bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14342: Relationship Between Peri-Strut Low Intensity Areas and Vascular Healing Response After Everolimus-Eluting Bioresorbable Scaffold Implantation: an Optical Coherence Tomography Study
Authors: Sato Takao , Abdel-Wahab Mohamed , El-Mawardy Mohamed , Tölg Ralph , Richardt Gert
Published: July 2021

Objects:
Peri-strut low intensity areas (PLIA) surrounding stent struts on optical coherence tomography (OCT) images has been histologically related to the delayed healing and inflammation, and have been previously associated with neointimal proliferation particularly in first generation drug-eluting stent era. However, the relationship between PLIA and bioresorbable vascular scaffolds (BRS) implantation remains to be clarified.

Methods:
Of 149 patients treated with the everolimus-eluting BRS at a single institution and followed-up for at least 6 months, 38 patients (50 lesions) underwent follow-up coronary angiography including OCT 11.0 ± 2.1 months after BRS implantation. All patients were prescribed lifelong aspirin (100mg/d) and prasugrel (10mg/d) for at least 6 months. The mean- and percent- neointimal area were evaluated by OCT. PLIA was defined as a peri-strut region with a homogenous lower intensity appearance than the surrounding tissue on OCT images without significant signal attenuation and was graded as follows:grade 0, no PLIA; grade 1, <1 quadrant; grade 2, ≥1 but <2 quadrants; grade 3, ≥2 quadrants but <3 quadrants; and grade 4, ≥ 3 quadrants. Additionally, all patients were divided into two groups (PLIA+ group, N=35 and PLIA- group,N=15).

Results:
The frequency of any PLIA within the scaffold segment was 70.0% (35/50 scaffolds). Mean PLIA grade score was 0.72± 0.77 [Median value (interquartile range), 0.51 (0, 1.07)]. There were significant positive correlations between PLIA score and both mean- (R=0.55,p<0.01) and percent- neointimal area (R=0.58,p<0.01). Both mean- and percent- neointimal area were significantly higher in the PLIA+ group than in the PLIA- group (1.95±0.65 vs. 1.51±0.27 mm
2
, p< 0.01 and 24.0±7.0 vs. 17.4±3.6 %, p< 0.01, respectively).Furthermore, when lesions were divided in 3 groups (group of PLIA score 0, N=15; group of 0<PLIA score<1, N=20; group of 1
<
PLIA score, N=15), mean- and percent- neointima area were different among 3 groups (1.51±0.27 vs.1.66±0.39 vs.2.39±0.73 mm
2
, p<0.01; 17.4±3.7 vs.21.6±5.0 vs. 27.4±8.1 %, p<0.01).

Conclusion:
The presence and extent of PLIA after BRS implantation on OCT imaging appeared to be significantly associated with neointimal formation.
Abstract 14345: Cardioprotective Effect of Trait Forgiveness on Elevated Heart Rates in Patients With Schizophrenia
Authors: Villa Brian , May Ross W , Fincham Frank D , Sanchez-Gonzalez Marcos A
Published: July 2021

Background:
Schizophrenia (SCH), which reduces the average life expectancy by 10-25 years, is associated with an increased risk of diabetes and cardiovascular disease. Elevated resting HR has been associated with increased risk for the development of cardiometabolic disease, which is common in SCH patients. This association may be due in part to increased sympathovagal tone inducing elevated resting HR. However, the impact of cardioprotective positive emotions such as trait forgiveness (TF) on HR and cardiac autonomic modulation via HRV in patients with SCH is not well known. We hypothesized that TF would be a significant predictor of HR in SCH patients.

Methods:
A total of 250 subjects (SCH patients = 80; male = 68; healthy controls [CON] = 170; Male = 115) participated in this study. SCH patients stopped antipsychotic medications 24-hrs before the experiments and were body weight (M ± SEM) (82 ± 5 Kg), aged matched (42 ± 4 years) with CON. Standardized scales were used to measure affectivity including depression (CESD), positivity of relationships (PR), rumination, and TF. After a 10-min rest period, 5-min ECG tracings were collected for HRV analysis. The non-parametric Mann-Whitney U Tests were used to evaluate the differences in HRV parameters at rest between SCH and CON. Hierarchical multiple regression (HMR) analyses were conducted to test the association between HR and affectivity to demonstrate the incremental contribution of sets of predictors in accounting for HR variance.

Results:
There were significant (p<0.01) differences between the groups (CON vs. SCH) in HR (72 ± 1.0 vs. 87 ± 1.4) and HRV the parameters Total Power (1822 ± 134 vs. 1183 ± 148), RMSSD (32.0 ± 1.7 vs. 19.0 ± 1.6), LF (762.7 ± 80.1 vs. 337.4 ± 45.0; surrogate of baroreflex function), and PR (26.1 ± 0.4 vs. 23.5 ± 0.7), but not TF. The HMR models showed that among affective symptoms, TF had an inverse relationship with heart rates and was the only significant predictor (p<.05) in the full model accounting for 8.1% in HR variance in the SCH group.

Conclusions:
These findings suggest that TF positively influences cardiac autonomic modulation in patients with SCH. Prospective studies aimed at examining TF as a cardioprotective behavioral intervention in SCH patients at increased cardiovascular risk.
Abstract 14347: Septal Myectomy is Associated With Worse In-Hospital Outcomes than Alcohol Septal Ablation: Data From the Nationwide Inpatient Sample in the United States, 2003-2011
Authors: Looser Patrick M , Swaminathan Rajesh V , Minutello Robert M , Wong S. C , Bergman Geoffrey , Singh Harsimran , Gade Chris , Charitakis Konstantinos , Kaple Ryan K , Feldman Dmitriy N , Kim Luke K
Published: July 2021

Introduction:
Septal myectomy (SM) and alcohol septal ablation (ASA) are performed for treatment of obstructive hypertrophic cardiomyopathy (HCM). Previous studies comparing ASA and SM are limited to single center registries. We aimed to compare in-hospital outcomes after ASA and SM within a large, national inpatient database.

