bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 11524: Preferential Use of Bare Metal Over Drug Eluting Stents in Primary Percutaneous Coronary Intervention: Can We Afford Current European Guidelines Recommendations?
Authors: Núñez García Alberto , Botas Rodriguez Javier , Inga Ayac Luis A , Del Castillo Medina Roberto , Hernando Marrupe Lorenzo , Adriana De la Rosa Riestra , Alonso Bello Javier , Chichakli Cela Maher
Published: April 2024

DES reduce TLR risk compared to BMS in primary percutaneous coronary intervention (PPCI), with no benefit in mortality, and are currently recommended as first line therapy by the ESC guidelines. In the current era of budget constraints, proper selection of pts who may truly benefit from DES implantation is important. This study aims to evaluate the clinical outcomes of pts undergoing PPCI with a predetermined strategy of preferential use of BMS over DES.

Methods:
We retrospectively analyzed 283 consecutive STEMI pts (63±13 years) referred to our institution for PPCI (2007-2013). Hospital protocol recommended default BMS utilization, although it allowed DES implantation at operator’s discretion if the lesion was deemed to have a high restenosis risk. Pts were retrospectively allocated in three groups: Group 1 (n=112, 39.5%) BMS in lesions without a high restenosis risk, Group 2 (n=123, 43.5%) BMS in lesions with a high restenosis risk and Group 3 (n=48, 17%) DES implantation. Mean follow-up was 31± 19 months. Only 2 pts were lost to follow-up.

Results:
Pts in Groups 2 and 3 had a higher prevalence of diabetes, and pts in Group 3 had a higher prevalence of previous MI. Rates of death, myocardial infarction and stroke were similar among groups. TLR rate was higher in Group 2 (10.7%) vs. Group 1 (2.7%) and 3 (4.2%); p 0.03. Pts treated with BMS (Groups 1 and 2 combined) had a 6.8% TLR rate vs. 4.2% in pts treated with DES (Group 3, p=0.4). Although stent prizes vary among countries, estimating a cost of 500 $ per BMS and 1,000 $ for DES, the cost of a strategy of routine DES utilization in our cohort would have been 283,000 $ instead of the actual 165.500 $ (Δ 117.500 $, 41% savings). Even if only pts with low restenosis risk (Group 1) had been treated with BMS the cost would have been 227.000 $ (Δ 56.000 $ 19.7% savings). DES utilization in Group 1 might have reduced TLR rates but the low figure observed in our cohort (2.7%) indicates that this strategy may not be cost-effective.

Conclusions:
In pts undergoing PPCI, a strategy of preferential use of BMS showed excellent clinical results and led to important cost savings. In the current era of cost-effectiveness and budget restrictions BMS should be considered at least in pts with a priori low restenosis risk.
Abstract 11531: The Three-Legged Stool, Balancing Diuretics, Sodium and Fluid Intake in Heart Failure
Authors: Riegel Barbara , Hill Julia , Wald Joyce , Knafl George , Daus Marguerite , Ciuffetelli Isabella , Basel-Brown Lisa
Published: April 2024

Stable sodium and fluid intake balanced with consistent oral diuretic use is thought to minimize fluid retention and avoid heart failure (HF) hospitalization. However, these 3 factors are rarely examined together so we know little about how patients manage this self-care.

Purpose:
To describe patterns of diuretic use with sodium and fluid intake in relation to readmission.

Methods:
We enrolled 24 hospitalized HF patients in a longitudinal, observational pilot study. All (16 men, 11 Blacks, mean age 60, mean HF duration 4.8 years) were discharged on a loop diuretic after hospitalization for a HF exacerbation. Over 3-months, diuretic use was measured daily using the medication event monitoring system (MEMS®). Percentage of prescribed doses taken (% PDT) was calculated and standardized (0 no adherence to 1.0 perfect adherence, >1.0 extra doses) for each 2-week period. Every 2 weeks patients were called to assess diet and fluid intake. Dietary sodium was measured using a list of 24 high sodium foods (e.g., pizza, hot dogs). Validity of the measure was confirmed with formal 3-day dietary recall assessments (randomly chosen days, 2 weekdays and 1 weekend day, each month) performed on 5 participants by a registered dietitian. After in-person training on cup size, fluid intake was estimated in cups for each 2-week period. Clinical events (ED visits, hospital readmissions, death) were obtained from the electronic medical record and confirmed by self-report.

Results:
Six (25%) were readmitted within 3 months; 2 of the 6 died before any diuretic data could be obtained. The remaining 4 readmissions were explainable with poor diuretic use usually coupled with high sodium and/or fluid intake. In the 18 patients not readmitted, few (n=4) managed all 3 factors simultaneously, but 14 were savvy in adjusting one or two factors, showing insight that was not evident in those readmitted. Some increased their diuretic use only when sodium and fluid intake were high and decreased diuretics again later.

Conclusion:
Rigid guidelines regarding diuretic use, sodium and fluid intake fail to acknowledge patients’ abilities to balance these 3 factors. Promoting skill in balancing diuretic use, sodium and fluid intake may encourage expertise in self-care.
Abstract 11582: Vascular, Hemodynamic and Hormonal Response to Mental Stress and Risk of Mental Stress Induced Myocardial Ischemia
Authors: Hammadah Muhammad , Alkhoder Ayman , Isakadze Nino , Almuwaqqat Zakaria , Obideen Malik , Abdelhadi Naser , Moureiden Mouwafak , Gafeer Mohamad Mazen , Al Mheid Ibhar , Wilmot Kobina , Ramadan Ronnie , Mohamed Kelli Heval , Hosny Kareem , Shah Amit , Pimple Pratik , Sun Yan , Garcia Ernest , Raggi Paolo , Pearce Brad , Esteves Fabio , Sheps David , Bremner J. Douglas , Vaccarino Viola , Quyyumi Arshed
Published: April 2024

Introduction:
Mental stress-induced myocardial ischemia (MSIMI) has been linked to adverse cardiovascular outcomes in patients with stable CAD. However, the underlying mechanisms are not well understood. We aimed to study vasomotor, hemodynamic and hormonal responses to mental stress (MS) and their relationships with MSIMI.

