bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2488: Correlation Between The Severity Of Diastolic Dysfunction And Cardiac Torsion
Authors: Park Sung-Ji , Miyazaki Chinami , Bruce Charles J , Bellavia Diego , Miller Fletcher A , Ommen Steve , Oh Jae K
Published: July 2021

Backgrounds:

Left ventricular torsion (LVtor) is an integral part of systole and untwisting plays an important role in diastole. The aim of this study was to characterize LVtor and untwisting in different grades of diastolic dysfunction.

Methods:

We studied 135 patients with normal LV EF with various grades of diastolic dysfunction (40 group1:mild,42 group 2:moderate,and 22 group 3:severe dysfunction) and 31 controls with normal diastolic function. Apical and basal short axis rotations were measured by 2D STE. LVtor was defined as net difference between apical and basal rotation.

Results:

Age, gender, and EF were similar in 3 groups and control. Mitral annulus early diastolic velocity was reduced in all 3 groups (see table

). Peak LVtor was significantly greater in group 1 compared with control, group 2 and group 3. The time from peak LVtor to Mitral valve opening, and to peak early diastolic velocity were significantly delayed in group 1 compared to control (p=0.0030 and 0.0409, respectively). The twisting rate and untwisting rate were found to be highest in group 1.

Conclusions:

Systolic torsion and diastolic untwisting are significantly increased in patients with mild diastolic dysfunction. In patients with advanced diastolic dysfunction with increased filling pressure, torsion and untwisting are normalized. Hence, vigorous LV torsion appears to be a compensatory mechanism during an early stage of diastolic dysfunction to maintain normal filling in the setting of reduced longitudinal myocardial motion.
Abstract 2550: N-terminal Pro-brain Natriuretic Peptide-defined Cardiomyopathy in Doxorubicin-treated Children with Acute Lymphoblastic Leukemia
Authors: Lipshultz Steven E , Lipsitz Stuart R , Scully Rebecca E , Miller Tracie L , Barry Elly , Rifai Nader , Dalton Virginia M , Silverman Lewis B , Colan Steven D , Asselin Barbara L , Athale Uma , Clavell Luis A , Larsen Eric , Moghrabi Albert , Samson Yvan , Schorin Marshall A , Gelber Richard D , Sallan Stephen E
Published: July 2021

Background: Doxorubicin damages heart muscle, placing long-term survivors of childhood cancer at elevated risk of cardiac dysfunction. N-terminal pro-brain natriuretic peptide (NT-proBNP), an independent predictor of mortality and cardiovascular events in other populations, may serve to indicate cardiomyopathy prior to irreversible damage in this population.

Methods: To determine the diagnostic value of NT-proBNP in children receiving doxorubicin, the NCI Dana-Farber Cancer Institute ALL Consortium collected serial serum samples and echocardiograms from children with ALL between 1995 and 2000 randomized to receive doxorubicin alone (dox; n = 74; 1203 samples; median age = 6.4 yrs; 30 mg/m
2
/dose for 10 doses) or doxorubicin preceded by the cardioprotectant dexrazoxane (dex/dox; n = 80; 1338 samples; median age = 7.1 yrs; 300 mg/m
2
/dose).

Results: Marked NT-proBNP elevation (NT-proBNP ≥ 100 pg/ml if age ≥ 1; proBNP ≥ 150 pg/ml if age > 1) was seen at baseline (treatment day 0; dox alone = 82.5% of patients abnormal; dex/dox = 87.4%;
p
= 0.527). During treatment, the percentage of patients with abnormal NT-proBNP levels fell to a minimum of 35.8% in the dox only group and 16.4% in the dex/dox group (
p
< 0.001) before rising progressively at the end of treatment (treatment day 220; dox only = 70.8%; dex/dox = 5.3%;
p
< 0.001). After controlling for treatment, a patient with abnormal NT-proBNP six months after the start of doxorubicin had 2.39 times the odds of having myocardial injury as indicated by elevated cardiac troponin T (cTnT ≥0.01 ng/mL; OR = 2.39; 95%CI 1.156 - 4.946;
p
= 0.019). Further, at any given time and for either treatment, a patient with abnormal NT-proBNP had 2.36 times the odds of having abnormal LV fractional shortening (OR = 2.36; 95%CI 1.026 - 5.449;
p
= 0.047).

Conclusion: Elevated serum NT-proBNP was significantly related to cumulative unprotected doxorubicin dose, left ventricular fractional shortening, and cTnT during doxorubicin therapy. A much higher percentage of patients exhibited levels of NT-proBNP suggestive of cardiomyopathy than showed death of cardiomyocytes as indicated by elevated cTnT levels. This might allow the testing of individualized preventative therapy for cancer patients at high risk for long-term cardiotoxicity.
Abstract 2645: Longer Ventricular Fibrillation Detection Duration Does Not Increase Rate of Undersensing: Results from the PREPARE Study
Authors: Moore Stephen , Stern Richard , Brown Mark L , Heubner Brooke M , Johnson Jim W
Published: July 2021

Background:
The PREPARE study was designed to evaluate ICD detection and therapy parameters strategically selected to safely reduce all-cause shocks in patients with primary prevention indications by treating only truly sustained fast VT/VF. Electrophysiologic properties have been shown to deteriorate during long-duration VF episodes. There was concern that electrogram deterioration might result in increased undersensing (US) and delayed detection of VF. In this analysis we compared the rate of US between episodes detected with shorter (number of intervals to detect (NID) =12/16) and longer (NID=30/40) detection settings to assess whether delayed detection times for VF increased the rate of US.

Methods:
All induced VT/VF episodes from PREPARE patients programmed to NID 12/16 or 30/40 and sensitivity 1.2 mV were included in the analysis. US was determined automatically from the stored episode record. The numbers of US and the times from onset through initial detection and from detection to shock were computed. The rates of US over time were compared between the shorter and longer NIDs using a GEE analysis with time as the offset.