Hypothesis:

SM is associated with worse in-hospital outcomes than ASA, particularly in low volume centers.

Methods:
We analyzed all patients who were hospitalized for ASA (n=6,386) or SM (n=4,862) in the Nationwide Inpatient Database from 2003 to 2011. Rates of adverse in-hospital events (death, stroke, bleeding, acute renal failure (ARF) and need for permanent pacemaker (PPM)) were examined. Multivariate adjusted analysis was performed to compare outcomes based on tertiles of hospital volume.

Results:
Patients undergoing SM were younger, more likely to be female, have anemia, chronic pulmonary disease, diabetes with complications, obesity, peripheral vascular disease and coagulopathy. The incidence of in-hospital death (5.2% vs. 0.7%), post-procedural stroke (1.8% vs. 0%) and ARF (9.7% vs. 3.3%) were greater in SM vs. ASA groups, respectively (all p<0.001). After adjustment for baseline differences and confounders using multivariate propensity-score adjusted logistic regression analysis, SM remained an independent predictor of in-hospital death (OR 5.59, 95%CI 3.71-8.43), stroke (OR 3.81, 95% CI 2.06-7.07) and ARF (OR 2.23, 95% CI 1.77-2.90). In addition, low hospital volume of SM was an independent predictor of mortality (adj OR 3.11, 95% CI 1.98-4.89) and bleeding (adj OR 3.77, 95% CI 2.12-6.70), while low volume of ASA was not independently associated with an increased risk of adverse post-procedural events.

Conclusions:
In conclusion, SM was associated with worse in-hospital outcomes, including death, stroke and acute renal failure. Low volume status is associated with worse in-hospital outcomes for SM but not for ASA.
Abstract 14365: The Role of Alcohol Abuse and Tobacco Use in the Incidence of Early Acute Coronary Syndrome
Authors: Alkhawam Hassan , Madanieh Raef , Fabisevich Mariya , Sogomonian Robert , El-Hunjul Mohammed , Madanieh Abed , Lieber Joseph J , Vittorio Timothy J
Published: July 2021

Objective:
To investigate the synergistic role of alcohol abuse/dependence and tobacco use in the early incidence of ACS.

Methods:
A retrospective chart analyses of 8076 patients diagnosed with ACS between 2000 to 2014, defined by ICD-9 codes for acute MI, alcohol abuse/dependence and tobacco use. Average age of ACS was calculated for the general population. Patients were then divided into 4 subgroups based on alcohol abuse/dependence and tobacco use status as follows: non-alcoholic non-smokers, non-alcoholic smokers, alcoholic non-smokers and alcoholic smokers.

Results:
The mean age of our 8076 ACS patients population was ~59.5 (95% CI 59.2-59.8). Patients with history of alcohol abuse/dependence appeared to develop ACS ~8.7 years younger than their non-alcoholic counterparts. When tobacco use is incorporated as a risk factor, those with both alcohol abuse/dependence and tobacco use seemed to develop ACS ~5 years earlier than those with history of either alone, and ~20 years earlier when compared to those with neither alcohol abuse/dependence nor tobacco use.

(Table 1 summarizes mean age of ACS incidence in our study subgroups)

Conclusion:
Alcohol abuse/dependence appears to be a risk factor for earlier ACS. In our population, the average age of ACS incidence in alcoholic patients was significantly earlier than non-alcoholic patients. Furthermore, alcoholic patients who also used tobacco developed ACS at an even younger age when compared to those who had history of either alcohol abuse/dependence or tobacco use alone, suggesting a possible synergistic effect of these two risk factors in developing early ACS. Healthcare intervention in this population through screening, counseling and education regarding alcohol abuse/dependence and smoking cession is warranted to reduce early ACS morbidity and mortality.
Abstract 14578: A Meta-analysis of Global Longitudinal Strain as a Predictor of Major Adverse Cardiac Events in Severe, Asymptomatic Aortic Stenosis With Preserved Ejection Fraction
Authors: Furlan Stefanie , Tamariz Leonardo , Chait Robert
Published: July 2021

Introduction:
The timing of surgical intervention in aortic stenosis (AS) is critical. Guidelines recommend aortic valve replacement in severe, asymptomatic AS with an ejection fraction (EF) less than 50%. Two-dimensional speckle tracking echocardiography is a relatively novel way to identify left ventricular dysfunction by measuring myocardial strain. Global longitudinal strain (GLS) is a measurement of deformation of the myocardium, and is considered a more sensitive marker for left ventricular dysfunction than EF.

Hypothesis:
Our aim was to determine if abnormal GLS predicts poor outcomes in severe, asymptomatic AS patients with a preserved EF.

Methods:
We conducted a meta-analysis and searched MEDLINE, EMBASE, Cochrane (2000 to 2015), supplemented by manual bibliographies of key relevant articles. We selected all cohort, cross-sectional, and case-control studies in which GLS was measured and major adverse cardiac events (MACE) were reported. In the case-control studies, we calculated the pooled standard mean difference (SMD) of GLS between those with MACE and those without MACE. In cohort studies, we calculated the pooled relative risk (RR) with the corresponding 95% confidence interval (CI) for incident MACE by using the fixed effects method.

