The Real World(desire) Registry
Authors: Moreira Adriana , Sousa Amanda , Costa José , Costa Ricardo , Cano Manuel , Maldonado Galo , Mattos Luiz Alberto , Feres Fausto , Pavanello Ricardo , Egito Enilton , Liguori Ieda , Sousa J Eduardo
Published: July 2021

Background:
Diabetic patients are traditionally related to higher rates of major adverse cardiac events (MACE) after percutaneous coronary intervention even in the drug-eluting stent (DES) era. We sought to evaluate the impact of diabetes status in the very long-term clinical outcomes after DES implantation in a complex, non-selected diabetic cohort.

Methods and Results:
Between May/2002 and May/2007, 2,500 patients treated exclusively with DES were consecutively enrolled in the non-randomized, single-center DESIRE Registry. Among them, 1,705 elective patients have completed 6 month-follow-up and were divided into 3 groups according to their
Diabetes mellitus
status. Primary endpoint was long-term combined MACE and stent thrombosis rate classified according to ARC definitions. Clinical follow-up was obtained at 1, 6 and 12 months and then annually up to 6 years. Mean follow-up time was 2.6±1.2 years and was achieved in 98% of the eligible cohort. Baseline clinical and procedure characteristics as well as late outcomes are displayed in the table

. In the multivariate logistic regression analysis, Diabetes mellitus (OR=1.45; 95%Confidence interval-CI 1.00 –2.11) and moderate/severe calcification at lesion site (OR=3.06;95%CI,1.47– 6.34) were independent predictors of MACE .

Conclusions:
In the DESIRE registry both insulin and non-insulin requiring diabetics carried poorer long-term outcomes (MACE) when compared to non-diabetic patients. Importantly, there was a tendency for higher stent thrombosis among diabetics. However, the type of diabetes (insulin vs. non-insulin) did not seem to impact the prognosis of PCI with DES.
Abstract 2551: Correlation Between the Number of Lipid Core Containing Plaques Identified by a Near Infrared Spectroscopy System and Histologic Findings
Authors: He Zhihua , Gardner Craig M , Madden Sean P , Hull Edward L , Lisauskas Jennifer B , Sum Stephen T , Doucet Cory M , Meese Thomas M , Clark Nisse V , Shi Tianchen , Muller James E
Published: July 2021

A catheter-based near infrared spectroscopy (NIRS) system has recently been cleared by the FDA for detection of lipid core containing plaques of interest (LCP) and lipid core burden index (LCBI) in patients undergoing coronary arteriography. NIRS data are plotted as a map (chemogram) of pullback distance versus rotation, with yellow indicating lipid (see below). Analyses for LCP were based on a 2mm block chemogram and LCBI. An algorithm has been developed to perform automated enhancement of the chemogram and facilitate calculation of the number of LCPs (nLCP) in a segment of artery. The goal is to determine if the enhanced algorithm performs as well as the previously validated LCP and LCBI measures, as determined by histology in human coronary autopsy specimens. NIRS data were obtained from 181 segments from 78 hearts and compared with histology at 2 mm intervals. The image analysis was applied to the chemogram and the nLCP calculated. The ROC analysis of the nLCP versus presence of fibroatheroma in each segment yielded an AUC of 0.84 (95% CI 0.77– 0.89). When one or more LCP was detected, 87% sensitivity and 70% specificity were observed for detection of fibroatheroma. The Spearman correlation between nLCP and LCBI was 0.83 (p-value ≤0.0001). The correlation coefficient of nLCP between repeat pullbacks was 0.83 (p-value ≤0.0001). The number of NIRS-detected LCP in chemograms identified with image enhancement correlates well with previously validated measures and the presence of fibroatheroma by histology. This method has the potential to enhance the clinical utility of the chemogram.
Abstract 2553: Novel Cobalt-Chromium Ultra-Thin Strut Stent: Feasibility, Vascular Compatibility, and Safety Evaluation in Porcine Coronary Arteries
Authors: Jabara Refat , Geva Sarah , Hou Dongming , Li Jinsheng , Chronos Nicolas , Robinson Keith Robinson
Published: July 2021