Results:
Seven hundred fifty six VF inductions in 432 patients from the PREPARE study were included in the analysis. There were 319 VF inductions (180 pts) with NID 12/16 and 437 VF inductions (261 pts) with NID 30/40. The average time from VF onset to shock increased from 6.0 to 9.5 seconds with the longer VFNID with no evidence of an increase in the rate of US over time.

Conclusion:
The longer NID delayed shock delivery by an average of 3.5 seconds but did not result in an increased rate of undersensing.
Abstract 2685: Assessment of Myocardial Perfusion With Stress-Contrast Echocardiography in Diabetics
Authors: Aggeli Constadina , Giannopoulos Georgios , Roussakis Georgios , Christoforatou Euaggelia , Marinos Georgios , Ioakeimidis Nikolaos , Kokkinakis Christos , Stefanadis Christodoulos
Published: July 2021

Background and purpose: The combination of myocardial contrast echocardiography with dobutamine-atropine stress echocardiography has shown promising results in the diagnostic approach of coronary heart disease (CHD). However, its diagnostic value in specific patient populations has not been clearly specified. The aim of the present study was to assess the value of stress contrast echocardiography (SCE) in diagnosing significant coronary heart disease in diabetic versus non-diabetic patients.

Methods: 127 individuals (60 males, 62±9.8 years old) with no known history of CHD, among which 59 patients with Type 2 diabetes mellitus, were submitted to stress echocardiography (four-stage dobutamine protocol 10 – 40 mcg/kg/min, with use of atropine as required to reach 90% of age-adjusted target heart rate), combined with intravenous contrast use to perform myocardial contrast echocardiography. New or worsening wall motion abnormalities during stress or reversible perfusion defects in >2 contiguous segments were considered as signs of ischemia. Significant CHD was defined as >50% stenosis in a major epicardial artery on coronary angiography (CAG).

Results: Among the 68 non-diabetic subjects and the 59 diabetics, 58 (85.3%) and 45 (76.3%) were found to have significant CHD on CAG, respectively. There were no significant differences as regards to age, sex and other major risk factors between diabetics and non-diabetics. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) in the total of 127 patients were 92%, 63%, 91%, 65% and 87%, respectively. These diagnostic parameters in non-diabetic vs. diabetic subjects were 93% vs. 91% (p=
NS
), 90% vs. 43% (p<0.01), 98% vs. 84% (p<0.05) and 69% vs. 60% (p=
NS
).

Conclusions: Stress contrast echocardiography is an exceptionally reliable technique for CHD diagnosis. However, our findings suggest that in diabetic patients it appears to exhibit inferior specificity and PPV compared to non-diabetics. A possible explanation could be that microcirculation abnormalities, which are common in diabetes, may cause appearance of signs of ischemia (wall-motion abnormalities and/or perfusion defects) on SCE, without presence of angiographically significant CHD.
Abstract 2924: Association of
NOS1AP
Genetic Variants with QT Interval Duration in Families from the Diabetes Heart Study
Authors: Lehtinen Allison B , Newton-Cheh Christopher , Ziegler Julie T , Langefeld Carl D , Freedman Barry I , Daniel Kurt R , Herrington David M , Bowden Donald W
Published: July 2021

Background:
Prolongation of the electrocardiographic QT interval is a risk factor for sudden cardiac death (SCD) in unselected samples as well as in post-myocardial infarction patients or those with diabetes. Common genetic variants in the nitric oxide synthase 1 adaptor protein
(NOS1AP)
gene have been reported to be associated with QT interval duration in individuals of European ancestry. We sought to replicate the association of
NOS1AP
variants with QT interval duration in pedigrees enriched for type 2 diabetes mellitus (T2DM).

Methods and Results:
Two single nucleotide polymorphisms (SNPs) in the
NOS1AP
gene, rs10494366 and rs10918594, were genotyped in a collection of 937 European Americans (EAs) and 177 African Americans (AAs) in 450 pedigrees containing at least two siblings with T2DM. An additive genetic model was tested for each SNP in ancestry-specific analyses using SOLAR in the total sample and in the diabetic subset (EA n=778, AA n=159), with and without exclusion of QT-altering medications. In the EA individuals, rs10494366 minor allele homozygotes had an 8.9 msec longer mean QT interval compared to major homozygotes (additive model p=4.4x10
-3
); rs10918594 minor homozygotes had a 12.9 msec longer mean QT interval compared to major homozygotes (p=9.9x10
-5
). Excluding users of QT-altering medications in the diabetic-only EA sample (n=514) strengthened the association despite the reduction in sample size (20.6 msec difference, p=2.0x10
-5
; 23.4 msec difference, p=8.9x10
-7
, respectively). No association between the
NOS1AP
SNPs and QT interval duration was observed in the limited number of AA individuals examined.

Conclusions:
Two
NOS1AP
SNPs are strongly associated with QT interval duration in a predominately diabetic EA sample. Stronger effects of
NOS1AP
variants in diabetic individuals compared to previously reported unselected samples suggest that this patient subset may be particularly susceptible to genetic variants that influence myocardial depolarization and repolarization as manifest in the QT interval.
Abstract 3013: Myocardium at Risk of Infarction during Acute Ischemia is Accurately Measured after Revascularization by MRI in Humans
Authors: Carlsson Marcus , Hedstrom Erik , Heiberg Einar , Arheden Hakan
Published: July 2021

PURPOSE:
The size of an infarct caused by coronary occlusion mainly depends on the duration of ischemia and the size of the ischemic myocardium, called myocardium at risk (MaR). T2-STIR imaging (visualizing oedema) has been shown to depict MaR in dogs. However, this has not been validated in humans. Therefore the purpose of this study was to validate the measurement of MaR by MRI against SPECT.

