bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9240: Successful Implementation of ACCF/AHA Performance Measures for Adults With Heart Failure Reduces Mortality in South-East Asian Patients With Chronic Heart Failure
Authors: Yeo Poh Shuan Daniel , Chai Ping , Ong Hean Yee , Koh Amanda , Low Rose Shiow Ling
Published: April 2024

Background:
Heart failure (HF) is a leading cause of hospitalization in Singapore (5541 discharges in Financial Year 2012/2013). The National Healthcare Group comprises 3 public hospitals with a total bed complement of about 2950 and receives 50% of HF admissions in the nation. We evaluated the recent outcomes of our 10-year Heart Failure Disease Management Program (HFDMP).

Methods:
Patients admitted with a clinical diagnosis of acute HF were recruited from Apr 2007 to Mar 2012. All patients were managed by cardiologists. A clinical carepath was used to standardize evidence-based care. Prognostically beneficial drugs such as Angiotensin-Converting Enzyme-Inhibitors and Beta-Blockers were commenced inpatient at low doses and up-titrated as tolerated in the outpatient HF clinic. Case Managers educate and counsel patients on managing their disease, and provide telephone follow-up. Performance measures were tracked as per ACCF/AHA Guidelines.

Results:
We recruited 2900 patients, of whom 2527 remained in the HFDMP for at least one year. Of these, 62.9% were male, age 67.6 ± 13.2 (range 17-103) years, and mean LVEF 31.4 ± 14.5%. Median baseline 6 minute walk test (6MWT) was 250.5m, Minnesota Living With Heart Failure Questionnaire (MLWHF) score 33.5, and NYHA Class 2. At 6 months, median 6MWT improved to 281.1m, MLWHF score fell to 25, and NYHA Class was 1.76 (all p < 0.005). The 1-year mortality rate improved from 16.75% in 2007 to 11.46% in 2011 (Fig 1)despite stable readmission rates at 1, 6, and 12 months (Fig 2).

Conclusion:
HF treatment based on ACCF/AHA Performance Measures and implemented by a HFDMP results in real-world reduction in mortality without compromising on readmission rates.
Abstract 9253: A Randomized Controlled Trial of the Effects of Vitamin D Supplementation on Central Blood Pressures and Aortic Stiffness in Native American Women
Authors: Gepner Adam D , Haller Irina V , Krueger Diane C , Korcarz Claudia E , Binkley Neil C , Stein James H
Published: April 2024

Background:
Low vitamin D status has been linked to increased cardiovascular disease (CVD) risk. Low vitamin D levels, hypertension, and CVD are highly prevalent in Native American populations. However, it is unclear if vitamin D supplementation improves central blood pressure or arterial stiffness in Native American women.

Methods:
Healthy postmenopausal Native American women without known CVD and with screening serum 25-hydroxyvitamin D (25(OH)D) between 10-60 ng/mL were randomized to receive daily vitamin D3 either 400 IU or 2,500 IU for 6 months. Central systolic blood pressure (cSBP), central pulse pressure (cPP) and aortic augmentation index (AIx) were estimated by tonometry (AtCor Medical, Sydney, Australia) at baseline and after 6 months of vitamin D supplementation. General linear models were used to evaluate cross-sectional and longitudinal associations. Repeated measures models were adjusted for baseline 25(OH)D.

Results:
At baseline, study volunteers (n=98) were mean (standard deviation) 61 (7.3) years old. Screening 25(OH)D was 26.4 (11.0) ng/mL; 25(OH)D was less than 20 ng/mL in 33 (34%) participants and between 20-30 ng/mL in 29 (29.6%) participants. Screening 25(OH)D was similar between the two treatment groups (p=0.291), as were baseline cSBP, cPP, age, body-mass index, glucose, lipids, and high sensitivity C-reactive protein levels (all p>0.1). Screening 25(OH)D was associated with cSBP (p=0.022) and cPP (p=0.007), but not AIx (p=0.807). Treatment with 2,500 IU of daily vitamin D3 did not affect cSBP (p=0.546), cPP (p=0.614), or AIx (p=0.103) compared to 400 IU daily.

Conclusions:
Despite relatively low serum 25(OH)D at baseline, 6 months of vitamin D supplementation did not improve central blood pressure parameters or arterial stiffness in Native American women.
Abstract 9297: Incidence and Implications of Aborted Myocardial Infarction in STREAM
Authors: Dianati-Maleki Neda , Van de Werf Frans , Goldstein Patrick , Adgey Jennifer , Lambert Yves , Sulimov Vitaly , Rosell-Ortiz Fernando , Gershlick Anthony H , Zheng Yinggan , Armstrong Paul W
Published: April 2024

Background:
Timely and effective reperfusion therapy in patients (pts) with ST-segment elevation myocardial infarction (STEMI) may avoid significant necrosis. Aborted MI (AbMI) was a pre-specified (previously unreported) endpoint in the STREAM (STrategic Reperfusion therapy Early After MI) trial comparing a pharmacoinvasive strategy (Gp A) vs. primary PCI (Gp B) in STEMI pts presenting within 3 hours of symptom onset.

Methods:
1754 pts with interpretable electrocardiograms (ECGs) and sequential biomarkers were included. AbMI was defined by successful reperfusion i.e. core laboratory assessed worst lead ST-elevation resolution ≥50% (90-min post-tenecteplase (TNK) in Gp A or 30-min post-PCI in Gp B), and minimal rise in biomarkers (≤2 times ULN rise in CK or CKMB) or if unavailable, ≤5xULN rise in troponin. All pts received heparin and clopidogrel at first medical contact.

