bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2774: Six-Month IVUS Analysis of Long Coronary Artery Lesions Treated with Biolimus-A9 Eluting XTENT interdigitating stent with bioabsorbable polymer: Results of the CUSTOM II Trial
Authors: Shimohama Takao , Ako Junya , Hassan Ali , Honda Yasuhiro , Grube Eberhard , Fitzgerald Peter J
Published: July 2021

Background:
Multiple overlapping drug-eluting stents have been used to treat diffuse coronary disease; however, this approach is associated with increased incidence of adverse cardiac events and target lesion revascularization (TLR). The XTENT platform consists of Biolimus-A9 eluting stent on a bioabsorbable polymer with an interdigitating design, which allows operators to customize stent length in 6 mm cobalt-chromium modular units. The aim of this IVUS study was to evaluate the efficacy of the XTENT in the treatment of long lesions.

Methods:
Data were obtained from the CUSTOM II trial, a prospective, multicenter study, to assess the safety and efficacy of this stent system. Thirty patients (39 lesions) were available, with 6 months follow-up IVUS analysis, including 25 serial lesions. Lesions were divided into 2 groups: short (<24 mm, n=13) and long (≥ 24 mm, n=12). Volumetric and/or cross-sectional analyses were performed. Each volume index was calculated as volume divided by stent length. Percent neointimal volume (%NIV) was calculated as (neointimal volume/stent volume) X100.

Results:
Baseline and 6 months follow-up IVUS data are shown in Table

. Despite very long lesions and stent length (34.4±9.5 mm and 42.5±7.7 mm, respectively), % neointimal volume was < 10%, even in the long lesion group. There were no differences in plaque volume index and vessel volume index at 6 months follow-up between the long and short lesion groups. One case with partial separation between the segments was found at follow-up in the long lesion group, but no lumen loss at the separation was observed. There was one TLR case in each group, but no cardiac death, AMI, and late-acquired incomplete stent apposition (ISA) in either group.

Conclusions:
The XTENT stent demonstrated excellent suppression of neointimal hyperplasia in long coronary artery lesions at 6 months follow-up. This stent system may offer an option for treatment of complex diffuse lesions.
Abstract 2778: Incomplete Neointimal Coverage Two Years after Sirolimus-Eluting Stent Implantation: A Serial Angioscopic Follow-up Study
Authors: Awata Masaki , Kotani Jun-ichi , Uematsu Masaaki , Morozumi Takakazu , Watanabe Tetsuya , Onishi Toshinari , Iida Osamu , Sera Fusako , Akahori Hirokuni , Yano Masamichi , Tanaka Nobuaki , Yasui Haruyo , Ikeoka Kuniyasu , Okamoto Shin , Nanto Shinsuke , Nagata Seiki
Published: July 2021

Background-

The time course of neointimal formation following sirolimus-eluting stent (SES) implantation has not been extensively studied by angioscopy.

Methods-

Serial angioscopic findings at 1st (3.6 ± 1.1 months), 2nd (10.5 ± 1.6 months), and 3rd (21.2 ± 2.2 months) follow-ups following stent implantation were compared between SES (n = 17) and bare-metal stents (BMS, n = 11). Neointimal coverage, existence of thrombus and yellow plaques underneath the stents were assessed. Neointimal coverage over the stent was graded as:
grade 0
= struts were exposed similarly to the time of implantation;
grade 1
= struts were covered, but not embedded;
grade 2
= struts were embedded by the neointima;
grade 3
= struts were fully embedded and invisible.

Results-

Neointimal coverage grades were significantly different between SES and BMS at any point of follow-ups (P < 0.001, Figure

). Serial changes were not significant in the BMS group, but the coverage grade slightly increased at the third follow up in the SES group (P< 0.05). Thrombi were detected in 4 SES. Yellow plaques had disappeared by the 2nd follow-up in the BMS group, whereas they were exposed in 71% of SES until the 3rd follow-up. Neointimal coverage grades correlated with thrombi (P=0.002) and yellow plaques (P<0.0001).

Conclusions-

Neointimal formation was not completed at least up to 2 years following SES, associated with thrombi and yellow plaques. Theses findings suggest the need for long-term dual-antiplatelet therapy after SES implantation.
Abstract 2781: Argatroban Anticoagulation for PCI: The E04 European Multi-Center Study
Authors: Roessig Lothar , Genth-Zotz Sabine , Rau Matthias , Heyndrickx Guy R , Baer Frank M , Gulba Dietrich C , Desaga Martin , Buerke Michael , Zeiher Andreas M
Published: July 2021

Background

—Argatroban is an attractive drug for cardiology because it has a fast onset and offset of anticoagulation, and is hepatically excreted. Argatroban received approval for PCI in patients (pts) with heparin-induced thrombocytopenia (HIT) in the U.S. in 2002. However, data about argatroban in the current PCI setting is limited.

Methods

–The E04 trial, an open-label, parallel-group, multiple-dose study, included 140 pts undergoing PCI. Pts were randomly assigned to three argatroban- (250, 300 or 350 ìg/kg as a bolus injection before PCI, followed by 15, 20 or 25 ìg/kg/min infusion until the end of the procedure) and one unfractionated heparin (UFH)-treated groups (70 –100 IU/kg as a bolus injection). Efficacy endpoints were the proportion of pts reaching the minimum target ACT (250 sec.) after the initial bolus injection of each anticoagulant; ACT time-course during PCI; number of additional bolus injections; composite incidence of all-cause death, myocardial infarction (MI) and urgent revascularization until Day 30; and incidence of hemorrhagic events during the hospital stay.

Results

—Argatroban dose-dependently prolonged ACT. Significantly (p < 0.01) more pts reached the minimum target ACT after the initial bolus injection with 86.1%, 89.5% and 96.8% in the low, middle and high dose argatroban groups, respectively, compared to 45.5% in the UFH group. Time to start of PCI after reaching minimum target ACT was significantly (p < 0.01) shortened in the argatroban groups compared to UFH. Composite incidences of death, MI and urgent revascularization were 2.8%, 0.0%, 3.2% and 3.0% in the low, middle and high dose argatroban groups, and the UFH group, respectively (n.s.). Major bleeding was observed only in the UFH group (3.0%), and minor bleeding occurred in the high dose argatroban (3.2%) and the UFH group (6.1%).