Results:
Our search strategy identified 3 studies that met the inclusion criteria, and included 370 AS patients. Of the 3 studies, all reported data using a case-control design and 2 reported data using a cohort design. The median age of AS patients included was 72.6 years old, the median indexed aortic valve area was 0.44 (cm
2
/m
2
), and the median ejection fraction was 64.2 (%). Of the 370 patients included in the analysis, 183 had MACE. Case-control studies revealed a pooled GLS SMD of 0.5 (95% CI: 0.30-0.69, p<0.01) for patients with MACE compared to those without MACE. Cohort studies revealed a RR of MACE of 2.07 (95% CI: 1.59-2.69, p<0.01) for those with abnormal GLS compared to those normal GLS.

Conclusions:
AS patients with a more positive global longitudinal strain value were more likely to have a major adverse cardiac event despite having a preserved EF and absence of symptoms. Therefore, if abnormal GLS is detected, earlier surgical intervention should be considered in severe, asymptomatic aortic stenosis.
Abstract 14589: Adiponectin Inhibits Hepatic Production of Triglyceride-Rich Apolipoprotein B Lipoproteins Through Both LDL-Receptor Dependent and Independent Mechanisms
Authors: Melone Michelle , Rashid Shirya
Published: July 2021

Background and Rationale:
Increasing plasma concentrations of the anti-inflammatory protein, adiponectin, are significantly and independently associated with a lower risk of coronary heart disease (CHD), while hypoadiponectinemia, conversely, is a strong risk factor for CHD. The mechanisms by which adiponectin mediates its cardioprotective role are not clearly understood. Here, we have elucidated a key cause of the cardioprotective effect of adiponectin, involving a direct inhibitory action on hepatic production of pro-atherogenic triglyceride-rich apolipoprotein B (apoB) lipoproteins, mediated through both LDL-receptor dependent mechanisms, involving PCSK9, and LDL-receptor independent mechanisms.

Methods and Results:
Cultured human hepatocytes (HepG2 cells) and primary human hepatocytes were treated with physiological concentrations of purified recombinant human adiponectin (10 μg/mL) for 24 hours. Adiponectin treatment reduced endogenous apoB cellular expression and secretion markedly by 60% and 30%, respectively, (P<0.01). Adiponectin also reduced apoB production stimulated by prior treatment of cells with oleate or with pro-inflammatory obese human serum (25% reduction for both, P<0.01). Adiponectin-mediated inhibition of cellular apoB production occurred through a substantial increase in levels of hepatocyte LDL-receptors (70%, P<0.01), which promote proteasome-mediated apoB degradation, and which resulted from a 50% reduction in cellular PCSK9 levels (P<0.01 for both). Multiple LDL-receptor independent effects of adiponectin involved mechanisms which reduce cellular apoB stability: (1) a decrease in cellular microsomal triglyceride transfer protein (MTP) (by 25%, (P<0.01); (2) an increase in AMP kinase (by 40%, P<0.01); and (3) marked stimulation of the Akt/Erk insulin signaling pathways.

Conclusions:
Adiponectin has a direct mitigating effect on hepatic apoB production through mechanisms mediated in part by the LDL-receptor and PCSK9, MTP and the insulin signaling pathway. These findings indicate that that inhibition of apoB may explain in large part adiponectin’s cardioprotective role. Furthermore, targeted adiponectin-based therapies may be a novel approach to inhibit hepatic apoB production.
Abstract 14602: Physical and Biophysical Coupling of the Cardiac Sodium Channel Involves 14-3-3
Authors: Clatot Jerome C , Hoshi Malcolm , Liu Haiyan , Wan Xiaoping , Shinlapawittayatorn Krekwit , Ficker Eckhard , Deschênes Isabelle
Published: July 2021

Introduction:
Mutations in SCN5A, the gene encoding for the cardiac sodium channel, produce alterations of the cardiac action potential that lead to life-threatening arrhythmias such as Long QT Syndrome (LQT3) and Brugada Syndrome (BrS). The conventional wisdom that sodium channels exist in complexes containing a single alpha-subunit has been challenged by the existence of dominant-negative (DN) mutations in BrS and the presence of polymorphisms that can restore trafficking and gating deficiencies of mutant channels in LQT and BrS. In fact, we have previously demonstrated that SCN5A subunits can interact with each other. Here we hypothesized that the physical and biophysical interactions between SCN5A alpha-subunits involve the partner protein 14-3-3, known to form dimers.

Methods:
SCN5A DN-BrS mutants and LQT3 gating deficient mutants were expressed in HEK293 cells and in commercially available iPS-derived cardiomyocytes, iCells©, in presence or absence of 14-3-3 inhibition. Resulting currents were measured using patch-clamp.

Results:
In order to investigate if the DN-effect seen by some BrS mutants is due to interaction of the sodium channel with the protein 14-3-3 which in turn would be involved in the alpha-alpha interaction, we expressed two different BrS DN-mutants in HEK293 cells with and without difopein, a specific 14-3-3 inhibitor. The presence of difopein abolished the DN-effect of both mutants. The DN-effect was also abolished when we mutated the putative 14-3-3 binding site on SCN5A and expressed the DN-mutants either in HEK293 cells or in iCells©. Inhibition of 14-3-3 also impaired the biophysical coupling observed in presence of SCN5A gating deficient mutants that affect either activation or inactivation of not only the mutants but also of the wild-type channel. Conclusions: Our results suggest that binding of 14-3-3 to the cardiac sodium channel alpha-subunit is involved in the alpha-alpha interaction and biophysical coupling of the channel. This study not only shifts paradigms in regards to sodium channel assembly and structure, but also puts forward the idea that physical and biophysical uncoupling of cardiac sodium channels could be a new therapy target for cardiac arrhythmias caused by SCN5A mutations.
Abstract 14609: Serum Protein Fingerprinting: A New Approach to the Clinical Screening of Coronary Artery Disease
Authors: Wigginton Katharine G , Dlouhy Luis J , Macfarlane Ronald D
Published: July 2021

Introduction:
A major goal of the 21st century is to mitigate disease and healthcare costs. Coronary artery disease (CAD) kills 370,000 Americans and costs the United States $109 billion each year. More accurate screening tools are needed to ameliorate CAD related morbidity and mortality. A new approach to the direct analysis of blood serum led to the development of a prospective clinical screening tool for CAD involving sodium dodecyl sulfate (SDS) capillary gel electrophoresis (CGE).