Stent-strut thickness is related to in-stent restenosis. Therefore, modern bare-metal stents (BMS) with lower strut thickness are in development. We sought to evaluate a new ‘third-generation’ BMS comprising an ultra-thin-strut, cobalt-chromium platform with fixed geometry and uniform cell sizes, in a clinically relevant animal model. 36 BMS of two types were implanted in pig coronaries using quantitative coronary angiography (QCA) to optimize stent apposition: a commercially available cobalt alloy thin-strut stent (91μm) as control (n=18), and an ultra-thin-strut (65μm) cobalt-chromium stent (Protea CoCr; n=18). Animals underwent angiographic restudy and termination 1-wk and 1-mo post-implant for coronary artery histology. In addition, 12 overlapping Protea CoCr stents were analyzed at 1-mo. All stents deployed without difficulties. Thin neointima and mild inflammation was seen in both groups at 1-wk. For 1-mo, QCA % diameter stenosis was significantly less for Protea CoCr (2±5% vs. 17±16%, p=0.032). By histomorphometry, intima thickness (0.11±0.05mm vs. 0.23±0.11mm, p=0.003) and % area stenosis (19±1% vs. 32±11%, respectively, p=0.004) were also significantly lower for Protea CoCr. The strut injury score was low and similar between the two groups. QCA % stenosis; intima thickness; and % area stenosis of overlapping Protea CoCr were 3±3%, 0.13±0.02mm, and 22±4%, respectively. Stable fibrocellular neointimal incorporation of all stents including overlapped Protea CoCr, with complete endothelialization and minimal inflammation, was seen at one month. Protea CoCr showed favorable arterial response with significant reduction of neointima formation compared to a commercial cobalt alloy BMS, one month post implant in pig coronary arteries. This ultra-thin-strut stent platform therefore appears to be a suitable and attractive alternative to current BMS. Combining the lower levels of neointima formation, fixed geometry, and uniform cell size, the Protea CoCr may be a preferred platform for next-generation drug-eluting stents.
Abstract 2559: Reflectance, Fluorescence, and Raman Spectroscopy Identify Features of Vulnerable Atherosclerotic Plaque
In Vivo
Including a Thin Fibrous Cap, Necrotic Core or Superficial Foam Cells, and Thrombus
Authors: Šćepanović Obrad R , Fitzmaurice Maryann , Miller Arnold , Kong Chae-Ryon , Dasari Ramachandra R , Kramer John R , Feld Michael S
Published: July 2021

Early detection and treatment of vulnerable atherosclerotic plaques, the lesions most prone to rupture, is critical to reducing patient mortality associated with cardiovascular disease. The combination of reflectance, fluorescence, and Raman spectroscopy - termed multimodal spectroscopy (MMS) - provides complementary and depth-sensitive information about tissue composition. We assessed the hypothesis that MMS can detect morphological features of vulnerable plaque: thin fibrous cap (TFC), necrotic core (NC), superficial foam cells (SFC), intralesional hemorrhage (IH), and thrombus. Methods. In vivo and ex vivo MMS spectra were collected from 12 patients undergoing peripheral vascular surgeries. The data collection was facilitated by means of a novel MMS probe catheter and a portable clinical instrument developed in our laboratory. During carotid endarterectomies, MMS spectra were collected in vivo from the intimal surface of the plaque with the probe held normal to the artery wall. During femoral bypasses, MMS spectra were collected in vivo either through the proximal anastomosis site from the posterior artery wall or adjacent to the incision. A tissue specimen was excised for additional MMS spectral collection ex vivo. Histopathological analysis was performed by a blinded cardiovascular pathologist to assess the vulnerability of each spectrally evaluated tissue site using a quantitative index based on the dimension or severity of the following: TFC, NC, SFC, IH, and thrombus. Across the total set of 76 evaluated tissue locations, MMS is shown to have the ability to detect vulnerability features including a TFC, NC or SFCs, and thrombus. A TFC is detected by measuring the relative amount of collagen assessed by fluorescence, a large NC or SFCs are detected through the combination of beta-carotene absorption and the Raman spectral signature of lipids, and thrombus is detected through its Raman signature. The results indicate that rupture-prone vulnerable plaques could be detected with a sensitivity of 96% and specificity of 72%. In conclusion, these encouraging results will help bring MMS into the clinical arena as a powerful, catheter-based diagnostic technique for early detection of vulnerable plaques.
Abstract 2595: Cardiopulmonary Bypass Does Not Cause Neurocognitive Decline in Children and Adolescents Undergoing Repair of Acyanotic Congenital Heart Disease
Authors: Quartermain Michael D , Ittenbach Richard F , Flynn Thomas B , Gaynor J. William , Zhang Xuemei , Licht Daniel J , Ichord Rebecca N , Nance Michael L , Wernovsky Gil
Published: July 2021