METHODS:
7 patients (69±8 years, all male) with ST-elevation infarction treated by PCI were included. Technetium-labelled tetrofosmin was injected during ongoing ischemia before opening of the occluded vessel. SPECT was performed after concluded PCI and cardiac MRI after 3±3 days. MaR was measured as absent perfusion on SPECT and oedema on MRI, and expressed in percent of the left ventricular myocardium. The observer of the MRI data was blinded to the SPECT results. The localisation of transmural ischemia by the two methods was compared by visual assessment.

RESULTS:
The difference between SPECT and MRI for measurement of MaR was 0±9 % (mean±SD). The localization of transmural ischemia agreed between the two methods (Fig. 1

) and expressed on vessel basis, MRI and SPECT showed 100 % concordant results.

CONCLUSIONS:
This study has showed for the first time in humans that T2-STIR accurately can determine myocardium at risk. This can be used in clinical research when studying new therapies for reducing infarct size.

Fig 1

:

Short axis slices of left ventricle showing inferior defect on SPECT (arrows, left panel) corresponding to the oedema signal on T2-STIR MRI (arrows, middle panel). For comparison, delayed enhancement in right panel shows subendocardial infarction (arrows).
Abstract 3057: Tissue Engineered Three-layered Artery Using Hemodynamically-equivalent Pulsatile Bioreactor
Authors: Iwasaki Kiyotaka , Kojima Koji , Kodama Shota , Paz Cristina , Umezu Mitsuo , Vacanti Charles A
Published: July 2021

Introduction: Due to lack of anti-thrombogenicity in small diameter vascular prostheses, there is a strong demand for tissue-engineering autologous small-diameter graft, which can function in arterial high pressure and flow environments. Here, we investigated a potential to engineer a robust and three-layered artery.

Methods: Endothelial cells (ECs), smooth muscle cells (SMCs) and fibroblasts were isolated with collagenase from bovine artery, then each cell were primary cultured. A polyglycolic acid (PGA) sheet seeded with SMCs was wrapped on silicon tube with a diameter of 6 mm. After 4 days of incubation, a polycaprolactone sheet seeded with SMCs was over-wrapped. Then, after incubation for another 3 weeks, a PGA sheet seeded with fibroblasts was over-wrapped and incubated for another 2 days. The luminal tube was then removed out, and the tubular tissue was mounted on a specially designed chamber. The luminal areas of engineered tubular structure were seeded with half a million of ECs and incubated for another 2days. Finally, bioreactor culture was performed for more 2weeks (n=10). Pulsatile flow and pressure were gradually increased from mean flow rate of 0.2(0.5/0) L/min and mean pressure of 20(40/15) mmHg to 0.6(1.4/0.2) L/min and 100(120/80) mmHg.

Results: Scanning electron microscopic examination and von Willebrand factor stain revealed that ECs lined over the lumen and oriented by flow stimulation. Stain of Elastica Van Gieson and Masson Tricrome showed that a lot of elastin components and collagen were produced in the tissue engineered grafts. Stain for α-SMA, calponin, and vimentin showed that engineered arteries were constructed from SMC and fibroblasts regions and morphologically organized as three layered. Tensile tests demonstrated that ultimate strength of engineered arteries were increased by 6.7 times as compared with that of biodegradable polymers (n=8) and become equivalent to that of the native arteries (Native: 882±133kPa, Engineered: 827±155kPa) (each n=8).

Conclusion: A robust and three-layered small-diameter elastic artery was engineered from vascular cells and biodegradable polymers using the hemodynamically-equivalent pulsatile bioreactor.
Abstract 3388: Usefulness Of The Valvulo-arterial Impedance To Predict Adverse Outcome In Aortic Stenosis
Authors: Hachicha Zeineb , Dumesnil Jean G , Pibarot Philippe
Published: July 2021

Background

. We recently proposed a new index: the valvulo-arterial impedance (Z
va
), which represents the valvular and arterial hemodynamic factors that oppose ventricular ejection. This index is calculated by dividing the estimated left ventricule (LV) systolic pressure (systolic arterial pressure + mean transvalvular gradient) by the stroke volume indexed for the body surface area. We previously demonstrated that Z
va
is superior to standard indices of aortic stenosis (AS) severity in estimating the global LV afterload and predicting the occurrence of LV dysfunction.

Objective

: to assess the usefulness of Z
va
to predict adverse outcome in AS.

Methods

. We retrospectively analyzed clinical and echocardiographic data of 544 consecutive patients (320 men and 224 women; mean age: 70±14 years) having at least moderate AS (aortic jet velocity ≥2.5m/s) and no symptoms at baseline. The primary end-point for this study was the occurrence of aortic valve replacement (AVR) or death.

Results

. The mean follow-up time was 2.5±1.8 years. Ninety one patients (17%) died and 176 (32%) had aortic valve replacement (AVR) during follow-up. The 3-year event-free survival was significantly lower in patients (n=180, 33%) with Z
va
≥ 4.5 mmHg.ml
−1
.m
−2
compared to those (n=192, 35%) with Z
va
between 3.5 and 4.5, and those (n=172, 32%) with Z
va
≥ 3.5: respectively 33±5% vs 51±4% and 56±5%, p<0.001. A value of Z
va
≥ 4.5 was associated with an age-adjusted risk of adverse event of 1.3 (95% confidence interval: 1.1–1.6, p=0.0015). On multivariate analysis, the independent predictors of the event-free survival were: peak aortic jet velocity (p<0.001), coronary artery disease (p=0.001) and Z
va
(p=0.03). Two-year overall survival was also significantly (p=0.001) lower in the patients with a baseline Zva ≥ 4.5 (70±5%) compared to those with Zva between 3.5 and 4.5 (80±3 %) and those with Z
va
≤ 3.5 (88±3 %).