Hypothesis:
The novel method generates serum protein profiles which can be used to screen individuals for heart disease by distinguishing profile features of macromolecules involved in CAD.

Methods:
Serum profiles were generated by SDS-CGE for each study participant (n=48), 30 with CAD and 18 ‘NonCAD’ as identified by histories of CAD or unremarkable coronary angiographies. Univariate and multivariate analyses of the profile features were conducted to identify biomarkers and statistically classify participants as CAD or NonCAD. To compare the accuracy of the method with that of an established clinical tool, participants’ 10 Year Framingham Risk Scores (FRS) were calculated. Individuals with FRS scores less than 10% (low) risk were classified as NonCAD and those with greater than 10% (moderate to severe) risk were classified as CAD.

Results:
A “serum protein fingerprint” profile is shown. Relative standard deviations of 2% for MW and 20% for absorbance indicate method repeatability. In the classification of participants as CAD or NonCAD, the respective accuracies of the multivariate canonical and linear discriminant analyses were 90% (p-value of 7E-5) and 94%. The classification accuracy of FRS was less than 42%. Two features of the serum profiles (#’s 3 and 7 (with Prob>F values of 0.01 and 4E-5 respectively)) are potentially novel markers for CAD.

Conclusions:
The proposed serum protein analysis method correlated proteins with CAD and was more accurate than the FRS method in this study.
Abstract 14631: Pulmonary Artery Calcification: A New Threat in Pulmonary Arterial Hypertension
Authors: Chabot Sophie , Ruffenach Grégoire , Tanguay Virginie F , Potus François , Provencher Steeve , Bonnet Sébastien
Published: July 2021

Background:
Pulmonary arterial hypertension (PAH) is associated with imbalance between proliferation and apoptosis of pulmonary artery (PA) smooth muscle cells (PASMCs). Recently, we uncovered a role for microRNA-204 (miR-204), whose downregulation sustains the phenotype in time. In systemic vascular disease, miR-204 downregulation increases the Runt-related transcription factor 2 (RUNX2), a key osteogenic factor inducing calcification. The fact that PAH patients live longer increases the odds of developing PA calcification lesions. Interestingly, the presence and development of calcified lesions in PAH have not been explored. We thus hypothesized that miR-204-dependent upregulation of RUNX2 triggers the development of proliferative and calcified vascular lesions within the lungs, thus worsening PAH.

Methods/Results:
Using CT-scan, we showed that PAH patients (n=50; p<0.05) had significant increase in distal PA calcification compared to control patients matched for age, sex and comorbidities known to promote vascular calcification. This non-invasive finding was histologically confirmed in the same patients post lung transplantation using Von Kossa staining (n=10; p<0.05). Finally, increase in calcification contributes to worsening of PA compliance and is associated with poorer PAH patients’ survival (n=50; p<0.05). At the molecular level, enhanced calcification in PAH patients correlates (n=43; p<0.05) with a miR-204-dependent up regulation of RUNX2 in lungs, distal PA and primary cultured PASMCs (n=12-40, fold change ≈ 2.5). Using gain and loss of function approaches, we demonstrated in PASMCs from PAH and healthy donors (using siRNA and adenoviruses respectively) that RUNX2, promotes PAH-PASMC proliferation (Ki67), resistance to apoptosis (Annexin-V) and calcification (Alizarin red) (p<0.05). Finally, in Sugen/hypoxia rat model of PAH, we demonstrated that RUNX2 inhibition improves pulmonary hemodynamic and reduces PA remodeling and calcification (n=5-12, p<0.05).

Conclusion:
We demonstrated for the first time the presence of significant calcification in PAH distal PA contributing to PAH worsening and identified RUNX2 as an attractive new therapeutic strategy to improve PAH.

*SC and GR equally contributed.
Abstract 14638: Stent-type at Percutaneous Coronary Intervention and Long-term Outcomes in Relation to Renal Function: Data From 103.747 Patients in the SCAAR-registry
Authors: Edfors Robert , James Stefan , Szummer Karolina , Evans Marie , Carrero Juan-Jesus , Spaak Jonas , Jernberg Tomas , Lagerqvist Bo
Published: July 2021

Objective:
To evaluate the risk of hard clinical endpoints of different types of PCI stents in relation to renal function.

Methods:
During 2007 and 2013, 103.747 patients enrolled in the Swedish Coronary Angiography & Angioplasty Registry (SCAAR) with a known serum creatinine were treated with PCI using new generation drug eluting stents (n-DES) (n=32.440), old generation drug eluting stents (o-DES) (n=17.363) or bare metal stents (BMS) (n=53.974). Renal function groups were derived from creatinine estimated glomerular filtration rate (eGFR) and expressed in ml/min/1.73 m2. The hazard risk (HR) of the combined endpoint (all-cause mortality or myocardial infarction readmission) was estimated using Cox landmark analyses (≤1 year and >1 year to 3 years). Adjustments were made for year, hospital, extent of coronary artery disease, indication for PCI, use of multiple stents, periprocedural antithrombotic treatment, number of stents, stent dimensions, diabetes, age, gender, risk factors and history of cardiovascular disease.