Methods:
660 patients with stable CAD underwent 99mTc sestamibi myocardial perfusion imaging before, and during a public speaking stressor. Hemodynamic parameters (heart rate, BP, rate-pressure product [RPP]), circulating catecholamines, and peripheral arterial tonometry (PAT, Itamar Inc.) were measured at rest, during, and after MS. MSIMI was defined as myocardial perfusion impairment with MS.

Results:
Participant age was 63±9; 72% male. Overall, 102 (16.1%) patients developed MSIMI. During MS, there was a significant increase in heart rate, BP, RPP and epinephrine, but not norepinephrine levels. The mean PAT ratio, measured as a ratio of the lowest pulse wave amplitude during the speaking task to the final three minutes of pulse wave amplitude during rest, was 0.7 ± 0.3 indicating vasoconstriction with MS. Patients with MSIMI had a greater hemodynamic response (Figure) and a lower PAT ratio (0.6±0.3 vs 0.7±0.3, p=0.008), in comparison to those with no ischemia. After adjustment for age, CAD risk factors and beta blocker use, both higher hemodynamic response (change in RPP≥median) and more vasoconstriction (PAT ratio<median), but not catecholamine response, were independent predictors of MSIMI [OR(95%CI) of 1.8 (1.1-2.9) and 2 (1.2-3.3), p=0.02 and p=0.01, respectively]. A greater hemodynamic response and a lower PAT ratio had an incremental effect on incidence of MSIMI (Figure).

Conclusion:
A greater hemodynamic response and peripheral vasoconstriction are associated with MSIMI, indicating that both increased myocardial demand and potentially coronary vasoconstriction contribute to this phenomenon.
Abstract 11615: Influence of Age and Gender on Marfan Phenotype: The NHLBI GenTAC Registry
Authors: Roman Mary J , Devereux Richard B , Preiss Liliana , Asch Federico M , Bavaria Joseph E , Eagle Kim A , Holmes Kathryn , Maslen Cheryl , Milewicz Dianna M , Morris Shaine A , Prakash Siddharth , Pyeritz Reed , Ravekes William J , Shohet Ralph V , Song Howard , Weinsaft Jonathan W
Published: April 2024

Background:
The influence of gender and age on phenotypic features of individuals with Marfan syndrome has not been systematically examined in a large cohort of both children and adults.

Methods:
We evaluated 789 Marfan patients enrolled in the NHLBI GenTAC Registry (53% male; mean age 31 [range: 1-86 years]). Females aged≥15 and males aged≥16 years were considered adults based on average age of skeletal maturity.

Results:
Children (n=183) and adults (n=606) (see Table) were comparable in revised Ghent systemic score, ectopia lentis, and most phenotypic features, including prevalences of aortic root dilatation and mitral prolapse. However, adults were more likely to have spontaneous pneumothorax, scoliosis, dural ectasia and striae. Prophylactic aortic root replacement and mitral valve surgery were rare during childhood vs. adulthood (2 vs. 35% and 1 vs. 9%, respectively, both p<0.0001). There was only one childhood aortic dissection (type B in 15 year old male). Overall females were more likely than males to have arachnodactyly (54 vs. 40%), scoliosis (60 vs. 49%), and dural ectasia (16 vs. 10%), all p<0.01. Adult males were more likely to have aortic root dilatation (92 vs. 84%), aortic regurgitation (55 vs. 36%) and to have undergone prophylactic aortic root replacement (47 vs. 24%), all p<0.001. Prevalence of prior aortic dissection was higher in males than females (25 vs. 18%, p=0.06), 44% of which were type B. Mean age at dissection (35 vs. 38 years), age at prophylactic surgery (32 vs. 35 years), and need for mitral valve surgery (9.5 vs. 10.0%) were similar between men and women, respectively.

Conclusions:
Pulmonary, skeletal and aortic complications, but not other phenotypic features, increase with aging in Marfan syndrome. Aortic aneurysms and prophylactic aortic surgery are more common in men. In the era of current surgical and medical treatment, aortic dissection, commonly type B, occurs in an appreciable proportion of Marfan patients, especially among men.
Abstract 11777: Acute and Long-term Success After Idiopathic Ventricular Arrhythmia Ablation: Clinical Outcome of Manual and Robotic Catheter Ablation
Authors: de Vries Leendert J , Hendriks Astrid A , Yap Sing C , Theuns Dominic A , van Domburg Ron T , Szili-Torok Tamas
Published: April 2024

Introduction:
The aim of this study was to compare the acute and long-term success of idiopathic ventricular arrhythmia ablation using manual catheter navigation (MAN) to the magnetic navigation system (MNS).

Methods:
Procedural data of 50 consecutive patients (20 MAN, 30 MNS) with idiopathic ventricular arrhythmia who underwent catheter ablation at our center were analyzed. Acute and cumulative success rates, procedure, fluoroscopy and ablation times and long-term follow-up data were recorded.

Results:
Patient age, gender and VT site were distributed equally. Acute success was achieved in 55% of the MAN group and 70% of the MNS group (P = 0,370), cumulative success in 55,0% versus 86,7% (P = 0,021). Procedure times were even (168,0 ± 68,3 vs 163,6 ± 64,7 minutes; P = 0,604). Median fluoroscopy time was significantly shorter in the MNS group (35 (15,0-46,1) vs 18 (9,9-28,0) minutes; P = 0,042). Overall, significantly more complications occurred in the MAN group (30,0% vs 6,7%; P = 0,047). There was no significant difference in major and minor complications (10% vs 0%; P = 0,155 and 20,0% vs 6,7%; P = 0,202, respectively). Median follow-up was 65.0 months (55.0 - 84.7 months) for the MAN group and 80.5 months (68.5 - 86.0 months) for the MNS group (P = 0,094). Long term significant symptom relief was equal in both groups (94,7% vs 100%; P = 0,404).