Background:
Previous studies describing the neurocognitive (neuro) effects of cardiopulmonary bypass (CPB) have been performed following surgery in infancy for complex congenital heart disease (CHD) and in adults with acquired heart disease. These patients (pts) have many causes for adverse neuro outcomes with conflicting results regarding the contribution of CPB. The impact of CPB in children with less complex CHD is unknown. We sought to describe the effects of CPB on neuro function in children following repair of acyanotic CHD.

Methods:
We performed a prospective cohort study of pts 5–18 yrs of age undergoing primary repair of CHD. Neuro testing battery included assessment of intellectual function (IQ), memory, motor skills, attention, executive function, and an evaluation by a pediatric neurologist pre- and 6 months post-CPB. Non-CPB effects of surgery were assessed by similarly testing pts undergoing repair of pectus excavatum (non-CPB). Practice effects of serial testing were controlled by enrolling non-surgical pts (mild CHD) and creating a reliability-stability index to adjust surgical group scores. Anxiety was assessed as a covariate.

Results:
CPB pts (
n
=41) included repair of atrial [17] or ventricular [6] septal defect, coronary anomaly [8], aortic valve [5] or other [5]. Control pts included pectus repair (
n
=20) and non-surgical CHD pts (
n
=16). Groups were similar in age, gender, race, socioeconomic status and baseline scores. Neurological exams before and after surgery were not different between groups. Controlling for the effects of serial testing, there were no significant (p<.05) changes in the mean scores of either surgical group in areas of IQ, memory, motor skills, attention, or executive function. In addition, there were no differences in the percentage of patients in either surgical group that had a significant (>1 SD) decline in scores after surgery.

Conclusions
: When controlling for the non-CPB effects of surgery (hospitalization, anxiety, etc.) and the practice effects of serial testing, there were no independent effects of CPB on neuro status 6 months after repair of acyanotic CHD. We believe that the potential neuro sequelae of CPB should not be a major factor in the decision to recommend CHD surgery in otherwise healthy children.
Abstract 2598: Individualized Heparin and Protamine Management Protocol in Infants Undergoing Cardiopulmonary Bypass for Cardiac Surgery Improves Immediate Post-operative Clinical Outcomes
Authors: Gruenwald Colleen , Manlhiot Cedric , Chan Anthony , Crawford-Lean Lynn , Foreman Celeste , Holtby Helen , Van Arsdell Glen , Richards Ross , Moriarty Helen , McCrindle Brian
Published: July 2021