Results:
N-DES was associated with a significantly lower up-to 1 year risk compared to BMS in patients with eGFR >60. These associations were attenuated and not significant in patients with eGFR <60. Adjusted HR comparing o-DES and BMS were not statistically different (≤1 year).

There was no significant difference between n-DES and BMS after 1 year. Compared to BMS, o-DES had significantly higher risks in patients with eGFR ≥60 and in patients with eGFR 30-59 HR was similarly but not significantly elevated.

Conclusion:
In this large national registry we found that in patients with normal renal function, n-DES was associated with a lower up to 1-year risk of MI readmission or all-cause mortality, whereas o-DES was associated with a higher risk after 1 year. A similar trend was seen for patients with moderately reduced renal function but not for patients with severely reduced renal function.
Abstract 14680: Evaluation of the Protective Effects of Long-term Doxycycline Treatment on Progression of Marfan-associated Aortic Aneurysm by High-resolution Ultrasound Imaging
Authors: Cui Jason Z , Lee Ling , Sheng Xiaoye , Tibbits Glen F , van Breemen Cornelis , Esfandiarei Mitra
Published: July 2021

Introduction:
Aortic aneurysm is the most life-threatening complication in Marfan syndrome (MFS), a connective tissue disorder caused by mutations in fibrillin-1 gene. We have previously reported that doxycycline, an antibiotic and a general inhibitor of matrix metalloproteinases (MMPs), could improve aortic contractility and elastin fibers structure and organization in a mouse model of MFS. However, the in vivo effects of MMPs inhibition on the progression of aneurysm and pulse wave velocity (PWV) have not been investigated. In this study, we assessed the hypothesis that a long-term treatment with a sub-antibiotic dose of doxycycline would delay the progression of aortic aneurysm and improve the PWV in the Marfan mouse.

Methods:
In this study, we have used a high-resolution, high-contrast ultrasound imaging technique to conduct a longitudinal study in order to measure aortic diameter (dilatation) and PWV (indication of aortic elasticity/stiffness) in the animals. Marfan (n=12) and control (n=13) mice were given a sub-antibiotic dose of doxycycline in their drinking water at a concentration of 0.24 g/L/day beginning at 6 weeks of age, whereas another group of Marfan (n=12) and control (n=12) mice were given plain drinking water for comparison. At 3, and 6 months of age, aortic diameter and PWV of the experimental animals were measured by ultrasound imaging.

Results:
At 3 months of age, measurement of aortic root diameter showed significant dilatation in both treated and non-treated Marfan mice as compared to control groups (p < 0.01). However, at 6 months of age, the aortic root diameter in treated Marfan mice was not different from those in controls. The same observation was made for the Sinus of Valsalva region. Especially in this region, treated Marfan aorta showed significantly reduced diameter compared to non-treated Marfan groups (p < 0.05). With respect to the measurement of PWV, a significant increase was observed in 3- and 6-month Marfan mice aorta vs. control (p < 0.01). Interestingly, doxycycline treatment normalized the PWV in 6-month old Marfan mice compared to non-treated Marfan aorta.

Conclusions:
Our findings show that long-term doxycycline treatment has protective effects in terms of reduction of aortic dilatation and stiffness in Marfan mice.
Abstract 14720: Firefighters Have the Highest Risk for Heart Disease Among Emergency Personnel
Authors: Moody Kelsey A , Matthews Tracey , Wood Richard , Ayvazian Laurel A , Woodbury Erin A , Gile Molly , Szalai Heidi , Pack Quinn R , Headley Samuel
Published: July 2021

Introduction:
Prior studies have shown obesity, lower activity levels and increased stress among emergency personnel, yet it is unclear if the specific sub-type of emergency personnel impacts stress levels and physical activity (PA). The purpose of this study was to compare emergency personnel sub-types for risk of heart disease and compare on and off duty PA and stress levels.

Hypothesis:
We hypothesized that there would be differences in cardiac risk factors, exercise behaviors, and salivary cortisol by type of emergency responders and would be different when on/off duty.

Methods:
We recruited 37 male emergency personnel workers (12 paramedics, 12 police officers and 13 firefighters, ages 20-40) who then underwent three non-sequential days of testing. We measured body composition, lipids, blood pressure, and peak VO2 with a standard Bruce treadmill protocol and calculated Framingham Risk Scores (FRS) on the first day of testing. Participants then wore an accelerometer and measured AM and PM salivary cortisol on and off duty.

Results:
Contrary to our hypothesis, PA levels did not differ between on and off duty. Firefighters expended significantly more kcals per day and took more steps per day compared to paramedics (p < 0.05). Cortisol concentration was significantly higher AM vs. PM on duty (p < 0.05); although off duty cortisol remained elevated. No significance was found between off duty values. Firefighters’ FRS was significantly higher than paramedics (p < 0.05). See Table.

Conclusion:
In conclusion, although firefighters were more active than police and paramedics, they had a higher FRS. Among all emergency personnel types, cortisol concentrations showed a prolonged stress response in the emergency personnel population suggesting a sustained off duty stress response for unclear reasons. These finding suggest that firefighters should focus on decreasing cardiac risk factors and interventions are needed to reduce emergency personnel off duty stress.
Abstract 14751: Rising NT-probnp Levels Are Associated With Reduced Survival in Patients With Patients With Heart Failure With Preserved Ejection Fraction (HFpEF) and Reduced Ejection Fraction (HFrEF)
Authors: Poonacha Thejaswi , Sahni Nishant
Published: July 2021

Objective/Aim:
To determine the impact of temporal trends in NT-proBNP levels on 6-month survival in HFpEF and HFrEF.

Introduction:
High levels NT-proBNP are associated with reduced survival patients with heart failure. However, it remains to be conclusively demonstrated that in addition to absolute NT-proBNP levels, temporal trends in NT-proBNP level in individual patients also impact survival.