Conclusions

—Argatroban had an adequate anticoagulant effect. More pts reached the minimum target ACT in the argatroban groups than in the UFH group. This resulted in a reduced time to start PCI. Although the sample size was too small to conclude an effect on clinical outcome, the results suggest that argatroban is a safe and effective anticoagulant for PCI in the current clinical setting.
Abstract 2787: Elevated Circulating Levels Of Platelet-derived Microparticles Are Associated With The Thrombus Formation In The Left Atrial Appendage In Patients With Ischemic Stroke That Is Resistant To Anti-coagulant Therapies
Authors: Tamura Harutoshi , Hirono Osamu , Okuyama Hidenobu , Nishiyama Satoshi , Takeishi Yasuchika , Kayama Takamasa , Kubota Isao
Published: July 2021

Introduction:
It is well known that elevation of fibrinolytic markers reflects thrombus formation in the left atrial appendage (LAA) that is identified as a fibrin-rich thrombus. On the other hand, it is sometimes difficult to remove LAA thrombus by the treatment of anti-coagulants alone.

Hypothesis:
Circulating platelet activation is also responsible for the thrombus formation in the LAA in patients with cardioembolic stroke.

Methods:
In 98 consecutive patients with cerebral infarction (mean age, 71±12 years old), we performed trans-esophageal echocardiography within 7 days after the onset, and at the same time, measured circulating platelet-derived microparticles (PDMP, as a marker of platelet activation, < 20 U/ml), and serum levels of D-dimer (DD, as a marker of fibrinolytic activity, normal level < 1.0 μg/ml). Patients with LAA peak emptying flow velocity < 20 cm/s were classified as having LAA dysfunction.

Results:
In patients without warfarin treatment, both PDMP and DD levels were significantly higher in LAA thrombus positive (n=12) than in negative group (n=70) (PDMP, 113.5±80.4 vs. 65.5±30.7 U/ml, P<0.001; DD, 7.3±10.4 vs. 2.9±3.7 μg/ml, p < 0.01). In patients with warfarin treatment (PT-INR 1.64±0.35), PDMP, but not DD levels, was markedly higher in LAA thrombus positive (n=6) than in negative group (n=10) (PDMP, 113.4±84.5 vs. 49.7±23.9 U/ml, P<0.05; DD, 2.1±1.8 vs. 1.6±1.3 μg/ml, NS), because DD were effectively suppressed by the anti-coagulant therapy. Furthermore, in LAA thrombus negative patients, there were no significant differences in PDMP between cases with and without LAA dysfunction (LAA dysfunction, n=13, 70.2±26.5 vs. No dysfunction, n=67, 63.3±31.1 U/ml).

Conclusions
: PDMP plays an important role in the LAA thrombus formation that is resistant to anti-coagulant treatment, and may be a useful predictor for the cardioembolic stroke occurrence.
Abstract 2799: Procollagen Type III Amino-terminal and Carboxyl-terminal Telopeptide of Collagen type I but not Carboxyl-terminal Propeptide Type I are Associated with Heart Failure in the Elderly; The Cardiovascular Health Study
Authors: Barasch Eddy , Gottdiener John S. , Aurigemma Gerard , Kitzman DW , Han Jing , Tracy Russel
Published: July 2021

Background:
The presence of excess myocardial matrix fibrosis (MF) contributes to alteration in the left ventricular (LV) diastolic and eventually, systolic performance. The increased collagen-derived serum peptides associated with collagen synthesis (procollagen type III aminoterminal peptide-PIIINP-, carboxyl-terminal propeptide type I -PIP-) and degradation (carboxyl-terminal telopeptide of collagen type I -CTIP-) have been shown in a number of small studies to correlate with histologic assessment of MF. While the prevalence of heart failure (HF), especially diastolic (D)HF increases with aging, no large studies evaluate the association of MF with DHF or systolic (S) HF in the elderly.

Aims:
To determine the association between the 3 biomarkers of MF turnover

Methods:
In 880 participants (ppt), mean age 77 ± 6 yrs, 52 % males, 79 % white, enrolled in the Cardiovascular Health Study, a prospective community based study of individuals > 65 yrs of age , serum levels of PIIINP, PIP and ICTP were measured by radioimmunoassay; 179 had HF with normal LVEF (DHF), 131 had HF with LVEF ± 55%, (SHF), 287 controls (no HF) and 283 healthy ppts.

Results:
Logistic regression models using a progressive number of adjustment variables are illustrated in the table

. The ROC curves showed for CTIP the AUC =0.69; p<0.0001 and for PIIINP, AUC = 0.66, p<0.0001. The comparison of two ROC curves = NS. Model 1: unadjusted model Model 2: adjusted by age, gender and race Model 3: model 2+ adjustment for LVH, hypertension, diabetes, CHD, any ACE inhibitor, potassium-sparing agents alone, any diuretic, serum creatinine, cystatin C

Conclusions:
1. PIP was not associated with SHF or DHF. 2. Even when adjusted for multiple potential confounders, there is still a strong association between CTIP, PIIINP and DHF as well as SHF. 3. The lack of association between PIP and HF might be a characteristic of this age group where possible PIIINP, reflecting the poorly cross-linked collagen, predominates .
Abstract 2807: Is Invasive Strategy A Feasible Alternative For Acute Coronary Syndromes In Patients Older Than 80 Years?
Authors: Stenestrand Ulf , Wallentin Lars , Melander Olle , Gränsbo Klas , Carlsson Jörg
Published: July 2021

Background:
Lack of consensus regarding use of an invasive strategy in the very elderly with coronary artery disease has repeatedly been demonstrated. This is in part due to the fear of complications and to the assumption that nothing can be done in most of these cases because of advanced disease. At the same time, the number of these patients is increasing in western societies.