Use of individualized heparin and protamine management in older children and adults undergoing cardiopulmonary bypass (CPB) has been associated with improved clinical outcomes. We sought to determine if using this method in infants was associated with similar enhancements. Infants 1 month to 1 year of age undergoing CPB were randomized in a controlled clinical trial to either weight based heparin and protamine management using the activated clotting time (ACT) to monitor anticoagulation, or the use of individualized heparin blood concentration calculated by the Hepcon Hemostasis Management System HMS (Medtronic, MN) using a modified protocol. Primary outcome measure was chest tube volume loss at 4 and 24 hours following cardiac critical care unit (CCCU) admission. Secondary outcomes included blood transfusion, duration of ventilation and hospital length of stay. A total of 34 patients (17 in each group), aged 1 month to 1 year, were enrolled in the study. Demographics and pre-operative variables were similar between groups. Patients in the HMS group received significantly more heparin (796 vs. 643U/kg, p<0.01) and protamine (6.1 vs. 3.9 mg/kg, p<0.01) than those in the ACT group. After accounting for age at surgery, bypass time and surgeon in multivariable regression models, patients in the HMS group experienced significantly less blood loss at 4 hours after CCCU arrival (7.6 vs. 9.2ml/kg, p=0.01). Difference in blood loss between 4 and 24 hours after CCCU admission (17.0 vs. 14.6ml/kg, p=0.88) was not significant. HMS group patients had significantly decreased blood transfusions in the CCCU (11 vs. 21ml/kg, p=<0.01), significantly shorter ventilation times (18 vs. 24hrs, p=0.01) and significantly shorter hospital length of stay (168 vs. 193hrs, p=0.01). Thrombosis was observed in 3 of the 17 patients in the ACT group, while none were noted in the HMS group. Higher heparin and protamine dosing, as managed by the HMS device, resulted in more stable levels of anti-Xa during CPB with improved immediate post-operative outcomes including reduced blood loss, transfusions, ventilation time and hospital length of stay. This study may support the use of the HMS device with a modified protocol for infants <1 year of age for heparin and protamine monitoring during CPB.
Abstract 2609: Mitochondrial Oxidative Stress Promotes Failure of the Pressure-Loaded Infant Right Ventricle
Authors: He Huamei , Poutias Dimitrios N , Kitahori Kazuo , Kawata Mistuhiro , Campbell Patrick , Cowan Douglas B , Friehs Ingeborg , Nido Pedro J del , McGowan Francis X
Published: July 2021

Background:
Right ventricular hypertrophy (RVH) and failure induced by chronic RV pressure overload is a major problem in congenital heart disease. We have previously shown that mitochondrial (Mito) damage accompanied load-induced infant RV failure. Here we assessed Mito electron transport chain(ETC) dysfunction and Mito oxidative stress in the transition of infant RVH to failure.

Methods
: Newborn rabbits underwent pulmonary artery banding (or sham) causing stable RV pressure load (~40 mmHg) and RVH by 2 weeks; RV contractile function (echocardiography) was preserved for ~4 weeks, followed by failure onset at ~8 weeks. Thus, RV free wall was assayed at 3, 4 and 8 weeks for ETC enzyme activities, high energy phosphates, Mito GSH/GSSH ratio (index of Mito ROS scavenging)
,
Mito 8-hydroxy-2-deoxyguanosine (8-OHdG, oxidative Mito DNA damage), Mito protein carbonyls (oxidative Mito protein damage) and Mito ultrastructure (electron microscopy).

Results:
By 4 weeks (RVH, preserved function), Mito 8-OHdG and protein carbonyl markedly increased, accompanied by decreased complex I and III activity. At 8 weeks (early failure), there were further increases in Mito 8-OHdG and protein carbonyls, significantly decreased GSH/GSSG ratio, further loss of complex I and III, and decreased activities of complexes IV and V; ATP content and ATP/ADP ratio were also significantly reduced. In parallel the number of abnormal disrupted RV mitochondria increased markedly.

Conclusion:
Pressure-load of the infant RV rapidly induces Mito oxidative stress. Due to the limited Mito scavenging and repair systems, this results in a cycle of Mito DNA and protein damage, progressive loss of ETC enzyme activity and further oxidative stress, as well as loss of functional mitochondria. This load-induced oxidative stress may be a therapeutic target to preserve RV function and oxidative metabolism and prevent the transition of RVH to RV failure. Changes in banded and sham-operated hearts after surgery
Abstract 2611: Transcatheter Valve Insertion A Model Of Enlarged Right Ventricular Outflow Tracts
Authors: Basquin Adeline , Boudjemline Younes
Published: July 2021

Background: Transcatheter pulmonary valve insertion has recently emerged as an alternative to surgery. To extend the indications to patients with large right ventricular outflow tract (RVOT), we previously developed an intravascular device that reduces the diameter of the main pulmonary artery (MPA) allowing the insertion of available valved stents. We report its use in a model of animals with enlarged RVOT and pulmonary valve incompetence (PVI).