Conclusion:
MNS is a favorable technique for the ablation of IVA’s in the long-term due to higher cumulative success rates and a better procedural safety profile
Abstract 11799: Silent Atrial Fibrillation in Pacemaker Early Post-implantation Period: An Unintentionally Provoked Situation?
Authors: Benezet-Mazuecos Juan , Iglesias Jose Antonio , Cortes Marcelino , de la Vieja Juan Jose , Rubio Jose Manuel , Sanchez-Borque Pepa , Miracle Angel , Farre Jeronimo
Published: April 2024

Introduction:
Identification of silent atrial fibrillation (AF) is crucial to avoid thromboembolic complications. Multiple studies have shown that atrial high rate episodes (AHREs) detected in pacemakers (PM) are related to an increased risk of stroke. Our group has also reported that AHREs are independently associated to a higher incidence of silent ischemic brain lesions (IBL) on CT-scan.

Hypothesis:
Our purpose is to evaluate the relation between AHREs and time from PM implantation / type of lead fixation used in patients with dual-chamber PM and no history of AF. AHREs soon after PM implantation might be related with the procedure itself and the prognosis could be different.

Methods:
We analyzed prospectively the incidence of AHREs > 5 min compatible with silent AF (at 3 months after inclusion and during follow-up) and the presence of silent IBL, in relation to time from implantation (≤ 3 months vs. >3 months) and the atrial lead fixation (active vs. passive).

Results:
We evaluated 110 consecutive patients (55% men, aged 74 ± 9 year-old) during a mean follow-up of 24 ± 8 months. Mean CHADS
2
and CHA
2
DS
2
VASc scores were 1.9 ± 1.2 and 3.5 ± 1.5, respectively. Time from PM implantation was ≤ 3 months in 88 patients (80%) and > 3 months in 22 (20%). The type of fixation used was active in 55 patients and passive in other 55 (50%). AHREs were present in 40 patients (36.4%), 16 patients (14.5%) at first 3 months and 36 patients (32.7%) after. CT-scan showed silent IBL in 26 patients (23.6%). Table. The presence of AHREs at 3 months was more frequent in the patients with PM implantation in the prior 3 months (17% vs. 4.5%, p=0.09) and significantly related to active fixation leads (OR 5.36, 1.43 - 20.07; p<0.05). The presence of silent IBL on CT-scan was related to the presence of AHREs during follow up (OR 3.12, 1.29 - 7.97; p<0.05) but not with AHREs at first 3 months (OR 1.58, 0.49 - 5.05; p=0.44).

Conclusions:
AHREs compatible with silent AF are really prevalent in patients receiving PM and have been associated to worse outcomes including a higher incidence of silent IBL on CT-scan. But our data show that when AHREs occur during the first 3 months after PM implantation, it could be related with the procedure and the use of active fixation leads, and these episodes might not be related to worse outcomes.
Abstract 11802: Transforming the Convergent Procedure- Thinking Inside the Box
Authors: Robinson M. Clive , Scierka Lindsey
Published: April 2024

Introduction:
We report on intermediate follow up using a technique of confluent posterior left atrial wall epicardial ablation designed to eliminate both existing and future atrial fibrillation (AF) substrate.

Hypothesis:
The purpose of this study is to report on our experience with a technique of extended ablation using a confluent pattern of posterior left atrial epicardial lesions combined with endocardial ablation, as part of the Convergent hybrid closed chest procedure, performed in a single setting.

Methods:
Multiple confluent epicardial ablations with radiofrequency energy were delivered spanning the vertical and transverse dimensions of the posterior left atrium, along with facilitated pulmonary vein isolation (PVI). Endocardial mapping and ablation were performed to complete PVI and ablate the cavo-tricuspid isthmus. All patients were followed clinically and with 2 to 4 weekly continuous monitoring at 6, 12, and 24 months. Average follow-up was 488 days.

Results:
Of 57 patients with long-standing or persistent AF (NPAF), mean duration of AF was 5.6 years. Single procedure freedom from AF at 24 months was 64.5% and for all arrhythmias was 58.9%. Sixty-eight percent were off antiarrhythmic drugs (AADs). Four patients (7%) required a second endocardial ablation procedure. Sub-analysis of the observed arrhythmia burden through follow-up showed it to be small (0 to less than 1%) in the majority of patients.

Conclusions:
This extended posterior wall ablation technique, as part of the Convergent hybrid method, achieved notable single procedure success in a consecutive series of patients with NPAF.
Abstract 11806: Early, Intensive Atorvastatin Treatment Reduces First and Recurrent Hard Cardiovascular Events After Acute Coronary Syndrome
Authors: Schwartz Gregory G , Fayyad Rana , DeMicco David , Szarek Michael , Olsson Anders G
Published: April 2024

Background:
Early, intensive statin treatment is standard of care after acute coronary syndrome (ACS), but only one placebo (PBO)-controlled trial has demonstrated an early benefit of such treatment. In the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial, the primary outcome of time to first occurrence of death, MI, resuscitated cardiac arrest, or hospitalization for unstable angina (UA) was reduced with atorvastatin (ATV) 80 mg/day, compared with PBO. However, this result was borderline significant (HR 0.84, 95% CI 0.70-1.00, p=0.048) and driven largely by reduced UA, leading some to argue that early intensive statin treatment does not modify early “hard” events after ACS. On the other hand, the efficacy of an intervention after ACS is only partially accounted for by time to first event because patients may experience multiple events of similar importance, especially when competing risk for death is relatively low.

Objective:
In a post-hoc analysis of MIRACL, we evaluated the efficacy of ATV to reduce total (first and recurrent) hard cardiovascular events after ACS. Hard events were defined as death, MI, stroke, and resuscitated cardiac arrest.

Methods:
3086 patients were randomly assigned to treatment with ATV or PBO, beginning 1-4 days after ACS and continuing for 16 weeks. Time to first event was assessed by Cox regression. Total events were analyzed by Cox regression with model-based variance estimation to determine correlation between events within a subject.