Methods:
Data from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA) was analyzed in 54850 patients of age 80 years or older admitted between the years 2000–2005 with an acute coronary syndrome (ACS). To evaluate potential early hazard or benefit from revascularization performed within 14 days 1-year mortality was evaluated both in all patients and in 14-days survivals (n=47865). A multivariable Cox regression analysis was performed including 15 covariates.

Results
: Crude 1-year mortality in patients revascularized within 14 days of admission was 16.0% (857/5369) vs. 35.6% (17596/ 49481) in those revascularized later or not at all (p<0.001) comparing patients from the admission day, and when only 14-day survivors were compared 9.4% (345/3664) vs. 25.9% (9407/36260) (p<0.001). In the Cox regression analysis revascularization was associated with reduced 1-year mortality RR 0.52 (95% CI, 0.48–0.56; p<0.001) in all patients and RR 0.43 (95% CI, 0.42–0.51; p<0.001) in 14-day survivors.

Conclusion:
Also in patients older than 80 years with ACS revascularization is feasible and with the selection done by physicians associated with improved survival when comparing patients with similar comorbidity and risk factors.
Abstract 2810: The Occluded Artery Trial (OAT) Viability Ancillary Study (OAT-NUC): Influence of Infarct Zone Viability on Left Ventricular Remodeling After PCI vs. Medical Therapy Alone
Authors: Udelson James E , Pearte Camille A , Kimmelstiel Carey D , Kruk Mariusz , Teresinska Anna , Bychowiec Bartosz , Marin-Neto Jose Antonio , Höchtl Thomas , Cohen Eric A , Caramori Paulo , Busz-Papiez Benita , Adlbrecht Christopher , Sadowski Zygmunt P , Ruzyllo Witold , Forman Sandy A , Kinan Deborah J , Lamas Gervasio A , Hochman Judith S
Published: July 2021

Introduction:
OAT recently reported no difference in long-term outcomes between percutaneous intervention (PCI) vs. medical therapy alone (MED) in stable post-MI patients with occluded infarct-related arteries (IRAs). Whether PCI may benefit a subset of patients with relative preservation of infarct zone (IZ) viability is unknown.

Hypotheses:

IZ viability influences left ventricular (LV) remodeling and

PCI patients with viability have less adverse remodeling than comparable MED post-MI patients with an occluded IRA.

Methods:
Patients were eligible for OAT-NUC based on the main OAT criteria. Enrolled patients underwent a resting nitroglycerin-enhanced 99m-Tc sestamibi SPECT study at baseline prior to OAT randomization and repeated 1 year after randomization. SPECT studies were quantitatively analyzed in a central core lab, blinded to OAT randomization and to sequence. Parameters included LV volumes (for remodeling over time), LV regional and global function, infarct size, and IZ viability.

Results:
There were 124 patients enrolled in OAT-NUC at 20 international sites. For patients with complete baseline and 1 year information as of May 2007 (n=78), infarct size was 24 ± 16% of the LV (mean ± SD), EF 48 ± 11%, end-diastolic volume 127 ± 52 ml, end-systolic volume 71 ± 46 ml, and sestamibi uptake within the IZ was 43 ± 8% of peak counts. Those with severe reduction in IZ viability (IZ uptake <40% of peak counts, n=25) compared to those with at least moderate preservation of viability (IZ counts <40% of peak counts, n=53) had larger infarct size (p<0.001), larger end-diastolic (p<0.001) and end-systolic (p<0.003) volumes at baseline. Complete data acquisition and analysis of the primary and secondary end point results examining the influence of IZ viability on extent of LV remodeling, and the interaction of IZ viability with extent of remodeling for PCI vs. MED in post-MI patients with occluded IRAs will be available for the entire patient cohort by August 2007.

Conclusions:
The OAT-NUC ancillary study examines the influence of IZ viability on LV remodeling in post-MI patients with occluded IRAs randomized to PCI vs. medical treatment alone and will provide mechanistic insights into the clinical findings of the main OAT study.
Abstract 2822: Imaging of the Propagation of the Contraction Wave Using RF-Based Speckle Tracking In Vivo
Authors: Konofagou Elisa E , Luo Jianwen , Saluja Deepak , Fujikura Kana , Cervantes Daniel , Coromilas James
Published: July 2021

OBJECTIVE
: Using a combination of high-frequency ultrasonography, ECG gating, and RF-based motion estimation, our laboratory has developed a novel technique for the noninvasive mapping of contraction waves in the intact murine left ventricle. In this study, we sought to measure the velocity and direction of contraction waves in the murine heart during native conduction and pacing.

METHODS
: Twelve wild-type mice were anesthetized with IP pentobarbital, and an octapolar pacing catheter introduced into the right ventricle (RV) through the external jugular vein. In vivo ultrasound RF frames (30 MHz) were acquired at 8000 fps (Vevo 770, Visualsonics, Inc.), using ECG gating. Axial frame-to-frame motion were estimated using a speckle tracking method. Images were obtained in the parasternal long axis view under three conditions; sinus rhythm (SR), right atrial (RA) pacing, and RV pacing. Contraction was analyzed using ciné-loop images.

RESULTS
: Distinct contraction patterns were noted during isovolumic contraction (IC) ejection under all conditions. In SR, during IC, convergent motion of the septal wall (SW) and posterior wall (PW) began during the latter half of the QRS at the apex and spread basally, causing divergent movement at the base. At the onset of ejection, medial contraction spread to the base. Similar results were obtained with RA pacing. During RV pacing, the IC phase began with convergent motion of the basal SW and PW that spread apically, causing divergent motion of the apical SW and PW. During ejection, convergent motion of the apical SW and PW developed which spread to the basal SW and PW. This difference between SR/RA pacing and RV pacing was found in all mice (n=12). We found a significantly slower contraction wave velocity during RV pacing (0.5213 +/- 0.3125 m/s) than during SR/RA pacing (0.8496 ± 0.2214 and 0.8379 ± 0.1967 m/s, respectively) (p<0.01), in line with previously reported results.