Methods:
We conducted a retrospective study on a cohort of 8255 patients who had at least one admission to the hospital with diagnoses of heart failure between Jan 2011 and Dec 2014.Using EMR data, we created a dataset that included all NT-proBNP levels obtained on these patients at any time during the study interval, irrespective of whether the test was done in a hospital or clinic setting. We used text-mining techniques to extract the numerical value of ejection fraction from reports of echocardiograms obtained during this interval. We performed multivariate regression analysis to identify factors independently associated with six-month survival. In addition, we also constructed Kaplan-Meier curves to determine the impact of temporal trends in NT-proBNP in individual patients on 6-month survival.

Results:
For patients with HFpEF (EF>45%), and HFrEF, maximum NT-proBNP levels achieved during the study period were associated with higher odds of 6-month mortality (p <0.05). Independent of the absolute NT-proBNP level, patients with a rising BNP level had higher odds of 6-month mortality (Odds ratio (OR): 1.29-1.52) as compared to patients with stable or declining NT-proBNP levels. This was true both for patients with HFpEF (OR: 1.30-1.66) and for patients with HFrEF (OR: 1.13-1.43). Kaplan-Meier survival curves demonstrated significantly higher 6 month survival rates for patients that did not have a net rise in NT-proBNP levels for patients both the subtypes of HF. (p <0.05)

Conclusion:
A rising NT-proBNP level is associated with higher 6-month mortality in patients with HFpEF as well as HFrEF. This may indicate that the use of NT-proBNP guided therapy for patients with heart failure merits further study.
Abstract 14767: Delayed R-Wave Peak Time on the 12-lead ECG is Associated With Increased Risk of Sudden Death
Authors: Darouian Navid , Narayanan Kumar , Uy-Evanado Audrey , Teodorescu Carmen , Reinier Kyndaron , Chugh Harpriya , Gunson Karen , Jui Jonathan , Chugh Sumeet S
Published: July 2021

Background:
Left ventricular hypertrophy (LVH) is associated with sudden cardiac death (SCD), and there is emerging evidence for unique electrical vs. ventricular myocardial mass related mechanisms. We investigated the correlation between delayed R-Wave Peak Time (DRWPT), or intrinsicoid deflection, in the lateral precordial leads and LV mass in patients who suffered SCD.

Methods:
In an ongoing prospective, population based study of SCD in a Northwestern US metro region (approx. 1 million population), SCD cases were compared to geographic controls with coronary artery disease (CAD) and no SCD. Archived ECGs (closest and unrelated to SCD event for cases) were evaluated for the presence of DRWPT defined as an intrinsicoid deflection of ≥ 0.05 seconds in V5 or V6. LV mass from echocardiograms and detailed clinical information was obtained for all subjects. Patients with wide QRS (>100 ms) were excluded.

Results:
Cases (n=146, Age: 67.7 ± 14.6 yrs, Male: 55.5%) as compared to controls (n=227, Age: 66.3 ± 11.5 yrs, Male: 59.0%) were significantly more likely to have DRWPT on ECG (17.1% vs 9.2%, p=0.02). DRPWT correlated poorly with echo determined LVH (Kappa statistic 0.03) with no significant difference in mean adjusted LV Mass between those with DRWPT versus those without (104.3 ± 34.9 vs. 100.9 ± 33.5 g/m
2
, p =0.55). Multivariable analysis adjusting for diabetes, renal failure, LV dysfunction and angiotensin receptor blocker use demonstrated a significant association of DRWPT with SCD risk (OR: 2.2, 95% CI: 1.1-4.3, p=0.020). With the addition of echo LVH to the model, this risk was not significantly attenuated (OR: 2.6, 95% CI: 1.3-5.4, p=0.008).

Conclusion:
DRWPT was independently associated with SCD risk, and not correlated with increased LV mass. These findings suggest that abnormalities of myocardial conduction velocity should be explored as mechanisms of electrical risk in LVH and SCD.
Abstract 14783: Relationship Between Native Papillary Muscle T1 Time and Severity of Functional Mitral Regurgitation in Patients With Non-ischemic Dilated Cardiomyopathy
Authors: Kato Shingo , Roujol Sébastien , Delling Francesca , Akhtari Shadi , Jang Jihye , Basha Tamer , Berg Sophie , Kissinger Kraig , Goddu Beth , Manning Warren , Nezafat Reza
Published: July 2021

Introduction:
Functional mitral regurgitation is one of the severe complications of non-ischemic dilated cardiomyopathy (DCM). Non-contrast native T1 mapping has emerged as a non-invasive method to evaluate myocardial fibrosis.

Hypothesis:
We hypothesized that papillary muscle native T1 time is correlated with severity of functional mitral regurgitation in DCM patients.

Methods:
Forty DCM patients (55±13 years) and 20 healthy adult control subjects (54±13 years) were studied. Native T1 mapping was performed using a slice interleaved T1 mapping sequence (STONE) which enables acquisition of 5 slices in the short-axis plane within a 90 sec free-breathing scan. We measured papillary muscle diameter, length and shortening. DCM patients were allocated into 2 groups based on the presence or absence of functional mitral regurgitation.

Results:
Papillary muscle T1 time was significantly elevated in DCM patients with mitral regurgitation (n=22) in comparison to those without mitral regurgitation (n=18) (anterior papillary muscle: 1127±36 msec vs 1063±16 msec, p<0.001; posterior papillary muscle: 1124±30 msec vs 1062±19 msec, p<0.001), but LV T1 time was similar (1129±38 msec vs 1134±58 msec, p=0.93). Multivariate linear regression analysis showed that papillary muscle native T1 time (β=0.109, 95%CI: 0.048-0.170, p=0.001) and tenting height (β=1.334, 95%CI: 0.434-2.234, p=0.005) are significantly correlated with mitral regurgitant fraction. Elevated papillary muscle T1 time was associated with larger diameter, longer length and decreased papillary muscle shortening (all p values <0.05).