Results:
ATV did not significantly reduce time to first hard event (HR 0.89, 95% CI 0.72-1.11, P=0.27), but did significantly reduce total hard events (
Table
). To prevent 1 hard event, only 10.6 patient-years of treatment with ATV were required. The HR for total events was minimally affected by inclusion or exclusion of UA.

Conclusion:
Intensive treatment with ATV reduces total hard events over 16 weeks following ACS, and is an efficient secondary prevention intervention.
Abstract 11811: Importance of Pulmonary Arterial Capacitance in Pulmonary Hypertension With Left Heart Disease
Authors: Sugimoto Koichi , Nakazato Kazuhiko , Yoshihisa Akiomi , Sato Takamasa , Kobayashi Atsushi , Yamaki Takayoshi , Kunii Hiroyuki , Suzuki Hitoshi , Saitoh Shu-ichi , Takeishi Yasuchika
Published: April 2024

Background:
Pulmonary hypertension due to left heart disease (LHD-PH) accounts for the largest proportion of pulmonary hypertension. However, prognostic factor of LHD-PH is poorly understood. Recently, pulmonary arterial capacitance (PAC) has attracted attention for being a factor of right ventricular afterload along with pulmonary vascular resistance. We investigated the clinical significance of PAC in LHD-PH.

Methods:
Two hundred fifty-two consecutive LHD-PH patients (145 men, mean age 63.4 ± 14.7 year) diagnosed by right heart catheterization were classified into four groups according to the level of PAC. PAC was estimated by the ratio between stroke volume and pulmonary arterial pulse pressure. The end point was a composite of cardiac mortality and rehospitalization due to worsening heart failure. The Cox proportional hazard regression model was used to determine what variables were associated with cardiac events.

Results:
Fifty-four patients encountered cardiac events during the follow-up period (median 943 days). The event free rate of the 1st quartile was significantly lower than that of the 3rd and 4th quartiles (66.7% vs 82.5% [3rd quartile], P = 0.008; and 92.1% [4th quartile], P < 0.001). The Cox hazard analysis revealed that PAC was associated with cardiac events (HR 0.556, 95% CI 0.424 - 0.730, P < 0.001). Cut-off value of 2.48 ml/mmHg of PAC from ROC curve analysis for prediction of cardiac events had 70.4% sensitivity and 58.1% specificity.

Conclusion:
PAC is the important prognostic factor in LHD-PH patients. PAC should be taken into account to manage patients with LHD-PH.
Abstract 11829: Improvement in Care and Outcomes for Ambulance-Transported ST-Elevation Myocardial Infarction Patients With and Without Out-of-Hospital Cardiac Arrest: A Mission: Lifeline STEMI ACCELERATOR Study
Authors: Kragholm Kristian , Lu Di , Chiswell Karen , Al-Khalidi Hussein , Roettig Mayme L , Roe Matthew , Jollis James , Granger Christopher B
Published: April 2024

Introduction:
ST-elevation myocardial infarction (STEMI) patients with out-of-hospital cardiac arrest (OHCA) may not only benefit from timely intervention (PCI) but also from temperature management and other critical care that often is offered at a PCI-center. Relative to non-OHCA STEMI patients, those with OHCA have previously been less likely to bypass the nearest hospital to reach a cardiac center.

Methods:
We reported time trends in emergency medical service (EMS) transport pattern and care of STEMI patients with and without OHCA included from ACTION®-GWTG™ hospitals (484 hospitals and 1253 EMS agencies in 16 US regions) with participation in the STEMI ACCELERATOR Mission: Lifeline (MLL) initiative between July 1
st
2012 (2012Q3) and March 31
st
2014 (2014Q1). Time trends by quarter were assessed using logistic regression with Generalized Estimating Equations to account for hospital clustering.

Results:
Of 13,189 EMS-transported patients, 88.7% (N=11,703) were direct presenters and 10.5% (N=1,227) of these had OHCA. Among 1,486 transfer-in patients, 21.7% (N=322) had OHCA. The proportion with OHCA taken directly to a PCI-center increased from 74.7% to 83.6% between 2012Q3-2014Q1 (OR per quarter= 1.07; 95% CI=1.02-1.14), compared to an increase of 89.0% to 91.0% for non-OHCA patients (OR=1.03; 95% CI=0.99-1.07; interaction p=0.23). Proportions examined with a prehospital ECG increased in both direct presenter groups (53.9% to 61.9% for OHCA; and 73.9% to 81.9% for non-OHCA; interaction p=0.12). Of 997 direct OHCA patients treated with primary PCI, a first medical contact(FMC-)-to-device time ≤90 minutes was met for 34.5% in 2012Q3 vs. 41.8% in 2014Q1 (51.6% and 56.1% for 9352 non-OHCA direct presenters treated with primary PCI; interaction p=0.72). In-hospital mortality for primary PCI-treated patients was 29.8% for direct OHCA presenters vs. 35.9% for transfer-in OHCA patients (OR=0.76; 95% CI=0.56-1.02), compared to 4.1% vs. 5.3% for non-OHCA direct vs. transfer-in patients (OR=0.86; 95% CI=0.64-1.16; interaction p=0.49).

Conclusion:
Increases in proportions with prehospital ECG, with direct transport to a PCI-center, and meeting FMC-to-device guideline-recommended goals were seen for STEMI patients with and without OHCA.
Abstract 11867: Effects of the Use of Preoperative Aspirin Among Patient Undergoing Cardiac Surgery
Authors: Zhang Zugui , Ding Qian , Liu Hong , Yuen Eric , Li Zhongmin , Yao Linong , Goldhammer J , R. Morris R , Weintraub William S , Sun Jianzhong
Published: April 2024

Background:
Continuing or stopping aspirin prior to coronary artery bypass graft (CABG) surgery remains controversial with a major concern of risk of bleeding, but some studies have shown that aspirin did not increase the risk of bleeding and may be beneficial to be continued until the time of surgery or after surgery.