CONCLUSION
: This study demonstrates the ability of this modality to noninvasively map the velocity and direction of contraction waves. Using this technique, we demonstrate the difference in motion patterns between native conduction and ventricular pacing. This technique has potential applications in the noninvasive assessment of ventricular dyssynchrony.
Abstract 396: Role of Monocyte Chemotactic Protein-1 in Obesity Involves a Newly Discovered Transcription Factor MCPIP
Authors: Azfer Asim , Fu Mingui , Kolattukudy Pappachan E
Published: July 2021

Monocyte chemotactic protein-1 (MCP) that is well known to play a major role in the development of cardiovascular diseases, was recently reported to be involved also in obesity. We recently discovered that MCP-1 treatment of human monocytes induces a novel CCCH zinc finger transcription factor designated MCP-induced protein (MCPIP). In the present study we report that in the white adipose tissue of high fat diet fed mice, MCPIP was induced when body mass and fasting glucose level were elevated, beginning at about 8 weeks on the diet. Six MCPIP-induced novel genes, with no previously known function,
ltv
,
lzp
,
creld2
,
ufm1
,
cdh12 and cdh19,
were induced in the white adipose tissue, starting at three months of high fat feeding; the increases in fasting glucose level, MCPIP transcript level and the transcript levels of the novel genes showed further progressive increases during the 5 months on the high fat diet. Similar molecular events were also observed during differentiation of NIH 3T3 -L1 cells into adipocytes in culture in the presence of dexamethasone and insulin. Under these conditions MCP-1 production was induced reaching a peak level at 24hr. MCPIP transcript level showed marked increase within 1 hr and reached a maximum at 2 days.
ufm1
,
lzp
, and
creld2
reached maximal levels at 4 hr, whereas
ltv
reached maximal level in 1–2 days, and
cdh12
and
cdh19
reached maximal levels in one day. Involvement of MCPIP in the differentiation process was indicated by the finding that transfection of 3T3 cells with MCPIP expression plasmid caused differentiation of these cells into adipocytes under non-inducing conditions in the absence of dexamethasone and insulin. This differentiation was accompanied by induction of the six novel MCPIP-induced genes. Knockdown of MCPIP with specific siRNA suppressed differentiation of 3T3 cells into adipocytes and induction of the six MCPIP-induced genes. These results indicate a role for MCP-1 in adipogenesis and that this role is mediated via the newly discovered transcription factor MCPIP.
Abstract 2833: Low Erythropoietin Serum Levels Are Associated With Angiographic No-reflow After Primary Intervention For Acute Myocardial Infarction
Authors: Niccoli Giampaolo , Marzo Francesca , Paglia Antonella , Santucci Eleonora , Spaziani Cristina , D’Amario Domenico , Andreotti Felicita , Crea Filippo
Published: July 2021

Background
: No-reflow after primary percutaneous coronary intervention (PCI) remains a clinical challenge. Erythropoietin (EPO) has been associated with reduced infarct size due to EPO’s antiapoptotic and nitric oxide enhancing effects. We aimed to assess the association between EPO serum levels measured on admission and angiographic no-reflow in patients undergoing primary PCI.

Methods
: From a consecutive series of 60 patients presenting with ST elevation myocardial infarction within 12 h of chest pain onset and undergoing successful primary PCI (i.e. residual stenosis < 20%), we included 48 patients (age 61±12 years, male sex 89%), comprising the first 24 with no-reflow and the first 24 without no reflow. Patients with iron deficiency, recent transfusions, liver or lung failure, other haematological disorders or undergoing treatment with EPO were excluded. EPO levels were measured by ELISA before PCI. Clinical, enzymatic, procedural and angiographic data were also collected. No-reflow was defined as a coronary TIMI flow grade ≤ 2 after vessel reopening or as a TIMI flow grade of 3 with a final myocardial blush grade <2. Multivariate predictors of no-reflow were assessed by logistic regression analysis (SPSS 13).

Results
: Patients with and without no-reflow did not differ significantly in age, sex, cardiovascular risk factors or standard therapy for acute myocardial infarction. Thrombus aspiration was used in 16 patients (32%) whereas abciximab in 31 (63%), and they did not differ between the two groups. Patients with angiographic no-reflow had lower EPO serum levels compared to those having angiographic reflow (4.2 (0.56 –9.5) vs 12.2 (5.7–20.2) mUI/ml, p=0.001). The left anterior descending artery (LAD) was the culprit vessel in 83% of patients having no-reflow as compared to 30% of those having reflow (p<0.0001). At multivariate analysis, including EPO levels, culprit artery and symptoms to balloon time, the independent predictors of no-reflow were LAD as culprit vessel (OR 15, 95% CI 3–75, p=0.001) and low EPO serum levels (OR 0.91, 95% CI 0.84 – 0.99, p=0.048).

Conclusion
: These data suggest a significant role for EPO in modulating microcirculatory injury after mechanical reperfusion in patients with ST elevation myocardial infarction.
Abstract 2845: Anger, Depression And Anxiety Are Associated With Endothelial Function In Childhood
Authors: Osika Walter , Montgomery Scott M , Dangardt Frida , Währborg Peter , Volkmann Reinhard , Gan Li Ming , Tideman Eva , Friberg Peter
Published: July 2021

Introduction
Psychological factors are associated with raised risk of cardiovascular disease (CVD) in adults. However it is not known whether this association is present already in children.

Hypothesis
We wanted to test if reactive hyperemia peripheral arterial tonometry (RH-PAT) - a measure of endothelial function predictive of CVD in adults - is associated with self-assessed psychological health in school children.

Methods
248 children (age 14.5±1.0, 136 girls, 112 boys) underwent RH-PAT testing. They completed the Beck Youth Inventories of Emotional and Social Impairment scales (BYI), used to screen for depression, anxiety, anger, disruptive behaviour, and self-perception in children.