Methods and Results: 33 sheep were included. They first underwent surgical MPA enlargement. We then intended to implant percutaneously a reducer followed by the insertion of a valve. Three animals died during interstage. The remaining were sacrificed acutely (group 1, n=6), after a mean follow-up of 1 (group 2, n=12) and 2 months (group 3, n=12). Animals from chronic groups were equally divided into 2 subgroups according to the difference between diameters of the device inserted and MPA (A: < 5-mm, B: ≥ 5-mm). Reducers were inserted successfully (n=30). One embolized after its insertion (Group 3A). A valved stent could be implanted in all animals but one which experienced a balloon ruptured during its inflation leading to incomplete expansion and death of the animal. Six animals had pulmonary regurgitation after valve insertion. Five of them (Group A, n=5; Group B, n=1) had downsizing of the reducer.

Conclusion: Pulmonary valve insertion is possible through a transcatheter technique using a PA reducer. Oversizing of this device reduces the risk of embolisation and paraprosthetic leak.
Abstract 2622: Serotonin And Endothelin Increase L-type Calcium Channel Current In Pulmonary Artery Smooth Muscle Cells, Unrelated To Changes In Membrane Potential
Authors: Hong Zhigang , Cabrera Jesus A , Dutt Mohan , Aloul Basel , Weir E. K
Published: July 2021

Serotonin (5-HT) and endothelin (ET-1) are both involved in the pathophysiology of idiopathic pulmonary arterial hypertension. In addition to the release of calcium (Ca
++
) from the internal stores in the smooth muscle cells (SMCs), these agents stimulate entry of Ca
++
through the L-type Ca
++
channel. In isolated rat pulmonary resistance artery (PA) rings, 5-HT (10 μM) caused a contraction of 110 ± 14 % of the contraction elicited by 60 mM KCl. After inhibition of K
V
and K
Ca
channels by 4-AP and TEA, 5-HT caused a stronger contraction of 176 ± 4% (p<0.01). Consequently, we studied the relationship of 5-HT- stimulated contraction to membrane potential (E
m
) and L-type calcium current in rat resistance PASMCs. Contrary to expectation, 5-HT (1, 10, 100 μM) had no effect on I
K
or E
m
(n=5 for each). However, 5-HT (10 μM) increased L-type calcium current between E
m
-20 and +30 mV (n=7). This effect was inhibited by a PKC blocker (BIS-1, 3 μM), which also caused a marked reduction of 5-HT-stimulated contraction of PA rings (>70% decrease at 10 μM 5-HT). In contrast to 5-HT, ET-1 (10 nM) reduced I
K
and caused membrane depolarization (from −41 ± 5 to −31 ± 3 mV, n=4). In addition to this effect, ET-1, like 5-HT, increased L-type calcium current over the same range of E
m
(n=7). This increase was inhibited by nifedipine (3 μM). These experiments indicate that both 5-HT and ET-1 increase calcium influx through the L-type calcium channel in a manner independent of E
m
. ET-1 has an additional effect of causing membrane depolarization, which also increases calcium entry through L-type channels by altering voltage gating of the channel.
Abstract 2623: Right Ventricular Hypertrophy in Monocrotaline-induced Pulmonary Hypertension is Associated with Impaired Oxidative Metabolism and Action Potential Prolongation
Authors: Piao Lin , Urboniene Dalia , Zhang Hannah J , Toth Peter T , Rehman Jalees , Archer Stephen L
Published: July 2021

Introduction:
Right ventricular hypertrophy (RVH) and right ventricular failure are major determinants of prognosis and functional state in pulmonary artery hypertension (PAH). We previously found a mitochondrial metabolic shift in the pulmonary circulation in clinical as well as experimental PAH that includes a shift from oxidation to glycolysis, decreased production of reactive oxygen species (ROS) and normoxic activation of HIF-1α and decreased expression of voltage-gated potassium channels. In this study, we hypothesize that during RVH there is a similar metabolic shift in the RV characterized by impaired mitochondrial respiration and that the resulting electrical remodeling causes action potential prolongation.