Conclusions:
In DCM, papillary muscle native T1 time is significantly elevated and related to mitral regurgitant fraction. These results suggest that papillary muscle diffuse fibrosis might be associated with severity of mitral regurgitation in this population.
Abstract 14789: 2013 ACC/AHA Cholesterol Guideline Undertreats HIV-infected Adults With Carotid Atherosclerosis by Ultrasound
Authors: Phan Binh An P , Weigel Bernard , Ma Yifei , Scherzer Rebecca , Li Danny , Hur Sophia , Kalapus S.C. , Deeks Steven , Hsue Priscilla
Published: July 2021

Background:
While HIV infection is associated with increased risk of ASCVD (atherosclerotic cardiovascular disease), it is unknown whether guidelines can identify HIV-infected adults who may benefit from statins. The purpose of our study was to compare the 2013 ACC/AHA and 2004 ATP III recommendations in a HIV population, and to evaluate associations with carotid artery intima-media thickness (CIMT) and plaque.

Methods:
We used ultrasound to measure CIMT at baseline and 3 years later in 352 HIV-infected adults with no ASCVD and not on statins. Plaque was defined as IMT > 1.5 mm. We compared 2013 ACC/AHA and 2004 ATP III recommendations, and evaluated associations with CIMT and plaque.

Results:
At baseline, the median age was 43 (IQR 39-49), 85% were male, 74% were on antiretroviral medication, and 50% had plaque. At follow-up, the median IMT progression was 0.052 mm/yr, and 66% had plaque. The 2013 guideline was more likely to recommend statins compared with the 2004 guideline, both overall (26% vs. 14%, p<.001), in those with plaque (32% vs. 17%, p=.0002), and in those without plaque (16% vs. 7%, p=.025). In unadjusted linear regression, the 2004 and 2013 risk score were strongly associated with CIMT (0.01 mm per 10% increase in risk, p<.001) and with CIMT progression (0.01 mm/yr per 10% increase in risk, p<.001). In multivariate analysis, older age, higher LDL-C, pack-years of smoking, and history of opportunistic infection were associated with baseline plaque.

Conclusions:
While the 2013 ACC/AHA guideline recommended statins to a greater number of HIV-infected adults compared to the 2004 ATP III guideline, both failed to recommend therapy in the majority of HIV-affected adults with carotid plaque. Both the 2004 and 2013 guidelines predicted higher levels of baseline CIMT and faster progression. HIV-specific guidelines that include detection of subclinical atherosclerosis may help to identify HIV-infected adults who are at increased ASCVD risk and may benefit from statins.
Abstract 14829: Semi-quantitative Assessment of OCT-macrophage Predicts Future Development of Thin-cap Fibroatheroma in Non-culprit Lipid Plaques: A Serial Optical Coherence Tomography Study
Authors: Minami Yoshiyasu , Ong Daniel S. , Uemura Shiro , Wang Zhao , Aguirre Aaron D. , Soeda Tsunenari , Vergallo Rocco , Gao Lei , Xing Lei , Lee Hang , Yu Bo , Jang Ik-Kyung
Published: July 2021

Introduction:
Previous pathological studies have demonstrated that macrophages play an important role for the deterioration of fibrous cap and the onset of acute coronary syndrome. However, the significance of macrophage on the development of thin-cap fibroatheroma (TCFA) had not been fully evaluated in vivo.

Aim:
To explore the impact of OCT detected macrophage on the development of TCFA in patients with coronary artery disease using serial OCT images.

Methods:
A total of 152 non-culprit plaques from 90 patients who had serial OCT imaging at baseline and follow-up (median 6.38 [6.07-12.5] months) were included. TCFA was defined as the plaque with the fibrous cap thickness <65μm.OCT detected macrophage was semi-quantitatively assessed in every 1mm along the entire target plaque using a previously introduced grading system; Grade 0: no macrophage, Grade 1: localized macrophage accumulation, Grade 2: clustered accumulation<1 quadrant, Grade 3: clustered accumulation≥1 quadrant but <3 quadrants, Grade 4: clustered accumulation≥3 quadrants. The summation of 0 to 4 grades was evaluated.

Results:
Among 45 TCFA at baseline, 19 remain as TCFA [persistent TCFA] and 26 changed to non-TCFA [resolved TCFA] at follow-up (Figure). The macrophage grade in persistent TCFA was significantly greater than that in resolved TCFA (13.0 [8.00-17.0] vs. 4.00 [2.00-8.25] (P<0.001)) at baseline. On the other hand, 11 among 107 non-TCFA at baseline changed to TCFA [acquired TCFA] at follow-up. The macrophage grade in acquired TCFA was significantly greater than that in non-TCFA (14.0 [11.0-19.0] vs. 2.0 [0.00-6.75] (P<0.001)) at baseline. The macrophage grade>7.5 at baseline had good performance in discriminating TCFA from non-TCFA at follow-up (area under the curve [AUC] = 0.884, P<0.001) (Figure).

Conclusions:
The semi-quantitative evaluation of OCT detected macrophage at baseline had the potential to predict the future development of TCFA in patients with coronary artery disease.
Abstract 14868: Incidence and Outcomes of Cardiopulmonary Resuscitation in Pediatric Intensive Care Units
Authors: Berg Robert , Clark Amy , Nadkarni Vinay M , Moler Frank , Sutton Robert M , Wessel David L , Berger John T , Meert Kathleen , Dean J M , Pollack Murray
Published: July 2021

Introduction:
Although registry and administrative data suggest that >6000 children have in-hospital cardiac arrests each year, most occur in pediatric intensive care units (PICUs), and 39% survive to hospital discharge, prospective research quality data on the incidence and outcomes of PICU CPR are not currently available.