Results
No sex difference was observed for the RH-PAT score (1.82±0.55, n=248). Girls had statistically significant higher BYI scores for depression, anger and anxiety than boys. Among girls there were statistically significant associations between lower RH-PAT scores and higher scores for anger (B coefficient = -0.100, p=0.040), depression (-0.108, p=0.009), and anxiety (-0.138, p=0.039), after adjustment for age. Among boys, disruptive behaviour was associated with higher RH-PAT scores (B coefficient 0.020, p=0.006). Boys had higher systolic blood pressure (110±9 vs. 108±8 mmHg, p=0.01) and lower diastolic blood pressure (57±6 vs. 60±5 mmHg, p<0.000) than girls. No sex differences were seen in BMI-z scores (0.48±1.1).

Conclusions
Girls have higher levels of self assessed anger, depression and anxiety compared with boys, and these characteristics are associated with lower RH-PAT scores, indicating attenuated endothelial function. Among boys, disruptive behaviour was associated with better endothelial function. Psychological adversity in childhood might be a risk factor for subsequent cardiovascular disease.
Abstract 2849: Family Variables in Early Recovery Predict Stroke Survivor Quality of Life in 12 months
Authors: Klinedinst N. J , Gebhardt M. C , Aycock Dawn M , Dunbar Sandra B , Wolf Steve L , Uswatte Gitendra , Clark Patricia C
Published: July 2021

Purpose
: Quality of life (QOL) after stroke may be influenced by the family context in addition to the stroke survivor’s physical ability. The purpose of this study was to determine whether baseline caregiver (CG) and family characteristics (age, physical function, depressive symptoms, and family communication) predict stroke survivor (SS) QOL: physical function, memory/thinking, social activities, communication, and mood at 1 year follow-up.

Methods
: Data were collected on 132 SS-CG dyads. SSs were 3–9 months post stroke, 30 to 83 years old (
M
= 62.2 ± 12.6), male (64%), Caucasian (74 %), and had an ischemic stroke (88%). CGs were age 25 to 85 years (
M
= 56.7 ± 13.7), female (74 %), well-educated (73 %), and spouses (80 %) enrolled in a multi-site caregiving study complementary to a clinical trial testing constraint-induced movement therapy in SSs. Measures included CG physical function (SF-36), CG depressive symptoms (CES-D), family communication (McMaster Family Assessment Device), and SS QOL (Stroke Impact Scale). Pearson’s correlations and hierarchal multiple regression analyses (n = 107) controlling for SS gender, the EXCITE intervention group, and SS functional level were used for analysis.

Results
: Baseline CG depressive symptoms were negatively related to both SS mood (
r
= -.24,
p
< .01) and social activities (
r
= -.26,
p
= .01) at 1 year. Better family communication was related to higher SS memory/thinking (
r
= -.24,
p
= .01). CG age and physical function were not associated with any SS QOL domains. In the regression models, CGs with more depressive symptoms (β = -.28,
p
= .007) at baseline predicted poorer SS mood (
F
= 2.56,
p
= .02;
R
2
= .13) and worse social participation (β = -.27,
p
= .01;
F
= 1.61,
p
= .15;
R
2
= .09). Although the overall model was not significant (
F
= 1.20,
p
= .31;
R
2
= .07), worse family communication (β = -.22;
p
= .04) predicted poorer SS memory and thinking at 1 year. No CG or family characteristics were associated with SS physical or communication QOL domains.

Conclusions
: Early recognition and intervention of CG depressive symptoms may have profound effects on both CG and aspects of SS QOL in the early and chronic stroke recovery periods. Family interventions focusing on improving communication early may also improve long term stroke recovery.
Abstract 2850: Morphological Variability: A New Electrocardiographic Technique for Risk Stratification After NSTEACS
Authors: Syed Zeeshan , Stultz Collin M , Scirica Benjamin M , Cannon Christopher P , Attia Khaled , Stebletsova Irina O , Mohanavelu Satishkumar , Stone Peter H , Guttag John V
Published: July 2021

Background
: ECG parameters such as low heart rate variability (HRV) identify patients at high risk post-ACS. We recently developed morphological variability (MV), a novel technique that quantifies differences in the morphology of entire beats using a dynamic time-warping algorithm. MV incorporates strictly more information than HRV, potentially offering a more complete evaluation of the ECG. We assessed the relationship among MV, HRV, and outcomes after NSTEACS.

Methods:
MV and HRV were calculated in 863 pts from the DISPERSE2 trial using the first 24 hrs of continuous ECG (CECG) after randomization for NSTEACS. Using each measure, pts were split into high and low variability groups (cutpoint for HRV (SDNN)= 75ms and for MV=0.7). Ischemia on CECG was defined as ≥1mm ST dep lasting ≥1min.

Results:
A total of 144 (16.7%) pts had high MV and 58 (6.7%) had low HRV. Pts with high MV experienced higher rates of death, death/MI/severe recurrent ischemia (SRI), and ischemia detected on CECG compared to low MV. (Table-Figure

) This relationship remained consistent in pts with no ischemia on CECG (hazard ratio for D/MI/SRI =2.5, p=0.016). There was no difference in mortality or ischemia on CECG in pts with low HRV v high HRV, but pts with low HRV did have higher rates of death/MI/SRI. (Table)

Conclusions:
MV correlates significantly with poor cardiovascular outcomes, including death, after NSTEACS, even after controlling for other high risk features and even among pts without electrocardiographic evidence of ischemia. MV may offer a new non-invasive measure for risk stratification after ACS.
Abstract 2851: Temporal QT Variability from Bipolar Ventricular Tip-to-Ring Electrograms Predicts Sustained Ventricular Tachyarrhythmia.
Authors: Tereshchenko Larisa G , Fetics Barry J , Domitrovich Peter P , Berger Ronald D
Published: July 2021

We assessed the hypothesis that ventricular tachycardia / ventricular fibrillation (VT/VF) risk stratification based on the repolarization assessment of intracardiac electrograms (EGMs) from implantable devices is feasible.