Results:
In Gp A, 11.1% (n=99) had AbMI vs. 6.9% (n=59) in Gp B (p< 0.01). AbMI pts were younger, more often had prior MI, exhibited Killip I, had less baseline ΣST-deviation, and fewer Q waves within their acute infarct zone (Table). Within Gp A, AbMI pts had faster time to TNK and a lower all-cause death/shock/congestive heart failure (CHF)/re-MI than non-AbMI pts; this distinction was not evident in Gp B. Total ischemic time was 100 minutes longer in Gp B AbMI pts. Forty-five pts (i.e. 2.5%; evenly distributed by treatment) had masquerading MI with minimal biomarker elevation and persistent ST-elevation in sequential ECGs related to left ventricular hypertrophy, pericarditis, or early repolarization.

Conclusions:
These data demonstrate that fibrinolysis coupled with anti-thrombotic and antiplatelet therapy more frequently aborts MI: such pts have more favorable outcomes compared to non-AbMIs. Diligent review of ECG evolution in STEMI is necessary to distinguish AbMI from infarct masquerade.
Abstract 9518: Follistatin-like 1 Functions as a Cardiokine That Plays a Protective Role in Renal Injury
Authors: Hayakawa Satoko , Ohashi Koji , Shibata Rei , Kataoka Yoshiyuki , Miyabe Megumi , Uemura Yusuke , Kambara Takahiro , Enomoto Takashi , Walsh Kenneth , Murohara Toyoaki , Ouchi Noriyuki
Published: April 2024

Objective:
Heart diseases including chronic heart failure contribute to the progression of chronic kidney disease. Heart tissue produces a variety of secretory proteins, also known as cardiokines, which play roles in inter-cellular and inter-tissue communication under physiological and pathological conditions. Recently we found that follistatin-like 1 (Fstl1) acts as a stress-inducible cardiokine that exerts cardio-protective function. Here, we investigated the role of cardiac Fstl1 in renal disease in a mouse model of subtotal nephrectomy.

Methods and Results:
Cardiac specific Fstl1-deficient (Fstl1-KO) mice were generated by crossing cardiac myocyte-specific α-MHC-Cre transgenic mice and Fstl1
flox/flox
mice. Subtotal (5/6) nephrectomy operation was performed in Fstl1-KO mice and control mice. At 2 months after operation, urinary albumin excretion was significantly increased in Fstl1-KO mice compared to control mice. A histological analysis of the remnant kidney demonstrated that Fstl1-KO mice showed a significant increase in intraglomerular cell number and glomerular size compared to control mice. Fstl1-KO mice also had a larger area of tubulointerstitial fibrosis in the remnant kidney compared to control mice, which was accompanied with increased mRNA levels of transforming growth factor-β1 and collagen type I/III. Furthermore, Fstl1-KO mice showed elevated expression levels of NADPH oxidase components and pro-inflammatory cytokines including TNF and IL-6 in the remnant kidney.

Conclusions:
Our findings indicate that Fstl1 functions as a cardiokine that prevents glomerular and tubulointerstitial damages through attenuation of oxidative stress and inflammatory response.
Abstract 9550: Anticipatory Racism Threat and Superwoman Schema: Elucidating the Relationship Between Racial Discrimination and Chronic Inflammation
Authors: Nuru-Jeter Amani , Chae David H , Price Melisa , Telesford James , Mendoza-Denton Rodolfo , Woods-Giscombe Cheryl
Published: April 2024

Introduction:
Racial discrimination has been linked with chronic inflammation among African American women, and may help explain their heightened risk of coronary artery disease. However, the mechanisms linking the two remain unclear.

Objectives:
We assessed the hypothesis that cognitive stress appraisals and coping mechanisms modify the association between racial discrimination and chronic inflammation among African American women.

Methods:
The African American Women’s Heart & Health Study recruited a community sample of African American women ages 30-50 residing in the San Francisco Bay area (n=200). Data collection included interviewer-administered questionnaire, computer assisted self-interview, anthropometric assessment, and venous blood draws. Blood samples were assayed for a variety of biomarkers including pro-inflammatory cytokines (e.g., IL-6) and acute phase proteins (e.g., hsCRP). Ordinary Least Squares regression was used to examine associations between study variables.

Results:
Cognitive stress appraisal and coping style both modified the association between racial discrimination and inflammation. Anticipatory Racism Threat (aRT) is a unique cognitive appraisal process commonly reported by African Americans (α=.90). Superwoman Schema (SWS) is a coping style commonly reported among African American women (α=.93). There were no significant main effects of racial discrimination on inflammation. However, there was a significant interaction between racial discrimination and both aRT and SWS (p<.05). Interaction results show a positive association between racial discrimination and elevated levels of pro-inflammatory biomarkers (IL-6, TNFα, hsCRP) among women reporting higher vs. lower levels of aRT (p<.05). There was also a significant inverse association between racial discrimination and inflammation among women reporting higher vs. lower levels of SWS (p<.05).

Conclusions:
The unique stress appraisals and coping styles used by African American women experiencing racial discrimination may represent novel bio-behavioral mechanisms linking racial discrimination to cardiovascular risk, particularly coronary heart disease, via inflammation and serve as potential avenues for intervention.
Abstract 9648: Aldosterone Increases Transforming Growth Factor-β Expression to Activate Autophagy and Increase Aortic Fibroblast Collagen Synthesis and Vascular Stiffness
Authors: Torquato Samantha , Maron Bradley A , Loscalzo Joseph , Leopold Jane A
Published: April 2024