Hypothesis:
The preoperative aspirin could have short- and long-term effects on patients with CABG or valve surgery.

Methods:
Consecutive patients (9584) with cardiac surgery from Thomas Jefferson University hospital, Abington Memorial hospital and UC Davis Medical Center during 2001 to 2015 were included in this study. The preoperative use of aspirin was defined as within 5 days preceding surgery. Patients excluded were those with preoperative anticoagulants (except unfractionated heparin), adenosine diphosphate receptor inhibitors, glycoprotein IIb/IIIa inhibitors, anti-platelets, unknown preoperative aspirin use. Outcomes were analyzed with the use of propensity scores and inverse-probability-weighting adjustment to reduce treatment selection bias.

Results:
Among 6219 patients met inclusion criteria, 4033 (64.8%) had preoperative aspirin (PreASA) and 2186 (35.0%) didn’t (No-PreASA). The median follow-up period was 3.6 years. At 30 days after surgery, there was significant difference in adjusted mortality between the groups (3.69% in the PreASA group vs. 5.31% in the No-PreASA group; risk ratio, 0.69; 95% confidence interval [CI], 0.59 to 0.84). At 4 years, there was still lower mortality with PreASA than with No-PreASA (15.79% in the PreASA vs. 17.78% in the No-PreASA group; risk ratio, 0.89; 95% CI, 0.86 to 0.92). With the use of different analytic methods and sensitivity analysis to assess residual confounding, similar results were noted in postoperative renal failure (4.02% in the PreASA group vs. 5.81% in the No-PreASA group; odds ratio: 0.74; 95%CI: 0.63-0.88 ) and major adverse cardiocerebral events (10.76% in the PreASA group vs. 14.46% in the No-PreASA group; odds ratio: 0.77; 95%CI: 0.69-0.85).

Conclusions:
In this observational study, we found that among patients with cardiac surgery, there was a short- and long-term survival advantage among patients who used preoperative aspirin as compared with patients who didn’t.
Abstract 11885: Neuromuscular Blockade Requirement is Associated With Good Neurologic Outcome in Cardiac Arrest Survivors Treated With Targeted Temperature Management
Authors: Lee Dong Hun , Lee Byung Kook , Jeung Kyung Woon , Min Yong Il
Published: April 2024

Introduction:
The optimal method for neuromuscular blockade (NMB) in post-resuscitation care has not been fully elucidated. We aimed to examine the association of NMB use with neurologic outcome and lactate clearance in cardiac arrest survivors treated with targeted temperature management (TTM).

Methods:
This retrospective observational study included consecutive adult cardiac arrest survivors treated with TTM from 2012 to 2015. NMB use was categorized into 3 groups: no NMB, bolus NMB (intermittent bolus use), and continuous NMB (continuous infusion). The serum lactate was obtained on admission and at 12 h, 24 h, and 48 h after admission. The primary outcome was poor neurologic outcome at hospital discharge. The secondary outcome was lactate clearance.

Results:
A total of 309 patients were included, and 206 (66.7%) were discharged with poor neurologic outcomes. No NMB, bolus NMB, and continuous NMB groups included 93, 119, and 97 patients, respectively. No NMB, bolus NMB, and continuous NMB use was associated with poor neurologic outcomes in 81/93 (87.1%), 78/119 (65.5%), and 47/97 (48.5%), respectively (
p
< 0.001). Multivariate analysis revealed that older age (odd ratio [OR] 1.038, 95% confidence interval [CI] 1.015-1.061,
p
= 0.001), shockable rhythm (OR 0.273, 95% CI 0.125-0.599,
p
=0.001), cardiac etiology (OR 0.262, 95% CI 0.115-0.599,
p
=0.001), longer downtime (OR 1.051, 95% CI 1.026-1.076,
p
<0.001), high Glasgow coma scale (OR 0.550, 95% CI 0.416-0.728,
p
<0.001), and continuous NMB (OR 0.317, 95% CI 0.124-0.815,
p
=0.017) compared to no NMB use were associated with poor neurologic outcomes. Serum lactate level (
p
= 0.658) and lactate clearance (
p
= 0.440) were not different among NMB groups. The serum lactate level decreased significantly over time (
p
<0.001), and was different between good and poor neurologic outcomes (
p
<0.001), while lactate clearance was not different (
p
= 0.701).

Conclusions:
Continuous NMB use, rather than no NMB use, was associated with good neurologic outcome at discharge in cardiac arrest survivors treated with TTM. The method of NMB was not associated with serum lactate level and lactate clearance.
Abstract 11935: A Novel Wire guided Ablation Catheter For Ablation Of Right Superior Pulmonary Vein In Experimental Pigs
Authors: Zhao Xue , Gong Hui , Hu Jian qiang
Published: April 2024

A novel wire guided ablation catheter for ablation of right superior pulmonary vein in pigs

Introduction:
A novel wire-guided ablation catheter (wire-guided cath) was invented based on principle of compasses for drawing circle.

Hypothesis:
This study was to investigate if the guiding wire can increase the efficiency and accuracy of catheter manipulation in right superior pulmonary vein (RSPV).

Methods:
Wire-guided cath was composed of a conventional cold saline-irrigated ablation catheter (conventional cath) & a guide-wire. The guide-wire came out from the distal part of catheter. When pushed into the distal of RSPV, the guide-wire can work as a pivot for the catheter to increase stability of catheter manipulation. EnSite Velocity system was used. Contact/mapping & mapping/ ablation were tried by using the catheters in RSPV separately. Seven pigs were used.

Results:
In comparison with conventional cath, wire-guided cath took marked less procedure & exposure time to complete the separate contact/mapping at four sites, to do circumferential contact/mapping, & to do radial-linear contact/mapping along RSPV. Furthermore, it can significantly decrease procedure & exposure time by using wire-guided cath to complete the circumferential RSPV ablation & RSPV-antrum radial-linear ablation. During procedures, the ablation catheter had unintentionally fallen into right atrium for 0.7±0.8 times in wire-guided cath group & for 5.1±1.3 times in conventional cath group; it had taken 1.0±0.2 min & 5.0±0.9 min for wire-guided & conventional cath to be pushed back into LA again from atrial septum puncture access. No thrombosis was found on guide-wire & the distal hole of guide-wire lumen, & no scratches, tears & thrombus found in RSPV intima after procedure.