Methods: Bipolar right ventricular tip-to-ring EGMs were recorded at rest (mean heart rate 66 ± 16 bpm) for 5.5 ± 2.6 minutes in 75 patients (58 ± 14 years, 72% men) with ischemic (60%) and non-ischemic (40%) cardiomyopathy who underwent single-chamber Medtronic ICD implantation for primary (77%) or secondary (23%) prevention of SCD. QT variability index (QTVI), variability of Tpeak-Tend area index, and T-wave alternans (TWA) were calculated as previously described elsewhere. Only 41 out of 75 recordings (55%) were eligible for analysis as determined by data quality requirements of the custom software (less than 10% non-analyzable beats or 5% ectopic beats). The endpoint was appropriate ICD therapy for VT/VF during follow-up > 6 months.

Results: During mean follow-up of 12 months (range 6–19 months), 12 patients had appropriate ICD therapy. The survival analysis showed that the top quartile of QTVI (> - 0.5) predicts an event-free survival rate from appropriate ICD therapies (p = 0.027). Neither increased Tpeak-Tend area variability nor TWA was associated with a significant increased risk for VT/VF.

Conclusions: In this prospective study, temporal QT variability measured from right ventricular tip-to-ring EGMs is associated with increased risk of sustained VT/VF events. Repolarization lability may be present throughout the ventricular myocardium, such that single-site EGMs may provide an effective means for VT/VF risk stratification.
Abstract 2870: In Women without Obstructive Coronary Artery Disease, Endothelial-Dependent and Non-Endothelial Dependent Coronary Reactivity Dysfunction are Associated with Different Types of Adverse Outcomes. The NHLBI Women’s Ischemia Syndrome Evaluation (WISE).
Authors: Midwall Scott , Anderson R. David , Johnson Delia , Handberg Eileen , Cooper-Dehoff Rhonda , Smith Karen , Pepine Carl
Published: July 2021

Backround:
Altered coronary reactivity frequently occurs in women with chest discomfort both with and without obstructive coronary artery disease (CAD). Among those with obstructive CAD, the endothelial-dependent and non-endothelial dependent components of this altered reactivity have been associated with adverse outcomes. The clinical events among those with altered coronary reactivity but without obstructive CAD are not well defined.

Methods:
We evaluated 169 women with suspected myocardial ischemia who had no obstructive CAD at coronary angiography. Coronary reactivity was assessed by measuring flow reserve (CFR) with adenosine (endothelial-dependent) and change in vessel diameter (DIAM) following acetylcholine (non-endothelial dependent). Women were then followed for major adverse events (death, myocardial infarction, stroke, or hospitalization for heart failure) as well as hospitalization for recurrent angina by annual telephone contact over a median of 6.0 years.

Results:
Mean age was 54 ± 10 years, 15% were non-white, 37% had abnormal CFR (<2.32), and 47% had abnormal DIAM (no change or constriction). Of the women receiving both coronary reactivity tests, results were concordant in only 52%. Major events occurred in 16% (28/169) of which 5% (8/169) died. An additional 24% (41/169) were hospitalized for worsening angina. Major adverse events were predicted by abnormal CFR (27% vs 10%, p = 0.006) but not abnormal DIAM, while abnormal DIAM, but not CFR, predicted hospitalization for angina.

Conclusion:
Endothelial-dependent and non-dependent coronary dysfunction coexist in approximately one-half of women tested without angiographic evidence of CAD and appear to predict different types of adverse outcomes during follow-up. These results should foster developement of new diagnostic and treatment strategies targeting both endothelial and non-endothelial (e.g. vascular smooth muscle) dependent coronary dysfunction in women.
Abstract 2879: Comparison of Bilateral Internal Thoracic Artery Revascularization Using Pedicled or Y Graft Configurations: A Prospective Randomized Clinical, Functional and Angiographic Mid-term Evaluation.
Authors: Glineur David , Hanet Claude , Noirhomme Philippe , Poncelet Alain , Funken Jean Christophe , Astarci Parla , Rubay Jean , Lacroix Valerie , Verhelst Robert , Khoury Gebrine El
Published: July 2021

For the left coronary system, bilateral internal thoracic arteries (BITA) have demonstrated their superiority over all others types of grafts in terms of patency and survival benefit. Several configurations of BITA have been proposed to achieve left-sided myocardial revascularization. Because the ideal BITA assembling has not yet been found, we have prospectively randomized two types of BITA configurations to evaluate at 6 months and 3 years the clinical, functional and angiographic outcome.From 03/2003 to 08/2006, 1297 consecutive patients underwent isolated bypass surgery in our institution. Of this group, 481 patients met the entrance criteria for randomization and 304 (64%) patients were randomized. BITA grafting was performed with a pedicled configuration in 147 patients and with a Y configuration in 152. Patients were interviewed by telephone every 3 months and had a systematic stress test twice a year performed under supervision of their referring cardiologists. Systematic angiographic follow-up was performed 6 months after surgery. The primary and secondary end point was respectively the major adverse cerebro-cardiovascular events (MACCE) and the proportion of ITA grafts that were completely occluded at follow-up angiography. More arterial anastomoses were performed in patients randomized in the Y than in the pedicled configuration (3.2 versus 2.4; p< 0.001). There were no significant differences between the 2 groups in terms of hospital mortality or morbidity. Clinical follow-up is 100 % complete with a mean of 16 ± 11 months. At follow-up there is no significant difference in any MACCE rate between the 2 groups. Angiographic follow-up is 90% complete with a mean of 6.5 months. 432 out of 446 anastomosis in the BITA Y group and 278 out of 286 in the BITA pedicled group were controled patent (p=0.96).Excellent patency rates were achieved in both groups with no significant difference in terms of MACCE or patency. Whether the higher number of ITA distal anastomoses in the Y configuration group will translate in better long-term results remains to be established.
Abstract 2884: Elevated Postoperative Cardiac Troponin I Levels Independently Predict Higher Long-Term Morbidity and Mortality Following Off-Pump CABG
Authors: El-Hamamsy Ismail , Stevens Louis M , Cartier Raymond
Published: July 2021

Background-

Cardiac enzyme elevations after CABG are frequent, but little is known about the long-term outcomes of patients. The aims of the present study were to evaluate the prognostic significance of postoperative cTnI and CK-MB elevations on long-term morbidity and mortality following off-pump CABG.