Elevated levels of aldosterone (ALDO) are associated with aortic remodeling and increased arterial stiffness; however, the role of fibroblasts in these processes remains unknown. Accordingly, human aortic fibroblasts (HAoF) were treated with ALDO (10
-9
-10
-7
mol/L) or a vehicle control (V) for up to 72 h. Compared to V, ALDO increased HAoF expression of transforming growth factor-β (TGFβ) in a dose- and time-dependent manner with a maximal increase of 2.9 ± 0.3-fold (p<0.01) at 72 h. This change was associated with a 252.6 ± 28.8 % (p<0.01) increase in collagen III protein levels in ALDO-treated HAoF; these findings were confirmed by immunohistochemistry. Increased TGFβ expression was also associated with an increase in reactive oxygen species generation (126.4 ± 15.6 vs. 435.5 ± 38.6 fluorescent units, p<0.01) and activation of autophagy as demonstrated by increased beclin1 expression (211.3 ± 23.2% vs. V, p<0.01), lipidation of LC3BI to LC3BII (p<0.01) and autophagic flux assay. To demonstrate that autophagy was necessary to increase collagen III expression, HAoF were transfected with beclin1 siRNA to decrease expression by 69%. Inhibition of autophagy led to a 78% decrease (p<0.01) in collagen III expression without influencing TGFβ levels. To confirm these findings
in vivo
, C57Bl/6 mice received ALDO (50 μg/kg/d) or V for 21 days. In ALDO-treated mice, aortic TGFβ and LC3BII expression were increased with a concomitant 3.5 ± 0.5-fold (p<0.01) increase in collagen deposition. Pulse wave velocity (PWV), a marker of arterial stiffness, was increased in ALDO-treated mice (288.4 ± 22.4 vs. 389.6 ± 19.8 cm/sec, p<0.01). Treatment with imatinib (40 mg/kg/d) for 14 days downregulated vascular TGFβ expression, diminished collagen deposition, and decreased PWV by 41.1 ± 9.8% (p<0.01). To determine the clinical relevance of these findings, human aorta segments from patients with atherosclerotic vascular disease had higher levels of TGFβ, LC3BII, and fibrosis compared to segments from subjects without disease. These data indicate that ALDO activates fibroblasts to modulate vascular collagen deposition and increase vascular stiffness through a mechanism that involves, in part, TGFβ-mediated activation of autophagy in fibroblasts.
Abstract 9684: Favourable Midterm Outcome After Heart Transplantation for Late Fontan Failure
Authors: Michielon Guido ,   European Congenital Heart Surgeons Association (ECHSA)
Published: April 2024

Background:
Fontan failure (FF) represents a growing and challenging indication for pediatric orthotopic heart transplantation (OHT).The aim of this study was to identify predictors of best midterm outcome in OHT after FF.

Methods:
retrospective multi-institutional study on 45 consecutive patients who underwent OHT for FF between 1992 ans 2011. Mean follow-up was 72.8±70.5 month and was 100% complete. Early FF was defined as failure requiring OHT within 2 years from Fontan completion.

Results:
45 patients underwent OHT 8.6±6.1 years after Fontan completion due to failing atriopulmonary (12) or TCPC (33). Modality of FF included protein losing enteropathy (PLE) (31%), complex obstructions in Fontan circuit (22%), arrhythmia (18%) and impaired ventricular function (29%). Early FF occurred in 15.6% patients. Mean age at OHT was 12.4±4.9 years. Hospital mortality was 17.8% and late mortality was 13.5%. Main causes of early death were infection (37.5%) and graft failure (37.5%). Mean time of mechanical ventilation was 8.6±2.3 days while mean hospital stay was 40.1±7.2 days. Overall Kaplan Meier (KM) survival was 82.2±5.7% at 1 year, 78.4±7.0% at 5 years and 55.3±11.2% at 10 years. KM one-year OHT survival was 89.5±5.1% in late FF and 42.9±9.7% in early FF (p=0.0031). Fisher exact testing showed a strong correlation between late FF and impaired ventricular function (p=0.0226). OHT survival for late FF was 84.5±6.7% at 5 years and 59.7±13.0% at 10 yrs. Protein dispersion improved after OHT in 78.6% patients with PLE, but overall 5-year OHT survival in PLE was 45.9±12.1 versus 87.1± 6.0% in non-PLE (p=0.027). Early FF (p=0.0017), PLE (p=0.0157) and complex obstructions of Fontan circuit (p=0.0087) were identified as independent predictors of mortality by Cox proportional hazards.

Conclusions:
OHT is an excellent surgical option for late FF with impaired ventricular function. Protein dispersion improves with OHT, but PLE and complex obstructions of Fontan circuit negatively affect midterm OHT outcome.
Abstract 9845: Alcohol Consumption and Risk of Cardiovascular Disease
Authors: Chung Jong-Won , Kim Beom Joon , Choi Nam-Kyong , Lee Seung-Hoon , Park Byung-Joo , Yoon Byung-Woo
Published: April 2024

Background:
Since the discovery of fermented beverage, alcohol has been the most widely used recreational drink for mankind. However, impact of alcohol consumption on CVD remains unclear.

Methods:
We conducted prospective nationwide cohort study (Korean national health insurance service cohort), including 18,080,391 Korean adults (age ≥19), to provide new evidence on the effect of alcohol consumption on CVD. Nationwide biennial health check-up results and national health information/surveillance system data were gathered during study period. Cox proportional hazard models were used to study the association between weekly alcohol consumption dose [none (reference), 60-119g, 120-179g, 180-239g, 240-419g, and ≥420g] and CVD events after adjusting for age, gender, body mass index (kg/m2), hypertension, diabetes, hemoglobin level (g/dl), total cholesterol level (mg/dl), smoking status, physical activity, and diet style.

Results:
The mean age of the subjects was 43.9±14.6 years, 53.9% were men, and 49.1% were alcohol drinkers. During mean follow-up period of 5.0 years, CVD developed in 211,202 subjects (coronary heart disease, 35,060; ischemic stroke, 137,426; intracerebral hemorrhage, 24,429; subarachnoid hemorrhage, 14,287). In multivariable adjusted analysis, protective effect of alcohol consumption was observed in all doses for coronary heart disease (maximum in ≥420g category, HR 0.47, 95% CI 0.43-0.51) and ischemic stroke (maximum in 120~179g category, HR 0.79, 95% CI 0.76-0.83). Harmful effect of alcohol consumption was observed in all doses for intracerebral hemorrhage and subarachnoid hemorrhage, with significant linear trend. Alcohol consumption reduced risk of total CVD events in all doses (maximum in 120~179g category, HR 0.81, 95% CI 0.79-0.84).