Conclusions:
The study shows wire-guided cath had significant advantages in manipulation of moving, positioning & contacting, which may help to improve ablation skills of atrial fibrillation for younger EP doctors.
Abstract 11978: Impact of Heart Rate and Beta-blockers on Mortality in Patients With Heart Failure and Preserved Ejection Fraction
Authors: KITAI Takeshi , Grodin Justin L , Tang W.H.Wilson
Published: April 2024

Background:
Heart failure (HF) can be associated with a higher resting heart rate (HR) and an elevated HR is associated with adverse long-term events in patients with HF and reduced ejection fraction (EF). However, the mechanistic and causal role of HR in HF and preserved EF (HFpEF) is unclear. This study aimed to investigate the association between HR and clinical outcomes as well as an interaction with beta-blocker therapy in patients with HFpEF.

Methods and Results:
Among 3,445 HFpEF patients who were enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) Trial, we studied 2542 (74%) patients without atrial fibrillation or pacemaker implantaion. In our study cohort (mean age 67±9 years, 54% male and 32% diabetic), the median baseline HR was 68 bpm (interquartile range 60 to 74 bpm) and 1954 (77%) patients had beta-blocker medication at baseline although all the study patients had preserved EF (>45%). There were 329 deaths during median follow-up of 3.5 years. Higher HR was associated with poor long-term survival (Quartile-4 versus 1: hazard ratio [95% confidence interval] 1.82 [1.28 to 2.36], P < 0.001, Figure), while the prognosis was comparable between patients with and without beta-blocker medication (P=0.27). After adjusting for age, gender, hypertension, dyslipidemia, diabetes mellitus, serum creatinine level, coronary artery disease, stroke, beta-blocker and angiotensin converting enzyme inhibitor or angiotensin receptor antagonist, HR was still independently associated with mortality risk (2.09 [1.44 to 2.75], P < 0.001). Beta-blocker medication had no significant interaction effects with HR.

Conclusions:
Higher HR was associated with poor survival in HFpEF patients with or without beta-blocker. Further studies are warranted to investigate whether HR modification improve outcomes in patients with HFpEF.
Abstract 12002: Delayed Inhalation of Hydrogen Improves Myocardial dysfunction in a Porcine Model of Cardiac Arrest and Cardiopulmonary Resuscitation
Authors: Yang Zhengfei , Yu Tao , Wen Cai , Zhai Xiaozhu , Peberdy Mary Ann , Ornato Joseph P , Tang Wanchun
Published: April 2024

Introduction:
Immediate inhalation of hydrogen (H
2
) has been demonstrated to improve post-resuscitation (PR) myocardial dysfunction. In this study, we investigated the effects of delayed treatments with H
2
on myocardial dysfunction in a porcine model of cardiac arrest (CA).

Hypothesis:
Delayed inhalation of H
2
improves myocardial dysfunction after resuscitation in a CA porcine model.

Methods:
Twenty male pigs weighing 39±2 kg were utilized. Ventricular fibrillation was electrically induced and untreated for 10 mins. All the animals were successfully resuscitated manually and then randomized into two groups: delayed inhalation of H
2
(DH group) or continuous inhalation of room air (C group). Animals in DH group were ventilated with 2% H
2
/21% oxygen from PR 2h till PR 4h. Left ventricle pressure (LVP) was recorded continuously and cardiac output (CO) was measured by the thermo-dilution technique at baseline (BL) and then hourly after resuscitation for 6 hours. Serum levels of troponin T (Tn T) and N-terminal probrain natriuretic peptide (NTpro-BNP) were measured by ELISA at BL, PR 180 min and PR 360 min.

Results:
Deteriorations in maximum rate of LVP increase (dp/dtmax), maximum rate of LVP decline (-dp/dtmax) and CO were observed in all the animals after PR 4 h (Figure 1). However, better dp/dtmax, -dp/dtmax and CO were achieved in the DH group after PR 5h when compared with the C group. Although levels of both Tn T and NTpro-BNP in serum increased after resuscitation, they were significantly lower in animals of DH group in comparison with C group (Figure 2).

Conclusion:
Delayed treatment of H
2
attenuates myocardial injury and improves myocardial dysfunction after resuscitation.
Abstract 12003: Brain Injury in Cognition and Mood Regulatory Regions in Adolescents With Single Ventricle Heart Disease
Authors: Pike Nancy A , Gupta Ritika , Roy Bhaswati , Woo Mary A , Halnon Nancy J , Lewis Alan B , Kumar Rajesh
Published: April 2024

Introduction:
Adolescents with palliated single ventricle congenital heart disease (SVCHD) show a distinct pattern of cognitive and mood impairment, indicating the probability of brain injury in regions that control these functions. However, brain tissue integrity in cognitive and mood regulatory sites in SVCHD remains unclear. Our aim was to evaluate regional brain tissue changes in SVCHD compared to controls using T2-relaxometry procedures, which measure free water in tissues (higher T2-relaxation values indicate tissue damage).

Methods:
Proton-density and T2-weighted images were collected from 9 SVCHD (age: 15.8±1.1 years, male: 6, BMI: 19.8±3.6 kg/m
2
) and 8 healthy controls (age: 16.3±0.9 years, male: 4, BMI: 25.4±8.1 kg/m
2
), using a 3.0-Tesla magnetic resonance imaging scanner. Whole-brain T2-relaxation maps were calculated, normalized to a common space, smoothed, and compared between groups using ANCOVA (covariates: age and gender).