Conclusion

. A value of valvulo-arterial impedance ≥ 4.5 mmHg.ml
−1
.m
−2
identifies patients with a poor outcome. These findings suggest that beyond standard indices of stenosis severity, the consideration of valvulo-arterial impedance may be useful to improve risk stratification and clinical decision making in patients with AS.
Abstract 3473: The Effect of Cigarette Smoking on the Antiplatelet Effect of Clopidogrel: The Smokers Paradox
Authors: Gurbel Paul , Dichiara Joseph , Bliden Kevin P , Antonino Mark J , Lookman Lawal
Published: July 2021

Background:
Wide response variability to clopidogrel therapy has been reported. Clopidogrel is a prodrug that requires metabolic activation by hepatic cytochromes (CYP). Cigarette smoking is an inducer of CYP1A2 and may, therefore, enhance the metabolism of clopidogrel. We sought to examine the effect of cigarette smoking on the platelet response to clopidogrel.

Methods:
Three hundred thirteen consecutive patients undergoing elective coronary stenting were studied. Platelet aggregation (PA) was assessed by light transmittance aggregometry (LTA) stimulated by 5 and 20μ M adenosine diphosphate. One hundred fourteen patients were on chronic clopidogrel therapy, were not reloaded, and had pre-stenting PA measurements. Pre-and post-stenting PA was measured in 199 patients: 60 were loaded with 300mg and 139 were loaded with 600mg. There were 120 current smokers (smoking within 2 weeks of PCI) and 193 non-smokers (no prior history of smoking). Low PA was defined as the lowest two quartiles of 5μM ADP-induced platelet aggregation (≤ 40%).

Results:
PA was significantly lower (p ≤ 0.008) in smokers on long term chronic clopidogrel treatment (Table

). Relative platelet inhibition (RPI) was higher in smokers treated with either 300mg or 600mg clopidogrel measured by 5 and 20μM ADP-induced PA. In a multivariate analysis, cigarette smoking was an independent predictor of low PA in patients on chronic clopidogrel therapy and in patients loaded with clopidogrel (r=0.3, p=0.0001).

Conclusion:
Clopidogrel therapy in smokers is associated with increased platelet inhibition and lower aggregation as compared to non-smokers. The mechanism of the smoking effect deserves further study and may be another cause of response variability to clopidogrel.
RPI =
100 x ((baseline aggregation-post-treatment aggregation)/(baseline aggregation))
Abstract 3507: Optimal Medical Therapy With or Without Percutaneous Coronary Intervention for Stable Coronary Artery Disease is Effective in Patients with Chronic Kidney Disease
Authors: Sedlis Steven P , Jurkovitz Claudine T , Hartigan Pamela M , Lorin Jeffrey D , Dada Marcin , Maron David J , Teo Koon K , O’Rourke Robert A , Boden William E
Published: July 2021

Background
: Chronic kidney disease (CKD) is a risk factor for poor outcomes in patients with CAD. Optimal management of such patients is uncertain. CKD patients (especially those with diabetes) are at risk for contrast nephropathy potentially limiting the benefits of percutaneous coronary intervention (PCI).

Methods:
To evaluate the impact of adding PCI to optimal medical therapy (OMT) in CKD patients with stable CAD we analyzed outcomes stratifying by renal function in the COURAGE trial. We used the abbreviated Modification of Diet in Renal Disease equation to estimate glomerular filtration rate (GFR).

Results:
A total of 2287 patients were enrolled in COURAGE. Of those, 30% (n=536) had CKD defined as GFR <60mL/min/1.73m
2
. CKD was present in 26% of OMT patients and 21% of OMT +PCI patients. The CKD group was older (66 ±10 versus 61 ± 9.6years P<0.001) had more females (24% versus 12 % p<0.001) more hypertension (71% versus 66% p <0.03) and higher systolic blood pressure (135 ±21 versus 131 ± 19mm/Hg p =<0.001). There was a trend to more diabetes (37% versus 34% p <0.22) and 3 vessel CAD (33% versus 30% p <0.09). ACEI or ARB use was 76% in CKD patients. By 36 months there was similar and intensive risk factor control in patients with and without CKD (systolic blood pressure 125 ± 17 versus 125 ± 17mmHg, LDL 79 ± 24 versus 78 ± 26mg/dL respectively p = NS). The primary composite end-point of COURAGE (death or MI) did not differ by treatment in patients with or without CKD. Rates of death, MI, CHF and angina-free survival at 36 months stratified by treatment status in patients with GFR>60 versus patients with GFR > 60 are shown in the table

.

Conclusion:
Patients with CKD and chronic stable angina when treated with OMT to aggressive blood pressure and lipid goals have marked and sustained improvement in angina similar to patients without CKD. Furthermore, patients with CKD can safely undergo PCI for improved angina control without excess death, MI or CHF when compared to patients treated by OMT alone.
Abstract 3532: Lipoprotein-Associated Phospholipase A
2
and High Sensitivity C-Reactive Protein Levels and the Prediction of Cardiovascular Risk Among Coronary Artery Disease Patients With Differing Clinical Presentations
Authors: May Heidi T , Anderson Jeffrey L , Horne Benjamin D , Pearson Robert R , Wolfert Robert L , Kolek Matthew J , Carlquist John F , Lanman Richard B , Ronnow Brianna S , Muhlestein Joseph B
Published: July 2021

Background
: Inflammation plays a role in the development and progression of coronary artery disease (CAD), with circulating markers of vascular inflammation being used in risk assessment including high sensitivity C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A
2
(LpPLA
2
). While hsCRP responds to the systemic inflammatory stimulus of acute myocardial infarction (AMI), LpPLA
2
has been proposed to be more vascular-specific and to vary minimally based upon clinical presentation. To test this hypothesis, we evaluated both biomarkers among CAD patients presenting with stable angina (SA), unstable angina (USA) or acute myocardial infarction (AMI).

Methods
: LpPLA
2
(PLAC
TM
test, diaDexus, Inc.) and hsCRP were measured from samples donated by consenting patients (N=1,010) enrolled in the registry of the Intermountain Heart Collaborative Study that underwent angiographic evaluation for CAD. Patients were categorized by presentation status (SA=637; USA=205; and AMI=168), stratified according to median levels of LpPLA
2
(350.2 ng/mL) and hsCRP above and below 3 mgl/L and followed for 7.5 ± 2.4 years for CAD death.