Conclusions:
Alcohol consumption is associated with reduced risk of overall CVD events, despite of deleterious association with hemorrhagic stroke.
Abstract 9876: Long-Term Treatment With Sitagliptin Provides Multiple Ultrasonic Manifested Antiatherosclerotic Effects Independent of Diabetic Improvement for Type-2 Diabetics
Authors: Murakami Tatsuaki , Mizuno Sumio
Published: April 2024

Background:
Diabetes mellitus is thought to be highly involved in complex atherothrombogenic processes, but the long-term antiatherosclerotic therapies in patients with type-2 diabetes mellitus have not been established. We previously demonstrated adverse prognostic impacts of endothelial dysfunction and intima-media thickening.

Therefore we assessed hypothesis long-term treatment with sitagliptin, a dipeptidyl peptidase-4 inhibitor recently developed antidiabetic agent, chronically inhibits atherosclerotic progression in patients with type-2 diabetes mellitus.

Methods:
Thirty-four type-2 diabetic patients with stable coronary artery disease were randomized to group-S where they received sitagliptin (50mg/day), or to group-C where they received enhanced antidiabetic therapy without a dipeptidyl peptidase-4 inhibitor for 2 years. We quantified flow-mediated endothelium-dependent dilation of right brachial artery after transient forearm occlusion (FMD), endothelium-independent dilation of brachial artery after sublingual administration of nitroglycerin (TNG), and intima-media thickness of common carotid artery (IMT) using high-resolution ultrasonography. Changes in FMD, TNG, and IMT were compared between the two groups.

Results:
Group-S (n=17) manifested good compliance to the long-term treatment and improvements in diabetic and lipid variables represented by HbA1c and LDL after long-term medication of sitagliptin, while there were no improvements in group-C. FMD improved after medication in group-S (from 4.0±1.9% to 6.3±2.7%, p<0.01) but not in group-C (from 4.1±2.0% to 4.0±1.9%, p=0.78). Changes of FMD in group-S did not correlate to those of HbA1c (r= 0.14, p=0.57). TNG (%) remained unchanged in both group-S and group-C. IMT did not increase in group-S (from 1.10±0.35mm to 1.08±0.40mm, p=0.17) but increased in group-C (from 1.09±0.47mm to 1.17±0.48mm, p<0.01).

Conclusion:
This ultrasonic study suggests that long-term treatment of sitagliptin safely improves endothelial function of brachial artery independent of reversal for diabetic status and reduces progression of wall thickness in carotid artery, which may have beneficial potentials for long-term management of atherosclerosis in type-2 diabetics.
Abstract 9928: Cardiac-specific Overexpression of High-mobility Group Box 1 Attenuates Cardiomyocyte Apoptosis and Mitochondrial Dysfunction During the Pathogenesis of Doxorubicin Cardiomyopathy
Authors: Narumi Taro , Shishido Tetsuro , Funayama Akira , Yokoyama Miyuki , Kinoshita Daisuke , Kadowaki Shinpei , Honda Yuki , Otaki Yoichiro , Nishiyama Satoshi , Takahashi Hiroki , Arimoto Takanori , Miyashita Takehiko , Miyamoto Takuya , Watanabe Tetsu , Kubota Isao
Published: April 2024

Background:
The mechanism of doxorubicin cardiomyopathy is thought to be related to cardiomyocyte apoptosis, which contributes to development of myocardial loss and severe contractile dysfunction. High-mobility group box 1 (HMGB1) is a nuclear DNA-binding protein, as well as having the potential of inhibiting apoptosis. Purpose of this work is to clarify the role of cardiac HMGB1 in response to cardiomyocyte apoptosis.

Methods and Results:
Doxorubicin was administrated in transgenic mice with cardiac-specific overexpression of HMGB1 (HMGB1-Tg) and wild-type littermate mice (WT). We evaluated the expression of heat shock protein B1 (HSPB1) which was reported to be a downstream target of HMGB1. Its expression was significantly higher in HMGB1-Tg mice compared with WT mice. Next, we assessed the localization of second mitochondria-derived activator of caspase (Smac), which is inhibited by HSPB1 and necessary for apoptosis in cardiomyocytes. Release of Smac from mitochondria was prevented in HMGB1-Tg mice compared with WT mice. Cardiomyocyte apoptosis were prevented in HMGB1-Tg mice. With electron microscopy, we observed distinguished mitochondrial damage and vacuolization in doxorubicin-treated WT, but not in HMGB1-Tg mice. Furthermore, the survival rate after doxorubicin administration of HMGB1-Tg mice was higher. In in vitro experiments, protein expression of cleaved caspase 3 which indicates the degree of apoptosis was higher in doxorubicin-treated HMGB1 knock down (HMGB1-KO) cardiomyocyte. In addition, protein expression of HSPB1 was lower in doxorubicin-treated HMGB1-KO cardiomyocyte. Moreover, we found that mitochondrial membrane potential evaluated by using 5,5’,6,6’-tetrachloro-1,1’,3,3’-tetraethylbenzimidazolylcarbocyanine iodide (JC-1) was markedly reduced in doxorubicin-treated HMGB1-KO cardiomyocyte.

Conclusion:
We report the first in vivo and vitro evidence that cardiac HMGB1 attenuate cardiomyocyte apoptosis and mitochondrial dysfunction during the pathogenesis of doxorubicin cardiomyopathy. These results may provide a novel therapeutic approach for doxorubicin cardiomyopathy.
Abstract 9950: Immunoadsorption can Improve Cardiac Function in Transplant Candidates With Non-Ischemic Cardiomyopathy Associated With Diabetes Mellitus
Authors: Dandel Michael , Englert Angela , Knosalla Christoph , Hetzer Roland
Published: April 2024

Background:
Diabetes mellitus (DM) is a risk factor for death by heart failure (HF). With prolongation of waiting times for heart transplantatation (HTx) new therapies are necessary to improve survival. Diabetic patients are also less eligible for HTx and DM is a risk factor for death also after HTx. In dilated cardiomyopathy, immunoadsorption (IA) can improve heart function and delay HTx listing, but its usefulness for therapy of HF associated with DM is unknown. We assessed this aspect.