Results:
Several brain regions in SVCHD showed increased T2-relaxation values, indicating tissue injury, including the prefrontal cortices (a, b; executive thinking), anterior and posterior cingulate cortices (f; conflict resolution; emotion and memory), bilateral insular cortices (c; autonomic and emotion control), and bilateral parahippocampal gyrus (g; facial and topographical recognition; see Figure). In addition to gray matter injury, white matter changes were also detected in regions that link important gray matter regions associated with cognition and mood, including bilateral frontal white matter, anterior corpus callosum, and middle cerebellar peduncles (d, e), compared to controls [all regions p<0.05].

Conclusion:
Adolescents with palliated SVCHD showed significantly increased T2-relaxation values, indicating tissue injury, in brain regions that control cognition and mood. These findings indicate that functional deficits in SVCHD may result from tissue injury in those regulatory areas.
Abstract 12041: Associations Between Acylcarnitine to Total Carnitine Ratio and Adverse Prognosis in Heart Failure Patients With Reduced or Preserved Ejection Fraction
Authors: Watanabe Shunsuke , Yoshihisa Akiomi , Sato Yu , Yokokawa Tetsuro , Miura Shunsuke , Sato Takamasa , Suzuki Satoshi , Oikawa Masayoshi , Kobayashi Atsushi , Yamaki Takayoshi , Kunii Hiroyuki , Nakazato Kazuhiko , Saitoh Shu-ichi , Takeishi Yasuchika
Published: April 2024

Background:
The failing heart is accompanied by disturbed energy metabolism with mitochondrial dysfunction. This metabolic change involves altered fatty acid metabolism. Carnitine is an essential cofactor for fatty acid oxidative metabolism, which is the predominant source of ATP in the normal aerobic condition. Decreased myocardial carnitine levels and increased plasma carnitine levels in heart failure (HF) have been reported. A plasma acylcarnitine to total carnitine ratio (AC/TC ratio) has been recently recognized as a marker of carnitine deficiency. We aimed to investigate the significance of the AC/TC ratio on prognosis of HF and compare its prognostic impact between HF patient with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF).

Methods and Results:
We analyzed 168 patients with HF who admitted to our hospital. These patients were divided into 3 groups based on the AC/TC ratio: 1
st
(AC/TC ratio <0.15, n = 56), 2
nd
(0.15≤ AC/TC ratio <0.25, n = 56) and 3
rd
(0.25≤ AC/TC ratio, n = 56) tertiles. In the average follow-up of 1004 days, 23 cardiac deaths and 28 re-hospitalizations from worsening heart failure occurred. In the Kaplan-Meier analysis, cardiac event rates progressively increased from 1
st
to 2
nd
and 3
rd
groups (21.4%, 26.8% and 42.9%, P = 0.022). In the Cox proportional hazard analysis, the AC/TC ratio was an independent predictor of cardiac event after adjusting for confounding factors (HR 1.33, 95% CI 1.01-1.74, P = 0.044). When analyzed separately between HFpEF (n = 66) and HFrEF (n = 168), the Kaplan-Meier analysis revealed that cardiac event rates progressively increased from 1
st
to 2
nd
and 3
rd
groups in HFpEF (P = 0.008), but not in HFrEF (P = 0.321). In the Cox proportional hazard analysis, the AC/TC ratio was an independent predictor of cardiac event in HFpEF (HR 2.00, 95% CI 1.09-3.67, P = 0.025), but not in HFrEF (HR 1.27, 95% CI 0.95-1.70, P = 0.101).

Conclusion:
The AC/TC ratio can identify high risk HF patients, especially in HFpEF.
Abstract 12044: East Meets West in the Assessment of Cardiac Risk: A Multicenter Comparative Study of the Influence of Racial, Ethnic and Cultural Risk Factors on Cardiac Surgical Risk Model Performance
Authors: Kurlansky Paul , Baser Onur , Nemeth Samantha , Tingley Judy , Argenziano Michael , Smith Craig
Published: April 2024

Introduction:
Numerous risk models have been applied to coronary artery bypass (CABG) patients. Their applicability across racial, ethnic and cultural backgrounds has not been well-described. We therefore compared the performance of the SinoSCORE, derived from 43 Chinese medical centers (c-statistic=0.80), with the Society of Thoracic Surgeons (STS) CABG mortality risk model in a population of CABG patients from a diverse multicenter American registry.

Hypothesis:
Racial, ethnic and cultural differences will impact the performance of surgical risk models.

Methods:
Perioperative data on all patients undergoing CABG between May 2006 and December 2015 from each of 8 centers was entered into the STS database. SinoSCORE and STS predicted risk of mortality was calculated for each patient. Logistic regression was used to develop a risk model based on SinoSCORE variables and performance was compared to STS risk model.

Results:
7918 patients underwent CABG of whom 1.36% % were Asian. Sino-SCORE successfully categorized surgical mortality into low (0.12%), medium (0.36%) and high (2.42%) risk of mortality. However, the discrimination and calibration was better for STS than for the derived SinoSCORE (c-statistic 0.8087 vs. 0.767; p=0.0007; Figure; Hosemer-Lemeshow χ
2
52.64 vs. 40.05). Moreover, several of the factors which were predictors of mortality in the original SinoSCORE (age 65-70, BMI<18, chronic renal insufficiency, extracardiac arteriopathy, COPD, atrial fibrillation, urgent status) were not predictors in the derived model when applied to this multicenter Western patient population

Conclusions:
A CABG risk model derived from a from a broad sampling of Chinese patients did not perform as well in a diverse multicenter American population as it did in the population of origin, or as did the STS risk model. Considerable caution should be exercised, even for common operations, in applying surgical risk models across racial, ethnic and cultural divisions.
Abstract 12046: ARFI Ultrasound Elastography Measures Isovolumic Relaxation Time Constant for Assessment of Diastolic Function
Authors: Vejdani-Jahromi Maryam , Freedman Jenna , Joong-Kim Young , Osborn Jenna , Trahey Gregg , Wolf Patrick
Published: April 2024

Introduction:
Diastolic dysfunction is a leading cause of morbidity and mortality in heart failure. Assessment of diastolic function has been a challenging topic for many decades. One index of diastolic function is the isovolumic relaxation time constant (τ). This measurement is not used routinely in the clinic because it requires a left ventricular (LV) pressure catheter. Other noninvasive methods provide correlates of the time constant but do not measure the actual value. It has been shown recently that ultrasound elastography (Acoustic Radiation Force Impulse Imaging (ARFI)) can provide a temporal stiffness measurement of the myocardium during the cardiac cycle. The clinical value of the ARFI measured time course of softening has not been shown.