Results
: Age averaged 64 ± 12 years and 70% were male. While median hsCRP (mg/L) levels differed significantly by presentation [2.86, 2.80, and 13.7 for SA, USA, and AMI, respectively (p<0.0001)], median LpPLA
2
(ng/mL) levels [350.2, 353.1, and 348.1 for SA, USA, and AMI, respectively (p=0.67)], did not. LpPLA
2
was not only a better predictor of CAD death among the entire cohort (LpPLA
2
: adjusted Hazard Ratio [HR]= 1.47, p=0.04; hsCRP: adjusted HR=0.95, p=0.81), it was a better predictor among patients presenting with AMI (LpPLA
2
: adjusted HR3 1.80, p=0.30; hsCRP adjusted HR=0.76, p=0.63).

Conclusions
: Among CAD patients, LpPLA
2
varies minimally among differing presentations compared to hsCRP and is a better a predictor of CAD death among those presenting with AMI. This information supports the hypothesis that LpPLA
2
is a vascular specific marker of inflammation and independent of transient systemic inflammatory effects.
Abstract 3553: Effect of Resolution of Metabolic Syndrome on Endothelial Function and Cardiovascular Events after Acute Coronary Syndromes
Authors: Miyazaki Shin-ichiro , Hiasa Yoshikazu , Takahashi Takefumi , Ogura Riyo , Suzuki Naoki , Hosokawa Shinobu , Kishi Koichi , Ohtani Ryuji
Published: July 2021

Background:
Metabolic syndrome (MetS) is associated with endothelial dysfunction, and recognized as a risk factor of cardiovascular events after acute coronary syndromes (ACS). We examined whether the resolution of MetS would improve endothelial function and provide a beneficial effect on clinical outcome after ACS.

Methods:
We studied 60 patients with MetS who underwent a percutaneous revascularization procedure for ACS. MetS was defined using modified International Diabetes Federation criteria. Brachial artery flow-mediated dilation (FMD) and several risk parameters related to metabolic disorders were assessed at baseline and at 6 months. Each patient was given basic spoken advice on lifestyle modification and optimal medications before discharge. Patients were divided into 2 groups according to whether the criteria for MetS were fulfilled at 6 months: resolved MetS (R-MetS, n=35) and persistent MetS (P-MetS, n=25). Cardiovascular events were defined as cardiac death, stroke, myocardial infarction, unstable angina, and target vessel revascularization.

Results:
During the 1-year follow-up, 3 patients with R-MetS (8.6%) and 14 patients with P-MetS (56%) had cardiovascular events (p=0.0002). The extent of improvement in FMD was significantly greater in patients with R-MetS than those with P-MetS (change in FMD: 1.5 vs −1.2: p=0.007; respectively). In a multivariate logistic regression analysis, P-MetS was an independent predictor of cardiovascular events (odds ratio 18.4, 95%CI 1.67–28.5, p=0.025).

Conclusion:
The resolution of MetS is associated with the recovery of endothelial function and prevents cardiovascular events after ACS.

Multivariate logistic regression analysis
Abstract 3711: School-based Early Prevention Interventions Decrease Body Mass Index Percentiles During School Year, but Children Experience Increase in Percentiles During Summer
Authors: Hollar Danielle , Hollar Theodore L , Agatston Arthur S
Published: July 2021

Introduction: The Healthier Options for Public Schoolchildren (HOPS) Study aims to understand the efficacy of early prevention efforts addressing nutrition and physical activity in elementary school setting during the school year.

Hypothesis: We assessed the hypotheses:

HOPS interventions improve age and gender-specific body mass index (BMI) percentiles more so than traditional dietary and physical activities;

intervention children maintain healthier BMI percentiles during summer vacation compared to controls.

Methods: HOPS, in its 3
rd
year, includes approximately 3,200 children (48% Hispanic) in six elementary schools (4 intervention; 2 control). Data are collected in fall and spring. Interventions include modified dietary offerings, nutrition and lifestyle curricula, school gardens, and other wellness projects, with the goal of reducing childhood obesity rates in a manner that is replicable in other public school settings.

Results: Overall, data for the academic year 2 show statistically significant differences between treatment groups with respect to changes in BMI percentiles. Analyses of subgroups show trends towards greater improvements for intervention children, but only those classified as normal and in the 3
rd
quintile at study baseline experienced statistically significantly improvement. Data analyzed for summer vacation time show increases in BMI percentiles for both intervention and control children with the exception of intervention children classified as overweight or in the 5
th
quintile at study baseline. Control children classified as at risk or overweight as well as those in the 3
rd
, 4
th
, and 5
th
quintiles experienced greater increases in their BMI percentiles during summer.

Conclusions: Early results show HOPS interventions improve BMI percentiles of elementary-aged children during the school year. However, all children appear to be losing ground during summer vacation as their BMI percentiles increase during this time.

Changes in BMI Percentiles during School Year
Abstract 3718: Preliminary Findings ff ECG Screening in 9,125 Young Adults
Authors: Nora Matthew , Zimmerman Frank , Ow Philip , Fenner Patrick , Marek Joseph
Published: July 2021

Introduction:
The occurrence of SCD in young adults is devastating to a community. It is estimated that over 1,000 of these deaths occur annually in the USA. Experience in Italy utilizing ECG screening has demonstrated an 89% reduction in SCD in young athletes. Reports in the literature suggest a high % of abnormal findings in athletes. Concern is therefore raised that ECG screening will lead to a large number of abnormal ECGs which may lead to widespread testing and anxiety for the students.

Methods:
We have developed an efficient screening process to perform ECG testing on high school students utilizing community volunteers. Six high schools in the Chicago suburban region cooperated in an ECG screening program. Screening was performed during regular school hours. A total of 9,125 students were tested. A total of 138 of ECGs were abnormal (2%). The ECG abnormalities detected are outlined in Fig. 1. Many of the ECG abnormalities are likely to represent clinically important findings for these young adults.