Methods:
Cardiac function and freedom from HF recurrence were evaluated in HTx candidates with non-ischemic chronic cardiomyopathy (NICCM) associated with DM who underwent IA in 6/2003-6/2012 (follow up 1–10 yrs). Non-diabetic NICCM patients referred for HTx in the same time period and who received the same IA served as controls. Before and after IA patients were tested for serum β
1
-autoantibodies (β
1
-AABs).

Results:
We evaluated 64 HF patients (32 with and 32 without DM). Before IA there were no differences between the 2 groups, neither in LV size and EF, nor in brain natriuretic peptide or β
1
-AAB levels. However, diabetic patients were older (51.5 ±7.0 vs. 44.2 ±12 yrs; p=0.005), their HF duration was longer (6.8 ±5 vs. 3.6 ±3 yrs; p<0.001) and their peak oxygen-uptake was lower (p=0.004). During the 1
st
post-IA year in both groups there a decrease in LV size and improvement in both LVEF (from 26.4±7 to 31.3±7% and from 25.6±6 to 31.2±9%, respectively) and NYHA class (p<0.05 for all). Post-IA 3-year freedom from HF recurrence and prevalence of responders to IA in patients with and without DM reached 81.3±8% and 78.4±8%, respectively and 73.3% and 67.7%, respectively. Post-IA 3-year freedom from β
1
-AAB reappearance in patients with and without DM reached 72.1±9.0% and 71.1±8.6%, respectively.

Conclusions:
IA improves heart function and exercise tolerance in patients with end-stage NICCM, with and without additional DM. Responsiveness to IA and freedom from HF recurrence where similar in patients with and without DM, although DM patients were older and had longer duration of HF. IA appeared able to delay HTx listing, improve survival on HTx lists and even spare patients from HTx, benefits of particular importance for DM patients who are at higher risk for pre-HTx and post-HTx mortality.
Abstract 10120: Increased Stroke Mortality Among Lean Japanese
Authors: Tsuji Hisako , Shiojima Ichiro
Published: April 2024

Background:
Several large cohort studies showed underweight was associated with an increased risk of death in Asians after major methodologic issues were addressed. We examined specific causes of death in lean Japanese of a general population.

Methods:
We studied 16,461 subjects (mean age 54±13 years, men 26%) who had the annual health checkup offered to adult citizens of Moriguchi city, Osaka, Japan in 1997. The subjects were divided into 5 groups according to body mass index (BMI) presented in the table. Proportional hazards regression analyses adjusted for age, sex, smoking status, drinking habit, history of CV disease, hypertension, diabetes, and hyperlipidemia were used to assess the association of BMI categories with mortality.

Results:
During a mean follow-up of 14.1±4.4 years, there were 1,939 deaths. Of those, there were 797 cancer deaths, 462 cardiovascular (CV) deaths including 114 coronary deaths, 156 stroke deaths with 88 ischemic stroke deaths. Hazard ratios (HR) relative to the BMI of 22.0-24.9 kg/m
2
group with 95% confidence intervals (CI) were presented in the table. Although underweight (<18.0 kg/m
2
) was not associated with cancer deaths, it was significantly associated with CV deaths (HR=1.92, 95%CI=1.33 to 2.78, p=0.0005) and stroke deaths (HR=2.02, 95%CI=1.07 to 3.81, p=0.0295). Among stroke deaths, ischemic stroke deaths tended to be higher in the underweight group (HR=1.95, 95%CI=0.90 to 4.26, p=0.0926).

Conclusions:
In the general Japanese population, underweight was associated with higher stroke mortality.
Abstract 10360: Prognostic Impact of Early Revascularization in Patients With Cardiac Arrest Due to Acute Coronary Syndrome Undergoing Extracorporeal Cardiopulmonary Resuscitation
Authors: Kuroki Norihiro , Abe Daisuke , Iwama Tooru , Tateishi Kazuya , Kaneko Masakazu , Harunari Tomohiko , Yui Yoshiaki , Yuba Takao , Suzuki Kou , Sugiyama Kazuhiro , Akashi Akiko , Hamabe Yuichi , Sato Akira
Published: April 2024

Introduction:
Extracorporeal cardiopulmonary resuscitation (ECPR) and emergency revascularization has been reported to improve survival in patients with refractory cardiac arrest complicated by acute coronary syndrome (ACS). However the best timing for this therapy is not clear. We investigated the relationship between the time interval from collapse to revascularization and mortality for ECPR in the patients with non-ST and ST elevation ACS.

Methods:
A cohort of 228 patients who underwent ECPR at our hospital was registered from January 2005 to April 2015. After excluding 121 patients with non-ACS, we analyzed the clinical outcome which was defined as all-cause death at 30 days of the remaining 107 patients (63±11years old, 90% male). We divided patients into 3 groups according to collapse to revascularization time; Group1 (time<90min: n=28), Group2 (90≦time<180min: n=40) and Goup3 (time≧180min or unsuccessful of revascularization: n=39).

Results:
43 patients was non-ST elevation ACS. 81 patients underwent emergency revascularization. 29 patients had 30 days survival.