Objectives:
To determine the incidence and outcomes CPR provided in PICUs.

Methods:
Multi-center prospective observational study of children <18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the NICHD-funded Collaborative Pediatric Critical Care Research Network from December 2011 to April 2013.

Results:
Among 10,078 children enrolled, 139 (1.4%) received CPR for ≥1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurological outcomes. The relative incidence of CPR events was higher for cardiac patients compared with non-cardiac patients (3.4% versus 0.8%, p<0.001), but survival rate to hospital discharge with favorable neurological outcome was not statistically different (41% versus 39%, respectively). Shorter duration of CPR was associated with higher survival rates: 66% [29/44] survived to hospital discharge after 1-3 minutes of CPR versus 28% [9/32] after >30 minutes, p<0.001. Among survivors, 26/29 (90%) had a favorable neurological outcome after 1-3 minutes versus 8/9 (89%) after >30 minutes of CPR.

Conclusions:
These data establish that contemporary PICU CPR, including long durations of CPR, results in high rates of survival to hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and non-cardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.
Abstract 14875: Impact of Calcification and Long-Term Outcomes of Intravascular Ultrasound-Guided Stent Implantation for Atherosclerotic Subclavian Artery Obstructive Lesions
Authors: Yorifuji Hiroki , Nishino Masami , Matuhiro Yutaka , Nakamura Hitoshi , Yasumura Keisuke , Yasumoto Koji , Nushiro Yu , Masuyama Kiyoshi , Okamoto Naotaka , Tanaka Akihiro , Mori Naoki , Makino Nobuhiko , Egami Yasuyuki , Shutta Ryu , Tanouchi Jun
Published: July 2021

Background:
Currently, stent implantation for Subclavian artery obstructive lesions (SAOD) is an established method. Intravascular ultrasound (IVUS) provides valuable information for vessel and lumen at pre and post stenting, but there are a few reports on the effect of calcification and long-term outcomes of these methods using IVUS.

Methods:
We performed IVUS-guided stent implantations for SAOD in 14 arteries of 14 patients between February 2010 and December 2014. The main indications for subclavian artery stenting were arm claudication (10 patients), subclavian steal syndrome (3 patients) and coronary steal syndrome (1 pateint). Ten lesions were stenotic and four lesions were completely obstructed. We divided our patients into 2 groups according to the grade of calcification using IVUS: mild-calc group who showed none or 1/3 circumference calcification in the lesion and severe-calc group who showed more than 1/3 circumference calcification. We compared the IVUS parameters including pre minimum lumen diameter (MLD) (short axis), pre minimum lumen area (MLA), post minimum stent area (MSA), post minimum stent diameter (MSD) (short axis) and symmetric index (minimum/maximum stent diameter) between the two groups.

Resutls:
IVUS-guided stent implantations for SAOD were successful without perioperative complications in all patients. During follow-up observation (4-60 months, mean 21.8 months), 1 restenosis occurred. Post MSD (short axis) and post MSA were significantly lower in severe-calc group than mild-calc group while there were no significant differences between the two groups.

Conclusion:
IVUS-guided stent implantation for SAOD achieved satisfactory long-term outcomes. However, calcification may be correlated with worse outcomes in these lesions.
Abstract 14898: Prognostic Value of Tissue Doppler Imaging for Predicting Ventricular Arrhythmias and Cardiovascular Mortality in Ischemic Cardiomyopathy
Authors: Biering-Sørensen Tor , Olsen Flemming J , Storm Katrine , Fritz-Hansen Thomas , Olsen Niels T , Jøns Christian , Søgaard Peter , Risum Niels
Published: July 2021

Background:
Only 30% of patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention respond appropriately to this therapy. The purpose of this study was to investigate the value of Tissue Doppler Imaging (TDI) Echocardiography at predicting appropriate ICD therapy and cardiovascular mortality (CVD) in patients with primary prevention ICD.

Methods:
In total, 151 ICD patients meeting primary prevention criteria, with no history of ventricular arrhythmias were included. All participants were examined by conventional 2D echocardiography and TDI echocardiography. Longitudinal systolic (s’), early diastolic (e’), and late diastolic (a’) myocardial velocities were measured using TDI at six mitral annular sites and averaged to provide global estimates.

Results:
Forty patients experienced the combined endpoint of ventricular tachycardia (VT), fibrillation (VF) or CVD during a median follow-up of 2.3 years. Neither left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), E/e’, global s’ nor global e’ were significantly impaired in patients who developed VT/VF/CVD (LVEF: 31 vs. 28 %, p=0.06; GLS: 9 vs. 9 %, p=0.85; E/e’: 16 vs. 16, p=0.80; s’: 3.8 vs. 3.7 cm/s, p=0.68; e’: 4.5 vs. 4.6 cm/s, p=0.61). In contrast, global a’ was significantly lower in patients with an unfavorable outcome compared to those without (5.7±1.8 vs. 4.8±2.0 cm/s, p=0.020). Global a’ remained an independent predictor of VT/VF/CVD after multivariable adjustment for age, gender, beta blocker therapy and deceleration time (HR=1.25 [1.02; 1.54], p=0.032). Regional analysis revealed that a depressed a’ in the inferior wall drives the predictive capability of a’ (Figure).

Conclusion:
Late diastolic velocity by TDI seems to be a superior echocardiographic predictor of VT/VF/CVD in ischemic cardiomyopathy. Additionally, impaired late diastolic velocity in the inferior myocardial wall seems to be a paramount marker of future VT/VF/CVD.