Conclusion:
ECG screening of high school student results in an acceptable % of abnormal findings. The types of abnormalities detected are often of clinical significance.

Number of Abnormal ECGs
Abstract 77: Effects Of Short-term Fasting On Mortality, Inflammatory And Coagulation Responses To Endotoxin-induced Shock In Rats
Authors: Kobayashi Kyoko , Taniguchi Takumi , Yamamoto Ken
Published: July 2021

Obesity is a common problem in sepsis. We evaluated the effects of short-term fasting on the mortality rate, inflammatory and coagulation response in rats with endotoxin-induced shock. Male Wister rats (n=30) were used. Animals were randomly assigned to one of two groups: control group (n=15), receiving intravenous Escherichia coli endotoxin (15 mg/kg over 2 mins); fasted group (n=15), short-term fasting for 3 days before endotoxin injection. The mortality rates, hemodynamics, arterial blood gases, plasma cytokine concentrations and coagulation parameters were measured. The mortality rates at 8hrs after endotoxin injection were 75% and 7% for control and fasted groups, respectively. Hypotension and the increases of TNF-alpha and interleukin-6 concentrations were less for the fasted group than the control group. Moreover, the increase of the prothrombin-time and thrombin-antithrombin III complex were less for the fasted group than the control group. The present study showed that short-term fasting inhibited hypotension and elevations in cytokine concentrations, reducing the mortality rate of rats with endotoxin-induced shock. Moreover, short-term fasting inhibited the elevation of coagulation parameters. These findings suggest that short-term fasting may exert favorable effects during sepsis and septic shock.

Survival curves for fasted and control groups
Abstract 5790: Dual Molecular Imaging for Assessment of Matrix Metalloproteinase and Apoptosis in Atherosclerotic Lesions before and after Statin Therapy
Authors: Fujimoto Shinichiro , Hartung Dagmar , Edwards D. Scott , Azure Michael , Zhou Jun , Fujimoto Ai , Isobe Satoshi , Matsumoto Yuji , Narula Navneet , Yamazaki Junichi , Petrov Artiom , Narula Jagat
Published: July 2021

We evaluated the correlation between matrix metalloproteinase (MMP) and apoptotic activities in atherosclerosis lesions, and the impact of lipid lowering by dietary modification and statin therapy employing molecular imaging with Tc-99m broad MMP inhibitor (MPI) and indium-111 annexin A5 (AA5). Atherosclerosis was produced in 13 New Zealand White rabbits by balloon deendothelialization and hypercholesterolemic diet for 4 months; 6 unmanipulated rabbits on normal chow were used as controls. In the last month, 3 of the 13 atherosclerotic rabbits were changed to normal chow, and 4 received fluvastatin (1mg/kg) once a day. MPI and AA5 imaging were performed using micro-SPECT/micro-CT. After in vivo imaging, aortas were explanted to acquire ex vivo images and calculate percent injected dose per gram (%ID/g) uptake. Histological and immunohistochemical characterization and extent of MMP and apoptosis were evaluated in representative aortic samples. Both MPI and Annexin uptake were clearly visualized in the atherosclerotic lesions by noninvasive imaging; No uptake were observed after diet withdrawal, fluvastatin, and in normal control groups. %ID/g MPI and AA5 uptakes in the atherosclerotic lesions (0.09 ± 0.02%, 0.03 ± 0.01%) were significantly higher than the uptake in control abdominal aorta (0.014 ± 0.004%, 0.0007 ± 0.0002%; p<0.0001). The quantitative uptake in fluvastatin (0.053 ± 0.013%, 0.02 ± 0.01%; p<0.05) and diet withdrawal (0.047 ± 0.005%, 0.02 ± 0.004%; p<0.05) groups were statistically significantly lower compared to diet uninterrupted group. There were significant direct relationship betweem MPI and AA5 uptake in all experimental group (r=0.62, p<0.0001). The decrease in the tracer uptake maintained the relationship in the fluvastatin group (r=0.62, p<0.0001) but became less apparent in the diet withdrawal (r=0.24, p<0.05). Histopathological and immunohisto-chemical studies revealed a significant correlation of both MPI and Annexin uptake with macrophage infiltration, MMP-2, 9 expression and the extent of apoptosis. Dual imaging with MPI and AA5 showed good correlation between apoptosis and MMP expression except diet withdrawal group.
Abstract 5927: Do Surgically Placed Left Ventricular Leads Provide the Same Benefit as Percutaneous Leads for Cardiac Resynchronization?
Authors: Maxwell Cory , Mahapatra Srijoy , Swenson Brian , Girotti Micah , Bergin James , Kron Irving L , Kern John , Ailawadi Gorav
Published: July 2021

Objective

: Cardiac resynchronization using a percutaneous left ventricular (LV) lead inserted via the coronary sinus improves symptoms of congestive heart failure (CHF), ejection fraction (EF), and survival. An epicardial LV lead is often placed surgically after failed percutaneous attempt, although it is unknown if they offer the same benefits. The objective of this study was to determine if patients with surgically placed LV leads derive the same therapeutic effect as those with percutaneously placed leads.

Methods

: Forty-five sequential patients who had surgically placed epicardial LV leads (via thoracotomy or thoracoscopy) after failed percutaneous lead attempt were 3:1 propensity score matched with 135 patients who had successful percutaneous placement. Patients’ scores were matched for the variables age, EF, and QRS interval using greedy methodology. Postoperative outcomes including mortality, CHF readmission, and New York Heart Association (NYHA) class were compared using standard univariate techniques.