Platelet and bicarbonate ion was higher in Group1. Lactate level was lower in Group1. But other baseline characteristics did not differ. Kaplan-Meier curve showed Group1 was better outcome compared with other groups (p<0.0001 log-rank) (Figure). Multivariate analysis revealed that independent predictors of 30 days in-hospital mortality were longer time interval from collapse to revascularization (per increase OR: 1.05, 95%CI:1.01-1.08, p<0.01), lactate level (OR:0.42 , 95%CI:0.22-0.83, p=0.01) and other factors. Incidence of all-cause death at 30 days was significantly higher both ST and non-ST elevation ACS in Group3 than in Group 1 and 2; (ST elevation in Group3 vs 2 and 1: 84% vs 58%; p<0.05) (non-ST: 100% vs 70% ;p<0.01).

Conclusions:
Shorter time interval from collapse to revascularization predict better clinical outcome in patients with non-ST and ST elevation ACS undergoing ECPR.
Abstract 10447: The Relationship Between Cerebral Regional Oxygen Saturation During Extracorporeal Cardiopulmonary Resuscitation and Neurological Outcome
Authors: Hirose Tomoya , Ehara Naoki , Shiozaki Tadahiko , Wakai Akinori , Nishimura Tetsuro , Mori Nobuto , Ohnishi Mitsuo , Sadamitsu Daikai , Shimazu Takeshi
Published: April 2024

Introduction:
In recent years, measurement of cerebral regional oxygen saturation (rSO2) has attracted attention during resuscitation. The objective of this study was to clarify the relationship between serial changes in cerebral rSO2 during extracorporeal cardiopulmonary resuscitation (ECPR) and neurological outcome. Hypothesis: Cerebral rSO2 during ECPR would predict neurological outcome.

Methods:
We measured serial changes in cerebral rSO2 in patients with out-of-hospital cardiac arrest before and after ECPR in Osaka National Hospital.

Results:
From January 2013 through March 2015, serial changes in cerebral rSO2 were evaluated in 16 patients. Their outcomes as measured by the Glasgow Outcome Scale (GOS) score at discharge included Good Recovery (GR) in 4 patients, Vegetative State (VS) in 2 patients, and Death (D) in 10 patients. In the poor neurological group (VS and D: n=12, 52.8±4.0 years), the values of cerebral rSO2 increased significantly with ECPR (5 min before ECPR: 52.0±1.8%; 2 min before: 56.1±2.3%; 2 min after ECPR: 63.5±2.2%; 5 min after: 66.4±2.2%; 10 min after: 67.6±2.3% [p<0.01]) (Figure). Contrastingly, in the good neurological group (GR: n=4, 53.8±6.9 years), the values of cerebral rSO2 did not increase significantly with ECPR (5 min before: 61.9±3.1%; 2 min before: 57.1±4.0%; 2 min after: 59.6±3.8%; 5 min after: 61.0±3.7%; 10 min after: 62.0±3.8% [p=0.88]) (Figure). Our study suggested that the patients who maintained a high value of cerebral rSO2 at admission and who did not have significant improvement of cerebral rSO2 after ECPR might have a good neurological prognosis.

Conclusion:
Cerebral rSO2 during ECPR could predict neurological outcome. Further evaluation of the validity of rSO2 monitoring during ECPR may lead to a new resuscitation strategy.
Abstract 10754: Nutritional Status in Elderly Heart Failure is a Determinant of Functional Status and Readmission After Cardiac Rehabilitation: A Retrospective Cohort Study
Authors: Katano Satoshi , Hashimoto Akiyoshi , Tsukada Takanori , Neki Toru , Iwamoto Erika , Uchizawa Ayumi , Yoshida Ryo , Fujito Takefumi , Oiwa Shotaro , Sawaguchi Yuji , Tsuchihashi Kazufumi , Katayose Masaki , Miura Tetsuji
Published: April 2024

Introduction:
The prevalence of malnutrition in elderly heart failure (HF) is high in cardiac rehabilitation (CR) settings. Malnutrition in elderly patients with chronic diseases admitted to hospitals is often associated with poor functional recovery in daily activities. However, there is few evidence of the impact of poor nutritional status on the effects of CR in HF patients.

Hypothesis:
We examined the hypothesis that nutritional status in elderly HF patients is a determinant of functional status and readmission after CR.

Methods:
One hundred ten HF patients at age of 65 years or older were included. All patients underwent CR during their hospitalization. Nutritional status and functional status were assessed by Mini Nutritional Assessment Short Form (MNA-SF) at the start of CR and Barthel Index score at discharge, respectively. The association between nutritional status and CR outcomes including functional status and the 1-year readmission rate were examined.

Results:
The medians of CR duration and sessions were 21 days and 11 sessions, respectively. Fifty-eight patients (53%) were malnourished (MNA-SF score ≦ 7). Patients with malnutrition had a lower Barthel Index score at discharge than those without malnutrition (median 85 vs. 90, p<0.01). Barthel Index score at discharge was lower in patients with chronic disease-related malnutrition, starvation-related malnutrition and acute disease or injury-related malnutrition. In multiple regression analysis, age, MNA-SF score, chronic disease-related malnutrition and starvation-related malnutrition were independent predictors of Barthel Index score at discharge (adjusted R
2
=0.20, p<0.01). The median follow up period was 150 days. Readmission due to worsening HF occurred in 55 patients (50%). The 1-year readmission rate by the Kaplan-Meier method was significantly higher in patients with malnutrition than those without malnutrition (p<0.05). Using Cox multivariate analysis adjusted for age and sex, BNP level, MNA-SF score and total lymphocyte count were independent predictors of the readmission (hazard ratio 2.58, 0.82, 0.99, respectively; p<0.05).

Conclusions:
Nutritional status in elderly HF patients is an important determinant of both functional status and readmission after CR.
Abstract 11465: Ultrafast Cooling With Total Liquid Ventilation Attenuates Multi-organ Failure and Sepsis-like Response After Experimental Shock Induced by Aortic Cross Clamping
Authors: Mongardon Nicolas , Kohlhauer Matthias , Lidouren Fanny , Barau Caroline , Costes Bruno , Giraud Sébastien , Hauet Thierry , Carli Pierre , Vivien Benoit , Nadeau Mathieu , Micheau Philippe , Cariou Alain , Dhonneur Gilles , Berdeaux Alain , Ghaleh Bijan , Tissier Renaud
Published: April 2024

Introduction:
Total liquid ventilation (TLV) provides ultrafast cooling and potent neuro- and cardioprotection after experimental cardiac arrest.