Methods and Results:
PAH was induced in Sprague-Dawley rats by single injection of monocrotaline (60mg/Kg). At 3 weeks, PAH was confirmed by a shortened pulmonary artery acceleration time vs controls (13.8±0.7 vs 36.2±0.2 msec, P < 0.001) as determined by Doppler Echo. RVH was also evident, with a thicker right ventricular free wall in monocrotaline vs control hearts (1.3±0.1 vs 0.9±0.0 mm, P < 0.001 vs control) as assessed by two-dimensional and M-mode Echo. Oxygen consumption of right ventricular tissues (140mg samples) was measured using high-resolution respirometry. In an RV Langendorff model, RV systolic pressure (RVSP) and RV monophasic action potential duration (MAP) were measured. The ratio of RV/LV+S weight increased to 2 fold with monocrotaline (P < 0.001). RVSP in MCT group was increased to 50.9±10.6 vs 21.3±2.7 mmHg, P < 0.05). RV O2-consumption in RVH was significantly reduced vs control [144.1±37.6 vs 277.0±27.4 pmol/(sec*ml), P < 0.05]. The duration of 90% and 75% repolarization of MAP (MAPD90 and MAPD75) was markedly prolonged in RVH (145% and 136% vs controls; P < 0.001, P < 0.05, respectively). Importantly, MAPD90 increased in direct proportion to the severity of PAH, as measured by RVSP.

Conclusions:
RVH was associated with impaired RV metabolism as evidenced by reduced O2 consumption. This metabolic shift was associated with significant action potential prolongation in the RV. The consequences of this ionic remodeling for arrhythmogenisis and contractility remain to be determined.
Abstract 2630: Lower Socioeconomic Status is Associated with Higher Rates of First Hospitalization for Stroke and Subsequent Case Fatality: A Population Study of 5.1 Million People in Scotland 1985–2005
Authors: Jhund Pardeep S , Lewsey James , Gillies Michelle , Chalmers James , Redpath Adam , Kelso Laura , Briggs Andrew , Walters Matthew , Langhorne Peter , Capewell Simon , McMurray John , MacIntyre Kate
Published: July 2021

Introduction Small, age or geographically restricted studies suggest that stroke incidence and case fatality increase with lower socioeconomic status (SES). We examined the relationship between SES and stroke incidence and case fatality in a whole country. Methods Linked morbidity and mortality data were used to identify all first hospitalizations in Scotland where stroke was coded in the principal diagnostic position at discharge from 1986 –2005. SES was measured using the quintiles of Carstairs index of deprivation (quintile 1= most affluent, 5=most deprived). Age and sex specific incidence rates by SES were calculated. Cox regression was used to model case-fatality by SES at 30 days, 1 and 5 years adjusted for comorbidities. Results From 1986 –2005 73,676 men and 88,808 women were admitted with a first stroke. In men (women) 11575 (14713) occurred in individuals in deprivation quintile 1 and 15800 (19022) in quintile 5. Rates of stroke were higher in the most deprived vs the most affluent individuals. In 1986, in men aged <55, 55– 64, 65–74, 75– 84 and >85 years, the rate ratios (deprived vs affluent) were 2.05(1.46 –2.87), 1.82(1.38 –2.38), 1.56(1.27–1.92), 1.06(0.87–1.31) and 1.16(0.78 –1.74) respectively. In women the respective ratios were 2.57(1.71–3.87), 2.06(1.50 –2.83), 1.62(1.32–1.99), 1.27(1.09 –1.49) and 1.36(1.07–1.74). These gradients persisted from 1986 to2005 in both men and women and in all ages. Adjusted case fatality did not vary by SES at 30 days,, HR (deprived vs affluent) = 1.01(95%CI 0.96 –1.06) in men, 1.03(0.99 –1.08) in women. However, at 30 days-1 year the HR was 1.17(1.09 –1.24) in men and 1.11 (1.05–1.17) in women. At 1–5 years the HRs were 1.20(1.13–1.26) in men and 1.14(1.09 –1.20) in women. The effect of SES on case fatality and hospitalization rates did not vary by year or stroke subtype (p for interactions >0.05). Conclusion Not only are stroke hospitalization rates highest in the most deprived individuals, but adjusted longer term case fatality after discharge is also higher. There is no evidence that this disparity is decreasing over time.