Hypothesis:
We assessed the hypothesis that ARFI Elastography can be used to measure the isovolumic relaxation time constant of the LV.

Methods:
This study was performed in eight isolated rabbit hearts in working mode. A pressure catheter was used to record the LV pressure simultaneously with ARFI. LV free wall ARFI measurements were recorded using an ultrasound probe. In order to extend the range of τ (tau) measurements, 3 of the subjects were subjected to ischemia (total of 11 measurements from 8 subjects).

Results:
Tau measured by ARFI was linearly related to the τ measurement derived from LV pressure with the slope of 0.92 and R
2
= 0.90 indicating the near equivalence of the values. Mean ± SEM of τ derived from pressure and ARFI were 33.7 ± 6.4 ms and 34.8 ± 6.2 ms respectively.

Conclusions:
ARFI ultrasound elastography can be used to measure the relaxation time constant of the left ventricle. This is the first time that τ has been measured directly using an ultrasound technique. ARFI measurements have the benefits of ultrasound imaging including noninvasiveness, cost efficiency and portability. Translation of this technique to transthoracic imaging in humans would provide an important screening measure of diastolic function.
Abstract 12060: The Extent of Myocardial Injury as a New Criterion
Authors: Ren Kaixi , Lomasney Jon , Arora Rishi K , Qin Gangjian , Johnson Steven E , Albaghadai Mazen , Haney Chad R , Waters Emily A , He Xingyao , Zhu Daocheng , Goldberger Jeffrey J , Zhao Ming
Published: April 2024

Introduction:
In acute coronary syndromes (ACS), infarct size is a primary criterion for gauging the pathological state of the post-ischemic heart and subsequent prognosis. However, early adverse outcomes may be noted even with small to moderate infarcts, suggesting that there are other contributing factors to the negative prognosis.

Hypothesis:
We hypothesize that the extent of injured myocardium, which may be significantly larger than the infarct zone, can be noninvasively assessed using membrane phospholipid reorganization as a molecular marker.

Methods:
The studies were conducted in a rat model of preconditioned myocardial ischemia and reperfusion. The area of injured myocardium was positively delineated by the uptake of
99m
Tc-duramycin, which detects phosphatidylethanolamine as a marker for cellular injury. Quantitative
ex vivo
studies (n = 8) were first conducted to determine the relationship among the area-at-risk, infarct size and myocardial injury, followed by
in vivo
radionuclide imaging studies (n = 6), with cross-validation using histopathology.

Results:
We demonstrated 1) that the extent of myocardial injury can be detected noninvasively; 2) the size of injured myocardium can extend substantially outside the infarct zone (Figure 1); and 3) the injured-but-noninfarct tissue, which was missed by conventional infarct measurement, contained significant pathological changes, including apoptosis in vulnerable cells, inflammation and denervation.

Conclusions:
“Global myocardial injury, or GMI” is a novel clinical concept which defines the full extent of myocardium that sustained injury both in and outside the infarct zone. Our data demonstrate the feasibility to conspicuously delineate this region of cardiac injury, thus providing an opportunity to better characterize its roles in cardiac impairment and prognosis following ACS.
Abstract 12116: Long-term Effects of Cumulative Fine Particulate Matter Exposures on Hemorrhagic Stroke Event: Nationwide Cohort Study
Authors: Noh Juhwan , Sohn Jungwoo , Cho Jaelim , Kim Changsoo , Shin Dong Chun
Published: April 2024

Introduction:
Epidemiological studies have revealed adverse associations between ambient fine particulate matter (PM
2.5
; aerodynamic diameter < 2.5 μm) and cardiovascular diseases. Recently, there has been increased interest in investigating the association between long-term PM
2.5
exposure and hemorrhagic stroke (HS) and identifying the most susceptible subpopulations to the PM
2.5
exposure, if any.

Hypothesis:
We assessed the hypothesis that long-term cumulative averages of PM
2.5
exposure affect HS and its effect might be modified by risk factors.

Methods:
This study was based on a nationwide representative cohort of 1,025,340 participants, or 2% of the National Health Insurance Service enrollees in Korea (2002-2013). We analyzed the effects of PM
2.5
on time to first hospital diagnosis for HS for participants living in Seoul. A time-dependent Cox proportional hazards model was used with adjustments for age, sex, household income, insurance type, body mass index, smoking status, exercise, medical history, and family history. Annual cumulative mean PM
2.5
concentrations for 25 districts were used as the time-dependent variables. Subgroup analyses were performed to evaluate potential effect modification.

Results:
Cumulative PM
2.5
exposure was associated with HS events with a hazard ratio of 1.04 (95% confidence interval [CI]: 1.01-1.07) per 1 μg/m
3
elevation in PM
2.5
. Its adverse effects were modified by risk factors with greater effects observed among women (1.05 [1.01-1.09]) and subgroups with hypertension (1.06 [1.03-1.10]), without diabetes (1.05 [1.02-1.09]), or without family history of stroke (1.04 [1.01-1.07]).

Conclusions:
To our best knowledge, this is the first study to investigate the effect of cumulative averages of PM
2.5
exposure on time to first hospital diagnosis for HS. Cumulative PM
2.5
exposure might increase the risk of HS. Participants with hypertension, without diabetes or family history of stroke, or women were more susceptible to PM
2.5
exposure. Our findings show the first time that long-term cumulative PM
2.5
exposure could be crucial to cerebrovascular event and have public health implications.