Hypothesis:
We determined whether it could also mitigate multi-organ failure and sepsis-like response after abdominal ischemia/reperfusion and subsequent shock.

Methods:
Anesthetized rabbits were submitted to 30 min of supracoeliac aortic cross-clamping and 300 min of reperfusion. They underwent a normothermic procedure (Control group) or rapid cooling toward 32-33°C with TLV started either before, during or after aortic clamping (PRE, PER and POST groups, respectively). TLV was maintained during 75 min after which rabbits were rapidly rewarmed and switched to conventional mechanical ventilation.

Results:
Control animals elicited a dramatic shock state with a low cardiac output, high demand in norepinephrine, liver failure and acute kidney injury. Cardiac output was gradually improved in POST, PER and PRE groups as compared to Control (53±3, 64±5, 90±10 and 36±8 ml/min/kg after 300 min, respectively; all p<0.05). A significant protection was also observed in the TLV groups regarding liver enzymes (ASAT, ALAT, L-FABP), acute kidney injury markers (nNAG, KIM-1, NGAL, β2-microglobulin) and renal function parameters (creatinine clearance and fractional Na+ excretion). The protection was maximal in the PRE group and achieved a lower extent in PER and POST groups when compared to Control. As example, urinary clearance of creatinine achieved 4.8±1.2, 1.3±0.9, 0.9±1.4 in PRE, PER and POST groups vs 0.5±0.4 ml/kg/min in Control (all p<0.05), respectively. Importantly, multi-organ failure was associated with elevated blood transcripts of inflammatory markers (e.g., IL-1β, IL-8, IL-10). This was attenuated in all groups submitted to TLV with no difference between PRE, PER and POST groups. As example, changes in IL-1β achieved 2.7±0.4, 3.8±0.4 and 3.2±1.1 in PRE, PER and POST groups vs 5.6±0.7 in Control (fold-change from baseline; p<0.05), respectively.

Conclusions:
Ultra-fast cooling with TLV attenuates shock and multi-organ failure in a model of abdominal ischemia/reperfusion. The cardiac, liver and renal protections but not anti-inflammatory effects depend upon the window of application.
Abstract 11489: Respiratory Quotient Correlates With Blood Lactate During Hemorrhage
Authors: Lampe Joshua W , Wijshoff Ralph , Muehlsteff Jens , Bartula Marek , Fuller Marc , Jorgenson Dawn , Becker Lance B
Published: April 2024

Background:
Cellular energy productions shifts from oxidative phosphorylation to glycolysis during periods of hypoxia, a symptom common to both shock and rigorous exercise. In critical care, serum excess lactate is measured as a marker of increased anaerobic metabolism. In exercise physiology, the respiratory quotient (RQ), defined as the ratio of the number of carbon dioxide molecules produced to the number of oxygen molecules consumed in a single breath, is used to track shifts between aerobic and anaerobic metabolism. We hypothesized that the respiratory quotient could be used to track the metabolic status of animals in shock.

Methods:
To compare lactate and RQ during two states of shock, 5 swine (~30kg) were subjected to 2 minutes of untreated VF followed by ACLS (2 minutes of CPR followed by defibrillation). After successful resuscitation and hemodynamic stabilization, 1 L of blood volume was removed through a femoral introducer sheath. In addition to standard physiological monitoring, we measured airway flow, oxygraphy, and capnography. Blood chemistry was measured at baseline, 1.5 minutes into arrest and at 3 time points after resuscitation. Serum lactate values were aggregated across all animals and fit with a least squares linear regression. The respiratory quotient was calculated using breath by breath values of oxygen consumption and carbon dioxide production.

Results:
All animals were successfully resuscitated. Blood pressures and heart rates normalized within 30 minutes of resuscitation for all animals. All animals died within 100 minutes of the initiation of hemorrhage. During and after hemorrhage, the serum lactate model increased 60% and the respiratory quotient increased 7%. The Pearson correlation coefficient between the serum lactate model and the mean respiratory quotient was R = 0.69 with p = 0.02.

Conclusions:
We have developed a stable model of altered hemodynamics and metabolic injury. Both serum lactate and the respiratory quotient increased monotonically with time, and were strongly correlated. These data suggest that the combination of volumetric capnography and volumetric oxygraphy can be used to track patient metabolic status in real time during shock.
Abstract 11608: Characteristics of Incident Heart Failure in HIV Disease at an Urban HIV Clinic and Hospital From 2007-2014
Authors: Daley Blake G , Miranda David F , Tetekpor Namo , Baker Jason V , Simegn Mengistu
Published: April 2024

Introduction:
HIV is an independent risk factor for coronary artery disease and the prevalence of subclinical systolic and diastolic abnormalities are greater than expected for age. However, less is known regarding the incidence and pattern of acute heart failure syndrome (HF) among contemporary HIV-positive patients.

Methods:
We performed a retrospective analysis of HIV-positive patients presenting with incident HF from 2007-2014. All patients with ICD-9 diagnoses for HIV and HF were selected and further adjudicated for incident HF based on symptoms, physical findings, biomarkers, and imaging studies. Clinical characteristics and echocardiographic findings were described, and subgroup comparisons were explored based on HIV viral suppression.

Results:
Among 2703 HIV-positive patients, 74 had a diagnosis of HF (prevalence of 2.7%), of which 28 were adjudicated incident HF (annual incidence of 0.15%). Patients with incident HF were younger (median age 50 yr.), predominantly male (75%), and African American (68%). The median duration of HIV infection prior to heart failure was 11 years with the majority (75%) on HAART (39% receiving a protease inhibitor) with a median CD4+ cell count of 295 cells/mm
3
. The major comorbid conditions include hypertension (82%), history of substance abuse (64%), and diabetes (32%). Table-1 presents the transthoracic echocardiographic findings for all incident HF patients. The mean ejection fraction (EF) for virally suppressed (HIV RNA <200 copies/ml) patients was 45.3% as opposed to 31.8 % for those unsuppressed.