Methods-

Between 1996 and 2004, 1004 consecutive off-pump CABG procedures were performed. Major adverse cardiac events (MACE) were defined as cardiac death or death of unknown cause, myocardial infarction, repeat revascularization and recurring angina. Mean length of follow-up was 4.6 ± 1.9 years (up to 9 years). Follow-up was 100% complete. Time-specific effects were estimated using parametric multiphase hazard regression.

Results-

Elevated cTnI (>0.3 ng/mL) and CK-MB (>50 ng/mL) were observed in 166/719 (23%) and 85/1001 (8%) of patients, respectively. Thirty-day mortality was 1.8%. The incidence of perioperative myocardial infarction was 2%. Overall 8-year survival was 71 ± 3% and cardiac survival was 93 ± 1%. Long-term mortality was independently predicted by cTnI (
p
<
.001
, respectively;

see figure

), but not by CK-MB (
p
>
.05
). Long-term incidence of MACE was independently predicted by postoperative cTnI (
p
=
0.02
), not by CKMB (
p
>
.05
). MACE-free survival at 5 years ranged from 86 ± 3% for the lowest cTnI quartile to 69 ± 4% in the highest (
p
<
.001
).

Conclusion-

Postoperative levels of cTnI bear significant prognostic value on long-term morbidity and mortality following off-pump CABG. cTnI is a more sensitive marker of long-term outcomes than CK-MB. Patients with mild cTnI elevations after CABG should be closely followed up despite an uneventful postoperative recovery.
Abstract 2885: Clinical Profiles of Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery: The California Coronary Artery Bypass Graft Surgery Outcomes Reporting Program
Authors: Li Zhongmin , Yeo Khung-Keong , Mahendra Geeta , Amsterdam Ezra A
Published: July 2021

Objective:
To compare the clinical and procedural characteristics, and operative mortality in patients undergoing off-pump coronary artery bypass surgery (OPCAB) and conventional coronary bypass surgery (CCB) among California hospitals, using data from the 2003 and 2004 California Coronary Artery Bypass Graft Surgery (CABG) Outcomes Reporting Program (CCORP).

Methods:
State mandated data from 121 hospitals that performed isolated CABG during 2003 and 2004 were analyzed, excluding patients with emergent or prior CABG. Patient characteristics associated with OPCAB were identified by multivariate logistic regression analysis. Predicted mortality was calculated using a multivariate model. Correlation between hospital OPCAB volume, OPCAB/CCB volume ratio and hospital risk-adjusted mortality rates was assessed.

Results:
OPCAB comprised 23% (8,139) of all isolated CABGs, with significant variation in volume among hospitals (median: 29; range 0–1,065). OPCAB was less likely in Caucasians compared with non-Caucasians (adjusted odds ratio [AOR]=0.85, 0.80–0.90), diabetics compared with nondiabetics (AOR 0.93, 0.87–0.98), those with myocardial infarction (MI) 1–7 days prior to CABG compared to no MI (AOR 0.87, 0.81–0.94), and in patients with ≥3 diseased vessels compared with 1 or 2-vessel disease (AOR 0.46, 0.44–0.49). However, OPCAB was more likely in those with peripheral arterial disease (PAD) compared with no PAD (AOR 1.16, 1.07–1.25), or cerebrovascular disease (CVD) compared with no CVD (AOR 1.14 1.03–1.26). OPCAB was associated with a significantly lower risk for observed operative mortality compared with CCB (1.84% vs. 2.49%, p<0.0001), which persisted after adjustment for 23 preoperative factors associated with operative mortality (AOR 0.67, p<0.0001). However, neither hospital OPCAB volume nor OPCAB/CCB volume ratio were associated with hospital risk adjusted operative mortality (p=0.324 and p=0.547, respectively.)

Conclusion:
OPCAB patients had generally better risk profiles associated with their lower predicted and observed operative mortality. But OPCAB results had no significant impact on hospital level risk-adjusted operative mortality.
Abstract 2888: Activation of the Endothelial and Coagulation Systems in Left Ventricular Assist Device (LVAD) Recipients
Authors: Panch Sandhya R , Hrabe Jennifer , Solovey Anna , Joyce Lyle D , Hebbel Robbert P , John Ranjit
Published: July 2021

Introduction: The success of LVADs has been limited by hemorrhagic and thromboembolic complications. Understanding the timing of changes in the endothelial and coagulation systems in LVAD patients may allow for potential therapeutic interventions.

Methods: Markers of endothelial dysfunction (circulating endothelial cells [CEC], VCAM-1, E-selectin, von Willebrand antigen [VWA]), thrombin generation (prothrombin fragments 1,2 [PF1+2] and thrombin antithrombin [TAT]), and fibrinolysis (D-dimer) were studied in 20 LVAD patients on day 0 and on post-op days 1, 7, 30 and 90 as well as in 5 control patients undergoing non-LVAD cardiac surgery.

Results: Baseline values of VCAM-1, E-selectin, TAT, VWA and D-dimer were significantly higher than the normal range in LVAD patients. Further evidence of endothelial and procoagulant pathway activation were seen on post-op day 1 and day 7. D-dimer, a marker of fibrinolysis, showed significant increase on day 7 and remained elevated up to day 90 while procoagulant and endothelial cell markers decreased significantly by day 30 (Table

). In control patients, baseline levels of D-dimer, TAT, VCAM-1, E-selectin were lower and declined significantly by day 7 as compared to LVAD patients ( 2-sample t-test p values < 0.05).