Results

: Mean follow-up was 20±15 months. There were no differences in preoperative variables including age, EF, NYHA class, and etiology of CHF. No differences in 30-day mortality, long-term mortality, CHF readmission rate or EF % increase were identified between groups. Post-procedure complications of acute kidney injury (defined by creatinine increase >1.0: 26.2% vs. 4.9%, P<.001) and infection (11.9% vs. 2.4%, P=.026) were more common in the surgical group. Improvement in NYHA class was more common in the surgical group.

Conclusions

: Surgical LV lead placement offers functional benefits similar to percutaneous placement and possibly greater likelihood of NHYA class improvement. This comes with the greater risk of reversible acute kidney injury and post procedural infection.
Abstract 5963: Prevention of Tilt-Table Induced Vasovagal Response by Angiotensin-Converting Enzyme Inhibition
Authors: Deftereos Spyridon , Giannopoulos Georgios , Kouvousis Nikolaos , Raisakis Konstantinos , Kossyvakis Charalampos , Ntzouvara Olga , Driva Metaxia , Panagopoulou Vasiliki , Michelakakis Nikolaos , Matsakas Evaggelos
Published: July 2021

The use of various pharmacologic agents has been proposed for the preventive treatment of vasovagal syncopal episodes, with conflicting efficacy results from various studies. Angiotensin-converting enzyme inhibitors (ACEIs), although reported in small studies to have a beneficial effect in patients with vasovagal syncope, have not been generally accepted as part of conventional treatment in such patients. Our population consisted of 125 consecutive patients (60 male, mean age 40±15 years), with a positive head-up tilt-table testing (HUTTT) (cardioinhibitory or vasodepressive or mixed response), who were randomized to receive either the ACEI fosinopril (N=63), at a dose of 10 mg qd, or placebo (N=62), for 30 days. They were then submitted to a new HUTTT (80 degrees, before and after infusion of isoproterenol, at a max. rate of 5 mcg/min). Before randomization, the patients were stratified according to the use of other vasoactive agents. Physicians performing the HUTTT were blinded as to each patient’s randomization group. Twenty-eight (44%) of fosinopril-treated patients were positive in the second HUTTT versus 52 (84%) in the placebo group (p=0.015). In a multivariate analysis, entering, apart from the treatment group, patient age, gender, smoking habit, hypertension, the use of beta-blocking agents and various demographic factors, with a negative result in the second HUTTT as the dependent variable, female gender, younger age and the use of fosinopril were independently associated with a negative repeat HUTTT. The present study reports a potential preventive effect of ACEIs in vasovagal syncope and indicates that younger, female patients, taking fosinopril were more likely to have a negative repeat HUTTT. The observed effect may be related to the ability of ACEIs to reduce cardiac wall tension, thus decreasing the activation of C-mechanoreceptors, as well as to their potential to inhibit angiotensin-related catecholamine release.
Abstract 5802: Whole-Heart Coronary Angiography using Volume Computed Tomography in Comparison to Conventional Coronary Angiography
Authors: Dewey Marc , Zimmermann Elke , Deissenrieder Florian , Laule Michael , Dübel Hans-Peter , Rutsch Wolfgang , Hamm Bernd
Published: July 2021

This is an initial report on the use of the recently introduced whole-heart 320-slice computed tomography (CT) scanner for noninvasive coronary angiography compared with conventional coronary angiography (CCA). Whole-heart CT avoids overscanning and overranging as necessary for helical coronary CT acquisitions thereby significantly reducing the effective radiation dose. Twelve patients with suspected coronary artery disease (4 women, 8 men; mean age 64.6 ± 11 years) have undergone coronary CT angiography using a 320-slice scanner (Aquilion ONE, Toshiba; 0.35 s gantry rotation time, 120 kV, and 350 – 450 mA) prior to clinically indicated CCA. CT images were manually reconstructed in motion-free phases with 0.5-mm slice thickness and 0.25-mm slice increment. Independent blinded assessment of CT and CCA (using quantitative analysis) was performed to detect significant (at least 50%) diameter stenoses. Of the 12 patients, in 8 patients, single-heart beat CT acquisition was performed, resulting in an effective dose of 5.6 ± 1.1 mSv and an image reconstruction window length of 175 msec. In the other 4 patients, because of higher heart rates, 2 or 3 heart beats were used for acquisition, resulting in higher radiation exposure (on average 17 mSv) and the possibility to perform multisegment reconstruction with improved temporal resolution (88 and 58 msec image reconstruction windows, respectively). Per-patient sensitivity and specificity for CT compared to CCA were 100%. Per-vessel sensitivity and specificity were 88% and 95%, respectively. Intraindividual comparison of CT with CCA revealed a nonsignificantly smaller effective radiation dose (9.4 ± 7.2 mSv vs. 10.5 ± 5.3 mSv, p<0.69) but significantly smaller contrast agent amount (80 ±0 ml vs. 107.3 ± 17.8 ml, p<0.01) for 320-slice CT. Whole-heart CT significantly reduces the contrast agent amount compared to CCA while radiation exposure is reduced in patients with slow heart rates. This initial report also indicates that diagnostic accuracy of coronary CT angiography using up to 320 simultaneous detector rows remains high as compared with CCA as the reference standard.
Abstract 3137: Failure of the Chromosome 9p21 Locus to Predict Myocardial Infarction when Non-Event Patients’ Coronary Disease Phenotype is Angiographically-Characterized
Authors: Horne Benjamin D , Carlquist John F , Muhlestein Joseph B , Bair Tami L , Anderson Jeffrey L
Published: July 2021