Conclusion:
Incident HF among urban HIV-positive patients occurs at younger age when compared to the rates of the uninfected in the general population, with a significant proportion presenting with preserved EF. Future research should focus on whether HF syndrome in HIV disease shifts from predominantly systolic dysfunction, to a pattern similar in the general population, particularly among the virally suppressed.
Abstract 11748: Edoxaban versus Warfarin in Patients at Increased Risk of Falling - A Subgroup Analysis of the ENGAGE AF-TIMI 48 Trial
Authors: Steffel Jan , Giugliano Robert P , Braunwald Eugene , Murphy Sabina , Mercuri Michele , Choi Youngsook , Antman Elliott M , Ruff Christian T
Published: April 2024

Background:
Patients at an increased risk of falling are particularly at risk for undertreatment with oral anticoagulation. The current subgroup analysis assessed the relative efficacy and safety of edoxaban vs. warfarin in patients at increased risk of falling in the ENGAGE AF TIMI 48 study.

Methods & Results:
Nine-hundred patients (4.3%) included in ENGAGE AF-TIMI 48 were judged to be at increased risk of falling by the investigator at randomization. These patients were older (median 77 years (IQR 72, 82) vs. 72 (64, 77); p <0.001), and had a higher prevalence of co-morbidities including prior stroke/TIA, diabetes and coronary artery disease. Patients at increased risk of falling demonstrated a higher risk for stroke or systemic embolism (2.68%/year vs. 1.77%/year, HR 1.51 (95% CI 1.17-1.96, p=0.002), major bleeding (4.72%/year vs. 2.67%/year, HR 1.74 (95% CI 1.39-2.18), p<0.001) and bone fractures (6.04%/year vs. 2.16%/year, HR 2.80 (95% CI 2.28-3.43), p<0.001). No treatment interaction was observed in patients at increased risk of falling, both for efficacy and safety endpoints, except for no fatal bleeds in patients with vs. without increased fall risk treated with edoxaban compared to warfarin. Due to the higher frequency of events, a larger absolute risk reduction was observed under edoxaban compared to warfarin in patients with vs. without increased risk of falling for intracranial hemorrhage and life threatening bleeding.

Conclusions:
Patients at increased risk of falling are a high-risk subgroup, with an increased risk for both stroke/SEE as well as for bleeding. These patients demonstrate consistent efficacy and safety with edoxaban as compared to well-managed warfarin. The absolute risk of the most severe bleeding complications was higher in patients at increased risk of falling resulting in an even greater absolute risk reduction in these patients with edoxaban vs. warfarin.
Abstract 11961: Impact of Left Ventricular Systolic Stress on Contractility in Hypertension Assessed by One-beat Three-dimensional Speckle Tracking Echocardiography With High Volume Rates
Authors: Kawamura Itta , Kawasaki Masanori , Tanaka Ryuhei , Otake Rina , Nakano Yoshie , Nomura Nozomi , Sato Hidemaro , Miwa Hirotaka , Minatoguchi Shingo , Ono Koji , Saeki Maki , Nagaya Maki , Sato Noriaki , Yoshizane Takashi , Tsuchiya Kunihiko , Tomita Shinji , Matsuo Hitoshi , Noda Toshiyuki , Watanabe Sachiro , Minatoguchi Shinya
Published: April 2024

Background:
Left ventricular hypertrophy (LVH) is known as compensative mechanism of LV against pressure overload to reduce LV stress and maintain systolic performance. However, the relationship between LV systolic stress and strain or torsion that reflects contractility assessed by 3-dimensional speckle tracking echocardiography with high volume rates (3D-STE) has not been examined. We sought to evaluate the impact of LV systolic stress on LV contractility in hypertension (HTN).

Methods:
A total of 162 subjects {131 HTN patients and 31 controls (age 65±12)} were enrolled. HTN were divided into 3 groups: 47 HTN patients without LVH (age 67±12), 47 HTN patients with LVH (age 70±11) and 37 patients with hypertensive heart failure (HHF) (age 74±15). We examined LV longitudinal, circumferential and radial peak strain, LV strain rate at systole (SR) and LV torsion by 3D-STE with 70-80vps. LV systolic stress was calculated as LV end systolic radius x systolic blood pressure / thickness.

Results:
LV strain and SR in 3 directions and torsion decreased in HHF (longitudinal strain; control: -19±3, HTN without LVH: -18±4, HTN with LVH: -17±4, HHF: -13±4*. Torsion; 1.4±0.2, 1.4±0.3, 1.5±0.3, 1.2±0.2* °/cm, *p<0.05 vs control) associated with increased systolic stress (129±24, 141±36, 143±40, 164±51* mmHg). There was correlation between LV systolic stress and longitudinal, radial and circumferential peak strain (r=0.18, p=0.024, r=-0.22, p=0.005 and r=0.18, p=0.021, respectively) and between LV stress and LV radial SR (r=-0.1.9, p=0.018) in total subjects. There was not a significant correlation between LV systolic stress and strain or SR in 3 directions in controls. Significant correlation was found between LV stress and circumferential strain or torsion in HHF (r=0.43, r=-0.34, p<0.05), but not between LV stress and longitudinal or radial strain in HHF.

Conclusion:
Reduction of LV contractility assessed by LV strain, SR-S and torsion was associated with LV stress. In HHF only circumferential strain and torsion were decreased associated with increased LV stress, suggesting that the beginning of reduction in circumferential strain and torsion after deterioration of longitudinal and radial contractility due to increased systolic stress may be responsible for HHF.