Conclusions: LVAD patients show significant baseline activation of endothelial and coagulation systems which are further accentuated in the early post-op period. Persistent activation of the fibrinolytic system may allow for reduction of anticoagulation therapy in these patients. Further understanding of these abnormalities is essential to improve outcomes after LVAD placement.

Table:

Changes in Endothelial and Coagulation function markers in LVAD patients
Abstract 2890: The Long Term Outcome Of Treated Presensitized Patients Who Undergo Heart Transplantation: Is It Successful?
Authors: Kobashigawa Jon , Patel Jignesh , Kawano Matt , Wu Grace , Kittleson Michelle , Kiyosaki Krista , Moriguchi Jamie , Ardehali Abbas
Published: July 2021

Background: Sensitized patients prior to heart transplantation are reportedly at risk for hyperacute rejection and for poor outcome after heart transplantation. It is not known whether reduction of circulating antibodies pre-transplant alters post-transplant outcome.

Methods: Between July 1993 and July 2003 we reviewed 523 heart transplant patients of which 95 had pre-transplant PRAs >10%. 21/95 were treated pre-transplant for circulating antibodies. These 21 patients had PRAs greater than 10% (majority 50%–100%) and were treated with combination therapy including plasmapheresis and intravenous gamma globulin to reduce antibody counts. The 74 untreated patients with PRAs >10% (untreated presensitized group) and those patients with PRAs <10% (control group) were used for comparison. Routine post-transplant immunosuppression included triple drug therapy (tacrolimus, mycophenolate, and corticosteroids).

Results: Circulating antibody levels pre-transplant decreased from a median of 77.5 to 29.0% (p = 0.017), which allowed a negative prospective donor specific cross match and successful heart transplantation. Compared to the untreated presensitized group, and the control group, the treated sensitized patients had similar five year survival (81.1% vs. 75.7% vs. 71.4%, p=0.523) and freedom from cardiac allograft vasculopathy (74.3% vs. 72.7% vs. 76.2%, p=0.850).

Conclusion: Treatment of sensitized patients pre-transplant appears to result in comparable long term outcome after heart transplant.
Abstract 2891: Reversible Pulmonary Hypertension has Comparable Survival - Analysis of 10331 Heart Transplant Recipients in Recent Era
Authors: Nwakanma Lois U , Weiss Eric S , Patel Nishant D , Baumgartner William A , Russell Stuart D , Conte John V
Published: July 2021

Background:
Conflicting data exist regarding the impact of reversible pulmonary hypertension (PHTN) on post-transplant outcomes. We sought to determine how reversible PHTN affects survival in a large cohort of heart transplant recipients.

Methods:
A retrospective cohort study of United Network for Organ Sharing (UNOS) data from January 1, 2000 to December 31, 2006 was performed. Based on the amount of pulmonary vascular resistance (PVR) at initial listing and the most recent PVR prior to transplant, patients were stratified into 3 groups (Normal -PVR always < 2.5 Wood units, Reversible - PVR initially > 2.5, but < 2.5 prior to transplant, Fixed - PVR always > 2.5) and survival post transplant was analyzed.

Results:
Data was available on 10331 recipients. Of those patients, 3886 (37.6%) patients were classified as Normal, 1621 (15.7%) were Reversible, and 4824 (46.7%) had Fixed PHTN. Among the fixed group, PHTN was severe in 1989 patients (PVR >=5). Kaplan-Meier survival was comparable by log rank test between the normal and reversible groups (p>0.05) but was significantly worse for the fixed group (p<0.001). Sub-analysis of patients with initial PVR>=5 in the reversible group also had comparable survival to the normal group. These survival results were confirmed in a propensity-adjusted multivariate Cox regression analysis, controlling for clinically relevant co-founders. Furthermore, similar results were obtained using PVR of 2.5 or 5 as the cut-off points.

Conclusions:
The UNOS database has provided the largest number of patients analyzed by PVR. Reversible pulmonary hypertension has comparable post-transplant survival regardless of initial severity.
Abstract 2901: Doppler Ultrasound Enhances the Thrombolytic Activity of Tissue-Plasminogen Activator-Loaded Echogenic Liposomes
Authors: Moody Melanie , Laing Susan T , Huang Shaoling , Kim Hyunggun , Smulevitz Beverly , Zou Yuejiao , McPherson David D , Klegerman Melvin E
Published: July 2021

Background:
Ultrasound has been shown to enhance thrombolysis when used in conjunction with a thrombolytic agent. We have loaded echogenic liposomes (ELIP) with tissue plasminogen activator (tPA) and shown that mechanical non-imaging 1 MHz ultrasound can enhance thrombolysis in an in vitro clot model. This study aimed to evaluate the efficacy of clinical Doppler ultrasound to enhance the thrombolytic effect of our tPA-ELIP.

Materials and Methods:
A standard reproducible whole blood porcine clot model was used. Clots were blotted dry, weighed, and placed in 10 ml fresh frozen porcine plasma. Clots were treated with tPA-ELIP with and without Doppler ultrasound (pulsed wave ultrasound, 6.6 MHz, 2 minute-treatment time). After 30 minutes, clots were similarly weighed. Data are reported as percent clot mass loss. Samples of the plasma were assayed for D-dimer levels.

Results:
Exposure of tPA-ELIP to clinical Doppler ultrasound enhanced thrombolysis (p=0.015 vs. tPA alone or Doppler ultrasound alone; Figure

). There was a trend towards higher D-dimer levels in the clots treated with tPA-ELIP + clinical Doppler ultrasound, corresponding to the higher percent clot mass loss seen in this treatment group.

Conclusions: This study demonstrates the ability of clinical Doppler ultrasound to enhance the thrombolytic effect of our tPA-ELIP in an in vitro clot model. This demonstrates the potential to translate our novel thrombolytic technique of combining a thrombolytic-loaded contrast agent and ultrasound to patient care.