A chromosome 9p21 locus is associated with coronary heart disease (CHD) phenotypes in at least 25 independent populations, but multiple clinically-distinct phenotypes have been evaluated. Utilizing angiographic coronary artery disease (CAD) phenotyping, this study evaluated whether 9p21 single nucleotide polymorphisms (SNPs) predict ischemic events (e.g., myocardial infarction [MI]) among CAD patients. Two populations of patients undergoing coronary angiography during 1994 –2007 (population 1: N=1,748; population 2: N=1,014) were evaluated for association of a 9p21 tagging SNP (rs2383206, A–>G) with a composite MI/death endpoint vs. no event among patients with angiographically-significant CAD. Secondary analyses evaluated rs2383206 in two additional angiographic populations that included both CAD and non-CAD patients (population 3: N=2,122; population 4: N=1,466) for the phenotypes of MI vs. CAD/no MI, MI vs. no CAD, and CAD/no MI vs. no CAD.
Post hoc
analysis evaluated three other 9p21 SNPs. No association of rs2383206 was found with MI/death in populations 1 (OR=0.95 per G allele, p-trend=0.48) and 2 (OR=0.91 per G allele, p-trend=0.28), or with MI vs. CAD/no MI in populations 3 (OR=0.96 per G allele, p-trend=0.57) and 4 (OR=0.89 per G allele, p-trend=0.21). Among CAD patients, no association of rs2383206 was found with Duke CAD Index, number of significantly diseased vessels, left main disease, ostial disease, or proximal disease in the four populations. In contrast, rs2383206 was associated with CAD/no MI compared with no CAD (population 3: p-trend=0.0001; population 4: p-trend=0.0008). These findings were confirmed for rs2383207, rs10757274, and rs10757278. The chromosome 9p21 locus was not associated with MI or a composite of MI/death, or with extent or location of CAD, although it did predict CAD presence. This suggests that 9p21 is involved in the initiation or facilitation of CAD, not CAD progression or the precipitation of acute events. These findings contradict prior reports of a 9p21 association with MI, likely due to differences in study design and phenotype quality. High-quality angiographic phenotyping would be a useful standard in genetic association studies of CHD.
Abstract 3147: Uric Acid Independently Predicted Acute Coronary Syndrome in a Large Cohort of Ethnic Chinese
Authors: Chuang Shao-Yuan , Chen Jonathan Jiunn-Horng , Wu Chih-Cheng , Pan Wen-Harn
Published: July 2021

Few studies examine the association between serum uric acid (SUA) and acute coronary syndrome (ACS). We aimed to investigate the association between SUA and ACS in a prospective study of ethnic Chinese. Enrolled were 128569 adults ≥ 20 yrs from 4 MJ Health Checkup Clinics in Taiwan during 1994 –1996, excluding those with heart disease, stroke, renal disease and cancer disease. All physical examination, biochemical test and structured questionnaire were executed in standardized central labs. ACS was defined by main ICD-9 of 410 – 414 from claim data of National Health Insurance for hospitalization and from Death certification registry. Cox proportional hazard model was used to estimate the hazard ratios (HRs) between levels of SUA and ACS events. A total of 2049 subjects (Men: 1239/Women: 810) developed ACS during the period from baseline to Dec.31.2002. Men had higher ACS incidence than women (2.84 vs. 1.61 per 1000 person-years [PY]; p < .0001). Independent risk factors of ACS unfolded from this study included age, male sex, waist circumference, body mass index, triglycerides, total-cholesterol, hypertension, diabetes, uric acid, and current smoking. The crude incidences of ACS were 1.27, 2.06, 3.27 and 4.61 per 1000 PY in that order for four consecutive SUA groups (group1: <5.0 mg/dl; group 2: 5.0 – 6.9 mg/dl; group 3: 7.0 – 8.9 mg/dl; group 4: ≥9.0 mg/dl) (p-value for trend <.0001). Compared to group1, the multi-variate adjusted HRs (95% Confidence intervals) were 1.14 (0.92, 1.42) for group 2, 1.38 (1.10, 1.72) for group 3 and 1.38 (1.10, 1.72) for group 4 among men, and 1.03 (0.87, 1.22), 1.30 (1.05, 1.62) and 1.43 (0.99, 2.05) among women after adjusting for age, systolic/diastolic BP, body mass index, triglycerides, total cholesterol, diabetes, smoking, alcohol drinking, physical activity, and occupation. One standard deviation increase in SUA corresponded to around 30% ACS risk increase in women (HR=1.33; 1.04 –1.70) and 60% in men (HR=1.59; 1.25–2.03). Baseline SUA level independently predicts the development of ACS and should be considered as a potential risk factor of ACS.
Abstract 5058: Dietary Intake of Fruits and Vegetables Improves Vascular Function in a Dose Dependent Manner - A Randomised Controlled Trial
Authors: McCall Damian O , McGartland Claire P , McCance David , Young Ian S , Woodside Jayne V
Published: July 2021

Observational evidence has consistently linked increased fruit and vegetable consumption with reduced cardiovascular morbidity. However, there is little direct trial evidence to support the concept that fruit and vegetable consumption improves vascular function. This study has assessed the dose-dependent effects of a fruit and vegetable intervention on arterial health in subjects with hypertension. Following a common 4 week run-in period during which fruit and vegetable intake was limited to 1 portion/day, participants consumed either 1, 3 or 6 portions daily for the next 8 weeks. Endothelium-dependent and independent arterial vasodilator responses were assessed using venous occlusion plethysmography in the brachial circulation pre- and post-intervention. Compliance was monitored using serial contemporaneous 4-day food records and by measuring concentrations of circulating dietary biomarkers. A total of 118 volunteers completed the 12 week study. Participants in the 1, 3 and 6 portions/day groups reported consuming on average 1.1, 3.2 and 5.6 portions of fruit and vegetables respectively, while serum concentrations of ascorbic acid, lutein and β-cryptoxanthin increased across the groups in a dose-dependent manner. For each 1 portion increase in reported fruit and vegetable consumption, there was a 6.2% improvement in forearm blood flow responses to intra-arterial administration of the endothelium-dependent vasodilator acetylcholine (p=0.03). There was no association between increased fruit and vegetable consumption and vasodilator responses to sodium nitroprusside, an endothelium-independent vasodilator. This study illustrates that among hypertensive volunteers, increased fruit and vegetable consumption produces significant improvements in an established marker of endothelial function and cardiovascular prognosis.